Skeletal Muscle Metastases from Pancreatic Carcinoma–A Case Report and Review of Literature

With an overall mortality approaching nearly 100 %, pancreatic cancer is still a challenging disease. A major proportion of pancreatic cancers are still diagnosed at the locally advanced or metastatic stage. Tumors originating from tail region present very late due to the absence of specific symptoms and signs. The usual sites of metastases are the liver, peritoneum and lungs, with occasional reports of metastases in other sites. There are very few documented cases of gastrointestinal cancers manifesting as metastases to muscle. This is a report on a case of pancreatic cancer presenting as metastases to skeletal muscle and multiple other viscera and review of literature for pancreatic cancer metastases.     

Infiltrating giant cell tumor in a case of Paget’s disease of bone

Giant cell tumor (GCT) of the bone, also called osteoclastoma, is a rare complication of Paget’s bone disease. We report a patient from Southern Italy who developed a GCT infiltrating the neighboring tissues. The natural history and the therapeutic outcomes of this unique complication of Paget’s bone disease are presented.     

Infiltrating angiolipoma or intramuscular hemangioma? A report of five cases

We report five cases of tumors composed primarily of angiomatous and adipose tissue occurring within skeletal muscle in relatively young individuals. Pain is frequently the presenting symptom. The tumors have been described in the literature as angiolipomas, infiltrating angiolipomas, and intramuscular hemangiomas. A discussion of the use of these terms is included. It is our conclusion the term "intramuscular hemangioma" is most appropriate for these lesions.     

An Endogenous Inhibitor of Angiogenesis derived from a Transitional Cell Carcinoma: Clipped β2-Glycoprotein-I

Background Invasive cell carcinoma of the bladder often develops after complete transurethral excision of superficial transitional cell carcinoma. It has been postulated that primary tumors release angiogenesis-blocking proteins which suppress distant metastases. We have identified an endogenous protein which might be responsible for tumor dormancy.Methods A transitional cell carcinoma cell line was developed (UMUC-3i) which inhibits the growth of a tumor implant at a distant site in SCID mice. Conditioned media of UMUC-3i cultured cells was first pooled and then fractioned, and the capacity of individual components to block endothelial cell growth was tested. The protein fraction responsible for blocking endothelial cell growth was identified by N-terminal amino acid sequencing as well as by mass-spectrometry. The effects of the purified protein in preventing endothelial cell proliferation and tube formation in an in vitro angiogenesis assay was investigated.Results The plasma protein β₂-glycoprotein-I (β₂gpI) was isolated and identified from conditioned medium of UMUC-3i cultured cells. Based on the in vitro angiogenesis assay, β₂gpI strongly inhibited endothelial cell growth and tube formation, whereby the inhibitory activity corresponded to the clipped version of β₂gpI (cβ₂gpI). Clipping was induced by adding plasmin at a molar ratio 1:15 (plasmin:substrate). Further analysis indicated that cβ₂gpI effects were mediated by annexin II surface receptors expressed on endothelial cells.Conclusions cβ2gpI may be involved in blocking angiogenic processes and bladder cancer progression. In this case, cβ2gpI may be a promising tool in bladder cancer therapy.     

Low-Grade Salivary Duct Carcinoma or Low-Grade Intraductal Carcinoma? Review of the Literature

Low-grade salivary duct carcinoma (LG-SDC) is a rare neoplasm characterized by predominant intraductal growth, luminal ductal phenotype, bland microscopic features, and favorable clinical behavior with an appearance reminiscent of florid to atypical ductal hyperplasia to low grade intraductal breast carcinoma. LG-SDC is composed of multiple cysts, cribriform architecture with “Roman Bridges”, “pseudocribriform” proliferations with floppy fenestrations or irregular slits, micropapillae with epithelial tufts, fibrovascular cores, and solid areas. Most of the tumor cells are small to medium sized with pale eosinophilic cytoplasm, and round to oval nuclei, which may contain finely dispersed or dark condensed chromatin. Foci of intermediate to high grade atypia, and invasive carcinoma or micro-invasion have been reported in up to 23 % of cases. The neoplastic cells have a ductal phenotype with coexpression of keratins and S100 protein and are surrounded by a layer of myoepithelial cells in non-invasive cases. The main differential diagnosis of LG-SDC includes cystadenoma, cystadenocarcinoma, sclerosing polycystic adenosis, salivary duct carcinoma in situ/high-grade intraductal carcinoma, and papillary-cystic variant of acinic cell carcinoma. There is no published data supporting the continuous classification of LG-SDC as a variant of cystadenocarcinoma. Given that most LG-SDC are non-invasive neoplasms; the terms “cribriform cystadenocarcinoma” and LG-SDC should be replaced by “low-grade intraductal carcinoma” (LG-IDC) of salivary gland or “low-grade intraductal carcinoma with areas of invasive carcinoma” in those cases with evidence of invasive carcinoma.     

Is There any Benefit from Expanding the Criteria for the Resection of Hepatocellular Carcinoma in Cirrhotic Liver? Experience from a Developing Country

Background

Patients with large-size (>10?cm) hepatocellular carcinoma (HCC) in Child B cirrhosis are usually excluded from curative treatment, i.e., hepatic resection, because of marginal liver function and poor outcome. This study was designed to evaluate the feasibility of the radiofrequency (RF)-assisted sequential “coagulate-cut liver resection technique” in expanding the criteria for resection of large HCC in cirrhotic livers with impaired liver function.

Methods

Forty patients with Child-Pugh A or B cirrhosis underwent liver resection from December 1, 2001 to December 31, 2008. Of these, 20 patients (13 Child-Pugh A and 7 Child-Pugh B) with advanced stage HCC (stage B and C according to Barcelona-Clinic Liver Cancer Group) underwent major liver resection. The two groups were comparable in terms of patient age, liver cirrhosis etiology, tumor number, and size.

Results

All resections were performed without the Pringle maneuver. There was no significant difference found between the two groups regarding resection time, perioperative transfusion, postoperative complications, hospital stay, and day 7 values of hemoglobin and liver enzymes. Likewise, there was no significant difference found in the overall survival between Child A and Child B patients who underwent major liver resection

Conclusions

RF-assisted sequentional “coagulate-cut liver resection technique“ may be a viable alternative for management of patients with advanced HCC in cirrhotic liver with impaired function.     

The Florid Subtype of Lobular Carcinoma In Situ: Marker or Precursor for Invasive Lobular Carcinoma?

Background

Lobular carcinoma in situ (LCIS) is considered a risk factor—not a precursor—for both invasive lobular and ductal carcinoma. Florid LCIS (F-LCIS) is an architectural subtype of LCIS that does not express E-cadherin, yet has the histologic and often radiographic appearance of solid-type ductal carcinoma in situ (DCIS). Since DCIS is considered a precursor to invasive ductal carcinoma, should F-LCIS be considered a precursor to invasive lobular carcinoma (ILC)?

Methods

Review of an institutional database identified cases of LCIS and solid-type DCIS diagnosed by excisional biopsy, segmentectomy, or mastectomy between 1991 and 2000 to determine the prevalence of associated invasive breast cancer. Archival specimens were evaluated for florid and nonflorid LCIS, nuclear grade of LCIS, and the presence and subtype of invasive breast cancer. Solid-type DCIS that lacked E-cadherin expression was classified as F-LCIS.

Results

Of 210 consecutive specimens of LCIS examined, 171 had nonflorid LCIS (81%) and 39 had F-LCIS (19%). Nonflorid LCIS had a diffuse pattern, whereas F-LCIS appeared as discrete foci adjacent to ILC. An invasive component was identified with 87% of F-LCIS lesions versus 73% of nonflorid LCIS lesions (P = 0.064); this component was lobular in 100% of F-LCIS lesions versus 82% of nonflorid LCIS lesions, a significant difference (P = 0.0044) that persisted when the analysis was adjusted for nuclear grade (P = 0.0082).

Conclusion

Its close spatial relationship to an invasive component and increased association with ILC suggest that F-LCIS may be a precursor for ILC.

     

Diagnosis of Bladder Carcinoma: A Clinician’s Perspective

In 2014, more than 74,000 new cases and 15,000 deaths from bladder cancer were estimated to occur. The most reliable prognostic factors for survival are pathologic stage and histologic grade. Accordingly, a good understanding of the pathologic features of these cancers is essential to guide optimal clinical treatment, which requires a multidisciplinary team of pathologists, urologists, radiation oncologists, and medical oncologists. This review highlights several clinical scenarios in which detailed pathologic evaluation and accurate reporting impact clinical management.     

Oncologic Outcomes of Post–Kidney Transplantation Superficial Urothelial Carcinoma

Purpose

To analyze the oncologic effect of post–kidney transplantation (KT) immunosuppressive status for end-stage renal disease (ESRD) patients with superficial urothelial carcinoma.

Adenosquamous Carcinoma of the Head and Neck: A Case–Control Study with Conventional Squamous Cell Carcinoma

Adenosquamous carcinoma (AdSC) is considered a rare variant of squamous cell carcinoma (SCC) which is considered to be more clinically aggressive. Data is very limited with very little case matched data on outcomes in the literature. It is also unknown whether the quantity of the adenocarcinoma component affects outcomes. A retrospective case–control study with 23 cases of AdSC and 1137 SCC controls was conducted. Cases were matched by anatomic subsite, treatment, and, for oropharynx, by p16 status. The following variables were adjusted for in the analysis: T classification (T1/T2 vs. T3/T4), N classification (N0–N2a vs. N2b–N3), age, and smoking. The adenocarcinoma component was quantified by the number of high power fields containing glands as low, moderate, or high. AdSCs had a significantly greater risk of disease recurrence but largely, the differences were not statistically significant. The quantity of adenocarcinoma did not correlate with disease recurrence or survival. This case–control study on AdSC shows modestly more clinically aggressive behavior than conventional SCC, even while controlling for p16 status for oropharyngeal cases. Further, it suggests the current definition of AdSC, with no minimum requirement for gland formation, is clinically accurate.     

Solitary Intraperitoneal Recurrence of α-Fetoprotein-Producing Gastric Carcinoma: Report of a Case

Abstact A solitary recurrence of gastric carcinoma in the peritoneal cavity is extremely rare. We herein present a case of solitary intraperitoneal recurrence in a patient with α-fetoprotein (AFP)-producing gastric carcinoma. As far as we can determine, this is the first report of such a form of recurrence in a patient with gastric carcinoma who underwent a successful resection. A review of our eight patients who had AFP-producing gastric carcinoma showed a frequent association with hepatic metastasis and a poor prognosis as has been reported previously. Our patient received intra-arterial chemotherapy with low-dose cisplatin and 5-fluorouracil to prevent hepatic recurrence, but eventually developed multiple hepatic metastases after ceasing this therapy. Therefore, adjuvant intra-arterial chemotherapy may have altered the site of first recurrence in this patient. Received: June 6, 2001 / Accepted: November 20, 2001     

Squamous Cell Carcinoma of the Prostate – A Case Report

Squamous cell carcinoma is a rare neoplasm of the prostate gland, forming about 0.5 of all prostatic malignancies. We present a case of squamous cell carcinoma of the prostate. Squamous cell carcinoma is usually indistinguishable from adenocarcinoma of the prostate by clinical features. Diagnosis is by histological examination. There are definite criteria for diagnosis like keratinisation, epithelial pearls and intercellular bridges. The cell of origin is widely accepted as the transitional epithelium of the urethra and periurethral ducts. This tumour is biologically much more aggressive than adenocarcinoma. There is no treatment modality which offers satisfactory results and the survival time is short.     

Pathology,Molecular Biology,and Prognosis of Penile Squamous Cell Carcinoma: What Can We Learn from the Specimen?

In the treatment of penile cancer, there is a need for prognostic and predictive factors allowing assessment of the likelihood of lymph node metastasis, as this would greatly facilitate clinical decision-making for invasive staging of inguinal nodes. Furthermore, systemic chemotherapy in metastatic disease has limited efficacy and more effective additional or second-line therapies are needed. There is a great interest in personalised and targeted therapies at present, but do we have any indications that these will be useful in penile cancer? This review examines the well-proven predictors of prognosis that pathologists can take from specimens, and reports which molecular markers are of proven value in penile cancer.     

Does Hürthle Cell Carcinoma of the Thyroid Have a Poorer Prognosis than Ordinary Follicular Thyroid Carcinoma?

Background

Hürthle cell carcinoma (HCC) is a rare form of thyroid carcinoma and is considered an oxyphilic variant of follicular thyroid carcinoma. However, little is known about its biological characteristics or clinical behavior. We conducted a retrospective study to determine whether the prognosis of HCC differs from that of ordinary follicular thyroid carcinoma (OFC).

Methods

The subjects were the 558 patients with follicular thyroid carcinoma who underwent initial surgery at our institution between 1989 and 2010 and consisted of 73 patients with HCC and 485 patients with OFC. There were 410 females and 148 males, and their median age was 51 years. A univariate analysis was conducted in relation to cumulative cause-specific survival (CSS) according to the Kaplan–Meier method for the following variables: age at the time of initial surgery, gender, tumor size, invasiveness, distant metastasis at presentation, and histological type (HCC vs OFC). Differences between groups were analyzed for significance by the log-rank test. Multivariate analysis was performed by using the Cox proportional hazard model.

Results

A total of 4 patients (5.5 %) in the HCC group had distant metastasis compared with 106 patients (21.9 %) in the OFC group. Significant factors in relation to CSS in the univariate analyses were age, tumor size, and invasiveness, but there were no significant differences between the HCC group and the OFC group. Multivariate analysis showed that age, tumor size, and distant metastasis at presentation were significant factors.

Conclusions

HCC does not have a poorer prognosis than OFC.     

Resection of Adrenocortical Carcinoma Liver Metastasis: Is it Justified?

Background

Adrenocortical carcinoma (ACC) liver metastases (LM) represent a therapeutic challenge, and it is unclear whether resection is justified. This study assesses long-term outcome and prognostic factors after liver resection for metastatic ACC.

Methods

Patients who underwent resection of ACC LM were identified from institutional databases. Recurrence, survival, and tumor characteristics, including ??-catenin and TP53 status based on immunohistochemistry and sequencing, were reviewed. The prognostic value of variables was assessed with log-rank test for univariate analysis and Cox proportional hazard models for multivariate analysis.

Results

From 1978 to 2009, 28 patients (20 females; median age, 45?years), including 11 with synchronous metastasis and 3 with extrahepatic metastasis, underwent resection for ACC LM (major hepatectomy in 61%). Postoperative mortality was nil and morbidity 55%. On pathological examination, tumors were multiple in 68%, with a median size of 43?mm, and resections were R0, 1, and 2 in 59%, 33%, and 7%, respectively. All 28 patients developed recurrent disease, which was treated surgically in 11, including repeat hepatectomy in 4. Of the 15 patients with adequate tissue for analysis, ??-catenin immunostaining was positive in 7, with 4 corresponding CTNNB1 mutations associated with decreased survival; p53 staining was positive in 5 (4 with corresponding TP53 mutations). The median disease-free and overall survival after hepatectomy was 7 and 31.5?months, respectively, with a 5-year survival of 39%. In multivariate analysis, nonfunctional tumor and surgical treatment of recurrence were independent predictors of good outcome.

Conclusions

In selected patients with ACC LM, resection is associated with long-term survival and is, therefore, justified but rarely curative.     

Predictors for Microinvasion of Small Hepatocellular Carcinoma ≤2?cm

Background

Hepatocellular carcinoma (HCC) ??2?cm in diameter is considered to have a low potential for malignancy.

Methods

A retrospective review was undertaken of 149 patients with primary solitary HCC ??2?cm who underwent initial hepatic resection between 1994 and 2010. The independent predictors of the microinvasion (MI) such as portal venous, hepatic vein, or bile duct infiltration and/or intrahepatic metastasis were identified by multivariate analysis. Prognosis of patients with HCC ??2?cm accompanied by MI was compared to that of patients with HCC ??2?cm without MI.

Results

Forty-three patients with HCC ??2?cm had MI in patients (28.9%). Three independent predictors of the MI were revealed: invasive gross type (simple nodular type with extranodular growth or confluent multinodular type), des-??-carboxy prothrombin (DCP) >100?mAU/ml, and poorly differentiated. Disease-free survival rates of patients with HCC ??2?cm with MI (3?year 44%) were significantly worse than those for HCC ??2?cm without MI (3?year 72%). This disadvantage of disease-free survival rate of patients with HCC ??2?cm with MI could be dissolved by hepatic resection with a wide tumor margin of ??5?mm (P?=?0.04).

Conclusions

Even in cases of HCC ??2?cm, patients who are suspected of having invasive gross type tumors in preoperative imaging diagnosis or who have a high DCP level (>100?mAU/ml) are at risk for MI. Therefore, in such patients, hepatic resection with a wide tumor margin should be recommended.