CILIATED-CELL ADENOCARCINOMA OF THE PANCREAS

An autopsy case of ciliated-cell adenocarcinoma of the pancreas was reported. A 65-year-old man, who had undergone subutotal gastrectomy because of advanced gastric carcinoma 6 years previously, died of obstructive jaundice. The autopsy revealed a primary tumor in the head of the pancreas and multiple metastatic foci in the liver, lungs, and regional lymph nodes. Histologically, the pancreatic tumor was moderately differentiated papillary adenocarcinoma with well developed cilia. The metastatic tumor also showed similar histology. Histologic and ultrastructural features of the tumor were described in detail and the cytogenesis of ciliated-cell adenocarcinoma was briefly discussed.     

Secondary tumors of the pancreas: Clinicopathological study of 103 autopsy cases of Japanese patients

To investigate the clinicopathological features of patients with secondary tumors of the pancreas, we reviewed autopsy records and pathological features of 103 cases with pancreatic secondary tumors from 690 cases of malignant tumors (excluding cases of primary pancreatic cancer) over a 10-year period. There were 67 men and 36 women in the study, ranging in age from 2 to 94 years (mean: 61 years). The incidence of pancreatic secondary tumors was 15% in the autopsy cases of malignant tumors, and the majority of the secondary tumors were carcinomas. The stomach was the most common primary tumor site (20%), followed by the lung (18%) and extrahepatic bile duct (13%). Because the total number of each primary carcinoma differed, we paid specific attention to the incidence of pancreatic metastasis in each primary carcinoma. We found that carcinoma of the papilla of Vater showed the highest rate of incidence (75%) of pancreatic metastasis in each type of primary carcinoma. Approximately half of the metastatic lesions were solitary, but the metastatic lesions in the pancreas could not be identified macroscopically in 34 cases (33%). Histologically, the most common carcinoma was adenocarcinoma, followed by large cell carcinoma, small cell carcinoma and neuroendocrine carcinoma. The most common non-epithelial tumor was leukemia, followed by malignant lymphoma. Undifferentiated carcinoma and neuroendocrine carcinoma were often found in cases of extrahepatic bile duct or urinary bladder carcinoma with pancreatic metastasis. As for the microscopic infiltration patterns of tumor cells, 73% of cases showed an interlobular and intralobular infiltration. Fat necrosis was most frequently seen as an associated pathological finding (19%). Our study indicates that secondary tumors of the pancreas can be found in approximately one out of six to seven autopsy cases of malignant tumors, and in Japan, the most common of these is adenocarcinoma of the stomach.     

The value of postmortem examination in cases of metastasis of unknown origin-20-year retrospective data from a tertiary care center

BACKGROUND: Metastasis of unknown origin (MUO) is a diagnostic challenge in clinical practice even with the state of current advanced diagnostic technology. To evaluate the value of autopsy in determining the primary site of MUO, this study reviewed the Hamilton experience-over the last 20 years-with patients autopsied with clinical diagnosis of MUO. METHODS: All autopsy diagnoses from cases performed at the Hamilton Health Sciences Center and St Joseph's Healthcare from 1980 to 2000 were reviewed. Fifty-three cases of MUO were identified (MUO was defined as a patient with pathological and/or radiological diagnosis of a metastatic tumor for which the primary site of malignancy was unknown). The clinical history and gross and microscopic diagnoses for these cases were reviewed. RESULTS: There were 31 men (58.5%) and 22 women (41.5%) in the study. Their mean age was 66 years. Pathological diagnoses at autopsy were adenocarcinoma (n = 37), small cell carcinoma (n = 6), anaplastic carcinoma (n = 3), and undifferentiated carcinoma (n = 3). Primary tumors were identified in 27 patients (51%), most commonly in the lung (n = 8), large bowel (n = 6), and pancreas (n = 4). Histochemical and immunohistochemical stains were helpful in reaching the diagnosis of a primary tumor in 4 of 27 cases. CONCLUSIONS: The following were observed: (1) in this series, autopsy was helpful in establishing the diagnosis of a primary tumor in 51% of the cases, reaffirming the value of postmortem examination in these instances; (2) adenocarcinoma was the most frequent tumor presenting as MUO; (3) the lung and the large bowel were the most frequent sites for primary tumors; and (4) careful gross and histological examinations remain the most important tools in identifying the primary site.     

Non-pancreatic cancer tumors in the pancreatic region

Most of tumors found in the pancreas are adenocarcinoma of the pancreas. A small number of tumors in the pancreas, such as islet cell tumors or neuroendocrine tumors, papillary cystic neoplasms, lymphoma, acinar cell tumors, metastatic tumors to the pancreas often, have a far better prognosis, and the majority of these tumors are non-malignant or benign. The author reviewed the recent literatures, and summarized where the tumor comes originally in the pancreas, what is the type of the tumor, and how to treat the tumor.     

Cardiac neurilemoma. Report of a case with electron microscopic examination

A cardiac neurilemoma was found at autopsy in a 70-year-old man. The patient had an adenocarcinoma of the lung with metastases to hilar lymph nodes and various organs. Light microscopic examination showed a small nodule of metastatic adenocarcinoma in the cardiac neurilemoma. Electron microscopic examination confirmed the Schwann's cell origin of the cardiac tumor. To our knowledge, this is the fifth reported case of cardiac neurilemoma.     

GIANT CELL CARCINOMA OF THE PANCREAS

A case of giant cell carcinom of the pancreas is reported herein. The patient is a 67-year-old Japanese woman complaining of ascites, general fatigue, loss of weight, abdominal distention, nausea, and vomiting. Cytological diagnosis of ascites revealed adenocarcinoma. At autopsy, a whitish tumor measuring around 5 cm in diameter was found at the head of the pancreas. Metastasis was seen only in the liver. Histological examination displayed bizarre multinucleated giant cells occasionally phagocytosing the tumor cells and neutrophils.     

Gastric collision between a papillotubular adenocarcinoma and a gastrinoma in a patient with Zollinger-Ellison syndrome

We report a unique case of a gastric collision tumor composed of an intramural gastrin-secreting tumor and a papillotubular adenocarcinoma of the intestinal type discovered at autopsy in a patient with Zollinger-Ellison syndrome. There was extensive metastatic dissemination of the neuroendocrine component to regional lymph nodes and to the liver. The unusual macroscopical, histological, and immunohistochemical features of this case and its specific clinical setting are discussed.     

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.     

Tumor-associated carbohydrate antigens in primary pulmonary adenocarcinomas and their metastases.

To better understand the metastatic behavior of pulmonary adenocarcinoma, we studied the differences in carbohydrate antigens between primary tumors and their metastases using three monoclonal antibodies (FH-2 defining Lewis [Le]x, AH-6 defining Le(y), and FH-6 defining sialyl Le(x-i)) on 56 autopsy cases (including 15 cases in which primary tumors were surgically resected) and 116 cases of surgically resected pulmonary adenocarcinoma. Metastatic lesions were divided into two groups according to the route of metastasis: group 1 comprised lymphatic metastases, such as lymph node and contralateral lung metastases, and group 2 comprised hematogenous metastases, such as extrathoracic spread. Both primary tumors and metastatic lesions with well-differentiated glandular patterns showed higher positive rates for Le(y) than the poorly differentiated lesions. Such a difference in the antigen expression in relation to tumor differentiation was barely demonstrated for Le(x) and sialyl Le(x-i). Discordance in antigen expression between primary and metastatic lesions (ie, positive primary tumors with negative metastatic lesions and negative primary tumors with positive metastatic lesions) was observed in the following order of frequency: extrathoracic metastatic lesion, contralateral lung, mediastinal lymph node (N2), and ipsilateral peribronchial and hilar (N1) lymph nodes. This study revealed increased biologic diversity of pulmonary adenocarcinoma in cell surface antigens following tumor progression, especially in extrathoracic metastasis.     

Pigmented dermatofibrosarcoma protuberans (Bednár tumor). An autopsy case with systemic metastasis

An autopsy case of pigmented dermatofibrosarcoma protuberans (Bednár tumor) with systemic metastasis is reported. No previous example of this tumor showing widespread metastasis has been reported in the literature. The patient, a 45-year-old man, developed a tumor on the right upper arm. The tumor recurred twice and metastasized to other parts of the skin, lungs and brain during the 8-year clinical course. The primary tumor contained melanin-laden tumor cells and showed a storiform growth pattern. Autopsy confirmed multiple metastatic lesions in the skin, lungs, brain, thyroid, pancreas, stomach, small intestine and thigh muscles. The recurrent and metastatic tumors lacked both melanin production and the storiform arrangement, and instead revealed "fibro-sarcomatous" change with a herring-bone or interlacing pattern of growth.     

Primary leiomyosarcoma of the liver

A 62 year old man developed an abdominal mass, which proved to be a hepatic leiomyosarcoma. During the subsequent two years he lost about 40 pounds. At autopsy the liver weighed 11,200 grams and was almost entirely replaced by tumor nodules. Small metastatic nodules were found in the lungs, pancreas, thyroid, adrenals, and kidneys. This appears to be the eighth case of primary smooth muscle tumor of the liver to have been reported. Primary smooth muscle tumors of the liver progress relatively slowly, even if they are histologically malignant.     

A case of adenocarcinoma of the lung with a spindle cell component.

We report a 60-year-old man, who was admitted to the hospital with complaints of cough and sputum. His chest x-ray showed an abnormal mass in the right upper lobe. After admission he noticed the painful gingival tumor. Right upper lobectomy and resection of the gingival tumor were performed. Their histological features showed that the tumor consisted of a papillary and tubular adenocarcinoma mixed with a component of spindle cells. Immunohistochemical study demonstrated a positive reaction in the epithelial component for keratin and epithelial membrane antigen, and not only these epithelial markers but also vimentin were expressed in some spindle tumor cells. Electron microscopic study confirmed the biphasic pattern, showing gland formation and undifferentiated cells. We diagnose this case as adenocarcinoma of the lung with a spindle cell component and the gingival tumor was metastatic. Autopsy showed that metastatic lesions were found in the left adrenal gland and in the left kidney. The tumor cells in the left adrenal gland were composed of spindle cells and the tumor in the left kidney showed gland formation. Immunohistochemical and electron microscopic findings of surgical and autopsy specimen suggest that this tumor is of epithelial origin, and the spindle cells are derived from immature mesenchymal cell transformation of epithelial cells.     

Electron microscopic study of mucoepidermoid carcinoma in the pancreas

An autopsy case of extremely rare mucoepidermoid carcinoma of the pancreas in a 58-year-old male was reported. The main tumor in the pancreatic tail associated with wide-spreading metastases, was histologically composed of squamous cancer cell nests intermingled with mucin-containing cells, but not true glandular structures except for metastatic foci in the liver. Electron microscopic findings of the main tumor revealed roughly three kinds of cancer cells, namely undifferentiated cells, squamous cells, and squamous cells with mucin-containing intracytoplasmic lumina, accompanied by variety of transitional forms. The mucin was similar to that of the intra-or interlobular duct epithelium of pancreas in mucin stains. Immunohistochemically, positive immune reaction of the cancer cells was observed by anti-keratin, -epithelial membrane antigen and -carcinoembryonic antigen sera. These findings suggested that the cancer cells originated from undifferentiated cells of pancreatic duct, which showed multipotency to differentiate predominantly into squamous cells, but also into mucin-producing cells.     

脾脏转移癌的临床病理特点

目的探讨脾脏转移癌的临床病理特点及其转移规律。方法总结16例脾脏转移癌病例,复习临床、外检、尸检记录资料,对其性别、年龄、临床症状、原发部位、组织学类型、脾脏的大体特点、脾脏内肿瘤的生长方式进行了分析。结果16例脾脏转移癌中,男性12例,女性4例;男性显著多于女性;年龄范围从48岁到90岁,其中位年龄为66．5岁;临床症状主要表现为左上腹不适,疼痛,消瘦乏力,食欲不振等,有些病例可扪及脾肿大,CT可发现脾内占位。肺是脾脏转移癌的最主要的原发部位,占总例数的43．8％（7／16）;男性最常见的原发部位是肺,占50．0％（6／12）,而女性最多见的是卵巢（2／4）。组织学类型中,肺未分化癌是最多见的类型,占25．0％（4／16）,其中小细胞未分化癌3例,大细胞未分化癌1例;其他依次为：肺细支气管肺泡癌2例;结肠腺癌2例;卵巢浆液性乳头状囊腺癌2例;前列腺腺癌2例。男性最多见的类型是肺未分化癌,而女性为卵巢浆液性乳头状囊腺癌。脾脏转移癌的生长方式分为单结节性、弥漫性和多结节性3种类型,多数肿瘤表现为单结节性的生长方式,少数高转移潜能的肿瘤（5／16）表现为弥漫性和多结节的生长方式,包括肺小细胞未分化癌（3／3）,肺腺癌（1／1）和前列腺腺癌（1／2）。结论脾脏转移癌少见,掌握其临床病理形态特点对于病理诊断和临床处理有指导意义。     

Pigmented Dermatofibrosarcoma Protuberans (Bednaf Tumor)

An autopsy case of pigmented dermatofibrosarcoma protuberans (Bednaf tumor) with systemic metastasis is reported. No previous example of this tumor showing widespread metastasis has been reported in the literature. The patient, a 45 year old man, developed a tumor on the right upper arm. The tumor recurred twice and metastasized to other parts of the skin, lungs and brain during the 8-year clinical course. The primary tumor contained melanin-laden tumor cells and showed a storiform growth pattern. Autopsy confirmed multiple metastatic lesions in the skin, lungs, brain, thyroid, pancreas, stomach, small intestine and thigh muscles. The recurrent and metastatic tumors lacked both melanin production and the storiform arrangement, and instead revealed “fibro sarcomatous” change with a herring bone or interlacing pattern of growth. Acta Pathol Jpn 40: 935–940, 1990.     

Intrapancreatic accessory spleen: A case report and review of literature

Intrapancreatic accessory spleen is not an uncommon entity and usually located in the tail of the pancreas. Most of them are asymptomatic and incidental findings on radiologic study or at autopsy. On imaging study, it appears to be a well‐defined, solitary, and hypervascular lesion; therefore, it may be confused with pancreatic neoplasms, such as neuroendocrine neoplasm, well‐differentiated adenocarcinoma, solid pseudopapillary tumor, or metastatic tumor to the pancreas. As such, the diagnostic fine‐needle aspiration biopsy of the lesion may be performed. Several case reports describing cytological features of the lesion have been published in recent years. Among them, the most commonly identified cytological findings are sheets of a heterogeneous population of lymphocytes and prominent traversing blood vessels. Herein, we report an unusual EUS‐FNA case of intrapancreatic accessory spleen. In addition to above previously well‐described cytological features, our case revealed many cells with fine granular chromatin and areas with pseudo rosette‐like architecture, mimicking and engendering the differential diagnosis of pancreatic neuroendocrine tumors. Although cytological findings of our case are rare, they may extend our current knowledge and provide additional differential diagnostic information for this entity. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Neuroendocrine carcinoma of the liver: An autopsy case

An autopsy case of hepatic neuroendocrine carcinoma Is descrlbed. An 84-year-old man had a white solid tumor measuring 5 cm In greatest diameter and multiple small nodules In the non-cirrhotic liver. Microscopically, these lesions were characterized by solid nesting, trabecular, and Insular arrangements of small- to medium-sized cells. The tumor cells were argyrophllic and electron microscopy showed dense core granules and formation of bile canall-culi. lrnmunohlstochernlcally, the tumor cells were positive for cytokeratln CAM 5.2, chromogranln A, Leu-7, neuron-specific enolase, and α-fetoprotein. The tumor was diploid by flow cytometry. The patient had metastases in the vertebrae, lung, pancreas, and an hepatic hilar lymph node. The patient had an occult rectal tumor of Intramucosal well-differentiated tubular adenocarcinoma without metastasis. No alternative primary source of the endocrine tumor was detected. The patient died 1 month after presentation.     

Metastatic tumors to the female breast. An autopsy study of 12 cases

Twelve cases of metastatic tumors to the female breast are reported. Ten of them were incidentally discovered at autopsy; two cases were diagnosed ante mortem but one was misinterpreted as primary. The patients' mean age was 58 years. The metastasizing tumors included cutaneous malignant melanoma (four cases); ovarian, renal and gastric adenocarcinoma (two cases each); and individual cases of pulmonary and pancreatic carcinoma. The patients with melanoma were younger than the others (49.7 vs. 62.7 years). The results of the present study indicate that breast metastases, although rare, are not exceptional especially in large autopsy series. Their recognition in surgical material would result in more adequate treatment against the primary tumor, thereby avoiding unnecessary radical surgery to the breast.