Analysis of imaging characteristics of undifferentiated carcinoma with pancreatic osteoclast-like giant cell / 中华消化杂志

Objective:To investigate the imaging characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of undifferentiated carcinoma with pancreatic osteoclast-like giant cell (UPC-OGC).Methods:From April 2015 to November 2019, at Zhongshan Hospital, Fudan University, 11 pathologically confirmed UPC-OGC patients who received upper abdominal CT or MRI before surgery and with complete clinical and pathological data were retrospectively included. The imaging characteristics of CT and MRI were analyzed, which included lesion location, number, shape, size, boundary, plain scan and enhancement features, adjacent tissue invasion and metastasis. Independent sample t test was used for statistical analysis. Results:The tumor lesions of 11 patients with UPC-OGC were all single, and the maximum diameter of lesion was (4.84±2.96) cm (ranged from 2.00 to 12.80 cm). The lesions of 7 patients with UPC-OGC were located in the head of pancreas, 2 located in the body of pancreas, 1 located in the tail of pancreas and 1 located in the junction of body and tail of pancreas. The lesion shapes of 3 patients with UPC-OGC were round, and the lesion shapes of 8 patients were oval with lobulation. The lesion boundaries of 8 patients with UPC-OGC were clear and the lesion boundaries of 3 patients were unclear. Seven patients with UPC-OGC were examined by plain and enhanced CT scan. Plain CT scan showed that the density of solid area of the tumor was similar to that of normal pancreatic parenchyma ((37.14±6.10) HU vs. (43.14±4.55) HU), and the difference was not significant ( t=-2.85, P=0.097). Contrast-enhanced CT scan in arterial phase showed that the degree of enhancement in solid area of the tumor was weaker than that of normal pancreatic parenchyma ((67.29±12.79) HU vs. (90.43±9.81) HU), and the difference was statistical significant ( t=-4.10, P=0.004), while contrast-enhanced CT scan showed that in venous phase the solid area of the tumor continued to strengthen and the degree of enhancement was similar to that of normal pancreatic parenchyma ((84.71±15.30) HU vs. (79.57±10.73) HU), and the difference was not significant ( t=0.38, P=0.535). Both CT and MRI enhanced scans showed uneven enhancement of the lesions, the degree of enhancement of solid component in arterial phase was slightly weaker than that of normal pancreatic parenchyma and the marginal and internal separation were progressively enhanced, and the degree of enhancement in the venous phase and balanced phase was slightly higher than that of the normal pancreatic parenchyma or similar to that of the normal pancreas. Conclusions:The imaging of CT and MRI of UPC-OGC have certain characteristics, which are helpful for the diagnosis and identification of the disease.

A report of two cases of dedifferentiated endometrioid carcinoma: A newly described underrecognized tumor of poor prognosis

Dedifferentiated endometrioid carcinoma or dedifferentiated endometrioid adenocarcinoma (DEAC) is defined by the presence of undifferentiated carcinoma with endometrioid carcinoma. Undifferentiated component can be misinterpreted as solid component of high-grade endometrioid carcinoma or sarcomatous component of malignant mixed mullerian tumor. We present two cases of DEAC. Two postmenopausal women underwent hysterectomy for vaginal bleeding. Microscopically, sections from the endometrial tumors showed a biphasic growth consisting of an undifferentiated component and a glandular component with sharp transition between the two components. The undifferentiated component showed focal positivity for cytokeratin and vimentin, while glandular component was diffusely positive for cytokeratin and negative for vimentin expression.

A rare presentation of Sinonasal Undifferentiated Carcinoma with brain metastasis and para-aortic mass

Sinonasal Undifferentiated carcinoma (SNUC) comprises 3% of the head and neck tumors, including metastatic neoplasms. Herein we report the case of a 60-year-old male who was brought dead to our institute with previous records of a contrast-enhanced CT scan of the brain and MRI with evidence of tumor in the maxillary sinus with intracranial extensions. The histopathological examination of the mass in the maxillary sinus proved to be SNUC with metastases to the brain, lungs, and around the aorta. These tumors are undifferentiated and are distinct from other poorly differentiated tumors in deriving their origin from the Schneiderian epithelium. The aggressive nature of the tumor renders the prognosis quite dismal. SNUCs need to be early recognized and distinguished from other poorly differentiated carcinomas with the help of immunohistochemistry.

A case report of large cell undifferentiated carcinoma of the urinary bladder / 中华泌尿外科杂志

The clinical pathological data of a patient large cell undifferentiated bladder carcinoma was retrospectively analyzed and understand.The clinical and imaging findings of large cell undifferentiated bladder carcinoma was nonspecific.Diagnosis depended on the pathological and immuno-histochemical staining.The tumor is aggressive with high risk of recurrence.It is mainly treated with radical resection.

Carcinoma indiferenciado con células gigantes de tipo osteoclastos en la cabeza de páncreas / Undifferentiated carcinoma with osteoclast-like giant cells (uc-ogc) of the head of pancreas

El carcinoma indiferenciado con células indiferenciadas tipo osteoclasto (UC-OGC) en cabeza de páncreas, es extremadamente raro. Las características clínicopatológicas, de imagen y la apariencia topográfica no están bien clasificadas. Este reporte de caso describe un paciente con UC-OGC de cabeza de páncreas. Nuestro paciente un adulto mayor de 75 años de edad, presentaba un tiempo de enfermedad considerable, sin sintomatología relevante hasta las etapas avanzadas del tumor, debutando con molestias gástricas someras, luego pérdida de peso. En los exámenes diagnósticos hallaron la presencia de un tumor que comprometía el estómago, duodeno y páncreas. El diagnóstico definitivo lo dio el estudio anatomopatológico. No se dispone de datos clínicos suficientes para un tratamiento que garantice una mayor tasa de supervivencia en los pacientes, sin embargo, la pancreatoduodenectomía es actualmente la alternativa que mejores resultados ofrece, por otra parte, el pronóstico después de la cirugía y la tasa de recurrencia sigue incierto

Undifferentiated carcinoma with undifferentiated osteoclast-like cells (UC-OGC) in the head of the pancreas is extremely rare. The clinicalpathological, imaging and topographic appearance characteristics are not well classified. This case report describes a patient with UC-OGC of the Pancreas Head. Our patient, an adult over 75 years of age, had a considerable illness time, without relevant symptoms until the advanced stages of the tumor, debuting with shallow gastric discomfort, then weight loss. In the diagnostic tests they found the presence of a tumor that compromised the stomach, duodenum and pancreas. The definitive diagnosis was given by the pathological study. There are not enough clinical data available for a treatment that guarantees a higher survival rate in patients, however, pancreatoduodenectomy is currently the alternative that offers the best results, on the other hand, the prognosis after surgery and the recurrence rate still uncertain.

A Case of Lymphoepithelioma-Like Carcinoma in the Thyroid Gland / 대한이비인후과학회지

Lymphoepithelioma-like carcinoma exhibits immunohistochemically similar features to lymphoepithelioma and commonly occurs in the skin, salivary gland, breast, lung, gastrointestinal tract, liver, urinary tract, prostate, vulva and vagina. Lymphoepithelioma-like carcinoma from the thyroid gland is extremely rare. We recently experienced a case of lymphoepithelioma-like carcinoma of thyroid gland in a 28-year-old female, who presented a thyroid nodule that was suspicious of papillary carcinoma. We report this unusual case of lymphoepithelioma-like carcinoma of thyroid gland with a brief review of literature.

Incidentally Detected Small Intestine Intussusception Caused by Primary Small Intestine Carcinoma on ¹⁸F-FDG PET/CT / 대한핵의학회잡지

Small intestine intussusception in adults is a rare condition mainly caused by primary or metastatic small intestine malignancy. Here, we present a 72-year-old male patient who was diagnosed with small intestine cancer that was presented as small intestine intussusception on hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). The patient was initially referred for an abnormality on a chest radiography and severe anemia. FDG PET/CT showed the lung lesion in the right upper lobe of lung as a high FDG uptake mass. Accidentally, FDG PET demonstrated another intense hypermetabolic intraluminal lesion in the small intestine accompanied with intussusception shown as a circumferential hypermetabolic wall. By pathologic examination, the patient was diagnosed as primary small intestine cancer with lung metastasis. This case highlights usefulness of hybrid FDG PET/CT to identify unexpected malignancy.

Sinonasal carcinoma presenting as chronic sinusitis and sequential bilateral visual loss.

Sinonasal undifferentiated carcinoma‑related rhinogenic optic neuropathy is rare and may lead to visual loss. To the best of our knowledge, this is the first report of bilateral sequential visual loss induced by this etiology. It is important to differentiate between chronic sinusitis and malignancy on the basis of specific findings on magnetic resonance images. Surgical decompression with multidisciplinary therapy, including steroids, chemotherapy, and radiotherapy, is indicated. However, no visual improvement was noted in this case, emphasizing the rapid disease progression and importance of early diagnosis and treatment.

A Case of Undifferentiated Carcinoma Originating from the Inferior Turbinate of Nasal Cavity / 대한이비인후과학회지

Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly aggressive malignant tumor arising from the schneiderian epithelium of the nasal cavity or paranasal sinuses. The presenting symptoms are diverse depending on the site involved and extent of tumor spread. The treatment of SNUC has evolved to improve overall survival rate and include disease-free control with complete surgical resection including radiotherapy and chemotherapy, but the prognosis still remains dismal. We present a patient with several months of history of intermittent nasal bleeding and stuffiness, which proved to be a rare malignant tumor of inferior turbinate origin, diagnosed as undifferentiated carcinoma of early stage in the disease process. The mass was excised en bloc with endoscopic surgical treatment from inferior turbinate without any additional combined treatment and there was no recurrence during the two-year follow-up period. We report herein, with a review of the literature, an undifferentiated carcinoma arising from the inferior turbinate, which was successfully treated by surgical resection only.

Esthesioneuroblastoma, Neuroendocrine Carcinoma, and Sinonasal Undifferentiated Carcinoma: Differentiation in Diagnosis and Treatment

Introduction: Malignant sinonasal tumors comprise less than 1% of all neoplasms. A wide variety of tumors occurring primarily in this site can present with an undifferentiated or poorly differentiated morphology. Among them are esthesioneuroblastomas, sinonasal undifferentiated carcinomas, and neuroendocrine carcinomas. Objectives: We will discuss diagnostic strategies, recent advances in immunohistochemistry and molecular diagnosis, and treatment strategies. Data Synthesis: These lesions are diagnostically challenging, and up to 30% of sinonasal malignancies referred to the University of Texas MD Anderson Cancer Center are given a different diagnosis on review of pathology. Correct classification is vital, as these tumors are significantly different in biological behavior and response to treatment. The past decade has witnessed advances in diagnosis and therapeutic modalities leading to improvements in survival. However, the optimal treatment for esthesioneuroblastoma, sinonasal undifferentiated carcinoma, and neuroendocrine carcinoma remain debated. We discuss advances in immunohistochemistry and molecular diagnosis, diagnostic strategies, and treatment selection. Conclusions There are significant differences in prognosis and treatment for esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma. Recent advances have the potential to improve oncologic outcomes but further investigation in needed...

Comparison on the Long Term Outcome between Endoscopic Submucosal Dissection and Surgical Treatment for Undifferentiated Early Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: There are controversies on the efficacy and safety of endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer (EGC) despite the expansion of ESD indications. The aim of this study was to evaluate the long term outcome of ESD compared to that of surgical treatment in patients with undifferentiated EGC. METHODS: A total of 76 patients who underwent ESD for undifferentiated EGC and 149 patients who met the ESD indication and received surgical treatment from January 2005 to December 2010 at Chonnam National University Hwasun Hospital were included. RESULTS: In the ESD group, en bloc resection and complete resection were achieved in 84.2% (64/76) and 76.3% (58/76) of patients, respectively. Among these patients, 58 (76.3%) met the ESD indication (indication group), and the remaining 18 (23.7%) did not meet the ESD indication (above indication group). Complete resection rates for indication group and above indication group were 86.2% (50/58) and 44.4% (8/18), respectively (p<0.05). The mean follow-up period was 42.2+/-19.2 months. Total recurrence rates in the ESD group and operation group were 14.1% (9/76) and 0.7% (1/149), respectively (p<0.05). The main complication of ESD was bleeding (5.2%, 4/76). In the operation group, 2 (1.3%) patients died from postoperative bleeding and leakage of anastomosis site. CONCLUSIONS: ESD may be a feasible and safe treatment modality compared to that of surgical treatment for undifferentiated EGC when managed according to the expanded criteria. However, close endoscopic surveillance is required in this group because of higher incidence of intragastric recurrence.

Therapeutic Outcomes of Endoscopic Submucosal Dissection in Undifferentiated-type Early Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment of early gastric cancer (EGC). However, the indication of ESD in undifferentiated-type EGC was controversial. The aim of this study was to evaluate the therapeutic outcomes of ESD in undifferentiated-type EGC according to expanded indication. METHODS: At Soonchunhyang University Bucheon Hospital, a total of 82 lesions in 81 patients with undifferentiated-type EGC were treated with ESD. The therapeutic outcomes of ESD were evaluated by resection method (en bloc resection; piecemeal resection), histologic curative resection, complications and recurrence rates after ESD. RESULTS: The rate on en bloc resection and complete resection rate were 87.8% (72/82) and 80.5% (66/82), respectively. In signet ring cell carcinoma, the complete resection rate was higher than those in poorly differentiated adenocarcinoma and poorly differentiated adenocarcinoma with signet ring cell features, but there was no statistical significance (89.3% vs. 75.0%, 76.7%; p=0.347). The lateral margin positivity rate in poorly differentiated adenocarcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma with signet ring cell features were 12.5%, 3.6% and 13.3%, respectively (p=0.395). The vertical margin positivity rate were 12.5%, 3.6% and 10.0%, respectively (p=0.485). The overall recurrence rate was 3.0% during a mean follow-up period of 37.4 months. CONCLUSIONS: ESD may be considered as a feasible treatment for undifferentiated-type EGC according to expanded indication. The therapeutic outcome of ESD in undifferentiated-type EGC is likely to be favorable, though further longer follow-up studies are needed.

A Case of Gastric Undifferentiated Carcinoma with Focal Yolk Sac Tumor and Hepatoid Carcinoma Differentiation

We report herein a case of gastric undifferentiated carcinoma with focal yolk sac tumor and hepatoid carcinoma differentiation. A 57-year-old man was referred after a gastroscopy for anemia evaluation. Gastroscopy revealed an approximately 3 cm ulcerofungating mass occupying the greater curvature of stomach body. Biopsy results revealed a poorly differentiated adenocarcinoma. Left gastric lymph node was enlarged, but there were no evidence of distant metastasis on the abdominal CT. He underwent a radical subtotal gastrectomy and gastroduodenostomy with dissection of the enlarged lymph nodes. Postsurgical histological examination revealed an undifferentiated carcinoma with focal yolk sac tumor and hepatoid carcinoma differentiation. Immunohistochemical staining revealed that the tumor cells were focal positive for AFP, anti-hepatocyte antibody.

Measurements of esophageal diseases and distribution / Монголын Анагаах Ухаан

Incidence rate of esophageal cancer is not similar in each country, for example higher incidence in Central Asia, North America and northern Africa. An esophageal cancer in Mongolia is 4th most common cancer after liver, stomach and lung cancers. At first to determine the structure and functional tendency we need to formulate mathematic analysis, processing and reference values of measurements. Formulation consists of 2 main parts that are quantitative and qualitative methods.Goal: By this research study we have aimed to determine pathological types and morphometric indices in esophageal cancer.Materials and Methods: Materials and samples for research study were chosen from biopsies, which were taken for diagnosis of esophageal disease in national center of cancer, Ulaanbaatar city among 1998-2002. These materials were diagnosed by international classification, 2006 of WHO. Totally 286 samples were prepared, here 184 (64.5%) samples were squamous cell carcinoma (well differentiated- 55, moderate differentiated-103, poorly differentiated-26), adenocarcinoma 20 (7%), undifferentiated carcinoma 7 (2.4%), intraepithelial neoplasia 74 (25.9%), low grade neoplasia 9 (3.1%) and high grade neoplasia was 65 (22.8%). Measurement was done by Video test 5.0 of Russia and software SPSS 17.0 was used for statistical analysis.Results: From the result of the study concluded the average indices are increased by 1.5 times in neoplasia cases of squamous epithelium, 2.1 times in well differentiated squamous cell carcinoma cases, 3.2 times in moderate differentiated squamous cell carcinoma cases, 2 times poorly differentiated squamous cell carcinoma cases, 2.1 times in adenocarcinoma cases and 1.7 times in the undifferentiated carcinoma cases in compare with relatively healthy average volume indices. But in the performed study was not observed a real difference between average volume indices of variable cancer cases. The most high rate of cell volume indices and square indices of nucleus were observed in moderate differentiated squamous cell carcinoma cases while in undifferentiated carcinoma and poorly differentiated squamous cell carcinoma cases were lowest rate of cell volume indices were observed.Conclusions: There are considerable signification on caryometrical and stereometrical research of differentiation between esophageal cancer and precancerous diseases.

A Case of Undifferentiated Carcinoma with Osteoclast-Like Giant Cells in the Pancreas / 대한내과학회지

Undifferentiated carcinomas with osteoclast-like giant cells are rare pancreatic and periampullary neoplasms that mimic giant cell tumors of bone morphologically. Recently, we experienced an osteoclast-like giant cell tumor arising in the tail of the pancreas. A 76-year-old male was admitted with epigastric discomfort and indigestion. Abdominal computed tomography (CT) and abdominal magnetic resonance imaging (MRI) showed a 3x3-cm mass containing necrotic and hemorrhagic areas in the tail of the pancreas. A distal pancreatectomy and splenectomy were performed. Histological examination showed tumor cell components consisting of mononuclear pleomorphic cells admixed with osteoclastic giant cells. The final diagnosis was undifferentiated carcinoma with osteoclast-like giant cells with ductal adenocarcinoma in the pancreas.

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells / 대한외과학회지

Undifferentiated carcinoma with osteoclast-like giant cells is a rare neoplasm of the exocrine pancreas. Some similar cases have been reported, but the histogenesis of these tumors varies and is controversial. We report here on a case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells. A 77-year old woman presented with abdominal pain and anorexia. Abdominal computed tomography and magnetic resonance imaging showed an approximately 10 x 5 cm highly attenuated mass arising from the tail of the pancreas and invading the spleen and adjacent bowel loop. The initial impression was a malignant endocrine tumor or solid-pseudopapillary tumor of the pancreas. The patient underwent a distal pancreatectomy with splenectomy and left hemicolectomy. The histopathology and immunohistochemistry helped make the diagnosis that of an undifferentiated carcinoma with osteoclast-like giant cells of the pancreas.

A Rare Case with Primary Undifferentiated Carcinoma of Pericardium

A primary pericardial tumor is very rare. A 77-year-old woman was admitted to our hospital with chief complaint of exertional dyspnea due to large amount of pericardial effusion. She was finally diagnosed as pericardial undifferentiated carcinoma without definite histopathologial, immunochemistry feature. Despite palliative radiation therapy, the patient died of multiple organ failure. The prognosis of primary pericardial undifferentiated carcinoma is known to be very poor, especially in old people.

A Case of Gastric Undifferentiated Carcinoma with Choriocarcinomatous and Hepatoid Carcinomatous Differentiation / 대한소화기내시경학회지

Here we report a case of a patient with gastric undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. A 62-year-old man was referred after a healthcare screening gastroscopy. Gastroscopy revealed an approximately 3x3 cm ulcerofungating mass in the posterior wall of the antrum. Biopsy results revealed a moderately differentiated adenocarcinoma. The initial serum alpha-FP levels were above 350 ng/mL. An abdominal CT scan revealed focal wall thickening along the greater curvature of the gastric antrum, with perigastric fat invasion and enlarged multiple perigastric lymph nodes. He underwent a palliative radical subtotal gastrectomy and gastroduodenostomy with dissection of the enlarged lymph nodes. Postsurgical histological examination revealed an undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. Immunohistochemical staining revealed that the tumor cells were positive for human chorionic gonadotropin (hCG), alpha-FP, and anti-hepatocyte antibody.

A Case of Sinonasal Undifferentiated Carcinoma Originating from the Ethmoid Sinus / 대한이비인후과학회지

Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy and commonly asymptomatic until the tumor has extensively progressed. Patients with SNUC usually show the involvement of multiple sinuses and the nasal cavity. In addition, the invasion of the orbit or cranial vault is a frequent finding. Most case series of SNUC report very poor prognosis despite aggressive multimodality therapy. We present a case of SNUC in a 19-year old female occurred from the right ethmoid sinus with invasion to the orbital content.