Sarcomatoid carcinoma of the urinary bladder with a spontaneous perforation: a case report

A 65-year-old woman was referred to our clinic with gross hematuria. Cystoscopy revealed a non-papillary and non-pedunculated tumor on the left lateral wall of the bladder. A piece of necrotic tissue obtained from the bladder irrigation was histologically squamous cell carcinoma. A perforation at the left lateral wall of the bladder was found on the cystogram. Bone scintigraphy showed multiple metastases and computed tomography scans showed multiple lymph node metastases in the pelvic cavity. The clinical diagnosis was bladder carcinoma of T4N2M1 stage with an abscess due to a spontaneous perforation. Total cystectomy with bilateral ureterocutaneostomy was performed. She died due to sepsis 13 days after the operation. Histologically, the tumor was composed of carcinomatous and sarcomatous elements. The carcinomatous element was compatible with squamous cell carcinoma and the sarcomatous element was composed of undifferentiated malignant spindle cells. Immunohistochemical examination showed that the carcinomatous component was positive for keratin and human chorionic gonadotropin (HCG) and the spindle cell component positive for vimentin, desmin and HCG. Therefore, we diagnosed the tumor as sarcomatoid carcinoma. We reviewed 56 cases of carcinosarcoma of the bladder in Japan and discussed the clinicopathology of the disease.     

Three primary cancers of pulmonary cancer, malignant melanoma and esophageal cancer; report of a case

A 61-year-old man, who had medical history of hepatitis type C, surgery for malignant melanoma of the lower limb, endoscopic mucosal resection for esophageal cancer, was pointed out a pulmonary nodule in the right middle lobe by surveillance computed tomography after 5 years of surgery for melanoma. Pathology of esophageal cancer was squamous cell carcinoma limited in mucosa without lymphatic nor venous invasion. The nodule gradually enlarged and respiratory endoscopic examination could not establish pathological diagnosis. Thoracoscopy-assisted pulmonary biopsy revealed squamous cell carcinoma, and right middle lobectomy with mediastinal node dissection was performed. Histological examination showed moderately differentiated squamous cell carcinoma without lymph node involvement. The stage of lung cancer was T1N0M0, stage IA. Although 9 months have passed since surgery for lung cancer, recurrence of each malignancy has not been detected.     

Axillary Lymph Node Recurrence of Papillary Thyroid Microcarcinoma: Report of a Case

We report a case of axillary lymph node recurrence of thyroid papillary microcarcinoma (PMC) in a 51-year-old woman who had undergone thyroidectomy with lymph node dissection 5 years earlier. We performed residual thyroid resection with cervical and bilateral axillary lymph node dissection, and pathological examination revealed well-differentiated papillary carcinoma, with partial poor differentiation. Postoperative radioiodine therapy was ineffective, and the patient died of systemic dissemination of the recurrence 8 months after her second operation. The positive cell rates of proliferating cell nuclear antigen and Ki-67 were clearly higher in the recurrent lymph nodes than in the primary thyroid tumor, suggesting increased cell proliferation in the recurrent lymph nodes. Thyroid papillary carcinoma rarely recurs in the axillary lymph nodes, but its possibility must be kept in mind, especially in patients with remarkable cervical lymph node metastasis and those who undergo extensive lymph node dissection.     

Papillary carcinoma with extensive squamous metaplasia arising from thyroglossal duct cyst in an 11-year-old girl: significance of differentiation from squamous cell carcinoma: a case report

We report a case of papillary carcinoma (PC) with extensive squamous metaplasia arising from a thyroglossal duct cyst (TDC) that required differential diagnosis from squamous cell carcinoma (SCC). An 11-year-old Japanese girl presented with a 9-month history of an anterior-midline neck mass that was clinically diagnosed as TDC. Open neck biopsy revealed nested proliferation of atypical squamous cells within the cystic structures, and SCC arising from TDC was initially suspected. Further examination, however, including immunohistochemistry, revealed the tumor to be of thyroid cell origin. The patient underwent wide local resection of the thyroglossal duct carcinoma by Sistrunk procedure and cervical lymph node dissection. Microscopically, the diagnosis was of PC with extensive squamous metaplasia and metastasis to the medial submandibular lymph node. Distinction of squamous metaplasia in PC from SCC is sometimes difficult, but has a significant effect on postoperative management.     

Heterotopic Epithelium in an Intramammary Lymph Node

Abstract: Heterotopic squamous-lined cysts and ductal epithelium occurring in an intramammary lymph node from a 23-year-old woman are described. The lesion presented as a 3 cm × 2 cm well-circumscribed mass lying anterior to the left anterior axillary line. Careful examination of the breast revealed no other clinically apparent lesions. The nodule was thought to represent a benign neoplasm and excisional biopsy was performed. Pathologic examination revealed a lymph node whose architecture was distorted by multiple squamous-lined cysts. The squamous epithelium demonstrated a prominent granular cell layer. No evidence of nuclear atypia was found within the squamous lining. Only rare cases of epithelial inclusions within axillary lymph nodes have been described. The majority have been unrelated to a breast malignancy and have followed a benign clinical course. Because these inclusions may lead to significant axillary or intramammary lymphadenopathy, they may be mistaken clinically for metastatic carcinoma. Disclosure of intranodal epithelial deposits on pathologic examination may result in an incorrect diagnosis of metastatic disease. However, careful evaluation of the epithelial nests will establish their benign character. Benign epithelial deposits within intramammary and axillary lymph nodes must be added to the list of heterotopic benign epithelial structures found in lymph nodes.     

Autologus groin lymph node transfer for “sentinel lymph network” reconstruction after head-and-neck cancer resection and neck lymph node dissection: a case report

Local or distant metastatic recurrence after therapy is observed in 20–30% of cases of head-and-neck cancer. An unfavorable course may occur after cervical lymph node dissection due to loss of immunoprotective lymph nodes in the head-and-neck region. To overcome this problem, we performed autologous lymph node transplantation from the groin after head-and-neck cancer resection and cervical lymph node dissection. The patient was a 63-year-old man with squamous cell carcinoma in the mesopharyngeal lateral wall. After tumor resection and right cervical lymph node dissection, a lymph node-containing superficial circumflex iliac artery perforator flap was transplanted from the left groin. Pathological examination showed that cancer had invaded the primary tumor tissue stump. Thus, radiotherapy (66 Gy) was performed for the residual tumor from days 28 to 84 after surgery. At 12 months after surgery, no recurrent lesion or has developed. The biopsy of flap and lymphatic vessel endothelial hyaluronan receptor-1 (LYVE1) immunostaining shows creditable lymph network in the flap, compared with normal free flap. This case suggests that autologous lymph node transplantation may keep watch on cancer recurrence by reconstruction of the lymph node system in the resected region, and we suggest that this approach may be very useful in cancer therapy.     

Carcinoma of the urachus with variable pathological findings: report of a case and review of literature

A 71-year-old man was admitted with the chief complaint of gross hematuria. Cystoscopic examination showed a broadbased papillary tumor at the apex of the bladder. There was edema of the mucous membrane around the tumor. CT-scan demonstrated a mass extending from the bladder dome superiorly. Partial resection of the bladder was done. Pathological examination revealed grade 3 transitional cell carcinoma, with scattered adenocarcinoma and squamous cell carcinoma foci. Chemotherapy with bleomycin (BLM) and cis-dichlorodiamine platinum (CDDP) was done postoperatively. Ten months after the operation, he was readmitted because of recurrence in retroperitoneal lymph nodes. Chemotherapy with BLM and CDDP was done, but he died of pulmonary complications. Autopsy revealed retroperitoneal lymph node metastasis of transitional cell carcinoma. There was no metastasis to any other organ. We briefly discuss 275 cases of the carcinoma of the urachus collected from the Japanese literature.     

A case of spindle cell carcinoma of the penis

Spindle cell carcinoma of the penis is extremely rare. The present case report is the nineth case in the world literature. A 71-year-old man was referred to our institution for examination of a penile tumor that showed non-specific granuloma histopathologically. We performed biopsy and total tumor resection. The histopathological finding showed squamous cell carcinoma with spindle type cells constituting the majority of the tumor, and the switching over from squamous cell carcinoma to spindle cell carcinoma was clearly visible in the histopathological examination. Therefore, we diagnosed this as spindle cell carcinoma of penis and performed partial penectomy with inguinal lymph node dissection. Spindle cell carcinoma is an uncommon variant of squamous cell carcinoma. We report the histopathological findings including the data of p53 immunohistochemical study, and reviewed the eight previous reports of spindle cell carcinoma of the penis.     

Clear cell carcinoma of the lung

We present here in the case of a patient who underwent resection of clear cell carcinoma of the lung, a rare histological type. A screening test of the 71-yearold woman revealed a 2.0-cm lesion in S4 of the right lung with a diagnosis of bronchioloalveolar carcinoma before resection. Under the guidance of video-assisted thoracoscopy, right middle lobe resection and mediastinal lymph node dissection were performed. The histopathological examination showed clear, slightly acidophilic tumor cells rich in fine granular components proliferating in an alveolar fashion. Immunostaining was diagnostically useful, distinguishing clear cell carcinoma from lung metastasis of renal clear cell carcinoma or clear cell squamous cell carcinoma.     

Primary ureteral tumor in the residual ureter: a report of two cases]

Two cases of primary ureteral tumor in the residual ureter are reported. One was in a 40-year-old woman who had undergone simple nephrectomy for renal tuberculosis 6 years earlier. The other was in a 59-year-old man 11 years after ureterostomy for hydronephrosis. They presented with hematuria. Cystoscopic examination revealed a ureteral tumor out of the residual ureteral orifice. Computed tomographic scan showed a perivesical mass attached to the urinary bladder. It is useful for examination of ureteral stump's condition. We performed ureterectomy. The pathological study revealed the former high grade transitional cell carcinoma with squamous cell carcinoma and lymph nodes metastasis and the latter low grade transitional cell carcinoma. They have been free of disease for 5.5 years and 1.75 years, respectively. These cases are the nine and tenth reports of primary ureteral tumor of the ureteral stump in the Japanese literature.     

Pulmonary small cell carcinoma associated with sarcoid reactions: Report of a case

A 45-year-old male was admitted to our hospital for investigation of a nodular shadow in segment 5 of the right lung on a chest computed tomogram. A right middle lobectomy with mediastinal lymph node dissection was performed under a diagnosis of lung cancer, and histologic examination confirmed small cell carcinoma. There were sarcoid reactions in the resected lymph nodes and the lung parenchyma, but no signs of systemic sarcoidosis were evident. Sarcoid reactions are rarely observed in the regional lymph nodes draining malignant tumors. Moreover, while they are most common in squamous cell carcinoma of the lung, they extremely rare in small cell carcinoma. To our knowledge, this is only the third report of this unusual entity in the English and Japanese literature.     

食管癌肉瘤14例

依据食管癌肉瘤的临床,病理特点,探讨其可能的组织学来源。方法对１４例食管癌肉瘤病人的临床资料进行了回顾性研究。结果：食管癌肉瘤多为息肉样腔内生长,有细短蒂和食管壁相连,个别呈浸润生长。     

A case of squamous cell carcinoma of the thymus

A case of squamous cell carcinoma of the thymus was reported. A 60-year-old female was admitted because of swelling of left cervical and left axillary lymph nodes. Chest X-ray revealed left anterior mediastinal mass shadow. The histological examination on the excised left axillary lymph nodes revealed well differentiated squamous cell carcinoma. After radiotherapy, the operation was performed with median sternotomy and then the mediastinal tumor was diagnosed squamous cell carcinoma originated from the thymus. The postoperative course of the patient was unfavorable, though adjacent postoperative radiotherapy and chemotherapy. Compared with ordinary thymoma, squamous cell carcinoma of the thymus commonly metastasizes outside the thorax and has poor prognosis. In view of these differences, it should be separated histologically from ordinary thymoma.     

The surgical management of synchronous hepatocellular carcinoma and thoracic esophageal carcinoma

A 73-year-old man was hospitalized with pathologically documented hepatocellular carcinoma and cirrhosis, and a 5.0-cm tumor located in the left lobe was resected by a left lateral segmentectomy. At the same time, metastatic squamous cell carcinoma was identified by frozen section in a perigastric lymph node in the lesser omentum. Intraoperative endoscopy revealed a 1.0-cm erosive lesion in the thoracic esophagus that was subsequently found to be primary squamous cell carcinoma. Seven weeks later, a transthoracic subtotal esophagectomy with substernal, cervical esophagogastrostomy was performed. Twenty-two months after these resections there has been no recurrence of either the hepatocellular or esophageal carcinomas.     

Expression of heat shock protein 70 in grossly resected esophageal squamous cell carcinoma

BACKGROUND: The aim of the present study was to use immunohistochemical methods to clarify the clinical implication of heat shock protein (HSP) 70 expression in esophageal squamous cell carcinoma and to investigate the function of HSP70 as a chaperone for p53. METHODS: Seventy-one patients with esophageal squamous cell carcinoma were admitted in the present study. Expression of HSP70 was analyzed by immunohistochemistry and correlated with TNM classification, vessel invasion, p53 expression, and clinical outcome after operation. RESULTS: Overexpression of HSP70 was related to sex (p < 0.05), tumor configuration (p < 0.05), lymph node metastasis (p < 0.01), and lymphatic vessel invasion (p < 0.05). Expression of p53 and HSP70 were not correlated with each other (p = 0.824). Esophageal squamous cell carcinoma with HSP70 expression exhibited a significantly better prognosis compared with HSP70-negative esophageal squamous cell carcinoma in univariate analysis (p < 0.05), but no significance was found in multivariate analysis. CONCLUSIONS: We suggest that HSP70 expression might be of use to assess the progression, lymph node metastasis, and lymphatic vessel invasion of esophageal squamous cell carcinoma. Inasmuch as both lymph node metastasis and HSP70 expression are prognostic variables in esophageal squamous cell carcinoma, examination of HSP70 expression may be of use to assess clinical outcome after operation.     

Positron emission tomography (PET)-computed tomography (CT) suggesting small intestinal metastasis from lung cancer; report of a case

A 75-year-old man admitted to our hospital due to an abnormal X-ray shadow detected during an annual health check-up. Chest computed tomography (CT) revealed 3.0 cm solid nodules with chest wall invasion in the left lung. We could not get a definitive diagnosis by transbronchial lung biopsy or CT-guided needle biopsy. Positron emission tomography (PET)-CT revealed positive findings in the tumor, aortopulmonary window lymph node and splenic flexure. Under a diagnosis of suspected lung cancer, thoracotomy was performed. As intraoperative diagnosis revealed a moderately differentiated squamous cell carcinoma, the patient underwent a left upper lobectomy, mediastinal lymph node dissection, and combined chest wall resection. Pathological stage was T3N2M0, stage IIIA. Ten days after surgery, the patient suffered from ileus and emergent surgery was performed. Subsequent pathological examination revealed lung cancer metastasis in the small intestine.     

Supraomohyoid neck dissection with frozen section biopsy as a staging procedure in the clinically node-negative neck in carcinoma of the oral cavity

A retrospective analysis was performed to evaluate the efficacy of elective supraomohyoid neck dissection in 57 newly diagnosed patients with squamous cell carcinoma of the oral cavity. The protocol included sampling of both the most suspicious and the largest node in the jugulodigastric region (if present) and the most distal jugulo-omohyoid lymph node (if present) for frozen section examination. In 10 cases, frozen section biopsy revealed metastatic disease, and surgery was continued using standard or modified radical neck dissection en bloc with the primary tumor. In another 10 cases, histologic examination of the supraomohyoid neck dissection specimens revealed occult nodal disease at other sites. In the histologically proven absence of metastatic disease in the supraomohyoid neck dissection specimens, disease recurrence in the neck occurred in only three cases (7%), all in the presence of local failure. The results of our analysis support the conclusion that elective supraomohyoid neck dissection with frozen section biopsy appears to be a valid staging procedure and a valuable approach to the management of the clinically node-negative neck in squamous cell carcinoma of the oral cavity.     

CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值

目的探讨CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值。方法采用回顾性描述性研究方法。收集2009年10月至2016年12月2家医疗中心收治的628例(中山大学肿瘤防治中心236例、郑州大学附属肿瘤医院392例)胸段食管鳞癌病人的临床病理资料;男462例,女166例;中位年龄为62岁,年龄范围为38~85岁。观察指标:(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能。(3)最佳截断值确定。(4)不同诊断标准的检测情况。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。以受试者工作特征曲线(ROC)的曲线下面积(AUC)评估检测方法的效能。约登指数最大值对应最佳截断点。结果(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况:628例病人中,572例行二野淋巴结清扫,56例行三野淋巴结清扫;408例行微创手术,220例行开放手术。628例病人中,60例发生左侧喉返神经旁淋巴结转移。628例病人共清扫左侧喉返神经旁淋巴结1666枚,其中左侧喉返神经旁淋巴结转移75枚,转移率为4.502%(75/1666)。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能:CT检查左侧喉返神经旁淋巴结短径预测左侧喉返神经旁淋巴结转移的AUC为0.854(95%可信区间为0.792~0.916,P<0.05)。(3)最佳截断值的确定:分别以CT检查左侧喉返神经旁淋巴结短径为5、6、7、8、9、10 mm作为最佳截断值,其对应的约登指数分别为0.556、0.384、0.258、0.063、0.003。确定CT检查左侧喉返神经旁淋巴结短径5 mm为最佳截断值。(4)不同诊断标准的检测情况:分别以CT检查左侧喉返神经旁淋巴结短径≥5 mm和≥10 mm作为胸段食管鳞癌左侧喉返神经旁淋巴结转移的诊断标准,两者灵敏度、特异度、准确度、阳性预测值、阴性预测值、漏诊情况分别为66.3%和5.0%、92.3%和99.8%、89.5%和90.7%、46.3%和75.0%、96.0%和90.9%、20和57例。结论CT检查淋巴结短径可用于评估胸段食管鳞癌左侧喉返神经旁淋巴结转移。以淋巴结短径≥5 mm作为胸段食管鳞癌左侧喉返神经旁淋巴结转移标准时,灵敏度、特异度和准确度较好。     

Single primary lung cancer consisting of three cancer cell types (small cell carcinoma, adenocarcinoma, and squamous cell carcinoma) in which each had metastasized to different lymph nodes

We report a case of a 70-year-old male smoker with a single primary tumor 2.5 x 3.0 cm in size in the right lung lower lobe. A transbronchial lung biopsy revealed squamous cell carcinoma of the lung. We performed right lower lobectomy with lymph node dissection (ND2a). The resected specimen consisted of three different cell types; small cell carcinoma, adenocarcinoma and squamous cell carcinoma (in a ratio of 70: 20: 10). Each cancer cell types had metastasized to different lymph nodes. The final diagnosis was a combined small cell carcinoma in the lung. Combined small cell carcinoma is uncommon, but is nevertheless a well-described diagnostic category in lung cancers.     

Sarcomatoid Carcinoma of Penis with Bilateral Inguinal Metastases—A Case Report and Review of Literature

Sarcomatoid carcinoma or carcinosarcoma of the penis is a rare entity with 36 cases reported in the literature. A 61-year-old male presented with swelling in the glans and shaft of the penis with bilateral inguinal lymph node metastases. He underwent total penectomy with bilateral inguinal block dissection. Histopathology revealed sarcomatoid carcinoma of the Penis with bilateral inguinal lymph node metastases. The patient later developed bilateral lung metastases in 6 months and was succumbed to death. Sarcomatoid carcinoma or carcinosarcoma is a rare malignancy with poor prognosis.