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PubMed1989

Role of nuclear grading in stage I renal cell carcinoma.

Through a retrospective histologic analysis of 55 cases of Stage I renal cell carcinoma, we evaluated the usefulness of the nuclear grading system (Fuhrman, Lasky, Limas) in identifying those tumors that will eventually metastasize and kill the patient. The difference in five-year survival rates between patients with combined nuclear grade 1-3 tumors (n = 50, 91%) and grade 4 tumors (n = 5, 9%) was significant (P less than 0.0046). Other predictors of death due to renal cell carcinoma included: tumor size greater than 8 cm (P less than 0.001) and mitoses greater than one per 10 high-power field (P less than 0.01). Within Stage I tumors, therefore, nuclear grade is an important morphologic variable for predicting long-term survival. Identification of nuclear grade 4 neoplasms may become prognostically indispensable to determine the metastatic potential of early-stage tumors and thereby to institute appropriate systemic therapy.

Adult↗
PubMed1992

Cytogenetic analysis of six renal oncocytomas and a chromophobe cell renal carcinoma. Evidence that -Y, -1 may be a characteristic anomaly in renal oncocytomas.

Renal oncocytomas are benign tumors whose morphologic features may sometimes be confused with those of certain low-grade malignant neoplasms of the kidney, e.g., chromophobe cell and granular cell variants of renal carcinoma. The presence of a specific genetic abnormality might help differentiate these tumors. Because very few cytogenetic studies of renal oncocytomas have been published, we investigated a consecutive series of six such tumors. We also performed chromosome analysis on a chromophobe cell carcinoma because cytogenetic analyses of this tumor have not been previously reported. Tumor cell metaphases were analyzed after mechanical and enzyme disaggregation, in situ culture, and robotic harvesting. Clonal abnormalities were present in five of the six oncocytomas, and loss of chromosome 1 with loss of the Y chromosome occurred in two. Review of the literature disclosed four other renal oncocytomas with the 44,X,-Y,-1 karyotype. In the chromophobe cell carcinoma, we noted an abnormal clone with a del(11)(p12p15.1); similar anomalies were not observed in the renal oncocytomas. We conclude that renal oncocytomas have clonal chromosome abnormalities and that a subgroup of these tumors may be specifically associated with loss of chromosomes 1 and Y. Because this is a small series, further investigation may help establish whether cytogenetic studies can provide diagnostic and pathogenic information about renal oncocytomas.

Adenoma↗
PubMed2006

A translocation involving the placental growth factor gene is identified in an epithelioid hemangioendothelioma.

Hemangioendothelioma is a relatively rare vascular tumor that is considered a low- to intermediate-grade malignant neoplasm. Cytogenetic reports of hemangioendothelioma are rare. Two reports with translocations involving chromosomes 1 and 3 have been described. Here we report a case of an epithelioid hemangioendothelioma arising in the foot of a 56-year-old female, with a 46,XX,-6,t(10;14)(p13;q24),+r. The regions in 10p13 and 14q24 encompass genes that participate in growth regulation. One of the genes at 14q24 encodes for placental growth factor [PlGF, also called vascular endothelial growth factor (VEGF)-related protein]. Placental growth factor is a member of the VEGF growth factor family. Placenta growth factor binds only to VEGF receptor-1 (FLT-1). It has been suggested that PlGF may modulate VEGF-induced angiogenesis by the formation of PlGF/VEGF heterodimers in cells producing both factors. It has been postulated that PlGF is involved in intra- and intermolecular cross-talk between VEGF receptor-1 (FLT) and receptor-2 (FLK-1/KDR). Since expression of VEGF and its receptor, FLK-1, is seen in several cases of epithelioid hemangioendothelioma and plasma VEGF level is also used to follow-up this tumor, we performed immunohistochemical analysis for PlGF and VEGF in our case. The strong positivity for both PlGF and VEGF observed in our case implies that the t(10;14)(p13;q24) most likely involves PlGF, which may be one of the genes driving oncogenesis in these tumors.

Chromosomes, Human, Pair 10↗
PubMed1997

Non-African Burkitt lymphoma presenting with oral thrush and an orbital mass in a child.

PURPOSE: To report an unusual case of orbital involvement with non-African Burkitt lymphoma in a child. METHODS: A 26-month-old boy developed oral thrush and painless right proptosis with eyelid swelling. Magnetic resonance imaging disclosed a diffuse mass involving the inferior, lateral, and superior right orbit and both maxillary sinuses. Incisional biopsy of the orbital mass was performed. RESULTS: Histopathology disclosed diffuse infiltration of the orbital tissues by a high-grade lymphoid neoplasm that showed positive immunoreactivity for B-cell markers. Immunoglobulin gene rearrangement studies disclosed a characteristic t(8;14) translocation consistent with a small, noncleaved malignant lymphoma of the Burkitt type. CONCLUSION: Non-African Burkitt lymphoma may manifest with orbital involvement.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Pulmonary capillary hemangiomatosis.

Pulmonary capillary hemangiomatosis (PCH) is a rare cause of pulmonary hypertension; only three cases have been reported. Four additional cases are described in this report. All of the patients in this study presented with signs and symptoms of pulmonary hypertension, and in none was a correct morphologic diagnosis made during life. Histologically, the most striking feature was the presence of numerous cytologically benign thin-walled capillary-sized blood vessels proliferating diffusely through alveolar walls and in and around larger vessels and airways. Venous infiltration was associated with intimal fibrosis and secondary veno-occlusive disease (VOD). Because of the presence of hemorrhage, the apparent interstitial widening and inflammation, and the venous changes, the condition in these cases was initially misdiagnosed as interstitial fibrosis or VOD. However, the identification of proliferating and invasive capillaries, which are unique to PCH, led to the correct diagnosis. Although the nature of PCH is unknown, it behaves like a low-grade vascular neoplasm.

Adolescent↗
PubMed1998

Borderline ovarian malignancy: ultrasound and fast dynamic MR findings.

Ovarian tumors of borderline malignancy are low-grade malignant neoplasms, and have a rather good prognosis. They account for approximately 10-20% of all ovarian tumors. Very few reports available in literature that analyses ultrasound and MR findings in establishing the diagnosis. The purpose of this study is to describe eight cases of ovarian tumors of borderline malignancy with dynamic gadolinium-enhanced MR imaging. Comparison is made with CA 125 serum levels and ultrasound findings. Early enhancing endocystic vegetations, local cystic masses in, and (irregular) thickened walls of large multicystic tumors were important findings in borderline malignant tumors. The accuracy to detect a malignant tumor of borderline malignancy with CA 125, ultrasound and MRI in these eight cases was 50, 63 and 75%, respectively. MRI is a valuable imaging modality to characterize adnexal tumors and might play a role in preoperative evaluation of borderline malignancies.

Female↗
PubMed1997

Massive pleural effusion as isolated manifestation of metastatic spread of salivary adenoid cystic carcinoma.

Adenoid cystic carcinoma is a low-grade malignant neoplasm that arises preferentially in the major and/or minor salivary glands. While it has a tendency to spread locally, distant metastases have been described occasionally. This case report describes a patient with a massive pleural effusion as primary manifestation of metastatic adenoid cystic carcinoma. This is a very uncommon, yet treatable, occurrence.

Carcinoma, Adenoid Cystic↗
PubMed1998

Long-term survival following bronchotomy for polypoid bronchial carcinoid tumours.

OBJECTIVE: Typical bronchial carcinoids are very low grade neuroendocrine neoplasm of the tracheobronchial tree and have very good results in surgical treatment. Surgical treatment varies from bronchotomy-excision to major resective procedures. We presented our results of bronchotomy, simple excision and long-term follow-up. METHODS: In Atatürk Centre for Chest Disease and Chest Surgery, 16 patients with bronchial carcinoid tumour underwent bronchotomy-excision over a 23-year-period. In all of the cases tumours were in polypoid type. Except these 16 cases 51 patients with bronchial carcinoids underwent operations in the same period. Presenting symptoms were haemoptysis, cough, recurrent pulmonary infection, dyspnea and chest pain. Rigid bronchoscopies were performed on all of the patients preoperatively for diagnosis of the tumour and to determine the surgical procedure and we performed control bronchoscopies on all of the patients in their follow-up period. RESULTS: Patients were checked for periods ranging from 2 to 23 years both radiologically and bronchoscopically. We did not find any recurrences and death related to surgery and morbidity rate were minimal. CONCLUSION: We think that bronchotomy and simple excision are effective and safe procedures for the treatment of bronchial carcinoid tumours with low morbidity in selected cases like polypoid type lesions and have as good a long-term survival rate as the other surgical treatment methods have.

Adult↗
PubMed2003

Parosteal osteosarcoma of the distal ulna. A rare tumour at a rare location: a case report.

We report a case of a histologically well differentiated, grade I, parosteal osteosarcoma of the distal ulna. The tumour's radiological and histological features are described, and the patient's course after wide en-bloc resection is detailed. Parosteal osteosarcoma is a rare low-grade malignant neoplasm. It belongs to the group of the osteosarcomas originating from the surface of the bone, representing a distinct tumour entity within this group, with defined histological and radiological features. We describe the radiological and histological characteristics of parosteal osteosarcoma and, based upon these features, present its classification. The differential diagnosis, including parosteal osteoma, myositis ossificans and osteochondroma, is also discussed. Finally, therapy and prognosis are outlined in accordance with the current literature. Wide en-bloc resection represents the mainstay of therapy offering an excellent prognosis with a 5-year survival rate of more than 90%. Incomplete resection, on the other hand, increases the risk of recurrence and dedifferentiation of the tumour. Dedifferentiation induces tumour spread and is associated with a poor prognosis equivalent to conventional osteosarcoma.

Bone Neoplasms↗
PubMed1991

Terminal parotid duct carcinoma.

Terminal duct carcinoma of salivary glands is an uncommon, histologically distinctive, low grade malignant neoplasm arising from the intercalated salivary duct. We present a case arising eight years after removal of a parotid tumour reported as a pleomorphic adenoma. We describe the clinico-pathological features of the present tumour, illustrate the difficulties that may be encountered in differentiating it from other salivary gland tumours, and discuss the possible significance of the previous tumour.

Adenoma, Pleomorphic↗
PubMed2000

Matrix metalloproteinase 2 (MMP-2) immunoreactive protein is associated with poor grade and survival in brain neoplasms.

UNLABELLED: Matrix metalloproteinases play an important role in the invasion of tumor cells and the progression of cancer. The 72 kDa type IV collagenase, a matrix metalloproteinase 2 (MMP-2) has been shown to contribute to the invasion and metastasis in diverse malignant neoplasms. OBJECT: To elaborate the potential role of MMP-2 in brain tumor invasion we studied the expression and localization of this enzyme protein in 101 brain tumors representing different types of brain neoplasms. For the first time, we also correlated the expression of MMP-2 protein to patient survival. METHODS: Using immunohistochemistry and a monoclonal antibody specific for MMP-2 we found that MMP-2 protein was primarily localized in tumor cells and vasculature cells as well as inflammatory cells. The expression of MMP-2 was absent or negligible in benign tumors (pilocytic astrocytoma and meningioma). Thirty-three percent (6/18) of astrocytomas, 38% (3/8) of anaplastic astrocytomas, 14% (1/7) of anaplastic oligodendrogliomas, 54% (19/35) of glioblastomas and 100% (6/6) of metastatic brain tumors were positive for MMP-2. A correlation between MMP-2 expression and survival was found in malignant brain tumors. The mean survival of patients with an MMP-2 negative tumor was 36 months, when it was only 7-14 months in patients with an MMP-2 positive tumor. CONCLUSIONS: Our data suggest that MMP-2 is associated with histological malignancy and poor survival in brain tumors.

Adult↗
PubMed2004

Immunohistochemical detection of human herpes virus-8 latent nuclear antigen-1 is useful in the diagnosis of Kaposi sarcoma.

Kaposi sarcoma is a low-grade vascular neoplasm that has been shown by molecular analysis to uniformly express the latent nuclear antigen-1 of human herpes virus 8. Differentiating Kaposi sarcoma from other benign or malignant vascular tumors, as well as other nonvascular spindle cell soft-tissue neoplasms, can be challenging. Thus, detection of human herpes virus 8 in fixed tissues would be diagnostically useful. Recently, a monoclonal antibody to human herpes virus 8 latent nuclear antigen-1 has become commercially available for immunohistochemical analysis. We sought to study the sensitivity and specificity of this antibody in the detection of human herpes virus 8 latent nuclear antigen-1 in Kaposi sarcoma. Fixed, paraffin-embedded tissue sections from 21 cases of Kaposi sarcoma, nine cases of spindle cell hemangioma, five cases of cutaneous angiosarcoma, five cases of dermatofibrosarcoma protuberans, one case of vascular transformation of a lymph node, four cases of pilar leiomyoma, four cases of stasis dermatitis, four cases of pyogenic granuloma, and three cases of spindled melanoma were examined immunohistochemically using the rat monoclonal antibody to human herpes virus 8 latent nuclear antigen-1, open reading frame-73 (Advanced Biotechnologies Inc.). Tissue sections were stained with automated immunostainers (Ventana) using heat-induced epitope retrieval and a standard DAB detection kit (Ventana) modified to detect rat Ab. Strong, diffuse, nuclear staining in >10% of tumor cells was considered a positive result. In all, 21/21 cases of Kaposi sarcoma showed strong, diffuse, nuclear staining for human herpes virus 8 latent nuclear antigen-1 (100%), whereas all cases of spindle cell hemangioma, cutaneous angiosarcoma, dermatofibrosarcoma protuberans, vascular transformation of lymph node, pilar leiomyoma, stasis dermatitis, pyogenic granuloma, and spindled melanoma were negative for this antigen. The monoclonal antibody to human herpes virus 8 latent nuclear antigen-1, open reading frame-73, is a highly sensitive and specific marker of human herpes virus 8 infection in paraffin-embedded tissue sections of Kaposi sarcoma. As such, it is an extremely useful tool for differentiating between Kaposi sarcoma and other vascular and nonvascular spindle cell lesions, which do not express human herpes virus 8 latent nuclear antigen-1.

Antibodies, Monoclonal↗
PubMed1998

De-differentiated chondrosarcoma is not a 'de-differentiated' chondrosarcoma.

AIMS: De-differentiated chondrosarcoma is characterized by the presence of two distinct chondroid and nonchondroid tumour portions. The aim of our study was to investigate the distribution of extracellular matrix components in this tumour entity and thus to shed light on its histogenetic origin. METHODS AND RESULTS: Histochemical and immunohistochemical analyses were performed for collagen subtypes I, II, III and VI and cartilage proteoglycans in three samples of de-differentiated as well as conventional chondrosarcomas (various grades). In the chondroid tumour areas of de-differentiated chondrosarcoma, typical cartilage matrix components could be detected similar to chondroid areas of grade 1 and 2 conventional chondrosarcomas. In contrast, the tumour matrix of the nonchondroid portions of de-differentiated chondrosarcomas contained matrix molecules which are typical for fibroblastic tissue. This matrix composition was not identical with less differentiated (nonchondroid) areas of grades 2 and 3 conventional chondrosarcomas. CONCLUSIONS: Our results confirm the chondroid nature of the differentiated portion of de-differentiated chondrosarcoma and indicate a nonchondrocytic nature of the nonchondroid portion. De-differentiated chondrosarcoma should not be considered as a 'de'-differentiated chondrosarcoma (grade 4 neoplasm), but as a tumour entity showing two types of mesenchymal differentiation.

Adult↗
PubMed1998

Focal endometrial stromal hyperplasia.

AIMS: To describe a patient in whom multiple endometrial biopsies revealed stromal proliferative lesions causing diagnostic difficulty. METHODS AND RESULTS: A 39-year-old woman with a history of menorrhagia and dysmenorrhoea underwent two endometrial biopsies and hysterectomy. In each case histopathology revealed apparently multifocal benign stromal proliferative lesions with no evidence of invasive growth pattern. The lesions were characterized by increased cellularity, nuclear enlargement and spindle cell morphology but no mitotic activity or nuclear pleomorphism were seen. The possibility of low grade stromal neoplasm was considered in the biopsy specimens. The hysterectomy revealed no evidence of malignancy but foci of ovarian endometriosis and cervical stromal endometriosis were present. CONCLUSION: We suggest that the lesions represent focal endometrial stromal hyperplasia, a potential mimic of stromal nodule or stromal sarcoma in biopsy samples.

Adult↗
PubMed1998

Male adnexal tumour of probable Wolffian origin occurring in a seminal vesicle.

AIMS: Adnexal tumours of probable Wolffian origin are rare low-grade malignant neoplasms that have been previously described in the broad ligament, ovaries and retroperitoneum of females. All are characterized by small, bland epithelial cells growing in a diffuse, trabecular, or tubular pattern. The majority of the cases reported have pursued a benign clinical course. However, recurrences and distant metastases have been described. We present a case of a male adnexal tumour of probable Wolffian origin occurring in the left seminal vesicle of a 29-year-old man with 23 years of follow-up. RESULTS: The diagnosis is supported by immunohistochemical and electron microscopic findings: The tumour cells were immunoreactive for cytokeratin and vimentin while smooth muscle antigen and S100 protein were uniformly negative. By electron microscopy cells were arranged in an acinar pattern and surrounded flocculent, electron-dense material. Individual cells contained numerous dense bodies and free ribrosomes. The patient had recurrences at 14 and 23 years after initial diagnosis. CONCLUSION: This is the first report of this entity in a male. The literature on this unusual tumour is reviewed and the clinicopathological, immunohistochemical and ultrastructural features are described. The differential diagnosis of this seemingly indolent tumour is discussed with genitourinary tumours having a more aggressive clinical course.

Adnexal Diseases↗
PubMed2002

Cutaneous natural killer/T-cell lymphoma.

Lymphomas are classified as either Hodgkin's or non-Hodgkin's. The 2 subtypes of non-Hodgkin's lymphoma that can present primarily in the skin are cutaneous T-cell lymphoma and cutaneous B-cell lymphoma, both of which tend to be low-grade malignant neoplasms. Recently another distinct subtype of lymphoma was discovered, the natural killer (NK)/T-cell lymphoma, which can involve the skin in a primary or secondary fashion. The NK/T-cell subtype of lymphoma is characterized by the expression of the NK-cell antigen CD56. These CD56(+) lymphomas are further subdivided into nasal NK/T-cell lymphomas that commonly present as midfacial destructive disease and non-nasal NK/T-cell lymphomas that often arise in extranodal locations, including the skin. We report a case of aggressive NK-cell leukemia/lymphoma with numerous secondary cutaneous lesions and review the clinical and histopathologic spectrum of non-nasal CD56(+) lymphomas, with an emphasis on the dermatologic findings.

Aged↗
PubMed2000

Anatomical segmentectomy of the head of the pancreas along the embryological fusion plane: a feasible procedure?

BACKGROUND: Less extensive resection of the head of the pancreas has been the procedure of choice recently for low-grade malignant neoplasms. The anatomical detail of the head of the pancreas is currently insufficient for segmental resection along the embryological fusion plane. METHODS: The anatomy of the head of the pancreas was analyzed in 31 consecutive autopsy specimens. An anterior (n = 10) or posterior (n = 10) segmentectomy of the head of each pancreas was performed along the macroscopically found fusion plane. The pancreatic arteries, the portal vein, the bile duct, and the pancreatic duct were visualized by injecting 3 silicon dyes of different colors. Another 11 specimens were examined by pancreatography before and after anterior (n = 5) or posterior (n = 6) segmentectomy. Eight of these 11 specimens were stained immunohistochemically to reveal the distribution of pancreatic polypeptide cells after segmentectomy. RESULTS: The cleavage between the anterior and posterior segments was discovered at the anterior inferior edge or at the posterior superior edge of the head of the pancreas. Anterior segmentectomy was accomplished while preserving the anterior and posterior pancreaticoduodenal arcades and the lower bile duct in the posterior segment. Posterior segmentectomy involved the removal of the lower bile duct and the posterior pancreaticoduodenal arcades. Pancreatography after segmentectomy showed the division of the ducts of Wirsung and Santorini with the peripheral branches. The immunohistochemical boundary of pancreatic polypeptide cells coincided with the surgical plane. These results showed the anterior and posterior segments were originated from the embryologically dorsal and ventral primordia, respectively. CONCLUSIONS: The current anterior or posterior segmentectomy of the head of the pancreas corresponded to the resection of the embryologically dorsal or ventral primordium, respectively. Anterior segmentectomy of the head of the pancreas might be a clinically applicable procedure; however, posterior segmentectomy involving the resection of the lower bile duct may be impractical.

Adult↗