Thymomas diagnosed during pregnancy: two cases in young women without paraneoplastic or autoimmune disease.

We report 2 cases of thymomas diagnosed during pregnancy. Neither of these 2 patients had paraneoplastic autoimmune conditions or previous neoplasia. The first patient had a 7.3-cm lymphocyte-predominant thymoma with capsular invasion. The second patient was diagnosed through fine needle aspiration biopsy after computed tomography showed multiple mediastinal masses. Although cases of thymoma during pregnancy have been reported, the exact cause has yet to be elucidated. We review the clinical, radiologic, pathologic, and immunohistochemical findings-including those of podoplanin, estrogen receptor, and progesterone receptor-of 2 previously unreported cases, as well as discuss the relationship of malignancy and pregnancy and review the available literature regarding pregnancy and thymoma.

Mucinous tubular and spindle cell carcinoma of the kidney: Diagnosis by fine needle aspiration and review of the literature.

Renal mucinous tubular and spindle cell carcinoma (MTSCC) was recently described as a distinct subtype of renal cell carcinoma (RCC) in the 2004 World Health Organization classification of kidney tumors. MTSCC is a rare low grade malignancy with < 100 cases reported in the literature. To the best of our knowledge, there are 5 case reports with a total of 6 patients describing its diagnosis by fine needle aspiration (FNA). All of these cases were diagnosed as conventional RCC on FNA. Subsequent excisions proved them to be MTSCC. We herein report a case in a 67-year-old male. He presented with abdominal pain and was found to have a new colon adenocarcinoma with metastasis to the liver and lungs. The extent of disease made the patient ineligible for surgical excision, and he received chemotherapy. Work-up also revealed a kidney mass which was later biopsied by FNA and core biopsy. The tumor was composed of epithelial and spindled cell components embedded in a myxoid background. It was positive for CK7, AMCAR, vimentin, and epithelial membrane antigen. The tumor was diagnosed as MTSCC. One year later the kidney mass remained stable. However, the patient developed new metastasis to the liver from colonic primary. The kidney mass was not resected. Although rarely encountered in FNA cytology of the kidney, we believe the cytologic features of this tumor are distinctive and are different from conventional and other subtypes of RCC. Therefore, its accurate diagnosis on FNA is possible once pathologists are aware that MTSCC should be considered in the differential diagnosis of kidney tumors.

Clinical applicability of microarray technology in the diagnosis, prognostic stratification, treatment and clinical surveillance of cervical adenocarcinoma.

Invasive cervical cancer is a common problem worldwide and while rates of squamous cell carcinoma of the cervix (SCC) have been declining with the implementation of community screening programs, adenocarcinoma of the cervix (ADC) has not shown a similar response to screening. At this time, the two entities are tested for and treated with the same clinical algorithms, namely gynecologic cytology and molecular testing for HPV DNA. However, ADC arises more proximally within the cervical canal and frequently occurs below the superficial mucosal lining, precluding it from being easily diagnosed with cytologic examination. Furthermore, ADC has a more aggressive course than SCC and is significantly less responsive to radiotherapy. These factors combine to produce a lesion that is diagnosed at a higher stage and has an overall poorer prognosis than SCC. While both lesions have pathogenic origins with the high-risk species of Human papilloma viruses (HPV), the high association of ADC with HPV 18, a virus with a higher genome integration rate, suggests that the transformation pathway of ADC differs from SCC. Modern methods of molecular analysis can produce gene expression profiles of various cell types and preliminary studies have shown that SCC and ADC do, indeed, produce a distinct genetic signature and can be reproducibly segregated. This technology has promise for clinical applicability in the diagnosis, the prognostic stratification, formation of a treatment care plan and post-therapeutic monitoring of ADC.

A case of IgD myeloma representing a missed biclonal paraproteinemia or isotype switch in a patient previously diagnosed with IgA-lambda myeloma.

BACKGROUND: Multiple myeloma is a clonal plasma cell neoplasm that is identified in the laboratory by a presence of a monoclonal immunoglobulin or increased plasma light chain levels. METHODS: The most commonly identified and tested immunoglobulins are IgA, IgG and IgM. RESULTS: Rare cases of multiple myeloma present with monoclonal IgD and IgE paraproteins. CONCLUSION: We present a case of IgD myeloma diagnosed in a patient who had achieved partial remission from a previously diagnosed IgA myeloma, possibly representing a missed biclonal paraproteinemia or isotype switch after treatment.