Benigner hellzelliger Lungentumor (≫Sugar Tumor≪)

Zusammenfassung Es wird ein Fall eines benignen hellzelligen Lungentumors (sugar tumor) bei einem 69jährigen Mann vorgestellt. In der Weltliteratur wurden bisher nur 16 ähnliche Fälle beschrieben. Probleme der Diagnose sowie der Pathogenese werden erörtert.

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Benign clear cell tumor (sugar tumor) of the lungCase report and review of the literature

Summary A case of a benign clear cell tumor of the lung (sugar tumor) in a 69 year old man is presented. The world literature lists only 16 similar cases to date. Problems concerning diagnosis and pathogenesis are discussed.

     

Adult Wilms’ Tumor: Management Considerations

Adult Wilms’ tumor are rare tumors. Recommended treatment guidelines are similar to those followed for Wilms’ tumor of childhood. Presented herein is a case of an Adult Wlims’ tumor stage II favorable histology which failed to respond to the first line combination chemotherapy schedule of Cyclophosphomide, vincristine, and Actinomycin D. In view of similar such reports in the literature a more aggressive chemotherapy schedule of Cisplatin and Etoposide based combination may be recommended as the first line of treatment for Early stage Adult Wilms’ tumor.     

Sklerosierender Sertoli-Zell-Tumor des Hodens – ein seltener Tumor

Sertoli cell tumors of the testis are extremely rare (0.4-1.5% of all testicular neoplasms) and have a heterogeneous pathology. Histopathologically classic, large cell calcifying and sclerosing subtypes are differentiated.Up to now, 14 cases of sclerosing Sertoli cell tumor are known. This article presents a new case and compares the three subtypes. The subtypes differ in particular in age of onset, malignant potential, prognosis, and therapy. While no cases of sclerosing Sertoli cell tumor with a malignant course have been reported, both other subtypes have been found to be potentially malignant. In the case of malignancy the prognosis is very poor, and it is difficult to select the best treatment because there is so little experience with this type of tumor. Once the diagnosis of a Sertoli cell tumor has been confirmed, exact determination of the histological subtype is essential to allow appropriate risk-adapted therapy. The various histological subtypes are presented with the clinical features, prognosis and treatment of each.     

Tumor Existence and Tumor Size as Prognostic Factors in Hepatitis B Virus–Related Cirrhosis Patients Who Underwent Liver Transplantation

Background

Hepatitis B virus (HBV)–related chronic liver disease is one of the most common indications for liver transplantation (LT). Patient data in our unit were collected to evaluate the impact of liver tumor on outcomes in patients with HBV-related cirrhosis who underwent LT.

Methods

HBV transplantation patients in our hospital from August 2002 to March 2012 were analyzed and compared according to LT indications: decompensated cirrhosis (DEC) or hepatocellular carcinoma (HCC). For HCC patients, receiver operating characteristic (ROC) curve analysis was used to determine the cutoff tumor size for prognosis, namely the maximum tumor diameter. According to the cutoff size, patients were divided into 2 groups: large-size HCC and small-size HCC. The correlations among other clinicopathologic factors were also investigated. Potential prognostic factors were evaluated with the use of Cox proportional hazards model analysis.

Results

The 1-, 3-, and 5-year overall survival rates of the 111 HBV-related patients were 76.2%, 43.2%, and 32.9%, respectively. Patients with HCC had significantly poorer overall survival than those with only DEC (P < .05). The mean tumor size was 5.97 cm, and ROC analysis indicated that the cutoff tumor size for prognosis was 4.25 cm, with sensitivity and specificity of 62.8% and 81.0%, respectively (area under the ROC curve, 0.760; 95% CI, 0.644–0.877; P < .001). According to this cutoff point, 31 patients had large tumor size (≥4.25 cm) and 33 had small tumor size (<4.25 cm). Patients with small tumor size had significantly better overall survival than those with large tumor size (P < .05). Univariate analysis showed that only the tumor size (risk ratio, 1.14; P < .001) was significantly associated with the overall survival.

Conclusions

Tumor existence and tumor size are prognostic factors in HBV-related cirrhosis. With the use of a tumor size cutoff value of 4.25 cm, patients with large-size tumors have significantly poorer overall survival than those with small-size tumors.     

Ein seltener inflammatorisch myofibroblastärer Tumor der Lunge

This case presents an inflammatory myofibroblastic tumor of the lung (IMT). In the presented case the tumor was diagnosed in an advanced stage, when the bronchus of the upper lobe was already obstructed. In the x-ray examination of the lung we found a complete atelectasis of the left lung. The incidence of an IMT is observed in every age group, with a higher prevalence in teenagers and young adults. A complete R0-resection is the only curative option. A limited resection with histological free margins seems to be sufficient. Because of the advanced stadium a limited resection was technically impossible in the case presented. It is worth mentioning that recurrences can be observed even 10 years after an operation. Therefore, a long-term follow-up is advised.     

Hepatic Tumor Growth: Target for Angiogenesis Inhibition?

Pathologic angiogenesis induced by a tumor is essential for its survival. The promise of tumor inhibition by targeting angiogenesis over the past several years has translated into numerous ongoing clinical trials. Recently, in a phase III trial involving patients with metastatic colorectal cancer, Bevacizumab (Genentech, Inc, San Francisco, CA), a recombinant humanized monoclonal antibody against vascular endothelial growth factor used in conjunction with standard chemotherapy was shown to increase survival, progression-free survival, response rate, and duration of response compared to chemotherapy alone. Thus far, duration of the increased response remains less than 6 months. The majority of deaths in patients with colorectal cancer are related to hepatic metastases. It is hoped that novel approaches directed at the complex interactions between tumor and microenvironment in the angiogenic process will strengthen the therapeutic armamentarium against hepatic malignancies.     

Reconstruction With β-Tricalcium Phosphate After Navicular Tumor Resection

Postresection reconstruction of the navicular bone is challenging. A composite hemangioendothelioma is an intermediate malignancy characterized by an admixture of differing vascular components. In the present report, a 40-year-old male with a composite hemangioendothelioma presented with multiple soft tissue lesions of the leg and sole and a navicular bone lesion. The navicular bone was resected and reconstructed using β-tricalcium phosphate of strong compression resistance with plating. The current reconstruction method can be applied, not only for tumors, but also for trauma.     

Undifferentiated Sex Cord—Stromal Tumor in a Young Adult

Undifferentiated sex cord-stromal tumor in post-puberty male is extremely rare. There were only three reported cases in the literature. We reported a 19-year-old patient presented with an asymptomatic right testicular nodule with normal level of serum marker for germ cell tumor. Excisional biopsy and subsequent orchidectomy was preformed and the final pathology supported the diagnosis of undifferentiated sex cord-stromal tumor. He was then put on regular surveillance with no adjuvant therapy given. He remained disease free 18 months after the operation. A summary of the literatures and discussion on the management of this rare tumor was provided.     

Solitärer fibröser Tumor des kleinen Beckens

Solitary fibrous tumors (SFT) are rare spindle cell neoplasms. To date only very few cases of pelvic SFT have been reported in the literature. SFT are characterized by unique microscopic and immunohistochemical findings. Complete local resection is the treatment of choice. Recurrence and metastasis may be related to infrequent malignant histological features, but histology is not always a reliable predictor for prognosis. Therefore long-term follow-up is necessary. We report about a male patient with a malignant pelvic SFT. After complete resection the tumor recurred after a short period of 6 months posterior to the original location in the pelvis. The differential diagnoses and the therapy options are discussed with a review of the present literature.     

Electrocorticographic–Histopathologic Correlations Implying Epileptogenicity of Dysembryoplastic Neuroepithelial Tumor

Based on intracranial-video electroencephalography (EEG), histopathological features, and postoperative seizure outcome, we elucidated the epileptogenicity in patients with dysembryoplastic neuroepithelial tumor (DNT). Five patients (P1–P5) pathologically diagnosed with DNT underwent intracranial-video EEG to identify the ictal onset zone and irritative zone. We evaluated the correlations of ictal onset zone and irritative zone with the magnetic resonance imaging-visible lesion (MRI-lesion) and their histopatho-logical features. Intracranial-video EEG located the ictal onset zone adjacent to the MRI-lesion margin in four patients with complex/simple forms of DNT subcategory, and on the MRI-lesion in P3 with a nonspecific DNT form. The irritative zone extended to surrounding regions of the ictal onset zone in all patients. Histopathologically, MRI-lesions were characterized by specific glioneuronal elements, whereas the ictal onset zone and irritative zone were represented with dysplastic cortex accompanying oligodendroglia-like cells in four (P1, P2, P4, and P5) of five patients. Cortical dysplasia was identified with typical histopathologic features in the irritative zone remote from the MRI-lesion in P5. P3, with a nonspecific form, indicated prominent component of dysplastic cortex with oligodendroglia-like cells scattered in the MRI-lesion. Lesionectomy of MRI-lesion with additional cortical resections (including the ictal onset zone and irritative zone) yielded postoperative seizure freedom (Engel Class I) in P3, P4, and P5, while P1 and P2 (with only lesionectomy) experienced postoperative residual seizure (Class II and III in each patient). Our results suggest the intrinsic epileptogenicity of DNT. The topographical correlation indicated that the dysplastic cortex accompanying oligodendroglia-like cells was more epileptogenic than the specific glioneuronal elements itself. Meticulous intracranial-video EEG analysis delineating the MRI nonvisible ictal onset zone and the irritative zone may yield better seizure outcome.     

Effective Hepatic Cryoablation: Does It Enhance Tumor Dissemination?

n = 12) were sacrificed after induction of liver tumors at 4 and 6 weeks. The animals in the treatment group (n= 16) underwent cryosurgery 2 weeks after tumor induction and were allowed to recover before sacrifice 2 and 4 weeks later. Pulmonary metastases were identified in 9 of 12 (75%) control animals at postmortem examination (2 and 6 weeks after tumor inoculation) and in 6 of 16 (38%) rats in the treatment group at sacrifice 2 and 4 weeks after cryosurgery (p= 0.11, Fisher's test for unpaired analysis). Peritoneal deposits were observed in 5 of 12 (42%) control animals at postmortem examination and in 8 of 16 (50%) of the treated animals at the time of cryosurgery (p= 0.95, Fisher's test for unpaired analysis). Two other study animals developed deposits after cryosurgery. The prevalence of peritoneal deposits in the study group was not altered by cryosurgery (p= 0.5, McNemar's test for paired analysis). The importance of the final subzero temperature at the edge of the iceball during tumor ablation by cryosurgery was confirmed by the histologic findings. Complete ablation with no residual viable tumor was obtained only when the subzero temperature had reached −38°C or below. The results of this study do not support the suggestion that hepatic cryosurgery enhances tumor dissemination. The findings also confirm that a subzero temperature at the edge of the iceball of −38°C or lower is necessary to ensure complete ablation of tumor.