Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis

Transitional cell carcinoma (TCC) of the ovary is a recently recognized subtype of ovarian surface epithelial-stromal cancer, and studies of its morphology are few. As a result, the criteria for its diagnosis and spectrum of its morphology are not clearly established. One hundred consecutive consultation cases of ovarian carcinoma with a pure or partial transitional cell pattern (excluding malignant Brenner tumor) diagnosed between 1989 and 2001 were evaluated for the frequency of various pathologic features and the relation of TCC to other surface epithelial-stromal carcinomas. The women were 33 to 94 years of age (mean, 56 years). A total of 47 tumors were stage I, 21 stage II, 31 stage III, and 1 stage IV; 13% of the stage I tumors and 41% of tumors of all stages were bilateral. The tumors ranged from 3.0 to 30 cm in greatest dimension (mean, 10 cm); 60% of them were solid and cystic, 24% solid, and 16% cystic. TCC was the exclusive or predominant component in 93% of the tumors and showed undulating (93%), diffuse (57%), insular (55%), and trabecular (43%) patterns. In four tumors with an insular growth, the pattern focally mimicked a Brenner tumor. Necrosis was present in 57% of the cases. Features that were seen in the tumors that in aggregate produced a relatively consistent appearance were "punched out" microspaces (87%), often the size of Call-Exner bodies, large cystic spaces (73%), and large blunt papillae (63%). Features that were sometimes seen, usually as a focal finding, included slit-like fenestrations (49%), bizarre giant cells (35%), small filiform papillae (18%), gland-like tubules (17%), squamous differentiation (13%), and psammoma bodies (4%). In 23 cases, TCC was a component of a mixed epithelial carcinoma, the additional components being serous adenocarcinoma in 16, endometrioid in 5, mucinous in 1, and clear cell carcinoma in 1. The tumor cells of the TCC component often were relatively monomorphic; 6% of the tumors were grade 1, 43% grade 2, and 51% grade 3. The nuclei were oblong or round and often had large single nucleoli (69%) or longitudinal grooves (48%). The cytoplasm was typically pale and granular but was rarely strikingly clear or oxyphilic. TCC of the ovary usually occurs in pure form but is also common as a component of a surface epithelial carcinoma of mixed cell type. In either situation, TCC has a constellation of architectural and cytologic features that readily distinguish it in most cases from other types of ovarian cancer. Recognition of these features will lead to a more consistent diagnosis of this tumor and aid in determining whether it has distinctive clinical features, particularly with regard to its behavior.     

Lung abscess revisited. A survey of 184 cases.

One hundred eighty-four patients with lung abscess, admitted to the Hospital of the University of Mississippi between 1960 and 1982, were studied with respect to sex (149 men and 35 women), age (mainly fourth to sixth decades), location of abscess(es) (RLL, RUL, and LLL mainly), predisposing factors (aspiration in sensorium disorders, obstruction, gingivo-dental suppuration, immunoincompetence) and nonoperative (89%) and operative (11%) therapy, usually lobectomy. Data from the different decades were compared, but there were few major differences. Mortality rate was 22% in the 1960s, 25% in the 1970s, and 28% in 1980-1982. Major management problems involved massive pulmonary hemorrhage, impaired immune defenses, old-age debility, bronchopleural fistula with empyema, or very large cavity. Anaerobic bacteria predominate and penicillin is the treatment of choice. Incidence of operation is declining, but cases are more often complicated. Prognosis is good in the uncomplicated case.     

Surgery for combined type small cell lung carcinoma

BACKGROUND—Combined type small cell lung cancer (SCLC) has been reported to occur in, at most, 1% of all cases of SCLC. These tumours consist of SCLC with a component of squamous cell carcinoma and/or adenocarcinoma. The survival of patients with combined and pure SCLC after surgical resection was assessed.
METHODS—From 1977 to 1994 2115 patients with bronchogenic carcinoma underwent pulmonary resection. From this group 26 patients (1.2%) were diagnosed as having combined SCLC and 74 patients (3.5%) as having pure SCLC.
RESULTS—From the 26 patients with combined SCLC (mean age 66.4 years) three were classified as pT1N0M0, eight as pT2N0M0, four as postoperative stage II, and 11 as postoperative stage III. Histological examination showed a component of squamous cell carcinoma in 21patients. There were 18 (69%) lobectomies, seven (27%) pneumonectomies, and one (4%) segmentectomy. In all patients surgery was thought to be curative. Overall hospital mortality was 4% (n = 1). Cumulative five year survival was 31% for all hospital survivors with combined SCLC postoperative stage I, 50% for those with pT1N0M0, and 25% for those with pT2N0M0 disease. No patients with postoperative stage II and III disease survived for five years. In the 74 patients with pure SCLC hospital mortality was 3% (n = 2); cumulative five year survival was 39% in patients with postoperative stage I disease, 46% for those with pT1N0M0 and 35% for those with pT2N0M0. When compared with pure SCLC, no significant differences in five year survival were evident in patients with postoperative stage I disease.
CONCLUSIONS—Surgical resection in patients with combined SCLC postoperative stage I yields a cumulative five year survival of 31% while for those with stage II and III disease there were no survivors at five years. In patients with stage I combined or pure SCLC surgery can offer a long term disease free interval or may even be curative.

     

胃小细胞癌六例并文献复习

目的 探讨胃小细胞癌的诊断及治疗方法,以提高诊疗水平.方法 总结1997至2007年间收治的6例胃小细胞癌的临床及病理资料,并复习分析国内外报道的胃小细胞癌的临床资料.结果 本组6例患者均为男性,平均年龄56.5岁(40～66岁);肿瘤位于贲门3例,胃底2例,胃体1例;溃疡型5例,隆起型1例;6例均行手术治疗,其中4例接受术后化疗.本组2例获得随访,1例术后4年仍生存无复发,1例于术后9个月因广泛复发转移死亡.胃小细胞癌国内外报道共223例,男164例,女59例;平均年龄64.2岁(42～84岁);肿痛位于贲门及胃底97例,胃体55例,胃窦54例;大体分型溃疡型137例,隆起型47例;肿瘤直径平均6.23 cm(0.8～17.0 cm).生存时间超过1年者43例,仅占19.3%.结论 胃小细胞癌术前、术中常不易确诊,手术范嗣可同胃癌而淋巴结清扫的范围可适当简化,术后采用针对肺小细胞癌的化疗方案可能有助于提高疗效.     

Incidentally detected renal cell carcinoma: report of two early small cases

We report two cases of small renal cell carcinoma, which were incidentally detected by abdominal computed tomography (CT) and ultrasound. Both tumors were less than 15 mm in diameter and low grade, stage I lesions. Incidentally found renal cancer does not always indicate better prognosis. However, in selected patients with small tumors, surgical enucleation may be an acceptable method of treatment even if the contralateral kidney is normal. Renal screening should be a routine part of abdominal ultrasound. In our institution, ultrasound revealed incidental renal cancer in 0.035% of non-urologic patients.     

Primary ovarian small cell carcinoma of pulmonary type. A clinicopathologic, immunohistologic, and flow cytometric analysis of 11 cases.

Eleven primary ovarian tumors that resembled small cell carcinoma of the lung are reported. They occurred in women 28-85 (mean 59) years of age, most of whom presented with abdominal swelling. Six of the tumors were unilateral and five bilateral; seven had spread beyond the ovary. The tumors ranged from 4.5 to 26 (mean 13.5) cm in greatest dimension and were mostly solid, with a variable minor cystic component. Microscopic examination showed small to medium-sized round to spindle-shaped cells with scanty cytoplasm, hyperchromatic nuclei, and inconspicuous nucleoli growing in sheets, closely packed nests, and occasionally islands and trabeculae. A component of endometrioid carcinoma was present in four tumors, another tumor showed squamous differentiation, another contained a cyst lined by atypical mucinous cells, and two others were associated with a Brenner tumor. Argyrophil granules were present focally in two of six tumors appropriately stained. Immunohistochemical staining was performed in nine cases: in six there was staining of the small cell component for keratin, in five for epithelial membrane antigen, in seven for neuron-specific enolase, in two for chromogranin, and in one for Leu-7. Vimentin staining was not observed. Flow cytometry was performed on eight tumors: five were aneuploid and three diploid. Five of seven patients with long-term follow-up died of, or with, disease at 1-13 (mean 8) months, one died after an unknown interval, and one was alive at 7.5 years. Two other patients had recurrent or residual disease at 6 and 8 months.     

胆囊小细胞癌五例报告

目的 总结胆囊小细胞癌(gallbladder small cell carcinoma,GSCC)的临床病理特点,探讨其诊断及治疗方法.方法 回顾性分析中国医学科学院肿瘤医院2000-2012年收治的5例GSCC患者的临床及病理资料.结果 5例患者中男1例,女4例,初次就诊年龄在42 ～ 67岁(中位年龄57岁),均以非典型的右上腹疼痛、不适为初始主诉;肿瘤位于胆囊底部3例,胆囊体部2例;4例患者伴有胆石症.2例行根治性胆囊切除术,术后辅以EP(依托泊苷+顺铂)方案化疗6个周期,1例行放射治疗1次,2例患者分别随访至术后45和32个月,生存良好;3例行姑息性胆囊切除术,术后行辅助性化放疗,分别于术后8、11及30个月死于肿瘤广泛播散转移.结论 GSCC为临床少见的恶性肿瘤,初期症状不典型,确诊率低,病情进展迅速且预后相对较差;肿瘤根治切除可以显著延长患者的生存期,以手术为主的综合治疗仍是GSCC的主要治疗手段.     

A combined small cell carcinoma of the lung containing three components: small cell, spindle cell and squamous cell carcinoma.

A 61-year-old man was referred to our hospital because of rapid growth of a mass shadow revealed by chest radiography. The mass was diagnosed as pure small cell carcinoma by CT-guided needle biopsy, and the patient underwent chemotherapy. However, as the tumor showed no response, we considered the possibility of some other form of malignancy and performed surgery. Postoperatively, the mass was diagnosed as small cell carcinoma combined with small cell, spindle cell and squamous cell carcinoma. We report this case in view of the rarity of this combination of morphologic patterns in a primary bronchogenic carcinoma.     

Thymic small cell carcinoma associated with pulmonary squamous cell carcinoma

A 63-year-old man presented with dyspnea on effort. Chest computed tomography showed an anterior mediastinal mass and a lung mass in the right lower lobe. Thallium scintigraphy revealed accumulation in the mediastinal mass. Therefore, under diagnosis of invasive thymoma or thymic carcinoma associated with suspected lung cancer, exploratory right thoracotomy was undertaken through a median sternotomy with video-assisted thoracoscopic support. The lung mass was intraoperatively diagnosed as squamous cell carcinoma. Right lower lobectomy and total thymectomy were then carried out without additional incision. Thymic small cell carcinoma was diagnosed; therefore the patient received 50 Gy of irradiation to the mediastinum. Ten months after surgery the patient is alive without recurrence.     

Three cases of small cell carcinoma of the urinary bladder: a case report

We report three cases of small cell carcinoma of the urinary bladder. Case 1: A 69-year-old man showed microscopic hematuria during follow up of prostate cancer of stage D2. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0. Complete remission was achieved by three courses of chemotherapy consisting of irinotecan and carboplatin. The patient was died by prostate cancer 16 months after the chemotherapy. Case 2: An 83-year-old woman presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0 and partial cystectomy was performed. The patient has been alive without any evidence of tumor recurrence at 6 months after surgery. Case 3: An 84-year-old man presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage ofcT3bN0M1 with multiple liver metastases. Complete remission was achieved by three courses of chemotherapy consisting of etoposide and carboplatin.     

Metastatic small intestinal tumor associated with transitional cell carcinoma: a report of 2 cases and review of cases in Japan

Transitional cell carcinoma (TCC) frequently metastasizes to lymph nodes, liver, lungs and bone. However, metastasis to the gastrointestinal tract is rare. We report two cases of bladder tumor which metastasized to the ileum. According to the literature, these are the 7th and 8th cases in Japan. Case 1: A 87-year-old man had a history of bladder tumor (TCC, grade 3, pT2bN0M0) and has transurethral resection of bladder tumor (TUR-BT) three times. Two months after the last TUR-BT, he was admitted with ileus. As computed tomography (CT) showed abdominal free air, our diagnosis was perforation of gastrointestinal tract. The patient received an operation which resected partial ileum. We found the elastic hard tumor in the ileum on the perforated lesion, which showed metastatic TCC in the ileum pathologicaly. Case 2 : A 53-year-old man visited our hospital with gross hematuria. Cystoscopy showed a non-papillary broad based tumor in the right wall of the bladder. CT showed a bladder tumor invaded into the prostate (pT4aN1M0), we performed total cyctectomy and ileal conduit after neo-adjuvant chemotherapy. During the operation, we found the tumor (2 cm in diameter) in the small intestine which was metastasized of bladder tumor.     

Surgical treatment for small cell carcinoma of the lung. Report of 102 cases]

One hundred and two patients with small cell carcinoma of the lung were operated on from June 1965 to December 1990. The five-year survival rate of the patients who underwent resection only was 9.4% (5/53). The five-year survival rate of those who received operation, chemotherapy and radiotherapy was 25.0% (1/4). There was a remarkable difference between the two groups (P < 0.01). Operation with adjuvant chemotherapy or radiotherapy is the first choice of treatment in patients with small cell carcinoma of the lung. Stage I and stage II cases should be considered as Operative candidates. Chemotherapy should be given before and after operation. Postoperative radiotherapy Should be given to the patients with residual Cancer.     

Prostate small cell carcinoma: report of two cases that differed in treatment responsiveness

Case 1 : A 76-year-old man with a chief complaint of dysuria had an elevated prostate specific antigen (PSA) level of 24.9. He underwent a transperineal needle biopsy of the prostate, and the histopathological diagnosis was prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1 with multiple lung metastases. He started receiving hormonal therapy. After three months of hormonal therapy, the multiple lung metastases disappeared. Thereafter, the serum PSA level and the tumor volume increased and he died 12 months from the start of therapy. Case 2: A 79-year-old man was referred to our hospital with a chief complaint of dysuria. The serum level of PSA was elevated to 10.4. Transperineal prostate biopsy revealed prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1, and hormonal therapy was started. Subsequently, although his serum PSA level declined, his condition worsened rapidly and he died five months after the start of therapy.     

A survey on incidental renal cell carcinoma in Japan.

A survey of renal cell carcinoma detected incidentally (incidental renal cancer) in 116 collaborating institutions was conducted nationwide in Japan between 1980 and 1988. The analysis of 1,428 cases demonstrated a dramatic increase in the frequency of incidental renal cancer from 20 cases in 1980 to 338 cases in 1988. Detection occurred at routine health examinations in 32.8% of the cases and during examinations for unrelated diseases in the remainder. The chief method of detection was ultrasonography (68.2%), followed by computerized tomography (21.8%) and excretory urography (6.4%). Tumor extension was within the renal capsule in 76.5% of the cases and the mean tumor diameter was 5.4 cm. The 5-year survival rate was 76.5% but it was better in cases detected by ultrasonography compared with other methods. These results were compatible with previous reports and suggest that incidental renal cancer detection may improve the prognosis of renal cancer as a whole.     

Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome

Summary An experience with 25 consecutive cases of craniocervical junction (CCJ) malformations operated upon via the transoral route is reported. Twenty-two patients also underwent posterior occipitocervical stabilization with alloplastic material and in only one patient was transoral odontoidectomy and fusion with bone autograph performed.Indication for the transoral route consisted of an irreducible ventral compression of the cervicobulbar junction by the abnormal bone complex.Two patients died during the early postoperative period and the remaining 23 survivors were followed for an average of 3.5 years: 17 of these showed marked improvement and 5 a stabilization of the neurological disturbances. A further patient, who refused posterior stabilization, eventually died because of progressive cranial settling.Long-term results have shown this approach to be decisive in the surgical management of well-selected CCJ anomalies.     

Metastatic carcinoma to the testis: a clinicopathologic analysis of 26 nonincidental cases with emphasis on deceptive features

Metastatic carcinomas to the testis may simulate primary testicular neoplasms, even in patients with known extratesticular primaries, but information on this topic is limited. We therefore reviewed our experience with 26 cases from consultation (N=23) or hospital (N=3) files; none of the cases were from autopsy material or incidentally discovered in therapeutic orchiectomies from patients with prostate cancer. The tumors occurred in men 29 to 90 years old, with the prostate the most common primary site (N=11), followed by the renal parenchyma (N=4), colon (N=4), urinary tract (N=3), lung (N=2), esophagus (N=1), and, most probably, small intestine (carcinoid, N=1). Noteworthy findings included: the frequent absence of a known primary tumor (62%), the rarity of bilateral involvement (8%), the occasional lack of a distinct mass on gross examination (15%), the infrequency of multinodularity either grossly (8%) or microscopically (35%), the prominence of intertubular growth (42%), conspicuous intrarete or intratubular growth in some cases (especially prostate carcinoma) (19%), prominent cytoplasmic vacuoles in occasional cases (15%), and the frequent presence of lymphatic involvement (69%). Four tumors (3 prostate, 1 renal) with prominent intrarete and/or intratubular growth had submitting diagnoses of either a primary rete neoplasm or seminoma. Four tumors (2 prostate, 1 renal, and 1 bladder) with prominently vacuolated pale cells simulated Sertoli cell tumor. We conclude that, if autopsy cases and incidental tumors in therapeutic orchiectomy specimens are excluded, metastatic carcinomas to the testis are usually solitary, unilateral tumors that may simulate primary neoplasms, including rete adenocarcinoma and Sertoli cell tumor. Despite the rarity of documented cases in the literature, the bladder and renal pelvis should not be overlooked as possible sources for testicular metastasis. The pathologist must have a high index of suspicion for the possibility of a metastatic carcinoma to the testis for any testicular tumor where the routine light microscopic or immunohistochemical findings are unusual for a primary neoplasm. Clues to the likely primary site can usually be gleaned from the pathologic findings.     

Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy.

From 1975 through 1988, 257 patients with carcinoma of the thoracic esophagus have been treated in our department. Operability was 90% (232/257); overall resectability, 77% (198/257), and for the operated group, 85% (198/232). Hospital mortality rate was 9.6% but decreased to 3% over the period 1986 to 1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. Tumor, nodes, and metastases (pTNM) staging was as follows: stage I, 11.6%; stage II, 23.2%; stage III, 37.9%; stage IV, 27.3%. Overall survival rate was 62.5% at 1 year, 42.4% at 2 years, and 30% at 5 years. According to the pTNM staging, 5-year survival was 90% for stage I, 56% for stage II, 15.3% for stage III, and 0 for stage IV. There were no statistically significant differences according to tumor localization, pathologic type, sex, or age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in patients in whom an operation with curative intention was performed, the 1 year survival rate being 90.8% versus 72%; 2-year survival, 81% versus 46%; and 5-year survival, 48.5% versus 41% for radical and nonradical resections, respectively. Based on multivariate Cox regression analysis, only TNM stage and presence or absence of lymph nodes are important factors in predicting survival: stage 1 tumors have lower risk, and involvement of lymph nodes creates higher risk. Using this analysis, there was only for the patients with involved lymph nodes (N1) a significantly better prognosis when a radical lymph node dissection was performed (p = 0.0055). Barrett adenocarcinomas have no worse prognosis than other esophageal carcinomas, with a 5-year survival rate of 91.5% if lymph nodes are negative, and a 54% overall 5-year survival rate. Functional results after restoration of continuity with gastric tubulation were judged excellent to very good in 86.5% at 1 year, but infra-aortic anastomoses have a much higher incidence of peptic esophagitis: 53% versus 8% for cervical anastomoses. From this study it can be concluded that in experienced hands surgery today offers the best chances for optimal staging, potential cure, and prolonged high-quality palliation.     

Treatment of oesophageal small cell carcinoma by combined chemotherapy and surgical resection: report of two cases and review of published cases.

Two patients with primary small cell carcinoma of the oesophagus were treated by multidrug chemotherapy followed by surgical resection. A partial response to chemotherapy was observed in both patients.     

Renal cell carcinoma: oncocyte type

A case of oncocyte-type renal cell carcinoma was reported. The tumor had developed from the upper posterior portion of the left kidney and was well circumscribed. However, the tumor showed expansion into the intraparenchymal space, invasive growth, and venous invasion. Marked cell atypia was not observed.