1
|
Wen LJ, Chen JH, Xu HJ, Yu Q, Deng Y, Liu K. The clinical profiles, management, and prognostic factors of biliary mixed neuroendocrine nonneuroendocrine neoplasms: A systematic review of the literature. Medicine (Baltimore) 2020; 99:e23271. [PMID: 33327249 PMCID: PMC7738038 DOI: 10.1097/md.0000000000023271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs) originating from the biliary system (gallbladder, biliary tract, or ampulla of Vater) are extremely rare and have not been discussed in detail or systematically. We aimed to present the demographics, clinicopathological characteristics, management, and prognostic factors of biliary MiNENs. METHODS A systematic search of electronic biomedical databases (Web of Science, PUBMED, and Embase) was performed to identify eligible studies. Survival was analyzed with the Kaplan-Meier method. Log-rank tests were used to evaluate the differences between groups, and the effects of various clinical and histopathological features on prognosis were analyzed by univariate and multivariate Cox regression. RESULTS Fifty-three publications (patients, n = 67) were included. The median overall survival time was 21.0 months. Fifty-one patients (76.1%) underwent radical surgery and median survival for 41 months (P < .001). Twenty-two patients who received adjuvant radiochemotherapy treatment after radical surgery had a median survival for 43 months (P = .076). Radical resection (P < .001), Ki-67 index (P = .011), tumor stage (P < .001), neuroendocrine (NEC) grade (P = .011), and non-NEC grade (P = .017) were independent statistically significant prognostic factors according to univariate analysis; radical resection (P = .010) and small morphological subtype (P = .036) were independent statistically significant prognostic factors associated with higher overall survival according to multivariate analysis, and radical resection (P = .005) and age < 65 years (P = .026) were associated with higher recurrence free survival time. CONCLUSION Radical resection is essential for long-term survival. Aggressive multimodality therapy with adjuvant radiochemotherapy and biotherapy may improve survival of biliary MiNENs. Further randomized controlled trials are needed to determine the standard treatment.
Collapse
Affiliation(s)
- Li-Jia Wen
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Jun-Hong Chen
- College of Clinical Medicine, Jilin University, Changchun
| | - Hong-Ji Xu
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Yu Deng
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Kai Liu
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| |
Collapse
|
2
|
Takeshima K, Ariyasu H, Uraki S, Morita S, Furukawa Y, Inaba H, Iwakura H, Doi A, Warigaya K, Murata SI, Enomoto K, Hotomi M, Akamizu T. False-positive staining of thyroglobulin distinguished from mixed medullary and follicular thyroid carcinoma by duplex in situ hybridization. Endocr J 2020; 67:1007-1017. [PMID: 32522910 DOI: 10.1507/endocrj.ej20-0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) may mimic mixed medullary and follicular thyroid carcinoma (MMFTC). MTC originates from para-follicular cells, while MMFTC is an uncommon tumor characterized by coexistence of follicular and para-follicular cell-derived tumor populations. A 35-year-old woman was diagnosed with MTC but showed a hot nodule in thyroid scintigraphy. The tumor included diffusely-spread follicular lesions within it, which were immunostained with thyroglobulin and calcitonin. Immunofluorescence showed the presence of several tumor cells that were double-stained with thyroglobulin and calcitonin. To clarify whether or not the tumor was MMFTC, we used duplex in situ hybridization (ISH). Thyroglobulin and calcitonin-related polypeptide alpha mRNA were not expressed together in a single cell, so we suspected false-positive staining of tumor cells with thyroglobulin. To make comparisons with other follicular lesions in MTC, we searched our hospital database. Five cases within a ten-year period had been pathologically diagnosed as MTC. All had follicular lesions in the tumor, but unlike the other case, they were peripherally localized. Dual differentiation into follicular or para-follicular tumor cells was not indicated by either immunofluorescence or duplex ISH. Compared with the case suspected to be MMFTC, there was only mild invasion of tumor cells into the follicular epithelium. The extent of follicular lesions and invasiveness of tumor cells may be associated with pseudo-staining of thyroglobulin in MTC. Duplex ISH can distinguish MTC that are stained with thyroglobulin from MMFTC.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/metabolism
- Adenocarcinoma, Follicular/pathology
- Adult
- Aged
- Calcitonin/metabolism
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/metabolism
- Carcinoma, Neuroendocrine/pathology
- Diagnosis, Differential
- False Positive Reactions
- Female
- Humans
- In Situ Hybridization
- Male
- Middle Aged
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/metabolism
- Mixed Tumor, Malignant/pathology
- Neoplasm Invasiveness
- Procalcitonin/metabolism
- RNA, Messenger/metabolism
- Radionuclide Imaging
- Thyroglobulin/metabolism
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/pathology
Collapse
Affiliation(s)
- Ken Takeshima
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Hiroyuki Ariyasu
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Shinsuke Uraki
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Shuhei Morita
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yasushi Furukawa
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Hidefumi Inaba
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Hiroshi Iwakura
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Asako Doi
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Kenji Warigaya
- Department of Human Pathology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Keisuke Enomoto
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Muneki Hotomi
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Takashi Akamizu
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| |
Collapse
|
3
|
Salemis NS. Metaplastic carcinoma of the breast with mesenchymal differentiation (carcinosarcoma). A unique presentation of an aggressive malignancy and literature review. Breast Dis 2018; 37:169-175. [PMID: 29504519 DOI: 10.3233/bd-170313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Metaplastic carcinoma of the breast with mesenchymal differentiation (MCMD), previously known as carcinosarcoma, is a very rare and aggressive tumor that has been recently classified as a subtype of metaplastic breast carcinoma. It accounts for 0.08%-0.2% of all breast cancers, with only a few cases reported in the literature. Histologically, MCMD is characterized by a biphasic pattern of malignant epithelial and sarcomatous components without evidence of a transition zone between the two elements. We herein describe a unique case of metaplastic carcinoma of the breast with chondrosarcomatous differentiation in a postmenopausal woman who presented with a large, rapidly growing, ulcerated, bleeding mass and signs of impending sepsis. Metaplastic breast carcinomas (MBC) are rare and aggressive tumors. They are characterized by larger size, lower rates of axillary node involvement, higher rates of triple negativity and distal metastases, earlier local recurrence and poorer survival compared with classic invasive breast cancer. Because of the rarity of MBC, the optimal treatment has not been well defined. Surgery is the main curative treatment modality since MBC has shown a suboptimal response to standard chemotherapy. Patients with MBC may be appropriate candidates for novel targeted therapies.
Collapse
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/diagnosis
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Diagnosis, Differential
- Disease-Free Survival
- Female
- Humans
- Mastectomy
- Metaplasia/pathology
- Middle Aged
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/drug therapy
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/surgery
- Neoplasm Staging
- Receptor, ErbB-2/metabolism
Collapse
|
4
|
Hanley KZ, Oprea-Ilies G, Ormenisan C, Seydafkan S, Mosunjac MB. Atypical Findings on Cervicovaginal Smears Correlate with Cervical Involvement by Malignant Mixed Müllerian Tumors of the Uterus. Acta Cytol 2015; 59:319-24. [PMID: 26315658 DOI: 10.1159/000439159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A malignant mixed müllerian tumor (MMMT) is a high-grade neoplasm commonly arising from the uterus. Patients present with bleeding and a mass protruding from the cervix. This study was designed to correlate Papanicolaou (Pap) smear findings with histological findings in women diagnosed with MMMT. STUDY DESIGN Women diagnosed with MMMT were identified. Preoperative Pap tests were correlated with histological findings. Statistical analysis was performed to assess associations between abnormal Pap tests and histological findings. RESULTS Forty patients with MMMT were included in the study. Age ranged from 37-85 years and tumor size ranged from 1.2 to 21 cm. In presurgical Pap tests (4 conventional and 36 liquid based), 11 smears (27.5%) were diagnosed as negative, 5 (12.5%) as atypical squamous cells of undetermined significance, 6 (15%) as atypical glandular cells, 16 (40%) as malignant and 2 (5%) as high-grade squamous intraepithelial lesion. Malignant cells detected on Pap smears showed a strong correlation with endocervical involvement by MMMT (p = 0.002). Larger tumors were more likely to involve the cervix (p = 0.0115). CONCLUSIONS The Pap test can predict cervical involvement by MMMT. On Pap smears, MMMT cells showed no correlation with other adverse histological features (lymphovascular invasion, myoinvasion or adnexal involvement).
Collapse
Affiliation(s)
- Krisztina Z Hanley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Ga., USA
| | | | | | | | | |
Collapse
|
5
|
Fulciniti F, Vuttariello E, Calise C, Monaco M, Pezzullo L, Chiofalo MG, Di Gennaro F, Malzone MG, Campanile AC, Losito NS, Botti G, Chiappetta G. Combined papillary and mucoepidermoid carcinoma of the thyroid gland: a possible collision tumor diagnosed on fine-needle cytology. Report of a case with immunocytochemical and molecular correlations. Endocr Pathol 2015; 26:140-4. [PMID: 25771987 DOI: 10.1007/s12022-015-9364-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fine-needle cytology (FNC) is frequently used to diagnose thyroid nodules discovered by palpation or imaging studies. Molecular tests on FNC material may increase its diagnostic accuracy. We report a case of a classic papillary thyroid carcinoma combined with a mucoepidermoid carcinoma correctly identified on FNC. The papillary component had a classic immunophenotype (CK19+, TTF1+), while the mucoepidermoid one was only focally CK19+. Point mutations (BRAF and RAS) and rearrangements (RET/PTC) of the papillary component have been also investigated on FNC samples, with resulting concurrent rearrangements of RET/PTC1 and RET/PTC3, but no point mutations. The histogenesis of combined papillary and mucoepidermoid carcinoma of the thyroid still remains partly unsettled, and further genomic studies are needed to shed some more light on this peculiar neoplasm.
Collapse
MESH Headings
- Adult
- Biopsy, Fine-Needle
- Carcinoma/diagnosis
- Carcinoma/metabolism
- Carcinoma/pathology
- Carcinoma, Mucoepidermoid/diagnosis
- Carcinoma, Mucoepidermoid/metabolism
- Carcinoma, Mucoepidermoid/pathology
- Carcinoma, Papillary
- Diagnosis, Differential
- Female
- Humans
- Immunohistochemistry
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/metabolism
- Mixed Tumor, Malignant/pathology
- Molecular Diagnostic Techniques
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/pathology
Collapse
Affiliation(s)
- Franco Fulciniti
- Istituto Cantonale di Patologia, Sevizio di Citologia Clinica, via Alberto Franzoni 45, 6601, Locarno, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Abid N, Kallel R, Mellouli M, Mnif H, Ayedi L, Khabir A, Boudawara T. Mixed stromal and smooth muscle tumours of the uterus: a report of two cases. Pathologica 2014; 106:330-334. [PMID: 25845049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Mixed stromal and smooth muscle uterine tumours, defined as those containing at least 30% of each component as seen by routine light microscopy, are rare. This report describes the morphological features of two such tumours diagnosed in 44-year-old and 50-year-old females complaining from recurrent uterine bleeding that was unresponsive to medical treatment. Morphological and immunohistochemical evaluations were performed, and a final diagnosis of mixed endometrial stromal nodule and smooth muscle tumour of the uterus was rendered in both cases.
Collapse
|
7
|
Ben Salah R, Mekni A, Doghri R, Kchir N, Haouet S, Besbes G, Bouchoucha S, Zitouna M. A mixed medullary-follicular thyroid carcinoma discovered by fine needle aspiration. Tunis Med 2012; 90:488-490. [PMID: 22693094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
MESH Headings
- Adenocarcinoma, Follicular/complications
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Biopsy, Fine-Needle
- Carcinoma, Neuroendocrine
- Diagnosis, Differential
- Female
- Humans
- Middle Aged
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/diagnostic imaging
- Mixed Tumor, Malignant/pathology
- Thyroid Neoplasms/complications
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Ultrasonography
Collapse
|
8
|
Sahli R, Christ E, Kuhlen D, Giger O, Vajtai I. Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosis. Pituitary 2011; 14:405-8. [PMID: 19760170 DOI: 10.1007/s11102-009-0199-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
We report on a 74-year-old male patient who presented with progressive neuroophthalmologic symptoms soon after the administration of a long-acting gonadotropin-releasing hormone agonist for treatment of a prostate cancer. Imaging revealed a destructively growing and extensively calcified sellar mass inconsistent with a pituitary adenoma. A transseptal transsphenoidal tumor mass reduction yielded a histological diagnosis of a collision tumor comprised of a gonadotroph adenoma intermingled with osteochondroma. We discuss a potential causal relationship between the administration of the long-acting gonadotropin-releasing hormone agonist and the sudden appearance of the previously unsuspected sellar lesion. Although the association of these two tumors is very likely coincidental, the possibility of causal relationship is addressed.
Collapse
Affiliation(s)
- Rahel Sahli
- Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital and University of Bern, Bern, Switzerland.
| | | | | | | | | |
Collapse
|
9
|
Wildemberg LEA, Vieira Neto L, Taboada GF, Moraes AB, Marcondes J, Conceição FL, Chimelli L, Gadelha MR. Sellar and suprasellar mixed germ cell tumor mimicking a pituitary adenoma. Pituitary 2011; 14:345-50. [PMID: 19116786 DOI: 10.1007/s11102-008-0161-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Germ cell tumors (GCT) are a heterogeneous group of lesions whose origin is not well established. Several cases of primary intrasellar germinomas have been reported, however non-germinomatous GCT have rarely been described. We report the case of a young adult male patient with a mixed GCT that presented with a sellar tumor with suprasellar extension. The patient seeked medical attention because of seizures and magnetic resonance imaging evidenced a tumor of the sellar region. Hyperprolactinemia was also present and dopamine agonist therapy was started. As there was a rapid tumor growth and the patient had concomitant central diabetes insipidus and elevated testosterone levels, a GCT was suspected and confirmed by elevated serum concentration of β-human chorionic gonadotrophin. Patient underwent surgical resection of the tumor and histopathological examination confirmed the diagnosis of a mixed GCT. Chemotherapy was initiated, followed by conventional radiotherapy. In conclusion, although pituitary adenomas respond for the vast majority of sellar tumors, concomitant symptoms such as central diabetes insipidus and rapid tumor growth should raise the suspicion of a diverse diagnosis. The present report intend not only to show a rare case of sellar and suprasellar mixed GCT but also to remind clinicians that if laboratory findings do not fit into patient's diagnosis (such as high testosterone levels in our patient), then the diagnosis should be reviewed.
Collapse
Affiliation(s)
- Luiz Eduardo Armondi Wildemberg
- Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Ho YH, Cheng MHW, Yap WM, Chuah KL. Cytokeratin-, calponin-, and p63-positive chondroblastoma with extensive soft tissue involvement and vascular invasion: a potential diagnostic dilemma. Ann Diagn Pathol 2011; 15:58-63. [PMID: 20952302 DOI: 10.1016/j.anndiagpath.2009.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 11/24/2009] [Accepted: 12/09/2009] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Howe Ho
- Department of Pathology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | | | | |
Collapse
|
11
|
Ogasawara M, Shikishima K. [Mixed tumor in the lower eyelid of Moll's gland origin]. Nippon Ganka Gakkai Zasshi 2011; 115:41-44. [PMID: 21348232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Mixed tumors originating from both tubular epithelial and myoepithelial cells usually develop in the major lacrimal gland of the ocular adnexa. They rarely develop in the eyelid. Mixed tumors arising from Moll's glands are extremely rare. CASE A 35-year-old woman reported a mass in the margin of the left lower eyelid of 5 years' duration. The tumor size was 4 mm and total resection of the lesion was performed. Histopathological examination showed a well-circumscribed nodular lesion located in the dermis; containing fibrous, hyaline and myxoid elements. The tumor growth showed cords and nests of proliferating tubular epithelial and myoepithelial cells. Spindle-shaped myoepithelial cells were observed. The tumor was diagnosed as a mixed tumor. Immunohistochemically, the tumor cells were positive for S-100 protein, and proliferative lesions of tubular epithelial cell origin were strongly positive for gross cystic disease fluid protein-15 (GCDFP-15). CONCLUSION Mixed tumors of the eyelid may arise from the accessory lacrimal glands of Krause and Wolfring, eccrine sweat glands or apocrine (Moll's) sweat glands. This case was considered to be of Moll's gland origin because of its location, the features of the surrounding tissue, its composition of tubular epithelial cells and its positive staining for GCDFP-15.
Collapse
Affiliation(s)
- Mikihide Ogasawara
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan.
| | | |
Collapse
|
12
|
Precetti FA, Prieto MDC, Pietrantonio A, González B. [Mixed carcinoid-adenocarcinoma in transverse colon]. Acta Gastroenterol Latinoam 2010; 40:357-360. [PMID: 21381410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The following case is a 69-year-old woman with a presumptive diagnosis of adenocarcinoma in transverse colon, which was diagnosed by pathology as a mixed carcinoid-adenocarcinoma tumor after surgery. We have found very few cases published of this type of tumor in the colon (around 20) but not cases in the transverse colon. We discuss in the following report the diagnosis, the therapeutic conduct and its results. We point out with particular consideration that, due to the lack of information related to the functional behaviour and clinical characteristics of these mixed tumors, more studies, analysis, follow-up and descriptions are necessary to perform future diagnosis and therapeutic procedures.
Collapse
|
13
|
Deschamps L, Dokmak S, Guedj N, Ruszniewski P, Sauvanet A, Couvelard A. Mixed endocrine somatostatinoma of the ampulla of vater associated with a neurofibromatosis type 1: a case report and review of the literature. JOP 2010; 11:64-68. [PMID: 20065557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Mixed endocrine tumors are double neoplasms with both glandular and endocrine components; these tumors are rare, especially those arising in the ampulla of Vater. Ampullary somatostatinomas are classically associated with neurofibromatosis type 1. We herein describe the first reported case of a mixed endocrine somatostatinoma of the ampulla of Vater associated with neurofibromatosis type 1; we also present a review of the literature of the 7 mixed endocrine tumors of the ampulla which have been reported so far. CASE REPORT A 49-year-old woman presented with atypical abdominal pain. Endoscopic examination revealed a tumor involving the ampulla of Vater and a CT scan identified stenoses of both the distal common bile duct and the main pancreatic duct. A pancreaticoduodenectomy was performed and pathological examination revealed two tumor components, exocrine (high grade adenoma with infiltrative adenocarcinoma) and endocrine (expressing somatostatin hormone) with lymph node metastases originating from both types. The patient was treated with adjuvant chemotherapy and has had no recurrence for 3 years. DISCUSSION In ampullary somatostatinomas, psammoma bodies are pathognomonic and chromogranin A is rarely expressed: these features should alert the pathologist to an association with neurofibromatosis type 1. The management of patients with mixed tumors is challenging. The treatment of choice is surgery, and adjuvant chemotherapy should be adapted to the most aggressive component, i.e. the exocrine one. CONCLUSION Because of their rarity, the diagnosis of ampullary mixed endocrine tumors is difficult. Our case points out the characteristic features of these neoplasms and their possible association with neurofibromatosis type 1.
Collapse
Affiliation(s)
- Lydia Deschamps
- Department of Pathology, CHU Pierre Zobda-Quitman, Fort-de-France, France
| | | | | | | | | | | |
Collapse
|
14
|
Ko ML, Jeng CJ, Huang SH, Shen J, Tzeng CR, Chen SC. Primary peritoneal carcinosarcoma (malignant mixed mullerian tumor): Report of a case with five-year disease free survival after surgery and chemoradiation and a review of literature. Acta Oncol 2009; 44:756-60. [PMID: 16227168 DOI: 10.1080/02841860500252016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Malignant mixed mullerian tumors (MMMTs), also known as carcinosarcoma because they contain both carcinomatous and sarcomatous elements are aggressive tumors, which usually arise in the uterus and ovary. Extragenital carcinosarcomas are extremely rare and most cases develop from the peritoneum. To our knowledge, only 29 cases have been described in English literature. Here we report a case of a primary carcinosarcoma of the pelvic peritoneum with five-year disease-free survival after managing the patient with surgery, chemotherapy and radiotherapy.
Collapse
Affiliation(s)
- Ma-Lee Ko
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
15
|
Sanada Y, Yoshida K. A case of benign intraductal papillary mucinous neoplasm of the pancreas containing two major subtypes. J Gastrointestin Liver Dis 2008; 17:457-460. [PMID: 19104710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Here we report a case of benign intraductal papillary-mucinous neoplasm (IPMN) of the pancreas containing two major subtypes. A 73-year-old man underwent pancreatoduodenectomy for a cystic mass, 5.0 cm in diameter. Histopathologic examinations revealed that IPMN was composed of gastric-type adenoma and intestinal-type borderline lesion. Marked intraluminal nodular growth was observed in the center of the tumor composed of intestinal-type cells positive for MUC2. Our observations suggest that gastric-type epithelium is a precursor of intestinal-type lesions in the stepwise progression of IPMN.
Collapse
MESH Headings
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Aged
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Cholangiopancreatography, Endoscopic Retrograde
- Humans
- Male
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/surgery
- Mucin-2/metabolism
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Pancreaticoduodenectomy
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Yuichi Sanada
- Department of Surgery, Saiseikai Kure Hospital, Department of Surgical Oncology, Gifu Graduate Sch. Med, 1-1 Yanagido Gifu 501-1194, Gifu, Japan.
| | | |
Collapse
|
16
|
Abstract
OBJECTIVE To report the outcomes of tumor-induced osteomalacia after treatment, particularly related to recovery of bone mass. METHODS We review the clinical course of a 61-year-old man extremely debilitated from multiple fractures and neuromuscular weakness due to tumor-induced osteomalacia and report the changes in biochemical markers and bone density after removal of the causative neoplasm. RESULTS At the time of diagnosis, the patient's serum phosphorus and 1,25 dihydroxyvitamin D levels were depressed, and his fibroblast growth factor-23 level was markedly elevated. These values normalized 2 days after surgery and remained within their respective reference ranges 4 and 12 months after resection of a mesenchymal tumor. Lumbar bone density values (T-scores) were 0.445 g/cm2 (-5.9) preoperatively, 0.939 g/cm2 (-1.4) 4 months after surgery, and 1.152 g/cm2 (0.7) 12 months after surgery. Left femoral neck values at the same time points were 0.525 g/cm2 (-3.0), 1.035 g/cm2 (-0.8), and 1.184 g/cm2 (1.9). Ultra-distal radius values at the same time points were 0.128 g/cm2 (-7.0), 0.191 g/cm2 (-5.9), and 0.259 g/cm2 (-4.8). In addition, he recovered neuromuscular function and was able to leave his wheelchair. CONCLUSION Tumor-induced osteomalacia can be an extremely debilitating disease. With successful localization, identification, and resection of the neoplasm, bone mass and physical function can recover.
Collapse
Affiliation(s)
- Lisa G Umphrey
- The Department of Internal Medicine, Mayo Clinic Scottsdale, Scottsdale, Arizona 85260, USA
| | | | | | | |
Collapse
|
17
|
Noun R, Zeidan S, Ghorra C, Slaba S, Menassa-Moussa L, Sayegh R. Jaundice in a chronic hepatitis B carrier. Gut 2007; 56:1409, 1425. [PMID: 17872570 PMCID: PMC2000233 DOI: 10.1136/gut.2006.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- R Noun
- Saint Joseph University of Beirut, Department of Digestive Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Myoepithelial tumors of the soft tissues have only recently been described. Two cases of lower extremity malignant myoepithelial tumors are reported. One case of malignant mixed tumor overlying the gastrocnemius muscle was treated with wide local excision, but metastasized to regional lymph nodes 14 months after surgical excision. One patient with malignant myoepithelioma of the right lower leg was treated with limb amputation and is alive without disease at 46 months. A review of the literature discloses 120 additional cases of soft tissue myoepithelial tumors, 102 of which are myoepitheliomas and 18 are mixed tumors. Thirty-seven percent of the myoepitheliomas met the criteria for malignancy, and 33% of the mixed tumors were malignant. Of these, 30% had locally recurrent disease and 32% developed metastatic disease. Treatment benefit from chemotherapy and radiation therapy is unclear.
Collapse
Affiliation(s)
- Jeffrey R Lee
- Department of Pathology, Medical College of Georgia, Augusta, GA 30912, USA.
| | | | | |
Collapse
|
19
|
Völker HU, Mühlmeier G, Maier H, Kraft K, Müller-Hermelink HK, Zettl A. True malignant mixed tumour (carcinosarcoma) of submandibular gland--a rare neoplasm of monoclonal origin? Histopathology 2007; 50:795-8. [PMID: 17376173 DOI: 10.1111/j.1365-2559.2007.02646.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
Abstract
A 35-year-old Japanese man was admitted to the National Cancer Center, Tokyo, Japan, in December 2000, with a 2-month history of pain around the left thigh. Radiographs showed a poorly demarcated osteolytic lesion with focal mineralisation and endosteal scalloping in the left proximal femur. Biopsy showed a proliferation of highly anaplastic cells without any cartilaginous component. A wide excision of the left proximal femur with a replacement by endoprosthesis was carried out in February 2001 after treatment with methotrexate and 20 Gy radiation therapy. Pathological examination of the surgical specimen showed a focus of low-grade chondrosarcoma and the coexistence of telangiectatic osteosarcoma-like features. The patient was diagnosed with dedifferentiated chondrosarcoma with telangiectatic osteosarcoma-like features. Lung metastasis appeared in July 2001 despite an adjuvant chemotherapy including methotrexate, cis-platinum and doxorubicin. The latest follow-up study in June 2004 showed multiple lung metastases. Establishing a definitive diagnosis of dedifferentiated chondrosarcoma may be difficult with limited small biopsy specimens. Dedifferentiated chondrosarcoma should be included in the differential diagnosis of osteolytic tumours with focal calcification and endosteal scalloping even if an extraosseous tumour component is not identified.
Collapse
Affiliation(s)
- K Okada
- Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan.
| | | | | | | | | |
Collapse
|
21
|
Lopez-Beltran A, Requena MJ, Alvarez-Kindelan J, Quintero A, Blanca A, Montironi R. Squamous differentiation in primary urothelial carcinoma of the urinary tract as seen by MAC387 immunohistochemistry. J Clin Pathol 2006; 60:332-5. [PMID: 16882698 PMCID: PMC1860555 DOI: 10.1136/jcp.2006.038802] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Squamous differentiation (SqD) is variably present in urinary tract tumours, but its significance remains unclear. In this study, SqD was assessed by immunohistochemistry using the monoclonal antibody Mac387 in 145 urothelial tumours (bladder, n = 115; renal pelvis, n = 30). Mac387 detects the myelomonocytic L1 antigen; a member of the calgranulin family shared by epithelial cells and keratinocytes. L1 antigen was shown in SqD in urothelial carcinomas of the bladder or the renal pelvis, including 11 cases with focal SqD unrecognised by conventional analysis. SqD is more frequent in renal pelvic tumours (p = 0.027) and increases with grade/stage mainly in bladder carcinoma (grade, p = 0.05; stage, p = 0.005). Stage Ta/T1 bladder carcinomas with SqD recurred more (p = 0.021). In conclusion, Mac387 efficiently shows SqD in urothelial tumours.
Collapse
Affiliation(s)
- Antonio Lopez-Beltran
- Unit of Anatomic Pathology, Cordoba University Medical School and Reina Sofia University Hospital, Cordoba, Spain.
| | | | | | | | | | | |
Collapse
|
22
|
Heye T, Kuntz C, Düx M, Encke J, Palmowski M, Autschbach F, Volke F, Kauffmann GW, Grenacher L. New coil concept for endoluminal MR imaging: initial results in staging of gastric carcinoma in correlation with histopathology. Eur Radiol 2006; 16:2401-9. [PMID: 16733675 PMCID: PMC1705470 DOI: 10.1007/s00330-006-0318-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 04/03/2006] [Accepted: 04/25/2006] [Indexed: 12/20/2022]
Abstract
Our aim was to conduct a prospective study to evaluate staging accuracy of a new coil concept for endoluminal magnetic resonance imaging (MRI) on ex vivo gastric carcinomas. Twenty-eight consecutive patients referred to surgery with a clinically proven primary gastric malignancy were included. Surgical specimens were examined with a foldable and self-expanding loop coil (8-cm diameter) at 1.5 Tesla immediately after total gastrectomy. T1- and T2-weighted and opposed-phase sequences (axial, frontal sections; 3- to 4-mm slice thickness) were acquired. Investigators blinded to any patient information analyzed signal intensity of normal gastric wall, gastric tumor, and lymph nodes. Findings were compared with histopathological staging. On surgical specimens, 2-5 gastric wall layers could be visualized. All gastric tumors (26 carcinomas, two lymphomas) were identified on endoluminal MR data (100%). Overall accuracy for T staging was 75% (18/24); sensitivity to detect serosal involvement was 80% and specificity 89%. N staging correlated in 58% (14/24) with histopathology (N+ versus N-). The endoluminal coil concept is feasible and applicable for an ex vivo setting. Endoluminal MR data provided sufficient detail for gastric wall layer differentiation, and therefore, identification of T stages in gastric carcinoma is possible. Further investigations in in vivo settings should explore the potential of our coil concept for endoluminal MR imaging.
Collapse
Affiliation(s)
- Tobias Heye
- Department of Diagnostic Radiology, Ruprecht-Karls University, Heidelberg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Szollosi Z, Scholtz B, Egervari K, Nemes Z. Transformed dermatofibrosarcoma protuberans: real time polymerase chain reaction detection of COL1A1-PDGFB fusion transcripts in sarcomatous areas. J Clin Pathol 2006; 60:190-4. [PMID: 16731589 PMCID: PMC1860621 DOI: 10.1136/jcp.2006.037200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Recent cytogenetic studies have shown that reciprocal translocation t (17;22)(q22;q13) and a supernumerary ring chromosome derived from the translocation r(17;22) are highly characteristic of dermatofibrosarcoma protuberans (DFSP). The chromosomal rearrangements fuse the collagen type Ialpha1 (COL1A1) and the platelet-derived growth factor B-chain (PDGFB) genes. The COL1A1-PDGFB fusion transcript has been shown not only in conventional DFSP but also in a small series of DFSP with fibrosarcomatons areas (DFSP-FS) using reverse transcriptase-based conventional polymerase chain reaction. Nothing is known about the status of the COL1A1-PDGFB chimaeric gene in the pleomorphic areas of DFSP-PleoSarc (formerly known as DFSP-malignant fibrous sarcoma). AIMS To show the COL1A1-PDGFB fusion transcript in transformed malignant fibrous histiocytoma. METHOD A real-time polymerase chain reaction assay for the COL1A1-PDGFB fusion transcript in a series of DFSP containing sarcoma was conducted to determine whether the chimaeric gene could be identified in both components of DFSP-FS and DFSP-PleoSarc. Eight cases were analysed. RESULTS In seven cases, transcriptable RNA was detected, and in these cases, translocations were found between COL1A1 and PDGFB genes involving exons 27, 32, 34, 40 and 47 of the COL1A1 gene and exon 2 of the PDGFB gene. CONCLUSIONS From a diagnostic aspect, this assay can be particularly useful in confirming the diagnosis of sarcomatous DFSP. On the other hand, the COL1A1-PDGFB fusion gene was shown in three cases of DFSP containing pleomorphic sarcoma, which supports the theory of the common histogenesis.
Collapse
MESH Headings
- Biomarkers, Tumor/metabolism
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 22/genetics
- Dermatofibrosarcoma/diagnosis
- Dermatofibrosarcoma/genetics
- Dermatofibrosarcoma/metabolism
- Humans
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/genetics
- Mixed Tumor, Malignant/metabolism
- Oncogene Proteins, Fusion/metabolism
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/metabolism
- Translocation, Genetic
Collapse
Affiliation(s)
- Zoltan Szollosi
- Department of Pathology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
| | | | | | | |
Collapse
|
24
|
Abstract
A 7-year-old boy presented with midline swelling in the neck. On fine-needle aspiration cytology it was diagnosed as papillary carcinoma of the thyroid. The patient underwent total thyroidectomy. Histopathological examination, immunohistochemistry and electron microscopy revealed the presence of two intermingled components: medullary carcinoma and papillary carcinoma. One of the submandibular lymph nodes had metastasis of both the components. The case was diagnosed as 'mixed medullary and follicular cell carcinoma' with papillary carcinoma pattern and lymph node metastasis. Mixed medullary and follicular cell carcinoma with intermingling of medullary and papillary carcinoma components is a rare tumor. In adults, only eight such cases with lymph node metastasis have been published. To the best of the authors' knowledge no pediatric case has previously been reported in the English-language literature.
Collapse
MESH Headings
- Biopsy, Fine-Needle
- Carcinoembryonic Antigen/analysis
- Carcinoma, Medullary/chemistry
- Carcinoma, Medullary/diagnosis
- Carcinoma, Medullary/pathology
- Carcinoma, Papillary, Follicular/chemistry
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/pathology
- Child
- Humans
- Immunohistochemistry
- Lymph Nodes/pathology
- Lymphatic Metastasis/diagnosis
- Lymphatic Metastasis/pathology
- Male
- Mixed Tumor, Malignant/chemistry
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/pathology
- Thyroglobulin/analysis
- Thyroid Gland/pathology
- Thyroid Neoplasms/chemistry
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
Collapse
Affiliation(s)
- Richa Goyal
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | |
Collapse
|
25
|
Abstract
We report here a case of combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. A 61-year-old female presented with right flank discomfort, microhematuria and progressive renal dysfunction. Following diagnosis of right renal pelvic carcinoma, radical nephroureterectomy with lymph node dissection was performed through a midline incision. The tumor was pathologically diagnosed to be combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. The patient had no evidence of recurrence or metastasis, 16 months postoperatively. Small cell carcinoma or sarcomatoid squamous cell carcinoma of the renal pelvis is very rare. We believe this is the first such case to be reported in the world.
Collapse
Affiliation(s)
- Nobuyuki Shimasaki
- Department of Urology and Pathology I, Kochi Medical School, Kochi, Japan.
| | | | | | | | | |
Collapse
|
26
|
Ballas KD, Rafailidis SF, Demertzidis C, Alatsakis MB, Pantzaki A, Sakadamis AK. Mixed exocrine-endocrine tumor of the pancreas. JOP 2005; 6:449-54. [PMID: 16186667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT Neoplasms of the pancreas usually show ductal, acinar or endocrine differentiation. Tumors with mixed exocrine and endocrine components are unusual. We herein describe a case of a mixed ductal-endocrine tumor. CASE REPORT A 65-year-old woman was referred to our department with a diagnosis of carcinoma of the tail of the pancreas. The patient had a short history of upper abdominal pain, nausea and melena. Upper gastrointestinal endoscopy revealed gastric fundus varices and CT scan demonstrated an inhomogeneous tumor located in the tail of the pancreas infiltrating the spleen and the splenic vein. The patient underwent distal pancreatectomy and splenectomy, and had an uneventful recovery. Pathological examination revealed a mixed ductal-endocrine tumor. The endocrine component was immunoreactive for glucagon, gastrin and somatostatin, and non-reactive for insulin. CONCLUSIONS Because of the rarity and unpredictable biologic behavior of these tumors, the need for adjuvant therapy has not yet been well-defined. The patient has had a follow-up CT scan every six months, and one and a half years later remains disease free.
Collapse
Affiliation(s)
- Konstantinos D Ballas
- Second Propedeutical Department of Surgery, Aristotles University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
27
|
Humble S, Carter E. Pathologic quiz case: a right adnexal mass in a postmenopausal patient. Malignant mixed müllerian tumor with heterologous elements arising in the fallopian tube. Arch Pathol Lab Med 2004; 128:e161-2. [PMID: 15504082 DOI: 10.5858/2004-128-e161-pqcara] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Scott Humble
- Department of Pathology, American Institute of Pathology, Washington, DC, USA
| | | |
Collapse
|
28
|
Mohan D, Rao GR, Swalsky PA, Bakker A, Martinez AJ, Finkelstein SD. Microdissection genotyping of mixed glial and primitive neuroectodermal central nervous system neoplasm. Arch Pathol Lab Med 2004; 128:1161-4. [PMID: 15387704 DOI: 10.5858/2004-128-1161-mgomga] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 22-year-old man with previous radiation treatment for childhood astrocytoma underwent resection of a right parietooccipital lesion. Histopathology revealed a malignant neoplasm with areas of astrocytic and primitive neuroectodermal components. To resolve the relationship and cellular origin, representative tissue was microdissected from several targets, obtaining a balanced mixture of each element. Nonneoplastic brain parenchyma was separately microdissected to determine polymorphic marker informativeness and to serve as an internal negative control. Despite the relatively small quantity of tissue removed for each microdissection target, sufficient material was available for reliable, balanced, polymerase chain reaction-format genotyping encompassing a panel of tumor suppressor genes and genetic loci associated with these forms of neoplasia. The findings revealed distinct discordant genotypic profiles for each of the neoplastic components. The efficacy of the approach used for molecular analysis of this complex neoplasm and the implication of the genotypic findings are discussed.
Collapse
Affiliation(s)
- Deepak Mohan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Numata T, Hiruma K, Tsukuda T, Asano T. [Malignant mixed tumor]. Gan To Kagaku Ryoho 2004; 31:314-7. [PMID: 15045931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The term "malignant mixed tumor" is usually synonymous with "carcinoma in pleomorphic adenoma," a secondary carcinoma developing in pre-existing pleomorphic adenoma. However, it sometimes indicates a group of tumors consisting of carcinoma in pleomorphic adenoma, carcinosarcoma (true malignant mixed tumor) and metastasizing benign mixed tumor, the latter 2 being the most infrequent. According to the data of the Japanese committee on TNM classification for salivary gland carcinomas, carcinoma in pleomorphic adenoma accounted for about 10% of all salivary gland carcinomas, both in the parotid and submandibular glands. The main type of carcinomas arising in pleomorphic adenoma were undifferentiated carcinoma, adenocarcinoma and squamous cell carcinoma. Crude 5- and 10-year survival rates were 54.7% and 42.7%, respectively. Invasive carcinomas and carcinomas of high grade malignancy carried worse prognoses. The treatment of choice for carcinoma in pleomorphic adenoma has consisted of en-bloc excision with wide margin. Invasive growth, facial nerve involvement, lymph node metastasis or high-grade malignant tumor are grounds for postoperative radiation therapy. The role of chemotherapy has not yet been well established.
Collapse
Affiliation(s)
- Tsutomu Numata
- Dept. of Otorhinolarygology, Chiba National Hospital, 4-1-2 Tsubakimori, Chuo-ku, Chiba 260-8606, Japan
| | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND No previous report of metastasizing mixed tumor (pleomorphic adenoma) of the external auditory canal (EAC) has been described. CASE A 12-year-old, Chinese girl with a history of mixed tumor of the EAC presented with a locally recurrent, aggressive tumor and metastases to the lung and bone five years later. The primary, locally recurrent and metastatic lung tumor showed epithelial and myoepithelial elements with duct formation, chondromyxoid stroma and mitotic activity in the cellular areas on histology. Fine needle aspiration cytology (FNAC) disclosed the presence of spindle cells blending into chondromyxoid fibrillar ground substance in the recurrent and metastatic lung tumors. CONCLUSION In primary mixed tumor of the EAC, FNAC plays a useful role in the diagnosis of recurrent and metastatic disease. Its ability to identify ominous features, such as increased mitoses in this case, may be limited by sampling. Since cytology and histology cannot reliably prognosticate, long-term follow up of mixed tumor of the EAC after complete excision is advocated.
Collapse
Affiliation(s)
- Seng Geok Nicholas Goh
- Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | | | | | | |
Collapse
|
31
|
Abstract
We report a case of mixed tumor arising in the lower vaginal wall. The patient was a 20-yr-old nullipararous woman. The tumor was relatively well-defined with expansile margin, and showed solid sheets or fascicles of stromal-type spindle cells and ovoid epithelial cells with sparsely scattered nests of mature squamous epithelium and glands lined by mucinous epithelium. Cellular atypia was not conspicuous, however, mitosis was counted upto 6 per 10 high power fields. We examined this tumor immunohistochemically and ultrastructurally and reviewed the articles to identify the histogenesis. Positive reaction for vimenin and cytokeratin of stromaltype spindle cells and presence of desmosome-like structures and tonofilaments on electron microscopic examination suggested the epithelial origin of the stromaltype spindle cells.
Collapse
Affiliation(s)
- Mi-Seon Kang
- Department of Pathology, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
| | | |
Collapse
|
32
|
Ichikawa H, Sugano H, Tanada S, Sawada T, Nakayama K, Yorimitsu S, Takahashi I, Iwata J. [Diabetes mellitus with mixed neuroendocrine-neural tumor]. Nihon Naika Gakkai Zasshi 2002; 91:1309-12. [PMID: 12056028 DOI: 10.2169/naika.91.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hirohisa Ichikawa
- Department of Internal Medicine, Kochi Municipal Central Hospital, Kochi
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Ribeiro-Silva A, Novello-Vilar A, Cunha-Mercante AM, De Angelo Andrade LAL. Malignant mixed Mullerian tumor of the uterine cervix with neuroendocrine differentiation. Int J Gynecol Cancer 2002; 12:223-7. [PMID: 11975686 DOI: 10.1046/j.1525-1438.2002.01100.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Malignant mixed Mullerian tumors (MMMTs) are rare neoplasms. We report the clinical, pathologic, and immunohistochemical features of an MMMT primary of uterine cervix. This lesion was composed of a poorly differentiated epithelial component (cytokeratin positive) and a spindle cell component (vimentin positive) with heterologous (myoblastic) differentiation (focal 1A4 positive). There were also cells with neuroendocrine features that expressed S-100 and chromogranin A. Along with a brief review of this amazing neoplasm, some histogenetic concepts relevant to this case are discussed. To our knowledge this is the first report of a malignant mixed Mullerian tumor of the uterine cervix with neuroendocrine differentiation.
Collapse
MESH Headings
- Aged
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Chemotherapy, Adjuvant
- Female
- Humans
- Hysterectomy
- Immunohistochemistry
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/therapy
- Mixed Tumor, Mullerian/diagnosis
- Mixed Tumor, Mullerian/pathology
- Mixed Tumor, Mullerian/therapy
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/therapy
Collapse
Affiliation(s)
- Alfredo Ribeiro-Silva
- Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP/USP), Avenida Bandeirantes, s/n-Campus Universitário Monte Alegre, CEP 14048-900, Ribeirão Preto-SP, São Paulo, Brazil.
| | | | | | | |
Collapse
|
34
|
Abstract
Salivary gland carcinomas displaying exclusively myoepithelial differentiation (myoepithelial carcinoma) are considered rare. Their histopathologic features, immunohistochemical profile, and clinical behavior are not well characterized. The authors reviewed the clinicopathologic features of 25 salivary gland tumors fulfilling two fundamental histologic criteria: unequivocally malignant and exclusively myoepithelial. For most of these, the original diagnosis was malignant mixed tumor. Thirteen men and 12 women aged 24 to 77 years (mean age, 55 yrs) participated in the study, and most presented with a painless mass. The parotid gland was the most common site (n = 15). Tumors ranged from 2.1 to 5.5 cm, arising either in association with a benign mixed tumor (n = 15) or de novo (n = 10). Histologically, all the tumors displayed infiltrative growth and most had a characteristic multinodular architecture with a cellular periphery and central necrotic/myxoid zones. Epithelioid, hyaline, spindle, clear, or mixed cell types were noted with accompanying myxoid and/or hyalinized extracellular matrix. Ten tumors were high grade cytologically and 15 were low grade. The mitotic rate ranged from three to 51 mitoses per 10 high-power fields. Necrosis was present in 15 tumors and perineural and vascular invasion were identified in 11 and four neoplasms respectively. Immunoreactivities included CAM5.2 (89%), AE1:AE3 (100%), 34betaE12 (92%), cytokeratin 7 (21%), cytokeratin 14 (53%), vimentin (100%), S-100 protein (100%), smooth muscle actin (50%), calponin (75%), muscle-specific actin (31%), glial fibrillary acidic protein (31%), carcinoembryonic antigen (0%), and epithelial membrane antigen (21%). Ultrastructural examination of three tumors showed myoepithelial features. Ten patients developed recurrences, mostly multiple. Follow up of 17 patients showed that eight patients (47%) developed metastases (six high grade, two low grade) and five patients (29%) died of disease (four high grade, one low grade) after a mean of 32 months. Two patients were alive with disease (19 and 49 mos). Ten patients (59%) were without any evidence of disease after a mean of 42.2 months. Myoepithelial carcinomas exhibit a wide spectrum of cytomorphologic features and diverse clinical outcomes. As a result of their morphologic heterogeneity, they can be confused easily with many tumors. Myoepithelial carcinomas have been underrecognized in the past, primarily by being lumped under a broader category of "malignant mixed tumor." Awareness of their unique cytoarchitectural patterns and immunohistochemical profile is crucial for accurate identification.
Collapse
Affiliation(s)
- A T Savera
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | |
Collapse
|
35
|
MESH Headings
- Biomarkers, Tumor
- Calcitonin/metabolism
- Carcinoma, Medullary/classification
- Carcinoma, Medullary/diagnosis
- Carcinoma, Medullary/metabolism
- Carcinoma, Papillary, Follicular/classification
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/metabolism
- Chromogranin A
- Chromogranins/metabolism
- Diagnosis, Differential
- Humans
- Mixed Tumor, Malignant/classification
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/metabolism
- Proto-Oncogenes/physiology
- Thyroglobulin/metabolism
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/metabolism
Collapse
|
36
|
Abstract
In total malignant mixed tumors (carcinosarcomas) represent a very rare gynecological neoplasm. In accordance with the embryological genesis primary localizations are with descending probability the uterus, the ovarians and finally the tubes. We report on a 55 year old female patient, with a paraurethral mass, which was primarily diagnosed in 1994. Histopathological evaluation of a transvaginal biopsy did not demonstrate evidence of malignancy at that time. After painful enlargement the paraurethral mass was resected surgically and histopathological evaluation revealed a primary paraurethral malignant mixed tumor (carcinosarcoma). Postoperatively, the patient underwent percutaneous (46.4 Gy) and intracavitary (2 x 6 Gy) radiation. Twelve months postoperatively there is no evidence of disease.
Collapse
Affiliation(s)
- M Braun
- Klinik und Poliklinik für Urologie, MEK, Universität Köln
| | | | | | | | | |
Collapse
|
37
|
Putti TC, Bhuiya TA, Wasserman PG. Fine needle aspiration cytology of mixed tall and columnar cell papillary carcinoma of the thyroid. A case report. Acta Cytol 1998; 42:387-90. [PMID: 9568142 DOI: 10.1159/000331622] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We report the first case of a composite tumor (tall cell and columnar cell variants) of papillary thyroid carcinoma (PTC) diagnosed by fine needle aspiration. It is important to differentiate these uncommon aggressive variants from the usual indolent papillary carcinomas. CASE Fine needle aspiration cytology was obtained from a rare composite tumor of tall cell and columnar cell variants of papillary thyroid carcinoma. The smears showed a cellular aspirate with scattered single tumor cells and several tissue fragments arranged in a papillary pattern. The tumor cells had abundant nuclear grooves and intranuclear pseudoinclusions. Several of the fragments showed columnar cells with nuclear pseudostratification, and a few clusters displayed tall columnar cells with basal nuclei and abundant cytoplasm. A rare cluster exhibited composite features of tall cell and columnar cell variants. CONCLUSION Columnar cell and tall cell variants of PTC manifest aggressive clinical behavior. The differential diagnosis of columnar cell variant includes medullary carcinoma of thyroid and metastatic adenocarcinoma. Immunohistochemical stains for calcitonin and thyroglobulin play an important role in difficult cases. The tall cell variant needs to be differentiated from Hürthle cell papillary neoplasm of thyroid, which displays prominent nucleoli and lacks the characteristic nuclear features of PTC. The preoperative diagnosis of these aggressive variants' is important in planning the most appropriate type of treatment.
Collapse
Affiliation(s)
- T C Putti
- Department of Pathology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA
| | | | | |
Collapse
|
38
|
Abstract
Malignant mixed tumors in the vagina are extremely rare. We experienced a case of a malignant mixed tumor (synovioid variant). Surgical treatment was performed, followed by 3 courses of chemotherapy. Up to the present time, 4 years after the first treatment, no signs of recurrence have been observed.
Collapse
Affiliation(s)
- M Takehara
- Department of Obstetrics and Gynecology, Sapporo Medical University, Japan
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Hemangiomas of bone are rare lesions accounting for approximately 1% of all primary bone tumors. Intraosseous hemangiomas of the foot are especially rare, with only sparse reports in the literature. Presented here is a case study of an erosive bony lesion of the midfoot that was microscopically and histopathologically proven to be a mixed cavernous and capillary hemangioma. Eradication of the lesion during diagnostic biopsy obviated further treatment.
Collapse
Affiliation(s)
- J L Davies
- Denver Presbyterian/St. Luke's Medical Center, Highlands Ranch, CO 80126, USA
| | | | | |
Collapse
|
40
|
|
41
|
Sticco SL. Problem-oriented case management. CRNA 1996; 7:213-5. [PMID: 9077155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S L Sticco
- Daniel Freeman Hospitals, Marina Facility, Marina del Ray, Englewood, California, USA
| |
Collapse
|
42
|
Abstract
The histological features of 124 ceruminous gland tumors from canine and feline biopsy submissions were reviewed. The tissues, which represented submissions from private veterinary practices and a veterinary college, included ceruminous gland adenocarcinomas and adenomas as well as a single, mixed ceruminous gland adenocarcinoma. A majority of the masses from both dogs and cats were identified as malignant processes.
Collapse
Affiliation(s)
- P G Moisan
- Animal Health Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing 48824-1314, USA
| | | |
Collapse
|
43
|
Affiliation(s)
- L Coscia Porrazzi
- Service of Pathological Anatomy, Ospedale dei Pellegrini, Napoli, Italy
| | | |
Collapse
|