1/1402. An extrahepatic bile duct metastasis from a gallbladder cancer mimicking Mirizzi's syndrome.We report a case of an extrahepatic bile duct metastasis from a gallbladder cancer that mimicked Mirizzi's syndrome on cholangiography. A 67-yr-old woman was admitted to our hospital with a diagnosis of acute calculous cholecystitis. As obstructive jaundice developed after the admission, percutaneous transhepatic biliary drainage was performed to ameliorate the jaundice and to evaluate the biliary system. Tube cholangiography revealed bile duct obstruction at the hepatic hilus, and extrinsic compression of the lateral aspect of the common hepatic duct, with nonvisualization of the gallbladder. No impacted cystic duct stone was visualized on CT or ultrasonography. laparotomy revealed a gallbladder tumor as well as an extrahepatic bile duct tumor. We diagnosed that the latter was a metastasis from the gallbladder cancer, based on the histopathological features. This case is unique in that the extrahepatic bile duct metastasis obstructed both the common hepatic duct and the cystic duct, giving the appearance of Mirizzi's syndrome on cholangiography. Metastatic bile duct tumors that mimic Mirizzi's syndrome have not been previously reported. The presence of this condition should be suspected in patients with the cholangiographic features of Mirizzi's syndrome, when the CT or ultrasonographic findings fail to demonstrate an impacted cystic duct stone.- - - - - - - - - - ranking = 1keywords = bile duct, bile, duct (Clic here for more details about this article) |
2/1402. A Val 677 activating mutation of the thyrotropin receptor in a Hurthle cell thyroid carcinoma associated with thyrotoxicosis.Thyroid nodules presenting as hot at 131I-scintigraphy are usually benign follicular adenomas. We report a 42-year-old female patient with an autonomously functioning Hurthle cell thyroid carcinoma causing thyrotoxicosis. Genetic analysis of her thyroid tumoral dna revealed a heterozygotic activating mutation of the thyrotropin receptor (TSHR) gene that was located downstream to all of the other genetic alterations currently identified, and is due to a base substitution at codon 677 (normal cytosine replaced by guanine, CTG for GTG causing leucine substitution by valine in the seventh transmembrane domain of the receptor). This mutation was detected in the tumor, but not in the leucocytes from the same patient. The Val 677-TSHR mutant showed constitutive activity, in terms of cyclic adenosine monophosphate (cAMP) production, when permanently transfected in Chinese hamster ovary (CHO) cells. Gsp and ras oncogenes and the p53 tumor suppressor gene were not present in the Hurthle cell cancer. The TSHR mutation in this Hurthle cell carcinoma may be responsible for maintaining differentiated thyroid function and hyperthyroidism.- - - - - - - - - - ranking = 0.037236523920009keywords = adenoma, duct (Clic here for more details about this article) |
3/1402. Arterial dynamic appearance of common bile duct carcinoma by helical CT on angiography (angio-HCT): four operated cases.We present four cases of common bile duct carcinoma in which both angiographic helical CT (angio-HCT) and pancreatoduodenectomy were done in the 3 years since 1995. Angio-HCT was performed with direct infusion of the contrast medium through the gastroduodenal artery inserted on angiography. Angio-HCT displayed the tumors as lower density areas in contrast to the strong enhancement of the circumferential nontumorous areas, including the pancreas and duodenum.- - - - - - - - - - ranking = 0.52696335461487keywords = bile duct, bile, duct (Clic here for more details about this article) |
4/1402. Unexpected gallbladder cancer after laparoscopic cholecystectomy: an emerging problem? Reflections on four cases.gallbladder cancer (GC) has been reported in 0.3-1.5% of cholecystectomies. Since the introduction of laparoscopic surgery, cholecystectomies have increased and occult GC may therefore be more frequent. Herein we analyze our own experience to determine whether there was an increase in GC. We also evaluate the risk factors for this outcome. Four patients with GC undiagnosed before surgery (four of 602 cases, or 0.66%) were submitted to laparoscopic cholecystectomy. The percentage in patients who underwent open surgery was 0.28% (two of 714 cases). Without reoperation, three patients died in the laparoscopic group and one is alive at 12 months. Trocar site metastasis was not observed. Although the percentage of GC (0.28% versus 0.66%) increased, the percentage is still in the referred average. Undiagnosed GC is on the increase. Examination of the gallbladder and a frozen section, if necessary, are recommended. Calcified gallbladders, age >70 years, a long history of stones, and a thickened gallbladder all represent significant risk factors.- - - - - - - - - - ranking = 0.010293192338647keywords = duct (Clic here for more details about this article) |
5/1402. Ductal ("endometrioid") adenocarcinoma of the prostate.Ductal ("endometrioid") adenocarcinoma of the prostate is a rare variant of prostatic carcinoma which may have a different clinical presentation than the more common acinar adenocarcinoma. Ductal adenocarcinoma usually involves the urethra and the large periurethral prostatic ducts with direct spread through the more peripheral ductal system. Centrally located tumours have a much better prognosis than tumours involving the deep prostatic parenchyma. Local recurrence rate is high and five-year survival rate is as low as 24% for adenocarcinomas that have spread to the peripheral prostatic ducts. Although there have been some doubts about the role of hormonal therapy in ductal ("endometrioid") adenocarcinoma of the prostate, it is now agreed that therapeutic regimens should not be different from those offered to patients with conventional acinar adenocarcinoma.- - - - - - - - - - ranking = 0.041172769354589keywords = duct (Clic here for more details about this article) |
6/1402. Fine-needle aspiration cytology of polymorphous low-grade adenocarcinoma of the tongue.The cytologic features derived from a fine-needle aspiration of polymorphous low-grade adenocarcinoma (PLGA) of the base of the tongue are described. The tumor cells were composed of cuboidal epithelial cells and short, spindle-shaped myoepithelial-like cells, and they formed large cell clusters. In the central portion of the clusters, myxoid materials were present, and palisading tumor cells occasionally surrounded them. Histological examination revealed solid proliferation of the epithelial cuboidal and spindle cells. The former frequently formed tubular and papillary structures. The tumor was not encapsulated, and invasion of adjacent muscle tissue was noted. Although the cytologic differentiation from cellular variants of pleomorphic adenoma and myoepithelioma is difficult, the feature of palisading tumor cells may be useful in the differential diagnosis.- - - - - - - - - - ranking = 0.026943331581362keywords = adenoma (Clic here for more details about this article) |
7/1402. learning from case reports: diagnostic issues in an epidemiologic study of pancreatic cancer.epidemiologic studies on exocrine pancreatic cancer show a large heterogeneity in diagnostic criteria applied to define "caseness." Reanalyses conducted after review of diagnostic information have yielded substantially different results than those based on more crude classifications of disease. During a multicenter prospective study on mutations in the K-ras gene in pancreatic and biliary diseases, hospital diagnoses from 602 patients were reviewed by a panel of experts. There were two main motivations to do so: a generic interest for the quality of the diagnostic data, and the anticipation that a firm diagnosis could be needed to assess whether patients whose tumors did not harbor the mutation were true negatives or false negatives. In addition, the review of diagnoses was helpful to minimize tissue misclassification, and it had a high educational value for clinicians and epidemiologists. This article illustrates why and how this was so through a brief presentation of the 10 most significant cases. With respect to selection and classification of subjects, the main issues that studies on pancreatic cancer need to address are the differential diagnosis of exocrine pancreatic cancer and pancreatitis, the differential diagnosis of exocrine pancreatic cancer and other abdominal tumors, and the use of survival as a hallmark of pancreatic cancer. In epidemiologic studies of pancreatic cancer, it is warranted that a panel of experts centrally reviews all the existing diagnostic evidence (cytohistological and other) of all patients, regardless of whether they have cytohistological confirmation and of their hospital discharge diagnosis.- - - - - - - - - - ranking = 0.010293192338647keywords = duct (Clic here for more details about this article) |
8/1402. Nephrogenic adenoma: a form of adenomatous metaplasia of the bladder. A clinical and electron microscopical study.3 additional cases of "nephrogenic adenoma" of the bladder are added to the 20 previously reported cases. light and electron microscopic studies of the first 2 cases support the hypothesis of urothelial metaplasia. The name "adenomatous metaplasia" should replace "nephrogenic adenoma". Malignant change occurred in the third case, suggesting that this ought to be regarded as a potentially dangerous from of metaplasia. In the absence of malignant change, ileocaecocystoplasty with subtotal cystectomy afforded symptomatic cure in 2 cases: radical cystectomy was performed in the third because of malignant adenocarcinoma.- - - - - - - - - - ranking = 0.29637664739498keywords = adenoma (Clic here for more details about this article) |
9/1402. Primary breast carcinoma of the vulva: a case report and literature review.BACKGROUND: In 1872, Hartung was the first to describe the case of a fully formed mammary gland arising in the left labium majora of a 30-year-old woman. Since Hartung's initial report, 38 additional cases of ectopic vulvar breast tissue have been described. This case report describes the rare occurrence of primary mammary adenocarcinoma arising within the vulva. CASE: A 64-year-old G4P4 white female presented with a 4-year history of a 2 x 1 cm firm, indurated, raised lesion of the left lateral mons. A wide local excision with ipsilateral inguinofemoral lymphadenectomy was performed. Given histological findings characteristic of both invasive ductal carcinoma and invasive lobular carcinoma, in conjunction with the presence of estrogen and progesterone receptors within the tumor, a diagnosis of infiltrating adenocarcinoma arising within ectopic breast tissue was made. CONCLUSIONS: Thirty-nine reported cases of ectopic breast tissue arising within the vulva have been reported in the world literature. Though the diagnosis of primary breast carcinoma arising within the vulva is based primarily upon histologic pattern, estrogen and progesterone receptor positivity provide supporting evidence. Given the rarity of this condition, guidelines for therapy are unavailable; we therefore suggest looking to the current management of breast cancer in order to establish a sensible approach.- - - - - - - - - - ranking = 0.010293192338647keywords = duct (Clic here for more details about this article) |
10/1402. Combined hepatocellular-cholangiocarcinoma. Diagnostic challenge in hepatic fine needle aspiration biopsy.OBJECTIVE: To study the cytohistologic features of combined hepatocellular-cholangiocarcinoma (CHCC-CC) in fine needle aspiration biopsy (FNAB) material. STUDY DESIGN: Six hepatic FNAB cases with cell blocks (five) and hepatic resections (two) were analyzed cytohistologically and immunohistochemically. RESULTS: The six cases were diagnosed as CHCC-CC based on clinicopathologic correlation. Unequivocal hepatocellular carcinoma (HCC) cells corresponding to Edmondson and Steiner's grade 3 lesions were identified in the FNAB in three instances. adenocarcinoma, represented by cohesive columnar cells with ovoid, basal nuclei displaying nuclear palisading, acini and/or papillary structures with variable intracytoplasmic intraacinar or brush border mucin production, was identified in all cases. Intermediate cells with hybrid/polymorphic cytologic features straddling malignant hepatocytes and glandular cells were identified in five instances. Tissue alpha-fetoprotein was negative. There was brush border and/or diffuse cytoplasmic p-carcinoembryonic antigen immunoreactivity in the glandular elements. CONCLUSION: FNAB diagnosis of CHCC-CC is possible if the clinical, cytohistologic and immunohistochemical findings support the presence of HCC and adenocarcinoma. Intermediate cells pose a great challenge to recognize and define: they tend to lose the classic cytologic features of malignant hepatocytes and acquire glandular characteristics. At the very least, there should be a high index of suspicion. These cases underscore the necessity for clinicopathologic correlation in enhancing the precision of FNAB diagnoses.- - - - - - - - - - ranking = 0.010293192338647keywords = duct (Clic here for more details about this article) |
| | Next -> |