RESUMO
Signet-ring cell carcinoma of the ampulla of Vater is a rare tumor. A 74-year-old woman presented with epigastric pain and was diagnosed with cholangitis. Her liver enzyme levels were elevated. Computed tomography showed an enhanced area in the periampullary region and marked common bile duct dilatation. On endoscopic retrograde cholangiopancreatography (ERCP), the ampulla exhibited a normal appearance without ulcer or mass. Histological biopsy confirmed the absence of malignancy. During follow-up, the patient again presented with acute cholangitis multiple times and underwent ERCP each time. The ampulla had the appearance of a reddish and erosive mucosa. Although biopsy was repeated, histological examination did not show any malignancy. After a total of 13 biopsies, the patient was diagnosed with ampullary carcinoma of non-exposed protruded type following the third ERC-guided biopsy. Careful follow-up and frequent endoscopic biopsies are important in cases of papillary carcinoma of non-exposed protruded type with normal ampullary mucosa on initial endoscopy because this condition is challenging to diagnose with a single biopsy.
Assuntos
Ampola Hepatopancreática , Carcinoma de Células em Anel de Sinete , Neoplasias do Ducto Colédoco , Idoso , Biópsia , Carcinoma de Células em Anel de Sinete/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias do Ducto Colédoco/cirurgia , Feminino , HumanosRESUMO
Sertoli-Leydig cell tumors (SLCTs) are representative of androgenic ovarian tumors, and they show diverse histologic differentiation, including heterologous differentiation. Genetically, SLCTs are characterized by the presence of DICER1 mutations. In the present study, we analyzed the correlation between somatic DICER1 hotspot mutations and clinicopathological features in 10 ovarian SLCTs. Six of the 10 (60%) SLCTs harbored a DICER1 hotspot mutation. Five of the 6 DICER1-mutated SLCT patients showed androgenic manifestations, including amenorrhea and hirsutism, and 4 of the 6 were associated with the significant elevation of serum testosterone. In contrast, none of the 4 DICER1 wild-type SLCT patients showed virilization. The patient age at diagnosis was lower in those with DICER1-mutated SLCTs (average, 24.7; range, 17-43) than in those with DICER1 wild-type tumors (average, 64.8; range, 47-77). Histologically, heterologous differentiation was found in 4 SLCTs, all of which were DICER1 mutant. Heterologous components included gastrointestinal-type mucinous epithelium (n=3), carcinoid (n=1), and rhabdomyosarcoma (n=1). In the latter, the rhabdomyosarcomatous component was dominant to the SLCT component. In summary, DICER1 hotspot mutations are closely associated with androgenic effects in ovarian SLCTs. It is suggested that DICER1 mutations are involved in the dysregulation of sex hormone synthesis in SLCT patients. Somatic DICER1 hotspot mutations are more common in SLCT patients during the reproductive years than in those during the postreproductive years. DICER1 hotspot mutations may support the pathological diagnosis of SLCTs in cases wherein the heterologous component overwhelms and masks the SLCT component.
Assuntos
Biomarcadores Tumorais/genética , RNA Helicases DEAD-box/genética , Mutação , Neoplasias Ovarianas/genética , Ribonuclease III/genética , Tumor de Células de Sertoli-Leydig/genética , Testosterona/sangue , Adolescente , Adulto , Amenorreia/sangue , Amenorreia/etiologia , Biomarcadores Tumorais/sangue , Biópsia , Análise Mutacional de DNA , Feminino , Proteína Forkhead Box L2 , Fatores de Transcrição Forkhead/genética , Predisposição Genética para Doença , Hirsutismo/sangue , Hirsutismo/etiologia , Humanos , Imuno-Histoquímica , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/enzimologia , Neoplasias Ovarianas/patologia , Fenótipo , Tumor de Células de Sertoli-Leydig/sangue , Tumor de Células de Sertoli-Leydig/enzimologia , Tumor de Células de Sertoli-Leydig/patologia , Regulação para Cima , Virilismo , Adulto JovemRESUMO
We report a case of diabetic mastopathy in an elderly woman with type II diabetes. The patient, a 66-year-old woman with a 6-year history of diabetes mellitus, has been received an oral diabetic agent. She noticed a lump in her right breast two months previously. Mammography of the breast showed a low density mass, but there was no microcalcification or architectural distortion. Ultrasonography of the lesion revealed a hypoechoic mass with a distinct margin. Fine needle aspiration cytology was performed but sufficient tissue was not obtained. However, a cluster of small epithelial cells with nucleus swelling and increased chromatin was demonstrated. Excisional biopsy was performed and diabetic mastopathy was demonstrated histologically.
Assuntos
Doenças Mamárias/complicações , Doenças Mamárias/patologia , Complicações do Diabetes/patologia , Diabetes Mellitus Tipo 2/complicações , Idoso , Linfócitos B/patologia , Doenças Mamárias/diagnóstico , Complicações do Diabetes/diagnóstico , Feminino , Fibrose , HumanosRESUMO
A 52-year-old man without a history of asthma or allergic diseases died of ventricular fibrillation early in the morning. His autopsy revealed no significant findings, except for a mild mural-thickening localized at the proximal region of the right coronary artery. Microscopic examination showed periarteritis with infiltration of numerous eosinophils in the adventitia. No significant vasculitis was found in any other organs. Based on the findings this seems to be the second reported case of isolated eosinophilic coronary periarteritis.