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Trichilemmal carcinoma: review of 8 cases.

Clinical and histological data from 8 trichilemmal carcinomas are reviewed. The tumors occurred mainly on sun-exposed skin of the face of elderly people as small solitary, frequently ulcerated nodules. Histologically, they consisted of multilobulate, infiltrative growths, connected to the epidermis and pilosebaceous structures and showing features reminiscent of the outer root sheath of the hair follicle. The presence of lobules of clear, glycogen-rich cells with peripheral palisading, hyaline basement membranes, trichilemmal keratinization, and abortive follicular sheaths and the absence of ductal or acinar differentiation allow distinction from other clear cell tumors of the skin. Although the histological picture suggests a high-grade malignant neoplasm, trichilemmal carcinoma has an indolent course. No recurrence or metastases have been observed.

Aged↗

Hyalinizing clear cell carcinoma: report of a case.

Hyalinizing clear cell carcinoma (HCCC) is a recently described low-grade malignant neoplasm of minor salivary glands. Of the thirteen reported patients with this neoplasm, the majority have occurred in the oral cavity of elderly women. We report another case and add further supporting evidence that hyalinizing clear cell carcinoma is a distinct pathological entity.

Adenocarcinoma, Clear Cell↗

Undifferentiated carcinoma of parotid gland.

Two cases of undifferentiated carcinomas of the major salivary glands were studied using immunohistochemical techniques. Results showed that this entity was a high grade malignant neoplasm arising from the excretory duct. Despite the undifferentiated appearance multiple immunophenotypes were evident in both cases.

Carcinoma↗

Combined high grade sarcoma and serous ovarian neoplasm.

A case of an ovarian serous epithelial neoplasm of borderline type admixed with sarcomatous elements is reported. This combination seems to be extremely rare with only four cases previously reported. It may represent a type of collision tumour or the development of a sarcoma in a growth with borderline differentiation.

Adenofibroma↗

Brain tumor volume measurement: comparison of manual and semiautomated methods.

PURPOSE: To compare the reliability of two approaches to measuring enhancing brain tumor volumes--the conventional manual trace method and a threshold-based, semiautomated computer software method. MATERIALS AND METHODS: Two operators rated contrast material-enhanced, T1-weighted axial magnetic resonance (MR) image data sets from 16 patients aged 21-71 years with high-grade gliomas. Each MR data set was rated twice by using manual tracing and twice by using the semiautomated method. The semiautomated measurement method involved a thresholding algorithm based on mixture modeling. The data collection time for each method was recorded. Reliability was measured by using inter- and intraoperator agreement indexes. RESULTS: Mean intraoperator agreement indexes (+/- SD) were 0.90 +/- 0.09 (operator 1) and 0.83 +/- 0.15 (operator 2) for the manual trace method and 0.83 +/- 0.17 (operator 1) and 0.84 +/- 0.16 (operator 2) for the semiautomated measurement method. The mean interoperator agreement was 0.85 +/- 0.14 for the manual method and 0.82 +/- 0.18 for the semiautomated method. The semiautomated method was faster than the manual trace method by an average of 4.6 minutes per patient. CONCLUSION: The semiautomated computer method of measuring tumor volume was faster than the manual trace method. Semiautomated computer approaches offer an alternative to manual tracing for measuring serial tumor volumes in patients with high-grade brain neoplasms.

Adult↗

Dependence of DNA-histograms on the sampling techniques in fine needle aspirates of the breast.

48 fine needle aspiration biopsy (FNAB) samples from 25 breast cancer cases, originally used for cytodiagnosis were subjected to DNA cytometry. There were air dried smears stained with the MGG method, and samples stained with HE or PAP stain after 50% ethanol fixation and cytocentrifugation. Different sampling strategies were applied. Four methods were tested: method 1: cell groups measured, method 2: all cells measured, method 3: free cells measured, and method 4: atypical free cells measured. Method 4 showed most often DNA aneuploid histogram patterns, sampling method 1 had the highest number of DNA diploid histogram patterns. Diagnostic approaches may benefit from a sampling method detecting the hiding aneuploid cell population. Grading of neoplasm could potentially benefit from other approaches.

Aneuploidy↗

Optical biopsy using tissue spectroscopy and optical coherence tomography.

'Optical biopsy' or 'optical diagnostics' is a technique whereby light energy is used to obtain information about the structure and function of tissues without disrupting them. In fluorescence spectroscopy, light energy (usually provided by a laser) is used to excite tissues and the resulting fluorescence provides information about the target tissue. Its major gastrointestinal application has been in the evaluation of colonic polyps, in which it can reliably distinguish malignant from benign lesions. Optical coherence tomography (OCT) has been used in the investigation of Barrett's epithelium (and dysplasia), although a variety of other applications are feasible. For example, OCT could assist in the identification and staging of mucosal and submucosal neoplasms, the grading of inflammation in the stomach and intestine, the diagnosis of biliary tumours and the assessment of villous architecture. OCT differs from endoscopic ultrasound, a complementary modality, in that it has a much higher resolution but lesser depth of penetration. The images correlate with the histopathological appearance of tissues, and the addition of Doppler methods may enable it to evaluate the vascularity of tumours and the amount of blood flow in varices. Refinements in these new optical techniques will likely make them valuable in clinical practice, although their specific roles have yet to be determined.

Animals↗

Pten loss causes hypertrophy and increased proliferation of astrocytes in vivo.

Somatic mutations of PTEN are found in many types of cancers including glioblastoma, the most malignant astrocytic tumor. PTEN mutation occurs in 25 to 40% of glioblastomas but is rarely observed in low-grade glial neoplasms. To determine the role of Pten in astrocytes and glial tumor formation, we inactivated Pten by a Cre-loxP approach with a GFAP-cre transgenic mouse that induced Cre-mediated recombination in astrocytes. Pten conditional knockout mice showed a striking progressive enlargement of the entire brain. Increased nuclear and soma size was observed in both astrocytes and neurons, which contributed in part to the increase in brain size. Pten-deficient astrocytes showed accelerated proliferation in vitro and aberrant ongoing proliferation in adult brains in vivo. In contrast, neurons lacking Pten did not show alterations in proliferation. This study shows cell-type dependent effects of Pten loss in the adult brain, including increased astrocyte proliferation that may render astroglial cells susceptible to neoplastic transformation or malignant progression.

Animals↗

Partial pancreatic head resection for intraductal papillary mucinous carcinoma originating in a branch of the duct of santorini.

We report partial pancreatic head resection of intraductal papillary mucinous carcinoma originating in a branch of the duct of Santorini. The tumor was located in the ventral part of pancreatic head at a distance from the Wirsung duct. Magnetic resonance cholangiopancreatography accurately showed the communication between the duct of Santorini and the cystic tumor, and was useful for determining the part of the pancreas to be resected. Both the duct of Wirsung and the duct of Santorini were preserved. Partial pancreatic head resection would play an important role in surgical management of low-grade malignant neoplasm.

Adenocarcinoma, Mucinous↗

Brain mapping for hemispheric tumors in children.

Hemispheric tumors are common in children. Pathologically, they range from indolent low grade astrocytic tumors to high grade malignant neoplasms. In general, the extent of resection correlates favorably with survival. Advances in technology are permitting surgical resection to be extended to near eloquent and eloquent regions of the brain. These techniques include advanced neuronavigation, brain mapping, and intra-operative MRI scanners. Incorporation of functional information in surgical planning should lead to safer surgical procedures with improvements in patient outcome.

Brain Mapping↗

Magnetic resonance imaging in the assessment and surgical management of epilepsy and functional neurological disorders.

Magnetic resonance imaging (MRI) offers significant advantages over computerized tomography (CT) and teleradiographic techniques when used for the evaluation and management of epilepsy and functional neurological disorders. Depth recording and radiofrequency electrodes can be more accurately positioned within structures such as the amygdala and hippocampus. The extent of corpus callosum section, lobectomy, topectomy, and radiofrequency stereotactic lesions can now be readily confirmed and related with seizure, neurological, and behavioral outcome. Occult, usually low grade, intraparenchymal neoplasms not visualized on CT scans can be located by MRI and biopsied or excised by MRI stereotactic techniques.

Corpus Callosum↗

Management of intracranial neoplasms in children with neurofibromatosis type 1 and 2. The Children's Cancer Study Group.

The association of central nervous system neoplasms in neurofibromatosis is common and children are at particular risk. Recent advances in neurodiagnostic techniques allow for non-invasive detection of these tumors, and often these tumors are found in asymptomatic patients. Due to the diversity of neoplasms, varying grades of malignancy, variable growth patterns, and the occupancy of non-neoplastic hamartomatous lesions, the clinician often has difficulty determining which patient should have a diagnostic biopsy or resection, or if therapy should be started without pathologic confirmation. Following a review of the neuroradiology and more common intracranial tumors, recommendations regarding management are proposed.

Brain↗

Prophylaxis of superficial bladder cancer with a modified intravesical epirubicin treatment schedule.

A controlled prospective trial on 99 eligible patients evaluated the efficacy of intravesical epirubicin administration as prophylaxis against tumor recurrences after complete endoscopic resection of superficial bladder cancer. The treatment schedule consisting of an initial 6- or 8-week course of instillations, followed by single maintenance doses (to the responders) at follow-up examinations, was modified in those of the initial responders who were at high risk for recurrence and who received an additional separate 4-week course of therapy. Sixty percent of the epirubicin-treated patients and 41% of the controls (who underwent resection alone) remained free of recurrences for a mean follow-up of 32.1 months, but the difference was not significant. However, in terms of relative risk for recurrences (recurrence rate per 100 patient-months and disease-free interval), comparisons between the two groups of patients revealed a significant benefit of epirubicin, overall as well as for those with a history of previous tumor recurrences, multifocal disease, and stage Ta and grade 2 neoplasms. Drug-induced toxicity was acceptable.

Administration, Intravesical↗

Limitations of ureteroscopy in diagnosis of invasive upper tract urothelial cancer.

The efficacy of ureteroscopic evaluation of upper tract abnormalities was evaluated in 40 patients. Twenty-eight patients presented with a radiologic filling defect, 9 with a filling defect and hematuria and 3 individuals exhibited hematuria alone. Cold cup biopsies revealed transitional cell carcinoma in 7 of 9 patients with papillary tumors and in 2 of 3 with nonpapillary tumors. Four patients without ureteroscopic diagnosis of urothelial cancer were found to have invasive tumors on subsequent nephroureterectomy. Of 15 patients with upper tract urothelial cancer, 12 were treated with total nephroureterectomy. Three individuals with grade 1 neoplasms received conservative ureteroscopic ablative therapy. Ureteroscopy is effective when combined with biopsy in the diagnosis and treatment of papillary lesions, but exhibits a low sensitivity in patients with invasive lesions.

Adult↗

Fine needle aspiration biopsy of precursor B-cell lymphoblastic lymphoma presenting as a sacral mass. A case report.

BACKGROUND: Lymphoblastic lymphoma (LBL) is a high grade, aggressive neoplasm, usually presenting in children and young adults. Precursor B-cell LBL is uncommon and may present with cutaneous or, less likely, bone lesions. This case represents the first reported presentation of LBL as a sacral lesion and was only the second fine needle aspiration biopsy (FNAB) of LBL presenting as a bony mass. CASE: A 50-year-old man presented with a 3-month history of a 7 x 5 x 4-cm mass in the sacral region. The mass was radiologically described as an expansile one with lytic bone destruction. Diagnosis of a chordoma was radiologically favored. Computed tomography (CT)-guided FNAB, with flow cytometry and cytochemical staining, was used to make the diagnosis of precursor B-cell LBL. CONCLUSION: FNAB was instrumental in reaching this unusual diagnosis in a patient who was free of disease after chemotherapy.

Antigens, CD↗

Fine needle aspiration of basal cell adenocarcinoma of the parotid gland. Report of a case with assessment of DNA ploidy in aspirates and tissue sections by image analysis.

BACKGROUND: Basal cell adenocarcinoma of the parotid gland is a low grade malignant neoplasm. It has cytologic features of basal cell adenoma and a histologically infiltrative growth pattern of malignant tumors with perineural and vascular invasion. CASE: Fine needle aspiration biopsy findings of basal cell adenocarcinoma of the parotid gland in a 77-year-old male were supplemented by DNA ploidy analysis. CONCLUSION: No single cytologic feature was found to unequivocally distinguish this lesion from basal cell adenoma and/or solid variant of adenoid cystic carcinoma. Therefore, for diagnostic purposes, we grouped all three lesions under the term basal cell tumor. Evaluation of DNA content of tumor cells revealed diploid histograms in both cytologic material and paraffin-embedded tissue. Infiltrative tumor nests, the histologic basis for differentiating basal cell adenocarcinoma from adenoma, showed the same diploid pattern. Though DNA quantitation may not discriminate basal cell adenoma from basal cell adenocarcinoma, it may prove useful in separating them from adenoid cystic carcinoma, which is considered to be a tumor with high malignant potential.

Adenocarcinoma↗

Gliomatosis cerebri: a brain tumour which is too difficult to treat?

Gliomatosis cerebri is a rare form of primary diffuse brain tumour first described by Nevin in 1938. It was originally considered to be a post-mortem diagnosis before Troost et al reported a clinically diagnosed case in 1987. However antemortem diagnosis remains difficult due to vague clinical symptoms and often non-specific findings on CT scanning. Gliomatosis cerebri has been classified by the World Health Organization as an infiltrative tumoural process, which involves at least two, and usually three, lobes of the brain. Magnetic resonance (MR) imaging shows a diffuse infiltrative process with possible mass effect but no necrosis. Histology is usually of a low grade astrocytic neoplasm which seemingly infiltrates out of proportion to the degree of anaplasia. We report two patients who presented over the past year, whose clinical and radiological features prompted a preoperative diagnosis of gliomatosis cerebri, confirmed by biopsy.

Adult↗

Comparison of computed tomography and angiography in the evaluation of soft tissue tumors of the extremities.

CT and angiography were performed in 21 patients with soft tissue tumors of the extremities (18 malignant and 3 benign) and the results were compared with the surgical and histopathologic findings. The tumor size was correctly evaluated at CT in 15 of 21 cases and at angiography in 17 of 21 cases. The main reason for overestimation of longitudinal tumor extent seems to be edema surrounding the poles of high grade malignant neoplasms. CT was superior to angiography in demonstrating the intra- or extramuscular tumor location. If only factors important for the surgical planning are considered, angiography yielded such information in 8 cases while CT was of critical value in the preoperative evaluation of 14 patients. It is concluded that CT should precede angiography in the examination of soft tissue tumors of the extremities. Angiography may be superior to CT in demonstrating vascular anatomy in relation to tumors of the medial thigh. With other tumor locations, angiography should be reserved for those lesions where vascular relationships are not adequately demonstrated at CT.

Adult↗