A Rare Manifestation of Secondary Hyperparathyroidism Due to Brown Tumors: A Case Report.

Purpose: Brown tumors, also known as cystic fibrosa, are rare, benign, osteolytic, fibrotic lesions of the bones that occur secondary to hyperparathyroidism. They are caused by increased osteoclastic activity leading to an abnormal bone metabolism. Case Description: Here, we present the case of a 58-year-old male, who presented with painful bony lesions, initially attributed to metastatic disease. After biochemical workout, imaging and biopsy, the nature of the lesions was revealed. We discuss the differential diagnosis and clinical management of the disease. Conclusion: Patients with brown tumors should be assessed in the differential diagnosis of bony lesions and should always be tested for hyperparathyroidism. An early diagnosis is crucial for the successful treatment of such patients.

Extraocular sebaceous carcinoma mimicking benign sebaceous cyst.

Extraocular sebaceous carcinoma (SC) is an exceptionally rare neoplasm and has been confused in the past with basal cell carcinoma showing sebaceous differentiation. However, in contrast to the latter tumour, SC can be an aggressive cancer. We describe the case of a 55-year-old man with a 3-year history of a 5 × 2 cm lesion on the posterior thoracic wall. It had increased in size during this period but was otherwise asymptomatic. There was no significant past medical history or lymphadenopathy. Nor was there a family history of malignancy. The lesion was totally excised. The histopathological report revealed SC. As this neoplasm may be associated with Muir-Torre syndrome, the patient was screened for underlying internal neoplasia. All haematological, biochemical and tumour markers, imaging and endoscopic examinations were normal. Since SC may appear before the development of internal malignancy, our patient was scheduled for follow-up visits every 3 months.

Primary retroperitoneal echinococcal cyst.

A 74-year-old man was admitted with right flank pain and discomfort lasting for 2 months. CT scanning revealed a large retroperitoneal cystic mass. There were no cysts elsewhere. Serological testing revealed hydatid disease. Preoperatively he was treated by Albendazole 400 mg for 1 month and then underwent laparotomy. The entire mass was excised en bloc and intact and right hemicolectomy was simultaneously performed for excision of the adhered ascending colon. He recovered uneventfully and was discharged on the eighth day, Albendazole was given and follow-up visits were arranged for every 6 months. Total cystectomy in case of active echinococcal cysts remains the treatment of choice.

Increased HIF-1 alpha immunostaining in psoriasis compared to psoriasiform dermatitides.

BACKGROUND: Expression of hypoxia inducible factor 1 (HIF-1) alpha can be linked to inflammation through reciprocal interactions with several cytokines. This finding is in accordance with the previously noted HIF-1 alpha overexpression in psoriatic lesional keratinocytes. METHODS: In this study we have employed a carefully selected panel of antibodies and quantitative morphometric analysis to compare HIF-1 alpha immunoreactivity in psoriatic biopsy samples vs. that in samples obtained from psoriasiform dermatitides. RESULTS: We found statistically significant HIF-1 alpha overexpression in psoriasis. Furthermore, we observed a previously unreported preferential localization of immunoreactive keratinocytes in the immediate vicinity of inflamed and elongated papillae. This pattern of immunoreactivity may partially account for the observed increase of HIF-1 alpha immunostaining in psoriasis. CONCLUSIONS: Overall, our findings imply that possible novel therapeutic intervention(s) on the HIF-1 alpha pathway may offer another approach in controlling the inflammatory activity of psoriatic lesions.

Primary renal epithelioid hemangioendothelioma.

BACKGROUND: Epithelioid hemangioendothelioma (EH) is a rare vascular neoplasm with an unpredictable malignant potential that has been described mainly in soft tissue, liver, and lung. CASE REPORT: We report a case of a primary renal EH in a 54-year-old woman who presented with a 3-month history of abdominal pain. Abdominal ultrasound and computed tomography scan revealed a solitary mass of 4.0 x 3.2 cm in the outer surface of the right kidney. Nephron-sparing surgery was performed. On the basis of the histological and immunohistochemical findings, the diagnosis of EH was made. The patient was free of disease 6 months after surgery. CONCLUSIONS: Although EH may have a histologically benign appearance and can be treated using a nephron-sparing approach, this neoplasm is potentially malignant urging the need for a long-term follow-up in these patients.

AFP-producing hepatoid adenocarcinoma of the stomach: a case report.

Hepatoid gastric adenocarcinoma is a distinct variant of gastric carcinoma which represents a comparatively small percentage of the disease and in many cases is producing high serum alpha-fetoprotein (AFP). We report a case of an 85 year old woman who presented with epigastric and right upper quadrant pain and was found in a CT scan to have multiple liver nodules and a gastric antrum mass as well as an elevated AFP level of 155000 IU/ml. An endoscopic biopsy of the antral mass showed hepatoid variant of gastric adenocarcinoma. The patient refused any further treatment and died 4 months after diagnosis. Hepatoid gastric adenocarcinoma is considered to have a poor prognosis, although cases with survival of several years have been reported. Poor outcome in most of the cases is due to the fact that, as in our patient, metastatic disease is already present at diagnosis.

INCENP (inner centromere protein) is overexpressed in high grade non-Hodgkin B-cell lymphomas.

Inner centromere protein (INCENP) is a member of the Chromosomal Passenger Complex (CPC), which is a four member protein complex essential for proper completion of mitosis and cell division (cytokinesis). Inappropriate chromosomal segregation and cytokinesis due to deregulated expression of chromosome passenger proteins may lead to aneuploidy and cancer including lymphomas. According to our knowledge this is the first study investigating immunohistochemical expression of INCENP in lymphoma cases and cancer tissues in general. Our purpose was to characterize the expression of INCENP in cases of non-Hodgkin B-cell lymphomas, to compare the immunoreactivity between low and high grades and to evaluate the correlation between INCENP and MIB-1 labeling indices. We examined INCENP and MIB-1 immunoreactivity in paraffin sections of 55 samples of non-Hodgkin B-cell lymphomas, obtained from 55 patients, 31 men and 24 women. Thirty were of high grade and 25 were of low grade. Our results showed significantly higher nuclear immunohistochemical expression of INCENP in high grade B-cell lymphomas versus low grade ones. Also INCENP expression was significantly correlated with MIB-1 labeling index. Taken together our results point to a possible association between increased INCENP immunostaining and B-cell lymphoma aggressiveness and also stress the need for further investigating the expression of INCENP and other mitotic regulatory proteins in lymphomas and other malignant neoplasms.

Fascin determination in urothelial carcinomas of the urinary bladder: a marker of invasiveness.

CONTEXT: Invasion and the depth of invasion affect significantly the prognosis in urothelial carcinomas. The histopathologic evaluation of invasion may be problematic in some cases. Application of new immunohistochemical markers may facilitate the assessment of invasion. Fascin, one of these markers, is an actin-bundling protein involved in tumor cell migration. Fascin expression is increased in various carcinomas. Prior to this research, to our knowledge, only one study exists regarding fascin expression in urothelial carcinomas. OBJECTIVE: To characterize the expression of fascin in additional cases of urothelial carcinoma and to verify statistically a relationship between fascin overexpression and invasiveness in these tumors. DESIGN: We examined fascin immunoreactivity in 116 specimens of urothelial carcinomas obtained from 116 patients including 96 men and 20 women. Fifty-eight cases were ranked as low-grade carcinomas, pTa stage, and 58 cases were ranked as high-grade carcinomas--11 were ranked as stage pTa, 21 were ranked as pT1, and 26 were ranked as pT2 carcinomas. Fascin immunoreactivity was assessed semiquantitatively in tumor cells. In each case, we ascribed 3 immunoreactivity scores, one for extent, one for intensity, and a combined immunoreactivity score. RESULTS: The combined immunoreactivity score was significantly higher in invasive carcinomas. In addition, strong staining was observed exclusively in invasive carcinomas. None of the pTa tumors demonstrated intense staining, including those ranked at the higher grade. CONCLUSIONS: Our results point to an association between fascin immunostaining and urothelial carcinoma invasiveness and suggest that fascin overexpression may be a marker of aggressive urothelial carcinomas.

Cervical spinal cord intramedullary teratoma.

We present the case of a 62-year-old patient suffering from the presence of a cervical spinal cord intramedullary teratoma and treated operatively. The purpose of this case report is to describe the highly unusual localization of the intramedullary teratoma associated with other vertebral malformations. A review of the literature is also presented.

Prevalence and clinical significance of immunoglobulin A antibodies against tissue transglutaminase in patients with diverse chronic liver diseases.

The prevalence of celiac disease (CD) and the prevalence and clinical significance of anti-tissue transglutaminase (tTG) antibodies (tTGAbs) in a large series of patients with chronic liver diseases were assessed. We studied 738 patients (462 with chronic viral hepatitis, 117 with autoimmune liver diseases, 113 with alcoholic or nonalcoholic fatty liver disease, and 46 with other liver disorders) and 1,350 healthy controls (HC). Immunoglobulin A (IgA) tTGAbs were measured by enzyme-linked immunosorbent assay and a microsphere-based flow cytometric assay. Positive sera were investigated for IgA antiendomysial antibodies (EmA). IgA tTGAb-positive subjects were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Four of 1,350 HC (0.3%) tested tTGAb(+) EmA(+) and underwent a biopsy (CD confirmation in all). Four of 738 liver disease patients tested tTGAbs(+) EmA(+) (0.54%; not statistically significant). Two were HCV infected (1.24%; not statistically significant), and two had transaminasemia of unknown origin. Forty-three patients tested tTGAbs(+) EmA(-) (5.8%; P<0.001 compared to HC). Inhibition experiments verified the existence of specific IgA anti-tTG reactivity. Twenty-six of 43 patients underwent a biopsy (all negative for CD). Binary logistic regression analysis revealed age (P=0.008), cirrhosis (P=0.004), alkaline phosphatase (P=0.026), and antinuclear antibodies (P=0.012) as independent risk factors for tTGAb reactivity among the patients. It was concluded that CD prevalence is the same in HC and patients with chronic liver diseases. The prevalence of tTGAbs is higher in hepatic patients compared to HC, but their specificity for CD diagnosis in this group of patients is low. tTGAbs in patients appear to be associated with the presence of autoimmunity, cirrhosis, and cholestasis, irrespective of the origin of the liver disease.