Villous Adenoma Arising in the Urethra of a Female with Bladder Augmentation History: A Case Report and Review of the Literature.

Villous adenomas (VAs) in the female urethra are rare with only seven cases in the English literature to our knowledge. In patients with bladder augmentation cystoplasty, the neoplasia development risk increases and most of these develop in the neobladder or anastomosis line. Only two cases of VA developing from the native bladder mucosa have been reported. Physical examination of a 76-year-old female who had a history of augmentation cystoplasty revealed a caruncula-like structure protruding from the urethral meatus. The urinary USG showed that the lesion had no relation with the bladder. The lesion was excised. Microscopically, it consisted of villous structures covered with pseudostratified intestinal type epithelium. Low-grade dysplasia was present in the epithelium but high-grade dysplasia or in-situ/invasive carcinoma was not observed. Immunohistochemical study showed positivity for CK7, CK20, EMA, CEA and CDX2. The case was reported as VA of the urethra. We presented the first VA case arising in the urethra of a female patient with intestinal bladder augmentation. Excision is curative for pure VAs. Transformation to carcinoma or recurrence has not been reported. However, in one third of the cases, a malignant tumor may accompany the lesion. Therefore, all excision material should be examined carefully. Routine endoscopic follow-up should be performed in cases with bladder augmentation.

Intestinal-type adenocarcinoma of the vagina: clinico-pathologic features of a common tumor with a rare localization.

Intestinal-type adenocarcinoma is a rare primary vaginal carcinoma and considerably more uncommon than metastatic lesions which represent the most frequent malignancy at this anatomic site. Among all malignant tumors, colorectal, breast and female genital tract carcinomas have the tendency to metastasize to the vagina.As morphologic and immunohistochemical features of intestinal-type adenocarcinoma occurring primarily in the vagina are not specific, clinical and radiologic information is crucial to exclude a metastatic lesion.Herein we present a rare case of intestinal-type adenocarcinoma from a villous adenoma, presenting as a polypoid mass in the posterior wall of vaginal introitus of 51-year-old menopausal woman. To the best of our knowledge, only 19 cases of intestinal-type adenocarcinoma of the vagina have been reported in the English literature so far. Notably the origin from a previous villous adenoma has been well documented only in a few cases.

Are all RAS mutations the same? Coexisting KRAS and NRAS mutations in a caecal adenocarcinoma and contiguous tubulovillous adenoma.

Mutations of the human Kirsten rat sarcoma viral oncogene homologue (KRAS) and the highly homologous human neuroblastoma RAS viral oncogene homologue (NRAS) are associated with resistance to antiepidermal growth factor receptor therapies in patients with colorectal cancer. In this report, we describe a caecal adenocarcinoma that contains both KRAS c.35G>T (G12V) and NRAS c.34G>A (G12S) mutations. The adenocarcinoma arises from a contiguous high-grade tubulovillous adenoma, which also carries the identical KRAS and NRAS mutations, supporting their common origin. While KRAS mutations are common in colorectal cancers, NRAS mutations are relatively rare and the coexistence of multiple RAS mutations is not documented, presumably reflecting similar functions of wild-type and mutant forms of RAS. Recent experimental evidence has suggested that KRAS and NRAS may in fact mediate distinct biological processes in the colon, and this unusual case potentially illustrates the hypothesis clinically. Characterisation of the diverse and divergent functions of RAS family members and mutant forms of RAS in the colon form important considerations for the development of RAS-targeting therapeutics.

Expression of TFF3 during multistep colon carcinogenesis.

The pathogenesis of colon cancer is not well understood. This common type of cancer is generally believed to occur in a multistep process which involves alterations of various tumor suppressor genes and oncogenes during the progression through benign lesions towards carcinoma. TFF3 is a product of the colonic epithelium and has been implicated in colonic mucosal protection and also in the aggressiveness of colon cancer cells. The aim of this study was to analyze the expression of TFF3 during propagation towards cancer development in the human colon. Colonic tissues representing colitis, adenomatous polyposis, tubulovillous adenoma, and mucoid/adeno-carcinomas were processed for immunohistochemistry using an antibody specific for human TFF3. The results were correlated with those of PCNA-labeling, quantified, and compared with those of control tissues obtained from the safe margin of macroscopically normal colonic mucosa of patients with colon cancer. The data showed marked down-regulation of TFF3 expression in adenomatous polyposis, then TFF3 expression returns to about control level during adenoma and remains high during mucoid- and adeno-carcinomas. Colonic tissues with highly invasive cancer cells were characterized by statistically significant down-regulation of TFF3 expression. The changes observed in expression of TFF3 showed an inverse correlation with cell proliferation and suggest that it might play a protective role against colon carcinogenesis.

Phenotypic alteration in malignant transformation of colonic villous tumours: with special reference to a comparison with tubular tumours.

AIMS: To clarify the cellular differentiation of colorectal villous tumours in malignant transformation, compared with that of tubular tumours (tubular adenoma and adenocarcinoma arising in tubular adenoma). METHODS AND RESULTS: Forty-nine cases of colorectal villous tumours [six cases of low-grade villous adenoma, 21 of high-grade villous adenoma (VA), nine of invasive carcinoma in villous adenoma (CIVA), and 13 of pure villous carcinoma (PVC)] and 46 cases of tubular tumours [14 cases of low-grade and 17 of high-grade tubular adenoma (TA), and 15 cases of carcinoma in tubular adenoma (CITA)] were selected for this study based on their expression patterns of CD10 (small intestinal brush border), MUC2 (intestinal goblet cell), and HGM (gastric foveolar epithelium). HGM was more frequently expressed in the adenomatous components of villous tumours (63%) than in those of tubular tumours (14%) (P < 0.05). CD10 expression of high-grade TAs (47%) and carcinomas arising in TA (60%) was significantly higher than that of villous tumours (0%) (P < 0.05). CONCLUSIONS: There were significant differences in the phenotypic expression of adenoma and adenocarcinoma between villous and tubular tumours, respectively. Villous tumours have a pathway of malignant transformation different from that of tubular tumours. Because of biological differences, colorectal villous tumours should be distinguished from tubular neoplasia. The analysis of the phenotype of colorectal neoplasms is useful for the evaluation of tumour progression.

Invasive papillary adenocarcinoma of the colon.

Colonic adenocarcinomas are among the most common type of tumors. In this report, we present the morphologic, immunohistochemical, and microsatellite findings of 2 cases with a distinct invasive papillary component. Both tumors arose from polyps in middle-aged patients, followed an aggressive course, and showed a superficial adenomatous component. The immunohistochemical stains showed that the tumor cells were negative for p27 and p53; both tumors were microsatellite stable, that is, with no microsatellite instability in the 6 markers studied, and there was no loss of the mismatch repair proteins hMSH2 or hMLH1. These findings suggest that these tumors follow the tumor-suppressor pathway and represent an aggressive subtype of colonic adenocarcinoma.

Expression of p185 and p53 in benign and malignant colorectal lesions.

The c-erbB2 gene has been found to be amplified in a number of human adenocarcinomas, leading to elevated levels of expression of its encoded product, p185. Mutations in the p53 gene are also common in colorectal carcinomas, brain tumours, leukaemia and lymphomas. In this study, p185 and p53 overexpression was analyzed in colorectal adenomas (22 tubular adenomas and 2 tubulo-villous adenomas) and moderately differentiated adenocarcinomas (n = 22) in order to determine whether there was a relationship between these two proteins. The proteins are encoded by two genes located in the same chromosome. p185 and p53 expression was determined on tissue sections by immunohistochemical staining procedure. Expression of p185 was significantly higher (p < 0.01) in preneoplastic lesions (95.8% of cases) than colorectal cancer (63.6% of cases). p53 showed an inverse pattern to p185, being expressed in 58.3% of benign lesions and 72.7% of adenocarcinomas. These results confirm that p185 overexpression is associated with the early stages of colorectal cancer, whereas p53 is associated with more advanced stages. Although there was no correlation between p185 and p53 expression in premalignant lesions and adenocarcinomas, these two proteins have an important role in the adenoma-carcinoma sequence.

Genetic alterations in poorly differentiated endocrine colon carcinomas developing in tubulo-villous adenomas: a report of two cases.

The genetic study of two cases of tubulovillous adenoma associated with poorly differentiated endocrine carcinoma (PDEC) is reported. Aim of this work was to assess whether the exocrine and endocrine growths share a common genotype. The analysis entailed the search for allelic loss (LOH) or imbalances of polymorphic microsatellite markers at the corresponding chromosomal loci of the genes MEN-1 (11q13), p53 (17p13). Deleted in Colorectal Carcinoma (DCC) (18q21) and hMSH-2 (BAT26) (2p21-22). Additionally, the exons 5-8 of the p53 gene were sequenced in the two PDECs only. One of the two cases investigated showed LOH for 18q DCC markers in the tubulo-villous adenoma while a point mutation of the p53 gene was observed in the PDEC component. No genetic abnormality was observed in both adenoma and PDEC components of the other case. In the two cases p53 protein accumulation was observed in both PDEC and adenoma cells. These data indicate that only the p53 gene abnormality is shared by both colon cancer and PDEC in the two cases reported. The lack of other common genetic defect may suggest a different histogenesis for the two tumor types. The development of colon PDEC implies the defect of p53 gene.

Villous adenoma of urinary tract: a common tumor in an uncommon location.

The presence of colonic-type epithelium in the urinary tract is not an uncommon occurrence, but tumors derived from it are rare. Tumors arising from colonic-type epithelium, including villous adenoma and adenocarcinoma, have been reported in the renal pelvis, ureter, urinary bladder, and urethra. Villous adenomas of the urinary tract are rare, being most common in the urinary bladder, followed by the urethra. Morphologic features of these tumors are similar to those of the colonic adenomas. The largest published series of villous adenomas of the urinary tract was a study of 23 patients. This study is reviewed and other reports on villous adenomas of the urinary tract are discussed.

Villous adenoma of the bladder.

Villous adenomas of the bladder are rare tumors and up to now they have not been seen to undergo malignant transformation. We report a case of villous adenoma of the bladder with areas of adenocarcinoma in a 72-year-old man. We describe all the morphological, histochemical and immunohistochemical features characterizing this tumor. We recommend adequate pathological sampling and a thorough follow-up of patients with villous adenoma. The prognosis and the behaviour of these adenomatous papillary lesions, morphologically similar to colonic adenomas, in the bladder is unclear. We report a case with focal area of adenocarcinoma and review the literature.

Tumor suppressor activity of neural cell adhesion molecule in colon carcinoma.

BACKGROUND AND AIMS: Neural Cell Adhesion Molecule (NCAM) is a well-characterized member of the immunoglobin superfamily. The structure of NCAM is similar to the tumor suppressor Deleted in Colon Carcinoma (DCC). NCAM has been found in some epithelial tissues and plays a role in tumorigenesis of some cancers. The purpose of the present study was to determine if NCAM is present in normal human colon. Once its presence was established, its function as a tumor suppressor was investigated. METHODS: Colon tumors and normal proximal margins were processed for reverse transcription-polymerase chain reaction (RT-PCR) of the NCAM-180 message. Immunohistochemistry of the tissue was performed to determine the distribution of NCAM. RESULTS: RT-PCR analysis demonstrated the presence of the NCAM-180 kD isoform in normal colonic epithelia. Immunohistochemistry showed NCAM on the basolateral surface of colonic epithelial cells of the villous tips. Tumors from 15 patients followed up for 4 years were studied. All seven tumors expressing NCAM-180 were from patients having a benign clinical course. Seven of eight tumors that lacked NCAM-180 were associated with aggressive clinical behaviors (presenting with obstruction, perforation or metastatic disease, or patient death within 18 months of presentation). The sole exception was in a villous adenoma excised from a patient who has had multiply recurrent polyps on follow-up. CONCLUSION: We conclude that like DCC, NCAM is an important colonic adhesion molecule that functions as a tumor suppressor.

PCNA defined proliferative activity of epithelial tumor cells in adenomas of the colon.

Proliferative activity of epithelial tumor cells was evaluated with the use of immunohistochemistry and anti-PCNA monoclonal antibodies in alcohol fixed paraffin embedded sections of 44 colonic adenomas, including 33 tubular, 5 villous and 6 tubulovillous adenomas. The mean PCNA index was 24.7 +/- 10.9%, 24.8 +/- 6.2% and 24.8 +/- 14.0% in tubular, villous and tubulovillous adenomas respectively. In 12 tubular adenomas with dysplasia the mean PCNA index in areas with dysplasia was significantly higher (38.2 +/- 11.5%) as compared to areas without dysplasia (17.0 +/- 8.9%; p < 0.05). The results indicate that PCNA index of epithelial tumor cells is significantly increased in adenomas with high grade of dysplasia irrespective of histological type or size of the tumour.

High c-erbB-2 protein level in colorectal adenocarcinomas correlates with clinical parameters.

Sections of normal colon, adenomas, and adenocarcinomas were examined by immunohistochemistry for the expression of c-erbB-2 proto-oncogene product in order to assess its potential diagnostic value in predicting the malignant potential of these lesions. We compared the degree of epithelial abnormality and clinical parameters, including Dukes' classification and survival time with the extent of immunoperoxidase staining. Sections of normal colon and tubular adenomas examined demonstrated a weak immunostaining localized to the luminal surface cells. However, higher level of c-erbB-2 expression was observed in dysplastic areas of one tubular and one villous adenoma. Out of 40 adenocarcinomas, only 2 samples showed weak immunoreaction, while 38 samples were moderately or strongly positive for c-erbB-2 protein. The intensity of staining correlated positively with the stage of disease and postoperative survival time.

[Possible prognostic role of PCNA in colonic adenomas]. / Possibile ruolo prognostico del PCNA negli adenomi colici.

Proliferating cell index has been valued in colic adenomas, using anti PCNA-PC10 antibody. The results have been compared with grading. An high proliferating grade has been shown in patients with multiple adenomas: this finding suggests a prognostic value of proliferating cell index.