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1.
Medicine (Baltimore) ; 99(33): e21599, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872013

RESUMO

INTRODUCTION: Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is a rare neoplasm characterized by morphological analogy to papillary thyroid carcinoma and the abnormal expression of thyroid transcription factor-1 (TTF-1). We herein report a rare case of TL-LGNPPA with a review of its clinical and morphological characteristics and the treatment provided. PATIENT CONCERNS AND DIAGNOSIS: The patient was a 50-year-old Chinese woman with the complaint of a three-year history of phlegm with blood with pharyngeal discomfort. There were no remarkable physical findings, and the laboratory tests were normal. Laryngoscopy and nasal computed tomography identified a mass at the posterior end of the nasal septum. Histologically, the tumor exhibited an oval papillary growth. Immunohistochemically, the neoplastic cells were positive for TTF-1, vimentin, cytokeratin 7, and cytokeratin 19. Pathological examination indicated a thyroid-like low-grade nasopharyngeal papillary adenocarcinoma. INTERVENTION: The neoplasm was completely resected without any complication. OUTCOMES: The patient had neither local recurrence nor distant metastasis 1 year after the removal of the tumor. CONCLUSION: Although TL-LGNPPA is a malignant tumor, complete surgical resection is an effective treatment.


Assuntos
Adenocarcinoma Papilar/patologia , Carcinoma Nasofaríngeo/patologia , Adenocarcinoma Papilar/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/cirurgia , Estadiamento de Neoplasias , Neoplasias da Glândula Tireoide/patologia
2.
Zhonghua Zhong Liu Za Zhi ; 42(6): 463-468, 2020 Jun 23.
Artigo em Chinês | MEDLINE | ID: mdl-32575941

RESUMO

Objective: To explore the differential protein expressions in papillary thyroid carcinoma (PTC) with or without Hashimoto's thyroiditis (HT). Methods: Tissue microarray was prepared and the protein expression levels of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF), vascular endothelial growth factor (VEGF), cyclinD1, mesothelial cell (MC) , CD56 and Galectin3 in the PTC tissues with or without HT were detected by immunohistochemical staining. Results: The positive expression rates of BRAF protein in the PTC tissues with or without HT groups were 55.4% (36/65) and 63.6% (42/66), respectively, without significant difference (P=0.336). The positive expression rates of VEGF protein in the PTC tissues with or without HT groups were 25.7% (19/74) and 25.8%(17/66), respectively, without significant difference (P=0.991). The positive expression rates of cyclin D1 protein in the PTC tissues with or without HT groups were 93.4% (71/76) and 97.6% (80/82), without significant difference (P=0.206). The positive expression rates of MC protein in the PTC tissues with or without HT groups were 86.1% (62/72) and 83.5%(71/85), without significant difference (P=0.654). The positive expression rates of Galectin3 protein in the PTC tissues with or without HT groups were 98.7% (76/77) and 97.5% (78/80), without significant difference (P=0.583). The positive expression rates of CD56 in the PTC tissues and adjacent thyroid follicular epithelial cells were 27.4% (32/117) and 65.0% (76/117), respectively, and the difference was statistically significant (P=0.001). The positive expression rates of CD56 in PTC tissues with or without HT were 35.5% (24/68) and 16.5% (13/79), respectively, and the difference was statistically significant (P=0.009). Conclusions: There are no significant differences in the expressions of BRAF, VEGF, CyclinD1, MC and Galectin3 between the PTC tissues with or without HT. However, the significantly differential expression of CD56 between the two group suggests that CD56 may be related to the pathogenesis of PTC with HT. CD56 may be used as a potential molecular marker in PTC diagnosis.


Assuntos
Adenocarcinoma Papilar/genética , Antígeno CD56/metabolismo , Carcinoma Papilar/patologia , Doença de Hashimoto/genética , Proteínas Proto-Oncogênicas B-raf/genética , Câncer Papilífero da Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adenocarcinoma Papilar/metabolismo , Adenocarcinoma Papilar/patologia , Animais , Biomarcadores/análise , Carcinoma Papilar/metabolismo , Ciclina D1/genética , Galectinas , Doença de Hashimoto/metabolismo , Doença de Hashimoto/patologia , Humanos , Camundongos , Valor Preditivo dos Testes , Proteínas Proto-Oncogênicas B-raf/metabolismo , Câncer Papilífero da Tireoide/metabolismo , Câncer Papilífero da Tireoide/patologia , Glândula Tireoide/metabolismo , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/metabolismo , Análise Serial de Tecidos , Fator A de Crescimento do Endotélio Vascular/genética
3.
Medicine (Baltimore) ; 99(24): e20668, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541511

RESUMO

INTRODUCTION: Pure invasive micropapillary carcinoma (IMPC) is a rare histologic subtype of pancreatic cancer which has a high propensity for lymph node metastasis and poor prognosis. PATIENT CONCERNS: An 81-year-old woman was admitted to our institution with a 3-month history of back pain. Computed tomography of the abdomen and pelvis confirmed the presence of a low-density mass in the tail of the pancreas. DIAGNOSIS: Endoscopic ultrasound-guided fine needle aspiration cytology (FNAC) from the pancreatic mass showed small tumor cell clusters with three-dimensional aggregates and morula-like structures. The tumor was diagnosed as adenocarcinoma with micropapillary features. INTERVENTIONS: The patient underwent radical antegrade modular pancreatosplenectomy and regional lymph node dissection. Histological examination showed small clusters of tumor cells that were closely adhered to one another. The cells were located in empty stromal spaces mimicking lymphovascular channels. All tumor cells showed reverse polarity, resulting in an "inside-out" pattern. An extensive search was performed, and no typical ductal adenocarcinoma component was found. The tumor measured 1.5 × 1.3 cm and invaded into the peripancreatic fat tissue without adjacent organ invasion. One of the 12 regional lymph nodes showed metastasis. Ion Torrent next-generation sequencing identified missense mutations in KRAS, TP53, and SMAD4 using the Oncomine Comprehensive Panel version 1. OUTCOMES: Twelve months following surgical resection the patient remained healthy with no evidence of recurrence at clinical follow-up. LESSONS: This report highlights the diagnostic features and molecular characteristics of pure pancreatic IMPC and the challenges with diagnosis by FNAC. A centralized and collaborative accumulation of additional cases of pure IMPC could further elucidate its pathogenesis.


Assuntos
Adenocarcinoma Papilar/diagnóstico , Técnicas de Diagnóstico Molecular , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma Papilar/patologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Invasividade Neoplásica , Neoplasias Pancreáticas/patologia
4.
Radiol Med ; 125(3): 257-264, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823295

RESUMO

OBJECTIVE: To investigate the PET/CT findings in lung invasive adenocarcinoma with minor components of micropapillary or solid contents and its association with lymph node metastasis. MATERIALS AND METHODS: A total of 506 lung invasive adenocarcinoma (≤ 3 cm) patients who underwent a PET/CT examination and resection surgery were included. According to the proportion of solid/micropapillary components, the patients were classified into three groups: solid/micropapillary-negative (SMPN) (n = 258), solid/micropapillary-minor (SMPM; > 5% not predominant) (n = 158) and solid/micropapillary-predominant (SMPP; > 5% most dominant) (n = 90). The patients' PET/CT findings, including SUVmax, MTV, TLG and CT characteristics, and other clinical factors were compared by one-way ANOVA test. Logistic regression analysis was done to identify the most predictive findings for lymph node metastasis. RESULTS: The value of SUVmax, MTV, TLG and tumor size was highest in SMPP group, followed by SMPM and SMPN group (P < 0.001).The areas under the curve for SUVmax, MTV and TLG for node metastasis were 0.822, 0.843 and 0.835, respectively. Univariate analysis found that the SMPP and SMPM group had more lymph node metastasis than the SMPN group (P < 0.001). Furthermore, the lymph node metastasis group had higher CEA, SUVmax, MTV, TLG, tumor size and more pleural invasion (P < 0.001). Logistic regression analysis found that SMPP pathological type, SMPM pathological type, higher CEA and male patients were risk factors for lymph node metastasis (P < 0.01). CONCLUSIONS: Lung invasive adenocarcinoma with micropapillary or solid contents had higher SUVmax, MTV, TLG and tumor size and was associated with lymph node metastasis, even if they were not predominant.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma Papilar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Adenocarcinoma de Pulmão/classificação , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/secundário , Adenocarcinoma Papilar/classificação , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/secundário , Idoso , Análise de Variância , Área Sob a Curva , Antígeno Carcinoembrionário , Feminino , Humanos , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Carga Tumoral
5.
Int J Clin Oncol ; 25(1): 59-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31414270

RESUMO

BACKGROUND: The aim of this study was to evaluate the prognostic veracity for disease-specific survival (DSS) of the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control tumor-node-metastasis staging system (TNM-8) compared with the seventh edition (TNM-7) in a Chinese population of patients with differentiated thyroid carcinoma (DTC) and to evaluate the impact of N1b redefinition and reclassification on prediction of survival. METHODS: A total of 569 DTC patients who underwent thyroid surgery in two Chinese hospitals were included in analysis to assess the predictive accuracy and N1b changes of TNM-8. Data from the Surveillance, Epidemiology and End Results (SEER) program were applied to validate the findings on N1b changes of TNM-8. Unadjusted DSS was calculated using the Kaplan-Meier method. Multivariable Cox proportional hazards models were used to evaluate the association of stage and lymph node metastasis (LNM) status with survival. The proportion of variation explained (PVE), Akaike information criterion (AIC), and Bayesian information criterion (BIC) were evaluated to compare model performance. RESULTS: When TNM-8 was applied, 39.7% of patients were downstaged relative to TMN-7. In comparison of TNM-7 and TMN-8, the PVE was 18.68% and 22.33%, the AIC was 704.22 and 680.50, and the BIC was 702.98 and 679.24, respectively. In 569 Chinese patients with DTC, levels I-V LNM was significantly related to poorer DSS compared with N0 and level VI LNM. Among patients aged ≥ 55 years, those with levels I-V and VII LNM had significantly worse DSS than those with N0 and Level VI LNM. In the SEER dataset, patients with levels I-V and VII LNM had significantly worse DSS compared with those with N0 and Level VI LNM, especially in older patients (age ≥ 55 years). CONCLUSIONS: TNM-8 staged a significant number of Chinese patients into lower stages and improved the accuracy of predicting DSS compared with TNM-7. However, changes in lateral LNM definition and classification of TNM-8 have a significant prognostic implication for patients with DTC, especially older patients (≥ 55 years). Our data suggest that a modified TNM staging system would be more useful for predicting mortality and determining a proper treatment strategy in patients with DTC.


Assuntos
Adenocarcinoma Papilar/patologia , Estadiamento de Neoplasias/normas , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Papilar/mortalidade , Adenocarcinoma Papilar/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático , Feminino , Hospitais , Humanos , Linfonodos/patologia , Masculino , Oncologia/organização & administração , Oncologia/normas , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/cirurgia
6.
J Matern Fetal Neonatal Med ; 33(2): 344-348, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29895203

RESUMO

Background: Whipple procedure is a complex operation usually performed to treat periampullary neoplasms. There are only four case reports of five pregnancies after Whipple procedure, with limited evidence about how to manage pregnancy after this surgery.Case: A 28-year-old gravida 5 Para 2022 presented to our hospital at 20 weeks with worsening depression. She had a history of Whipple for a solid pseudopapillary neoplasm of the pancreas followed by two pregnancies. In the first, she underwent successful induction of labor at 38 weeks for pregestational diabetes. In her second pregnancy, she had multiple admissions for diabetic ketoacidosis. She was scheduled for induction of labor at 35 weeks but given unstable lie, underwent cesarean delivery.Conclusion: Women with a history of Whipple procedure generally have successful pregnancies with the most common antenatal complications including diabetes mellitus, abdominal pain and pancreatitis/cholangitis.


Assuntos
Pancreaticoduodenectomia/efeitos adversos , Complicações na Gravidez/cirurgia , Adenocarcinoma Papilar/diagnóstico por imagem , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/cirurgia , Adulto , Cesárea , Colangite/etiologia , Diabetes Gestacional/etiologia , Feminino , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Pancreatite/etiologia , Gravidez , Complicações na Gravidez/diagnóstico por imagem
7.
Am J Surg Pathol ; 44(5): 711-717, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31876586

RESUMO

Hidradenomas are benign sweat gland tumors that typically present as small nodules in adulthood. Their anatomic distribution is wide and rarely includes acral sites. In this setting, reliable separation from digital papillary adenocarcinoma is important, but notoriously difficult. Hematoxylin and eosin-stained sections of 25 hidradenomas on acral skin were retrieved. The clinical presenting features and morphologic findings were recorded, and follow-up was obtained. Immunohistochemistry was performed for AE1/3, CK5/6, EMA, CEA, SMA, S100, p40, and p63. The tumors presented as solitary nodules on the hands (n=17) and feet (n=8) of adults (age range: 20 to 81 y; median: 50 y), with an equal sex distribution. Histologically, the well-circumscribed tumors were lobular, with a solid and cystic growth within dermis. Duct and squamous differentiation and vascularized hyaline stroma were frequent. The majority (n=18) were poroid hidradenomas. Scattered cytologic atypia and mitotic activity (median: 2/10 HPF) were common, and a pseudoinfiltrative growth of strands in a hyaline to sclerotic matrix was noted in 5 tumors. No papillary structures, atypical mitoses, or tumor necrosis were present. Immunohistochemically, all tumors expressed AE1/3, CK5/6, p40, and p63 strongly and diffusely. Luminal differentiation was highlighted by epithelial membrane antigen and carcinoembryonic antigen staining. S100 and SMA staining was absent. Follow-up (1 to 288 mo; median: 61 mo), available for 20 patients, showed no local recurrences and no disease-related mortality. Acral hidradenomas and digital papillary adenocarcinomas share a well-circumscribed dermal growth pattern containing solid, cystic, and tubular areas with mitotic activity and at least focal cytologic atypia. Lack of papillary structures and the diffuse positivity for p40 and p63 in the absence of S100 and SMA expression are helpful features in favor of acral hidradenoma.


Assuntos
Acrospiroma/patologia , Adenocarcinoma Papilar/patologia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Acrospiroma/química , Acrospiroma/cirurgia , Adenocarcinoma Papilar/química , Adenocarcinoma Papilar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alberta , Biomarcadores Tumorais/análise , Biópsia , Diagnóstico Diferencial , Feminino , Dedos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Escócia , Neoplasias Cutâneas/química , Neoplasias Cutâneas/cirurgia , Neoplasias das Glândulas Sudoríparas/química , Neoplasias das Glândulas Sudoríparas/cirurgia , Polegar , Dedos do Pé , Resultado do Tratamento , Adulto Jovem
8.
Int J Surg ; 71: 91-99, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31546033

RESUMO

BACKGROUND: Previous studies have indicated that there may be a difference in tumor biology between intraductal papillary mucinous carcinoma (IPMC) and pancreatic ductal adenocarcinoma (PDAC). However, the data are still controversial. The aim of this systematic review and meta-analysis was to summarize and compare the outcome of IPMC and PDAC after surgical resection. METHODS: Studies comparing IPMC and PDAC were identified using Medline and Embase search engines. Primary outcomes of interest were survival and recurrence. Secondary outcomes were clinicopathological characteristics. Meta-analysis of data was conducted using a random-effects model. RESULTS: A total of 14 studies were included. Pooled analysis revealed an improved 5-year overall survival (OS) for IPMC compared to PDAC (OR 0.23, 95% CI 0.09-0.56). Both colloid and tubular IPMC showed improved 5-year OS compared to PDAC (OR 0.12, 95% CI 0.05-0.25 and OR 0.38, 95% CI 0.26-0.54, respectively). Median survival time ranged from 21 to 58 months in the IPMC group compared to 12-23 months in the PDAC group. No meta-analysis could be performed on recurrence or on time-to-event data. Descriptive data showed no survival difference for higher TNM stages. IPMC was more often found at a TNM-stage of 1 (OR 4.40, 95% CI 2.71-7.15) and had lower rates of lymph node spread (OR 0.43, 95% CI 0.32-0.57). CONCLUSION: Available data suggest that IPMC has a more indolent course with a better 5-year OS compared to PDAC. The histopathological features are less aggressive in IPMC. The reason may be earlier detection. However, for IPMC with higher TNM stages the survival seems to be similar to that of PDAC.


Assuntos
Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Papilar/patologia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal Pancreático/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma Mucinoso/mortalidade , Adenocarcinoma Papilar/mortalidade , Idoso , Neoplasias da Mama/mortalidade , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal Pancreático/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pancreáticas/mortalidade , Taxa de Sobrevida
9.
Am J Clin Pathol ; 152(5): 582-589, 2019 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-31287861

RESUMO

OBJECTIVES: Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TLLGNPPA) is a relatively rare nasopharyngeal tumor. We performed morphological characterization, immunohistochemical profiling, and investigated gene mutations. We also provide clinical follow-up data and brief review of the literature. METHODS: Immunohistochemistry was used to evaluate the expression of TTF-1, CK19, CK7, EMA, TG, Pax-8, CK5/6, S100, and Ki-67. Additionally, in situ hybridization was utilized to identify the presence of EBV. We investigated mutations in hot-spot exons of KRAS/NRAS/BRAF to rule out common mutations seen in thyroid tumors. RESULTS: Histopathologic examination of four cases identified tumors that were mainly occupied by papillary architectures. One case had a predominantly glandular structure. The tumors expressed TTF-1 and CK19, while TG and Pax-8 were negative. S100 was moderately expressed focally in three cases. CONCLUSIONS: While TLLGNPPA displays a morphological resemblance to papillary thyroid carcinoma (PTC), it is vital to differentiate nasopharyngeal metastasis from PTC for appropriate treatment.


Assuntos
Adenocarcinoma Papilar/patologia , Neoplasias Nasofaríngeas/patologia , Câncer Papilífero da Tireoide , Adenocarcinoma Papilar/genética , Adenocarcinoma Papilar/cirurgia , Adulto , Biomarcadores Tumorais/análise , Proteínas de Ligação a DNA/análise , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Masculino , Mutação/genética , Neoplasias Nasofaríngeas/genética , Neoplasias Nasofaríngeas/cirurgia , Proteínas S100/análise , Tomografia Computadorizada por Raios X , Fatores de Transcrição/análise
10.
Int J Clin Oncol ; 24(12): 1565-1573, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31327070

RESUMO

BACKGROUND: Invasive micropapillary carcinoma (IMPC) is a relatively rare subtype of gastric adenocarcinoma and has aggressive histopathologic characteristics, including lymphatic and vascular invasion. However, the associated long-term survival outcomes remain unclear. This study aimed to compare the clinicopathological characteristics and prognosis of gastric adenocarcinoma with and without IMPC using propensity score-matched (PSM) analysis. METHODS: Patients with gastric adenocarcinoma who underwent gastrectomy between 2006 and 2015 were included in the analysis. PSM analysis was performed to compensate for the background heterogeneity between the groups. The primary endpoint was disease-free survival (DFS) after gastrectomy, and the secondary endpoints were disease-specific survival (DSS) and recurrence pattern. RESULTS: Of 882 patients who underwent gastrectomy for gastric adenocarcinoma, with a follow-up duration greater than 36 months, 35 were diagnosed as having gastric adenocarcinoma with IMPC. After PSM, 70 patients, including 35 with IMPC and 35 without IMPC, were selected. Gastric adenocarcinoma with IMPC is characterized by lymphatic invasion (94% versus 69%, p = 0.012). Patients with IMPC had significantly poorer DFS than those without IMPC, with 3-year DFS rates of 62.2% and 93.4% (p = 0.003), respectively. Furthermore, a significant difference was also observed in DSS (p = 0.016); patients with IMPC more frequently developed liver metastasis (20%) than those without IMPC (3%, p = 0.006). CONCLUSIONS: Resected gastric carcinoma with IMPC was associated with poorer DFS and DSS; furthermore, an increased rate of lymphatic invasion and liver metastasis was noted than in cases without IMPC.


Assuntos
Adenocarcinoma Papilar/mortalidade , Adenocarcinoma Papilar/cirurgia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Adenocarcinoma Papilar/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Gastrectomia , Humanos , Neoplasias Hepáticas/secundário , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias Gástricas/patologia
11.
Medicine (Baltimore) ; 98(29): e16455, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335701

RESUMO

RATIONALE: About 8384 cases of solid pseudopapillary neoplasms (SPN) of pancreas have been published in English literature, from 1933 to 2018. This is a low-grade tumor that usually occurs in children but is rare in adults and, in exceptional cases, can show extrapancreatic localization. In this paper we present 2 unusual cases of SPNs, 1 with retroperitoneal location (case 1) and 1 that was firstly diagnosed as a G1 neuroendocrine tumor (NET) and showed hepatic metastases after 13 years (case 2). PATIENT CONCERNS: No symptoms in first case. The tumor was incidentally diagnosed, during ultrasound examination. In the second case, the metastasis was observed during regular follow-up. DIAGNOSES: The diagnosis was established based on the histological features and immunohistochemical profile that showed positivity for vimentin, nuclear ß-catenin, cyclin D1, CD10, and SRY-related high-mobility group box 11 and negativity for maspin. INTERVENTIONS: Surgical excision, in both cases. OUTCOMES: No recurrences in first case, at 5 months after diagnosis. Hepatic metastases in the second case, at 13 years after diagnosis, with portal invasion after another 15 months. LESSONS: Without a complex immunoprofile, SPN can be misdiagnosed as NET. SPN can be a low-grade tumor but long-time follow-up is mandatory to detect delayed metastases. A correct diagnosis is necessary for a proper therapeutic management.


Assuntos
Adenocarcinoma Papilar , Biomarcadores Tumorais/análise , Neoplasias Císticas, Mucinosas e Serosas , Tumores Neuroendócrinos/diagnóstico , Pâncreas/patologia , Neoplasias Pancreáticas , Adenocarcinoma Papilar/imunologia , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/fisiopatologia , Adenocarcinoma Papilar/terapia , Adulto , Ciclina D1/análise , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neoplasias Císticas, Mucinosas e Serosas/imunologia , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Císticas, Mucinosas e Serosas/fisiopatologia , Neoplasias Císticas, Mucinosas e Serosas/terapia , Neprilisina/análise , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Neoplasias Pancreáticas/imunologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/fisiopatologia , Neoplasias Pancreáticas/terapia , Prognóstico , Resultado do Tratamento , Vimentina/análise , beta Catenina/análise
12.
Surg Laparosc Endosc Percutan Tech ; 29(4): 261-266, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31206421

RESUMO

This study aimed to evaluate the safety and efficacy of endoscopic transpapillary pancreatic duct stent placement (ETPS) for symptomatic peripancreatic fluid collection caused by postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). ETPS was also compared with percutaneous drainage (PTD). Retrospectively 38 patients were studied who developed clinically relevant POPF. Of 38 patients, 4 underwent PTD and 11 underwent ETPS. Technical and clinical success rates of ETPS (100% and 91%, respectively) were comparable with PTD (100% and 75%, respectively). The tip of a pancreatic stent was placed over the pancreatic stump in 4 patients and draining of pus through the pancreatic stent was observed. The hospital stay after DP and the interval from intervention to discharge were significantly shorter in the ETPS group than in the PTD group. ETPS is safe and successful for managing peripancreatic fluid collection caused by POPF after DP and should be considered as a therapeutic option.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Drenagem/métodos , Pancreatectomia/efeitos adversos , Ductos Pancreáticos/cirurgia , Fístula Pancreática/cirurgia , Stents , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatectomia/métodos , Fístula Pancreática/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Medição de Risco , Resultado do Tratamento
13.
BMJ Case Rep ; 12(6)2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31177192

RESUMO

We report a 35-year-old woman with complaints of nasal obstruction and mild post-nasal drip for 6 months. She did not improve with medical treatment. Clinical examination had no positive finding. She was evaluated with a CT scan and MRI that revealed a polypoid mass lesion in nasopharynx without any adhesion to adjacent tissue. Endoscopic examination of nasopharynx revealed an exophytic nasopharyngeal mass in anterior wall of nasopharynx that complete macroscopic transnasal endoscopic resection was performed. The histopathological examination reported thyroid-like low-grade nasopharyngeal papillary adenocarcinoma that was confirmed on immunohistochemical staining. After complete macroscopic resection of the mass, patient was regularly followed-up for 6 years and there was no evidence of recurrence. This example has the educational tips of the optimal therapeutic strategies for primary nasopharyngeal adenocarcinomas with long follow-up.


Assuntos
Adenocarcinoma Papilar/patologia , Neoplasias Nasofaríngeas/patologia , Nasofaringe/patologia , Adenocarcinoma Papilar/metabolismo , Adenocarcinoma Papilar/cirurgia , Adulto , Assistência ao Convalescente , Endoscopia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Neoplasias Nasofaríngeas/cirurgia , Nasofaringe/diagnóstico por imagem , Glândula Tireoide/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Ann Diagn Pathol ; 41: 43-50, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132651

RESUMO

CONTEXT: Invasive micropapillary adenocarcinoma (MPC) is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival. OBJECTIVE: Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it. DESIGN: Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS). RESULTS: Cluster analysis revealed three subgroups with the following diagnoses: "MPC", "combined papillary and MPC", and "others". The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the "MPC" and "combined papillary and MPC" groups. CONCLUSIONS: Our study provides objective diagnostic criteria to diagnose MPC of lung.


Assuntos
Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Patologistas , Patologia Cirúrgica/normas , Reprodutibilidade dos Testes
16.
Ann Diagn Pathol ; 40: 88-93, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31077876

RESUMO

Intracholecystic papillary-tubular neoplasms (ICPNs) account for <0.5% of all cholecystectomies. There is a lack of significant published data from the Indian subcontinent on ICPN to the best of our knowledge. The objective of the current study was to describe the clinicopathological features of ICPN of gallbladder from the departmental archives during a 5.5-year period. We also aimed to classify them into various histological subtypes and to correlate the clinicopathological parameters of ICPN with invasive adenocarcinoma. This study included 36 cases diagnosed over a period of 5.5 years (2013-2018). Clinical, radiological and histopathological data were analyzed in detail. The incidence of ICPN was 0.8%. The mean age of patients was 45.7 years with a female to male ratio of 1.3:1. Biliary phenotype was associated with invasion (p ≤0.001). Papillary pattern was present in 15 cases (41.6%) and was associated with invasion (p ≤0.001). High grade dysplasia was seen in 34 cases (94.4%), of which invasion was seen in 18 cases (50%). One case in our study also had synchronous common bile duct carcinoma. Majority (92%) of the patients were alive and well at the end of available follow-up (mean of 7 months and 25 days). ICPNs are mass forming neoplasms of the gallbladder with a slight female predominance. Biliary phenotype has an aggressive course, often associated with an invasive adenocarcinoma component. Papillary configuration of the lesion is significantly associated with an invasive component. Diligent follow-up of these lesions is warranted as they can be associated with other malignancies of the biliary system.


Assuntos
Adenocarcinoma/patologia , Neoplasias do Ducto Colédoco/patologia , Neoplasias da Vesícula Biliar/patologia , Adenocarcinoma Papilar/patologia , Ducto Colédoco/patologia , Feminino , Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Ann Surg Oncol ; 26(9): 2703-2710, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30830539

RESUMO

BACKGROUND: Differentiated thyroid cancer (DTC) survival is excellent, making recurrence a more clinically relevant prognosticator. We hypothesized that the new American Joint Committee on Cancer (AJCC) 8th edition improves on the utility of the 7th edition in predicting the risk of recurrence in DTC. METHODS: A population-based retrospective review compared the risk of recurrence in patients with DTC according to the AJCC 7th and 8th editions using the Surveillance, Epidemiology, and End Results-based Kentucky Cancer Registry from 2004 to 2012. RESULTS: A total of 3248 patients with DTC were considered disease-free after treatment. Twenty percent of patients were downstaged from the 7th edition to the 8th edition. Most patients had stage I disease (80% in the 7th edition and 94% in the 8th edition). A total of 110 (3%) patients recurred after a median of 27 months. The risk of recurrence was significantly associated with stage for both editions (p < 0.001). In the 7th edition, there was poor differentiation between lower stages and better differentiation between higher stages (stage II hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.39-2.11; stage III HR 3.72, 95% CI 2.29-6.07; stage IV HR 11.66, 95% CI 7.10-19.15; all compared with stage I). The 8th edition better differentiated lower stages (stage II HR 4.06, 95% CI 2.38-6.93; stage III HR 13.07, 95% CI 5.30-32.22; stage IV 11.88, 95% CI 3.76-37.59; all compared with stage I). CONCLUSIONS: The AJCC 8th edition better differentiates the risk of DTC recurrence for early stages of disease compared with the 7th edition. However, limitations remain, emphasizing the importance of adjunctive strategies to estimate the risk of recurrence.


Assuntos
Adenocarcinoma Folicular/patologia , Adenocarcinoma Papilar/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/epidemiologia , Adenocarcinoma Folicular/terapia , Adenocarcinoma Papilar/epidemiologia , Adenocarcinoma Papilar/terapia , Idoso , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Estudos Retrospectivos , Sociedades Médicas , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/terapia , Estados Unidos/epidemiologia
18.
Am J Surg Pathol ; 43(6): 783-791, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30807303

RESUMO

Although intracholecystic papillary neoplasms (ICPNs) have been increasingly recognized, their features remain unclear because of the lack of standardized definition. This study aimed to elucidate clinicopathologic and genetic features of ICPNs using stringent diagnostic criteria. On the basis of the recently proposed criteria, gallbladder neoplasms showing delicate papillary growth were diagnosed as ICPNs, while polypoid papillary adenocarcinomas arranged in a complex architecture were categorized as papillary gallbladder cancers (GBCs). Clinicopathologic features were compared among ICPNs (n=7), papillary GBCs (n=24), and nonpapillary GBCs (n=44). Whole-exome and validation Sanger sequencing was also conducted. Gross mucin hypersecretion was detected in 3/7 ICPNs (43%), 1/24 papillary GBCs (4%), and 1/44 nonpapillary GBCs (2%) (P<0.001). All patients with ICPN lacked lymphovascular invasion and nodal metastasis, while these features were occasionally observed in patients with papillary or nonpapillary GBC (13% to 59%). ICPNs were less advanced than papillary and nonpapillary GBCs (P<0.001) with all cases of ICPNs being recurrence-free. Whole-exome and Sanger sequencing identified somatic mutations in STK11 (a causative gene of Peutz-Jegher syndrome; n=3), CTNNB1 (n=2), and APC (a gene of familial adenomatous polyposis; n=1) in ICPNs, while those alterations were exceptional in papillary and nonpapillary GBCs. ICPNs more commonly showed cytoplasmic and/or nuclear expressions of ß-catenin than papillary and nonpapillary GBCs. In conclusion, the histology-based classification of gallbladder papillary neoplasms is useful for identifying ICPNs that share clinicopathologic features with the pancreatic counterpart. ICPNs meeting the criteria were genetically distinct from papillary and nonpapillary GBCs, with STK11, CTNNB1, and APC being identified as major driver genes for ICPNs.


Assuntos
Adenocarcinoma Papilar/genética , Adenocarcinoma Papilar/patologia , Neoplasias dos Ductos Biliares/genética , Neoplasias dos Ductos Biliares/patologia , Biomarcadores Tumorais/genética , Neoplasias da Vesícula Biliar/genética , Neoplasias da Vesícula Biliar/patologia , Sequenciamento Completo do Exoma , Adenocarcinoma Papilar/química , Adenocarcinoma Papilar/terapia , Proteína da Polipose Adenomatosa do Colo/genética , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/química , Neoplasias dos Ductos Biliares/terapia , Biomarcadores Tumorais/análise , Biópsia , Diagnóstico Diferencial , Feminino , Neoplasias da Vesícula Biliar/química , Neoplasias da Vesícula Biliar/terapia , Predisposição Genética para Doença , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fenótipo , Valor Preditivo dos Testes , Proteínas Serina-Treonina Quinases/genética , Fatores de Risco , Resultado do Tratamento , beta Catenina/genética
20.
AJR Am J Roentgenol ; 212(3): 596-601, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30620679

RESUMO

OBJECTIVE: The objective of our study was to test for the possibility that published malignancy risks for side-branch intraductal papillary mucinous neoplasms (IPMNs) are overestimates, likely due to verification bias. MATERIALS AND METHODS: We tested for possible verification bias using simulation modeling techniques. First, in age-defined hypothetical cohorts of 10 million persons, we projected the frequency of pancreatic ductal adenocarcinoma (PDAC) arising from side-branch IPMNs over 5 years using published estimates of their prevalence (4.4%) and rate of malignant transformation (1.9%). Second, we projected the total number of PDAC cases in corresponding cohorts over the same time horizon using national cancer registry data. For each cohort, we determined whether the percentage of all PDAC cases that arose from side-branch IPMNs (i.e., side-branch IPMN-associated PDAC cases) was clinically plausible using an upper limit of 10% to define plausibility, as estimated from the literature. Model assumptions and parameter uncertainty were evaluated in sensitivity analysis. RESULTS: Across all cohorts, percentages of side-branch IPMN-associated PDACs greatly exceeded 10%. In the base case (mean age = 55.7 years), 80% of PDAC cases arose from side-branch IPMNs (7877/9786). In the oldest cohort evaluated (mean age = 75 years), this estimate was 76% (14,227/18,714). In a secondary analysis, we found that if an upper limit threshold of 10% for side-branch IPMN-associated PDAC was imposed, the model-predicted rate of malignancy for side-branch IPMNs would be less than 0.24% over a 5-year time horizon, substantially lower than most literature-based estimates. CONCLUSION: Our results suggest that reported malignancy risks associated with side-branch IPMNs are likely to be overestimates and imply the presence of verification bias.


Assuntos
Adenocarcinoma Papilar/patologia , Carcinoma Ductal Pancreático/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma Papilar/epidemiologia , Viés , Carcinoma Ductal Pancreático/epidemiologia , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/epidemiologia , Prevalência
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