A 14‐YEAR‐OLD GIRL WITH MULTIPLE TUMORS

Pleomorphic xanthoastrocytoma (PXA) is a rare astrocytic tumor that usually occurs in the superficial cerebral hemispheres of children and young adult and has a favorable prognosis. We report a case of a 14‐year‐old girl with a recent history of sciatica and ataxic gait. Pre‐ and post‐contrast brain and spinal MRI revealed the presence of multiple solid lesions with a cystic component in the cerebellum and the spinal cord with a concomitant massive leptomeningeal involvement Histological and immunohistochemical findings were concordant with a final diagnosis of WHO grade II PXA. Even the biological indolent PXAs'' behavior, this is the third report in the literature of such an unusual multicentric PXA with leptomeningeal dissemination.     

Lymph node metastases of a Merkel-cell tumor of unknown origin: possibilities and limitations of fine-needle aspiration cytology

The authors report a case of lymph node metastasis of a Merkel cell carcinoma with unknown primary localization. The definitive diagnosis was posed histologically since the FNA report was--in this case--only "coherent with a small malignant cells proliferation".     

TP53, β-Catenin and c-myc/N-myc status in embryonal tumours with ependymoblastic rosettes

M. Gessi, A. zur Muehlen, L. Lauriola, M. P. Gardiman, F. Giangaspero and T. Pietsch (2011) Neuropathology and Applied Neurobiology 37, 406–413
TP53, β‐Catenin and c‐myc/N‐myc status in embryonal tumours with ependymoblastic rosettes Background: The primitive neuroectodermal tumours of central nervous system (CNS‐PNET) are a heterogeneous group of neoplasms, occurring in the CNS and composed of undifferentiated or poorly differentiated neuroepithelial cells which may display divergent differentiation along neuronal, astrocytic and ependymal lines. The WHO classification includes in this group of tumours also ependymoblastomas and medulloepitheliomas. Several groups have reported examples of CNS‐PNET with combined histological features of ependymoblastoma and neuroblastoma, defined as ‘embryonal tumour with abundant neuropil and true rosettes’. The presence of the amplification of chromosome region 19q13.42, common in both ependymoblastoma and embryonal tumour with abundant neuropil and true rosettes, suggests that they represent a histological spectrum of a single biological entity. Methods: We examined 24 cases of ependymoblastoma/embryonal tumour with abundant neuropil and true rosettes (EPBL/ETANTR) for the presence of mutations of TP53 and β‐Catenin and for amplification of c‐myc/N‐myc. Results: The single strand conformation polymorphism‐mutational screening did not identify any mutation in exons 5 to 8 of the TP53 gene. However, we found a point mutation affecting codon 34 (GGA→GTA) of β‐Catenin gene resulting in a Glycine → Valine substitution. No cases presented c‐myc/N‐myc amplification. Conclusions: EPBL/ETANTRs show molecular features different from other CNS‐PNET and medulloblastomas. The presence of alterations in the β‐Catenin/WNT pathway seems to be noteworthy due to the close relationship between this pathway and miR‐520g encoded in chromosome 19q13.42 region amplified in these tumours.     

What’s growing on? The growing teratoma syndrome

Background

The growing teratoma syndrome (GTS) consists of a mature teratoma paradoxically enlarging during or after chemotherapy for malignant nongerminomatous germ cell tumors.

Methods and results

We report two cases of GTS occurring in association with NSGCT of the pineal gland. Although an unusual event, clinicians and radiologists should be aware of its natural history.

Conclusions

When normalized tumor markers after chemotherapy are associated with imaging features of a growing mass, the hypothesis of GTS must be taken in consideration. When early diagnosed, GTS can be managed surgically with good results.     

Detection rate and factors predictive the presence of prostate cancer in patients undergoing ultrasonography‐guided transperineal saturation biopsies of the prostate

Study Type – Diagnostic (case series)
Level of Evidence 4

OBJECTIVES

To assess the prostate cancer detection rate and predictive factors for prostate cancer after transrectal ultrasonography (TRUS)‐guided transperineal saturation re‐biopsies of the prostate, using a 24‐core scheme.

PATIENTS AND METHODS

We evaluated 143 consecutive patients undergoing TRUS‐guided transperineal saturation re‐biopsy of the prostate using a 24‐core scheme. The inclusion criteria were a previous negative biopsy and a prostate‐specific antigen (PSA) level of ≥10.0 ng/mL, or of 4.0–10.0 ng/mL with a free/total ratio of <20% or an abnormal digital rectal examination or previous high‐grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP).

RESULTS

The mean (sd ) age of the patients was 66.5 (6.1) years and the median (interquartile range) PSA level was 9.0 (6.1–12.8) ng/mL. The number of previous biopsies was one in 59% of patients, two in 26% and three or more in 15%. We detected prostate cancer in 26%, ASAP in 5.6% and HGPIN in 2.1%. The cancer detection rate was 47%, 25.5% and 14% for prostate volumes of <40, 40–60 and ≥60 mL, respectively (P = 0.002). On a multivariate analysis the total prostate volume (40–60 vs <40 mL, hazard ratio 5.683; >60 vs <40 mL, hazard ratio 6.965; P = 0.01) was the only significant predictor of prostate cancer at saturation biopsy.

CONCLUSIONS

TRUS‐guided transperineal saturation re‐biopsy of the prostate using a 24‐core scheme resulted in a high cancer detection rate also in patients who had had two or more previous biopsies. The total prostate volume was the only predictor of prostate cancer.