RESUMEN
OBJECTIVES: This study sought to better characterize patient characteristics, treatment options, and outcomes for osteoclast-like giant cell carcinoma of the pancreas, a rare subtype of pancreatic adenocarcinoma. METHODS: This is a retrospective study of all patients with osteoclast-like giant cell carcinoma of pancreatic origin treated at Mayo Clinic from 2000 to present. Baseline patient characteristics, treatment modalities utilized, and outcomes were compiled. Overall survival (OS) and progression-free survival were assessed using Kaplan-Meier analysis with a significance level of P ≤ 0.05. RESULTS: Fifteen patients met criteria for inclusion. Four patients had distant metastases at diagnosis, the remaining 11 with locoregional disease. Median OS for the entire cohort was 11 months. Metastatic disease was associated with significantly shorter OS (3.5 vs 14.1 months; P = 0.005). Three patients had no evidence of disease at time of analysis; all 3 were treated with complete resection followed by adjuvant chemotherapy. CONCLUSIONS: Osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy with poor prognosis. For patients with locoregional disease, surgical resection followed by adjuvant chemoradiation may play a role in extended disease-free survival. Metastatic disease presents a challenging entity to treat with little data to support any effective chemotherapy regimens.
Asunto(s)
Carcinoma de Células Gigantes/terapia , Pruebas Genéticas/métodos , Osteoclastos/patología , Anciano , Anciano de 80 o más Años , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/genética , Quimioradioterapia/métodos , Quimioterapia Adyuvante/métodos , Terapia Combinada , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pancreatectomía/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/terapia , Pronóstico , Estudios RetrospectivosRESUMEN
Pleomorphic giant cell carcinoma (PGCC) of the prostate is a rare entity categorized as a variant of prostatic acinar adenocarcinoma in the 2016 World Health Organization (WHO) classification system. PGCC differs from conventional prostatic adenocarcinoma by having bizarre, markedly enlarged, and pleomorphic cells. It differs from high grade urothelial carcinoma by negativity for urothelial differentiation markers, and can be distinguished from sarcomatoid carcinoma by lack of spindle cells. Including two new cases described herein, there have been 51 cases of prostate PGCC reported in the English literature. Clinical features shared by cases of prostate PGCC include poor prognosis, occurrence in older patients, and frequent association with prior therapy. Pathologic features common to cases of prostate PGCC include admixture with a high-grade conventional prostate carcinoma component and absent or reduced expression of prostate differentiation markers. More recent studies have begun to elucidate the molecular characteristics of PGCC, detecting specific mutations and chromosomal translocations, and showing evidence of a high degree of molecular instability in these tumors. We report novel findings in two cases of PGCC including a PIK3CA p.His1047Arg mutation not previously described. One of our cases is the first to clearly demonstrate chronological loss of prostate markers during dedifferentiation from prior conventional prostate carcinoma to PGCC. Herein, we present our two new cases and comprehensively review the literature on all reported cases of PGCC with critical commentary on findings in cases of this rare tumor.
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Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/metabolismo , Neoplasias de la Próstata/patología , Neoplasias de la Vejiga Urinaria/patología , Adulto , Anciano , Biomarcadores de Tumor/análisis , Carcinoma de Células Acinares/patología , Desdiferenciación Celular , Fosfatidilinositol 3-Quinasa Clase I/genética , Fosfatidilinositol 3-Quinasa Clase I/metabolismo , Diagnóstico Diferencial , Proteínas de Homeodominio/genética , Proteínas de Homeodominio/metabolismo , Humanos , Inmunohistoquímica/métodos , Masculino , Persona de Mediana Edad , Mutación , Clasificación del Tumor/métodos , Pronóstico , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Urotelio/patologíaRESUMEN
OBJECTIVE: Although uncommon, pulmonary sarcomatoid carcinoma carries a worse prognosis due to poor chemotherapeutic response. Currently, a histologic spindle and/or giant cell component indicates sarcomatoid differentiation, with zinc E-box binding homeobox 1 (ZEB1) implicated in promoting epithelial-mesenchymal transition. However, diagnostic use of ZEB1 in limited specimens, including cell block (CB) preparations, remains unclear. MATERIALS AND METHODS: Pulmonary sarcomatoid (SARC, n = 15), typical (TC, n = 10) and atypical carcinoid (AC, n = 10), small cell (SCLC, n = 8) and large cell neuroendocrine carcinoma (LCNEC, n = 9), squamous cell carcinoma (SQ, n = 7), and adenocarcinoma (ADC, n = 7) CBs along with 69 SARCs, 20 TCs, 21 ACs, 9 SCLCs, 10 LCNECs, 71 SQs, 402 ADCs, 16 large cell carcinoma (LCC) and 17 other thoracic tumor (OT) surgical specimens between 2007 and 2018 were retrieved. ZEB1 (Sigma Aldrich, St. Louis, Mo and Novus Biological, Centennial, Colo) immunohistochemistry was graded 1+ to 3+, with ≥1+ and >5% staining considered positive. RESULTS: Nuclear ZEB1 was seen in 80% SARC (12/15), 0% TC (0/10), 0% AC (0/10), 12.5% SCLC (1/8) and 11.1% LCNEC (1/9), 0% SQ (0/7), and 0% ADC (0/7) CBs. In surgical specimens, 75.4% SARCs (52/69), 0% TCs (0/20), 0% ACs (0/21), 11.1% SCLCs (1/9), 30% LCNECs (3/10), 0% SQs (0/71), 0.2% ADCs (1/402), 12.5% LCCs (2/16), and 11.8% OTs (2/17) demonstrated ZEB1. ZEB1 sensitivity and specificity in cytology and surgical specimens were 80% and 96.1%, and 75.4% and 98.1%, respectively. CONCLUSIONS: ZEB1 is sensitive and highly specific for pulmonary sarcomatoid carcinoma in limited cytologic and surgical specimens. Diagnostic pitfalls include high-grade neuroendocrine tumors and large cell carcinoma, which are resolvable by morphologic considerations.
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Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/metabolismo , Carcinosarcoma/diagnóstico , Carcinosarcoma/metabolismo , Citodiagnóstico/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/metabolismo , Blastoma Pulmonar/diagnóstico , Blastoma Pulmonar/metabolismo , Homeobox 1 de Unión a la E-Box con Dedos de Zinc/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Biopsia con Aguja Fina , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/metabolismo , Tumor Carcinoide/patología , Tumor Carcinoide/cirugía , Carcinoma de Células Gigantes/patología , Carcinoma de Células Gigantes/cirugía , Carcinoma de Células Grandes/diagnóstico , Carcinoma de Células Grandes/metabolismo , Carcinoma de Células Grandes/patología , Carcinoma de Células Grandes/cirugía , Carcinoma Neuroendocrino/diagnóstico , Carcinoma Neuroendocrino/metabolismo , Carcinoma Neuroendocrino/patología , Carcinoma Neuroendocrino/cirugía , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Carcinosarcoma/patología , Carcinosarcoma/cirugía , Femenino , Humanos , Inmunohistoquímica , Pulmón/metabolismo , Pulmón/patología , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Blastoma Pulmonar/patología , Blastoma Pulmonar/cirugía , Estudios Retrospectivos , Carcinoma Pulmonar de Células Pequeñas/diagnóstico , Carcinoma Pulmonar de Células Pequeñas/metabolismo , Carcinoma Pulmonar de Células Pequeñas/patología , Carcinoma Pulmonar de Células Pequeñas/cirugíaRESUMEN
Cancer is an uncommon event in pregnancy. The most common gestational cancers arise from the breast and cervix. Although lung cancer is the most common malignancy, its occurrence in pregnancy is a distinctly rare event. Diagnosing it during pregnancy is an additional challenge as the pregnancy, common respiratory ailments, and the lung cancer can have overlapping symptoms. We report an uncommon histological variant of lung cancer - giant cell carcinoma, which resulted in a fatal outcome in a 26-year-old pregnant woman. A high level of suspicion and vigilance should be exercised during pregnancy to diagnose such rarer entities.
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Carcinoma de Células Gigantes/diagnóstico , Adulto , Autopsia , Carcinoma de Células Gigantes/patología , Femenino , Humanos , Embarazo , Adulto JovenRESUMEN
Osteoclast-like giant cell-type (OCGC) anaplastic carcinoma is a rare variant of pancreatic ductal adenocarcinoma, and its imaging characteristics and progression pattern have not been fully clarified. The patient was a 73-year-old man who had been incidentally found to have a pancreatic head tumor. Computed tomography demonstrated a 3-cm marginally enhanced mass at the pancreatic head, continuing toward the duodenum. Diffusion-weighted magnetic resonance imaging showed a retained diffusion capacity. Duodenoscopy revealed a 1.5-cm polypoid lesion, covered by a dirty coat, near the major papilla. Surgical material revealed OCGC pancreatic anaplastic carcinoma protruding to the duodenum, accompanied by multiple hemorrhagic foci and hemosiderin precipitations.
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Carcinoma de Células Gigantes/diagnóstico , Duodeno/patología , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico , Anciano , Carcinoma de Células Gigantes/complicaciones , Carcinoma de Células Gigantes/patología , Duodenoscopía , Hemorragia/etiología , Humanos , Masculino , Osteoclastos/patología , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/patología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
INTRODUCTION: Pulmonary sarcomatoid carcinomas (PSCs) are rare tumors within the sarcomatoid carcinoma group. Giant cell carcinoma of the lung (GCCL) is a rare type of PSCs that consists entirely of highly pleomorphic tumor giant cells; the prognosis is poor. PATIENT CONCERNS: A patient presented with a single cyst and was diagnosed with GCCL. The patient was a 59-year-old male who was admitted to the hospital with a cough. A chest computerized tomography (CT) scan showed a single, thin-walled cyst containing air in the left upper lobe of the lung. Bronchoscopy revealed chronic bronchitis. The initial diagnosis was pulmonary infection and the patient was treated with antibiotics. The cyst wall increased in thickness, and the cyst eventually formed a cavity. DIAGNOSIS: Surgery was performed, and a diagnosis of GCCL was established. The stage was pT1bN1M0 (equal to stage IIB). INTERVENTIONS: The patient underwent video-assisted thoracoscopic surgery and 4 cycles of adjuvant chemotherapy consisting of cisplatin and docetaxel. After 9 months, the patient occurred mediastinal lymph node metastasis, and received radiotherapy (60Gy/30F). OUTCOMES: His prognosis was good without progression (complete response) based on serial CT scans over 9 months of follow-up evaluations, then the patient occurred mediastinal lymph node metastasis. The patient lived during 30 months of follow-up, after which he was lost to follow-up. CONCLUSION: A solitary pulmonary parenchymal cystic lesion usually suggests an infectious disease or congenital abnormality; however, a cystic lesion is occasionally encountered in GCCL.
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Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Broncoscopía/métodos , Carcinoma de Células Gigantes/diagnóstico por imagen , Carcinoma de Células Gigantes/terapia , Quimioterapia Adyuvante , Quistes/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: MNNG HOS transforming gene (MET) abnormalities such as amplification and exon 14 mutations may be responsive to targeted therapies. They are prevalent in lung sarcomatoid carcinomas (LSCs) and must be diagnosed as efficiently as possible. Hypothetically, c-MET overexpression by immunohistochemistry (IHC) may prove effective as a screening test for MET abnormalities. METHODS: Tissue samples were obtained from consecutive patients with a resected LSC in four oncologic centers. IHC was performed using the SP44 antibody (Ventana, Tucson, Arizona) and evaluated using the MetMab score and H-score. Fluorescence in situ hybridization was applied with the dual color probe set from Zytovision (Clinisciences, Nanterre, France). True MET amplification was diagnosed when MET gene copy number was 5 or greater and the ratio between MET gene copy number and chromosome 7 number was greater than 2. All MET exon 14 alterations including those affecting splice sites occurring within splice donor and acceptor sites were detected in the routine molecular testing on genetic platforms. RESULTS: A total of 81 LSCs were included. Fourteen (17%) exhibited positive IHC using the MetMab score and 15 (18.5%) using the H-score. MET amplification was detected in six tumors (8.5%) and MET exon 14 mutation in five (6%). A weak positive correlation between IHC and fluorescence in situ hybridization was found (r = 0.27, p = 0.0001). IHC sensitivity for MET amplification was 50%, with a specificity of 83%, positive predictive value of 21.4%, and negative predictive value of 94.7%. IHC sensitivity for MET exon 14 mutations was 20%, with a specificity of 83%, positive predictive value of 7%, and negative predictive value of 94%. CONCLUSION: IHC is not a relevant screening tool for MET abnormalities in LSC.
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Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Exones/genética , Amplificación de Genes , Neoplasias Pulmonares/diagnóstico , Mutación , Proteínas Proto-Oncogénicas c-met/genética , Proteínas Proto-Oncogénicas c-met/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/genética , Carcinoma de Células Gigantes/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/metabolismo , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Hibridación Fluorescente in Situ , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Masculino , Persona de Mediana Edad , Pronóstico , Sarcoma/diagnóstico , Sarcoma/genética , Sarcoma/metabolismoRESUMEN
In pleomorphic, spindle cell, and giant cell carcinoma (PSCGC) of the lung, we wondered if an integrated diagnosis including morphological and immunohistochemical features could be related to molecular status. We performed immunohistochemistry on 35 PSCGCs against TTF1, napsin A, p40, ALK, ROS1, and c-MET. Mutational status regarding EGFR, KRAS, BRAF, HER2, and PIK3CA genes was established. Of 18 PSCGCs with adenocarcinomatous or "undifferentiated" carcinoma differentiation, 8 were mutated for EGFR (n = 1), KRAS (n = 2), BRAF (n = 1), HER2 (n = 3), and PIK3CA (n = 1). No PSCGC (0/4) with only squamous cell or adenosquamous (0/2) differentiation was mutated. c-MET overexpression was only seen in PSCGC with adenocarcinomatous or undifferentiated component (n = 5) without squamous cell component. ROS1 and ALK were negative. The presence of a "targetable mutation" was correlated to the presence of morphological or immunohistochemical adenocarcinomatous differentiation (P = .0137). Integrated diagnosis of an adenocarcinomatous component in PSCGC could be associated with the presence of targetable gene mutation. Because only PSCGC with adenocarcinomatous or undifferentiated carcinoma harbors mutations, whereas PSCGC with only squamous or adenosquamous differentiation does not in our study, this might represent a prescreening for patients with PSCGC to be tested for molecular targets. Our results emphasize that careful morphological examination and the use of immunohistochemistry might be useful for the selection of PSCGC tested for a mutational target.
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Adenocarcinoma/diagnóstico , Adenocarcinoma/tratamiento farmacológico , Antineoplásicos/uso terapéutico , Biomarcadores de Tumor , Carcinoma Adenoescamoso/diagnóstico , Carcinoma Adenoescamoso/tratamiento farmacológico , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/tratamiento farmacológico , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/tratamiento farmacológico , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamiento farmacológico , Terapia Molecular Dirigida , Adenocarcinoma/química , Adenocarcinoma/genética , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Anciano , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Biopsia , Carcinoma Adenoescamoso/química , Carcinoma Adenoescamoso/genética , Carcinoma Adenoescamoso/patología , Carcinoma de Células Gigantes/química , Carcinoma de Células Gigantes/genética , Carcinoma de Células Gigantes/patología , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Diferenciación Celular , Análisis Mutacional de ADN , Femenino , Francia , Predisposición Genética a la Enfermedad , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/química , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Masculino , Mutación , Selección de Paciente , Fenotipo , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
AIMS: Seven cases of primary giant cell carcinomas of the lung are presented. METHODS AND RESULTS: The patients were five women and two men between the ages of 48 and 72 years (average: 63 years). Clinically, the patients presented with symptoms of cough, chest pain, dyspnoea and general malaise. Diagnostic imaging revealed the presence of intrapulmonary masses; five tumours were located in the right lung and two in the left, with a general predilection for the upper lobes. All patients underwent surgical resection and staging of their tumours. Five patients were staged as T2 and T3 with nodal metastasis, while two patients in stages T1 and T3, respectively, had no nodal disease. Histologically, the giant cells were typed as syncytiotrophoblast-like or 'null type', according to the expression of ß-human chorionic gonadotrophin or expression of cytokeratin alone. Follow-up information revealed that five patients died within a period of 1-3 years, while two patients remain alive between 1 and 3 years. CONCLUSIONS: The cases presented herein highlight the importance of separating these tumours from the group of sarcomatoid carcinomas and analysing them carefully by immumohistochemical means, as we believe that these neoplasms represent a specific tumour entity.
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Carcinoma de Células Gigantes/diagnóstico , Neoplasias Pulmonares/diagnóstico , Anciano , Carcinoma de Células Gigantes/patología , Carcinoma de Células Gigantes/cirugía , Resultado Fatal , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
OBJECTIVES: To collect data on the clinical characteristics, pathologic presentation, and prognosis of patients with pulmonary sarcomatoid carcinoma. METHODS: From September 24, 2008 to June 3, 2014, 95 patients were hospitalized at the Shanghai Chest Hospital for the treatment of pulmonary sarcomatoid carcinoma. We retrospectively collected patient gender, age, smoking history, time of initial diagnosis, diagnostic methods, tumor location, pathohistological subtype, tumor size, TNM stage, immunohistochemical results, subsequent treatments, and patient survival. RESULTS: Of the 95 patients included in this study, 80 were male and 15 were female. Median patient age was 64 years (range: 43-80 years). There were 29 cases of pleomorphic carcinoma, one case of giant cell carcinoma, six cases of spindle cell carcinoma, and six cases of carcinosarcoma. The other 53 cases were not subtyped. The median survival was 11.54 months (range: 0.9-100.9 months). 1-, 2-, 3-, and 5-year survival was 32%, 30%, 25%, and 21%, respectively. Univariate analysis showed that tumor size, stage, T1+T2 vs T3+T4 stage, N stage, and M stage were prognostic factors for survival. Multivariate regression analysis showed that T stage and lymph node metastases were independent prognostic factors. CONCLUSION: Pulmonary sarcomatoid carcinoma is an uncommon, aggressive cancer. T1+T2 vs T3+T4 stage and lymph node metastases were independent prognostic factors. Our results underscore the importance of early detection and early diagnosis. Effective treatments for this disease are lacking.
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Carcinoma de Células Gigantes/patología , Carcinoma/patología , Carcinosarcoma/patología , Neoplasias Pulmonares/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico , Carcinoma/epidemiología , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/epidemiología , Carcinosarcoma/diagnóstico , Carcinosarcoma/epidemiología , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Pronóstico , Análisis de Regresión , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Basal cell carcinoma (BCC) and squamous cell carcinoma are the most common type of nonmelanoma skin cancers (NMSCs). Bowen's disease (BD), a premalignant condition, has a marginal potential (3-5%) to progress to invasive carcinoma. We report here a rarest of a rare case of multiple pigmented BD with overlying squamous cell cancer along with a giant neglected BCC on the scalp of a 76-year-old man. The occurrence of multiple BD and NMSC in a single patient compelled us to explore the following hypothesis: (1) The multiple precancerous and cancerous lesions can be due to common etiopathogenesis. Chronic ultraviolet exposure, immunosupresssion, human papillomavirus infection, dietary factors, and environmental factors including arsenic exposure were probed in to. (2) There is evolution of precancerous lesions into a different type of cancers in different time frame. (3) The new cancerous lesions are subsequent cancers that developed after neglected untreated primary cancer.
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Enfermedad de Bowen/diagnóstico , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Gigantes/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Cutáneas/diagnóstico , Anciano , Humanos , Masculino , Pigmentación de la PielRESUMEN
Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.
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Carcinoma de Células Gigantes/secundario , Neoplasias del Íleon/secundario , Intususcepción/diagnóstico , Intususcepción/etiología , Neoplasias Pulmonares/patología , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/terapia , Femenino , Humanos , Neoplasias del Íleon/diagnóstico , Neoplasias del Íleon/terapia , Intususcepción/cirugía , Persona de Mediana EdadRESUMEN
Granulocyte colony-stimulating factor (G-CSF)-producing tumors are known for their aggressive behavior. Only four cases of G-CSF-producing colorectal carcinoma have been previously reported. Herein, we present a case of an undifferentiated carcinoma of the descending colon showing G-CSF production and giant cell carcinoma morphology in a 93-year-old woman. A tumor with a diameter of 80 mm was identified in the descending colon via computed tomography. Descending colectomy was performed involving the abdominal wall where tumor invasion was observed. The white blood cell count, which was elevated before resection, decreased to normal levels after intervention. However, local recurrence at the resected site was detected 39 days after surgery. Upon recurrence, increased white blood cell counts and serum G-CSF were seen. The patient died because of respiratory failure 98 days after colectomy. By using immunohistochemistry, G-CSF expression was detected in tumor cells in the resected specimen, along with overexpression of CD44 and highly proliferating nestin-positive tumor vessels. The poor clinical outcome of this patient is consistent with previous reports that the expression of these three molecules predict poor prognosis. While G-CSF can be a therapeutic target considering its auto/paracrine function to induce tumor growth via the G-CSF receptor, CD44 and nestin may also be possible candidate therapeutic targets. Further studies are required to assess the efficacy of treatments targeting these three molecules.
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Biomarcadores de Tumor/análisis , Carcinoma de Células Gigantes/diagnóstico , Carcinoma/irrigación sanguínea , Carcinoma/química , Neoplasias del Colon/irrigación sanguínea , Neoplasias del Colon/química , Factor Estimulante de Colonias de Granulocitos/análisis , Receptores de Hialuranos/análisis , Neoplasias Pulmonares/diagnóstico , Nestina/análisis , Anciano de 80 o más Años , Biopsia , Carcinoma/patología , Carcinoma/cirugía , Colectomía , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Inmunohistoquímica , Recurrencia Local de Neoplasia , Neovascularización Patológica , Valor Predictivo de las Pruebas , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Carga TumoralRESUMEN
A 56-year-old woman was admitted to our hospital with fever and systemic malaise. Abdominal computed tomography revealed an enhanced tumor of the pancreatic head, measuring 9cm in maximal diameter and containing a low-density area. Subtotal stomach-preserving pancreatoduodenectomy was performed. Hemorrhage and necrosis were evident within the tumor, and osteoclastic polynuclear giant cells were also identified. A diagnosis of giant cell anaplastic ductal carcinoma of the pancreas was made. The patient has been free from recurrence for 6 months since surgery.
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Carcinoma de Células Gigantes/cirugía , Carcinoma Ductal Pancreático/cirugía , Neoplasias Pancreáticas/cirugía , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/patología , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/patología , Femenino , Humanos , Persona de Mediana Edad , Tratamientos Conservadores del Órgano , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Linear porokeratosis is one of the infrequent variants of porokeratosis, a rare disorder of keratinization that may develop into several epidermal malignancies, among them squamous cell carcinoma. Clinical surveillance for malignancy is imperative, but in cases when large or many lesions are present, surgical removal of porokeratosis lesions would result in an unfavorable amount of scarring. A case of a large, nonhealing full-thickness ulcer caused by a giant ulcerating squamous cell carcinoma occurring within lesions of long-standing linear porokeratosis is reported in a 43-year-old woman with a recent diagnosis of ulcerative colitis (UC). Wide excision of the ulcer and plastic surgical reconstruction of the area were performed. PET scans did not show metastases, so her prognosis is good based on definitive excision of the tumor. Physicians should be aware of this cutaneous disease and the importance of annual follow-up for these patients to monitor for any lesion that exhibits clinical features concerning for malignancy.
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Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Poroqueratosis/diagnóstico , Neoplasias Cutáneas/diagnóstico , Adulto , Carcinoma de Células Gigantes/cirugía , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Poroqueratosis/cirugía , Neoplasias Cutáneas/cirugíaAsunto(s)
Carcinoma de Células Gigantes , Neoplasias Pulmonares , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/tratamiento farmacológico , Carcinoma de Células Gigantes/patología , Carcinoma de Células Gigantes/cirugía , Quimioterapia Adyuvante , Cisplatino/uso terapéutico , Etopósido/uso terapéutico , Resultado Fatal , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Imagen Multimodal , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XAsunto(s)
Carcinoma de Células Gigantes/diagnóstico , Fémur/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , Osteosarcoma/diagnóstico , Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Carcinoma de Células Gigantes/clasificación , Diagnóstico Diferencial , Humanos , Masculino , Osteosarcoma/clasificaciónRESUMEN
BACKGROUND: Giant cell tumor is an infrequent and unpredictable bony lesion. Although numerous attempts have been made to predict the behaviour of GCT, there are no definite biological or histological parameters to determine the prognosis or aggressiveness of this lesion MATERIALS AND METHODS: We analyzed Ki 67 immuno-histochemistry of 31 consecutive cases staged III giant cell tumor to determine the clinico-pathological correlation. There were 19 male patients compare to 12 females. The mean age was 33.8 years ranged from 18 to 59 years. Five cases presented with local recurrence prior to wide resection and one case had multiple recurrences there after. Six cases had pulmonary metastases. Expression of Ki 67 antigen was evaluated by immuno-histochemical staining techniques using the avidin-biotin perioxidase complex method using an LSAB2 kit (Dako, Glostrup, Denmark). The primary antibody used in this study was Ki-67 (MIB-I clone, dilution 1:25; Dako). RESULTS: The mean value of Ki-67 index obtained as a percentage of 1000 background cells was 8.15 (ranged 1.00 - 20.0). The median Ki 67 index was 7.5 with standard deviation of 5.12. The Ki 67 index of recurrence tumor was 4.323 compared to 6.05 without recurrence and was not statistically significant (mean difference of 0.865 with p value in independent t test of 0.736). The Ki 67 index was also not statistically significant in the presence of pulmonary metastases with the mean value of metastases group of 6.681 compared to 2.890 without metastases (mean difference of 1.895 with p value in independent t test of 0.424). CONCLUSION: Ki 67 index is not use-full prognostic marker for aggressive type of giant cell tumor of the bone.
Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias Óseas/diagnóstico , Carcinoma de Células Gigantes/diagnóstico , Antígeno Ki-67/análisis , Adolescente , Adulto , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
INTRODUCTION: Pleomorphic giant cell pancreatic cancer is a very rare and aggressive pancreatic neoplasm. A case of pleomorphic giant cell pancreatic cancer presenting as a cystic lesion and in association with a serous cystadenoma presents a unique case which has not been described before. CASE PRESENTATION: A 44-year-old alcoholic man presented with abdominal pain, vomiting, and weight loss. Initially, imaging suspected a pancreatic pseudocyst measuring 4.2 cm. Endoscopic ultrasound- (EUS-) guided fine-needle aspiration revealed a serous cystadenoma. With conservative intervention only (fluid resuscitation, analgesia, and antiemetics) the patient improved and was discharged under close observation. Follow-up scan at four months revealed minimal change. Three months later, he was admitted acutely. Repeat scans demonstrated mild cyst enlargement with new liver lesions. Laparoscopic biopsy revealed pleomorphic giant cell carcinoma with the organ of origin the pancreas. CONCLUSION: This unusual case highlights the challenges in managing pancreatic cystic lesions and emphasizes the importance of considering less common forms of pancreatic cystic masses when the findings are atypical for the presentation. Surgical excision in these cases over conservative steps may be the most appropriate management.
Asunto(s)
Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/secundario , Cistadenoma Seroso/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Pancreáticas/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Pancreáticas/patologíaRESUMEN
The paper describes a case of maldiagnosis of giant-cell tumor in a patient with parathyroid osteodystrophy, in this connection elbow joint resection and replacement were made. Parathyroid adenoma with the symptoms of primary hyperparathyroidism was diagnosed only two years after surgery. Progression of diseases was accompanied by severe bone changes and the development of urolithiasis complicated by chronic renal failure. Thus, the interpretation of bone tissue changes without considering clinical and laboratory data led to the unwarranted surgical intervention and the late diagnosis of primary hyperparathyroidism. Differential diagnosis of a giant-cell tumor should be made, by obligatorily considering clinical and laboratory data, including the parameters of calcium metabolism.