1/65. Intrasellar adenoid cystic carcinoma and papillary mucinous adenocarcinoma: two previously undescribed primary neoplasms at this site.Most carcinomas involving the sella turcica are metastases. We report two previously undescribed carcinomas that appear to be primary at this site. The first occurred in a 44-year-old woman who presented with hemianopsia. A mass was noted by computed tomography to occupy the sella turcica, from which it appeared to originate. Transphenoidal biopsy showed the tumor to be an adenoid cystic carcinoma with a typical cribriform pattern. The patient died shortly after a subsequent attempt at tumor resection. The second tumor arose in a 55-year-old man who presented with diplopia. Computed tomography showed a mass in the sella turcica that was presumed to be a pituitary adenoma. However, transphenoidal resection revealed a mucinous adenocarcinoma composed of small papillae and glands lined by columnar epithelium. The tumor cells exhibited varying degrees of stratification with prominent interspersed mucin vacuoles. Focal solid areas showed a component of signet ring-type cells. In contrast to the apparent aggressive behavior of the adenoid cystic carcinoma, the papillary mucinous adenocarcinoma appeared much less aggressive, as the second patient was alive and without evidence of disease 5 years later. Both tumors may be derived from epithelial rests within the pituitary gland, either minor salivary gland rests or Rathke's cleft remnants.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
2/65. Mucin Hypersecreting Intraductal Papillary Neoplasm of the pancreas.Mucin Hypersecreting Intraductal Papillary Neoplasm is a rare neoplasm that arises from ductal epithelial cells. This entity is distinct from the more commonly known Mucinous cystadenoma or Mucinous cystadenocarcinoma. Despite this distinction, it has been erroneously categorized with these more common cystic neoplasms. Characteristic clinical presentation, radiographic, and endoscopic findings help distinguish this neoplasm from the cystadenomas and cystadenocarcinomas. Histopathologic identification is not crucial to the preoperative diagnosis. This neoplasm is considered to represent a premalignant condition and, therefore, surgical resection is warranted. prognosis, following resection, is felt to be curative for the majority of patients. We present two cases of Mucin Hypersecreting Intraductal Papillary Neoplasm and discuss their diagnosis and surgical therapy.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
3/65. Metachronous carcinoma of the vulva and fallopian tube.BACKGROUND: Metachronous carcinoma of the vulva and fallopian tube is an unusual co-occurrence of gynecological malignancies. A report of such a case that developed and recurred over a 7-year period is presented. CASE: A 53-year-old G3P3 female presented with a verrucous carcinoma of the vulva and a serous papillary adenocarcinoma of the left fallopian tube metachronously. To investigate a possible association between the co-occurrence of the rare neoplasms and factors associated with multiple gynecological malignancies, we analyzed the status of human papillomavirus infection and dna mismatch repair deficiency as indicated by microsatellite instability. All samples analyzed were negative for these factors. CONCLUSION: The present results support the possibility that metachronous carcinomas of the vulva and fallopian tube involve unknown etiological factors or arise independently.- - - - - - - - - - ranking = 0.25keywords = neoplasm (Clic here for more details about this article) |
4/65. Use of immunohistochemistry in fine needle aspiration of thyroid nodules in patients with a history of malignancy. A report of two cases.BACKGROUND: A history of a nonthyroid malignancy may present a diagnostic dilemma in the assessment of fine needle aspiration (FNA) of thyroid nodules. One reported series, on patients with prior malignancies and a thyroid nodule, indicated that in 17% of patients, the thyroid nodule represented metastatic malignancy, 6% were classified as primary thyroid cancers, and the remainder were benign or inconclusive lesions. The resolution of this problem is essential to patient management. CASES: We report two cases in which patients with a history of renal cell carcinoma presented with a thyroid nodule. The first patient was an 80-year-old female whose Papanicolaou-stained FNA demonstrated clusters of round to polygonal cells with round to ovoid, hyperchromatic nuclei and abundant, wispy cytoplasm. The second patient was a 55-year-old female with clusters and single cells with round to oval, eccentric nuclei and copious, granular, gray cytoplasm noted on Papanicolaou-stained material. In each case, the diagnosis was inconclusive on initial review of Papanicolaou-stained slides, and immunohistochemical staining was ordered to better characterize the lesions. Tumor cells from case 1 were positive for cytokeratin cocktail and vimentin and negative for thyroglobulin, epithelial membrane antigen and calcitonin, suggestive of metastatic renal cell carcinoma. In contrast, the tumor cells from case 2 expressed cytokeratin, thyroglobulin and vimentin, consistent with a primary thyroid neoplasm. In each case, the cytologic diagnoses were confirmed in the resected specimens. CONCLUSION: immunohistochemistry is a helpful adjunct in the evaluation of thyroid nodules in patients with a past history of malignancy.- - - - - - - - - - ranking = 0.25keywords = neoplasm (Clic here for more details about this article) |
5/65. Nucleus of the tractus solitarius metastasis: relationship to respiratory arrest?BACKGROUND: A 52-year-old woman with metastases in brain and bone had clinical and radiological response to therapy but died about 10 weeks after diagnosis. General autopsy failed to identify a primary neoplasm or an anatomic cause of death. Investigation of sudden respiratory cessation was a consideration when undertaking an anatomic study of the brain. methods: review of patient records and careful examination of the brain following autopsy were carried out. RESULTS: The patient had terminal episodes of hypersomnia but episodes of sleep apnea were not observed. She received no respiratory support and no respiratory difficulties were recorded until she was pronounced dead at 7 a.m. autopsy revealed metastatic adenocarcinoma in a pattern suggestive of a primary pulmonary neoplasm, including multiple cerebral metastases, although no significant pulmonary lesions of any type were found. A 0.2 cm metastatic adenocarcinoma was found in the nucleus of the tractus solitarius (NTS). No other tumor was present in the brain stem. CONCLUSIONS: Unilateral destruction of the NTS in the medulla would have severely disturbed the most critical point of convergence of autonomic and voluntary respiratory control and of cardiocirculatory reflexes in the central autonomic network. It is postulated that this caused respiratory arrest during a state transition from sleeping to waking. Few metastases to the medulla are reported, most are relatively large, and several have caused respiratory symptoms before death. The very small metastasis in our patient could be the direct anatomic cause of death, and as such it is an unusual complication of metastatic disease of which clinicians should be aware. It is speculated that dysfunction of direct NTS connections to the pons or of connections passing close to the metastatic deposit resulted in terminal hypersomnia.- - - - - - - - - - ranking = 0.5keywords = neoplasm (Clic here for more details about this article) |
6/65. Bilateral papillary renal cell carcinoma.Papillary renal cell carcinoma is a subgroup of malignant renal epithelial neoplasms. We report the clinical and imaging findings of a case with multifocal and bilateral renal cell carcinoma which are nonspecific.- - - - - - - - - - ranking = 0.25keywords = neoplasm (Clic here for more details about this article) |
7/65. pancreaticoduodenectomy as treatment of adenocarcinoma of the papilla of Vater diagnosed during pregnancy. A case report.BACKGROUND: Papillary adenocarcinomas are rare tumors of the gastrointestinal tract. There are few reports of this neoplasm diagnosed during pregnancy. CASE: A case of adenocarcinoma of the papilla of Vater was diagnosed by sonographically guided biopsy during pregnancy. The patient underwent radical resection of the tumor at 25 weeks' gestation; pregnancy termination was not indicated. At 39 weeks' gestation, a cesarean-section was performed. The postoperative period entailed total parenteral nutrition until intestinal motility stabilized. This ensured the mother and fetus' well-being until delivery. CONCLUSION: Papillary adenocarcinoma is associated with good prognosis since it is totally removed by radical resection, and pancreaticoduodenectomy can be performed successfully during pregnancy, but the patient must receive special prenatal care.- - - - - - - - - - ranking = 0.25keywords = neoplasm (Clic here for more details about this article) |
8/65. Ventral pancreas-preserving pancreatic head and body resection.A new procedure that included ventral pancreas-preserving pancreatic head and body resection for a huge mucinous cystic neoplasm was performed to preserve pancreatic function. A 45-year-old man was diagnosed as having a huge mucin-producing pancreatic neoplasm. The ventral pancreas-preserving pancreatic head and body resection was performed. The stumps of the caudal pancreas and the uncinate process were negative for cancer by frozen-section histology. The remaining pancreas was anastomosed by a method of double pancreatojejunostomy with a Roux-en-Y loop. The resected specimen was 15 x 10 cm in size and contained mucin. The papillary tumor was 5.0 x 4.5 x 3.0 cm in size, which was an intraductal papillary adenocarcinoma without pancreatic invasion microscopically. The postoperative course was uneventful and the patient was discharged 14 days after surgery. glucose tolerance test was normal 24 months after surgery and both sides of the pancreatic duct were patent confirmed by magnetic resonance. The patient is well now two years after surgery. A new limited pancreatic resection, ventral pancreas-preserving pancreatic head and body resection, was safely applied to a huge mucinous cystic neoplasm of the pancreas.- - - - - - - - - - ranking = 0.75keywords = neoplasm (Clic here for more details about this article) |
9/65. Brain metastases from fallopian tube carcinoma responsive to intra-arterial carboplatin and intravenous etoposide: a case report.Fallopian tube carcinoma is the least common neoplasm of the female genital tract. Although rare, neurological complications such as brain metastases can develop. It remains unclear, however, what role chemotherapy has in the treatment of these patients and what route of administration is most effective. Intra-arterial (IA) regional administration of chemotherapy may increase intra-tumoral drug concentrations and improve efficacy. We report the case of a 47-year-old woman who developed bilateral fallopian tube cancer and multifocal brain metastases. After progression through radiation therapy and oral chemotherapy, she was placed on IA carboplatin (200 mg/m2/d x 2 days every 4 weeks) and intravenous etoposide (100 mg/m2/d x 2 days every 4 weeks). During treatment she had objective tumor shrinkage that has remained stable for more than 12 months. For patients with fallopian tube carcinoma that develop brain metastases and respond poorly to surgery and/or irradiation, multi-agent chemotherapy containing carboplatin should be considered. The effectiveness of carboplatin may be improved if administered by the IA route.- - - - - - - - - - ranking = 0.25keywords = neoplasm (Clic here for more details about this article) |
10/65. The role of pancreatoscopy in the preoperative evaluation of intraductal papillary mucinous tumor of the pancreas.BACKGROUND: Intraductal papillary mucinous tumor of the pancreas is a rare neoplasm managed by operative resection of the affected segment of the pancreas. goals: To evaluate the role of peroral pancreatoscopy in the diagnosis and preoperative localization of the affected region of the pancreatic duct and to undertake the appropriate operation for each patient. STUDY: Five patients with suspected intraductal papillary mucinous tumor of the pancreas were studied using endoscopic retrograde cholangiopancreatography, computed tomography of the abdomen, endoscopic ultrasonography, and peroral pancreatoscopy. The findings from these studies were compared, and operative resection was performed in each patient based on pancreatoscopic findings. RESULTS: Of the five patients with suspected intraductal papillary mucinous tumor, only four had histologically confirmed tumor, and the remaining one patient had a retention cyst of the pancreas. Pancreatoscopy correctly identified all four patients with the tumor while excluding the diagnosis of papillary tumor in one. CONCLUSION: Peroral pancreatoscopy is valuable in the preoperative evaluation of intraductal papillary mucinous tumor of the pancreas, especially in the localization of such tumor.- - - - - - - - - - ranking = 0.25keywords = neoplasm (Clic here for more details about this article) |
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