Tumor-to-tumor metastasis: case report of a pulmonary adenocarcinoma metastatic to a clear cell renal cell carcinoma

Tumor-to-tumor metastasis is a very rare event. The recipient tumor may be benign or malignant. Renal cell carcinoma is the most common tumor recipient of metastasis while lung carcinoma is the most common donor tumor. We report a 57-year-old Caucasian male who presented with chest pain. On PET CT Scan, he was also found to have a large renal mass for which he underwent left nephrectomy. On histology of the renal mass, the tumor was a conventional renal cell carcinoma with areas of metastatic non-small cell lung carcinoma. The two components had a distinctive morphology which was confirmed on subsequent immunohistochemistry. The physiopathological mechanisms making clear cell renal cell carcinoma an avid recipient of a metastatic carcinoma have been speculated upon, but are still unknown.     

Tumor-to-tumor metastasis: lung adenocarcinoma metastasizing to a follicular variant of papillary thyroid carcinoma

Cancer-to-cancer metastasis into a thyroid neoplasm is an uncommon phenomenon with possible diagnostic difficulties. Here, we describe a case of lung adenocarcinoma metastatic into a follicular variant of papillary thyroid carcinoma (FVPTC). A 60-year-old woman with no prior history of malignant neoplasm presented with a nodule in the right lobe of the thyroid gland, some masses in the left lung were found by radiological examination. Histopathological examination of the thyroidectomy specimen demonstrated two different components of carcinoma in a single thyroid nodule; one was FVPTC and the other was high-grade adenocarcinoma. Although both components shared the TTF-1+/CK7+/CK19+/CK20-/SP-A- immunoprofile, only the former was positive for thyroglobulin, and only the latter was positive for CEA. The epidermal growth factor receptor (EGFR) gene mutation at exon21 (L858R) was present only in the latter. The lung biopsy specimen showed cytological, immunohistochemical, and EGFR genotypic features similar to those of the high-grade adenocarcinoma component of the thyroid nodule. These findings resulted in a reliable diagnosis of lung adenocarcinoma metastasizing into an FVPCT and treatment with EGFR-targeted therapy. These results demonstrate that a panel of immunohistochemical staining and molecular analysis is helpful for both diagnosis and appropriate postoperative treatment for a patient with cancer-to-cancer metastasis.     

Tumor-to-tumor metastasis: Hepatocellular carcinoma metastatic to parathyroid adenoma

Tumor‐to‐tumor metastasis is a rare, but well‐recognized phenomenon. Here, we report a unique case of hepatocellular carcinoma (HCC) metastatic to parathyroid adenoma. A 53‐year‐old‐man with a history of HCC presented with hypercalcemia. It was found that he also had hyperparathyroidism with a hypoechoic mass in the lower portion of the right thyroid gland area. The patient underwent parathyroidectomy, and a mass measuring 1.5 × 1.0 cm was detected. Microscopic and immunohistochemical examination disclosed parathyroid adenoma with a focus of metastatic HCC. For the patient, it was the only distant metastasis revealed until the last follow‐up. To the best of our knowledge, this is the first reported case of tumor‐to‐tumor metastasis in which HCC is the donor.     

Metastasis of lung adenosquamous carcinoma to meningioma: case report with literature review

The occurrence of metastasis of a systemic neoplasm to an intracranial tumor is a rare phenomenon. Meningiomas have been reported as the most common intracranial tumor to harbor a systemic metastasis, with breast and lung carcinomas being the most common sites of origination. Here, we report a case of an adenocarcinoma metastasis of an adenosquamous lung carcinoma found within a meningioma, resulting in the patient’s first clinical manifestations. We also review the literature for other cases of adenocarcinoma metastatic to a meningioma and suggest mechanisms that make meningiomas likely to harbor systemic metastases including increased vascularity, slow growth rate, increased hyaline content and expression of cell-cell adhesion molecules.     

Tumor-to-tumor metastasis to a thyroid follicular adenoma as the initial presentation of a colonic adenocarcinoma

The incidence of thyroid involvement by metastatic disease from distant organs ranges from an average of 3.1% in surgical series to 5.3% in autopsy series. However, the metastasis of one tumor into another (traditionally referred to as 'tumor-to-tumor metastasis') is distinctly uncommon. Typically, they are identified as new manifestations or necropsy findings of a known, pre-existing donor tumor. Herein is described the case of a 59-year-old woman whose thyroid nodule (a follicular adenoma) was resected and found to contain foci of a well-differentiated adenocarcinoma with a morphologic and immunohistochemical profile consistent with origination from the lower gastrointestinal tract. Subsequent diagnostic work-up revealed a sigmoid colon tumor with metastases to the liver. This is, to the authors' knowledge, the first reported example of a colon adenocarcinoma whose initial clinical manifestation was a metastasis to a thyroid neoplasm and only the third reported example of a colonic adenocarcinoma metastatic to a thyroid tumor. In a review of previously reported examples of tumor-to-tumor metastases involving a thyroid neoplasm as the recipient, the following features were present in the majority: (i) multifocality of the metastatic tumor aggregates; (ii) a total lack of, or only minimal amounts of reaction (desmoplastic, inflammatory or myxoid) of the recipient tumor to the metastatic deposits; and (iii) retention of the histopathologic characteristics of the donor tumor in the metastatic deposits. In general, strikingly divergent morphologic features in an otherwise typical thyroid neoplasm should elicit a differential diagnosis that takes into consideration the possibility of metastasis.     

Low grade intracranial meningioma presenting with pulmonary metastasis: Case report and literature review

Meningioma is a common neoplasm in the central nervous system. Even though most meningiomas tend to have a benign, indolent clinical course, metastasis can occur. We describe a case of a 59-year-old woman who presented with an incidental finding of multiple lung masses. The patient underwent a wedge lung excision, and a diagnosis of meningioma was rendered. Magnetic resonance imaging of the brain revealed an extra-axial mass with left transverse venous sinus involvement, supporting the diagnosis of metastatic meningioma to the lung. Metastatic meningioma can be a challenging diagnosis in a patient with no previous diagnosis of an intracranial lesion. Thus, it should be considered in the differential diagnosis when encountering a spindled cell proliferation with a whorled pattern and psammoma bodies. Positive immunohistochemical staining with epithelial membrane antigen (EMA) and vimentin may be helpful in achieving the diagnosis.     

Solitary bone metastasis in the tibia as a presenting sign of endometrial adenocarcinoma: a case report and the review of the literature

Background Metastasis to bone from endometrial adenocarcinoma is rare, when metastasises it usually locates in axial skeleton. Metastasis to extremities is extremely rare. Additionally the detection of the bone metastasis as a presenting feature is uncommon. In the present study we report the 10th cases of bone metastasis in the literature which located at tibial diaphysis and originated from endometrial adenocarcinoma as a presenting feature of the primary disease. Case Single tibial lesion was observed in a 70 years old woman. Biopsy confirmed metastatic adenocarcinoma of the unknown origin. We couldn’t find the primary origin with aggressive work-up. Tibial lesion regressed with radiotherapy. Endometrial adenocarcinoma is detected after the end of disease-free one year with the symptom of vaginal bleeding. After 47 months from initial tibial lesion and 35 months from gynaecologic operation, patient is still alive and disease free. Discussion Patients with endometrial adenocarcinoma presenting an isolated skeletal metastasis may exhibit an unusual group with a better prognosis. This study was presented as a poster exhibition at the 5th Meeting of Asia-Pasific Musculo Skeletal Tumour Society held between 23 and 25, April 2004, Izmir, Turkey.     

Molecular pathology of non-small cell lung cancer

Our increasing understanding of the molecular pathogenesis of non-small cell lung cancer (NSCLC), particularly adenocarcinomas, has opened the door to ‘personalised medicine’ and the advent of new therapeutic strategies. Over the last few years new drugs, or classes of drugs, have been licensed and entered clinical practice for use in advanced NSCLC. The activity of these drugs is dependent on the presence of specific molecular or protein changes in cancer cells which are usually identified using ‘companion diagnostic tests’ specifically designed for this purpose. Pathologists and Pathology Departments have had to forge new links with Clinical Scientists in order to facilitate these additional investigations on the, often limited, tissue obtained for diagnosis. This collaboration plays a critical role in providing the link that allows integration of the traditional morphological diagnosis with the results of these new ‘companion diagnostic’ tests to guide patient management.     

Metachronous metastasis from the right colon adenocarcinoma to the vulva: an unusual report and literature review

A 67-year-old woman who was presented to the gynecologist with a two-month history of heavy vaginal bleeding, after an excisional biopsy of vulvar mass, was diagnosed with the right colon adenocarcinoma metachronous metastasis to the vulva. Pathological examination preliminarily revealed by primary adenosquamous carcinoma of vulva. The original submitting pathologist and gynecologist were contacted to obtain the pathological and clinical information whenever possible, combining with a history of the right colon cancer, subsequently, which confirmed the diagnosis of vulvar metastatic adenocarcinoma. Distinguishing metastatic carcinoma from primary vulvar adenocarcinoma is crucial, since these carcinomas are different. Herein reports the second case of the right colon carcinoma presenting as a vulvar metastasis. This report also shows the differentiation, diagnosis and treatment of metastatic colon carcinoma and its metastatic route.     

神经影像信息数据库构建与数据处理策略探讨

目的：为解决目前神经科学所面临的海量数据及不同格式神经信息数据资源的整合分析问题，促进对神经系统结构和功能的了解，拟构建神经影像信息数据库：方法：采用数据库相关新技术，构建一个有关神经影像的专题文献信息数据库，然后在此基础L进行文献挖掘，最终绘制m脑功能、结构和神经网络图谱：结果：论述了神经影像信息数据库的设计理念，探讨了神经影像数据的获取、表征、分析、整合、管理、可视化和数据共享等技术、方法，以及神经影像数据处理中存在的主要问题。结论：基于现有的浪潮天梭TS10000集群系统，通过采用数据处理的新技术和新方法能够达到构建神经影像信息数据库的目的．     

ERBB2 kinase domain mutation in a gastric cancer metastasis

ERBB2 is a member of the epidermal growth factor receptor (EGFR) family. Recent studies revealed that the kinase domain of the ERBB2 gene was mutated in human cancers, including gastric cancer. Despite the importance of cancer metastasis in the pathogenesis of cancers, data on the ERBB2 kinase domain mutation in cancer metastasis are lacking. In this study, to explore the possibility that ERBB2 mutation is involved in the metastasis mechanism, we analyzed the kinase domain of ERBB2 for the detection of somatic mutations in 58 gastric adenocarcinomas with lymph node metastasis. We found one ERBB2 mutation, which was detected in the lymph node metastasis, but not in the primary tumor of the same patient. The ERBB2 mutation was a missense mutation which substituted an amino acid in exon 21 (V832I). We simultaneously analyzed the somatic mutations of EGFR, K-RAS, PIK3CA and BRAF genes in the sample with the ERBB2 mutation, and found that this metastatic carcinoma did not harbor any of the mutations. Our data suggest that ERBB2 kinase domain mutation occasionally occurs in metastatic gastric carcinoma and might play a role in the metastatic process of some gastric carcinomas.     

肾上皮样血管平滑肌脂肪瘤肺转移1例报告并文献复习

目的：探讨肾上皮样血管平滑肌脂肪瘤病理特点及生物学行为。方法：对1例低热患者行肺肿块穿刺活检,然后行HE染色和免疫组织化学染色。复习肾肿瘤病理切片并进行文献复习。结果：穿刺活检病理分析：密集分布的上皮样细胞,细胞体积大,呈圆形、多边形;异型明显;无血管平滑肌脂肪瘤结构;免疫组织化学：人黑色素瘤蛋白阳性,平滑肌肌动蛋白阳性,上皮膜抗原阴性。病理诊断：左肺上皮样血管平滑肌脂肪瘤;考虑来源于肾。结论：上皮样血管平滑肌脂肪瘤是一种有恶性潜能的间叶性肿瘤,可以发生远处转移。     

Cytological features of myxoid adrenocortical adenoma with a pseudoglandular component: a case report with differential diagnostic considerations

Myxoid adrenocortical tumors are extremely rare neoplasms with only nine adenomas and eleven carcinomas reported in the literature. They occasionally have a pseudoglandular component resembling metastatic mucinous adenocarcinoma in the adrenal gland. However the cytological features of this unusual tumor have not been previously described. We report here the first cytopathological study of a myxoid adrenocortical adenoma with a pseudoglandular component, contributing especially to the differential diagnosis from metastatic mucinous adenocarcinoma. Two major cytopathological features distinguishing myxoid adrenocortical adenoma from metastatic mucinous adenocarcinoma in the adrenal gland are: (1) the myxoid material is found only in the extracellular space, and not in the cytoplasm; and (2) nuclei are usually located in the central portion of the cytoplasm, and not compressed to the periphery. Careful observation of these cytological features and positive immunoreactivity to Melan A, alpha-inhibin and synaptophysin can lead to the correct diagnosis.     

Low-contact and high-interconnectivity pathology (LC&HI Path): post-COVID19-pandemic practice of pathology

The COVID-19 pandemic situation may be viewed as an opportunity to accelerate some of the ongoing transformations in modern pathology. This refers primarily to the digitalisation of the practice of tissue and cellular pathology diagnostics. However, it is also an opportunity to analyse the modus operandi of a discipline that has been practised in a similar manner for more than 100 years. The challenge is to define the next generation of interconnectivity tools that would be necessary to achieve a new operational model that, while ensuring low face-to-face interaction between the main players of the diagnostic pipeline, allows maximum interconnectivity to serve our patients and the immediate teaching and research needs associated with clinical tissue/cellular samples. This viewpoint aims to describe what this new paradigm, a low-contact and high-interconnectivity pathology (LC&HC Path) operation, may require in the near future.     

Antigen expression associated with lymph node metastasis in gastric adenocarcinomas

A total of 100 gastric adenocarcinomas, comprising 50 cases with lymph node metastasis and 50 cases without lymph node metastasis, were examined for immunohistochemical reactivity with the monoclonal antibody to urokinase-type plasminogen activator (u-PA), Le^x related 4C9 antigen, Jun, or to nucleobindin (Nuc). In tumors with lymph node metastasis, 41 (82%) were positive for u-PA and 28 (56%) were positive for Nuc. In tumors without lymph node metastasis, 26 (52%) were positive for u-PA and five (10%) were positive for Nuc. The percentage of cases positive for u-PA or Nuc was significantly higher in tumors with lymph node metastasis than that in tumors without lymph node metastasis ( P < 0.01). The expression of u-PA was found to be significantly correlated with that of Nuc ( P < 0.001), mode of infiltrative growth ( P < 0.05), depth of invasion ( P < 0.01), and grade of lymphatic invasion ( P < 0.01). However, the expression of Nuc was found to be significantly correlated with the expression of Jun ( P < 0.05), depth of invasion ( P < 0.01), and grade of lymphatic invasion ( P < 0.001). These results suggest that immunohistochemical examination for the expression of u-PA and Nuc in tumor cells may help evaluate the potential of adenocarcinomas of the stomach for lymph node metastasis.     

Intraparotid metastasis from lung adenocarcinoma diagnosed by FNAC—Report of a rare case

Metastasis to the parotid gland accounts for 10%‐16% of parotid malignancies. Head and neck malignancies constitute the major bulk of metastatic lesions to the parotid. The other common primaries include the breast, kidney, lung, and prostate. Metastasis from the lung to the parotid is a relatively rare occurrence whose exact percentage is not known. Though intralymphatic spread into the parotid is known, intraparenchymal spread through hematogenous route is rare. The presence of intraparenchymal spread of lung Adenocarcinoma to the contralateral parotid diagnosed on fine needle aspiration (FNA) makes it a case worth reporting, highlighting the utility of cell block preparation and immunohistochemistry for a precise and early diagnosis.     

Advantages of current fetal neuroimaging and genomic technologies in prenatal diagnosis: A clinical case

The diagnosis of prenatal microcephaly, as well as the possibility of underlining a genetic cause, is becoming more frequent thanks to advances in prenatal imaging and parallel massive sequencing. One case of primary microcephaly in three sibs demonstrates how complementary diagnostic exams can help to diagnose and establish the etiology.     

Functional neuroimaging of normal aging: Declining brain,adapting brain

Early functional neuroimaging research on normal aging brain has been dominated by the interest in cognitive decline. In this framework the age-related compensatory recruitment of prefrontal cortex, in terms of executive system or reduced lateralization, has been established. Further details on these compensatory mechanisms and the findings reflecting cognitive decline, however, remain the matter of intensive investigations. Studies in another framework where age-related neural alteration is considered adaptation to the environmental change are recently burgeoning and appear largely categorized into three domains. The age-related increase in activation of the sensorimotor network may reflect the alteration of the peripheral sensorimotor systems. The increased susceptibility of the network for the mental-state inference to the socioemotional significance may be explained by the age-related motivational shift due to the altered social perception. The age-related change in activation of the self-referential network may be relevant to the focused positive self-concept of elderly driven by a similar motivational shift. Across the domains, the concept of the self and internal model may provide the theoretical bases of this adaptation framework. These two frameworks complement each other to provide a comprehensive view of the normal aging brain.     

横纹肌样型脑膜瘤临床病理学分析

目的探讨横纹肌样型脑膜瘤（rhabdoid meningioma,RM）的临床病理特征。方法对4例RM进行病理形态学观察及免疫组化分析。结果4例发病年龄为11—40岁,平均27岁,3例为单纯型,1例为混合性。瘤细胞呈圆形、多边形,富含胞质呈嗜酸性或嗜中性,均见有胞质或核内假包涵体。瘤细胞呈弥漫性、腺泡状和乳头状排列。免疫组化均表达vimentin和EMA,而HMB45和MG均阴性,仅有1例GFAP呈小灶性阳性。结论RM的诊断应依据细胞学和组织结构的特征,辅以免疫组化分析。     

Understanding genes,environment and their interaction in attention-deficit hyperactivity disorder: is there a role for neuroimaging?

Attention-deficit hyperactivity disorder (ADHD) has an established heritable component, but identifying the genes involved has proven difficult. To date, the two most investigated risk genes in ADHD are the DRD4 and DAT1-genes. However, individual risk genes have only explained up to 1% of the variance in the phenotype, suggesting that they represent only relatively small risk factors for ADHD. As such, the role of environmental factors, gene–gene and gene–environment interactions are being investigated. However, studies have not always been able to address the neurobiological mechanisms by which environmental factors and interactions with genes exert their effect on the ADHD-phenotype. Neuroimaging is being used as a tool to investigate the neurobiological effects of individual risk genes. We suggest it could also be applied to investigate the mechanisms involved in environmental effects and interactions between genetic and environmental factors.