Loss of p16 INK4 expression in invasive squamous cell carcinoma of the uterine cervix is an adverse prognostic marker.
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A 51-year-old mason presented with a large tumour on his scalp which had developed over the previous 2 years. Histological examination showed the presence of large vessels with muscular coats some of which appeared to be venules and others arterioles. They had markedly swollen cuboidal endothelial cells and a surrounding mononuclear cell infiltrate which in areas formed lymphoid follicles some of which had germinal centers. There was no evidence of tissue or blood eosinophilia. The unusual clinical and histological features of this case are emphasized and the nosology of this rare condition is discussed.
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AIM: To investigate the incidence and localizations of lymphoid follicles (LFs) in early colorectal neoplasms in human beings. METHODS: From July 1992 to September 1999, a total of 1,324 early colorectal neoplasms were removed endoscopically or surgically at our hospital; 1,031 (77.9%) were available for analysis in this study. Localization of LFs was defined histologically: as submucosal LFs, if located under the muscularis mucosa; and as intramucosal LFs, if located across or over the muscularis mucosa. RESULTS: Histologically, the materials included 903 intramucosal neoplasms and 128 submucosal cancers. Overall incidence of LFs was 27.2% (280/1 031). The incidence of LFs was significantly higher in females (33.6% vs 24.9%, P=0.0064), the right-sided colon (32.2% vs 25.6%, P=0.0403) and in flat or depressed type lesions (34.6% vs 25.2%, P<0.0001) as compared to males, left-sided colon and protruding type lesions, respectively. The incidences of intramucosal neoplasms and submucosal cancers were 24.3% and 43.8%, respectively (P<0.0001). Localizations of LFs (intramucosal LF/submucosal LF) in depressed, flat, and protruding types were 1/24, 14/36, and 131/74, respectively. CONCLUSION: The incidence of LFs in early human colorectal neoplasms significantly differs by gender, location, macroscopic type, and histology. Moreover, localization significantly differs by macroscopic type.
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A case of myxopapillary ependymoma located subcutaneously in sacrococcygeal area of a 18 months male child with metastasis to right inguinal lymph nodes is described; the tumour was present since birth. Histological examination of the tumour besides myxopapillary structures, also revealed an ependyma lined cystic space, resembling ventricular cavity. So far only two cases of congenital metastasising subcutaneous sacrococcygeal ependymoma have been described. However, the present case had a very aggressive post-operative biological behaviour.
A case of extraskeletal osteosarcoma arising in the axilla in a 77-year-old woman is described. Because of its association with an ipsilateral breast carcinoma, the axillary mass was at first assumed to be a lymph node with metastatic breast carcinoma. The occurrence of extraskeletal osteosarcoma in the axillary is rare and association with breast carcinoma has never, to our knowledge, been described.
Computed tomographs of the malignant fibrohistiocytic tumors metastatic to the lung were demonstrated in two elderly patients. The lymphatic spread of the tumors and the manifestation as pleura-based cyst-like lesions are stressed.
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A malignant lymphoma (ML) was found in resected stomach and regional lymphnodes of a 62-year- old woman. The process looked like flattening of mucosal folds or slight map-like elevation of antral and pyloric mucosa. Tumorous foci were spread in submucosa, muscular layer and lymphatics of the stomach wall. Tumour histology equaled centrocytic follicular ML with lymphoepithelial lesions and many plasmacytes in gastric mucosa. Differential diagnosis of this peculiar type of ML which was defined by Isaacson et al., has to distinguish especially so called pseudolymphoma and immunocytoma as well as undifferentiated stomach carcinoma. A relatively favourable behaviour of this centrocytic ML gives reasons for separating it in a group of ML of mucosal lymphatic tissue.
In 117 patients with colorectal cancer, the serum levels of CEA, TPA, CA 19-9, IAP, and, AFP have been compared with the clinical findings. The combined assay of 5 tumor markers were found to be useful for the screening of colorectal cancer. Excluding the AFP, positive rate of the markers for colorectal cancer was higher than that for breast cancer (p less than 0.01) and similar to that for gastric cancer. The serum levels of TPA, CEA and CA 19-9 correlated with the histological progression. Thus, they may be an indicator of the degree of lymph node metastasis, liver metastasis, the histological depth, and also may be useful in evaluating the prognosis of patients with colorectal cancer.
We report on a 26-year-old male patient suffering from a rapidly progressing sclerodermiform induration and edema on his chest, neck, and face, which was more pronounced on the left side of his body. The disease had developed within two months and took a lethal course. Two months before the disease set on, the patient had removed a bluish nodule from his left axilla. Histopathologic analysis of the indurated skin showed massive infiltration of the fatty tissue by a malign, undifferentiated blastoma. Pathoanatomical investigation revealed a massive metastatic infiltration of the soft tissue in the thoracic area and the fatty tissue, as well as metastases developed in the lymph nodes.
In the period 1977-1983, 183 adult patients with soft tissue sarcomas of the extremities were treated in the Netherlands Cancer Institute. One hundred and seventy-one patients had initially operable tumors. Fifteen patients (8.2%) developed regional lymph node metastases (RLNM) during the course of their disease. Only two patients (1.2%) developed RLNM as first site of tumor recurrence. The incidence of RLNM varied according to the histological subtypes: liposarcoma: 1/64, fibrosarcoma: 1/12, tendosynovial sarcoma: 5/24, unclassifiable sarcoma: 3/8. The outcome in patients with RLNM was invariably fatal. In all cases with RNLM distant metastases were present either at the time RLNM were found or shortly afterwards (median 4 months). Based on this experience we now consider RLNM in soft tissue sarcoma an expression of systemic tumor spread, which should be treated as such. We find no indication for elective lymph node dissection as part of the initial treatment of soft tissue sarcoma of any histological subtype. Therapeutic lymph node dissection might be indicated as part of the palliative management.
The rare case of a cystic lymphangioma is described in an elderly patient. Most of these tumors occur in patients under the age of five. The intraabdominal localisation is also rare, here the common localisation is the mesentery and in only 5% the retroperitoneum. The woman lived for 11 years after clinical manifestation of the lymphangioma. We give a brief review of the literature.
A patient with malignant epithelioid schwannoma in the right triceps muscle of the arm is reported. This tumor was mainly composed of plump epithelioid cells, which showed focal necrosis and nuclear arrangement in palisades. The structures and the presence of long cytoplasmic processes, discrete basal lamina, and long spaced collagen on electron microscopic examination suggested schwannian derivation of the tumor. The tumor exhibited metastasis to the axillary lymph nodes. However, no recurrence was observed a year after surgical removal, irradiation, and chemotherapy.
Serum TPA and CEA level were measured in patients with gastric or colon cancer during the course of surgical treatment, and those clinical utility was evaluated. Both markers level were shown to be highest in colon cancer, followed by gastric cancer, benign diseases, and healthy subjects. Late stage patients, especially inoperable patients or patients in recurrence showed significantly high TPA and CEA level compared to early stage patients. Both markers were considered to be useful not only postoperative following up for recurrence but also preoperative evaluation for resectability and prognosis and postoperative evaluation for the treatment itself.