Assuntos
Neoplasias das Glândulas Suprarrenais , Doença Relacionada a Imunoglobulina G4 , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Humanos , Imunoglobulina G , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Feocromocitoma/diagnóstico por imagemRESUMO
Malignant melanoma is a tumour, which usually involves skin melanocytes. Involvement of the male genitourinary (GU) system by melanoma is an uncommon and challenging diagnosis. We report the first case of seminal vesicle metastasis from a primary cutaneous melanoma in a 58-year-old man, with hemospermia as the only clinical sign. This case highlights the role of multiparametric magnetic resonance imaging, as a more sensitive assessment to early detect metastatic melanoma in the GU system. The patient underwent a robot-assisted laparoscopic bilateral seminal vesiculectomy, which had good functional and oncological results and is still in complete remission at the 1-year follow-up.
RESUMO
The Gleason system is the internationally recognized standard for grading prostate cancer, due mainly to its strong prognostic capability. However, interobserver reproducibility is variable in the community setting. Herein we present a novel approach to evaluating Gleason grading among pathologists using high-density tissue microarrays (TMAs). A CD-ROM containing 537 different TMA spot images of 0.6-mm diameter was sent to 10 genitourinary pathologists in France. The pathologists were expected to score each TMA spot based on their experience evaluating standard prostate biopsies, transurethral resections, and prostatectomy samples. There was no consensus meeting beforehand to agree on how the group would apply the Gleason grading system for this project. Percentage of agreement and kappa value were used to assess the level of agreement. A short questionnaire was sent to assess pathologists' opinion on this new approach to evaluating Gleason grading. An average of 311 images were analyzed (range, 104 to 537; median, 256.5). Four of the pathologists evaluated all 537 images and assigned Gleason grades to 149 images with an overall kappa for interobserver agreement for the exact score between 0.31 and 0.52 and between 0.45 to 0.69 if 3 Gleason categories (=6, 7, and >7) were used. When 2 categories were considered (=7 or >7), kappa ranged from 0.58 to 0.83. All pathologists analyzed 104 images. Similar results were obtained with an agreement between 0.28 and 0.54 for the 3 Gleason categories. After finishing this test, 90% of genitourinary pathologists considered this approach useful for resident training and 90% for pathology teaching. We conclude that a Gleason score can be easily assigned to each TMA spot of a 0.6-mm-diameter prostate cancer sample. These data also indicated that using TMA spot images may be a good approach for teaching the Gleason grading system due to the small area of tissue.
Assuntos
Adenocarcinoma/patologia , Neoplasias da Próstata/patologia , Biópsia por Agulha , Humanos , Masculino , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias/normas , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosAssuntos
Carcinoma Papilar/patologia , Neoplasias Ovarianas/patologia , Teratoma/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/genética , Diagnóstico Diferencial , Feminino , Genes ras/genética , Humanos , Mutação/genética , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/genética , Proteínas Proto-Oncogênicas B-raf/genética , Teratoma/diagnóstico , Teratoma/genética , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genéticaRESUMO
Infantile pancreatic vascular tumors are very unusual and are described with an old and imprecise terminology. We report two new cases in 2 and 4 months old children, the first one associated with Kasabach-Merritt syndrome, the second revealed by cholestasis. The histology diagnosis was kaposiform hemangioendothelioma and juvenile capillary hemangioma respectively. Outcome was favourable after selective embolization for one and biliary derivation for the other. These case reports show that infantile vascular pancreatic tumors form a heterogeneous group. Most of them would be in fact kaposiform hemangioendothelioma with a benign behavior, in contrast with aggressive growth for retroperitoneal localizations.