RESUMEN
Mucinous differentiation of the endometrium can occur in a spectrum of changes ranging from benign (metaplasia) to malignant (adenocarcinomas with mucinous differentiation). A rarer differential which is usually not considered is a teratoma. We present a case of a 55-yr-old woman with history of irregular perimenopausal bleeding. Endometrial curetting revealed proliferative mucinous epithelium on histology raising a possibility of low-grade epithelial mucinous malignancy. Hysterectomy was performed and histologic examination revealed a diagnosis of uterine mature teratoma. Mature cystic teratoma of the lower uterine segment is very rare and presence of just one element such as mucinous epithelium can lead to a misdiagnosis of carcinoma on biopsy or curetting.
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Endometrio , Teratoma , Endometrio/patología , Endometrio/cirugía , Epitelio/patología , Femenino , Humanos , Histerectomía , Teratoma/patología , Útero/patologíaRESUMEN
Objective: To identify and compare significant or relevant prognostic factors in pre-operatively diagnosed, surgically resectable, gallbladder cancer and in incidentally detected gallbladder cancer cases. Material and methods: Gallbladder resections (October 2009-March 2016) were identified on the histopathology Winpath database. Cases with a final histological diagnosis of gallbladder cancer (GBC) were categorised into: Group A: clinically suspected operable GBC (n = 13). Group B: incidental GBC with staged liver bed resection (n = 5). Group C: incidental GBC without staged liver bed resection (n = 15). The clinicopathological features were analysed in each group separately. Results: The overall incidence of primary (GBC) was 0.66% and all the cases were adenocarcinomas, of which, 6 of 33 (18.2%) were grade 1 and 15 of 33 (45.4%) were grade 3. Male to female ratio is 1:2.3. Of the 33 patients with GBC 14 (42.4%) has died of disease at 18-month follow-up. 15 of 33 had perineural invasion and 10/21 (47.6%) cases showed lymph node matastasis. Six cases had positive surgical margin and 9/15 showed direct liver invasion. Higher stage disease (T3/T4) was seen in 10/14 cases. Conclusion: The prognosis of primary GBC is poor and best clinical outcomes can be achieved with early diagnosis followed by radical cholecystectomy and staged liver resection with negative margins.
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Carcinoma in Situ , Neoplasias de la Vesícula Biliar , Carcinoma in Situ/cirugía , Colecistectomía , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/patología , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Escisión del Ganglio Linfático , Masculino , Márgenes de Escisión , Pronóstico , Reino Unido/epidemiologíaRESUMEN
Extrapleural solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm, presenting most commonly in the intrathoracic sites but which has been reported at numerous extrathoracic locations. The majority of intra-thoracic SFTs are benign, but 10%-15% behave aggressively. We report a case of primary hepatic SFT with histologically benign and malignant areas. A 65-year-old man underwent an abdominal CT scan following a cerebrovascular accident, which demonstrated a sharply demarcated large liver mass with a heterogenous enhancing area and occupying most of the left lobe of the liver. Histological examination following a hemihepatectomy showed an SFT with morphological patterns ranging from benign to malignant areas, including pleomorphism, increased cellularity, herringbone pattern, necrosis and a raised mitotic count. On review of the literature, only an occasional case report with malignant areas in a hepatic SFT was identified. This case highlights that SFT should be included in the differential diagnosis of a hepatic spindle cell lesion, and that on rare occasions, malignant areas can occur in this already uncommon neoplasm.
Asunto(s)
Neoplasias Hepáticas/patología , Neoplasias Complejas y Mixtas/patología , Tumores Fibrosos Solitarios/patología , Anciano , Biomarcadores de Tumor/análisis , Biopsia , Hepatectomía , Humanos , Inmunohistoquímica , Hallazgos Incidentales , Neoplasias Hepáticas/química , Neoplasias Hepáticas/cirugía , Masculino , Mitosis , Necrosis , Neoplasias Complejas y Mixtas/química , Neoplasias Complejas y Mixtas/cirugía , Tumores Fibrosos Solitarios/química , Tumores Fibrosos Solitarios/cirugía , Tomografía Computarizada por Rayos XRESUMEN
AIM: To retrospectively evaluate the characteristic clinicopathological spectrum in patients with suspicion of IgG4-related disease (IgG4RD). METHODS: Winpath histology database from January 2011 to April 2018 identified all suspected IgG4RD cases wherein IgG4 immunohistochemistry was performed. The histology slides were reviewed to categorise cases into Boston criteria groups-highly suggestive of IgG4RD, probable IgG4RD and insufficient evidence. Information regarding clinical data, treatment received, follow-up and serum IgG4 levels was obtained from medical records and AllScripts Patient Administration System (APAS) clinical database. RESULTS: The study included 204 patients and the most common sites of biopsy/resection were pancreas and duodenum. The most common clinical presentation was fibroinflammatory lesion or mass/lump. On histology, 54/204 (26.47%) cases showed typical storiform fibrosis, 65/204 (32.64%) had >10 IgG4+ plasma cells per high power field and only one case showed thrombophlebitis (0.49%). There were 14/204 (6.78%) cases categorised as highly suggestive of IgG4RD; 8 of these showed high serum IgG4 levels and were managed clinically as true IgG4RD. CONCLUSION: Histological diagnosis of IgG4RD remains challenging, as not all characteristic features are always present especially in small biopsies. Due to the novelty of its experience, fear of over diagnosis in the context of malignancy and features overlapping with diseases of similar clinical scenario, diagnosis of IgG4RD has become more puzzling. Further multicentre clinical trials/studies are advisable.
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Enfermedades Autoinmunes , Enfermedad Relacionada con Inmunoglobulina G4 , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Enfermedad Relacionada con Inmunoglobulina G4/patología , Estudios Retrospectivos , Biopsia , Inmunoglobulina G , Reino Unido/epidemiología , Enfermedades Autoinmunes/diagnósticoRESUMEN
Malignancy arising within a gastric duplication cyst (GDC) is extremely rare; only 15 cases have been reported in the literature. We present a 70-year-old woman who was referred with a history of vague postprandial abdominal discomfort. Subsequent imaging identified a gastric cystic mass. A laparoscopic sleeve gastrectomy of a 90 × 60 × 60-mm cystic mass was performed. Histopathological examination showed the presence of a sarcomatoid carcinoma arising within a GDC. The patient, unfortunately, died 5 months after surgery with metastatic disease. To the best of our knowledge, this is the first case of sarcomatoid carcinoma arising within a GDC.
RESUMEN
Pancreatic Ductal Adenocarcinoma (PDAC) and biliary-tract cancers (BTC) often present at a late stage, and consequently patients have poor survival-outcomes. Circular RNAs (circRNAs) are non-coding RNA molecules whose role in tumourigenesis has recently been realised. They are stable, conserved and abundant, with tissue-specific expression profiles. Therefore, significant interest has arisen in their use as potential biomarkers for PDAC and BTC. High-throughput methods and more advanced bioinformatic techniques have enabled better profiling and progressed our understanding of how circRNAs may function in the competing endogenous RNA (ceRNA) network to influence the transcriptome in these cancers. Therefore, the aim of this systematic review was to describe the roles of circRNAs in PDAC and BTC, their potential as biomarkers, and their function in the wider ceRNA network in regulating microRNAs and the transcriptome. Medline, Embase, Scopus and PubMed were systematically reviewed to identify all the studies addressing circRNAs in PDAC and BTC. A total of 32 articles were included: 22 considering PDAC, 7 for Cholangiocarcinoma (CCA) and 3 for Gallbladder Cancer (GBC). There were no studies investigating Ampullary Cancer. Dysregulated circRNA expression was associated with features of malignancy in vitro, in vivo, and ex vivo. Overall, there have been very few PDAC and BTC tissues profiled for circRNA signatures. Therefore, whilst the current studies have demonstrated some of their functions in these cancers, further work is required to elucidate their potential role as cancer biomarkers in tissue, biofluids and biopsies.
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BACKGROUND: The most common tumours of the adrenal gland are adenoma, pheochromocytoma, adrenocortical carcinoma, and metastases. Although the imaging features of these tumours are established, the imaging characteristics of uncommon adrenal masses are less well known. In patients with extradrenal tumour, incidental discovery of an adrenal mass necessitates excluding the possibility of metastatic malignancy. CASE PRESENTATION: A 52 year-old female was diagnosed with oesophageal adenocarcinoma and treated with oesophagectomy and adjuvant chemotherapy. Sixteen months later on staging CT scan a 2 x 2 cm adrenal mass was detected, which increased in size over a period of time to 3 x 3 cm in size. Adrenalectomy was performed and histological examination revealed metastatic adenocarcinoma within an adrenal adenoma. CONCLUSION: The present case highlights the unusual behaviour of an oesophageal adenocarcinoma causing metastasis to an adrenocortical adenoma.
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Adenocarcinoma/secundario , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias Esofágicas/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Biopsia con Aguja , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Medición de Riesgo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Human spleen, though being the largest component of reticuloendothelial system, is a very rare site of tumor metastases. Splenic metastases are usually seen as part of multi-organ involvement. Autopsy study conducted over a period of 10 years revealed that the incidence of neoplastic involvement of spleen was 1.45% (70/4812). Primary malignant involvement of spleen was also noted to be a rare entity in present study.
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Neoplasias del Bazo/patología , Neoplasias del Bazo/secundario , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Autopsia , Niño , Preescolar , Femenino , Humanos , Incidencia , Neoplasias Pulmonares/patología , Linfoma/patología , Masculino , Persona de Mediana Edad , Bazo/patología , Neoplasias del Bazo/epidemiologíaRESUMEN
This is a case report of a mesenchymal tumor of uterus in a 60 year female initially interpreted as myxoid leiomyosarcoma. Immunohistochemical studies were negative for smooth muscle actin, desmin and p53 but positive for S-100 protein. The tumor was therefore reclassified as a low grade malignant mesenchymal tumor of neural origin.
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Sarcoma/patología , Neoplasias Uterinas/patología , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Leiomiosarcoma/diagnóstico , Persona de Mediana Edad , Proteínas S100/metabolismo , Sarcoma/diagnóstico , Sarcoma/metabolismo , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/metabolismoRESUMEN
Gall bladder malignancy predominantly comprises adenocarcinoma and is found mostly in a late stage whereas primary lymphoma of mucosa associated lymphoid tissue (MALT) within the gall bladder is exceedingly rare and has an incidental presentation. We report a case of well differentiated adenocarcinoma with MALT lymphoma of the gall bladder in an 83 year old woman. To our knowledge, this is the first case of a carcinoma and lymphoma occurring simultaneously in the gall bladder.
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Adenocarcinoma/patología , Neoplasias de la Vesícula Biliar/patología , Linfoma de Células B de la Zona Marginal/patología , Neoplasias Primarias Múltiples/patología , Adenocarcinoma/cirugía , Anciano de 80 o más Años , Biopsia , Diferenciación Celular , Cistectomía , Femenino , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Linfoma de Células B de la Zona Marginal/cirugía , Neoplasias Primarias Múltiples/cirugíaAsunto(s)
Braquiterapia/efectos adversos , Neoplasias Hepáticas/terapia , Microesferas , Radioisótopos de Itrio/uso terapéutico , Adenocarcinoma/patología , Adulto , Colecistectomía , Colecistitis/etiología , Embolización Terapéutica/métodos , Femenino , Vesícula Biliar/efectos de la radiación , Hepatectomía , Humanos , Neoplasias Hepáticas/secundario , Neoplasias del Recto/patologíaRESUMEN
Cardiac sarcoidosis has been known to give rise to heart failure, arrhythmias and sudden cardiac death. We have a large database of sudden cardiac death cases at the CRY Centre for Cardiac Pathology at Imperial College, London, UK in which we found 17 of 1,720 cases with a diagnosis of cardiac sarcoid. Macroscopic examination showed a variety of findings including left ventricular hypertrophy, a dilated thin-walled left ventricle, areas of fibrosis, changes resembling arrhythmogenic right ventricular cardiomyopathy and in some cases, no gross abnormalities. Histological examination revealed large areas of fibrosis and focal lymphocytic inflammation mimicking infarction/myocarditis. Careful search had to be made for non-necrotizing granulomata, since the lymphocytic foci, fibrosis and granulation tissue often predominated throughout the heart. The conduction tissue is often not sampled at autopsy despite the history of heart block. The heterogeneous nature of the macroscopic appearance and histological findings means that widespread sampling of the heart and the conduction system is essential in cases of sudden death in order that a diagnosis of myocardial sarcoidosis is not missed.
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Cardiomiopatías/complicaciones , Cardiomiopatías/patología , Muerte Súbita Cardíaca/etiología , Sarcoidosis/complicaciones , Sarcoidosis/patología , Adulto , Anciano , Anciano de 80 o más Años , Displasia Ventricular Derecha Arritmogénica/patología , Fibrilación Atrial/patología , Autopsia , Cardiomiopatías/diagnóstico , Diagnóstico Diferencial , Femenino , Fibrosis/patología , Sistema de Conducción Cardíaco/patología , Insuficiencia Cardíaca/patología , Ventrículos Cardíacos/patología , Humanos , Hipertrofia Ventricular Izquierda/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sarcoidosis/diagnósticoRESUMEN
BACKGROUND: Primary lymphomas of mucosa associated lymphoid tissue (MALT) within the gall bladder are exceedingly rare and may have an incidental presentation. CASE REPORT: We report a case of gall bladder MALT lymphoma diagnosed after cholecystectomy in a 65-year old woman. CONCLUSION: Normally the gall bladder is devoid of lymphoid tissue; however, it has been suggested that MALT lymphomas may occur secondary to chronic cholecystitis with cholelithiasis or bacterial infection based on similar mechanism as described previously in the stomach and conjunctiva. Surgical resection is considered curative if the disease is localised only to the gall bladder.
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Neoplasias de la Vesícula Biliar/patología , Linfoma de Células B de la Zona Marginal/patología , Neoplasias Primarias Múltiples/patología , Anciano , Colecistectomía , Femenino , Humanos , PronósticoRESUMEN
OBJECTIVE: To analyze the importance of unique cytoarchitectural patterns and the immunohistochemical profile in the diagnosis of myoepithelial carcinomas. DESIGN: Retrospective case analysis. SETTING: Tertiary cancer center. PATIENTS: A total of 51 patients with myoepithelial-rich carcinomas diagnosed over a 14-year period were studied for demographic data and tumor histologic characteristics and biologic behavior. MAIN OUTCOME MEASURES: We analyzed various histopathologic parameters and an immunohistochemical profile consisting of pan-cytokeratin (Pan-CK), epithelial membrane antigen (EMA), CD10, smooth-muscle actin (SMA), S-100 protein, p63, calponin, and carcinoembryonic antigen (CEA). RESULTS: The parotid gland (n = 15) and the palate (n = 15) were common sites involved. The cell types encountered were epithelioid, stellate, plasmacytoid, spindle, clear, and mixed with myxoid, hyaline, or myxohyaline stroma. Immunohistochemical analysis revealed vimentin (100%), CK (74%), EMA (27%), CD10 (62%), SMA (35%), S-100 protein (82%), p63 (28%), and calponin (98%) positivity and CEA (100%) negativity. Cervical node dissection was performed in 17 cases: 7 showed nodal metastasis, 2 with pure spindle-cell morphologic characteristics and 3 with spindle cells mixed with other cells. Distant metastasis was noted in 3 of these 7 cases: 2 of these 3 cases showed spindle-cell morphologic characteristics. CONCLUSIONS: Myoepithelial carcinomas showed varied cell types and patterns leading to a wide range of differential diagnoses. Immunohistochemical analysis helped determine the diagnosis. Spindle morphologic characteristics were observed with nodal and distant metastasis.
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Ganglios Linfáticos/patología , Mioepitelioma/patología , Invasividad Neoplásica/patología , Recurrencia Local de Neoplasia/patología , Neoplasias de las Glándulas Salivales/patología , Adolescente , Adulto , Anciano , Biopsia con Aguja , Instituciones Oncológicas , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , India , Estimación de Kaplan-Meier , Escisión del Ganglio Linfático/métodos , Masculino , Persona de Mediana Edad , Mioepitelioma/mortalidad , Mioepitelioma/terapia , Recurrencia Local de Neoplasia/mortalidad , Procedimientos Quirúrgicos Orales/métodos , Radioterapia Adyuvante , Estudios Retrospectivos , Medición de Riesgo , Neoplasias de las Glándulas Salivales/mortalidad , Neoplasias de las Glándulas Salivales/terapia , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), accounts for â¼5% of all cases of Hodgkin lymphoma and is characterized by involvement of the peripheral lymph nodes. NLPHL occurs in young adults and is associated with frequent relapses. In 3% to 7% of cases, NLPHL progresses to a diffuse large B cell lymphoma. Furthermore, a proportion of NLPHL also have areas with features of T cell/histiocyte-rich large B cell lymphoma (THRLBCL), either at presentation or on follow-up. Here, we describe a 32-year-old man who presented to the emergency department with small bowel perforation. The resected small bowel showed full-thickness mural ulceration and involvement by a lymphoma with features of NLPHL that also had areas resembling THRLBCL. The patient had axillary lymphadenopathy, biopsy of which showed NLPHL with focal THRLBCL-like areas. Such a lymphoma presenting as small intestinal lesion/perforation has not been reported in the literature before. We take this opportunity to review the literature on extranodal presentations of NLPHL and discuss the natural history of this disease.
RESUMEN
Cardiac lymphomas are rare neoplasms and account for a minor proportion of primary cardiac malignancies. Secondary involvement of the heart and pericardium by systemic lymphoma is well documented, but primary lymphomas of heart and pericardium are extremely rare, accounting for approximately 2% of all primary cardiac tumours. Most cases are diagnosed at autopsy, but nowadays, with modern imaging technologies, early diagnosis and treatment is possible. Here, we present two unique incidental presentations of primary cardiac lymphomas (PCL), one in an atrial myxoma and other involving a valvular homograft and discuss the potential pitfalls and prognosis of this rare entity.