Cutaneous metastasis from vulvar adenocarcinoma.
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Biomedical subjects
Publications and source records attributed to C Urso.
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BACKGROUND: Intestinal-type adenocarcinoma (ITAC) of the nose and paranasal sinuses is a relatively rare tumor. It commonly affects subjects exposed to wood or leather dust. METHODS: The authors present the clinicopathologic findings of 18 cases of sinonasal ITACs and review the proposed histologic classifications. RESULTS: All patients, except one, were males; mean age was 60 years (range, 41-79); in 9 cases an occupational exposure to wood or leather dust was found. Common presenting symptoms were epistaxis, nasal obstruction and rhinorrhea. Histologically, tumors were divided into four groups: well-differentiated (G1) ITACs = 3 cases; moderately differentiated (G2) ITACs = 8 cases; poorly differentiated (G3) ITACs = 2 cases; mucinous (M) ITACs = 5 cases. Immunocytochemically, 16/17 cases were positive for carcinoembryonal antigen, 1/17 for somatostatin, and 0/16 cases for gastrin. CONCLUSIONS: Sinonasal ITACs are aggressive tumors, often diagnosed in a relatively advanced stage. Owing the close similarity of the microscopic aspects, a histologic classification of ITACs analogous to that of colonic adenocarcinomas is proposed.
Seven cases of sweat-gland carcinomas showing eccrine ductal differentiation (ductal carcinomas) are presented. The tumors had a variable histological appearance, but were basically characterized by the following histological elements: (a) tubular structures, sometimes cystic or having a "tadpole" appearance; (b) solid islands of squamous, basaloid, or clear cells; (c) periodic acid-Schiff-positive endoluminal and/or intracellular material; and (d) infiltrating growth. Immunocytochemically, tumor cells were positive for keratin and negative for actin. Endoluminal material contained carcinoembryonic antigen in five of seven cases. Although it is not yet clear whether carcinomas exhibiting eccrine ductal differentiation may represent a specific histotype or a group encompassing several distinct clinicopathological entities, the histological analysis of the cases suggested that the wide spectrum of their histological appearances may be due to variable grades of differentiation.
The 3H-thymidine labelling (LI) and mitotic (MI) indexes were calculated in 29 cutaneous melanocytic lesions: 6 common nevi (CN), 11 dysplastic nevi, subclassified as nevi with architectural atypia (NAA = 4) and nevi with cyto-architectural atypia (NCAA = 7), 2 melanomas in situ (MIS), 4 invasive superficial spreading melanomas (IM) and 6 metastatic melanomas (MM). The LI mean values resulted to be: CN = 0.23%, NAA = 0.98%, NCAA = 1.79%, MIS = 5.75%, IM = 5.16%, MM = 3.80%. In CN, NAA, NCAA and MIS, these values were calculated at epidermal level; in IM and MM at dermal level. At dermal level, the LI mean values of CN, NAA and NCAA were: 0.20%, 0.20%, 0.23% respectively. The MI mean value was close to 0 in CN, NAA, NCAA, MIS; 0.18% in IM, 0.16% in MM. Confirming a low proliferative activity in CN and a high activity in melanomas (MIS, IM, MM), the results showed that dysplastic nevi (NAA, NCAA) had a proliferative activity intermediate between common nevi and melanomas. The lesions with melanocytic atypia (NCAA) resulted to have a higher proliferative activity than those without this histological feature (NAA).
A retrospective evaluation of 201 stage I cutaneous melanomas was performed to investigate the prognostic significance of histological regression (present in 67 cases). Thin melanomas showed regression more frequently than thick lesions (48% less than or equal to 0.75 mm vs 12% greater than 3 mm). The mean disease-free interval was 33.53 months in regressing tumours and 19.9 in non-regressing tumours (p = 0.07): differences between the survival curves were not significant (p = 0.61). Metastases developed in 13 (19.40%) patients with regressing tumours and by 40 (29.85%) patients with non-regressing tumours. Although we observed a higher frequency of regression in thin melanomas we could not demonstrate an influence of regression on disease-free interval and survival.
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Two cases of primary cutaneous adenoid cystic carcinoma (ACC) of sweat gland origin are reported. The patients were a 83-year-old man and a 40-year-old woman. Histologically, the neoplasms showed the classic appearance of ACC. CEA, actin and S-100 protein were immunocytochemically demonstrated to be contained in some neoplastic cells. The literature on sweat gland ACC is reviewed and the clinicopathologic profile of this rare tumor considered.
Intratumoral and peritumoral infiltration of T-zone histiocytes, mainly of mature Langerhans cells, was investigated in 88 patients with squamous cell carcinoma of the larynx by immunohistochemical methods using polyclonal antibodies against S100 protein and lysozyme. Granulocytic and lymphoid inflammatory infiltration and its relationship to the presence of Langerhans cells were also evaluated. Langerhans cells were present within the cancer tissues and showed a relationship with lymphoid infiltrate. No significant correlation was present among the density of Langerhans cells and the site of neoplastic growth (supraglottic or subglottic), granulocytic inflammatory infiltration, histological tumor grade, or clinical stage. Patients with high or intermediate density of Langerhans cells survived longer than those with low density (mean survival, 61%, 62%, and 0%, respectively). The number of Langerhans cells was relevant in patients with evident infiltration of lymphocytes and plasma cells, according to their ability to present antigens to sensitized T cells. Our results indicate that the presence of high or intermediate density of Langerhans cells and of marked lymphoid inflammation may be considered favorable prognostic factors for patients with squamous cell carcinoma of the larynx.
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Trabecular carcinoma has been renamed as Merkel cell carcinoma because, ultrastructurally, tumour cells resemble Merkel cells of the skin. Recently, evidence of exocrine (sweat gland) differentiation in some trabecular carcinomas has been reported. These findings raise two possibilities: (1) trabecular carcinomas are a heterogeneous group of lesions; or (2) that trabecular carcinomas are glandular tumours, in which exocrine features are rarely detected.
An intraoral adenocarcinoma showing syringomatous features is reported in a woman aged 71. The tumor, which appeared to arise in minor salivary glands, ulcerated the overlying epithelium. Histologically, it was composed of dilated ductal structures and, in deeper parts, of tumor nests, elongated cords and small ducts containing small lumina. In wide areas, neoplastic ducts were lined by flattened cells, resembling syringoma of the skin. Other ductal structures were lined by atypical columnar or squamous epithelium. Solid squamous islands and superficial small horny cysts were also observed. Salivary glands tumors with syringomatous features have rarely been reported. They probably represent a rare variant of salivary adenocarcinoma.
Hepatic fibrosis represents an important stage in the progression of chronic liver disease to cirrhosis. In the present paper we have investigated whether capsaicin-sensitive neuropeptide-containing sensory neurons may participate in the development of liver fibrosis. The expression of hepatic fibrosis induced by common bile duct obstruction has been studied both in capsaicin- and vehicle-treated rats. Common bile duct-induced liver fibrosis was less marked in capsaicin-treated rats than in vehicle-treated rats. Diffuse alterations of liver parenchyma structure with marked collagen deposition and nodular regeneration occurred 8 weeks after common bile duct ligation in vehicle-treated animals, while none of the capsaicin-treated rats exhibited the formation of complete connective septa altering the parenchyma architecture. Both vehicle- and capsaicin-treated rats showed an increasing number of desmin-positive cells in the perivenular zone, but the density of these cells was lower in treated animals than in untreated rats. The hydroxyproline content of the liver increased after common bile duct ligation in a time-dependent manner. Eight weeks after bile duct obstruction vehicle-treated rats showed a 7-fold increase of liver collagen content in comparison to normal animals. This enhancement was about 3.5-fold in capsaicin-treated rats. These findings raise the possibility that the peripheral release of neuropeptides stored in sensory nerves might participate in the development of liver fibrosis following common bile duct obstruction.
The diagnostic category "malignant acrospiroma" includes acrosiryngeal-derived sweat gland malignant neoplasms. Many terms are usually employed to indicate different histologic types of such tumours, lacking a definitive classification. We describe a patient suffering from malignant acrospiroma (malignant poroma) with unusual clinico-evolutive presentation.
A case of Dermatofibrosarcoma Protuberans (DFSP) with unusual cystic features is described. It is difficult to evaluate the actual incidence of this feature on the basis of literature; on the other hand we observed it only once in a series of 27 patients studied from 1975-1989.
Fifty cutaneous pigmented lesions characterized by an intraepidermal proliferation of atypical melanocytes were reviewed. Several histological parameters (position of melanocytes in the epidermis, nuclear melanocytic atypia, presence or absence of pagetoid melanocytes, nucleoli, and others) were evaluated. On the basis of the results, the investigated cases were classified into three groups. In group 1, pagetoid melanocytes were present, melanocytic atypia was severe and continuous, all epidermal layers were involved by melanocytic proliferation, and a pattern of epidermal infiltration was recognized. In group 2, pagetoid melanocytes were absent, melanocytic atypia was mild-moderate and discontinuous, the lower epidermis only was involved by melanocytic proliferation, and a pattern of epidermal pseudoinfiltration was recognized. Group 3 cases were in an intermediate area between the two major groups. The results showed that intraepidermal proliferations of atypical melanocytes lie on one line, in which groups 1 and 2 account for the extremes.
We report a case of cutaneous myxoid melanoma in a 61-year-old man. Histologically, the tumor, which showed an adjacent intraepidermal proliferation of atypical melanocytes, was composed of spindle-shaped and epithelioid cells with atypical nuclei, arranged in lobules and embedded in a prominent myxoid stroma. Primary cutaneous myxoid melanoma is rare: we found only one other example in the literature.
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Nuclei of melanocytes in 10 common acquired melanocytic nevi, 10 malignant melanomas and 10 dysplastic melanocytic nevi (melanocytic dysplasia) (MD) were morphometrically analyzed. MD group consisted of 6 lesions with (MD 1) and 4 without (MD 2) the clinical features of dysplastic nevi. The considered parameters were area, perimeter and form Ar. In the MD group, the results showed that median values of each considered parameter of MD 1 were close to those of MD 2. For each evaluated parameter, median values of MD turned out to be intermediate between those of common acquired melanocytic nevi and of malignant melanomas. Confirming the histologic evidence of a double - nonatypical and atypical - melanocytic population in melanocytic dysplasia, our data showed that nonatypical melanocytes were indistinguishable from melanocytes of common acquired nevi, while the atypical melanocytes were close to melanoma cells. The importance of atypical melanocytes is stressed in the diagnosis of melanocytic dysplasia.