Solid Pseudopapillary Tumor of Pancreas: A Clinicopathologic Report from a Single Institution in Southern Iran

BACKGROUND

Solid pseudopapillary tumor of pancreas (SPTP) is a rare tumor of the pancreas which mostly occurs in young women. Since its first description in 1969, more than 500 cases have been reported. There have been just 2 case reports and 1 review (7 cases) from Iran. In this study, we reported our experience with 22 patients with SPT from the largest pancreaticobiliary center in Southern Iran.

METHODS

During 6 years (2012-2017), 22 cases of SPTP were operated on in our center. All of these cases were recruited and after confirmation of the pathological diagnosis, clinical charts were evaluated and all the clinicopathologic findings as well as outcome of the surgery were evaluated.

RESULTS

Among the 22 patients, 20 were female and 2 were males. The age range was 15-52 years and the tumor sizes were 3.5 to 17 cm. All of the tumors had preoperative diagnosis by imaging modalities and were operated on with no complication or recurrences. Just one case showed liver metastasis. All of the patients with SPTP in this study were alive and in good condition.

CONCLUSION

SPTP is not very rare in our center. In young patients presenting with pancreatic mass, especially in female patients, one of the most important diagnoses is SPTP. Conservative surgery and tumor excision is satisfactory and patients show excellent prognosis even after liver metastasis.

Enhancement Patterns of Intrahepatic Cholangiocarcinoma on Contrast-Enhanced Ultrasound: Correlation with Clinicopathologic Findings and Prognosis

To evaluate the correlations between the enhancement pattern of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and clinicopathologic findings and prognosis, a retrospective study was performed on 197 patients with mass-forming ICC who underwent pre-operative CEUS and surgical resection. The contrast medium we employed in CEUS was SonoVue, which contains microbubbles consisting of sulfur hexafluoride bubbles within a phospholipid shell. This study was approved by the institutional review board with informed consent waived. Patients were classified into an arterial rim-like enhancement group or an arterial non-rim-like enhancement group, and arterial enhancement patterns were correlated with clinicopathologic factors. Overall survival (OS) times were calculated using the Kaplan-Meier method, and differences between groups were compared with the log-rank test. Univariate and multivariate Cox regression models for OS were used to evaluate the independent prognostic factors. The mean and range of ICC tumor size of the arterial rim-like group (59.41 ± 22.09 mm, 20-100 mm) were similar to those of the arterial non-rim-like group (59.82 ± 30.35 mm, 14-162 mm, p = 0.914). Arterial enhancement patterns were correlated with chronic viral hepatitis or cirrhosis, vascular invasion, lymph node metastasis and single/multiple tumors. A total of 78 patients (39.6%) exhibited arterial rim-like enhancement, and the other 119 patients (60.4%) exhibited arterial non-rim-like enhancement. Arterial enhancement pattern (p = 0.045), vascular invasion (p = 0.005), lymph node metastasis (p = 0.000) and number of tumors (p = 0.001) were independent prognostic factors for OS. The arterial non-rim-like enhancement pattern of ICC on CEUS is an independent prognostic factor for better OS and may offer new information for predicting the prognosis of ICC patients before surgical resection.

The clinicopathologic findings of a subchondral insufficiency fracture of the femoral head in a male patient: a case report

There are few reports describing the clinicopathologic characteristics of subchondral insufficiency fractures of the femoral head (SIF) in men over 50 years of age. A 59-year-old man experienced a sudden onset of the left hip pain without any antecedent trauma. The hip pain did not improve despite conservative treatments, and he underwent a total hip arthroplasty. The mid-coronal cut section of the resected femoral head revealed a fracture line paralleling the subchondral bone endplate beneath the articular cartilage. In addition, the subchondral fracture broadly underlaid the weight bearing area of the femoral head. Histopathologically, reparative tissue including fracture callus and granulation tissue, as well as thin disconnected bone trabeculae were observed. These clinicopathological findings were similar to those of previously described SIF in women. It is therefore important to consider SIF in cases of acute hip pain, even in middle-aged men.

Evaluation of estrogen receptor expression and its relationship with clinicopathologic findings in gastric cancer

Background:

The presence of estrogen receptor alpha has been reported in the cell and tissue levels in gastric cancer; however, its impact on patients’ survival remains unclear. The aim of this study was to investigate the expression of estrogen receptor in gastric carcinoma as well as its relationship with the clinicopathologic findings of the patients.

Materials and Methods:

The study was performed on 100 endoscopic biopsies of gastric adenocarcinoma for estrogen receptor expression using an immunohistochemical method, and their relationship with the clinicopathologic findings of the patients, such as age, gender, tumor site, size, grade, depth of tumor invasion (T), and lymphatic status (N), were analyzed using independent sample t-test and Pearson Chi-square test. A P < 0.05 was considered significant in all analyses.

Results:

Using an immunohistochemical method on endoscopic biopsies of 74 males and 26 females with the mean age of 63 years, estrogen receptor was found to be positive in 41% of patients. No significant difference was found between estrogen receptor expression and other clinicopathologic findings (P = 0.75). There was a significant difference between estrogen receptor (+) and estrogen receptor (−) groups in nodal involvement (P = 0.001). The estrogen receptor (+) patients had more number of lymph nodes involved.

Conclusion:

This study showed that lymph node involvement has a significant relationship with estrogen receptor expression. However, no significant relationship was found between estrogen receptor expression and other clinicopathologic findings such as age, gender, tumor site in stomach, tumor size, tumor grade, and T-stage.