1/30. Malignant mixed mesodermal tumor presenting as metastatic lymph node adenosquamous cell carcinoma: a case report.A solitary inguinal lymph node metastasis from a poorly differentiated adenosquamous cell carcinoma of unknown origin in a 52-year-old female is described. The patient was reported to have had a 2-cm palpable mass in the left inguinal area for three years. She had made regular annual clinic visits for Pap smears since the age of 45 years. Her last visit was eight months prior to a complaint of progressive abdominal distention and dull pain of three months' duration. physical examination showed a huge pelvic mass, and ultrasound and magnetic resonance imaging of the abdomen showed a 12-cm complex solid mass on the left ovary. The patient underwent a complete excisional biopsy of the left inguinal lymph node. Frozen section pathology revealed a poorly differentiated adenosquamous cell carcinoma. Exploratory laparotomy immediately followed pathologic confirmation of malignancy of the left inguinal lymph node. Complete surgical staging including abdominal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, retroperitoneal lymph node sampling and excisional biopsy was performed for all suspicious lesions. Stage IIIC malignant mixed mesodermal tumor (MMMT) was diagnosed due to positive left inguinal lymph node metastasis. However, the retroperitoneal lymph node and intra-abdominal cavity did not show spread of the tumors, except those confined to the left ovary with adhesion to the cul-de-sac, and sole lymph node metastasis in a left inguinal lymph node. Although we could not prove that the left inguinal lymph node metastasis had been present for the three years that it was palpable without histologic confirmation, we believe that any enlarged inguinal lymph node might be the first hint of underlying malignancy in the pelvic area, lower extremities or perineal area. In cases of a poorly differentiated carcinoma of inguinal lymph nodes of unknown origin, the abdomen should be carefully evaluated.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
2/30. Suprasellar malignant mixed germ cell tumour presenting as craniopharyngioma.A 15 year old boy presented with diminution in vision of both eyes, diabetes insipidus and hypopituitarism. MRI was suggestive of a large suprasellar and retrosellar craniopharyngioma with stretching of the optic chiasma. Histopathological findings on the first surgical specimen were interpreted as a craniopharyngioma. He was reoperated on account of clinical deterioration and increase in tumour size. Histological examination this time revealed derivatives of all three germ cell lineages along with areas of embryonal carcinoma, and yolk sac tumour besides squamous cysts, establishing the diagnosis of malignant mixed germ cell tumour. serum and CSF were strongly positive for alpha foetoproteins.- - - - - - - - - - ranking = 0.14285714285714keywords = carcinoma (Clic here for more details about this article) |
3/30. Mixed ductal-pancreatic polypeptide-cell carcinoma of the pancreas.AIMS: Mixed ductal-endocrine carcinomas of the pancreas are rare tumours with 10 cases reported in the English literature. We report the first case with a polypeptide-cell component. methods AND RESULTS: : The tumour was fortuitously discovered in a 72-year-old woman during the exploration of an endometrial adenocarcinoma. It measured 100 mm and was located in the tail of the pancreas. On microscopic examination two intermingled endocrine and exocrine components were present. The endocrine component consisted of trabeculae and solid nests composed of cells immunoreactive for chromogranin a, synaptophysin and pancreatic polypeptide, but negative for p53 and Bcl-2 proteins. The exocrine component was composed of tubules lined by atypical cylindrical cells immunoreactive for CK19, CEA, p53 and Bcl-2. The stroma of the endocrine component contained amyloid deposits. CONCLUSION: Mixed ductal-endocrine carcinomas of the pancreas are often described in middle-aged patients. The tumours are usually large and located in the head of the pancreas. An endocrine syndrome is rare and the prognosis is often unfavourable. We report the first case of mixed endocrine-exocrine carcinoma of the pancreas with a pancreatic polypeptide-cell component. The histogenesis of mixed carcinoma of the pancreas is still uncertain but the over-expression of p53 and Bcl-2 could play a major role in the neoplastic progression of the ductal component.- - - - - - - - - - ranking = 1.2857142857143keywords = carcinoma (Clic here for more details about this article) |
4/30. Combined small cell carcinoma and clear cell carcinoma of the gallbladder: report of a case and review of the literature.We report a case of an incidental combined carcinoma of the gallbladder in a 66-year-old woman who underwent cholecistectomy for gallstones. The neoplasm was mainly constituted by a clear cell component and a small cell, chromogranin-positive one; it also showed some areas of conventional adenocarcinoma and foci of vascular invasion. The patient died after 3 years following treatment with combination chemotherapy. The histologic and immunohistochemical profile of the lesion is described, together with a brief review of the pertinent bibliography.- - - - - - - - - - ranking = 1.4611968685626keywords = carcinoma, small cell (Clic here for more details about this article) |
5/30. Malignant mixed mullerian tumor of the ovary and false negative punctures.Malignant mixed mullerian tumour (MMMT) of the ovary is a rare and aggressive tumour with a poor prognosis. We present a case of a 57-year-old woman with a large pelvic mass, omental cake, ascites and pleural effusions, clinically highly suspect of an ovarian neoplasm. paracentesis and ultrasound-guided biopsy of the ovary were negative for malignant disease. Therefore a CT-guided true cut biopsy was performed. The latter gave a histopathologic diagnosis of an endometrioid adenocarcinoma of the ovary. However after cytoreductive surgery anatomopathologic examination revealed a malignant mixed mullerian tumour of the ovary with heterologous differentiation. Apparently only one of the two components was found in the puncture. Adjuvant chemotherapy, active against the sarcomatous and the carcinomatous component, was given. At present the patient is well and disease free 35 months after the initial diagnosis. Cytological examination of ascites may be negative in the presence of malignant disease. If a tumour consists of two components, puncture can miss one, which may lead to undertreatment. punctures should be discouraged as a diagnostic tool in patients in whom an ovarian malignancy is suspected.- - - - - - - - - - ranking = 0.28571428571429keywords = carcinoma (Clic here for more details about this article) |
6/30. Cutaneous myoepithelial neoplasms: clinicopathologic and immunohistochemical study of 20 cases suggesting a continuous spectrum ranging from benign mixed tumor of the skin to cutaneous myoepithelioma and myoepithelial carcinoma.BACKGROUND: Myoepithelial neoplasms, both benign and malignant, are rare but well-established clinicopathologic entities in the salivary glands, the breast, and the lung. Despite similarities between cutaneous sweat glands and glandular structures in the above-mentioned organs as well as the presence of regular myoepithelial cells around cutaneous eccrine/apocrine glands, the concept of cutaneous myoepithelial neoplasms is still debatable and not commonly accepted. methods: Twenty cutaneous myoepithelial neoplasms have been studied histologically and immunohistochemically. RESULTS: Nine neoplasms showed features of benign mixed tumor of the skin (chondroid syringoma) (five females and four males, age range 19-65 years, all cases arose in the head and neck region). Two cases represented the eccrine and seven the apocrine subtype. Interestingly, in three cases of the apocrine subtype, solid areas composed predominantly of myoepithelial cells were detected; these neoplasms were designated as benign mixed tumors with prominent myoepithelial cells. Nine cutaneous neoplasms were composed of spindled, epithelioid, and plasmocytoid cells without ductal differentiation and immunohistochemically stained variably positive for vimentin, epithelial and myogenic markers, S-100 protein, calponin, and glial fibrillary acidic protein (four females and five males, age range 3-71 years, four cases arose in the head and neck region and one case each on the finger, the thigh, the lower leg, the foot, and the breast, respectively); these neoplasms were designated as cutaneous myoepitheliomas. Two morphologically malignant neoplasms with cytologic and immunohistochemical features of myoepithelial cells arose on the face of a 70-year-old female and a 79-year-old male patient; these neoplasms were designated as malignant cutaneous myoepitheliomas (cutaneous myoepithelial carcinomas). CONCLUSIONS: The study suggests a continuous spectrum of cutaneous myoepithelial neoplasms ranging from benign mixed tumor of the skin to cutaneous myoepithelioma and cutaneous myoepithelial carcinoma. Further studies with extended follow-up information are necessary to establish prognostic factors.- - - - - - - - - - ranking = 0.85714285714286keywords = carcinoma (Clic here for more details about this article) |
7/30. Renal cell carcinoma metastatic to follicular adenoma of the thyroid gland. A case report.BACKGROUND: Renal cell carcinoma is an unpredictable tumor that can recur many years after the original diagnosis and metastasize to uncommon sites, including the thyroid gland. Differential diagnosis from primary thyroid tumor is often difficult both clinically and pathologically. We report a case of metastatic renal cell carcinoma in follicular adenoma of the thyroid gland. CASE: A 48-year-old woman presented with a 3-cm-diameter, palpable mass in the left lobe of the thyroid gland. The patient's history included removal of a left renal mass, which was conventional renal cell carcinoma. Fine needle aspiration cytology smears contained a few small clusters of polygonal cells with abundant, clear cytoplasm and irregular, hyperchromatic nuclei as well as bland-looking thyroid follicle cells and stromal cells. A papillary or follicular growth pattern was not detected. A cell block made from the aspirated sample was composed mainly of clear cells. By immunohistochemical stains, the clear cells were completely negative for TTF-1, thyroglobulin, calcitonin and inhibin while equivocally staining for cytokeratin, CD10 and galectin-3. The histologic diagnosis was renal cell carcinoma metastatic to follicular adenoma of the thyroid gland. CONCLUSION: Renal cell carcinoma metastatic to the thyroid may masquerade as a primary thyroid neoplasm. A history of prior nephrectomy, the presence of unremarkable thyroid follicle cells, the absence of a papillary or follicular growth pattern and immunohistochemical study can help differentiating metastatic renal cell carcinoma from a primary thyroid lesion with clear cell change.- - - - - - - - - - ranking = 1.4285714285714keywords = carcinoma (Clic here for more details about this article) |
8/30. Mixed micropapillary and trophoblastic carcinoma of bladder: report of a first case with new immunohistochemical evidence of urothelial origin.The micropapillary variant of urothelial carcinoma has a reported incidence of 0.7%. Trophoblastic urinary carcinoma is very rare, with roughly 30 cases reported during the last century. This is the first report of mixed micropapillary and trophoblastic bladder carcinoma. A 45-year-old man presented with gross hematuria. His tumor contained choriocarcinomatoid areas with syncytiotrophoblasts, classic micropapillary carcinoma, conventional high-grade urothelial carcinoma, and flat carcinoma in situ. He underwent radical surgery; tumor stage was T4N2M0. Despite postoperative combination chemotherapy, he developed pulmonary and retroperitoneal metastases and died 20 months after presentation. The tumor was immunopositive for human chorionic gonadotropin and human placental lactogen in trophoblast and for cytokeratin 20 and high-molecular-weight cytokeratin in all tumor components. Because high-molecular-weight cytokeratin is expressed by urothelium but is rarely found in placental trophoblast or germ-cell choriocarcinoma, its presence in trophoblastic bladder carcinoma is new evidence that the latter is a transformed neoplasm of urothelial origin.- - - - - - - - - - ranking = 1.8571428571429keywords = carcinoma (Clic here for more details about this article) |
9/30. Cytoreductive surgery plus intraperitoneal hyperthermic perfusion is an effective treatment for metastasized malignant mixed mesodermal tumours (MMMT)--report of six cases.BACKGROUND: Malignant mixed mesodermal tumours (MMMT) of the female genital tract are rare and heterogeneous malignancies that impart grim prognosis. These tumours are characterized by an admixture of malignant epithelial and stromal elements comprising carcinomatous and sarcomatous neoplastic cells. Thus far, almost 350 cases of MMMT have been recorded in the international medical literature. Due to its rarity, there is no agreement on the best treatment strategy in women with metastasized MMMT. methods: Six women (mean age 59 years) with metastasized MMMT defined to the peritoneal cavity have been treated by cytoreductive surgery plus hyperthermic peritoneal perfusion plus postoperative adjuvant chemotherapy. All patients have been pre-treated by surgery for primary tumour and one by systemic chemotherapy. As cytostatics for hyperthermic peritoneal perfusion, we have used mitomycin in a dosage of 18 mg/m2 plus melphalan in a dosage of 25 mg/m2. As adjuvant treatment CDDP 40 mg/m2/dl, mitomycin 7 mg/md2/dl and Ifosfamid 100 mg/kg 24 h/dl was applicated via intraaortic catheter three times with a treatment free interval of 3 weeks. RESULTS: A complete cytoreduction without remnant tumour formations in the peritoneal cavity could be carried out in all six patients. The postoperative course was uneventful in all cases except for one where a spontaneous small bowel perforation and prolonged gall secretion had to be treated by re-operation. One patient died 4 months later by pneumonia without evidence of disease. Four patients are without evidence of disease after 2, 4, 14 and 19 months, whereas one patient developed liver metastases after 9 months still treated by systemic chemotherapy. CONCLUSION: Complete cytoreduction plus hyperthermic peritoneal perfusion plus adjuvant chemotherapy seems to be an effective treatment for recurrent or metastasized MMMT. Further studies have to define the value of this new treatment strategy for this rare tumour entity.- - - - - - - - - - ranking = 0.14285714285714keywords = carcinoma (Clic here for more details about this article) |
10/30. Collision tumor of the thyroid: a case report of metastatic liposarcoma plus papillary thyroid carcinoma.BACKGROUND: The term collision tumor represents the proximal coexistence of two histologically distinct tumors. Collision tumors within the thyroid are extremely rare, and reported cases are usually of mixed histologies of papillary and medullary carcinomas. Metastatic disease to the thyroid is also an uncommon scenario but may develop after long disease-free intervals. Carcinomas, most commonly renal cell carcinoma, are the likeliest group of neoplasms to metastasize to the thyroid. Soft tissue sarcomas metastasize to the thyroid with a much lower frequency. methods: We are reporting this highly unusual case of metastatic liposarcoma from the thigh to thyroid, which harbored a collision tumor of papillary thyroid carcinoma. This 86-year-old woman had undergone an initial resection for liposarcoma of the thigh two decades before being seen with a thyroid mass. RESULTS: Histologically, the thyroid mass was a metastatic myxoid liposarcoma, identical to the primary neoplasm. Papillary thyroid carcinoma was present within this metastasis and in the adjacent thyroid. CONCLUSION.: For any patient seen with a thyroid mass with a history of prior malignancy, no matter how remote, metastatic disease should be considered in the differential diagnosis.- - - - - - - - - - ranking = 1.1428571428571keywords = carcinoma (Clic here for more details about this article) |
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