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11/289. Remarkable suppressive effect of consecutive low-dose cisplatin therapy on advanced ovarian clear cell adenocarcinoma.

    Ovarian clear cell adenocarcinoma (OCCA) is known to be less responsive to cisplatin and most other anti-cancer drugs and to have a poorer prognosis than other ovarian cancers. We report a rare case of stage IIIc OCCA in a patient who has been treated postoperatively with cisplatin alone and continues to survive after 7.5 years. In this case, 25 mg/m2/day of cisplatin was administered for 5 consecutive days every 4 weeks. After remission, intermittent administration of cisplatin every 3 to 4 months was performed 8 times. This case suggests that induction and intermittent chemotherapy using consecutive low-dose cisplatin administration may be a useful treatment for OCCA. ( info)

12/289. Clear-cell basal cell carcinoma of the upper eyelid: a case report.

    A clear-cell variant of basal cell carcinoma in a previously unreported site is described. This rare variant appeared on the upper eyelid of an 81-year-old woman. light microscopic examination showed an intradermal tumor with circumscribed lobules composed of clear cells. Histological differential diagnosis of tumors with clear-cell formation is often confusing and can have a great influence on treatment decision making, including surgical intervention. ( info)

13/289. Unusual recurrence of ovarian carcinoma 9 years after initial diagnosis.

    Ovarian carcinomas typically metastasize to multiple sites via exfoliation, lymphatic spread, or direct invasion. gastrointestinal tract involvement is usually the result of exfoliation with direct invasion of tumor within the mesentery or through serosal surfaces. We present a case of late recurrence of ovarian carcinoma isolated to the sigmoid mucosa, heralded only by brief left lower quadrant pain with hematochezia in a patient otherwise disease free for 9 years. This unusual presentation illustrates the therapeutic dilemma faced by clinicians when a tumor is of uncertain origin and underscores the need for continued follow-up and close scrutiny of new symptoms in patients with stage I disease and for those who enjoy prolonged disease-free intervals. ( info)

14/289. Combined pedicle and free-tissue transfer to improve functional restoration of the foot: the "backpack principle".

    Reconstruction of weight-bearing areas of the foot remains a challenging problem for the reconstructive surgeon. The principle described involves the combination of an innervated regional pedicle flap providing sensate, durable coverage of the weight-bearing heel, and a microvascular fascia flap for thin, pliable coverage of a large surface defect, based on the same vascular bundle. This provides excellent long-term stability and minimizes the disruption of blood supply to the foot. The result after 3 years demonstrates that this concept may represent an interesting solution for these particular problems. ( info)

15/289. Regional proliferation of HMB-45-positive clear cells of the lung with lymphangioleiomyomatosislike distribution, replacing the lobes with multiple cysts and a nodule.

    The authors report a case of a localized lesion of the lung presenting as multiple cysts and as a tumor in the right upper and middle lobes, consisting of a diffuse proliferation of clear cells with intralysosomal glycogen granules and human melanin black (HMB)-45 immunoreactivity. A 33-year-old woman complained of dyspnea because of the enlargement of bullae in the right upper and middle lung fields without stigmata of tuberous sclerosis. Resection showed multiple, various-size air-filled cysts and a tumor. The cysts in the resected lungs were reminiscent of lymphangioleiomyomatosis (LAM), accompanied by the diffuse proliferation of clear cells in the interstitium. The tumor, 1.8 cm in diameter, resembled a clear cell tumor of the lung (CCTL) and showed proliferation of clear cells with sinusoidlike vascular spaces. Both forms of proliferation were continuous spatially, and both constituent cells showed diffuse HMB-45 immunoreactivity. The cells that comprised a nodule revealed ultrastructurally abundant cytoplasmic glycogen, which was in the form of free and membrane-bound glycogen granules. This case may represent a particular pulmonary lesion consisting of CCTL-LAM hybrid cells, which share the cytologic features with CCTL cells on one hand, and the proliferative pattern and potential with LAM cells on the other. ( info)

16/289. A case of adenocarcinoma with clear cell carcinoma of the bladder.

    A case of adenocarcinoma with clear cell carcinoma of the bladder in a 65-year-old male is reported. Our patient had a walnut-sized nodular tumor located on the anterior wall of the bladder. The patient underwent radical cystoprostatectomy with urethral hemi-Koch pouch. Histopathological examination revealed a lesion composed of poorly-differentiated adenocarcinoma and clear cell carcinoma with diffuse sheet patterns of cells with abundant, clear cytoplasm. The patient died of general metastasis 18 months after operation. To our knowledge this is the first case of adenocarcinoma with clear cell carcinoma arising from the anterior wall of the bladder in a male. ( info)

17/289. Cytologic diagnosis of vaginal metastasis from renal cell carcinoma. A case report.

    BACKGROUND: Metastasis of renal cell carcinoma to the vagina is rare, although it may be the first evidence of the existence of the primary tumor. CASE: A metastatic deposit of renal cell carcinoma in the vagina was diagnosed by cytology as clear cell adenocarcinoma, which was confirmed by biopsy. Radiographic and ultrasound examinations confirmed the renal site of origin, which was corroborated by immunohistochemistry of the biopsy specimen. CONCLUSION: When a cytologic diagnosis of vaginal clear cell adenocarcinoma is made, metastasis of renal cell carcinoma should be considered in the differential diagnosis. ( info)

18/289. Differential diagnosis between monomorphic clear cell adenocarcinoma of salivary glands and renal (clear) cell carcinoma.

    Clear cell adenocarcinoma of salivary glands (CCASG) is a relatively rare tumor, composed entirely of clear cells of putative ductal origin. It bears striking morphologic similarities to renal cell carcinoma (RCC) of clear cell type on hematoxylin and eosin stains. Differentiation between CCASG and metastatic RCC to the salivary glands has been considered problematic or even impossible on morphologic grounds. We examined three cases of CCASG and 12 cases of RCC (6 primary and 6 metastatic) by hematoxylin and eosin staining, immunohistochemistry, and electron microscopy. Two distinctive immunohistochemical and ultrastructural patterns emerged from this analysis. CCASG showed positivity for high molecular weight cytokeratin and carcinoembryonic antigen and ultrastructurally showed prominent squamoid differentiation, glycogen pools, and absence of lipid. In contrast, RCC was characterized by positivity for vimentin and complete absence of staining for high molecular weight cytokeratin and carcinoembryonic antigen. On ultrastructural studies, RCC lacked any squamoid differentiation, and the tumor cells contained abundant cytoplasmic lipid in addition to glycogen. Thus, based on the consistent differences on the immunohistochemical staining patterns and their characteristic subcellular morphology, CCASG and RCC can be distinguished on pathologic evaluation. The different direction of differentiation of the cells in CCASG and RCC (i.e., ductal in the former and renal tubular and mesodermal in the latter) results in their distinctive immunophenotypical and ultrastructural features. ( info)

19/289. Pancreatic metastasis from clear cell renal carcinoma: diagnosis with chemical shift MRI.

    Some clear cell renal cell carcinomas contain intracellular lipid, which can be detected with chemical shift MRI. We present an example of surgically proven metastatic clear cell renal carcinoma to the pancreas, which was diagnosed using chemical shift MRI. ( info)

20/289. Extrapulmonary neoplasms among asbestos-exposed power plant workers.

    Three cases of fatal extrapulmonary neoplasms among asbestos-exposed power plant workers are described. These cases add to the growing evidence for a causal relationship between asbestos exposures and extrapulmonary neoplasms. ( info)
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