Liver metastasis or a pseudocyst? A rare presentation of leiomyosarcoma's metastasis in the liver.

Gastrointestinal neoplasms most commonly metastasize to the liver, where they are typically found as solid and hypervascular lesions. Here, we describe a case of a 44-year-old man with a leiomyosarcoma of the rectum, who at the time of diagnosis presented with a small (5 mm in diameter) cyst-like lesion in the liver. Positron emission tomography demonstrated no increased metabolism in the area of the cyst, suggesting a benign character of the lesion. However, after 3 years, CT scans revealed enlargement of the cyst, and local surgical excision was performed. The results of histopathological examination of the resected material were consistent with metastatic leiomyosarcoma. Subsequently, the patient developed lung metastases and died within 2 years. Our case describes a very rare presentation of leiomyosarcoma's metastasis that led to an ill-fated misdiagnosis and dismal disease outcome.

Abdominal Wall Actinomycosis Associated with Foreign Body Perforation.

Abdominal wall actinomycosis is a very rare infection caused by anaerobic Gram-positive bacteria Actinomyces. We present a case of a 72-year-old female with chronic pain located in the right hypochondriac region and anterior abdominal wall mass which had developed six months before. An ultrasonography (USG) and computed tomography (CT) scan of the abdomen were performed and showed an inflammatory change with a strong internal linear reflection in the right upper abdomen. The tumor was located inside the rectus abdominis muscle and connected with internal organs and subcutaneous tissue. The patient qualified for surgery. En block tumor excision was made with partial resection of the transverse colon. Postoperative study revealed fishbone-associated inflammatory actinomycosis tumor. The patient was successfully managed postoperatively with penicillin and discharged on the 11th day after the surgery.

Amplification of Her-2/neu oncogene in GERD - Barrett's metaplasia ­ dysplasia - adenocarcinoma sequence.

BACKGROUND/AIMS: Esophageal adenocarcinoma (ADC) incidence has been increasing dramatically in the past 3 decades despite the surveillance programs in patients with Barrett's esophagus (BE). Therefore, markers of early neoplastic progression are required to predict of cancer risk in BE patients. The aim of this study was to investigate the frequency of Her2/neu amplification in different stages during Barrett's-related carcinogenesis. METHODOLOGY: Her2/neu amplification analysis in 39 patients with gastroesophageal reflux disease (GERD), in 34 with BE, in 11 with dysplasia and 13 with ADC were performed with PCR. RESULTS: Her2/neu amplification was detected in 8% (3/39) GERD patients, 15% (5/34) with BE, 41% (7/17) with dysplasia and in 54% (7/13) with ADC. We observed an increasing trend in the frequency of Her2/neu alteration between BE-carcinogenesis stages (p=0.001). This finding was confirmed in the logistic regression analysis showing gradient in odds ratios between BE (2.07; 95% CI: 0.46-9.39), dysplasia (8.4; 95% CI: 1-83-38.53) and ADC (14.0; 95% CI: 2.81-69.69) compared to GERD; it was even higher after adjustment for age and gender. CONCLUSIONS: Her2/neu alterations may occur early and increasingly during Barrett's malignant progression. We suggest that it may be useful to stratify the risk of adenocarcinoma in patients with Barrett's esophagus.

Mucinous cystadenocarcinoma of the spleen - a very rare case of a primary splenic MCN.

INTRODUCTION: We present the case of a primary spleen mucinous cystadenocarcinoma. Several cases of this primary tumor of the spleen have been described worldwide so far. These tumors are classified as mucinous cystic neoplasms (MCN) and occur mainly in the ovaries and pancreas. <br/><br/>Case report: The case concerns a 45-year-old female patient with an accidentally diagnosed splenic tumor with approximately 20 cm in size. Histopathological examinations, following a splenectomy, confirmed the presence of mucinous cystadenocarcinoma.

Expression of FFAR3 and FFAR4 Is Increased in Gastroesophageal Reflux Disease.

BACKGROUND: The negative impact of a high-fat diet on the course of gastroesophageal reflux disease (GERD) has been previously reported. Free fatty acid receptors (FFARs) may be mediators of this phenomenon. The aim of this study was to characterize the role of FFARs in the course of nonerosive (NERD) and erosive (ERD) reflux disease. METHODS: Collectively, 73 patients (62 with GERD and 11 healthy controls (HCs)) were recruited to the study. Esophageal biopsies were drawn from the lower third of the esophagus and kept for further experiments. Quantitative, real-time polymerase chain reaction was used to assess the expression of FFAR1, FFAR2, FFAR3, and FFAR4 in biopsies. Histological evaluation of dilated intracellular spaces (DISs) was also performed. RESULTS: FFAR3 exhibited the highest expression, and FFAR4 exhibited the lowest expression in all esophageal samples. Higher relative expression of FFAR1 and FFAR2 and significantly higher expression of FFAR3 (p = 0.04) was noted in patients with GERD compared to respective HCs. Patients with nonerosive GERD (NERD) presented higher expression of all FFARs compared to patients with erosive GERD (ERD) and respective HCs. Interestingly, in patients with ERD, the expression of FFAR3 was lower than in HCs. Significant, weak, positive correlation was found for FFAR3 and FFAR4 expression and DIS scores (r = 0.36, p < 0.05 for FFAR 3, and r = 0.39, p < 0.05 for FFAR4). CONCLUSIONS: In this study, we show that FFARs may play a role in GERD pathogenesis, particularly in the NERD type. It may be assumed that FFARs, in particular FFAR3 and FFAR4, may have diagnostic and therapeutic potential in GERD.

Langerhans cell histiocytosis in a 3-year-old girl: a case report and literature review.

The report presents a case of Langerhans cell histiocytosis with diagnostic problems and fatal outcome in a 3-year-old girl, as well as a short literature review.

[Polymorphism/loss of heterozygosity of APC gene in GERD-Barrett's metaplasia-dysplasia-adenocarcinoma sequence]. / Polimorfizm/utrata heterozygotycznosci genu APC w sekwencji GERD-przelyk barretta-dysplazja-rak gruczolowy przelyku.

UNLABELLED: The incidence of esophageal adenocarcinoma (ADC) has been increasing rapidly over the past few decades. Gastro-esopageal reflux disease (GERD), Barrett's esophagus (BE) and Barrett-associated dysplasia are a risk factor for esophageal cancer, but endoscopic surveillance have only a limited influence on cancer mortality. There is a great need to find molecular biomarkers predicting increased progression risk in GERD-Barrett's metaplasia-dysplasia-adenocarcinoma sequence to improve risk assessment and stratification of patients to surveillance program. AIM OF THE STUDY: To evaluate the polymorphism and prevalence of loss of heterozygosity (LOH) of APC tumor suppressor gene in mataplasia, dysplasia and adenocarcinoma. MATERIAL AND METHODS: In esophageal mucosal samples of 79 patients with: GERD (n=33), BE (n=27), BE+dysplasia (n=8) and ADC (n=11) we have studied LOH of APC tumor suppressor gene using PCR-restriction fragment length polymorphism (RFLP). A 133 bp fragment, spanning exon 11 of the APC gene was amplified, and Rsal digestion of the PCR product defined the alleles as either homozygous 133 bp (Rsa(-/-)) or 87 and 46 bp (Rsa(+/+)) fragments, and heterozygous (Rsa(+/-)) exhibiting the three fragments. Control peripheral blood cell DNA samples have been collected from 60 normal healthy subjects. RESULTS: Among 79 patients, there were 16 heterozygous (20%) for APC gene. In 16 informative heterozygous LOH was detected in 7 cases: 2/5 with GERD, 3/7--with BE, 1/2--with BE+dysplasia and 1/2--with ADC. There were no statistical differences between studied groups (NS). Distribution of the three alleles, Rsa(+/-), Rsa(+/+), and Rsa(-/-) was: 38, 47 and 15% in the healthy individuals, 25%, 25% and 50%--in GERD patients, 29%, 41% and 29%--in BE, 36%, 45% and 18% in BE+dysplasia and 25%, 67% and 8% in ADC patients, respectively. The frequency of heterozygous cases in control group was significantly higher than in patients group (p = 0.018), whereas Rsa (-/-) were the most frequent in patients group (p = 0.008). Rsa (-/-) were seen significantly more often in GERD compared to ADC patients (p = 0.005), in opposite to Rsa (+/+), which were significantly more frequent in ADC vs. GERD (p = 0.007). CONCLUSIONS: APC gene inactivation concerns minority of patients with esophageal adenocarcinoma, however, its detection indicates higher risk of progression to ADC. APC alternations appear to be early in GERD-BE-dysplasia-ADC sequence. The specific polymorphism may identify patients with high risk of progression into BE.

[Solitary fibrous tumor of the nasal cavity, paranasal sinuses and anterior fossa]. / Solitary fibrous tumor nosa, zatok sitowych i przedniego dolu czaszki.

Solitary fibrous is rare mesenchymal neoplasm that usually arises in the pleura or less commonly is related to other serosal surfaces. There were reported SFTs in some extrapleural locations. There locations cause diagnostic difficulties. Ethmoid sinuses, nasal cavity and anterior fossa are rare site for SFTs. Authors report a case of SFT of the nasal cavity, paranasal sinuses and anterior fossa in 33 year-old woman to show the difficulty and importance of recognition. Diagnostic procedures and medical treatment are presented. This report pays attention that SFT should be taken into consideration during diagnostic process of spindle-cell lesions of the nasal cavity and paranasal sinuses in order to avoid some confusions.

Expression profiles of cancer stem cell markers: CD133, CD44, Musashi-1 and EpCAM in the cardiac mucosa-Barrett's esophagus-early esophageal adenocarcinoma-advanced esophageal adenocarcinoma sequence.

INTRODUCTION: Barrett's esophagus (BE), which develops as a result of gastroesophageal reflux disease, is a preneoplastic condition for esophageal adenocarcinoma (EAC). A new hypothesis suggests that cancer is a disease of stem cells, however, their expression and pathways in BE - EAC sequence are not fully elucidated yet. AIMS: We used a panel of putative cancer stem cells markers to identify stem cells in consecutive steps of BE-related cancer progression. METHODS: Immunohistochemistry was performed on formalin-fixed, paraffin-embedded blocks from 58 patients with normal cardiac mucosa (n=5), BE (n=14), early EAC (pT1) from mucosal resection (n=17) and advanced EAC (pT1-T4) from postoperative specimens (n=22). Expression of the CD133, CD44, Musashi-1 and EpCAM was analyzed using respective monoclonal antibodies. RESULTS: All markers showed a heterogeneous expression pattern, mainly at the base of the crypts of Barrett's epithelium and EAC, with positive stromal cells in metaplastic and dysplastic lesions. Immuno-expression of EpCAM, CD44 and CD133 in cardiac mucosa was significantly lower (mean immunoreactivity score (IRS)=1.2; 0.0; 0.4; respectively) compared to their expression in Barrett's metaplasia (mean IRS=4.3; 0.14; 0.7; respectively), in early adenocarcinoma (mean IRS=4.4; 0.29; 1.3; respectively) and in advanced adenocarcinoma (mean IRS=6.6; 0.7; 2.7; respectively) (p<0.05). On the contrary, Musashi-1 expression was higher in BE and early ADC compared to GM and advanced ADC (NS). CONCLUSION: Our results suggest that the stem cells could be present in premalignant lesions. EpCAM, CD44 and CD133 expression could be candidate markers for BE progression, whereas Musashi-1 may be a marker of the small intestinal features of Barrett's mucosa.

The importance of the concept and histological criteria of "intraepithelial squamous cell carcinoma" of the esophagus: in comparison between Western and Japanese criteria.

BACKGROUND: There are differences in the histological diagnostic criteria for early stage gastrointestinal carcinoma between Western and Japanese pathologists. Western histological criteria of carcinoma are "presence of stromal invasion of neoplastic cells", while Japanese criteria are "the degree of cytological and structural abnormality of neoplastic cells, regardless of stromal invasion". The aim of the present study is to clarify and review the present status of the Western and Japanese histological criteria of early stage esophageal squamous cell carcinoma (SCC) and also to clarify their significance and accuracy. METHODS: Twenty-nine Polish, German, and Japanese pathologists participated in this study. A total of 18 histological slides of biopsy, endoscopic submucosal dissection (ESD), and surgical resection of esophageal squamous lesions were diagnosed using a virtual slide system. RESULTS: Most of noninvasive (intraepithelial) carcinomas diagnosed by Japanese pathologists were diagnosed as high- or low-grade dysplasia (intraepithelial neoplasia) or reactive atypia by the majority of Polish and German pathologists. Diagnoses of not only high-grade dysplasia but also low-grade dysplasia or reactive lesion by Western criteria were given for many biopsy specimens of cases in which the corresponding ESD or surgical specimens showed definite stromal invasion. CONCLUSION: There still exist differences in the histological diagnostic criteria for early stage esophageal carcinoma between Western and Japanese pathologists. The Japanese diagnostic criteria could improve agreement of diagnoses between biopsy and resected specimens of esophageal SCC. Moreover, diagnostic approaches using Western criteria may cause delay in the early diagnosis and treatment of esophageal SCC.

[Practical application of proliferation markers' (MIB-1, PCNA, AgNOR) expression analysis for differential diagnostics of nodular thyroid lesions]. / Przydatnosc oceny wskazników proliferacyjnych (MIB-1, PCNA, AgNORs) do diagnostyki róznicowej zmian guzkowych w tarczycy.

In the study authors tried to estimate the diagnostic value ofAgNOR number and MIB-1 and PCNA expression in thyreocytes from various pathological lesions, with special attention to differential diagnosis of border-line lesions (nodule in adenomatus goiter--adenoma--follicular carcinoma). Fifty four thyroid glands were examined (10 adenomatous goiters, 20 follicular adenomas, 10 follicular carcinomas, 14 papillary carcinomas). Statistical analysis of obtained results allows in most cases to differentiate carcinomas from benign nodular lesions. The best differentiating factor for border-line lesions (especially differentiation between benign nodular lesions, neoplasms, nodules in adenomatous goiter adenomas and adenomas carcinomas) has turned out to be MIB-1. PCNA expression has differed significant between adenomatous goiter and follicular carcinoma and between adenoma and both carcinomas. AgNOR number has only helped in differentiation between nodules in adenomatous goiter and follicular carcinoma - correlations for other lesions have not been statistically significant.

Expression of vascular endothelial growth factor (VEGF) in vulvar squamous cancer and VIN.

Angiogenesis plays an important role both in progression of solid tumors and in metastasizing. An invasive growth of a neoplasm is mainly connected with appearing of blood vessels within a tumor. Inhibition of angiogenesis in solid neoplasms may deter both tumor growth and metastases. New treatment strategies based on suppressing of angiogenesis and selective damaging of neoplastic blood vessels may prove to be as efficient as those based on direct destruction of neoplastic cells. One of important angiogenic factors is vascular endothelial growth factor (VEGF), which is produced by neoplastic cells and shows high promitotic activity almost entirely for endothelial cells (paracrine activity). We decided to investigate VEGF expression in precancerous lesions as well as in squamous cancers of vulva. Our material included 31 cases of vulvar squamous cancer, 28 cases of VIN (vulvar intraepithelial neoplasia) III, 10 VIN II cases and 12 VIN I cases. A diagnosis was established according to WHO criteria on the ground of post-operative histopathological examination complemented with proliferation index estimated by the use of MIB-1 antibody. Immunohistochemical examinations were performed on paraffin-embedded material, using MIB-1 antibody (Immunotech), VEGF antibody (Santa Cruz), Goat serum Normal (DAKO), DAKO StreptAB-Complex/HRP Duet, Mouse/Rabbit DAKO DAB Chromogen Tablets, TBS (Sigma). Positive cytoplasmic expression of anti-VEGF polyclonal antibody (diffuse and/or focal and of various intensity) was observed in almost all samples from precancerous and cancerous lesions. The expression was especially strong and diffuse in all cancer cases; in cases of VIN it was mainly focal and weak.

Expression of vascular endothelial growth factor (VEGF) in human thyroid tumors.

Vascular endothelial growth factor (VEGF) is one of the factors related to angiogenesis of tumors and physiological and pathological proliferative processes. Location of VEGF in human thyroid tissue with various thyroid disorders was studied in order to explore its possible involvement in proliferative processes. Immunohistochemical examination was performed on 69 formalin-fixed, paraffin-embedded thyroid tissue specimens using the labelled streptavidin biotin peroxidase complex detection system. VEGF was not identified in normal thyroid follicular cells. Some but not all tumor thyreocytes expressed VEGF in cytoplasm. VEGF positive expression was found in 6/15 patients with papillary carcinoma, 4/9 with follicular carcinoma, 14/28 with follicular adenoma and 2/17 with adenomatous goiter. In benign follicular adenoma and adenomatous goiter the weak expression of VEGF was found in small areas of the tumor tissues, whereas in malignant tumors it was found strongly in many cells. VEGF probably functions as a hypoxia-inducible angiogenic factor, and the expression of VEGF is stronger in malignant tumors, which need more oxygen supply to proliferate. An intensive VEGF production by differentiated thyroid carcinomas could be a promising marker of tumor aggressiveness and may also be useful as a predictor of metastatic potential and extension of tumor mass.