Multicentric adrenocorticotropic hormone -producing steroid cell tumor of the fallopian tube & broad ligament in a 15 year old girl.

Steroid cell tumors occur usually in the ovaries with very few reported cases of extra-ovarian origin. Our patient was a fifteen year old female, complaining from secondary amenorrhea and voice deepening. Values of serum cortisol, DHEA, FSH & LH were normal. Serum Testosterone was elevated while ACTH-pm was markedly elevated. MRI described bilateral solid para-ovarian masses. Exploration revealed two bilateral tubal extraluminal cysts & a right broad ligament cyst which were all excised. Pathological examination led to the diagnosis of steroid cell tumor. Serum testosterone & ACTH returned to normal levels after surgery with subsequent regression of the virilizing symptoms. We can conclude that extra-ovarian steroid cell tumors are extremely rare. They are usually presented with virilizing symptoms and hormonal abnormalities. Surgery is the main line of treatment.

Clinicopathological analysis of clinically occult extrapulmonary lymphangioleiomyomatosis in intra-pelvic and para-aortic lymph nodes associated with pelvic malignant tumors: A study of nine patients.

The clinicopathological and immunohistochemical characteristics of clinically occult extrapulmonary lymphangioleiomyomatosis in lymph nodes (LN-LAM) being dissected during surgical staging of pelvic malignancy have not been well investigated. We assessed samples from nine female patients (median age, 61). None had past or familial history of tuberous sclerosis and had LAM lesions other than LN such as lung. The primary malignancies included four endometrial endometrioid carcinomas, one endometrial carcinosarcoma, three ovarian serous carcinomas and one urothelial carcinoma. Median follow-up was 43 months. The number of affected LNs ranged from 1 to 15 (median, 2) with sizes ranging from 1 to 13 mm (median, 3.0). Six cases had clinically occult LN-LAM only within the pelvic LNs, two only within para-aortic LNs, and one within both pelvic and para-aortic lymph nodes. Immunohistochemically, LAM cells exhibited a strong diffuse positivity for ß-catenin and E-cadherin in all nine cases. Clinically occult LN-LAM mainly affects peri- or post-menopausal women. On rare occasions, occult LN-LAM may manifest as systemic LAM, including in the lung. ß-catenin and E-cadherin carry potential utility as additional diagnostic markers.

Improving the cytological diagnosis of high-grade serous carcinoma in ascites with a panel of complementary biomarkers in cell blocks.

INTRODUCTION: Precise cytological diagnosis of pelvic high-grade serous carcinoma (HGSC) in ascites is important for tumour staging, therapeutic decision-making and prognostic evaluation. However, it can often be difficult to distinguish metastatic HGSC cells from reactive mesothelial cells based on morphology alone. Immunocytochemical analysis of ascites cell blocks has been used to obtain accurate diagnosis and provide a reliable basis for treatment decisions in the clinic. This study was performed to determine whether a panel of antibodies is necessary to achieve high specificity and sensitivity for the identification of HGSC cells. METHODS: Ascites samples from 70 cases (70/253, 27.7%) of histologically confirmed HGSC were postoperatively collected from 2012 to 2015 and were immunocytochemically analysed. RESULTS: The sensitivity and specificity of Ber-EP4 (a marker of HGSC) for detecting HGSC was 85.7% and 82.1%, respectively, whereas the sensitivity and specificity of HBME-1 for identifying mesothelial cells was 100% and 68.3%, respectively. To improve the rate of detection further of HGSC, 29 cases of ascites were also stained for E-cadherin (a marker of HGSC) and calretinin (a marker of mesothelial cells). The combination of Ber-EP4 and E-cadherin as markers of adenocarcinoma cells increased the sensitivity and specificity for HGSC detection to 100% and 88.9%, respectively. Meanwhile, the sensitivity and specificity for mesothelial cell identification increased to 100% and 90%, respectively, when HBME-1 and calretinin were combined. CONCLUSION: This panel of complementary biomarkers is valuable and ideal for the differential diagnosis of HGSC based on ascites cytology.

Synonymous mutation in TP53 results in a cryptic splice site affecting its DNA-binding site in an adolescent with two primary sarcomas.

Pathologic variants in TP53 are known risk factors for the development of cancer. We report a 17-year-old male who presented with two primary sarcomas. Germline sequencing revealed a novel TP53 c.672 G>A mutation. Sequencing revealed wild-type TP53 in the parents, and there was no history of cancer in first-degree relatives. This de novo synonymous germline mutation results in a 5' cryptic splice site that is bound by U1, resulting in a shift of the splice site by 5 base pairs. The frame shift results in a truncated protein at residue 246, which disrupts the DNA-binding domain of p53.

FDG PET-CT for lymph node staging of bladder cancer: a prospective study of patients with extended pelvic lymphadenectomy.

BACKGROUND: The purpose of this study was to evaluate the diagnostic accuracy of [(18)F] fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) for lymph node (LN) staging of bladder cancer patients undergoing radical cystectomy (RC) with extended pelvic lymphadenectomy compared to conventional CT. METHODS: A total of 61 patients underwent FDG PET-CT before RC and extended pelvic lymphadenectomy. A template for extended pelvic lymphadenectomy to the level of the inferior mesenteric artery was divided into 11 anatomic nodal packets. Definitive pathologic findings of resected LNs were correlated with the results of FDG PET-CT and CT alone in a patient- and nodal packet-based manner. RESULTS: Among the 61 patients, pathological staging confirmed LN metastasis in 17 patients (27.9 %). In total, 627 LN packets (2580 LNs) were resected and histologically evaluated. The mean number of LNs removed was 42 (median 40; range 22-118). Of the 627 LN packets removed, 27 packets (4.3 %) were positive for LN metastasis based on pathologic analysis. On a patient-based analysis, FDG PET-CT and conventional CT showed a sensitivity of 47.1 and 29.4 %, respectively, specificity of 93.2 and 97.7 %, respectively, positive predictive value (PPV) of 72.7 and 78.2 %, respectively, and negative predictive value (NPV) of 82.0 and 78.2 %, respectively. On a nodal packet-based analysis, sensitivity, specificity, PPV, and NPV were 14.8, 97.8, 23.5, and 96.2 %, respectively, for PET-CT and 11.1, 98.7, 27.3, and 96.1 %, respectively, for conventional CT. CONCLUSIONS: Combined FDG PET-CT did not improve the diagnostic accuracy of conventional CT for the detection of LN metastasis in bladder cancer patients scheduled for RC.

A Unique Case of Extraovarian Sex-Cord Stromal Fibrosarcoma, With Subsequent Relapse of Differentiated Sex-Cord Tumor.

Primary fibrosarcoma arising from ovarian sex-cord stroma is a very rare neoplasm, with only a few reports in the literature. These tumors have been reported to express inhibin which allows their distinction from fibrosarcomas of soft tissue. Here, we report a case of a fibrosarcoma arising in the broad ligament. Despite being totally separate from the ovary, the tumor was diagnosed as sex-cord stromal type on the basis of inhibin expression. Furthermore, this patient suffered a recurrence of her tumor in the pelvis, which showed both the fibrosarcomatous, as well as other sex-cord elements, confirming the sex-cord stromal differentiation of the sarcoma. To our knowledge, this is the first case of a sex-cord stromal fibrosarcoma arising from an extraovarian site. Furthermore, this is also the first case of a recurrent fibrosarcoma, which showed redifferentiation of the tumor into other sex-cord components.

The presence of mucosal iron in the fallopian tube supports the "incessant menstruation hypothesis" for ovarian carcinoma.

The incessant ovulation hypothesis for the etiology of ovarian carcinoma has been accepted for decades, but recent evidence strongly implicates the fallopian tube mucosa as the source of most high-grade "ovarian serous carcinomas." Menstrual reflux through the tubes, a normal phenomenon, is a putative source of tubal mucosal exposure to carcinogens. We searched for histologic evidence of deposition of iron, a well-recognized carcinogen, in the fallopian tubes in 196 women with advanced-stage high-grade pelvic serous carcinomas in comparison with 370 controls. Tubal hemosiderin and/or pseudoxanthoma cells were found in 20% of the serous carcinoma cases, and an iron stain was positive in 30% of a sample of pigment-negative cases. Controls displayed pigment in 5% (P<0.001). In both cases and controls, pigment was significantly more frequently present in women with endometriosis as compared with those without. We conclude that tubal mucosal iron is present in a significant proportion of women with advanced-stage high-grade pelvic serous carcinoma. As a carcinogen, iron may play a role in the pathogenesis of these tumors. As compared with the incessant ovulation hypothesis, the recently proposed "incessant menstruation hypothesis" may be a better explanation of the well-recognized association of ovarian carcinoma with the length of the reproductive life uninterrupted by pregnancy.

Serous tubal in situ carcinoma (STIC) in primary peritoneal serous carcinomas.

Recent new data in the pathogenesis of serous pelvic cancer and the introduction of serous tubal in situ carcinoma (STIC) and its precursors have raised the question that whether all primary peritoneal cancers (PPC) are in fact of tubal origin. Therefore, the present study evaluates the frequency of STIC and its precursor lesions in cases that were diagnosed as PPC using the morphologic criteria of the most recent WHO classification. The present study evaluates immunohistochemically (Ki-67 and p53 staining) the presence of STIC and its precursor lesions (p53 signature, serous tubal intraepithelial lesion [STIL]) in the completely processed Fallopian tubes of 46 consecutive PPCs. STIC was detected in 10 patients (21.7%) and p53 signature in 9 cases (19.6%). No STIL was observed. All except 1 STIC occurred at the fimbriated end of the Fallopian tube, and a bilateral involvement was detected in 2 cases. These precursor lesions were missed during the initial routine screening. Repeated staining for p53 was negative in STIC in 2 cases. STIC and p53 signature as precursor lesions of pelvic serous cancer are detected in some but not all the cases of primary serous peritoneal cancer. There might be the 2 different carcinogenetic pathways within PPC, and further studies are required to identify the source of serous cancer in cases without an STIC lesion.

Differential expression of p-ERM, a marker of cell polarity, in benign and neoplastic oviductal epithelium.

Serous tubal intraepithelial carcinoma (STIC) is a noninvasive phase of pelvic serous cancer at risk for metastasizing. Because of its biologic significance, its accurate distinction from nonmalignant mimics is important. Loss of cell orientation is an important feature of STIC. We sought to determine whether the immunohistochemical localization of cytoskeletal-organizing proteins phospho-ezrin-radaxin-moesin (p-ERM) would be useful in making this distinction. The benign oviductal entities (normal and p53 signatures), premalignant atypias (tubal intraepithelial lesions in transition), serous intraepithelial carcinomas (STICs), and carcinomas were analyzed for 5 staining patterns and compared. Linear or uniform luminal p-ERM staining was strongly associated with benign mucosa in contrast to STICs, in which it was lost and often replaced by nonlinear or nonuniform patterns highlighting individually cell groups or single cells. Premalignant atypias were similar to benign mucosa by p-ERM staining and retained the linear luminal pattern. This study shows, for the first time, that patterns of staining for an immunohistochemical correlate of cell polarity (p-ERM) differ between STICs, their benign counterparts and premalignant atypias that do not fulfill the criteria for STICs. If confirmed, these findings warrant further analysis of indices of cell polarity as objective markers for the diagnosis and mapping of the evolution of pelvic serous precursors.

Current MR imaging lipid detection techniques for diagnosis of lesions in the abdomen and pelvis.

One application of the unique capability of magnetic resonance (MR) imaging for characterizing soft tissues is in the specific detection of lipid. Adipose tissue may be abundant in the body, but its presence in a lesion can greatly limit differential diagnostic considerations. This article reviews MR imaging fat detection techniques and discusses lesions in the abdomen and pelvis that can be readily diagnosed by using these techniques. Traditional fat detection methods include inversion-recovery and chemically selective fat-suppression pulse sequences, with the former being less sensitive to field heterogeneity and less tissue specific than the latter. Chemical shift-based sequences, which exploit the inherent resonance frequency difference between lipid and water to depict intracytoplasmic fat, have great utility for evaluating hepatic steatosis and lesions such as adrenal and hepatic adenomas, hepatocellular carcinoma, focal lipomatosis of the pancreas, and adrenal cortical carcinoma. The signal from large amounts of fat can be suppressed by using a narrow radiofrequency pulse for selective excitation of fat protons (ie, fat saturation imaging), a technique that increases image contrast resolution and highlights lesions such as contrast-enhancing tissue, edema, and blood products. This technique is especially useful for evaluating renal angiomyolipomas, adrenal myelolipomas, ovarian teratomas, and liposarcomas. MR spectroscopy is a promising method for quantifying absolute liver fat concentration and changes in hepatic triglyceride content during treatment. New and evolving techniques include magnetization transfer and modified Dixon sequences. A solid understanding of these techniques will help improve the interpretation of abdominal and pelvic imaging studies.

[Diagnosis and surgical treatment of solitary fibrous tumor of the pelvis].

OBJECTIVE: To explore the clinical diagnosis and surgical treatment of pelvic solitary fibrous tumor (SFT). METHODS: The data of nine cases of pelvic solitary fibrous tumor from April 2008 to February 2012 were reviewed retrospectively. RESULTS: There were 7 male and 2 female patients in this group with a median age of 56 years, of whom 6 were asymptomatic. Their CT showed the tissue density was inhomogencous. Multivisceral resections were performed in 5 patients. Microscopically, the tumor cells were shuttle-shaped, short spindle-shaped or round, and mitoses was rare, immunohistochemistry: CD34, CD99, Bcl-2, Vimentin positive rates were 100%. One patient died 34 months after the surgery, and there was no recurrence in other patients. CONCLUSION: Pelvic SFT is rare. It is difficult to make an accurate diagnosis. Surgery is the most effective therapy. Multivisceral resections are needed sometimes. The prognosis is good for most patients.

PAX2-null secretory cell outgrowths in the oviduct and their relationship to pelvic serous cancer.

With the exception of germ-line mutations in ovarian cancer susceptibility genes, genetic predictors for women destined for ovarian serous cancer cannot be identified in advance of malignancy. We recently showed that benign secretory cell outgrowths (SCOUTs) in the oviduct are increased in frequency with concurrent serous cancer and typically lack PAX2 expression (PAX2-null). The present study examined the relationship of PAX2-null SCOUTs to high-grade serous cancers by comparing oviducts from women with benign gynecologic conditions and high-grade serous cancers. PAX2-null SCOUTs were identified by immunostaining and computed as a function of location, frequency (F) per number of cross-sections examined, and age. Six hundred thirty-nine cross-sections from 35 serous cancers (364) and 35 controls (275) were examined. PAX2-null SCOUTs consisted of discrete linear stretches of altered epithelium ranging from cuboidal/columnar, to pseudostratified, the latter including ciliated differentiation. They were evenly distributed among proximal and fimbrial tubal sections. One hundred fourteen (F=0.31) and 45 (F=0.16) PAX2-null SCOUTs were identified in cases and controls, respectively. Mean individual case-specific frequencies for cases and controls were 0.39 and 0.14, respectively. SCOUT frequency increased significantly with age in both groups (P=0.01). However, when adjusted for age and the number of sections examined, the differences in frequency between cases and controls remained significant at P=0.006. This study supports a relationship between discrete PAX2 gene dysregulation in the oviduct and both increasing age and, more significantly, the presence of co-existing serous cancer. We propose a unique co-variable in benign oviductal epithelium-the PAX2-null SCOUT-that reflects underlying dysregulation in genes linked to serous neoplasia.

Endometrial stromal sarcoma arising from endometriosis: a clinicopathological study and literature review.

OBJECTIVES: We aimed to investigate the nature of endometrial stromal sarcoma (ESS) arising from endometriosis. METHODS: The clinical data of 5 patients with ESS arising from endometriosis were reviewed retrospectively. The expression of CD117, HER2/neu, EGFR, VEGF, and PDGFR was analyzed by immunohistochemical staining. RESULTS: The median age of the 5 patients was 45 years. The primary tumor sites were the ovary in 2, the pelvis in 2, and the cervical canal in 1 patient. Three patients had disseminated disease at diagnosis. Four patients underwent complete tumor resection. All of the 5 cases received adjuvant chemotherapy and 2 received progesterone therapy, while none were treated with radiotherapy. No recurrence occurred in the 4 cases who had complete tumor resection, and the only patient who progressed was the patient in whom the tumor was unresectable. Tumor cells in all cases exhibited positive staining for PDGFR and were negative for CD117 and HER2/neu. The expression of EGFR and VEGF was observed in 2 and 4 cases, respectively. CONCLUSION: ESS arising from endometriosis is rare. Complete tumor resection in ESS arising from endometriosis may reduce the recurrence rate.

Robot-assisted laparoscopic excision of a pelvic extragastrointestinal stromal tumor: a case report and literature review.

A 61-year-old male presented with long standing urinary frequency and the sensation of incomplete emptying. Computed tomography (CT) revealed a 9.5 cm x 7.9 cm x 6.9 cm pelvic mass behind the bladder and abutting the rectum. The mass was excised using a robotic-assisted laparoscopic approach. Pathologic examination of the mass demonstrated an extragastrointestinal stromal tumor (EGIST), an extremely rare entity. To the best of our knowledge, this is the first EGIST to be found in the rectovesicular pouch of a male and the first to be resected robotically. Our case adds to the understanding of EGISTs and their possible origin and demonstrates that robotic-assisted resection of large pelvic masses can be safe and potentially curative.

High-grade and low-grade pelvic serous neoplasms demonstrate differential p53 immunoreactivity in peritoneal washings.

OBJECTIVE: Serous neoplasms of the female pelvis share a müllerian phenotype. Unlike low-grade serous neoplasms (LGSNs), high-grade serous carcinomas (HGSCs) commonly display p53 mutations. The current study correlates p53 immunoreactivity in peritoneal washings with the cytologic interpretation and histology of the corresponding serous neoplasm. STUDY DESIGN: Peritoneal washings from consecutive cases of pelvic serous neoplasms were identified (n=45, 31 HGSCs and 14 LGSNs), with a control population selected from benign resections. Immunoreactivity for p53 was scored as a percentage of positive epithelioid cells by blinded manual cell count. RESULTS: Washings from LGSNs and HGSCs were cytomorphologically positive with similar frequency (57 vs. 77%, respectively, p=0.15, Fisher's exact test). Immunoreactivity for p53 was not predictive of morphologic positivity. The percentage of p53-positive cells was higher in HGSCs (47±42%), compared to LGSNs (9±9%) and negative controls (2±2%, n=10). The difference in p53 immunoreactivity was statistically significant (p<0.00009, ANOVA). CONCLUSIONS: The proportion of p53 immunoreactive cells was higher in cases of HGSCs, reflecting the importance of p53 mutations in high-grade serous tumorigenesis. The presence of p53 staining is not diagnostic for neoplastic cells; however, peritoneal washings are potential specimens in the investigation of serous neoplasia.

[Morphological features of the fimbria of the fallopian tube in pelvic serous adenocarcinoma].

OBJECTIVE: To study the serous lesions of the fimbria of the fallopian tube in patients with pelvic serous adenocarcinoma and investigate its significance in the serous carcinogenesis. METHODS: To observe the morphological features of the fimbria of the fallopian tube in 43 cases of pelvic serous adenocarcinoma (31 cases of ovarian carcinoma and 12 cases of peritoneal carcinoma). Immunohistochemical examination of p53 expression was performed on samples of 69 fallopian tubes of 40 cases. RESULTS: Fimbria carcinoma was identified in 44 tubes in 31 of 43 cases. Fourteen of the carcinoma foci were ≤ 5 mm. In 68.3% of the fimbria carcinomas demonstrated involvement of the mucosa. Twenty eight tubes of 20 cases exhibited intraepithelial carcinoma. Twenty three of 44 tubes of the fibria carcinomas showed fimbria adherence and unclear appearance. The early histological changes of the fimbria epithelium included proliferation of local secretory cells, homogeneity, and straightening of the mucous folds. Clusters of tumor epithelial cells or single gland with atypical features floated between mucosal folds were found in 71.4% of the fimbria with intraepithelial carcinoma. The positive expression rate of p53 in the fimbria carcinomas and the fimbria intraepithelial carcinomas were 86.4% and 60.7%, respectively. CONCLUSIONS: Fimbria carcinomas is an important component in pelvic serous adenocarcinomas. The fimbria intraepithelial carcinoma is also very common among the cases of pelvic serous adenocarcinoma. The fimbria may be an important primary site of pelvic serous adenocarcinomas.

[Preliminary study on the relationship between tubal intraepithelial carcinoma of the fimbria and pelvic high-grade serous carcinoma].

OBJECTIVE: To explore the relationship between tubal intraepithelial carcinoma (TIC) of the fimbria and pelvic high-grade serous carcinoma. METHODS: All 34 cases of pelvic high-grade serous carcinoma with clear fimbria were evaluated from January 2009 to June 2010, including ovarian carcinoma (n = 26), tubal carcinoma (n = 7) and peritoneal carcinoma (n = 1). Among of these ovarian carcinomas, 12 cases were surface deposits and the other 14 cases within ovarian parenchyma. All 42 cases of non high-grade serous carcinoma in this period including 13 endometrioid ovary carcinomas, 11 clear cell ovary carcinomas, 11 mucinous ovary carcinomas, 6 low-grade serous ovary carcinomas, 1 low-grade serous tubal carcinoma, were also collected as a reference. The presence of tubal intraepithelial carcinomas was assessed. Based on the presence of TIC, high-grade serous ovary carcinomas were divided into TIC positive(+) and TIC negative(-) groups, and the clinical and pathological features of them were also evaluated. RESULTS: Fifteen cases (44%) were identified TIC in 34 high-grade pelvic serous carcinomas, and all of them were in the fimbria only, while none of TIC was found in control cases. There were significant difference between the two groups (χ(2) = 23.086, P = 0.000). Eleven cases (42%) were identified TIC in all 26 high-grade ovarian serous carcinomas, in which 8 cases with unilateral ovary carcinomas were associated with ipsilateral TIC, 2 cases with bilateral ovary carcinomas associated with unilateral TIC and one case with bilateral ovary carcinoma was associated with bilateral TIC. Four TIC (4/7) were identified in 7 cases with high-grade tubal serous carcinomas, and there was no presence of TIC in the 1 high-grade serous peritoneal carcinoma. Of all 26 high-grade ovarian serous carcinomas, 6/11 cases were surface deposits, and 5/11 were parenchyma tumors in TIC(+) group while 6/15 cases were surface deposits and 9/15 were parenchyma tumors in TIC(-) group, in which there were correlated in distribution of TIC between the two groups (P > 0.05). The average diameter of ovarian cancer were 6.9 and 6.5 cm between the two groups with no significant differences (t = 0.409, P = 0.690). CONCLUSION: TIC is specific to high-grade serous carcinomas and maybe have something to do with the pathogenesis of pelvic serous carcinomas.

[Clinicopathologic features of calcifying fibrous tumor with reappraisal of its histogenesis].

OBJECTIVE: To study the clinicopathologic features and histogenesis of calcifying fibrous tumor (CFT). METHODS: The clinical manifestations, histopathologic characteristics and immunophenotype were analyzed in 11 cases of CFT. RESULTS: The male-to-female ratio was 5:6, with a mean age of 38 years and age range of 25 to 52 years. The sites of involvement included abdominopelvic cavity (n=6), soft tissue (n=4) and scrotum (n=1). Most patients presented with a gradually enlarging and painless mass. Nearly half of the cases were associated with other diseases or history of inflammation, trauma or surgical intervention. One third of the tumors represented incidental findings and showed no recurrence after resection. Imaging revealed a solitary solid soft tissue mass or multiple nodules with clear borders and associated high-density calcifications. Macroscopically, the tumors were well-circumscribed but non-encapsulated. They ranged from 0.5 to 20.0 cm in diameter and were tan-greyish, round to oval, lobulated or irregular and solid with rubbery consistency. The cut surface was whitish to tan-yellowish, gritty and showed scattered spotty yellowish discoloration corresponding to the foci of dystrophic calcifications. Histologically, CFT was composed of hyalinized fibrous tissue and thickened vessel walls with interspersed bland spindly fibroblastic cells, scattered psammomatous calcifications, dystrophic calcification and lymphoplasmacytic infiltration. In addition, focal cloak-like polymorph infiltration at the tumor periphery and entrapment of adipocytes and nerves were demonstrated in some cases. Foci resembling solitary fibrous tumor, fibromatosis, keloid or inflammatory myofibroblastic tumor were observed. Immunohistochemical study showed that the tumor cells were diffusely positive for vimentin and focally positive for CD34, factor VIII-related antigen and beta-catenin. The admixed plasma cells were notably IgG positive, with more than 50% being IgG4 positive. CONCLUSIONS: CFT has characteristic histopathologic manifestations and shows morphologic and immunohistochemical overlaps with known IgG4-related sclerosing diseases. It is possible that CFT may represent another example of IgG4-related diseases. It often runs a benign clinical course, with rare recurrence after surgical resection. Previous inflammation and trauma may be the precipitating factors of CFT.

Differentiating renal pelvic cancer from renal cell carcinoma with 18-fluorodeoxyglucose positron emission tomography-computed tomography.

BACKGROUND: The differential diagnosis of pelvis renalis cancer (PRC) from renal cell cancer (RCC) is difficult. Because of that, in this study, we compared the standardized uptake value (SUV) with positron emission tomography-computed tomography (PET-CT) of the RCC and PRC. METHODS: Twenty-one patients (12 males, 9 females; age range: 33-74 years; mean age ± standard deviation [SD]: 57.14 ± 17.6) with suspected primary renal cell cancer as Group 1 and 8 patients (6 male, 2 female; age range, 61-81; mean age ± SD, 71.5 ± 5.65) with suspected renal pelvis cancer as Group 2 detected by conventional imaging techniques (CT, magnetic resonance [MR] imaging, ultrasound, intravenous urogram, CT urography, MR urography) underwent fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT imaging between August 2010 and October 2012. RESULTS: Mean age is 57.14 (33-74) years in Group 1 and 71.5 (61-81) years in Group 2, respectively. The mean maximum SUV (SUVmax) value was 4.6 ± 2.1 in RCC group and 16.6 ± 6.9 in PRC group. At the 18-FDG PET/CT scanning, SUVmax value higher in patients with PRC than in the patients with RCC. It was statistically different (P < 0.001). CONCLUSION: We suggested that PET/CT can be used for the differential diagnosis of renal pelvis tumor and RCC. However, further studies with larger patient number are needed to confirm our suggestion. To clarify the mechanisms of underlying these differences, molecular advanced molecular studies are needed.