Small cell neuroendocrine carcinoma of the ovary

A 64-year-old woman (gravida 0, para 0) had a unilateral ovarian mass measuring 14 cm in its greatest diameter, which was mostly solid. Microscopically, the tumour was characterized by two predominant proliferating patterns: a carcinoid-like pattern with trabecular, tubular, glandular, or insular arrangements and a closely packed nesting pattern with central coagulation necrosis and occasional glandular arrangements. These two patterns were intermingled, and numerous mitotic figures were present. Electron microscopy showed neurosecretory granules in the cells, which were argyrophilic and positive for neuroendocrine markers (chromogranin, leu 7, neuron-specific enolase, and synaptophysin). The tumour was aneuploid by flow cytometry. The patient received chemotherapy postoperatively, developed brain and multiple bone metastases and died of disease 10 months after surgery. This tumour must be distinguished from other small cell neoplasms, especially ovarian small cell carcinoma of the hypercalcaemic type.     

Small cell neuroendocrine carcinoma of the rectum

Poorly differentiated small cell neuroendocrine (NE) carcinoma of the colon and rectum is a rare primaty epithelial malignancy at this location. A case of a highly aggressive NE tumor of small cell type, combined with non-invasive well-differentiated papillary adenocarcinoma in villous adenoma is reported. The patient died rapidly with massive and progressive liver metastasis. The tumor cells were argyrophilic and diffusely immunoreactive for neuron-specific enolase and synaptophysin. Ultrastructural analysis disclosed NE-type cored granules in most of the small tumor cells. NE tumors of the colon and rectum are briefly reviewed.     

Small cell neuroendocrine carcinoma of the urinary bladder

Summary Small cell carcinoma with the histological appearance of pulmonary small cell carcinoma is a rare tumour in the urinary bladder. In previous case reports the neuroendocrine nature of small cell bladder carcinoma has been accepted, but on review the evidence for true neuroendocrine differentiation appears unsatisfactory. In this study the histological, immunohistochemical and ultrastructural characteristics of three cases of small cell carcinoma of the urinary bladder are described. Ultrastructurally, the cytoplasm of all three tumours contained neurosecretory-type granules and each of the tumours demonstrated positive immunoreaction for two or more neuroendocrine markers, from a panel including neuron-specific enolase, chromogranin A, Leu-7, bombesin and synaptophysin. Although the combination of ultrastructural and immunohistochemical examination obviously offers the strongest evidence in establishing neuroendocrine differentiation, it is argued that immunohistochemistry alone may also yield important information in demonstrating a neuroendocrine nature, provided that at least neuron-specific enolase and synaptophysin are included as markers. The clinical relevance of identifying neuroendocrine differentiation in small cell bladder carcinoma is suggested by the favourable response to combination chemotherapy in two of our cases.     

Small cell neuroendocrine carcinoma of cervix--a case report

Small cell neuroendocrine carcinoma of uterine cervix is a rare variant of cervical carcinoma with features of high aggressiveness. It is difficult to manage these tumors. It is often diagnosed at an advanced stage and its prognosis is generally poor. The present report describes a 65 year old woman who presented with postmenopausal bleeding and had a friable polypoidal growth hanging from the cervix. Microscopic examination of the growth showed features of small cell carcinoma. Neuroendocrine cellular characteristics were assessed by using antibodies against neuron specific enolase. The case is being reported to create awareness of this rare entity     

Small cell sweat gland carcinoma of childhood

Small cell sweat gland carcinoma appears to represent a very unusual histological type of sweat gland anlage tumour presenting in children. The differential diagnosis from other small blue cell tumours involving the skin is often difficult. The present report confirms the original observation describing two patients of 2 and 5 years of age harbouring cutaneous tumours. The histology of these lesions showed a monomorphic proliferation of small cells with a high mitotic rate and areas of necrosis. Immunohistochemically, the cells were negative for desmin, cytokeratin 7, cytokeratin 20, Cam 5.2, CD99, chromogranin, CD56, synaptophysin, and S-100, and focally positive for the pancytokeratin marker AE1/AE3, carcinoembryonic antigen (one case), and neurone specific enolase (one case). The prognosis of this type of tumour seems to be good. As more cases are added, the clinical pathological spectrum of the lesion will become better defined.     

Bartholin's gland mixed carcinoma predominantly of the transitional cell type following radiotherapy for a cervical carcinoma

An unusual case is described of Bartholin's gland carcinoma which developed 28 years after radiotherapy for a cervical carcinoma. The tumor showed three-directional differentiation with predominance of the papillary non-invasive transitional cell pattern.     

Small cell type neuroendocrine carcinoma colliding with squamous cell carcinoma at esophagus

Collision tumor is an extremely rare tumor which defined as the concrescence of two distinct primaries neoplasms. We report here a case of collision tumor at lower third esophagus composed of small cell type neuroendocrine carcinoma (NEC), which is an very rare, highly aggressive and poorly prognostic carcinoma and squamous cell carcinoma (SqCC). In our case, pathologically, the small cell carcinoma display the characteristic of small, round, ovoid or spindle-shaped tumor cells with scant cytoplasm, which colliding with a moderately differentiated squamous cell carcinoma. Immunohistochemical staining demonstrated positive activities for CD56, synaptophysin, 34βE12, CK 5/6, ki-67 (70%-80%), but negative for CD99, chromogranin A, and TTF-1. Accurate diagnosis was made base on these findings.     

Small cell carcinoma of the lung and large cell neuroendocrine carcinoma interobserver variability

den Bakker M A, Willemsen S, Grünberg K, Noorduijn L A, van Oosterhout M F M, van Suylen R J, Timens W, Vrugt B, Wiersma‐van Tilburg A & Thunnissen F B J M
(2010) Histopathology 56, 356–363 Small cell carcinoma of the lung and large cell neuroendocrine carcinoma interobserver variability Aims: To test the hypothesis that the published morphological criteria permit reliable segregation of small cell carcinoma of the lung (SCLC) and large cell neuroendocrine carcinoma (LCNEC) cases by determining the interobserver variation. Methods and results: One hundred and seventy cases of SCLC, LCNEC and cases diagnosed as neuroendocrine lung carcinoma before LCNEC had been established as a diagnostic category were retrieved from the archives of the assessor’s institutes. A representative haematoxylin and eosin section from each case was selected for review. Batches of cases were circulated among nine pathologists with a special interest in pulmonary pathology. Participants were asked to classify the cases histologically according to the 2004 World Health Organization (WHO) criteria. The diagnoses were collected and κ values calculated. Unanimity of diagnosis was achieved for only 20 cases; a majority diagnosis was reached for 115 cases. In 35 cases no consensus diagnosis could be reached. There was striking variability amongst assessors in diagnosing SCLC and LCNEC. The overall level of agreement for all cases included in this study was fair (κ = 0.40). Conclusions: Using non‐preselected cases, the morphological WHO criteria for diagnosing SCLC and LCNEC leave room for subjective pathological interpretation, which results in imprecise categorization of SCLC and LCNEC cases.     

Small cell (neuroendocrine) carcinoma of the vagina

We report a case of vaginal small cell (neuroendocrine) carcinoma. Immunostaining for neuron-specific enolase, PGP 9.5, chromogranin, synaptophysin, Leu 7 and cytokeratin was positive. Neurosecretory granules were found by electronmicroscopy. There was local recurrence and regional lymph node metastases. The patient survived for 10 months following local surgical therapy only.     

Histochemical and cytochemical studies of metastasizing carcinoma of Bartholin's gland

A case of adenocarcinoma of Bartholin's glands in a middle aged female is presented. This well known, but rather uncommon malignancy is reported since it shows an unusual structure consisting of a combination of two different histological entities, namely an adeno-cystic component and adenopapillary component. An interval of 21 years elapsed between the appearance of the primary lesion and the recurrence which showed extensive haematogenous and lymphogenous metastases and proved fatal within two years of the recurrence. The study includes an enzyme histochemical evaluation and a fine needle cytological examination. The former revealed a high degree of activity of the NADP+ regenerating enzymes of the pentose shunt as well as a definite, but variable, activity of many lysosomal enzymes, mainly non specific esterases, acid phosphatase, aryl sulphatase and beta-glucuronidase. In contrast to other adenocarcinomas arising in the female genital tract, especially those of endometrium and ovary, the tumour cells showed only a slight activity of alkaline phosphatase, As is the case in many other adenocarcinomas, the activity of lactate dehydrogenase was strongly evident.     

Adenocarcinoma of Bartholin's gland

Bartholin's gland carcinoma is an uncommon disease representing 0.1% of all female genital malignant neoplasms. Five Bartholin's gland adenocarcinomas were selected by the criteria of Chamlian and Taylor. Three patients died from metastatic disease within four years; two are free of apparent disease 14 months and 13 years, respectively, after initial diagnosis. Poor prognosis was associated with large tumor size, poor histopathologic differentiation, and lymph node involvement. Transmission electron microscopy verified the glandular nature of the poorly differentiated lesions. All five tumors demonstrated junctional complexes, abundant rough endoplasmic reticulum, secretory vacuoles, and glandular formation. Low levels of estrogen receptor and moderate levels of progesterone receptor were present in the one case measured. Endogenous peroxidase, and inducible enzyme in estrogen-sensitive tissues, was observed in two of the five tumors.     

Malacoplakia of Bartholin's gland

Two cases of malacoplakia involving Bartholin's glands occurred in postmenopausal women. Grossly the lesions were ovoid cysts with rubbery, soft walls. Microscopically there were sheets of von Hansemann's histiocytes and rare Michaelis-Gutmann bodies. After surgical excision, both patients remained asymptomatic. These cases involving Bartholin's glands are, to our knowledge, the first reported in the female genital tract.     

Small cell neuroendocrine (oat cell) carcinoma of the male breast

Summary A case of small cell neuroendocrine (oat cell) carcinoma of the breast in a 52-year old male is presented. Oat cell carcinomas have been reported in various extrapulmonary sites, but this is the second case of a primary oat cell carcinoma of the breast and the first one to have been documented in a male. The tumor was investigated histologically, immunocytochemically and ultrastructurally. The relationship to so-called carcinoid mammary tumors is discussed.Dedicated to Prof. Dr. J. Kracht on the occasion of his 60th birthday     

Nodular hyperplasia of Bartholin's gland

AIMS: There has been very little mention of benign solid lesions of the Bartholin's gland (BG) in pathology and gynaecology textbooks, and very few cases have been reported in the literature. Among these lesions, the distinction between nodular hyperplasia (NH) and adenoma has not been well defined. We report ten cases of NH of the BG, describe their clinicopathological, immunohistochemical and ultrastructural findings, and review the literature. METHODS: We examined retrospectively all lesions involving BGs from our surgical pathology records from 1990 to 2004 with emphasis on NH. To separate NH from adenoma, we applied the criteria proposed by Koenig and Tavassoli. Special stains (PAS with and without prior digestion, Mayer's mucicarmine and Alcian blue with and without hyaluronidase) and immunohistochemistry (CAM5.2, AE1/AE3, HMWK, monoclonal CEA, EMA, ER, PR, ALA, SMA, Ki-67, p53 and polyclonal CEA) were performed on NHs. Two cases were examined ultrastructurally. RESULTS: Using specific criteria, ten cases (age range 23-45 years; mean 36.1) of NH were identified, two of which were diagnosed previously as adenoma, but re-classified as NH. Clinically, these lesions were described either as Bartholin's duct cysts (BDCs) or vulvar lumps. Grossly, NHs were solid, tan and unencapsulated, measuring 12.5-45.0 mm in maximum dimension (mean 23.8). Histologically, the NHs were composed of a proliferation of mucus-secreting acini with preservation of the normal duct-to-acinar relationship. Chronic inflammation and squamous metaplasia were present. Eight lesions focally involved the surgical margins. Intracytoplasmic and intra-luminal secretions were positive for PAS with and without digestion, Alcian blue with and without hyaluronidase and mucicarmine. All lesions showed positive staining for CAM5.2, AE1/AE3, HMWK, EMA, and polyclonal CEA. There was negative staining for Ki-67, ER, PR, ALA, p53 and monoclonal CEA. Periacinar myoepithelial cells stained for SMA. Ultrastructurally, the findings included abundant intracytoplasmic secretory granules, granulofibrillar bodies, prominent Golgi and ribosomes. Myoepithelial cells were identified. There was no tumour recurrence or malignant transformation in eight patients with clinical follow-up. CONCLUSION: NH of the BG is a rare lesion with benign behaviour. It is a distinct entity and can be separated histologically from an adenoma.     

Small cell neuroendocrine carcinoma of the rectum associated with chronic ulcerative colitis

A case of small cell carcinoma of the rectum in a patient with chronic ulcerative colitis is described. There was no evidence of enteroendocrine cell hyperplasia.     

Microbiology of Bartholin's gland abscess in Japan

This study was conducted to determine the current epidemiology concerning the causative organisms for Bartholin's gland abscess in Japan. Microbiological examination of 224 cases showed positive results in 219 cases and negative results in 5 cases. Of all of the bacterial isolates, 307 and 118 were aerobes and anaerobes, respectively. The most frequently isolated bacterium was Escherichia coli. Of the anaerobes, the most frequently isolated organism was Bacteroides species, followed by Prevotella species. The organisms related to respiratory infectious diseases, such as Streptococcus pneumoniae and Haemophilus influenzae, including resistant bacteria, were sometimes involved between 2000 and 2004.     

Bartholin's gland abscess caused by Brucella melitensis

We report herein a case of Bartholin's gland abscess caused by Brucella melitensis. Clinical microbiology laboratory workers in areas where this disease is endemic should be familiar with the bacteriological features of this organism and consider the possibility of a brucellar etiology in a broad range of clinical settings.     

喉大细胞神经内分泌癌

目的：探讨喉大细胞神经内分泌癌的临床及病理特征。方法：复习2例患者的临床病史，肿瘤组织的病理形态和免疫表型及相关文献。结果：2例患者均为男性，以声音嘶哑、喉部不适为主要表现；病变均位于声门上，以具有丰富嗜酸性胞质，巢状排列为肿瘤细胞的形态特征，免疫组化表达神经内分泌肿瘤标志物。2例均因短期内发生肿瘤广泛转移而死亡，结论：喉大细胞神经内分泌癌属于高度恶性的肿瘤。形态上需与低分化鳞癌，甲状腺样癌，肺神经内分泌癌，副神经节瘤和无色素性黑色素瘤等相鉴别。