Angioleiomyoma of the uterus: report of a distinctive benign leiomyoma variant.

Angioleiomyoma is a relatively rare type of leiomyoma of the uterus that originates from smooth muscle cells and contains thick-walled vessels. Angioleiomyoma is usually found in the skin of the lower extremities. Uterine angioleiomyoma has similar morphological features to that of the skin. The authors present a case of a 50-year-old woman who was admitted to the present hospital with the complaint of lower abdominal pain. On clinical examination, she was found to have a palpable lower central abdominal mass. Pelvic ultrasound revealed uterine enlargement, multiple small leiomyomas, and a large mass in the myometrium. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy. On histological examination, the mass was diagnosed as angioleiomyoma. Hemangioma, angiofibroma or angiomyofibroblastoma were also included in the differential diagnosis. The treatment of choice for angioleiomyoma is surgical excision, and either angiomyomectomy or simple hysterectomy are proven to be equally effective; the decision depends on the patient's symptoms and her desire to preserve fertility.

Solid neuroendocrine carcinoma of the breast: a rare tumor.

Solid Neuroendocrine carcinoma of the breast (SNECB) is a subtype of primary neuroendocrine carcinoma (NEC) of the breast with several distinctive features. In the present study, the authors report a case of 84-year old woman who was admitted in the hospital with a lump in her right breast. Mammography revealed a well-defined nodule in the outer lower quadrant of her right breast. She underwent lumpectomy and sentinel lymph node biopsy, which showed no metastasis. The histological diagnosis was solid neuroendocrine carcinoma of the breast. Microscopically, the tumor is formed from cells arranged in nests or trabeculae and separated by scant connective tissue. Immunohistochemical staining demonstrates strong positivity for NSE, chromogranin, synaptophysin, ER, and PR. The patient is still alive 14 months after diagnosis. Because of the rarity of this disease, there is no standard treatment protocol and a large variety of chemotherapy protocols have been employed in treating this disease.

Primary hepatic lymphoma: a challenging diagnosis.

Introduction. Primary hepatic lymphoma is an unusual malignancy and is very difficult to diagnose promptly. An intrigue case presenting with cholestatic jaundice is reviewed and main disease characteristics are further discussed. Case Report. A 70-year-old male presented with dull right upper quadrant abdominal pain and mild cholestatic jaundice. Initial evaluation revealed mildly elevated liver function tests and normal tumor markers, while imaging with an abdominal CT-scan showed multiple hypodense nodules in both liver lobes. First impression of metastatic deposits from gastrointestinal origin was not confirmed by endoscopic means. After CT-guided biopsy, primary diffuse large B-cells non-Hodgkin lymphoma was revealed. Appropriate chemotherapy improved patient's condition markedly. Discussion. Primary hepatic lymphoma is a rare form of extranodal lymphomas, accounting for less than 1% of all extranodal lymphomas in general. In order to define the condition as PHL, liver has to be the only site of lymphoma occurrence or to be involved in a major degree with minimal nonliver disease. Most PHLs are of B-cell origin with large cells as the main cell type.

Dermatofibrosarcoma protuberans of the mons pubis.

Dermatofibrosarcoma protuberans (DFSP) is a rare fibrous tumor with intermediate malignant potential and in rare cases the vulva is involved. The most common clinical presentation is a firm plaque with surrounding red to blue discoloration, or less often with multiple small subcutaneous nodules. The authors present a case of a 66-year-old woman who came to the hospital complaining of longstanding painless nodules in the area of the mons pubis. On physical examination, a diffuse area of erythematous induration involving the mons pubis was recognized and within this area there were smaller nodules. The histological diagnosis was dermatofibrosarcoma protuberans. Microscopically DFSP has a storiform pattern of uniform cytologically bland spindle cells, with a characteristic honeycomb pattern of infiltration into the subcutaneous fat. Immunohistochemical staining demonstrates strong positivity for vimentin and CD34. The treatment has been through a wide local excision (WLE), although microscopic tumor projections beyond the central tumor nodule explain the tumors propensity for local recurrence.

Pancreatoduodenectomy for pancreatic cancer in a low volume institution.

PURPOSE: To report the patient morbidity and mortality rates following pancreatoduodenectomy (PD) carried out in our low volume institution, and compare our results with results from other high volume institutions. METHODS: A retrospective analysis was conducted on patients with pancreatic malignancies surgically treated with PD from 2005 to 2010 in our institution. Data were collected with particular emphasis on morbidity and mortality rates. All patients were followed from the date of discharge to the date of death or status at the last follow-up (July 2011). RESULTS: In a period of 5 years 42 patients underwent PD. Morbidity rates were as follows: 11.9% wound infections, 21.4% pancreatic fistulae, 23.8% delayed gastric emptying (DGE), 14.3% hemorrhage, and 7.1% biliary leak. Two patients required re-laparotomy one for delayed hemorrhage and one for sepsis. The mortality rate was 7.1%. The 2-year survival rate was 45.17 percent; and the median survival 22 months. CONCLUSION: PD in our low volume institution had high morbidity and mortality rates compared with results published in the literature. There is a need, however, to establish a policy for referral of patients with pancreatic cancer to other centers with a higher number of resections, in order to decrease morbidity and mortality rates.

Atypical polypoid adenomyoma of the uterus. A case report and a review of the literature.

Atypical polypoid adenomyoma (APA) is a rare, benign lesion. The tumor occurs in nulliparous women aged 22-48 years (average 33 years) and it has been suggested as being related to prolonged estrogenic stimulation. We describe a case of a 72-year-old woman who presented at our hospital with persistent, worsening urinary incontinence and pelvic pain. Physical examination and pelvic ultrasound disclosed uterine enlargement, a mass in the endometrial cavity and multiple small myomas. Total hysterectomy with bilateral salpingo-oophorectomy was performed. The histological diagnosis for the mass of the endometrial cavity was atypical polypoid adenomyoma. APA should be distinguished from endometrial carcinoma and other malignant uterine neoplasms such as adenofibroma, adenosarcoma and malignant mixed mullerian tumor. The immunohistochemical panel which usually includes alpha smooth muscle actin, desmin, Ki67 and recently CD10 is often helpful in establishing the diagnosis. The treatment may vary depending on the patient's age, her desire to preserve fertility, and the severity of her symptoms.

Expression of pSTAT3 in human colorectal carcinoma: correlation with clinico-pathological parameters.

PURPOSE: Signal transducers and activators of transcription (STATs) are tyrosine phosphorylated transcription factors activated by the Jak family kinases. Various ligands, including interferons and growth factors induce activation of STATs. STATs are key signaling molecules in malignant transformation and tumor progression. Constitutive activation of the STAT3 has been observed in a wide variety of human malignancies. The purpose of this study was to evaluate the clinical significance of phosphorylated (p) STAT3 expression in human colorectal adenocarcinomas (CRC). METHODS: 135 primary human CRC were immunohistochemically studied, from which 11 were intramucosal and 124 invasive carcinomas. The observed pattern of pSTAT3 immunostaining was nuclear and cytoplasmic. Nuclear pSTAT3 staining was calculated as the number of pSTAT3 positive nuclei divided by the total number of nuclei in at least 10 fields, and then expressed as a percentage. Cytoplasmic positivity of pSTAT3 was measured, depending on the intensity of immunoreactivity and scored as mild, moderate and intense. RESULTS: Positive staining for pSTAT3 immunoreactivity was significantly correlated with the depth of tumor invasion (p<0.001), venous invasion (p<0.05), lymph node metastasis (p<0.05) and advanced Dukes stage (p<0.001). There was no significant correlation between pSTAT3 immunoreactivity and poor differentiation of CRC. CONCLUSION: The expression of pSTAT3 is an important factor related to tumor and vascular invasion, nodal involvement and advanced CRC stage.

Pure Sertoli cell tumor. a case report and review of the literature.

Pure Sertoli cell tumor (SCT) is a rare sex cord tumor and a subtype of Sertoli-Leydig cell tumors according to the WHO Classification. They lack a Leydig cell component and do not contain the immature neoplastic stroma found in the neoplasms of the Sertoli-Leydig cell category. The age of the patients ranges between two and 79 years. Sertoli cell tumors occur in women of reproductive age but a few can also occur in children. The most common clinical presentation when occurring in children is isosexual pseudoprecocity. Women of reproductive age and postmenopausal women frequently present with abdominal pain, swelling and menstrual abnormalities. Occasionally SCTs occur in patients who have Peutz-Jeghers syndrome. The tumors are hormone functional in 40-60% of cases. They are often estrogenic, occasionally also androgenic or rarely both. Grossly they are usually yellow to brownish, solid or with several cystic areas. Microscopically they show always almost a tubular growth pattern, but they may also have other growth patterns which can be extensive, making the correct diagnosis difficult. These histologic patterns may result in SCTs mimicking other ovarian tumors. The immunohistochemical panel which usually includes EMA, inhibin, chromogranine, CD99 and calretinin is often helpful in establishing the diagnosis. Most SCTs are Stage I, unilateral, cytologically bland, and clinically benign, but occasional examples are high stage. About 11% of Stage I tumors have worrisome histologic features that may portend an adverse outcome.

Intravascular T-cell lymphoma of the vulva, CD30 positive: a case report.

Primary non-Hodgkin's lymphoma involving the vulva is very rare. It affects predominantly the labia major but it can also present as a clitoral mass or can even be located in the Bartholin's gland. Vulvar lymphoma is an aggressive disease. We describe a case of a 48-year-old woman who presented to our hospital with fever and a slow growing mass in the vulva. She had no other clinical symptoms. CT-scan showed no evidence of disease in any other organ or lymph node tissue. A local excision of the mass followed and the final diagnosis was primary intravascular vulvar lymphoma, of T-cell origin, CD30 positive. In general, intravascular lymphomas are clinically and immunophenotypically heterogenous and may represent more than one entity. They are predominantly of B cell lineage, involving most commonly the skin and rarely other systems or organs. Because of the fact that the vulva is a cutaneous site the development of intravascular lymphoma in this region is possible.

Hepatoid carcinoma of the ovary. A case report and review of the literature.

Hepatoid carcinoma (HCO) is a rare ovarian tumor and is thought to be a different subtype from hepatoid-type yolk sac tumor based on its pathologic features. In contrast to hepatoid yolk sac tumor in which the patients are usually young, patients with HCO are elderly with a peak incidence during the sixth decade of life. None of the patients with HCO have had gonadal dysgenesis or recognizable germ cell components within the tumors. We describe a case of a 42-year-old woman who presented to our hospital complaining of abdominal pain. Physical examination and CT scan revealed a large tumor in the left adnexa. She underwent total hysterectomy and bilateral salpingo-oophorectomy with omentectomy. A left ovarian mass measuring 11 cm in diameter was found. Histological diagnosis was hepatoid carcinoma of the left ovary. Immunohistochemical findings suggest that hepatoid carcinoma of the ovary is probably a most likely variant of a common epithelial carcinoma by a process of neometaplasia or transdifferentiation.

Malignant adenomyoepithelioma of the breast--case report.

Malignant adenomyoepithelioma (MAME) of the breast is a rare tumor characterized on the basis of histologic, immunohistochemical and ultrastructural features by malignant proliferation of the epithelial and myoepithelial cells. We report a case of an 80-year-old woman with malignant adenomyoepithelioma of the breast, one of the oldest patients described up to today. A primary tumor in the left breast grew within a short period of time. A modified mastectomy with sampling of the axillary lymph nodes was performed. The lymph nodes did not include any metastatic lesions. In this case the malignancy was evidenced by the presence of a high mitotic rate, several nuclear atypia, necrosis, and local invasion. The tumor was associated with adenosis and in adjacent positions to the infiltrating portions a circumscribed nodule with histological features of benign adenomyoepithelioma was present. Reviewing the literature MAME has been reported in women aged between 26-76 years. The metastatic potential of this entity is not well studied. It appears to have hematogenous rather than lymphatic spread and usually occurs in primary tumors more than 2 cm in size.

Immunohistochemical expression of bcl-2 in UICC stage I and III colorectal carcinoma patients: correlation with c-erbB-2, p53, ki-67, CD44, laminin and collagen IV in evaluating prognostic significance.

BACKGROUND: The objective of this study was to evaluate the expression of bcl-2 in UICC stage I and stage III (Dukes's stage B and C) colorectal adenocarcinoma and to examine its association with clinicopathological features, c-erbB-2, p53, ki-67, CD44, laminin and collagen IV and long term outcome. METHODS: Paraffin embedded specimens from 61 patients with UICC stage I (Dukes's stage B) and 39 patients with UICC stage III (Dukes's stage C) colorectal adenocarcinoma who were treated with surgery were assessed. We determined by immunohistochemistry the expression of bcl-2, c-erB-2, p53, ki-67, CD44, laminin and collagen IV with 5 year follow up. RESULTS: Cytoplasmic staining of the bcl-2 gene product was seen in the tumour cells of 27 cases (27%). Expression of bcl-2 protein was unrelated to patient sex, age, tumour site or tumour grade, but was related to tumour stage (p = 0.012). No significant association was demonstrated between bcl-2 and c-erbB-2, p53 or CD44. However, there was very strong evidence of correlation between bcl-2 staining and ki-67, laminin and collagen IV. There was a trend towards increased survival in patients whose tumours expressed bcl-2 protein. When a correlation between bcl-2 and the other markers had been made the positive expression of bcl-2 was beneficial. CONCLUSIONS: The results from this study would suggest that expression of bcl-2 appear to be useful in selecting a group of colorectal cancer patients with a better prognosis.

Bilateral primary breast lymphoma--case report.

Primary lymphoma of the breast is an uncommon malignant breast tumor which is seldom distinguished preoperatively from other more common forms of breast cancer. Bilateral breast lymphoma affects younger women especially during pregnancy or postpartum. We report a case of a 55-year-old woman who was admitted to our hospital with painless bilateral breast enlargement. A bilateral radical mastectomy with bilateral axillary lymph node dissection was performed. The histology of the surgical specimen was non-Hodgkin's malignant lymphoma of the diffused large B cell type. Most of the neoplastic cells resembled large centrocytes and sometimes blast cells showing some degree of plasmacytoid differentiation. Foci with a sufficient number of immunoblasts were also noted. The patient was also found to have a bilateral axillary lymph node metastasis. After additional clinical and laboratory screening, there was no other evidence of lymphatic disease at other sites. The patient was submitted to the anticancer hospital for further treatment. She was free of recurrence two years after surgery. The rarity of the disease, lack of uniform classification and variable treatment modalities make prognostic predictions of breast lymphoma difficult.

Prognostic evaluation of CD44 expression in correlation with bcl-2 and p53 in colorectal cancer.

To investigate the expression of CD44 in colorectal cancer and examine its association with clinicopathological features, bcl-2, p53 and long-term outcome, paraffin-embedded tumour specimens from 61 patients with Dukes stage B (AJCC/UICC stage I) and 39 patients with Dukes stage C (AJCC/UICC stage III) colorectal adenocarcinoma were assessed by immunohistochemistry. The expression of CD44, bcl-2 and p53 were correlated with 5-year follow-up. Low CD44 expression was present in 30%, moderate in 30% and extensive in 40% of cases. It was not related to patient sex and age but was related to tumour differentiation, stage and tumour site. No association was demonstrated between CD44 and bcl-2. However, there was significant evidence of an association between CD44 and p53 in 66 cases in which p53 was previously assessed. There was a trend towards increased survival in patients whose tumours expressed lower levels of CD44 protein. When entered into multivariate analysis model, which also included bcl-2 and p53, CD44 staining emerged as an indicator of poor prognosis in colorectal cancer patients.