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1/185. The elevated serum alkaline phosphatase--the chase that led to two endocrinopathies and one possible unifying diagnosis.

    A 39-year-old Chinese man with hypertension being evaluated for elevated serum alkaline phosphatase (SAP) levels was found to have an incidental right adrenal mass. The radiological features were characteristic of a large adrenal myelolipoma. This mass was resected and the diagnosis confirmed pathologically. His blood pressure normalised after removal of the myelolipoma, suggesting that the frequently observed association between myelolipomas and hypertension may not be entirely coincidental. Persistent elevation of the SAP levels and the discovery of hypercalcaemia after surgery led to further investigations which confirmed primary hyperparathyroidism due to a parathyroid adenoma. The patient's serum biochemistry normalised after removal of the adenoma. The association of adrenal myelolipoma with primary hyperparathyroidism has been reported in the literature only once previously. Although unconfirmed by genetic studies this association may possibly represent an unusual variation of the multiple endocrine neoplasia type 1 syndrome.
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ranking = 1
keywords = neoplasia
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2/185. Squamous cell carcinoma with necrotizing scleritis.

    PURPOSE: To report on a case of limbal squamous cell carcinoma (SCC) with necrotizing scleritis in a young, previously healthy, white Australian male. methods: A 31-year-old man presented with a left limbal lesion intermittently causing a red eye and foreign body sensation. He had enjoyed surfing for many years. Repeat hiv tests were negative and the lesion was biopsied. RESULTS: biopsy showed a well-differentiated SCC apparently arising in an intra-epithelial (in situ) carcinoma of the conjunctiva. The lesion was excised and a corneoscleral graft repair was performed. CONCLUSION: The present case highlights the potential for a significant increase in the prevalence of ocular surface neoplasia in healthy young people who have had excessive UV-B exposure.
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ranking = 1
keywords = neoplasia
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3/185. Metachronous pulmonary and oesophageal neoplasia.

    Primary carcinomas of the lung and oesophagus are common, surgical resection offers the only hope of long-term survival with both conditions. We present the unusual case of a patient who underwent transhiatal oesophagectomy for an adenocarcinoma carcinoma of the oesophagus, 5 years after left pneumonectomy for small cell carcinoma of the lung.
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ranking = 4
keywords = neoplasia
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4/185. Large cell neuroendocrine carcinoma of the uterine cervix: a report of a case with coexisting cervical intraepithelial neoplasia and human papillomavirus 16.

    Large cell neuroendocrine carcinomas (LCNECs), one of the four newly categorised endocrine tumors of the uterine cervix, are unusual and aggressive tumors. The present report describes a case of LCNEC diagnosed at an early stage and associated with cervical intraepithelial neoplasia (CIN). The LCNEC showed organoid and trabecular growth patterns and was positive for chromogranin and synaptophysin. The CIN lesion was of a high grade and was negative for these neuroendocrine markers. polymerase chain reaction (PCR) using genomic dna extracted from archival tissue demonstrated human papillomavirus (HPV) type 16 dna in both the LCNEC and CIN lesions. These histological, immunohistochemical and PCR findings suggested that the LCNEC lesion was distinct from the CIN lesion and that both resulted from the carcinogenic field effect of HPV 16.
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ranking = 35.935503099903
keywords = intraepithelial, intraepithelial neoplasia, neoplasia
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5/185. Ampullary somatostatinoma in a patient with Merkel cell carcinoma.

    A 59-yr-old white man with Merkel cell carcinoma of his right leg status post extensive skin resection and chemotherapy had dilated hepatic and common bile ducts on a routine follow-up abdominal CT scan. A 1.9-cm ampullary mass was appreciated on endoscopy. histology showed psammoma bodies and positive immunoperoxidase staining consistent with a somatostatinoma. Merkel cell tumors and somatostatinomas are extremely rare neuroendocrine tumors derived from neural crest cells. Associations have been found between somatostatinomas and other islet cell tumors with multiple endocrine neoplasia syndromes, but no reported association has been published between islet cell tumors and Merkel cell tumors. This patient represents the first documented case of Merkel cell carcinoma and somatostatinoma in a single patient. Such an occurrence may represent a previously undescribed neuroendocrine tumor syndrome, and this possibility should be considered when either tumor is diagnosed.
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ranking = 1
keywords = neoplasia
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6/185. Anogenital intraepithelial lesions in hiv positive patients. Report of 3 cases with 3-year follow-up.

    Three cases of hiv-positive immunocompromised women, complicated by anogenital intraepithelial lesions are presented in the present paper. Two patients, aged 42 and 33, had a combination of cervical intraepithelial neoplasia grade 3 (CIN 3) and anal intraepithelial neoplasia grade 2 (AIN 2). The other one, aged 26, presented an association of CIN 2 and AIN 1. All lesions were HPV-associated and proved by colposcopically-guided biopsies.
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ranking = 30.010760295941
keywords = intraepithelial, intraepithelial neoplasia, neoplasia
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7/185. Anal intraepithelial neoplasia in an inflammatory cloacogenic polyp.

    A rare case of anal intraepithelial neoplasia arising in an inflammatory cloacogenic polyp is reported. While the occurrence of neoplasia complicating benign anal conditions is recognised, this case re-emphasises the need for careful histological examination of all perianal lesions.
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ranking = 36.935503099903
keywords = intraepithelial, intraepithelial neoplasia, neoplasia
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8/185. Extension of extramammary Paget disease of the vulva to the cervix.

    Extramammary Paget disease of the vulva was found in association with vulval adenocarcinoma in an elderly woman who also had a uterine prolapse. The characteristic histological appearances of extramammary Paget disease were masked by striking reactive changes in the squamous epithelium. Primary excision of both the intraepithelial and invasive disease appeared complete. However, a subsequent hysterectomy with repair of the prolapse revealed extramammary Paget disease in the upper vaginal mucosa and cervix, a finding which is very rarely described. Pathogenesis and diagnosis of extramammary Paget disease is discussed, with differential diagnosis and reference to immunohistochemical methods.
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ranking = 3.127311811196
keywords = intraepithelial
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9/185. Foamy gland high-grade prostatic intraepithelial neoplasia.

    A 60-year-old man underwent radical prostatectomy for biopsy-proved adenocarcinoma of the prostate. Histologic examination of the entirely embedded prostatectomy specimen revealed extensive ordinary adenocarcinoma, Gleason's grade 3 3 = 6, involving both sides of the gland, and extending into extraprostatic soft tissue at the left base. Adjacent to the carcinoma, and separately, extensive high-grade prostatic intraepithelial neoplasia (PIN) was identified, much of which showed bland nuclei and abundant xanthomatous cytoplasm, identical morphologically to that seen in foamy gland prostate carcinoma. However, unlike foamy gland carcinoma, the foamy glands in the current patient were large, showed papillary infolding, and were associated with a discontinuous layer of basal cells, demonstrated by immunostaining for high-molecular weight cytokeratin. No invasive foamy gland carcinoma was identified in the prostatectomy specimen. Immunostains for Ki-67 showed an increased proliferation rate in foamy high-grade PIN glands when compared with adjacent benign glands. review of additional outside biopsy material revealed foamy gland high-grade PIN on four of seven needle cores, two of which showed no carcinoma. This patient demonstrates a new subtype of high-grade PIN that is difficult to recognize on needle biopsy. It is important to distinguish foamy gland high-grade PIN from its infiltrating counterpart, and it is critical to recognize because of the association of high-grade PIN with prostate carcinoma.
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ranking = 35.935503099903
keywords = intraepithelial, intraepithelial neoplasia, neoplasia
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10/185. chromogranin a expression in hepatocellular carcinoma in a patient with germline MEN1 gene mutation.

    Hepatocellular carcinoma (HCC) was found in a patient with multiple endocrine neoplasia type 1 (MEN 1). The intriguing finding was that the HCC in the patient was positively stained for chromogranin a (CgA), a cellular marker for endocrine and neuroendocrine tumors. The patient had a pancreas endocrine tumor and type C hepatitis, that made pathological diagnosis of the origin of the tumor complicated.
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ranking = 1
keywords = neoplasia
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