Tumor-to-tumor metastases: Latent renal cell carcinoma discovered after elective surgical resection of a convexity meningioma

BackgroundTumor-to-tumor metastases are extremely rarely reported lesions, which usually involve an indolent lesion hosting a more aggressive neoplasm. We present an unusual initial manifestation of a previously unknown clear cell renal cell carcinoma as a tumor-to-tumor metastasis in a typical meningothelial meningioma.Case reportA 73-year old patient with transient left slight monoparesis was addressed to our Neurosurgical Department after being evaluated by his general practitioner and passing a cerebral MRI which revealed a right frontotemporal mass attached to the meninge. At presentation, no deficits were identified; therefore an elective surgery was proposed. Histological analysis revealed a typical meningothelial meningioma containing a metastatic clear cell renal cell carcinoma. Additional thoraco-abdominal computer tomography identified a 6 cm diameter lesion within the right kidney with radiological features highly suggestive of a primary clear cell renal cell carcinoma.ConclusionOur case highlights the need for a specialized neuropathological approach to clinical and imagistic indolent meningiomas, as they may require important differential diagnosis that can highly impact the treatment and follow-up of brain tumor patients.     

Adult Renal Cell Carcinoma: A Review of Established Entities from Morphology to Molecular Genetics

According to the current World Health Organization (WHO), renal cell carcinomas (RCCs) that primarily affect adults are classified into 8 major subtypes. Additional emerging entities in renal neoplasia have also been recently recognized and these are discussed in further detail by Mehra et al (Emerging Entities in Renal Neoplasia, Surgical Pathology Clinics, 2015, Volume 8, Issue 4). In most cases, the diagnosis of a RCC subtype can be based on morphologic criteria, but in some circumstances the use of ancillary studies can aid in the diagnosis. This review discusses the morphologic, genetic, and molecular findings in RCCs previously recognized by the WHO, and provides clues to distinction from each other and some of the newer subtypes of RCC. As prognosis and therapeutic options vary for the different subtypes of RCC, accurate pathologic distinction is critical for patient care.     

原发鼻腔透明细胞癌3例及文献复习

目的:分析原发鼻腔部透明细癌胞的起源,病理,临床特点及治疗.方法:分析本院1992年9月～2003年9月收治的3例原鼻腔透明细胞癌患者资料,均有病理证实,中位年龄为60岁;主要症状为鼻塞逐渐加重,流涕,间断性流血涕,咽部不适等.3例均行放疗,1例为肿物切除术后放疗,1例初治放疗,1例肿物切除术后放疗后骨转移行化疗,采用6MV-X线治疗2例,8MV-X线治疗1例,DT 40Gy.结果:2例健在,1例死于呼吸,循环衰竭.结论:原发鼻腔部透明细胞癌较罕见,以局部浸润生长为主,发展迅速,可有淋巴道、血液转移,手术加放疗、化疗有效.     

透明晶体超声乳化摘除和低或负度数折叠人工晶体植入治疗高度近视

目的:探讨透明晶体超声乳化吸出并植入后房型折叠人工晶体矫正高度近视的安全性和有效性.方法:对32例(50眼)均采用表麻下经透明角膜切口行透明晶体超声乳化吸出并植入后房型折叠人工晶体.眼轴长平均29.64mm.比较手术前后最佳矫正视力(BCVA),散光度及角膜内皮计数,随访观察手术并发症情况.并对术前BCVA低于0.3的37只患眼应用扫描激光检眼镜(SLO)的微视力软件,检查微视力,评估术后潜在视力.周边视网膜格子样变性7只眼,均行氩激光周边变性区光凝.结果:术后随访平均24月.BCVA由术前0.20±0.19,术后提高到0.61±0.24,其中≥0.5的由术前4只眼(8％)增加到34只眼(68％)。手术前后平均散光度比较,经t检验无显著性差异(P>0.1).手术后无1例发生视网膜脱离,有5只眼发生后发障,均行YAG激光治疗.角膜内皮计数术后平均损失207个/mm2±96个/mm2.且SLO作为术后潜在视力预测手段拥有很高的准确度(94.6％).结论:透明晶体超声乳化摘除加后房型折叠人工晶体植入矫正高度近视是少数屈光矫正有效方法之一,可获得较好的术后BCVA.但是熟练掌握超声乳化手术操作及采取术前积极的预防性治疗是开展此项技术的根本和关键,且需进行长期的临床随访.     

Epithelial-myoepithelial Carcinoma of the Parotid Gland in a Child

A rare case of epithelial myoepithelial carcinoma of the parotid gland, which occurred in a child, is reported. An 8 year old boy presented with swelling of the right parotid gland. He underwent total parotidectomy followed by irradiation for a parotid gland tumor. Three years after the operation, a recurrent tumor invading the base of the skull and the brain and metastases in the lung were noted. The patient expired in spite of extirpation of the intracranial recurrent tumor. The resected tumor showed a character istic histologic feature:double -layered tubular structures composed of inner dark cells (epithelial cells) and outer clear cells (myoepithelial cells). This patient may be the youngest one with the epithelial-myoepithelial carcinoma reported in the literature. Acta Pathol Jpn 42: 358–363, 1992.     

Neural crest origin of clear cell sarcoma of tendons and aponeuroses

Summary In order to clarify the histogenesis of clear cell sarcoma of tendons and aponeuroses (CCS), two cases of human and one nude mouse-transplanted CCS line were studied using an ultrastructural and enzyme cytochemical approach. Most of the tumour cells obtained from the primary and transplanted CCS demonstrated melanosomes in various stages of development within the cytoplasm, whereas no melanosomes could be identified in the metastatic CCS. However, cholinesterase and tyrosinase activities could be demonstrated not only in the melanotic primary and transplanted CCS but also in the amelanotic metastatic CCS. The results therefore support the hypothesis that CCS is a soft tissue tumour derived from the neural crest.     

Adjuvant therapy in renal cell carcinoma

Several drugs have demonstrated clinical activity in metastatic renal cell carcinoma (mRCC). The identification of key metabolic pathways has led to the development of novel targeted therapies which have drastically changed the treatment paradigm of mRCC. Moreover, immune-checkpoint inhibitors have recently shown significant activity in advanced disease. Despite these advancements, the role of adjuvant therapy in localized, non-metastatic RCC remains unclear. The utility of many of these agents in the adjuvant setting is currently being actively explored. In this review, we will summarize the main clinical trials investigating adjuvant therapy in renal cell carcinoma, focusing primarily on immunotherapy and targeted agents.     

Differential diagnosis of epithelioid and clear cell tumors in the liver

A tumor composed of large eosinophilic cells in the liver raises concern for hepatocellular carcinoma, which is typically composed of such cells. However, there are other tumors, both primary and metastatic, that may be composed predominantly of large epithelioid cells. Distinction of these tumors from hepatocellular carcinoma and from each other is of obvious importance for patient management. Similarly, a clear cell tumor anywhere in the body triggers suspicion for renal cell carcinoma. However, other tumors, including hepatocellular carcinoma can rarely be composed entirely of cell cells and the distinction of these from one another, and of primary from metastatic disease is vital. As with the latter, accurate diagnosis is essential for patient management. Using illustrative examples, this article discusses differential diagnosis of liver tumors comprised predominantly of epithelioid cells or clear cells.