Diffuse-Type Tenosynovial Giant Cell Tumour Involving Bone Masquerading as Langerhans Cell Histiocytosis.

We presented a case of diffuse-type tenosynovial giant cell tumour (DTSGCT) of foot masquerading as Langerhans cell histiocytosis. Preliminary diagnosis by needle biopsy was difficult due to the major involvement of bones and the overshadowing effect of the accompanying Langerhans cells. The complete curettage specimen with relevant immunohistochemistry and molecular tests made the final diagnosis of DTSGCT possible. The biomolecular mechanism for the masquerading phenomenon was explained by CSF1 overexpression in the neoplastic cells attracting migration and proliferation of CSF1R-positive Langerhans cells.

Scrotal wall metastasis as the first manifestation of primary gastric adenocarcinoma.

Metastases to the scrotal wall are very rare, and being the initial manifestation of occult primary tumours is even rarer. We report on a patient presenting with painless scrotal swelling, attributed to a solid extra-testicular mass found on ultrasonography. Subsequent investigations and surgical exploration revealed it to be a scrotal wall metastasis from an occult gastric primary. To our knowledge, this is the first report of a scrotal wall metastasis from gastric adenocarcinoma. The ensuing discussion and literature review highlight the diagnostic challenges posed by an extra-testicular scrotal metastasis from an occult primary tumour.

Can the analysis of ERCC1 expression contribute to individualized therapy in nasopharyngeal carcinoma?

PURPOSE: To analyze the expression of excision repair cross-complementation group 1 (ERCC1) protein in predicting the clinical outcome of nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: The histologic specimens of 258 patients with Stage III to IVB nonkeratinizing NPC who were treated with radiotherapy alone (Group I) or concurrent-adjuvant chemoradiotherapy (Group II) were retrieved. Immunostaining on ERCC1 protein was performed. The relationship of ERCC1 expression and clinical outcomes was analyzed. RESULTS: The median ERCC1 score (proportion score of positively stained cells times intensity) was 200 (range, 0-300), and ERCC1 expression was defined as high if the score was above the median. In Group I high-score tumor had a statistically lower locoregional failure-free rate (LRFFR) compared with low-score tumor (p < 0.05) but not distant failure-free rate (DFFR) and overall survival (OS). In Group II no statistically differences were noted in LRFFR, DFFR and OS with regard to the ERCC1 expression. Resistance to cisplatin-containing chemotherapy in high-ERCC1 score tumor was not observed in Group II. Interestingly, low-score tumor in Group I achieved similar local and distant control compared with Group II. Multivariate analysis showed that ERCC1 score was an independent prognostic factor in LRFFR (p < 0.05) and approached statistical significance in failure-free survival (p = 0.08) and OS (p = 0.07). Tumor with high ERCC1 score had a 2-fold (95% confidence interval, 1.02-3.85) increased risk of locoregional failure. This may imply an association of ERCC1 expression with the repair of radiation damage. CONCLUSIONS: High ERCC1 expression predicts poor locoregional control in NPC. Chemotherapy response is not affected by ERCC1 expression. Further validation is required.

Schneiderian papillomas and carcinomas: a retrospective study with special reference to p53 and p16 tumor suppressor gene expression and association with HPV.

Schneiderian papillomas are uncommon benign tumors of the sinonasal area. They are prone to local aggressiveness and recurrence, and some undergo malignant progression. We analyzed specimens obtained from 67 Chinese patients who had presented to the ENT department of a regional hospital with biopsy-proven schneiderian papilloma. Seven of these patients had either synchronous or metachronous carcinoma, 1 of whom had pure carcinoma in situ. For each case, we documented the morphology, immunohistochemical expression of tumor suppressor genes p53 and p16, and any association with human papillomavirus (HPV) infection as detected by either polymerase chain reaction or in situ hybridization techniques. We found that severe dysplasia and p53 positivity were strongly associated with malignant progression. Association with HPV was demonstrated in 22 of the 67 patients (33%); the association was strongest among patients with exophytic papillomas and carcinomas. The effect of HPV in papilloma oncogenesis probably begins during the early phase, while other factors are responsible for progression to carcinoma. We conclude that p53-positive, dysplastic schneiderian papillomas warrant aggressive surgical treatment.

Transitional cell metaplasia of the uterine cervix is related to human papillomavirus: molecular analysis in seven patients with cytohistologic correlation.

BACKGROUND: Transitional cell metaplasia of the uterine cervix is an under-recognized entity in cervical pathology. The underlying etiology and biologic significance remains uncertain. The thin-layer cytology findings and association with human papillomavirus (HPV) have not been studied thoroughly. METHODS: The authors retrospectively reviewed the clinical findings, thin-layer cytology and histologic features of pure transitional cell metaplasia of the uterine cervix occurring in seven perimenopausal or postmenopausal Chinese women at Pamela Youde Nethersole Eastern Hospital, Hong Kong, during the period from January, 1998 to April, 2001. Molecular techniques for HPV screening and genotyping using polymerase chain reaction and restriction fragment length polymorphism analysis were employed in the thin-layer cytology specimens and paraffin block material. RESULTS: In all seven patients, transitional cell metaplasia represented an incidental histologic finding. It occurred in the ectocervix, transformation zone, endocervix, or vagina. Histologically, it resembled urothelium of the urinary bladder and was comprised of multilayers of mitotically inactive, immature epithelial cells with vertically aligned oval nuclei, fine chromatin, indistinct nucleoli, and conspicuous longitudinal nuclear grooves. The superficial cells were oriented more horizontally and contained pale-staining cytoplasm similar to umbrella cells. Features consistent with transitional cell metaplasia were identified in two of seven preoperative thin-layer preparations. Cytologically, the affected parabasal cells recapitulated the features that were seen in histologic sections. In addition to the bland nuclear morphology and longitudinal nuclear grooves, the cell borders appeared distinct, and the appearance of a perinuclear cytoplasmic halo was common. Sometimes, the metaplastic cells assumed a spindle shape and appeared as cohesive, streaming cell clusters. Molecular study successfully demonstrated the presence of HPV in all seven patients, mostly in the liquid-based cytology samples. In general, the viral DNA load was relatively low; and, for samples in which HPV genotyping was feasible, HPV type 58 was the prevalent genotype. CONCLUSIONS: The current study demonstrates that transitional cell metaplasia of the uterine cervix is related to HPV. It also carries a distinctive cytologic appearance in thin-layer preparations. Based on the limited follow-up data from a small number of reported patients, transitional cell metaplasia seems to run an indolent clinical course. However, its peculiar association with HPV and its possible correlation, both morphologic and histogenetic, with cervical intraepithelial neoplasia need further investigation.