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1/430. Combined hepatocellular-cholangiocarcinoma. Diagnostic challenge in hepatic fine needle aspiration biopsy.

    OBJECTIVE: To study the cytohistologic features of combined hepatocellular-cholangiocarcinoma (CHCC-CC) in fine needle aspiration biopsy (FNAB) material. STUDY DESIGN: Six hepatic FNAB cases with cell blocks (five) and hepatic resections (two) were analyzed cytohistologically and immunohistochemically. RESULTS: The six cases were diagnosed as CHCC-CC based on clinicopathologic correlation. Unequivocal hepatocellular carcinoma (HCC) cells corresponding to Edmondson and Steiner's grade 3 lesions were identified in the FNAB in three instances. adenocarcinoma, represented by cohesive columnar cells with ovoid, basal nuclei displaying nuclear palisading, acini and/or papillary structures with variable intracytoplasmic intraacinar or brush border mucin production, was identified in all cases. Intermediate cells with hybrid/polymorphic cytologic features straddling malignant hepatocytes and glandular cells were identified in five instances. Tissue alpha-fetoprotein was negative. There was brush border and/or diffuse cytoplasmic p-carcinoembryonic antigen immunoreactivity in the glandular elements. CONCLUSION: FNAB diagnosis of CHCC-CC is possible if the clinical, cytohistologic and immunohistochemical findings support the presence of HCC and adenocarcinoma. Intermediate cells pose a great challenge to recognize and define: they tend to lose the classic cytologic features of malignant hepatocytes and acquire glandular characteristics. At the very least, there should be a high index of suspicion. These cases underscore the necessity for clinicopathologic correlation in enhancing the precision of FNAB diagnoses.
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2/430. A case of multiple sebaceous epithelioma: analysis of microsatellite instability.

    Sebaceous gland tumor is a rare disease that is a sign of muir-torre syndrome, an autosomal, dominantly inherited genodermatosis characterized by the presence of at least one sebaceous gland tumor and a minimum of one internal malignancy. Recent studies have indicated that defective dna mismatch repair occurs in muir-torre syndrome. Cutaneous lesions may occur before diagnosis of the internal cancer. We describe a 64-year-old male patient with multiple sebaceous epitheliomas with no evident internal malignancy. microsatellite instability, determined by examining dinucleotide CA repeats at the microsatellite loci, was observed in DNA from one sebaceous epithelioma but not from the other two sebaceous epitheliomas or from one basal cell epithelioma with sebaceous differentiation, suggesting that this condition is unlikely to be due to germ-line mutation of mismatch repair genes.
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3/430. Multiple primary cancers and HPV infection: are they related?

    Multiple primary cancers have been reported with increasing frequency in recent years, but the presence of foreign DNA sequences of infectious agents in tumours arising in the same patient has so far not been investigated. We report a case of a patient with Hodgkin's lymphoma, an "in situ" cervix carcinoma and an adenocarcinoma of the right and left mammary gland. In all the tumour samples we detected the presence of DNA genomic sequences of Papillomavirus type 16. Our results suggest that HPV infection may be an exogenous risk factor even in second primary tumours of non-epithelial origin.
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4/430. brain metastases from adenoendocrine carcinoma of the common bile duct: a case report.

    A 68-year-old man with metastatic brain tumors from adenoendocrine carcinoma of the common bile duct is reported. A common bile duct tumor and a metastatic liver tumor had been resected 6 years and 3 years prior to admission, respectively. Microscopically they showed two components; moderately differentiated tubular adenocarcinoma and neuroendocrine carcinoma. He presented with headache and vomiting and MRI revealed two metastatic brain tumors. They were successfully resected and radiotherapy was carried out. Histological diagnosis of the metastatic brain tumors was neuroendocrine carcinoma, but carbohydrate antigen (CA)-19-9 and carcinoembryonic antigen (CEA)-immunoreactive cells were observed without glandular pattern. Immunohistochemically serotonin and pancreatic polypeptide were detected, but somatostatin was not. As the endocrine cells demonstrated in the normal extrahepatic bile ducts are only somatostatin-containing D cells, these cells are considered to originate as part of a metaplastic process. To our knowledge, this represents the second case of adenoendocrine carcinoma of the common bile duct.
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5/430. Synchronous unilateral parotid neoplasms of different histological types.

    The occurrence of multiple tumours in the salivary glands is an unusual phenomenon and the simultaneous development of tumours different types is extremely rare. Two cases are presented with synchronous tumours of the parotid gland of different histological types. The first was a Warthin tumour in combination with a metastatic lung carcinoma and the second was a pleomorphic adenoma in combination with non-Hodgkin's malignant lymphoma.
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6/430. Synchronous pleomorphic adenomas of the major salivary glands: a case report.

    The presentation of multiple distinct tumors in major salivary glands is rare. Although the most common tumor with bilateral synchronous or metachronous development is the Warthin tumor, pleomorphic adenomas have been diagnosed simultaneously as well. We report the case of a female patient who was diagnosed with pleomorphic adenomas in the right parotid and submandibular glands, concomitant with sialolithiasis affecting the submandibular gland. This patient had been exposed to head and neck radiotherapy in childhood, which may have played a role in the development of her tumors. A review of the relevant literature is included.
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ranking = 3.5740386710348
keywords = submandibular gland, gland, submandibular
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7/430. Triple pituitary adenoma in Cushing's disease: case report.

    A case of a triple pituitary adenoma identified in a surgically removed pituitary gland from a 52-year-old woman operated on for Cushing's disease is presented. The histology revealed 3 distinctly separate microadenomas, 1 corticotroph and 2 immunoreactive for prolactin (PRL). The latter were apparently silent, since the serum PRL levels were within normal range. The problems associated with the inability to identify multiple adenomas pre-operatively and the possible failure of selective transsphenoidal adenomectomy in case of multiple adenomas are emphasised.
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8/430. Paget's disease of the vulva associated with local adenocarcinoma and previous breast adenocarcinoma: report of two cases.

    We report two women in whom vulval Paget's disease occurred in association with local adenocarcinoma and previous breast adenocarcinoma. The first patient presented at the age of 83 years with moist erythematous changes over the perineum and an indurated area near the anus. biopsy of the indurated area showed Paget's cells throughout the epidermis and, below, adenocarcinoma infiltrating the dermis. Ten years previously, she had undergone a left mastectomy for infiltrating ductal carcinoma of the breast. The second patient was diagnosed as having Paget's disease at the age of 74 years. A vulval biopsy showed Paget's cells in the epidermis but, in addition, there were changes suggestive of adenocarcinoma of the sweat glands. Her symptoms of vulval itching had started at the age of 45 years and had led to a simple vulvectomy at the age of 57 years. Retrospective review of this vulvectomy specimen showed Paget's disease. She had also previously been treated for infiltrating ductal adenocarcinoma of the breast and adenocarcinoma of the rectum. The management of Paget's disease is difficult because of its high recurrence rate and, as illustrated by our two cases, treatment is difficult if the patients are elderly and in poor general health.
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9/430. Squamous cell carcinoma arising in a Warthin's tumor.

    Warthin's tumor is a well-defined salivary gland neoplasm consisting of epithelial and lymphoid components. However, malignant transformation is extremely rare. Such a patient who developed squamous cell carcinoma within a Warthin's tumor of the parotid gland is described and possible pathogenesis is discussed.
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10/430. Hybrid carcinomas of salivary glands. Report of 4 cases and review of the literature.

    OBJECTIVE: To report 4 cases of hybrid carcinoma and to review the literature on these rare neoplasms of the salivary gland. methods: hematoxylin-eosin-stained, formalin-fixed, paraffin-embedded tissue sections from 3 parotid tumors and 1 palate tumor were examined. RESULTS: The cases were classified as adenoid cystic and mucoepidermoid carcinoma, adenoid cystic and epithelial-myoepithelial carcinoma, epithelial-myoepithelial and salivary duct carcinoma, and adenoid cystic and salivary duct carcinoma. All patients were men, 28 to 71 years old; 3 patients presented with parotid mass, and 1 patient presented with palatal mass. One patient presented with facial nerve paralysis and pain. The soft palatal tumor was a slowly growing mass with maxillary sinus involvement at the time of the diagnosis. All patients were treated with surgery and radiotherapy. CONCLUSIONS: Correct identification of 2 or more neoplastic entities will help assess the aggressiveness and metastatic potential of the tumor and influence the clinical course and treatment.
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keywords = gland
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