A collision tumor of nasopharyngeal carcinoma and primary mantle cell lymphoma in the nasopharynx: a case report and review of the literature.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is more common in men aged 40 to 59, and radiotherapy is an effective treatment. Nasopharyngeal lymphoma (NPL) is rare, and the coexistence of nasopharyngeal mantle cell lymphoma (MCL) and NPC is even rarer. A collision tumor is a rare type of tumor that refers to two or more different tumors occurring in the same organ. No reports to date have described a collision tumor of NPC and MCL occurring within the same nasopharyngeal mass. We herein report the successful treatment of a unique case of synchronous coexistence of NPC and MCL occurring in the nasopharynx of a Chinese man. CASE PRESENTATION: A 58-year-old man presented with a 5-month history of swallowing discomfort. Biopsy was performed under nasopharyngeal endoscopy, and histopathology revealed NPC. Magnetic resonance imaging revealed lesions in the nasopharynx, oropharynx, and tonsils, as well as enlarged lymph nodes in the parotid gland, posterior ear, and neck. This may be a synchronous dual primary tumor coexisting with NPC and NPL. Pathology consultation confirmed that the biopsy specimen of the nasopharynx was a collision tumor of NPC and MCL. Positron emission tomography computed tomography (PET-CT) revealed thickening of the posterior wall of the nasopharynx, which was considered NPC with lymphoma. The enlargement of the pharyngeal lymph ring and multiple hypermetabolic lymph nodes were evaluated as lymphoma infiltration. The patient received two courses of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by head and neck radiotherapy. At the time of this writing, he had remained alive without recurrence for 61 months since the initial treatment and was still undergoing follow-up. CONCLUSIONS: It is very important to correctly recognize collision tumors. Magnetic resonance imaging helps identify different components of collision tumors. Pathological examination helps to confirm the diagnosis. Histological examination reveals different components, and PET-CT can help determine the extent of the lesion. Dose-adjusted chemotherapy combined with radiotherapy may have promising herapeutic effects, but additional case studies are needed to confirm.

Collision tumor of primary malignant lymphoma and adenocarcinoma in the colon diagnosed by molecular pathology: A case report and literature review.

BACKGROUND: Collision tumors of primary malignant lymphoma and adenocarcinoma in the colon are rare. Primary diffuse large B-cell lymphoma (DLBCL)-adenocarcinoma collision tumors are especially rare. CASE SUMMARY: A 74-year-old woman presented with abdominal pain of 1 mo duration. Biopsy under colonoscopy revealed adenocarcinoma of the ascending colon. Subsequently, the patient underwent laparoscopic radical resection of right colon cancer with lymph node dissection. A collision tumor was found incidentally through postoperative pathological sampling. Genetic analysis showed a collision tumor of DLBCL with germinal center B-cell subtype and TP53 mutation, and adenocarcinoma arising in a tubulovillous adenoma in the colon, with BRAF mutation and mutL homolog 1 promoter methylation. The patient died 3 mo after surgery. To our knowledge, this is the 23rd reported case of collision tumor of colorectal adenocarcinoma and lymphoma. The mean age of the 23 patients was 73 years. The most common site was the cecum. There were 15 cases with follow-up data including 11 living and four dead with a 3-year overall survival rate of 71.5%. CONCLUSION: Based on pathological and genetic analysis, surgery combined with chemotherapy or chemoradiotherapy may have good therapeutic effects for collision tumor.

Clinical Analysis of Primary Tracheobronchial Tumors in Children and Evaluation of the Predicting Models for Mucoepidermoid Carcinoma.

OBJECTIVE: To determine the clinical characteristics and prognosis of primary tracheobronchial tumors (PTTs) in children, and to explore the most common tumor identification methods. METHODS: The medical records of children with PTTs who were hospitalized at the Children's Hospital of Chongqing Medical University from January 1995 to January 2020 were reviewed retrospectively. The clinical features, imaging, treatments, and outcomes of these patients were statistically analyzed. Machine learning techniques such as Gaussian naïve Bayes, support vector machine (SVM) and decision tree models were used to identify mucoepidermoid carcinoma (ME). RESULTS: A total of 16 children were hospitalized with PTTs during the study period. This included 5 (31.3%) children with ME, 3 (18.8%) children with inflammatory myofibroblastic tumors (IMT), 2 children (12.5%) with sarcomas, 2 (12.5%) children with papillomatosis and 1 child (6.3%) each with carcinoid carcinoma, adenoid cystic carcinoma (ACC), hemangioma, and schwannoma, respectively. ME was the most common tumor type and amongst the 3 ME recognition methods, the SVM model showed the best performance. The main clinical symptoms of PPTs were cough (81.3%), breathlessness (50%), wheezing (43.8%), progressive dyspnea (37.5%), hemoptysis (37.5%), and fever (25%). Of the 16 patients, 7 were treated with surgery, 8 underwent bronchoscopic tumor resection, and 1 child died. Of the 11 other children, 3 experienced recurrence, and the last 8 remained disease-free. No deaths were observed during the follow-up period. CONCLUSION: PTT are very rare in children and the highest percentage of cases is due to ME. The SVM model was highly accurate in identifying ME. Chest CT and bronchoscopy can effectively diagnose PTTs. Surgery and bronchoscopic intervention can both achieve good clinical results and the prognosis of the 11 children that were followed up was good.

Prognosis of eight Chinese cases of primary vaginal yolk sac tumor with a review of the literature.

BACKGROUND: Primary vaginal yolk sac tumor is a rare malignancy in the pediatric population, and a diagnostic challenge and appropriate initial treatment remains unsolved. The aim of this study was to investigate the clinicopathologic features, treatment and prognosis of this tumor. MATERIALS AND METHODS: Eight cases of primary vaginal yolk sac tumor were reported with a literature review. RESULTS: There were 4 pure yolk sac tumor cases and four mixed germ cell tumors containing yolk sac tumor element, including two cases with embryonal carcinoma and two cases with embryonal carcinoma and dysgerminoma. Partial vaginectomy was performed in four cases and all patients received chemotherapy. 85 cases in literatures were reviewed and 9 cases were misdiagnosed. Follow-up data was available in 77 cases and 5-year overall survival rate was 87.6%. 5-year survival rate of biopsy with chemotherapy, conservative surgery with chemotherapy and radical surgery with chemotherapy was 91.1%, 100% and 28.6%, respectively (p<0.001). Compared to cases without relapse or metastasis after initial treatment, patients with relapse or metastasis had a shorter overall survival (35.6% vs 96.6%, p<0.001). CONCLUSIONS: Mixed germ cell tumor containing yolk sac tumor element was not uncommon and partial vaginectomy may be a good choice for primary vaginal mixed yolk sac tumor type to eradicate local tumor cells and provide complete information for pathological diagnosis and postoperative adjuvant therapy.

Expression and significance of Cyr61 in distant metastasis cells of human primary salivary adenoid cystic carcinoma.

OBJECTIVE: The objective of this study was to examine the expression of cysteine-rich protein 61 (Cyr61) in the distant metastatic tumor cells of human primary salivary adenoid cystic carcinoma (SACC) and its relationship with tumor angiogensis and metastasis. STUDY DESIGN: The experimental group comprised 35 paraffin-embedded tumor specimens of distant metastasis from primary SACC, with their corresponding primary tumor tissues and matched normal salivary gland tissues used as the control groups. Immunohistochemical staining was used to detect the expression of Cyr61 and vascular endothelial growth factor in the experimental and control groups. Vascular endothelial cells were highlighted by the anti-CD34 antibody, and the Weidner method was used to quantify microvessel density (MVD). RESULTS: Cyr61 was overexpressed in distant metastatic tumor cells of primary SACC. Positive expression of Cyr61 and vascular endothelial growth factor (VEGF) progressively increased in normal salivary gland tissues, primary tumor tissues, and tumor tissues of distant metastasis (P < .05). Compared with primary tumor tissues, Cyr61 expression and VEGF expression showed significant increase in tumor tissues of distant metastasis (P < .05). Cyr61 expression significantly correlated with VEGF expression and MVD (P < .05). CONCLUSIONS: Cyr61 appeared to have a significant association with tumor angiogenesis and metastasis in SACC and may be an important target in tumor antiangiogenesis therapy.

Expression of Cyr61 in primary salivary adenoid cystic carcinoma and its relation to Ki-67 and prognosis.

Cysteine-rich protein 61 (Cyr61) selectively binds heparin and insulin-like growth factors and mediates a variety of biological actions, including cell adhesion, differentiation, proliferation, migration, angiogenesis, and tumorigenesis. Cyr61 is also a prognostic factor for tumor progression and survival of individuals with various types of tumors. This study investigated the relationship between the expression level of Cyr61 and clinicopathological features, as well as the prognostic significance of Cyr61 expression in human salivary adenoid cystic carcinoma (SACC). The expression of Cyr61 and Ki-67, a cell-proliferation marker, was examined immunohistochemically in paraffin embedded tissue specimens from 60 SACC patients who underwent radical surgery between 1995 and 2004. A chi-square test was used to investigate the relationship between Cyr61 and Ki-67 expression and clinicopathological features. Survival analysis was performed to determine the prognostic significance of Cyr61 expression. Cyr61 expression was observed in 39 cases (39/60, 65%) of SACC, and Cyr61 expression was positively correlated with Ki-67 expression (P=0.002). A high expression of Cyr61 was significantly associated with solid subtype, perineural invasion, vascular invasion or cancer embolus, advanced stage, recurrence, and metastasis (P<0.05). The survival rate of patients with high expression of Cyr61 or Ki67 was significantly lower than that of patients with low expression. Multivariate Cox's proportional hazards analysis showed that vascular invasion, TNM stage, recurrence, distant metastasis, Ki-67 expression, and Cyr61 expression were independent prognostic factors of overall survival (P<0.05). Cyr61 expression is significantly correlated with Ki-67 expression and may have potential value in screening high-risk cases for recurrence and metastasis, as well as identifying poor prognosis in SACC patients.

[Value of multi-slice spiral CT with three-dimensional reconstruction in the diagnosis of neoplastic lesions in the jawbones].

OBJECTIVE: To assess the value of multi-slice spiral CT (MSCT) with three dimensional (3D) reconstruction in the diagnosis of neoplastic lesions in the jawbones. METHODS: Thirty-three patients with neoplastic lesions of the jawbones underwent MSCT scanning with 3D reconstruction. Of these patients, 14 had ameloblastoma, 8 had hemangioma, 3 had osteosarcoma, 3 had ossifying fibroma, 2 had chondrosarcoma, 2 had fibrosarcoma, and 1 had odontogenic myxoma. Preoperative MSCT scanning was performed with the slice thickness of 2 mm, and 3D reconstruction of the images was conducted by means of multi-planar reconstruction (MPR), curved-planar reformation (CRP), and 3D volume rendering technique (VRT). The results were compared with those observed during the operations. RESULTS: In the 33 cases, the neoplastic lesions of the jawbones were displayed by 2D or 3D imaging and confirmed by intraoperative findings. Two-dimensional imaging allowed better observation than 3D imaging of the deep structures, whereas 3D imaging was superior in visualizing the morphological changes of the compromised bones and the spatial relationship between the tumors and surrounding structures. Two-dimensional imaging and MPR were excellent in revealing the internal structures and pathological changes of tumors, having also better performance in showing the tumors involving the soft tissues. Benign tumors were most visualized as bone expansion changes with well defined ovoid or lobulated borderlines, and malignant ones often resulted in adjacent bony destruction and soft tissue masses. CONCLUSION: MSCT examination is useful in defining the scope of tumor involvement and bony changes to help in the definite diagnosis, differential diagnosis and choice of clinical treatment. Two-dimensional imaging, MPR, VRT and CRP have their respective advantages and limitations in showing jawbone tumor, and their combination can be of great clinical value.

[Analysis of 53 cases with bronchoscopically confirmed pediatric tracheobronchomalacia].

OBJECTIVE: Tracheobronchomalacia is one of the common respiratory tract dysplasia in children. Its symptoms are nonspecific, and routine methods are unreliable in the assessment of tracheobronchomalacia in children. In addition, many physicians are confused about its clinical characteristics, so tracheobronchomalacia is often underdiagnosed. The purpose of this study was to explore the clinical features of tracheobronchomalacia in children and to investigate the diagnostic value of flexible bronchoscopy for children with tracheobronchomalacia. METHOD: For diagnosis and treatment, 229 children out of 4725 patients hospitalized in the division of respiratory disorders were examined by Olympus BF3c-20 flexible bronchoscopy or by Olympus BF-P20 flexible bronchoscopy under general anesthesia with propofol, in Chongqing Children's Hosptial from April 2004 to April 2006. Fifty-three cases were confirmed to have tracheobronchomalacia by bronchoscopy, patients' data including airway lesion, age, sex, clinical characteristics, aided examinations, treatment, final outcomes, were collected and analyzed. RESULTS: (1) Of the 53 children with tracheobronchomalacia, 31 were not suspected for this diagnosis prior to bronchoscopy, who were instead misdiagnosed as refractory pneumonia, difficult-to-control asthma, bronchial foreign body, bronchopulmonary dysplasia and pulmonary atelectasis of unknown origin or bronchiolitis. (2) In the 53 children with tracheobronchomalacia aged one month to eight years, 41 were infants, 6 were younger than two years, 4 were younger than 3 years and the rest 2 cases were older than 3 years. The risk of tracheobronchomalacia related inversely with ages. Ten cases were girls and 43 were boys. (3) Eleven cases had tracheomalacia, 24 bronchomalacia, 18 tracheobronchomalacia; 12 cases had malacia on left lung, 11 on right lung, 19 on both sides; 21 children were mild cases, 25 moderate cases, 7 severe cases. (4) In the 53 children with tracheobronchomalacia, 28 had recurrent or prolonged wheezing, 16 chronic cough, 5 recurrent respiratory infections, 2 atelectasis of unknown origin, and 2 dyspnea. CONCLUSIONS: The infants and toddlers seem to be predisposed more to the bronchomalacia than the older children. Clinical features of children with airway malacia were variable and atypical, expiratory stridor and cough are the most commonly reported symptoms. Flexible bronchoscopy should be regarded as a "golden standard" method for diagnosing TBM.

[Diagnosis of thyroid carcinoma by magnetic resonance imaging (MRI)].

BACKGROUND & OBJECTIVE: Magnetic resonance imaging (MRI) has been demonstrated to be important for the evaluation of thyroid diseases. Several foreign authors have reported MRI manifestation of thyroid carcinoma; however, there were few reports about this in China. This study was designed to investigate the diagnostic value of MRI in thyroid carcinoma by comparing MRI manifestation with histopathological features of thyroid carcinoma. METHODS: Thirty-one cases of thyroid carcinoma were analyzed retrospectively with preoperational MRI and postoperational pathological findings. RESULTS: Among 31 cases of thyroid carcinoma, 20 cases showed heterogeneous intensity in MRI and liquefied or hemorrhagic or cystic degeneration at histopathological examination. Twenty-two cases showed ill defined. Twenty-two cases showed irregular shapes, of 10 cases showed "the discontinuous capsule-like sign with low signal intensity around the tumor" in MRI and that pseudocapsules have been penetrated and partially destroyed by tumors in histopathological findings. Nineteen cases showed the tumors infiltrated the adjacent structures. Nineteen cases showed metastatic lymphadenopathy on the neck. CONCLUSION: "The discontinuous capsule-like sign with low signal intensity around the tumor" is the characteristic manifestation of thyroid carcinoma on MRI. Heterogeneous signal, obscure margin, and irregular shape are the important features for diagnosis of thyroid carcinoma. MRI can demonstrate small lesions, provide the precise morphologic characteristics of lesions, and accurately define the local extension of tumors.

[Relationship between computed tomography (CT) manifestations and pathology in thyroid carcinoma].

BACKGROUND & OBJECTIVE: In clinical diagnosis and treatment of thyroid carcinoma, the misdiagnosis rate is about 40%-70%and the recurrence is about 30%. This study was designed to investigate the relationship between the CT features of thyroid carcinoma and its clinical pathology. METHODS: Fourty-six cases of thyroid carcinoma, pathologically proven, were retrospectively analyzed for CT and histological findings. RESULTS: Of 46 patients with thyroid carcinoma, 31 cases showed heterogeneous density, 30 cases showed irregular shape, 37 cases showed untidy margin, 16 cases showed peninsular tubercles around the tumor,and 10 cases showed no complete enhanced ring around the tumor. 20 cases were detected calcifications, including 9 cases fine globular calcifications, 4 cases nodular calcifications, 7 cases mixture calcifications. In addition,"calcified nodule in cyst sign" were found in 7 cases. 23 cases infiltrated the adjacent structures and 15 cases were revealed metastatic lymphadenopathy on the neck. CONCLUSION: Some cases of thyroid carcinoma can be diagnosed correctly according to the characteristic manifestations on CT. Different pathological types of thyroid carcinoma were related to calcification manifestations and adjacent structure invasion. CT scan can provide reliable information in selecting therapeutic methods.