Canalicular adenoma of buccal mucosa

Canalicular adenoma is a benign tumor which comprises 1% of salivary gland neoplasms and 4% of minor salivary gland tumors. It occurs in the upper lip mucosa in about 90% of cases. The next most common location is the buccal mucosa (9.5% of tumors). We present herein a new case of canalicular adenoma of buccal mucosa involving a 74-year-old man. He was suffering of a slowly growing and painless nodule of the right buccal mucosa. The treatment was surgery and histological findings were consistent with the diagnosis of canalicular adenoma. No recurrence was noted one year later.     

Adenomas arising in Barrett's esophagus

Three cases of the unusual esophageal adenoma are described. The patients included two men and one woman, with a mean age of 61 years, who presented with dysphagia or heartburn. Histologically, the esophageal adenomas were composed of dysplastic epithelium in a polypoid configuration, similar to adenomas elsewhere in the gastrointestinal tract. All three adenomas arose within Barrett's esophagus (columnar epithelium-lined distal esophagus), and dysplastic Barrett's mucosa was found in the adjacent mucosa of each case. Critical review of the literature identified three additional cases; similar clinicopathologic features were described. Esophageal adenomas are a complication of Barrett's esophagus and are best considered as macroscopic variants of epithelial dysplasia rather than as isolated adenomatous polyps. As such, they likely represent premalignant lesions.     

Membranous basal cell adenoma arising in the eyelid

Basal cell adenoma (BCA) is a specific entity that lacks the myxochondroid stromal component of pleomorphic adenoma. Membranous basal cell adenoma is a rare variant of BCA, which is characteristic by abundant eosinophilicextracellular hyaline material deposited either inside or at the periphery of the epithelial islands. Herin we describe the first case of membranous BCA arising in the upper eyelid in a 38-year-old woman. A well-demarcated nodule arising in the eyelid was composed of isomorphic basaloid cells organized with a prominent basal cell layer and distinct basement membrane-like material. Immunohistochemically, S100 protein and p63 highlighted the basal aspect of the peripheral epithelial cells, while CK7 expressed on the luminal cells. A diagnosis of membranous basal cell adenoma of the eyelid was made. At follow-up for 2 years and 3 months later, there was no evidence of recurrence. Further pathological characteristics of this disease are discussed.     

Parathyroid adenoma in submucosa of esophagus

We recently excised and examined a parathyroid adenoma that was located in the submucosa of the esophagus. It was discovered when an elevated calcium level was found on a screening chemistry profile. Subsequently, the patient was found to have renal stones. At operation two other small parathyroid glands were identified. A fourth one was not found. Following removal of the adenoma, the patient's calcium level returned to normal and has remained normal for several months.     

Villous adenoma arising in Meckel's diverticulum.

The first well documented case of villous adenoma arising in a Meckel's diverticulum not associated with a carcinoma is reported. A 21 year old man with long history of medically treated ulcerative colitis was admitted to hospital with severe pain and bleeding. Total abdominal colectomy and ileo-anal anastomosis was performed and during this procedure Meckel's diverticulum containing a villous adenoma showing minimal dysplasia was found and resected. The diverticulum was lined partly by ileal and partly by gastric epithelium, and the villous adenoma originated from the gastric mucosa.     

Minute carcinoid arising in gastric tubular adenoma

We report a minute carcinoid tumour forming multiple, endocrine nodules or glandular structures and located within a gastric tubular adenoma. The tumour cells were positive for the argyrophilic reaction and a few revealed serotonin immunoreactivity. This case may represent the third histogenetic type of gastric carcinoid tumour.     

Carcinoma with multidirectional differentiation arising in Barrett's esophagus

Four cases of esophageal carcinoma arising in metaplastic Barrett's epithelium are presented in which multidirectional differentiation was demonstrated by light and/or electron microscopy and immunohistochemistry. All tumors and adjacent mucosa produced both neutral and acidic mucins, as well as one or more hormones indigenous to the gut, including gastrin, bombesin, substance P, somatostatin, and serotonin. Gastrin and somatostatin were the peptides most frequently identified in the tumors, while somatostatin and serotonin predominated in Barrett's epithelium. Ultrastructurally, neurosecretory-type granules, 80-250 nm in diameter, were present in 2 cases; squamous features also were present in one of these cases. One patient displayed hypertrophic osteoarthropathy, which disappeared after the tumor was resected. These cases represent the majority of the Barrett-associated carcinomas in our material. Compared to the "pure" esophageal adenocarcinomas not included in this report, these tumors behaved more aggressively, with wider local involvement and nodal and systemic metastases at the time of presentation. The incidence of multidifferentiation in esophageal carcinomas is not known nor is its possible significance, particularly with regard to tumors arising in metaplastic epithelium. This group may merit further study to detect true differences, if any, between these esophageal carcinomas and their apparently more common counterparts.     

Cytology of small-cell carcinoma arising in Barrett's esophagus

The cytologic and histologic features of a rare case of small-cell carcinoma arising in Barrett's esophagus are reported. The patient presented with progressive dysphagia and an endoscopy revealed a distal esophageal mass with luminal constriction. The brushing smears showed small-cell carcinoma and dysplastic glandular epithelium. The concomitant biopsy confirmed the diagnosis of small-cell carcinoma arising in Barrett's esophagus.     

Granular cell tumor arising metachronously in the bronchus and esophagus

We present a case of granular cell tumor (GCT) occurring in the esophagus 7 years after operation for bronchial GCT. A 59-year-old Japanese man complained of epigastralgia, and endoscopic examination of the upper digestive tract disclosed a submucosal tumor in the lower esophagus. Histological examination of the endoscopic mucosal resection of the esophageal tumor showed a proliferation of neoplastic cells with an eosinophilic and granular cytoplasm. The cytoplasm of the neoplastic cells was histochemically positive for PAS stain and immunohistochemically positive for S-100. This tumor did not fulfill any of the diagnostic criteria for malignancy at either the macroscopic or microscopic level. I believe that this is the first case of GCT occurring metachronously in the respiratory and digestive tracts. Clinicians and pathologists should bear in mind that GCT may arise metachronously in the respiratory and digestive tracts.     

Primary duodenal carcinoma arising in a non-vaterian tubulo-villous adenoma

Summary Primary duodenal carcinoma and duodenal adenoma are rare tumours. Duodenal carcinoma makes up about 0.3% of all malignant tumours of the gastrointestinal tract (Alwmark et al. 1980; Spira et al. 1977). The present paper describes a duodenal carcinoma arising in a mixed tubulo-villous non-Vaterian adenoma in a 68 year old male. Immunocytochemical analysis revealed evidence of neuroendocrine differentiation in both adenoma and carcinoma. In a review of the literature a correlation between the size of adenoma and the probability of concomitant carcinoma is demonstrated. Duodenal adenoma measuring more than 4 cm in diameter should be considered potentially malignant.     

Clear cell carcinoma arising in pleomorphic adenoma of the salivary gland

Malignant change in pleomorphic adenoma of the salivary gland is not common. Clear cell carcinoma is an extremely rare form of malignant salivary gland tumor. A case of clear cell carcinoma of the submandibular gland arising in pleomorphic adenoma is reported.     

Benign pleomorphic adenoma arising in a parotid lymph node

Summary A rare case of a benign pleomorphic adenoma is reported, arising in a parotid lymph node in a 52-year-old woman. Serial sections showed that the tumor tissue was surrounded by a mantle of lymphoid tissue which had the essential characteristics of a lymph node. The pathogenesis of the lesion is discussed and the literature is briefly reviewed.     

Rhabdomyomatous well-differentiated liposarcoma arising in giant fibrovascular polyp of the esophagus

We report an example of an esophageal giant fibrovascular polyp harboring a well-differentiated liposarcoma with rhabdomyomatous differentiation in a 68 year-old man. Initial imaging studies including fiberoptic endoscopy and 2 computed tomographic examinations, and laparoscopic myotomy failed to demonstrate the polypoid intraluminal nature of the lesion. Thus, alternative diagnoses including a malignant neoplasm and achalasia were entertained. A third computed tomography with contrast showed a pedunculated mass. Surgical resection revealed a 15-cm smooth-surfaced club-shaped mass composed of a well-differentiated liposarcoma demonstrating myoglobin, muscle-specific actin, and myogenin-positive rhabdomyomatous differentiation. To date, no previously reported giant fibrovascular polyp case has described a liposarcoma with rhabdomyomatous change.     

Tubulovillous adenoma arising 30 years after ileocystoplasty.

The possibility of recurrent colonic metaplasia occurring as a complication of pelvic ileal pouches after ileo-rectal anastomosis has been raised. Several reports have documented malignant bladder tumours developing in patients many years after an ileocystoplasty. The case of a 50 year old man, who developed a tubulovillous adenoma in the ileal patch 30 years after an ileocystoplasty had been performed to enlarge a tuberculous shrunken bladder, is reported. The adjacent small intestinal mucosa showed features suggestive of colonic metaplasia.     

Malignant rhabdoid tumor arising from a pleomorphic adenoma

Malignant transformation of pleomorphic adenomas often occurs in long-standing tumors or tumors with multiple local recurrences. The malignant component is usually a carcinoma. The case reported herein concerns a 60-year-old man who had a malignant rhabdoid tumor arising in a painless parotid mass that remained untreated for 25 years. Malignant rhabdoid tumors are clinically aggressive neoplasms with phenotypic features that resemble rhabdomyomatous differentiation but lack genuine skeletal muscle differentiation. The salient features of rhabdoid tumor cell include large, pleomorphic, and eccentric nucleus and a solitary and prominent intracytoplasmic inclusion that is strongly immunoreactive for vimentin. It is our understanding that this is the first reported case of malignant rhabdoid tumor arising in the parotid gland in the English literature. The pathologic features of our case will be discussed in context with malignant rhabdoid tumors from other parts of the body.     

Papillary mucinous adenoma arising in adenomyomatous hyperplasia of the gall bladder.

A case of papillary mucinous adenoma arising in adenomyomatous hyperplasia (AMH) of the gall bladder is reported. The lesion was unsuspected and discovered by routine palpation of the gall bladder during laparotomy. The adenoma developed within fundal AMH and showed cytological atypia. This case illustrates that neoplastic proliferation is indeed possible in AMH and challenges the classical opinion that AMH is devoid of neoplastic potential.     

Primary squamous cell carcinoma of the colon arising in a villous adenoma

The first case of pure squamous cell carcinoma arising in a villous adenoma of the cecum is reported, and the literature of squamous cell carcinoma of the colon is reviewed. The possible origin of this neoplasm in adenomas of the colon, similar to that of adenocarcinoma, is discussed, and the site distributions of adenocarcinoma and squamous cell carcinoma are compared. The distribution of primary colonic squamous cell carcinoma is found to be predominantly right-sided in comparison to adenocarcinoma (p less than 0.05). Although this result does not preclude adenomas as the origin of most squamous cell carcinomas, it suggests the influence of as yet unknown site-asymmetric factors that are different from those for adenocarcinoma.