1/40. The blastic variant of mantle cell lymphoma arising in Waldeyer's tonsillar ring.We present three cases of blastic mantle cell lymphoma with an unusual initial manifestation in Waldeyer's ring with methods for differentiating it from other blastic neoplasms of the head and neck. All cases presented with a feeling of fullness in the area of the mass. Morphologically, the tumours were blastic with a high mitotic rate (three to nine per high power field). All were B-cell phenotype with coexpression of CD43. In all cases cyclin d1 and bcl-2 were positive and CD23 negative. Blastic mantle cell lymphoma occurring in Waldeyer's tonsillar ring may be mistaken for other high grade haematopoietic neoplasms. immunohistochemistry and awareness of this type of lymphoma are helpful in differentiating it from other neoplasms.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
2/40. Nasal and nasal-type T/NK-cell lymphoma with cutaneous involvement.Natural killer (NK) cells are a third lymphocyte lineage, in addition to B- and T-cells, that mediate cytotoxicity without prior sensitization. NK cells also have phenotypic and genotypic characteristics; they express the NK-related antigen CD56 and T-cell markers such as CD2 and CD3 epsilon, but their T-cell receptor (TCR) locus is not rearranged. Non-Hodgkin's lymphomas are divided into B- and T-cell neoplasms and NK-cell lymphomas. We describe 2 Japanese patients with nasal and nasal-type T/NK-cell lymphoma in which the skin, nasal/nasopharyngeal region, bone marrow, and lymph node were the sites of involvement. The clinical and histopathologic findings were recorded. In addition, immunophenotyping, TCR gene rearrangement, and the existence of Epstein-Barr virus (EBV) dna by polymerase chain reaction amplification were determined. Clinically, the cutaneous eruptions were purplish, hard, multiple nodules. Histologically, angiocentric proliferation of small-to medium-sized, pleomorphic, lymphoid cells were observed. They revealed hand-mirror-shaped lymphocytes with azurophilic granules with the use of Giemsa staining by touch smear. These lymphocytes were found to be positive to immunophenotyping for CD2 (Leu5b), CD3 epsilon (DAKO), CD4 (Leu3a), and CD56 (Leu 19). No clonal rearrangement of TCR-beta, -gamma, and -delta genes and immunoglobulin gene markers were found, and no positive results of identification of EBV dna were shown. The patients underwent cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with complete remission; however, both had recurrence of disease. Because NK-cell lymphomas express some T-cell markers, they may be mistakenly diagnosed as peripheral T-cell lymphomas if they are not investigated for the NK-cell-specific marker, CD56. Therefore the importance of immunophenotypic investigations of CD56 should be stressed. Also, the importance of clinical investigation of nasal/nasopharyngeal lymphomas should be stressed when NK-cell lymphoma is diagnosed involving the skin, because NK-cell lymphomas are often associated with the nasal and nasopharyngeal region.- - - - - - - - - - ranking = 0.33333333333333keywords = neoplasm (Clic here for more details about this article) |
3/40. Idiopathic thrombocytopenic purpura associated with breast cancer: a case report and review of the current literature.The association of solid tumors with idiopathic thrombocytopenic purpura (ITP) is rare. Before this study, there have been three case reports indicating an association between breast cancer and ITP. We present a 69-year-old man with metastatic breast cancer and progressive thrombocytopenia without any evidence of a leukoerythroblastic picture or etiologies for the thrombocytopenia. serum platelet antibodies were identified. A bone marrow biopsy showed small foci of metastatic breast cancer, thrombocytopenia, and normal number of megakaryocytes. A subsequent trial of steroids resulted in a marked improvement of the patient's thrombocytopenia. This is the fourth case report indicating an association of breast cancer and ITP.- - - - - - - - - - ranking = 1442.1398458464keywords = cancer (Clic here for more details about this article) |
4/40. Sub-super bone scan caused by bone marrow involvement of prostate cancer.A 67-year-old man presented with malaise and marked anemia. A diagnostic workup revealed severe pancytopenia on a complete blood count and diffuse sclerotic change in the axial skeleton on a plain abdominal radiograph. Bone metastases being suspected from these findings, bone scintigraphy was performed. The bone scan demonstrated uniformly increased skeletal activity with faint soft-tissue activity. The findings of the bone scan, however, appeared atypical of the super scan caused by diffuse bone metastases, without any decrease in radioactivities of the appendicular skeleton and kidneys. bone marrow scintigraphy with In-111 chloride demonstrated central marrow failure and peripheral expansion, which indicated the possibility of myelophthisis. The patient underwent bone marrow biopsy, which revealed replacement of the bone marrow by metastatic adenocarcinoma. Further examinations detected the primary lesion in the prostate. In this case, the findings of the bone scan were insufficient for the super scan, and might be categorized as a sub-super scan. It would be important to recognize this incomplete form of super scan as a rare scintigraphic pattern of diffuse bone marrow metastases.- - - - - - - - - - ranking = 721.06992292322keywords = cancer (Clic here for more details about this article) |
5/40. Hypotetraploidy in a patient with small cell carcinoma.While numerical and structural chromosomal abnormalities characterize many hematopoietic and nonhematopoietic malignancies, the occurrence of polyploidy is by and large rare. We report here an interesting patient with small cell carcinoma (SCC) and hypotetraploidy initially referred to us because of a question of acute nonlymphocytic leukemia, M3 subtype, with a question of a 15;17 translocation characteristic of acute promyelocytic leukemia. However, the patient did not have a 15;17 translocation and the final hematopathologic analysis of the bone marrow aspirates and immunohistochemistry studies subsequently revealed the patient to have SCC. Small cell carcinoma is a highly malignant and a very aggressive neoplasm. A review of the literature, using medline, Cancerlit, and the science Citation Index, revealed that in most, if not all, reports, the presence of polyploidy is noted as a rare entity. In leukemia, reports of polyploidy point to a distinct category of patients with a poor risk for which more intensive treatment is needed. Limited information is currently available to assess the risk of polyploidy in small cell carcinoma. Our case is important not only because of the relative rarity of polyploidy, but also because insights gained from the study of this and other similar patients may help shed additional light on the mechanism of carcinogenesis, which is not fully known to date. As polyploidization is a manifestation of genetic instability and as genetic instability has been implicated in the genesis and progression of many cancers, it is perhaps not too surprising that polyploidy in our case was associated with a poor disease outcome. The patient has since expired.- - - - - - - - - - ranking = 180.60081406414keywords = cancer, neoplasm (Clic here for more details about this article) |
6/40. Acute myelomonocytic leukemia with histologic features resembling sarcomatoid carcinoma in bone marrow.We report a case of primary acute myelomonocytic leukemia involving the bone marrow that resembled sarcomatoid carcinoma. The neoplastic cells in bone marrow biopsy specimens formed cohesive-appearing clusters and cords separated by an immature fibroblastic proliferation and myxoid stroma. Blasts in the bone marrow aspirate smears formed clusters and sheets, and a subset of blasts exhibited erythrophagocytosis. Dysgranulopoiesis was also present. Lineage was confirmed by immunohistochemical analysis of formalin-fixed, paraffin-embedded tissue. The tumor cells showed strong reactivity for lysozyme, myeloperoxidase, CD45, and CD68 and were negative for keratin, S100, CD20, and CD3. The serum lysozyme concentration (110 microgram/mL) was 13 times greater than the normal value (8 microgram/mL). Cytogenetic studies performed on bone marrow aspirate material revealed a complex karyotype, including trisomy 8 and abnormalities of chromosome 11q. We report this case of acute myelomonocytic leukemia because the neoplastic cells appeared cohesive and spindled, resembling sarcomatoid carcinoma, and therefore caused diagnostic difficulty. Other monocytic neoplasms with similar resemblance to carcinoma or sarcoma have been reported in the literature, suggesting that the tendency to appear cohesive may be an inherent characteristic of neoplastic cells with monocytic differentiation.- - - - - - - - - - ranking = 0.33333333333333keywords = neoplasm (Clic here for more details about this article) |
7/40. Myelophthisis as a solitary manifestation of failure from rectal carcinoma. A Batson phenomenon?Rectal carcinoma is uncommonly associated with systemic metastases in the absence of liver metastases, reflecting the predilection for spread via the portal system. Occasionally, isolated lung metastases are seen, which are usually attributed to spread via the portosystemic anastomoses in the distal rectum. However, myelophthisis is an unreported complication of rectal cancer as an isolated form of systemic failure. We present a case of fatal myelophthisis associated with otherwise localized rectal carcinoma secondary to metastatic rectal cancer. This observation led to the hypothesis that spread to the bone marrow occurred via a "third circulation," the Batson plexus, a network of deep pelvic veins with rich anastomoses to the vertebral plexus.- - - - - - - - - - ranking = 360.53496146161keywords = cancer (Clic here for more details about this article) |
8/40. Extramedullary hematopoiesis in the uterine isthmus: a case report and review of the literature.Extramedullary hematopoiesis (EH) is the ectopic production of myeloid, erythroid and megakaryocytic elements. In postfetal life it usually occurs in conditions with hyperactive, depleted or infiltrated marrow; it is extremely rare in the genital tract. We report a case of EH in the uterine isthmus (UI) which was found incidentally in a 40-year-old patient who presented with a right ovarian cyst and a history of a right modified radical mastectomy for infiltrating invasive lobular carcinoma one year earlier. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Microscopic examination of UI revealed foci of hematopoiesis, consisting of white blood cell precursors confirmed by positive chloroacetate-esterase staining. bone marrow biospy showed diffuse infiltration secondary to breast cancer. Further work-up, including a bone scan, showed multiple metastases suggesting that the high degree of bone marrow infiltration by neoplasmatic cells had stimulated the EH. In conclusion, the unusual finding of EH in UI heralded widespread infiltration of bone marrow.- - - - - - - - - - ranking = 180.60081406414keywords = cancer, neoplasm (Clic here for more details about this article) |
9/40. gallium avid breast carcinoma.Primary breast carcinomas are generally thallium (Tl-201) avid but uncommonly accumulate gallium (GA-67). Therefore, GA-67 scans are not routinely performed in patients with suspected breast cancer. We report a rare case of a primary breast carcinoma with bone marrow metastases where the primary lesion was GA-67 avid but did not accumulate Tl-201. The case also illustrated an unusual presentation of aggressive metastatic breast adenocarcinoma with pancytopenia or bone marrow failure. The extensive bone marrow metastases of the primary breast carcinoma were evident on both the Tl-201 and GA-67 scans.- - - - - - - - - - ranking = 180.2674807308keywords = cancer (Clic here for more details about this article) |
10/40. Improved diagnosis of advanced bone marrow metastases by means of radiolabeled antigranulocyte antibodies.Assessment of bone marrow metastases using Tc-99m-labeled antigranulocyte antibodies and Tc-99m-labeled nanocolloids is discussed in osseous metastasizing breast cancer. A 53-year-old patient with bone metastases of breast cancer (pT2 pN1biv cM1) developed leukocytopenia WHO Grade III following polychemotherapy. bone marrow scintigraphy with Tc-99m labeled nanocolloids and Tc-99m-labeled antigranulocyte antibodies revealed pronounced bone marrow infiltration as the cause. Comparing both procedures, the images with antigranulocyte antibodies showed a clearly better bone marrow image, considerably higher contrast and almost no superimposition of the liver over the spine. In osseous metastasizing breast cancer, scintigraphy with Tc-99m-labeled antigranulocyte antibodies enables assessment of metastases in the entire bone marrow.- - - - - - - - - - ranking = 540.80244219241keywords = cancer (Clic here for more details about this article) |
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