Clear cell mesothelioma presenting as an incarcerated abdominal hernia

A clear cell mesothelioma presenting as an incarcerated ventral abdominal hernia in a 67-year-old man who had no history of asbestos exposure is described. The cause of the cytoplasmic clearing was the presence of large amounts of glycogen. Although uncommon, this variant of mesothelioma is important to recognize because it can be easily confused with other clear cell tumors involving the serosal membranes. Significant recent advances in the immunohistochemistry of epithelioid mesothelioma are briefly reviewed because immunohistochemical studies can be helpful in establishing the correct diagnosis.     

Endobronchial clear cell adenocarcinoma occurring in a patient 15 years after treatment for DES-associated vaginal clear cell adenocarcinoma

BACKGROUND: Clear cell adenocarcinoma (CCA) of the vagina and cervix in young women is associated with prenatal exposure to diethylstilbestrol (DES). Parenchymal pulmonary metastases are known to occur following treatment of the primary tumor. Most recurrences present within 2 to 3 years of the initial diagnosis. CASE: This is a case report of a solitary endobronchial clear cell adenocarcinoma occurring 15.3 years after the initial diagnosis of DES-induced CCA. CONCLUSIONS: This case suggests that management of clear cell cancer survivors should involve long-term follow-up because of the potential for the appearance of a new focus of clear cell adenocarcinoma.     

Clear cell tumor of the lung

Clear cell tumor of the lung is a rare benign tumor. We report herein a case of clear cell tumor of the lung. A 45 year-old woman with a round mass lesion of approximately 2 cm diameter on chest X-ray underwent a thoracotomy. Pathologic examination revealed sheets of large round or polygonal cells with clear cytoplasm and immunoreactive positivity for HMB-45 and vimentin. Investigation with abdominal CT scans showed no evidence of renal disease, and the tumor was diagnosed as clear cell tumor of the lung.     

Role of carbonic anhydrases in the progression of renal cell carcinoma subtypes: proposal of a unified hypothesis

Renal cell carcinoma (RCC) has the highest rate of occurrence within the US when compared with other countries. Recent advances in the basic research and molecular diagnostics of this malignancy have revealed that RCC is not a single disease, but it is a mixture of several types of malignancies with unique molecular mechanisms and pathological attributes. RCC is now divided into clear cell carcinoma (80% of all kidney cancers), papillary type 1 and papillary type 2 neoplasms (10-15% of all RCC patients) and RCC with chromophobic and oncocytic features, called the Birt-Hogg-Dube (BHD) subtype, in roughly 5% of all patients. Apart from these, neoplasms such as the tuberous sclerosis (TSC) syndrome may occur with a mixed pathological features with a renal presentation. In this review, molecular evidence, both direct and indirect, published so far on all these RCC subtypes have been analyzed to find out whether there is any common thread that could run through these disparate malignancies that happen to occur in a single organ, i.e., the kidney. We believe that the role played by the expression and certain non-traditional activities of the cabonic anhydrase (CA) family members, along with the differing levels of hypoxia induced within these tumors may be the most common denominators. Evidence is presented focusing on how the CA family members could participate in the genesis and progression of each and every one of these RCC subtypes and how their function could be influenced by hypoxia, activities of receptor type protein tyrosine kinases and certain other pre-disposing factors. These rationalizations point towards a unified hypothesis that may help explain the occurrence of all these RCC subtypes in a molecular manner. We hope that these analyses would a) stimulate further studies aimed toward a better understanding of the role played by carbonic anhydrases in RCC subtypes and b) would pave way to a better and rationally designed therapies to interfere with their function to benefit patients with RCC and possibly other cancers.     

Successful diagnosis of thromboembolism before surgery in a woman with clear cell adenocarcinoma of the endometrium

Patients with ovarian cancer with clear cell histology often have venous thromboembolism (VTE) even before surgery. In view of the possible association between clear cell histology and VTE in endometrial cancer, we measured the plasma levels of thrombin-antithrombin III complex (TAT) and D-dimer (DD) in the preoperative examinations of a patient with clear cell adenocarcinoma of the endometrium. Plasma TAT and DD were both highly elevated, though the patient had no symptoms of VTE or risk factors such as obesity or diabetes mellitus. Ultrasound Doppler examination and lung perfusion scintigraphy just before surgery revealed a thrombosis in the left popliteal vein and a pulmonary embolism. After implanting an inferior vena cava filter to prevent a fatal embolism of the lung, we performed abdominal total hysterectomy, bilateral salpingo-oophorectomy, and sampling of the pelvic lymph nodes. The VTE gradually disappeared and the plasma levels of TAT and DD returned to normal after surgery. Possibly, the VTE in this patient may have been associated with the clear cell histology.     

Malignant melanoma of the soft parts showing calciphylaxis

Calciphylaxis is a poorly understood and highly morbid syndrome of vascular calcification and skin necrosis. Hypercalcemia, hyperphosphatemia, and secondary hyperparathyroidism are the factors implicated in the pathogenesis of calciphylaxis, which is generally identified in patients with hyperparathyroidism secondary to end-stage renal disease. It has also been observed in primary hyperparathyroidism, end-stage liver disease, and rheumatoid arthritis, in the absence of renal disease. There are few case reports of calciphylaxis occurring in hypercalcemia of malignancy. An unusual case is reported of calciphylaxis associated with malignant melanoma of the soft parts in the absence of renal or parathyroid disease. This is the first reported case of this soft tissue sarcoma showing calciphylactic changes.     

Clear cell chondrosarcoma: radiographic, computed tomographic, and magnetic resonance findings in 34 patients with pathologic correlation

Objective To describe the radiographic features of clear cell chondrosarcoma (CCCS), including the computed tomographic (CT) and magnetic resonance (MR) findings, and to correlate them with the histopathologic findings.Design and patients A retrospective review was carried out of 72 patients with histopathologically confirmed CCCS. Imaging studies were available for 34 patients: conventional radiographs (n=28), CT scans (n=14), and MR images (n=15). Radiographic studies were reviewed by three radiologists who rendered a consensus opinion; the studies were correlated with the histopathologic findings.Results Of the 34 patients with imaging studies, 30 were male and 4 were female (mean age 38.6 years; range 11–74 years). Twenty-two lesions were in long bones (15, proximal femur; 1, distal femur; 1, proximal tibia; 5, proximal humerus) and 11 were in flat bones (5, vertebra; 4, rib; 1, scapula; 1, innominate). One lesion occurred in the tarsal navicular bone. Typically, long bone lesions were located in the epimetaphysis (19/22) and were lucent with a well-defined sclerotic margin and no cortical destruction or periosteal new bone formation. More than one-third of the long bone lesions contained matrix mineralization with a characteristic chondroid appearance. Pathologic fractures were present in six long bone lesions (4, humerus; 2, femur). Lesions in the proximal humerus were more likely to have indistinct margins (4/5) and extend into the diaphysis. Flat bone lesions were typically lytic and expansile and occasionally demonstrated areas of cortical disruption. Typically, matrix mineralization, when present, was amorphous. MR imaging, when available, was superior to conventional radiographs for demonstrating the intramedullary extent of a lesion as well as soft tissue extension. CT images better delineated the presence of cortical destruction and the character of matrix mineralization patterns. CCCS lesions were typically low signal intensity on T1-weighted images and moderately or significantly bright on T2-weighted images. Areas of lesion heterogeneity on T1- and T2-weighted images and on post-gadolinium T1-weighted images corresponded pathologically to areas of mineralization, intralesional hemorrhage, and cystic changes. Adjacent bone marrow edema was typically absent (12/15) or only minimally observed in a few cases (3/15). No cases examined with MR imaging demonstrated periosteal new bone formation.Conclusions CCCS typically presents radiographically as a geographic lytic lesion located in the epimetaphyseal region of long bones. Most commonly lesions are found in the proximal femur, followed by the proximal humerus. Lesions within the proximal humerus may exhibit more aggressive features. Lesions in the axial skeleton are typically expansile and destructive, often with soft tissue extension and lack of mineralization. MR imaging may show the presence or absence of bone marrow edema.     

Clear corneal incision leakage after phacoemulsification––detection using povidone iodine 5%

The purpose of this work was to study the incidence of clear corneal wound leakage at the conclusion of standard co-axial phacoemulsification in a prospective observational series of 100 consecutive cataract cases in a single surgeon’s institutional practice. At the conclusion of standard co-axial phacoemulsification using a 2.75 mm temporal single plane clear corneal incision with a 1 mm clear corneal side-port incision, the wounds were hydrated and checked for water-tightness. Povidone iodine 5% (P-I) was then evenly dripped over the cornea and the wounds were inspected visually. Any leakage of aqueous observed was recorded. The amount of leakage was graded as small or large from each wound. Leaky wounds were further hydrated and retested with P-I until sealed. Wound integrity was reassessed on the first postoperative day by use of fluorescein. Of the 100 cases, wound leakage was observed for 31 eyes (31%)—ten main incisions, nineteen side-port incisions, and both incisions in two cases. Wound leakage was easily detected as a ribbon of clear fluid streaming from the incision amid a pool of brown solution. Povidone iodine was not observed within the tract in any incision. All wound leakage was small except for one from the main incision and two from the side-port incision. None of the eyes developed wound leakage the day after surgery and none developed endophthalmitis. In conclusion, leakage from clear corneal incisions at the conclusion of phacoemulsification occurs in almost a third of cases, predominantly from the side incision. It is easily detected by use of the P-I test.     

脑出血不伴意识障碍病人的心理行为调查

为了解脑出血不伴意识障碍病人的心理状态和行为特点，为临床护理提供依据，对1997年12月－2000年3月的121例脑出血住院病人中49例不伴意识障碍者的心理状态及行为进行调查分析。结果：49例病人表现为焦虑和恐惧、内疚和自责、悲观和抑郁、角色紊乱等不良心理状态和行为，且与性别、职业和文化程度有一定的相关性。提示：对于此类病人应加强心理护理，提高病人的自我保护意识，增加康复的信心。     

改良单细胞凝胶试验与标准方法的对比研究

本文报导了采用在透明玻片上预先制备琼脂层的改良单细胞凝胶试验与标准方法的对比实验结果。研究表明，本法对ＤＮＡ损伤与修复效应的检测灵敏度与标准方法相同。但本法能明显改善ＤＮＡ迁移形态的视野清晰度和稳定性，且凝胶片经固定可长期保存。文中还对该法某些实验条件进行了探讨。