Papillary adenocarcinoma in thyroid hemiagenesis.

Variation in the gross anatomy of the thyroid gland is relatively common. Although thyroid hemiagenesis is felt to be a rare anomaly, its incidence is probably underestimated as the diagnosis is usually incidental. The case of a 41-year-old woman with right thyroid hemiagenesis associated with papillary adenocarcinoma is presented. The diagnosis of hemiagenesis was established by isotope imaging and surgical exploration for a benign nodule. Seven years later she was seen with a recurrent neck mass, and an isotope scan revealed it to be a cold thyroid nodule. As she was diagnosed to have papillary adenocarcinoma, total thyroid lobectomy was performed and at present she remains disease-free.     

Malignant fat-forming solitary fibrous tumor (so-called "lipomatous hemangiopericytoma"): clinicopathologic analysis of 14 cases

Fat-forming solitary fibrous tumor is a rare variant of solitary fibrous tumor (SFT). Generally regarded as benign, very few fat-forming SFTs with malignant histologic features have been reported. Here, we report 14 histologically malignant fat-forming SFTs to better characterize this subset. Seven patients were female and 7 were male, with ages ranging 20 to 93 years (median, 57 y). Five tumors were located in the lower limb, 3 in the trunk, 3 in abdominopelvic locations, 2 in the head and neck region, and 1 in the upper limb. The tumor size ranged from 3.4 to 20 cm (median, 8.6 cm). Histologically, all exhibited at least focal hypercellularity; 12 tumors had mitoses >4/10 high-power fields (range, 2 to 37; median, 8), 12 showed at least moderate atypia, and 8 showed necrosis. It should be noted that 7 tumors contained only mature adipose tissue, whereas 5 contained multivacuolated lipoblasts and 2 had areas resembling atypical lipomatous tumor (ALT). Immunohistochemically, CD34 and CD99 were positive in most cases (11 of 14 and 8 of 10, respectively); MDM2 and CDK4 were both negative in all 4 cases tested (including both tumors with ALT-like areas). Follow-up data from 10 cases (median duration, 47.5 mo; range, 5 to 76) showed 2 patients with multiple metastases (both to lung and bones, and 1 each to breast and to soft tissue), both of whom died of disease. In conclusion, fat-forming SFTs exhibiting malignant histologic features have potential for aggressive behavior. The presence of lipoblasts and/or ALT-like areas, although described in some "benign" examples of fat-forming SFT, seems much more common in the malignant subset and may prompt a careful search for morphologic evidence of malignancy in any case of fat-forming SFT.     

Papillary adenocarcinoma of ureter

A well-differentiated papillary adenocarcinoma developed in a ureteral stump thirty-six years after nephrectomy and was associated with a combined transitional-epidermoid carcinoma in the urinary bladder. Carcinoma in a ureteral stump is not uncommon and should be suspected in patients with a ureteral stump and hematuria. The very rare adenocarcinoma of the ureter is typically papillary and is associated with urinary tract infection and stones. At present successful treatment requires the early identification and extirpation of the ureteral tumor and consideration of associated cancer elsewhere in the urinary tract.     

甲状腺乳头状微小癌的诊治分析

目的探讨甲状腺乳头状微小癌的临床特征、诊断及治疗方式。方法回顾性分析1985～ 2 0 0 2年间我院收治并经病理证实的甲状腺乳头状微小癌 89例患者的临床资料。结果随访 89例 ,时间 5～ 196个月 ,平均 6 8 9个月。复发 5例 ,无死亡 ,未发现远处转移。因甲状腺良性病变手术而发现微小癌 38例 ,另 5 1例术前怀疑为癌 ,经活检发现微小癌。颈部淋巴结转移 4 0例 ,最多发生在颈深上、中组和气管食管沟组淋巴结。腺叶多发结节转移的发生率显著高于单发结节。不同大小的原发肿瘤 (≤ 5mm ;>5mm)在颈部淋巴结转移的发生率其差异有显著性。是否可触及肿大淋巴结对局部复发率的影响差异有显著性。结论术前触诊、B超检查、术中探查及冰冻组织切片对提高甲状腺乳头状微小癌的诊断非常重要。根据病情选择不同的切除范围 ,疗效是同样的。建议区分两类甲状腺乳头状微小癌 :一类良性进展 ,应以保守性手术为主 ;另一类侵袭性进展 ,有不良预后 ,应行积极的手术方式。     

Papillary adenocarcinoma of the subvesical duct

This is, to our knowledge, the first report of papillary adenocarcinoma originating in the subvesical bile duct. A 77-year-old man was referred to our hospital for further evaluation of liver dysfunction. Serum liver function test results on admission included: aspartate aminotransferase, 99 IU/l; alanine aminotransferase, 149 IU/l; lactate dehydrogenase, 438 IU/l; alkaline phosphatase, 992 IU/l; leucine aminopeptidase, 320 IU/l; and gamma-glutamyl transpeptidase, 593 IU/l. Serum carbohydrate antigen (CA) 19-9 value was high (80 U/ml). Abdominal ultrasonogram, computed tomographic scan, and percutaneous transhepatic cholangiogram demonstrated a mass in the common hepatic duct, and dilatation of the intrahepatic bile ducts. A laparotomy was performed on May 14, 1997. The tumor originated in the dilated subvesical duct that joined the common hepatic duct, and projected into the common hepatic duct. The patient underwent cholecystectomy, resection of the subvesical duct and the common hepatic duct, dissection of regional pericholedochal lymph nodes, and Roux-en-Y hepaticojejunostomy. The resected tumor presented macroscopically as a papillary mass measuring 4.0 × 2.0 cm. The pathological diagnosis was papillary adenocarcinoma. The immunostaining positivity rates for MIB-1 and p53 protein were 49.6% and 33.8%, respectively. Received: March 21, 2001 / Accepted: August 1, 2001     

Papillary adenocarcinoma of the prostatic urethra

Three cases of papillary carcinoma of the prostate (also called endometrial adenocarcinoma of the prostate; endometrioid carcinoma) were studied for prostate-specific antigen in order to determine their origin and histogenesis. All 3 cases were prostate-specific antigen positive. Two patients were treated with hormonal therapy, 1 with radiotherapy.     

Papillary adenocarcinoma of prostate.

Papillary adenocarcinomas of the prostate are rare tumors which may arise from the prostatic ducts and the utricle; 2 cases are described. The diagnosis of these tumors is best established by cystourethroscopy and transurethral resection. The more common prostatic acinar adenocarcinoma is frequently associated with these tumors. The histopathologic recognition of papillary adenocarcinoma of the prostate and its differentiation from acinar adenocarcinoma is important since the natural history and response to treatment may be different.     

Papillary carcinoma arising from thyroglossal duct cyst with thyroid and lateral neck metastasis

INTRODUCTIONThyroglossal duct carcinomas (TGDC) are rare, with approximately 274 reported cases since the first report in 1915. The prevalence of carcinomas in surgically removed thyroglossal duct cyst (TGD) is less than 1%. The usual recommended treatment for this condition is the Sistrunk operation, but controversies remain regarding the need for total or partial thyroidectomy.PRESENTATION OF CASEA 28-year-old woman was admitted to our hospital with the symptoms of painless midline neck swelling and growing mass. A preoperative computed tomography (CT) showed a 4 cm sized heterogeneous mass at the infrahyoid anterior neck. Ultrasonography of the neck additionally showed suspicious metastatic lymph node at right level VI, both level VI. The patient underwent a Sistrunk operation. The frozen section revealed papillary carcinoma arising from TGDC and also revealed metastatic papillary carcinoma in the right thyroid, at right level III and level VI. Total thyroidectomy, right modified radical neck dissection and central neck dissection were performed. The thyroid gland and TGD were confirmed papillary carcinoma. The dissected neck lymph nodes revealed metastatic papillary carcinoma.DISCUSSIONThe usual recommended treatment for TGD is the Sistrunk procedure. There is controversy regarding whether total or partial thyroidectomy should be performed.CONCLUSIONPhysicians should be aware of extended operation, including thyroidectomy and/or neck node dissection for TGDC with metastatic lesion of thyroid and neck node.     

Ductal ("endometrioid") adenocarcinoma of the prostate

Ductal ("endometrioid") adenocarcinoma of the prostate is a rare variant of prostatic carcinoma which may have a different clinical presentation than the more common acinar adenocarcinoma. Ductal adenocarcinoma usually involves the urethra and the large periurethral prostatic ducts with direct spread through the more peripheral ductal system. Centrally located tumours have a much better prognosis than tumours involving the deep prostatic parenchyma. Local recurrence rate is high and five-year survival rate is as low as 24% for adenocarcinomas that have spread to the peripheral prostatic ducts. Although there have been some doubts about the role of hormonal therapy in ductal ("endometrioid") adenocarcinoma of the prostate, it is now agreed that therapeutic regimens should not be different from those offered to patients with conventional acinar adenocarcinoma.     

Papillary adenocarcinoma of the common bile duct

Five patients with papillary adenocarcinoma of the common bile duct (CBD) are described. These are rare tumors and make up 5% of all malignant tumors of the biliary tract. The symptoms and signs at the time of initial diagnosis resemble benign obstructive lesions of the bile ducts. The tumor is soft, less invasive to adjacent tissues and tends to grow into the lumen. The early onset of the symptoms results in early intervention, with a better prognosis. Two of our patients are doing well after two and four years, where as three others were readmitted with recurrent disease.     

Papillary carcinoma of the thyroid gland

Papillary thyroid cancer is after ovarian cancer the most frequent malignant disease of the endocrine system and because of this fact, early detection and appropriate surgical treatment is essential. Radical surgical treatment lower the risk of the disease relapse and postoperative adjuvant therapy with radioiodine is possible as well as postoperative follow up with thyreoglobulin measurement. If the total thyroidectomy is performed in highly specialized institution the risk of postoperative complications is acceptable and therefore is the treatment of choice for papillary thyroid cancer. Only the patients with occult papillary thyroid cancer can be treated with hemithyroidectomy. In our series of 410 patients the majority of the patients (85.12%) were in the early phase of the disease and the degree of successfully performed radical surgery for papillary thyroid cancer was very high (tumor reduction was performed in only 1.46% of cases).     

Papillary adenocarcinoma in situ of bladder

To the best of our knowledge papillary adenocarcinoma in situ of the bladder has not been reported previously. We describe a case of transitional cell carcinoma in situ of the bladder associated with papillary adenocarcinoma in situ. While it is believed that most nonurachal adenocarcinomas of the bladder originate within cystitis glandularis, such transition is difficult to document. We assume that severe dysplasia of a papillary adenomatous component adjacent to papillary adenocarcinoma in situ represents an intermediate morphological change between cystitis glandularis and adenocarcinoma. Electron microscopic evaluation of glandular epithelium indicates that it represents the process of aberrant differentiation rather than a metaplastic phenomenon.