[DNA determinations in breast cancers: cytophotometric proliferation behavior and cyto/histologic malignancy grade].
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Breast↗
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Cancer of the urogenital tract: bladder cancer. Group 1, Stages 0, A, and B, grades I and II: superficial, low-grade carcinomas.
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Humans↗
[Papillary transitional cell carcinoma of the bladder after 1 year use of a double-J ureteral catheter].
A 37-year old man with a five-year history of nephrolithiasis was catheterized with a double-J ureteral stent (Angiomed) in the left ureter before extra corporeal shock wave lithotripsy. After eight lithotripsy treatments over the course of one year, the double-J stent was removed. Papillary tumor was discovered around the left ureter ostium. Histology showed papillary transitional cell carcinoma grade 2 without invasive growth. No neoplasm has previously been observed after using double pigtail stents for longtime-stenting. One should keep this case in mind, when controlling ureteral stents that are left in place for longer periods.
Adult↗
Low-grade astrocytomas: treatment results and prognostic variables.
Low-grade astrocytomas in adults are uncommon malignant neoplasms of the central nervous system which are fatal in the great majority of patients despite a lack of aggressive histologic features. Several series of such patients have been previously reported, but prognostic factors have not been fully identified. Between 1960 and 1986, 50 patients with low-grade astrocytomas have been treated with megavoltage radiation at the Naval Hospital, Bethesda, MD, following surgical biopsy or excision. Overall actuarial survival at 10 years for the entire treated group was 32%, similar to other series. The most significant prognostic factor was patient age, with decreasing survival for each age decade and a highly significant difference in survival between patients less than age 40 compared to older patients (p = .0017). The era of treatment (before or after 1978) was also an important prognostic indicator (p = .057), largely due to an effect of dose, although better tumor localization in the CT era may also have played a role. There was a trend toward increasing survival with increasing dose of radiation, although not reaching statistical significance at the p = .05 level on multivariate analysis. Patient sex, extent of surgical resection, use of whole brain irradiation, and tumor grade did not significantly affect survival. In comparison, in a separate group of 10 patients who received surgery without radiation during the same period, all patients who were completely resected were long-term survivors, whereas none of those with incomplete resections survived longer than 6 years.
Adolescent↗
Cytologic diagnosis of adenoid cystic carcinoma of salivary glands.
The cytomorphologic features in fine-needle aspiration (FNA) biopsies from 31 primary and 33 recurrent adenoid cystic carcinomas (ACC) were investigated. The correct FNA diagnosis was established in 24 of 31 primary ACC (77%). The diagnostic clue in aspirates from ACC are large globules of extracellular matrix, partially surrounded by basaloid tumor cells. In FNAs with predominance of basaloid tumor cells, but lacking characteristic globules, all other benign and malignant salivary gland tumors of epithelial-myoepithelial differentiation should be considered in the cytologic diagnosis. Pleomorphic adenoma is most frequently confused with ACC, and therefore, the cytologic findings in FNAs from 50 pleomorphic adenomas were compared with those diagnosed as ACC. Furthermore, rare neoplasms of salivary glands with epithelial-myoepithelial cell differentiation, including basal-cell adenoma and carcinoma, epithelial-myoepithelial carcinoma, and polymorphous low-grade adenocarcinoma, as well as some nonsalivary gland neoplasms presenting an adenoid cystic pattern, must be considered. The cytologic features of these entities are discussed in detail with respect to the cytologic diagnostic criteria of ACC.
Adenoma, Pleomorphic↗
CD10 is a sensitive and diagnostically useful immunohistochemical marker of normal endometrial stroma and of endometrial stromal neoplasms.
AIMS: The CD10 antigen is expressed in acute lymphoblastic leukaemia and follicle centre cell lymphoma. A recent study investigating the expression of CD10 in a wide range of non-haematopoietic neoplasms found positive staining in a small number of endometrial stromal sarcomas as well as in normal endometrial stroma. The present study aimed to ascertain whether CD10 positivity is indeed found in normal endometrial stroma and endometrial stromal neoplasms. Staining of a range of tumours which can be confused morphologically with endometrial stromal neoplasms was also undertaken to ascertain whether antibodies against CD10 are of value in a diagnostic sense. METHODS AND RESULTS: Neoplasms included in the study were endometrial stromal nodule (n=1), low-grade endometrial stromal sarcoma (ESS) (n=13), high-grade ESS (n=6), mixed endometrial stromal-smooth muscle tumour (n=1), uterine cellular leiomyoma (n=10), uterine leiomyosarcoma (n=5), adult granulosa cell tumour (AGCT) (n=10), undifferentiated endometrial carcinoma (n=6), uterine carcinosarcoma with an endometrial stromal component (n=1) and type II uterine mesenchymal tumour with sex cord-like elements (n=1). Cases of proliferative (n=5), secretory (n=5) and atrophic (n=3) endometrium were also stained. There was positive staining of stroma but not of glands in all cases of non-tumorous endometrium. There was positive staining of the endometrial stromal nodule and of all low-grade ESS. Staining in these varied but was often diffuse and of moderate to strong intensity. There was positive staining of four of six high-grade ESS, but this was usually focal. There was also positive staining of the endometrial stromal component in the mixed endometrial stromal-smooth muscle tumour and in the uterine carcinosarcoma. Most cellular leiomyomas were completely negative although three exhibited weak positivity. There was some positivity, usually focal or weak, of three of five leiomyosarcomas. Most AGCT and undifferentiated carcinomas were completely negative although one case of each exhibited focal staining. There was focal staining of the type II uterine mesenchymal tumour with sex cord-like elements. CONCLUSION: CD10 is a reliable and sensitive immunohistochemical marker of normal endometrial stroma. Positivity, which is often strong and/or diffuse is found in endometrial stromal nodules and low-grade ESS. Positive staining with CD10, when strong and diffuse, may be useful in distinguishing these tumours from histological mimics, especially cellular leiomyoma and AGCT which are generally negative. In this situation, CD10 should be used as part of a panel which might include desmin and alpha-inhibin depending on the differential diagnosis considered. Positive staining with CD10 in a high-grade uterine sarcoma which is negative with muscle markers might indicate endometrial stromal differentiation and identify a group of neoplasms which it is correct to diagnose as high-grade ESS rather than undifferentiated uterine sarcoma.
Endometrial Neoplasms↗
Lymphoma of the breast.
Three cases of malignant lymphoma of the breast are described, seen over a 14 year period in the district of Kuopio University Central Hospital. The neoplasms were either of high or intermediate grade of malignancy: one immunoblastic, one Burkitt-type, and one centroblastic-centrocytic malignant lymphoma. The patient with centroblastic-centrocytic malignant lymphoma had advanced disease with pulmonary and adenoidal involvement and died 15 months after the detection of the breast tumor. The two other neoplasms were confined to the breast with no evidence of further dissemination. The patient with immunoblastic malignant lymphoma developed intestinal lymphoma 3 years later which was treated with surgery and cytostatic therapy. The patient has since been in remission for a period of 10.5 years. The patient with Burkitt-type malignant lymphoma was subjected to surgical resection which was followed by cytostatic treatment. The patient has remained in good health during the 20-month follow-up. The correct diagnosis is especially important in breast lymphoma because without it the appropriate treatment cannot be applied.
Adult↗
Histologic grading of noninvasive papillary urothelial tumors: validation of the 1998 WHO/ISUP system by immunophenotyping and follow-up.
Cytokeratin (CK) 20, Ki-67, and p53 were applied to 84 noninvasive papillary urothelial tumors graded by the 1973 World Health Organization (WHO) and 1998 WHO/International Society of Urological Pathology (ISUP) systems. In the WHO/ISUP classification, all benign lesions showed normal CK20 staining and all carcinomas showed abnormal staining. The Ki-67 index was significantly different between benign and malignant lesions (P < .05) and between low- and high-grade carcinomas (P < .001). p53 was negative in all benign lesions, with a significant difference between low- and high-grade carcinomas (P < .001). Tumor recurrence was significantly different between low- and high-grade carcinomas (no recurrences among the papillary urothelial neoplasms of low malignant potential). By the 1973 WHO classification, normal CK20 staining was present both in benign lesions and in carcinomas. Ki-67 staining did not distinguish between grade 2 and grade 3 carcinomas (P > .05), and there was no difference in p53 staining in grades 1 and 2 carcinomas (P > .05). Recurrences were not different between grades 1, 2, and 3 carcinomas. All biologic markers studied and tumor recurrences were significantly different among papillary lesions classified by the WHO/ISUP system but not by the 1973 WHO system, validating the predictive value of the WHO/ISUP system and providing objective markers for the grading of papillary urothelial tumors.
Biomarkers, Tumor↗
Immunohistochemistry as a diagnostic aid in the evaluation of ovarian tumors.
Aspects of immunohistochemistry (IHC), which are useful in the diagnosis of ovarian tumors (mostly neoplasms but also a few tumor-like lesions), are discussed. The topic is first approached by considering the different growth patterns and cell types that may be encountered. Then a few other specific situations in which IHC may assist are reviewed. Selected findings largely, or only, of academic interest are also mentioned. One of the most common situations in which IHC may aid is in the evaluation of tumors with follicles or other patterns which bring a sex cord-stromal tumor into the differential. The distinction between a sex cord tumor and an endometrioid carcinoma with sex-cord-like patterns may be greatly aided by the triad of epithelial membrane antigen (EMA), inhibin, and calretinin, the latter two being typically positive and EMA negative in sex cord tumors, the converse being typical of endometrioid carcinoma. It should be emphasized that granulosa cell tumors may be inhibin negative and, albeit less specific, calretinin is more reliable in evaluating this particular issue. Lack of staining for inhibin and calretinin may also be supportive in leading to consideration of diverse other neoplasms that may form follicles, including metastatic tumors as varied as carcinoid and melanoma. The well-known staining of the latter neoplasm for S-100 protein and HMB-45 may be very helpful in evaluating melanomas with follicular or other unusual patterns, a challenging aspect of ovarian tumor interpretation. The most common monodermal teratoma, struma ovarii, usually has an overt follicular pattern and is easily recognized, but recognition of unusual appearances ranging from oxyphilic to clear cell to various patterns of malignant struma may be greatly aided by a thyroglobulin or TTF 1 stain. IHC for neuroendocrine markers may assist in the diagnosis of primary and metastatic carcinoid tumor. The broad differential diagnosis of glandular neoplasms with an endometrioid-pseudoendometrioid morphology, or mucinous cell type, has been the subject of much exploration in recent years, particularly the distinction between primary and metastatic neoplasms. The well-known CK7 positive, CK20 negative phenotype of primary endometrioid carcinoma, and the converse profile in most metastatic large intestinal adenocarcinomas with a pseudoendometrioid morphology, has been much publicized but albeit an appropriate supportive adjunct in many cases, exceptions from the typical staining pattern may be encountered. It is even less helpful in the case of primary versus metastatic mucinous neoplasia. Evaluation of the expression of mucin gene products has shown mixed, essentially unreliable, results. Experience with other new markers, such as CDX-2, villin, beta catenin, and P504S (racemase), is limited but is in aggregate promising with regard to providing some aid in this area. The rare differential of metastatic cervical adenocarcinoma versus primary ovarian mucinous or endometrioid carcinoma may be aided by strong p16 staining of the former. Staining for alpha-fetoprotein may aid in confirming the diagnosis of endometrioid-like (and hepatoid) variants of yolk sac tumor. Ependymoma of the ovary may also have an endometrioid-like glandular pattern, but positive stains for glial fibrillary acidic protein contrast with the negative results in others neoplasms with a similar pattern. Immunostains may be very helpful in the evaluation of oxyphilic tumors and tumor-like lesions and in some unusual forms of clear cell neoplasia, such as clear cell struma, both subjects being reviewed herein. Immunostains may highlight both the presence and extent of epithelial cells in a variety of circumstances, including microinvasive foci in cases of serous borderline tumors and mucinous carcinomas, and in determining the extent of carcinoma cells and reactive cells within mural nodules of mucinous neoplasms. As in tumor pathology in general, various markers may be crucial in the diagnosis of small round cell tumors of the ovary, and familiar markers of epithelial, lymphoid, leukemic, and melanocytic neoplasms may assist in the analysis of high grade tumors with a poorly differentiated carcinoma, lymphoma-granulocytic sarcoma, malignant melanoma differential. The evaluation of ovarian cystic lesions may be aided by thyroglobulin or TTF 1 (cystic struma), glial fibrillary acid protein (ependymal cysts), and inhibin-calretinin (follicle cysts and unilocular granulosa cell tumors). Stains for trophoblast markers may occasionally aid in the evaluation of germ cell tumors, although routine stains should usually suffice; they may be of academic interest in confirming trophoblastic differentiation in some high grade surface epithelial carcinomas.
Biomarkers, Tumor↗
Fluorescent in situ hybridization on isolated tumor cell nuclei: a sensitive method for 1p and 19q deletion analysis in paraffin-embedded oligodendroglial tumor specimens.
In oligodendroglial neoplasms, losses of chromosomal material at 1p and 19q associate with chemosensitivity and prolonged survival. Thus, 1p/19q testing is increasingly proposed for use in brain tumor diagnosis and prognostic assessment. Fluorescent in situ hybridization (FISH) is a classic technique for investigation of 1p/19q status in paraffin-embedded tissues. A major limitation of this method is truncation of tumor cell nuclei complicating assessment of hybridization results. In our study, we analyzed 1p and 19q status in a series of 79 oligodendroglial neoplasms (49 oligodendrogliomas, 30 oligoastrocytomas, WHO: 57 Grade II, 22 Grade III tumors) and controls (gliotic brain tissue: n = 4, diffuse low-grade astrocytoma: n = 4) using FISH on isolated whole tumor cell nuclei, prepared as cytospin preparations, thus bypassing the problem of nuclear truncation. For interpretation of FISH results, we used consensus criteria as defined by the SIOP-Europe Neuroblastoma Study Group for analysis of peripheral neuroblastic tumors. FISH yielded interpretable results in 98.7% for 1p and 92.1% for 19q. Chromosome 1p/19q alterations comprised deletions (1p: 79.5%, 19q: 80%) and imbalances (1p: 11.5%, 19q: 12.9%). 1p aberrations were more frequent in oligodendroglioma than in oligoastrocytoma (100% versus 75.9%, P =.001). The frequency of 1p/19q alterations was not significantly different in WHO Grade II or Grade III tumors or in primary and recurrent tumors. We conclude that FISH on isolated cell nuclei, with application of the SIOP Europe Neuroblastoma consensus criteria, is a sensitive method for detection and interpretation of 1p and 19q aberrations in paraffin-embedded tissue specimens of oligodendroglial neoplasms.
Brain Neoplasms↗
Benign and malignant spindle cell lesions of the breast.
Spindle cell lesions of the breast constitute a wide spectrum of benign and malignant proliferations. Myofibroblasts, normal cellular constituents of the mammary intra- and interlobular stroma, compose many of these lesions, which include reactive proliferations and benign or locally aggressive neoplasms. Because of its morphology, low-grade metaplastic spindle cell carcinoma, "fibromatosis-like" is also considered together with spindle cell lesions of the breast. Although certain of the lesions do not occur commonly, they represent diagnostic challenges. This review outlines the morphology of certain spindle cell lesions of the breast including pseudoangiomatous stromal hyperplasia, reactive spindle cell nodule, nodular fasciitis, myofibroblastoma, primary mammary fibromatosis, and low-grade metaplastic spindle cell carcinoma, "fibromatosis-like." The differential diagnosis and diagnostic work-up of these lesions is discussed, and their clinical treatment and prognosis briefly summarized.
Breast Neoplasms↗
Leiomyosarcoma of the left atrium: case report and review of the literature.
Leiomyosarcomas are extremely rare primary cardiac tumours. A 46-year-old woman presenting with symptoms and signs of rapidly progressive left ventricular failure and apparent systemic lupus erythematosus was subsequently found to have a grade III/III left atrial leiomyosarcoma which was confirmed surgically. Pathology showed a cellular neoplasm arranged in fascicles with multinucleated giant cells, with areas of high grade sarcomatous change. The patient died seven months postoperatively with intractable heart failure. At autopsy, tumour infiltrated the pericardium, both atria and the right ventricle, with invasion of the diaphragm and posterior mediastinum. The current world literature is reviewed with respect to this rare and often misdiagnosed tumour.
Female↗
[Correlation of the x-ray morphology with the histopathological staging and grading of colorectal cancer].
In a retrospective study stage grouping as well as histopathological grading (G category) of colorectal carcinomas was compared to radiographic findings at double contrast barium enema. A good correlation of tumour stage according to Dukes and the pT category and histopathological grading could be established to radiographic morphology. Apple core lesions and eccentrically obstructing neoplasms as well as saddle-like tumours exhibited worse staging and grading categories in comparison to polypoid lesions; plaque-like tumours are probably in between. It can therefore be assumed that the radiographic appearance of colorectal carcinomas may be a valuable tool to indicate stage group and G-category and thus offer information about patient prognosis.
Adult↗
Lymphoid neoplasms associated with concurrent t(14;18) and 8q24/c-MYC translocation generally have a poor prognosis.
We identified 14 B-cell neoplasms with concurrent t(14;18) and chromosome 8q24 or c-MYC translocations shown by conventional cytogenetics or fluorescence in situ hybridization analysis. All cases assessed by conventional cytogenetics had a complex karyotype. There were 10 men and four women, with a median age of 55 years (range, 29-72). None of these patients had a history of follicular lymphoma. The biopsy specimens were obtained from bone marrow, lymph node, and extranodal sites. Morphologically, nine neoplasms had features of Burkitt or atypical Burkitt lymphoma/leukemia and three were diffuse large B-cell lymphoma with high-grade cytologic features. The remaining two cases were plasmablastic myeloma and low-grade B-cell lymphoma, respectively. All cases expressed BCL-2. The proliferation index assessed by using Ki-67 (MIB1) was 5% in the low-grade B-cell lymphoma, 80% in the plasmablastic myeloma, 90-95% in three cases of diffuse large B-cell lymphoma, and ranged from 90 to >99% in most Burkitt and atypical Burkitt neoplasms. The patient with low-grade B-cell lymphoma was treated with rituximab. All other patients received intensive combination chemotherapy. Two of these patients underwent bone marrow transplantation, and one patient received radiation therapy in addition to transplantation. The median follow-up period was 9 months (range, 3-81). In all, 10 patients died with a median survival of 9 months (range, 3-81). We conclude that most B-cell lymphomas with concurrent t(14;18) and 8q24/c-MYC translocations fall within the morphologic spectrum of diffuse large B-cell and Burkitt lymphoma. These neoplasms are high-grade and are associated with a poor prognosis. However, this combination of molecular abnormalities can also rarely occur in other neoplasms, such as the cases of low-grade B-cell lymphoma and plasmablastic myeloma in this study.
Adult↗
[DNA index and bronchopulmonary neoplasms].
The authors take into consideration 40 cases of lung neoplasms in order to see the relationship between DNA index examined by image analysis, and histological grading we deduced from the results that DNA index agrees with the grading and better points out the biological pattern of the neoplasm, beharing differently in each histological type.
DNA, Neoplasm↗
Ewing's sarcoma of bone and soft tissues.
Ewing's sarcoma is a distinctive clinical and pathologic entity that may be intraosseous or of soft-tissue origin. In the facial bones, the incidence of the sarcoma is estimated at 2.5% of all Ewing's sarcoma of bone. The soft tissue of the head and neck account for 11% of extraskeletal sites of the neoplasm. Combined modality treatment has modified its high-grade malignancy.
Bone and Bones↗
Metastatic tumors to the testicles.
Metastatic tumors to the testicles are rare. The most common primary sites are the prostate, the lung, the kidney, the gastrointestinal tract and the skin (melanomas). The majority of these tumors are diagnosed at autopsy or at orchiectomy for metastatic prostatic carcinoma. Their clinical manifestations can antedate the clinical discovery of the primary tumor and the correct pathologic diagnosis of the testicular tissue may result in the identification of an "occult" carcinoma. Although they commonly occur in old patients with a peak incidence in the fifth and sixth decade, they may also involve younger patients and should be differentiated from primary testicular tumors. The most common routes of metastasis to the testes are the lymphatics, the vas deferens, the spermatic veins and the hematogeneous (arterial) pathways. Their diagnosis, although suspected by the patient's age and clinical symptoms should be confirmed histologically. Their treatment which includes a high inguinal orchiectomy is directed to the primary neoplasm. The prognosis depends on the site, type, grade and extent of the original tumors.
Adult↗
[Oral cavity and oropharynx malignant neoplasms in the material of the 2nd ENT Department of Silesian Medical Academy Zabrze].
UNLABELLED: Malignant neoplasms of the oral cavity and oropharynx in Poland make about 4% of all the malignant tumors in men and 1% in women. 90% of the histologic diagnoses is the squamous cell carcinoma. The most frequent sites of these neoplasms are: lower and lateral surface of the tongue, the bottom of the oral cavity, lingual surface of the labial gingiva, retromandibular triangle, tonsils and the root of the tongue. About 85% of all oral cavity and oropharynx tumors are detected after they reached 2 centimetre in diameter. 60% of these tumors are recognized in the level III or IV of the clinical grading. The aim of the study was to estimate the frequency of the oral cavity and oropharynx malignant neoplasms, their clinical grading, evaluation of histologic results and a kind of treatment. A retrospective analysis of 201 patients treated at The II ENT Department Silesian Medical Academy in Zabrze because of the oral cavity and oropharynx malignant neoplasms. RESULTS: In our group were 45 women and 156 men. The majority of the patients were clinically advanced of the disease. The most frequent site of the tumor was the tongue and tonsils. Histopathological study showed that the most frequent diagnosis was the squamous cell carcinoma (92.5%). In the greater part of the patients the combined treatment (surgery and radiotherapy) was applied (62.7%). The most important activity for the survival time elongation and decrease of the crippledom after surgery is the early detection of the disease.
Aged↗