RESUMO
We present a case of Merkel cell carcinoma (MCC) coincident with squamous cell carcinoma (SCC) on the breast of a woman with chronic arsenism. This case demonstrates the distinct association of chronic arsenism with two different primary cutaneous carcinomas. Merkel cell polyomavirus (MCPyV) was identified in the lesional skin of the MCC but not in that of the SCC, suggesting there are different interactions of MCPyV in the pathogenesis of SCC and MCC related to arsenic. Physicians need to be vigilant in the occurrence of both SCC and MCC in patients with chronic arsenism. To our knowledge, this is the first study to show the presence of MCPyV in the MCC but not the SCC portion of an arsenic-induced tumour.
Assuntos
Arsênio/toxicidade , Doença de Bowen/induzido quimicamente , Neoplasias da Mama/virologia , Carcinoma de Célula de Merkel/virologia , Carcinoma de Células Escamosas/virologia , Poliomavírus das Células de Merkel/isolamento & purificação , Neoplasias Primárias Múltiplas/virologia , Infecções por Polyomavirus/virologia , Neoplasias Cutâneas/induzido quimicamente , Infecções Tumorais por Vírus/virologia , Idoso , Feminino , HumanosRESUMO
Hepatic angiomyolipoma (AML), a rare benign mesenchymal tumour, is characterised by the presence of mature adipose tissue, smooth-muscle cells and thick-walled blood vessels. Increasing attention to hepatic AMLs has led to the discovery that sufficient proportions of fat often allow for definite diagnoses preoperatively. However, the proportion of fatty tissue in these tumours is highly variable. One case of hepatic AML is reported, where the amount of fat was <1%. In this case, the viral hepatitis markers, including hepatitis B antigen and anti-hepatitis C virus antibody, were negative. The serum alpha-fetoprotein level was 3.4 ng/ml and in the normal range. Abdominal ultrasonography showed a hypoechoic mass measuring 5 cm in diameter and without an obvious capsule in the left lobe of the liver. A dynamic computed tomography scan showed a well-defined and slightly enhanced mass in the medial segment of the left lobe of the liver. Angiography showed that the mass was hypervascular in character. As hepatocellular carcinoma was highly suspected from these preoperative image studies, a left lobectomy was carried out. Microscopically, the amount of fat was too low to establish a diagnosis of hepatic AML. However, positive homatropine methylbromide 45 immunoreactivity of the smooth-muscle cells seemed to assist in arriving at the diagnosis.
Assuntos
Tecido Adiposo/patologia , Angiomiolipoma/patologia , Neoplasias Hepáticas/patologia , Adulto , Angiomiolipoma/diagnóstico , Angiomiolipoma/diagnóstico por imagem , Biomarcadores Tumorais/análise , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X , Tropanos/análiseRESUMO
BACKGROUND: Intraductal papillary-mucinous carcinoma (IPMC) of the pancreas is a newly identified clinicopathologic entity of the exocrine pancreas. It has been considered a slowly growing and less-aggressive carcinoma with a favorable prognosis. There have been only a few documents reporting its distant metastasis and cytologic features, with no report of thyroid metastasis until the present. CASE: A case of IPMC occurred in a 45-year-old male, who was admitted with rapid growth and tenderness of the thyroid. Abdominal computed tomography showed the typical cystic dilatation of IPMC with adjacent organ metastasis. Fine needle aspiration of the thyroid yielded papillary fronds of carcinoma cells with nuclear pleomorphism, abundant cytoplasm and prominent nucleoli in a mucinous background. Immunohistochemical findings from the skin and thyroid characterized the papillary-mucinous carcinoma as having originated in the pancreas. CONCLUSION: This case suggests that papillary carcinoma fronds aspirated from the thyroid should be further differentiated from the primary site and that a pleomorphic nucleus in a mucinous background is a useful feature to exclude a thyroid origin. Before this, distant metastasis of IPMC to the skin and thyroid has not been reported. The prognosis of IPMC with wide, distant metastasis at an advanced stage is poor.
Assuntos
Adenocarcinoma Mucinoso/secundário , Carcinoma Ductal Pancreático/secundário , Carcinoma Papilar/secundário , Neoplasias Pancreáticas/patologia , Neoplasias da Glândula Tireoide/secundário , Adenocarcinoma Mucinoso/patologia , Biópsia por Agulha , Carcinoma Ductal Pancreático/patologia , Carcinoma Papilar/patologia , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/patologiaRESUMO
Bladder wall calcification has relatively few etiologies. We present such a case and review the literature to discuss it and the method for management. This case suffered from bladder wall calcification about 3 years after intravesical chemotherapy of mitomycin C. It was found accidentally during the transurethral resection of recurrent bladder tumor. The pathology confirmed the recurrence of transitional cell carcinoma combined with marked calcification. A repeat cystoscopy was done 3 months later. Massive calcified deposits in bladder wall especially in lesion of previous transurethral resection were still noted. Randomized biopsy showed dystrophic calcification without evidence of malignancy. We suggest that biopsy and/or resection (if possible) is a reasonable approach to eliminate the possibility of invasive bladder cancer.
Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Calcinose/induzido quimicamente , Mitomicina/efeitos adversos , Doenças da Bexiga Urinária/induzido quimicamente , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagemRESUMO
Inverted follicular keratosis (IFK) is a benign skin lesion that typically presents as an asymptomatic, solitary nodule on the face of middle-aged and older individuals. IFK may mimic malignant lesions, especially squamous cell carcinoma (SCC), both clinically and pathologically. We report a 35-year-old male patient who had an exophytic nodule with papillary surface on his right nasal ala of 3 months' duration. The nodule was solitary, flesh colored, 5 mm in diameter and tended to bleed. The patient received shave excision with cautery under the clinical impression of pyogenic granuloma. Pathologically, diagnostic confusion existed between IFK and SCC. Squamous eddy formation and lack of epithelial dysplasia were suggestive of IFK. The tissue was investigated for the presence of human papillomavirus (HPV) DNA sequences by polymerase chain reaction (PCR) and negative result was obtained. This patient healed satisfactorily after removal of the lesion and no visible recurrence occurred during the following 10 months. The possibility of histologically confusing IFK with SCC, leading to unwarranted disfiguring treatments of a benign lesion, is emphasized.
Assuntos
Ceratose/patologia , Adulto , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , DNA Viral/análise , Diagnóstico Diferencial , Humanos , Ceratose/diagnóstico , Masculino , Papillomaviridae/isolamento & purificaçãoRESUMO
Primary abscess of the omentum is an infrequent disease entity. We report a case of 60-year-old male patient who suffered from left lower quadrant abdominal pain with localized abdominal wall tenderness, nausea and high-grade fever for the previous few days. Computerized tomography scan revealed a heterogeneous lesion that adhered to the abdominal wall. A pre-operative diagnosis of colonic diverticulitis complicated with intra-abdominal abscess was made and a laparotomy was done. At surgical exploration, an indurate mass consisting of abscess within the omentum was identified. The surgical procedure consisted of resection of the omental abscess with abdominal wall debridement, and subsequent antimicrobial therapy was administered. Postoperatively, the patient recovered uneventfully. Clinicians who treated such patients should be aware of this problem because of the difficulty of preoperative diagnosis.
Assuntos
Abscesso/complicações , Omento , Abscesso/patologia , Abscesso/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The HER-2/neu proto-oncogene amplification or oncoprotein overexpression is an important prognostic factor and a predictive factor for resistance to endocrine therapy and adjuvant chemotherapy in breast cancers. Moreover, it is an entry criterion in the assessment of patients for whom Herceptin (Trastuzumab) treatment is considered. The overexpression rate of HER-2/neu oncoprotein has been identified in 10% to 40% of human breast cancers. In Taiwan, a higher grade of pathobiologic characteristics of familial breast cancer was also noted than that found in the non-familial group. It is worthwhile to evaluate whether the overexpression is more frequent in familial breast cancers. Fifty-six familial and 111 non-familial breast cancers were studied between 1990 and 1999 to assess both the overexpression of HER-2/neu oncoprotein immunohistochemically and the correlation with the histological type, grade and stage of breast carcinoma. The overexpression rate is higher in the familial breast cancer group (50.0%) when compared with non-familial breast cancer group (36.9%), which did not prove to be statistically significant (P = 0.1068). However, when the infiltrating ductal carcinomas of both groups are compared, it is statistically significant (52.3% vs. 33.7%, P = 0.0429). Overexpression correlated with node status and histological grade of infiltrating ductal carcinomas in non-familial and overall breast cancers. It also correlated with nuclear pleomorphism and mitotic counts, but not tubule formation or tumor size. All 3 cases of Paget's disease revealed overexpression, whereas all 12 cases of mucinous and one case of metaplastic carcinoma and one case of medullary carcinoma were negative. The overexpression rate was higher both in familial and non-familial intraductal carcinomas (57.1% vs. 73.3%, P = 0.4716). No statistical difference was identified between the 2 subsets. A case of infiltrating ductal carcinoma combined with intraductal carcinoma revealed heterogeneous staining in the component of ductal carcinoma in situ, while the invasive component did not. This suggests that overexpression decreases within individual tumors as they evolve from in situ to invasive lesioins. The HER-2/neu may imply a different role in intraductal carcinoma, Paget's disease and invasive duct carcinoma. Although the overexpression rate of HER-2/neu oncoprotein of familial breast cancer was not significantly higher than that of the non-familial group, it is appropriate to evaluate the rate of HER-2/neu overexpression according to the histological type of breast cancers from familial breast cancer and non-familial breast cancer. The prognoses will be needed for future evaluation.
Assuntos
Neoplasias da Mama/química , Receptor ErbB-2/análise , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/química , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Proto-Oncogene MasRESUMO
Congenital glomus tumor is a rare variant of glomus tumor, and glomangiomyoma is the least frequent histological type of glomus tumor. We present a case of congenital multiple plaque-like glomangiomyoma in an 11-year-old child with multiple diffuse plaques on his right lateral trunk. Histopathologic study showed a picture of typical glomus cell undergoing transition to smooth muscle cell. After literature review, this might be the first case report of congenital multiple plaque-like glomus tumor in trunk with histological appearance of a glomangiomyoma.
Assuntos
Tumor Glômico/congênito , Tumor Glômico/patologia , Criança , Humanos , MasculinoRESUMO
We present a rare case of Kimura's disease of bilateral upper eyelids. A 41-year-old Chinese male had multiple masses over retroauricular, submandibular regions and bilateral upper eyelids since 13 years previously. Tumor recurred after each surgical excision, chemotherapy and Co 60 radiotherapy. Eosinophilia and elevation of blood immunoglobulin E (IgE) were noted in this admission. We operated on left upper eyelid to relieve the blocking of vision. A diffuse infiltration with numerous fibrotic bands was noted. Histological section showed a lymphoid hyperplasia, remarkable infiltration of eosinophils and proliferation of capillaries. Oral prednisolone 60 mg was given postoperatively. The patient had a satisfactory appearance and a relief of visual block.
Assuntos
Hiperplasia Angiolinfoide com Eosinofilia/patologia , Doenças Palpebrais/patologia , Adulto , Hiperplasia Angiolinfoide com Eosinofilia/diagnóstico , Hiperplasia Angiolinfoide com Eosinofilia/terapia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/terapia , Humanos , MasculinoRESUMO
The purpose of this study is to evaluate whether there are pathobiologic differences and differences in overall rates survival between familial and non-familial breast cancer patients in Taiwan. A retrospective study was performed evaluating 76 familial breast cancer patients in 69 families, which included two BRCA1 related cases and six BRCA2 related cases. Patients were compared with 425 non-familial sporadic cases. Familial breast cancer patients had similar ages and stages as non-familial patients (mean, 46.6 years vs 48.9 years, p = 0.306). However, the familial breast cancer patients with BRCA1 and BRCA2 related cases presented at lower stages (p = 0.034) and younger ages than non-familial patients (mean, 45.1 years vs 48.9 years P = 0.042). The occurrence of infiltrating ductal carcinoma and lobular carcinoma in situ was not significantly different in the two groups. Mucinous carcinoma was represented with 6.7% (4/76) and 1.3% (1/76) medullary carcinoma. The overall grade of familial breast cancer, including BRCA1 and BRCA2 related cases in 8 infiltrating ductal carcinoma, was significantly higher than that of controls. The mean follow up was 4.5 years for familial breast cancers. Five- and 10-year overall survival rates were 69% and 61% for those with a family history, compared with 86% and 64% for those in the control group (p = 0.644). There were no statistically significant differences in disease-free survival rates between the two groups at 5 or 10 years (69% vs 78% in 5 years; 48% vs 58% in 10 years) (p = 0.862). Despite the younger ages and earlier stages at presentation in familial breast cancer patients with BRCA1 and BRCA2 related cases, the familial breast cancer patients had higher grade patholobiologic characteristics, but similar prognoses when compared with sporadic breast cancer patients. Owing to the limited number of familial cases in this study, more cases and longer follow up are needed.
Assuntos
Neoplasias da Mama/genética , Proteína BRCA2/genética , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Feminino , Seguimentos , Genes BRCA1 , Humanos , Estadiamento de Neoplasias , Taxa de SobrevidaRESUMO
A primary renal lipoma is a very rare neoplasm of the kidney and only 20 cases have been reported in the literature. We report a case of a huge retroperitoneal mass that presented as a hypervascular tumour with a prominent fat component, mimicking an angiomyolipoma or a liposarcoma in imaging studies. This finding presented a diagnostic challenge in terms of selecting medical versus surgical intervention. Surgical excision of the lesions was performed and the pathological evaluation revealed a renal lipoma with extrarenal growth.
Assuntos
Angiomiolipoma/diagnóstico , Neoplasias Renais/diagnóstico , Lipossarcoma/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
Video-assisted thoracoscopic surgery (VATS) is a newly developed technique, the advantages of which mainly benefit the patient. Its feasibility and indications have been described widely, but to the best of our knowledge no report of the successful VATS management of a large mediastinal teratoma has ever been documented. When such a tumor is encountered, conversion to thoracotomy would usually be carried out. We report our experience of removing a large teratoma, 8 x 7 x 11 cm in size, from the anterior mediastinum, employing VATS and utilizing only four small intercostal incisions without spreading the ribs.
Assuntos
Neoplasias do Mediastino/cirurgia , Teratoma/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Teratoma/diagnóstico por imagem , Teratoma/patologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Our goal was to determine whether dynamic MR subtraction images could be used to detect and stage gastric tumors. METHOD: Dynamic MR subtraction images were prospectively performed in 20 patients without gastric lesions and in 39 patients with gastric tumors. The flat- or depressed-type early gastric cancers were excluded. The MR findings were assessed for layered pattern of the normal gastric wall, detectability of tumors, enhanced pattern of tumor, and depth of the tumor invasion. Surgical specimens were obtained from 30 of the patients with tumors, and histopathologic sections were made in the dynamic MR scanning direction. RESULTS: The three-layered structure of the normal gastric wall was apparent in more of the dynamic MR subtraction images (60%) than of the nonsubtraction images (30%) in the control group. All 39 gastric tumors were detected by MRI. The intact inner layers overlying stromal tumors and outer layers interrupted by advanced gastric cancers were clear on the subtracted images. MRI accurately T-staged 88% of the gastric cancers. CONCLUSION: Dynamic MR subtraction images can be used to identify gastric tumors and to stage gastric cancers.
Assuntos
Meios de Contraste , Aumento da Imagem , Imageamento por Ressonância Magnética , Neoplasias Gástricas/diagnóstico , Técnica de Subtração , Adulto , Idoso , Feminino , Gastrectomia , Mucosa Gástrica/patologia , Humanos , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Prospectivos , Sensibilidade e Especificidade , Neoplasias Gástricas/patologiaRESUMO
The aim of this study is to evaluate the effect of ultraviolet B (UVB) on arsenic-induced Bowen's disease. Four patients were irradiated with 750 mJ/cm2 of UVB and biopsies were performed before treatment and 2 weeks later. Immunohistochemical stains of p53 and Ki-67 were compared by the labelled-streptavidin method before and after the UVB treatment. We found that the number of p53 and Ki-67 positive cells after the UVB treatment were significantly fewer than those of non-UVB-treated specimens. These results suggest that the UVB inhibitory effect in Bowen's disease needs further studies to clarify its value in potentially retarding the progression of the hyperproliferative status in overt skin cancer on a molecular basis.
Assuntos
Arsênio/efeitos adversos , Doença de Bowen/etiologia , Doença de Bowen/terapia , Antígeno Ki-67/biossíntese , Antígeno Ki-67/efeitos da radiação , Proteína Supressora de Tumor p53/antagonistas & inibidores , Proteína Supressora de Tumor p53/efeitos da radiação , Terapia Ultravioleta , Doença de Bowen/patologia , Humanos , Antígeno Ki-67/análise , Masculino , Coloração e Rotulagem , Proteína Supressora de Tumor p53/biossínteseRESUMO
An 81-year-old woman came to our clinic (Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan) with multiple erythematous, indurated papules over the left side of her face. Two years earlier, the patient had a skin biopsy done at a similar anatomical area with the histopathological diagnosis of Bowen's disease. After reviewing surgical specimens and confirming no systemic involvement, clear cell eccrine porocarcinoma with extensive cutaneous metastasis has been diagnosed. In addition, the peripheral blood lymphocyte function of the patient was evaluated. The expression of interleukin-2 receptors on lymphocytes after stimulation is abnormal compared with the age-matched normal control and a patient with cutaneous squamous cell carcinoma. This clinical manifestation of eccrine porocarcinoma is exceptional, and lymphocyte dysfunction in this patient has probably contributed to extensive cutaneous metastasis.
Assuntos
Acrospiroma/patologia , Neoplasias Cutâneas/secundário , Neoplasias das Glândulas Sudoríparas/patologia , Acrospiroma/imunologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfócitos/imunologia , Receptores de Interleucina-2/sangue , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/imunologiaRESUMO
PURPOSE: To evaluate the potential use of technetium 99m (99mTc) (V) dimercaptosuccinic acid (DMSA) scintigraphy in the detection and localization of intestinal inflammation. MATERIALS AND METHODS: In a prospective study, 62 patients who were suspected of having intestinal inflammation and 30 control subjects were enrolled. All patients underwent 99mTc (V) DMSA scintigraphy and colonoscopy with biopsy within 1 week. 99mTc (V) DMSA scintigrams were interpreted blindly with respect to clinical information, and radiotracer uptake in the bowel segments was graded. The findings were then compared with the results of the colonoscopy and colonoscopic biopsy. RESULTS: In the detection of intestinal inflammation, findings at 99mTc (V) DMSA scintigraphy were as follows: true-positive in 55, false-positive in two, true-negative in 32, and false-negative in three. Overall sensitivity was 95%; overall specificity, 94%; and overall accuracy, 95%. CONCLUSION: Our results show that 99mTc (V) DMSA scintigraphy is a useful noninvasive diagnostic test for the detection and localization of intestinal inflammation.