A Double-Clear Variant of Epithelial-Myoepithelial Carcinoma of the Parotid Gland

The hallmark of the histology of epithelial-myoepithelial carcinoma (EMC) is the presence of a regular repetitive mixture of bilayered duct-like structures with an outer layer of myoepithelial cells and inner ductal epithelial cells. Clear cell change in the myoepithelial component is common, but clearing of both cell types, giving an impression of a monocellular neoplasm, is rare. A parotid biopsy was received from an 83-year-old male and subject to routine histologic processing for conventional staining and immunohistochemistry. The encapsulated tumour was composed of sheets of PAS/diastase negative clear cells, separated by fibrous septae. The clear myoepithelial cells were positive for S-100 protein, SMA, and p63 and negative for CK19 and surrounded CK19-positive luminal cells. It is important to utilise immunohistochemistry to differentiate this tumour from others with a similar histologic pattern. Information about the behaviour of the double-clear EMC is limited since there are few cases reported.     

养阴柔肝清热利湿法治疗慢性乙型肝炎临床研究

目的:探讨治疗慢性乙型肝炎的治则治法,观察养阴柔肝,清热利湿法治疗慢性乙型肝炎的临床效果.方法:确诊的慢性乙型肝炎患者88例以益气养阴,清热利湿为基本治则,方选一贯煎合茵陈蒿汤加减,治疗8～12个月,采用治疗前后对照方法观察临床症状、体症、乙肝病毒复制指标,比较肝功能变化.结果:临床症状体征均有不同程度改善,血清谷丙转氨酶(GPT),谷草转氨酶(GOT)降低有统计学意义(P＜0.05),HbeAg、HBV-DNA病毒复制指标转阴率48.86%.结论:益气养阴,清热利湿治疗慢性乙型肝炎有较好疗效.     

Clear cell hidradenoma of the index finger

A patient with a benign clear-cell hidradenoma of the index finger is presented. Clear cell hidradenoma is a rare tumor originating from the eccrine sweat glands and infrequently appears on the hand.     

Advances in the Genetics of Familial Renal Cancer

We discuss recent advances in the diagnosis and management of renal cell cancer (RCC) given the enhanced molecular genetics knowledge in this area. A number of hereditary renal cancer syndromes have been described, including von Hippel-Lindau disease, Birt-Hogg-Dubé syndrome, hereditary leiomyomatosis/RCC syndrome, and hereditary papillary renal cancer. Early molecular diagnosis now facilitates the management and prevention of RCC in families. Recommendations for screening in families are discussed.     

Primary hepatic clear cell myomelanocytic tumor. Case report and review of the literature

A case of hepatic clear cell myomelanocytic tumor in a 31-year-old woman presenting clinically with abdominal pain is reported. Histopathologic examination showed a lesion characterized by a population of large epithelioid cells with clear or eosinophilic granular cytoplasm, rich in glycogen. Immunohistochemically, the tumor cells were positive for HMB-45, Melan-A and muscle-specific actin, but negative for epithelial markers, desmin, S-100 protein, and neuroendocrine markers. Ultrastructurally, the tumor cells had abundant glycogen, well-developed rough endoplasmic reticulum, microtubules and aberrant melanosomes. Clinical and pathologic features with a brief review of the relevant literature for hepatic CCMMT as a variant of perivascular epithelioid cell tumor (PEComa) are discussed.     

肺透明细胞瘤临床病理学观察

目的探讨肺透明细胞瘤的临床病理学和免疫组化表型特点、组织起源及鉴别诊断。方法对1例肺透明细胞瘤运用光镜、HE及免疫组化方法分析,并复习相关文献。结果肺透明细胞瘤瘤细胞圆形或椭圆形,胞界清楚,胞浆透明或嗜伊红,无明显核分裂像。免疫组化:HMB-45(+)、CD34(+)、CK(-)、EMA(-)、S-100(-)、Syn(-)、CgA(-),组织化学PAS(+)。结论肺透明细胞瘤是一种较罕见的肿瘤,大多呈良性,坏死罕见,若有坏死,需考虑恶性可能,治疗通常为手术切除。其诊断和鉴别诊断主要依靠组织病理学及免疫组化,熟悉其形态学有利于与其它类似病变如转移的肾透明细胞癌及肺自身发生的透明细胞癌等鉴别。     

Forces and moments delivered by the PET-G aligner to a maxillary central incisor for palatal tipping and intrusion

Objective:To evaluate the effect of material thickness and width of the gingival edge on the forces and moments delivered by aligners prepared from Duran foil (PET-G) to a maxillary incisor during tipping and intrusion.Materials and Methods:Aligners prepared from PET-G of three material thicknesses (0.5, 0.625, and 0.75 mm) and three widths of gingival edges (0–1, 3–4, and 6–7 mm) were investigated during incisor palatal tipping and intrusion of 0.5 mm each. Forces and moments were measured with a six-component measuring device. The influence of aligner thickness and aligner extend on the force and moment development were tested for statistical significance (P < .05).Results:The F_x and F_z forces produced during palatal tipping and intrusion by the 0.75-mm aligner material was significantly higher than those produced by the 0.5-mm-thick material (P = .005 and P = .047, respectively). There was no statistical difference between aligner thickness of 0.5 and 0.625 mm and between 0.625 and 0.75 mm. The same behavior was observed for the palatal moment (M_y). The F_x and F_z forces produced during palatal tipping and intrusion by the aligner with an extension of 0–1 mm edge was significantly lower than that of the aligner with a larger extension (3–4 mm edge: P = .003; 6–7 mm: P = .001). However, there was no statistical difference between aligners with a 3–4-mm and a 6-mm edge. The same behavior was observed for the palatal moment (M_y).Conclusions:The forces and moments exerted by the PET-G aligner on teeth vary, depending on the material thickness, width of the aligner edge, and direction of tooth movement.     

P2X7 receptor predicts postoperative cancer‐specific survival of patients with clear‐cell renal cell carcinoma

The P2X7 receptor, an ATP‐gated plasma membrane ion channel, is involved in inflammation, apoptosis and cell proliferation, and thereby plays a crucial role during oncogenic transformation in various malignancies. This study aims to evaluate the impact of P2X7 receptor expression on postoperative cancer‐specific survival of patients with clear‐cell renal cell carcinoma (ccRCC). A total of 273 patients with ccRCC undergoing nephrectomy at a single institution were retrospectively enrolled in this study, among which 86 patients died of this disease and six patients died of other causes. Clinicopathologic features and cancer‐specific survival (CSS) were recorded. P2X7 expression was assessed by immunohistochemistry in clinical specimens. Kaplan–Meier method with log rank test was performed to compare survival curves. Cox regression models were used to evaluate the prognostic values of variables on CSS. Concordance index was calculated to assess prognostic accuracy of prognostic models. Median follow‐up period was 90 months (range, 11–120 months). Intratumoral P2X7 expression was significantly lower than peritumoral tissues (P < 0.001). Moreover, high intratumoral P2X7 expression, which was significantly associated with shorten CSS (P < 0.001), high TNM stage (P = 0.038), Fuhrman grade (P = 0.035), SSIGN (stage, size, grade, and necrosis) score (P = 0.021) and University of California Integrated Staging System (UISS) score (P = 0.007), was indicated to be an independent prognostic factor for CSS (hazard ratio [HR], 1.693; P = 0.034). The prognostic accuracy of TNM stage, UISS and SSIGN scoring models was improved when intratumoral P2X7 expression was added. Intratumoral P2X7 expression is a potential independent adverse prognostic indicator for postoperative CSS of patients with ccRCC.     

The incidence of pelvic and para-aortic lymph node metastasis in uterine papillary serous and clear cell carcinoma according to the SEER registry

Objective

In this study we utilized the Surveillance, Epidemiology and End-Results (SEER) registry to identify risk factors for lymphatic spread and determine the incidence of pelvic and para-aortic lymph node metastases in patients with uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC) who underwent complete surgical staging and lymph node dissection.

Methods

Nine hundred seventy-two eligible patients diagnosed between 1998 to 2009 with International Federation of Gynecology and Obstetrics (FIGO) 1988 stage IA-IVA UPSC (n=685) or UCCC (n=287) were identified for analysis. Binomial logistic regression was used to determine risk factors for lymph node metastasis, with the incidence of pelvic and para-aortic lymph node metastases reported for each FIGO primary tumor stage. The Cox proportional hazards regression model was used to determine factors associated with overall survival.

Results

FIGO primary tumor stage was the only independent risk factor for lymph node metastasis (p<0.01). The incidence of pelvis-only and para-aortic lymph node involvement according to the FIGO primary tumor stage were as follows: IA (2.3%/3.8%), IB (7.5%/5.2%), IC (22.5%/16.9%), IIA (20.8%/13.2%), IIB (25.7%/14.9%), and III/IV (25.7%/24.3%). Prognostic factors for overall survival included lymph node involvement (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.09 to 1.85; p<0.01), patient age >60 years (HR, 1.70; 95% CI, 1.21 to 2.41; p<0.01), and advanced FIGO primary tumor stage (p<0.01). Tumor grade, histologic subtype, and patient race did not predict for either lymph node metastasis or overall survival.

Conclusion

There is a high incidence of both pelvic and para-aortic lymph node metastases for FIGO stages IC and above uterine papillary serous and clear cell carcinomas, suggesting a potential role for lymph node-directed therapy for these patients.