Cases reported "Carcinoma, Small Cell"

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1/15. Desmoplastic small round-cell tumor: a case report on the large cell variant with immunohistochemical, ultrastructural, and molecular genetic analysis.

    examination. The patient died 10 months after surgery. Histologically, the tumor was composed of predominantly large epithelioid cells with foci of anaplasia mimicking metastatic carcinoma. Immunohistochemically, the tumor cells stained with anti-cytokeratin, EMA, desmin, and NSE antisera. Electron microscopy showed secretory lumina, desmosomes, cell processes with microtubules and electron-dense granules, and focal whorls of intermediate filaments. Reverse transcriptase-polymerase chain reaction performed on paraffin block-retrieved tissue demonstrated the EWS/WT-1 fusion transcript characteristic of the t(11;22)(p13;q12). This case illustrates a less common histological pattern of DSRCT, i.e., diffuse large cells, thus supporting the view that this tumor presents a wider morphological spectrum than that previously recognized.
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2/15. Neuroendocrine carcinomas associated with squamous cell carcinomas of the uterine cervix: light and electron microscopic observations in two cases.

    Small cell carcinomas are rare in cervical cancers and appear to be a heterogeneous group of tumors. Neuroendocrine carcinoma of the cervix, one subtype of small cell carcinomas of the cervix, can be identified by characteristic light and electron microscopic criteria. Two cases of neuroendocrine carcinomas associated with squamous cell carcinomas of the uterine cervix are reported in which electron microscopic studies were performed. The presence of small dense-core membrane-bound granules (120 to 160 nm) in cytoplasmic process under electron microscopic observation confirmed the diagnosis of neuroendocrine carcinoma of the cervix. The coexistence of electron dense-core membrane-bound granules, abundant tonofibrils, and desmosomes within the cancer cells, suggests that these tumors may have derived from the multipotential precursor cells with neuroendocrine and squamous differentiation. Because neuroendocrine carcinomas appear to have the highest incidence of recurrence and the poorest prognosis, it is necessary to distinguish these neoplasms from squamous cell carcinomas of the cervix. literature about neuroendocrine carcinomas of the cervix is also reviewed.
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3/15. Oat cell carcinoma of the esophagus with multiple differentiation.

    We report an esophageal oat cell carcinoma with multiple differentiation in a 75-year-old man who had a flat lesion with nodular projections in the middle third of the esophagus. Most of the resected tumor consisted of small round cells that contained neurosecretory granules, tonofilaments, and desmosomes. The tumor cells invaded only into the submucosa with extensive intraepithelial spreading. Foci of adenoid cystic, glandular, and squamous differentiation were found in some areas, and had continuity with the intraepithelial spreading carcinoma. Transition was also found. These findings suggest that the small cells had a propensity to undergo further adenoid cystic, glandular, and squamous differentiation.
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4/15. Simultaneous presentation of a small-cell carcinoma involving the ovary and the uterine endometrium.

    A case of simultaneous presentation of a small-cell carcinoma involving the ovary and the uterine endometrium is reported. We consider the endometrium as the primary localization of the tumor. The epithelial origin and neuroendocrine differentiation were confirmed by electron microscopy. Tumor cells were attached by small desmosomes, and in the cytoplasm typically neurosecretory granules measuring 100-200 nm were found. Immunohistochemically, no content of polypeptide hormones (ACTH, calcitonin, Gastrin, glucagon, insulin, somatostatin and VIP) were encountered. The tumor stained strongly for neuronspecific enolase. The histogenetic possibilities are shortly presented.
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5/15. Hematopoietic cell surface markers on metastatic small cell carcinoma detected with monoclonal antibodies.

    Using a panel of monoclonal antibodies, cells from lymph node biopsies have been examined in three patients with small cell carcinoma presenting with cervical lymphadenopathy. Two patients had small (oat) cell carcinoma of the lung; in the third patient, a primary tumor was not found. Two lymph node biopsies showed typical small (oat) cell carcinoma, and one was an intermediate cell variant; in the last, lung biopsy showed small (oat) cell carcinoma. Electron microscopy demonstrated desmosomes in all three tumors. In each case, lymph node cell suspensions were examined by indirect immunofluorescence with the use of a panel of monoclonal antibodies to antigens usually associated with lymphoid or myeloid cells. In two of the three cases malignant cells were positive with the lymphoid marker BA-2; in two cases malignant cells were positive with OK1a1, a marker for the Ia-like antigen (HLA-DR); and in one case malignant cells were positive with My-1. Caution is needed in the interpretation of cell surface marker studies in the differential diagnosis of small round cell tumors.
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6/15. Small cell carcinoma of the skin "non-Merkel cell type".

    An 81-year-old Japanese woman developed small cell carcinoma of the skin, which was different from trabecular carcinoma or neuroendocrine carcinoma of the skin. The tumor was composed of spindle-shaped or fusiform cells with scanty cytoplasm and numerous mitoses. The tumor cells were arranged in a streaming pattern and not in anastomosing trabecular fashion at all. No granules were detected by Grimelius' stain either. Immunoperoxidase staining for neuron specific enolase (NSE) did not reveal any activity. Ultrastructural study showed scanty organelles in the cytoplasm which contained a few round mitochondria, rough endoplasmic reticulum, and free polysomes. Occasionally, filamentous bundles, desmosomes, and intracytoplasmic canaliculi were recognized in the cytoplasm, but neurosecretory granules were not found throughout the cytoplasm. Electron microscopic features suggest that this tumor originated from the embryonal stratum germinativum. The present tumor can be distinguished from trabecular carcinoma or neuroendocrine carcinoma of the skin, and may be regarded as "small cell carcinoma" of the skin.
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7/15. Ultrastructural and immunocytochemical definition of component neoplasms in an unusual gastro-oesophageal collision tumour.

    An unusual collision tumour (concrescence of two neighbouring independent neoplasms) is reported. One tumour was a small cell undifferentiated (oat cell) carcinoma of the lower oesophagus and the other was a gastro-oesophageal adenocarcinoma. There was little intermingling of the two patterns. The adenocarcinoma stained strongly positive for mucin and carcinoembryonic antigen (CEA), but the small cell carcinoma was negative for both and also argyrophil-negative; both were negative for neurone-specific enolase and common leukocyte antigen. Ultrastructural study showed extra-cellular glandular lumina lined by cells with apical microvilli and junctional complexes in the adenocarcinoma; primitive cells without tonofilaments or dense-core granules, and joined by rudimentary desmosomes were seen in the small cell carcinoma. Collision carcinomas may result from a carcinogenic stimulus affecting two neighbouring regions of mucosa or may simply be the chance apposition of two unrelated tumours.
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8/15. Extrapulmonary oat-cell carcinoma of the tongue: an electron-microscopic study.

    An extrapulmonary oat-cell carcinoma arose in the tongue of a 62-year-old man who had a long history of cigarette smoking and ethanol ingestion. At presentation, he had the primary tongue lesion and cervical lymph-node metastases only, and search for a pulmonary primary was negative. Ten months later he died with metastases to liver, cerebrum, ribs, vertebrae, calvarium, and clavicle. Electron microscopy demonstrated cells with cytoplasmic processes and many dense-core neurosecretory granules that had a tendency to concentrate in the processes. Cells were linked by desmosomes. Electron microscopy is necessary for definitive diagnosis of extrapulmonary oat-cell carcinomas.
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9/15. Host-tumor cellular junctions: an ultrastructural study of hepatic metastases of bronchogenic oat cell carcinoma.

    A light and electron microscopic study of a metastatic oat cell carcinoma of the lung in the liver of an elderly male is presented. In addition to the finding of a few desmosomes between the tumor cells, desmosomes were also found between the tumor cells and adjacent hepatocytes. The latter feature does not appear to have been reported previously in man.
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10/15. Small cell epidermoid carcinoma of salivary glands. 'Pseudo'-oat cell carcinoma.

    Two patients had small cell carcinomas of the salivary glands, with pathological features indicating squamous differentiation, heretofore not described. One is free of disease at seven years, and the second is alive, with regional metastases at four years. Sections from one tumor were studied by electron microscopy and revealed tonofilaments and desmosomes. Most cases of small cell carcinomas of the salivary glands have been considered akin to bronchogenic oat cell carcinoma. Their less aggressive behavior, however, suggests that at least some of these tumors were not true oat cell carcinomas. Our findings, and those of others, indicate that small cell carcinomas of the salivary glands (or head and neck) represent a heterogeneous group. Electron microscopy should be used to determine the exact nature of these neoplasms. If an oat cell nature is ruled out, local and regional treatment should be aggressive, since small cell carcinomas other than oat cell appear not to have a dismal prognosis.
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