RESUMO
Elastofibromatous change, also referred to as elastofibromatous polyp or elastofibroma, has been extremely rarely described in the gastrointestinal tract. This lesion is characterized histopathologically by an excessive accumulation of elastic fibers occasionally with a fibrous component involving the submucosa and/or muscularis mucosae of the gastrointestinal tract. Herein, we report four additional lesions of the intestine and review the clinicopathological features of this rare lesion. Three patients (76-, 72-, and 52-year-old males) were detected with polypoid lesions in the jejunum, transverse and sigmoid colons, and sigmoid colon, respectively. All four lesions showed fundamentally the same histopathological and immunohistochemical features. The polypoid lesions were covered by non-neoplastic epithelium, and degenerated and truncated elastic fibers occasionally with a fibrous component had accumulated in the submucosa and/or muscularis mucosae. The characteristic feature was the elastofibromatous change centered around collections of elastotic submucosal vessels. Desmin-positive degenerative ruptured smooth muscle fibers were scattered within the elastic fibers in the submucosa. Our analyses of the clinicopathological features of the previously reported 32 cases of elastofibromatous change of the gastrointestinal tract as well as the present cases demonstrated that this type of lesion is most commonly found in the colon or rectum (29 cases), males, and middle-aged to elderly persons. Although the pathogenesis remains unclear, the convincing hypothesis that this lesion represents elastic degeneration of submucosal vessels by previous persistent vascular injury has been proposed. The collections of degenerative elastotic vascular walls may have an important role in the development of this lesion.
Assuntos
Colo/patologia , Pólipos do Colo/patologia , Tecido Elástico/patologia , Pólipos Intestinais/patologia , Doenças do Jejuno/patologia , Jejuno/patologia , Doenças do Colo Sigmoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Endoscopia por Cápsula , Colo/química , Colo/cirurgia , Colo Sigmoide/química , Colo Sigmoide/patologia , Colo Sigmoide/cirurgia , Pólipos do Colo/química , Pólipos do Colo/cirurgia , Colonoscopia , Desmina/análise , Feminino , Fibrose , Humanos , Imuno-Histoquímica , Pólipos Intestinais/química , Pólipos Intestinais/cirurgia , Doenças do Jejuno/metabolismo , Doenças do Jejuno/cirurgia , Jejuno/química , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças do Colo Sigmoide/metabolismo , Doenças do Colo Sigmoide/cirurgia , Adulto JovemAssuntos
Hidrocistoma/patologia , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adulto , Biomarcadores Tumorais/análise , Biópsia , Feminino , Hidrocistoma/química , Hidrocistoma/cirurgia , Humanos , Imuno-Histoquímica , Metaplasia , Neoplasias Císticas, Mucinosas e Serosas/química , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Neoplasias das Glândulas Sudoríparas/química , Neoplasias das Glândulas Sudoríparas/cirurgiaAssuntos
Adenocarcinoma/patologia , Carcinoma de Células Grandes/secundário , Carcinoma Neuroendócrino/secundário , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias Pulmonares/patologia , Couro Cabeludo/patologia , Neoplasias Cutâneas/secundário , Adenocarcinoma/química , Adenocarcinoma/terapia , Adenocarcinoma de Pulmão , Idoso , Biomarcadores Tumorais/análise , Biópsia , Carcinoma de Células Grandes/química , Carcinoma de Células Grandes/terapia , Carcinoma Neuroendócrino/química , Carcinoma Neuroendócrino/terapia , Neoplasias de Cabeça e Pescoço/química , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/química , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Couro Cabeludo/química , Neoplasias Cutâneas/química , Neoplasias Cutâneas/terapia , Adulto JovemAssuntos
Carcinoma Adenoescamoso/diagnóstico , Neoplasias da Língua/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/metabolismo , Idoso , Carcinoma Adenoescamoso/metabolismo , Carcinoma Adenoescamoso/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Queratinas/metabolismo , Proteínas de Membrana/metabolismo , Neoplasias da Língua/metabolismo , Neoplasias da Língua/cirurgia , Resultado do TratamentoAssuntos
Cisto Epidérmico/diagnóstico , Ossificação Heterotópica/diagnóstico , Dermatopatias/diagnóstico , Adulto , Idoso , Dorso , Bochecha , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Masculino , Ossificação Heterotópica/patologia , Ossificação Heterotópica/cirurgia , Dermatopatias/patologia , Dermatopatias/cirurgia , Resultado do TratamentoRESUMO
The occurrence of small cell carcinoma in the urinary bladder and prostate is rare. Only a few reports on the cytological features of small cell carcinoma of the urinary bladder in the urine specimen have been documented and, moreover, the urinary cytological features of prostate small cell carcinoma have been rarely reported. In this study, we analyzed the cytological features of four cases of small cell carcinoma of the urinary bladder and prostate, and discussed the usefulness of cytological examination of urine specimen for this type of tumor. This study included two urinary bladder and two prostate small cell carcinoma cases. Analyses of the cytological features of these cases revealed the following: i) the background was mostly inflammatory and necrotic material was also occasionally observed; ii) numerous tumor cells were present in two cases, whereas only a few neoplastic cells were observed in the remaining cases; iii) the neoplastic cells were small in size, had scant cytoplasm and a high nuclear/cytoplasmic ratio, and were arranged in small clusters or occasionally as single cells; iv) the tumor cell clusters showed prominent nuclear moldings; and v) the nuclei of the neoplastic cells were round to oval in shape with finely granular chromatin containing inconspicuous nucleoli. The cytological features of small cell carcinoma in the urine specimen are characteristic. Therefore, careful observation of the urine specimen may lead to a correct diagnosis of small cell carcinoma of the urinary bladder and, moreover, cytodiagnosis of prostate small cell carcinoma may also be possible.
RESUMO
Herpes simplex virus (HSV) infection is usually observed in the oral cavity and external genitals, and HSV peritonitis is extremely rare. Herein, we report a case of type II HSV peritonitis successfully diagnosed by ascitic cytology. A 66-year-old Japanese man, who had been treated with steroid inhalation for 5 years due to chronic obstructive pulmonary disease, was suspected to have acute cholecystitis. Laparoscopic cholecystectomy and intraoperative cytological examination of ascitic fluid were performed. Cytological study of ascitic fluid revealed that abundant granular cell debris, degenerative cells and apoptotic bodies were present, as well as some single or multinucleated cells with ground glass nuclei. However, vivid mesothelial cells were rarely seen. Immunocytochemical staining for type II HSV was positive in single or multinucleated cells with ground glass nuclei. Therefore, a diagnosis of type II HSV peritonitis was made. This is the first reported case of type II HSV peritonitis successfully diagnosed by ascitic cytology. This report highlights that the presence of abundant cell debris, degenerative cells and apoptotic bodies, and the absence of vivid mesothelial cells are the key cytological findings to suspect HSV peritonitis, and the diagnosis can be confirmed by careful surveillance for characteristic nuclear findings of single or multinucleated cells. The frequency of opportunistic infection is increased because of the increased numbers of iatrogenic immunocompromised patients as seen in this case, therefore, cytological examination is a useful method for early detection of the causative agent of peritonitis including HSV.
Assuntos
Líquido Ascítico/patologia , Herpesvirus Humano 2/patogenicidade , Imuno-Histoquímica/métodos , Idoso , Apoptose , Forma do Núcleo Celular , Colecistite Aguda/patologia , Células Gigantes/patologia , Herpes Simples/patologia , Herpesvirus Humano 2/metabolismo , Humanos , Fígado/metabolismo , Fígado/ultraestrutura , Masculino , Microscopia Eletrônica , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Esteroides/administração & dosagem , Esteroides/uso terapêuticoRESUMO
Cytological diagnosis is a valuable method for detection of mediastinal tumors, and recent reports have shown the usefulness of fine-needle aspiration cytology for diagnosis of mediastinal tumors, including germ cell tumors. We report a case of mediastinal seminoma diagnosed intraoperatively by cytological examination of cystic fluid containing tumor cells. An anterior mediastinal tumor with cystic component was incidentally found in a 28-year-old Japanese male. Cytological examination of the cystic fluid at the time of tumor resection showed single and loose aggregates of large round to polygonal cells with large round nuclei, vesicular chromatin and nucleoli, and mild to moderate amounts of PAS-positive cytoplasm admixed with mature lymphocytes. A diagnosis of seminoma was made intraoperatively. On subsequent immunostaining, the tumor cells showed nuclear positivity for SALL4, a recently recognized germ cell marker that, in the appropriate setting, can be helpful to distinguish germ cell tumors from other mediastinal neoplasms, such as malignant lymphoma, thymoma, and thymic carcinoma.
Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias do Mediastino/metabolismo , Neoplasias do Mediastino/patologia , Seminoma/metabolismo , Seminoma/patologia , Fatores de Transcrição/metabolismo , Adulto , Líquidos Corporais/metabolismo , Humanos , Imuno-Histoquímica , MasculinoRESUMO
Sarcomatoid variant of urothelial carcinoma (SV-UC) is characterized by the presence of biphasic malignant neoplastic components exhibiting morphological and/or immunohistochemical evidence of epithelial and mesenchymal differentiation. SV-UC is a rare variant of UC and the cytological features of this tumor have not been well described. In the present study, we analyzed the cytological features of a series of SV-UC cases; 6 voided urine specimens from 3 patients with SV-UC were reviewed. Several characteristic cytological features were revealed: i) tumor cells were abundant in a necrotic background and while single tumor cells were predominant, small clusters of cells were occasionally present; ii) tumor cells were large-sized and round to polygonal in shape with ill-defined cell borders; iii) tumor cells had a high nuclear/cytoplasmic ratio and enlarged round to oval nuclei containing coarse chromatin and occasional nucleoli; and iv) spindle-shaped atypical cells were rarely identified (1/6 specimens). The cytological features of i), ii) and iii) are indistinguishable from those of conventional invasive high-grade UC. We hypothesize that these tumor cells originated from the conventional high-grade UC component of SV-UC as this component is usually present in this type of lesion, particularly on the surface of the tumor. Moreover, the sarcomatoid component of SV-UC is usually present in the deeper portion of the tumor and therefore detection of this component in the voided cytological specimen is low. Although cytodiagnosis of SV-UC is extremely difficult, cytodiagnosis of malignancy may prove possible due to the presence of a conventional UC component.
RESUMO
It is known that the serum iron level shows a transient elevation after chemotherapy in some cases; however, the cause of this phenomenon has not been clearly described. We report two cases of colorectal cancer whose serum iron level demonstrated recurrent elevation after administration of irinotecan as a second-line chemotherapy. The transferrin saturation rate showed marked elevation together with serum iron. This fact indicates that the release of non-transferrin bound iron (NTBI) occurs and then, NTBI binds with transferrin immediately thereafter. Additionally, elevation of indirect bilirubin in case 1, and mild anemia in case 2 were observed after every course of chemotherapy. All these phenomena were synchronized with the fluctuation of the serum iron level. These observations suggest that the transient elevation of the serum iron was related with the release of the NTBI from red blood cells after chemotherapy including irinotecan.
Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Camptotecina/análogos & derivados , Neoplasias Colorretais/sangue , Neoplasias Colorretais/tratamento farmacológico , Ferro/sangue , Idoso , Antineoplásicos Fitogênicos/efeitos adversos , Camptotecina/efeitos adversos , Camptotecina/uso terapêutico , Feminino , Humanos , Irinotecano , Transferrina/metabolismoRESUMO
A 52-year-old Japanese woman was referred to our Institute because of Helicobacter pylori(H. pylori)-positive gastric mucosa-associated lymphoid tissue(MALT)lymphoma. Since she had a penicillin allergy, we could not eradicate H. pylori using the standard triple therapy including amoxicillin. Additionally, H. pylori was resistant to both clarithromycin and metronidazole. So she was treated with minomycin (MINO), levofloxacin (LVFX), and rabeprazole (RPZ) based on a drug sensitivity test. MINO+LVFX+RPZ appear to be a promising, appropriate, and well-tolerated eradication regimen for H. pylori demonstrating resistance to both clarithromycin and metronidazole, and for patients who are allergic to penicillin.
Assuntos
2-Piridinilmetilsulfinilbenzimidazóis/uso terapêutico , Hipersensibilidade a Drogas/imunologia , Infecções por Helicobacter/tratamento farmacológico , Levofloxacino , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Minociclina/uso terapêutico , Ofloxacino/uso terapêutico , Penicilinas/imunologia , 2-Piridinilmetilsulfinilbenzimidazóis/administração & dosagem , Biópsia , Feminino , Infecções por Helicobacter/complicações , Helicobacter pylori/efeitos dos fármacos , Humanos , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/patologia , Pessoa de Meia-Idade , Minociclina/administração & dosagem , Ofloxacino/administração & dosagem , RabeprazolRESUMO
The serum iron level reportedly shows transient elevation after chemotherapy in some cases. However, the cause of this phenomenon has not been clearly described. We report two cases of colorectal cancer whose serum iron level demonstrated recurrent elevation after chemotherapy. Both were advanced colorectal cancer cases with liver metastases, so we started chemotherapy with modified FOLFOX6+bevacizumab. After several courses, we changed the regimen to simplified LV5FU2+ bevacizumab in both cases. The serum iron level showed transient, periodical elevation irrespective of the therapeutic regimen. Additionally, indirect bilirubin also showed transient elevation, which was completely synchronized with the fluctuation of the serum iron level. These observations suggest that hemolysis is the main cause of periodic, transient elevation of serum iron level after chemotherapy including 5-FU.