Renal cystadenoma in a domestic shorthair

An 11-year-old domestic shorthair was examined after an enlarged left kidney was palpated by the referring veterinarian. No abnormalities were noted on complete blood count, serum biochemical profile and total thyroxine concentration, and the urine specific gravity was 1.039. An abdominal ultrasound identified the presence of a large cystic structure on the caudal pole of the left kidney. No abnormalities of the right kidney were seen. A left ureteronephrectomy was performed, and the cat recovered uneventfully from the procedure and was discharged from the hospital 5 days after surgery. The cat remains clinically normal 16 months postoperatively. Histopathology of the removed kidney demonstrated the presence of a renal cystadenoma. This report describes the successful surgical treatment of a renal cystadenoma. Renal cystadenoma should be considered as a differential diagnosis when renomegaly is noted. To the author's knowledge, a renal cystadenoma has not been previously reported in a cat.

Concentrations of follicle stimulating hormone are increased in ovarian tumor fluid: implications for the management of ovarian cancer

PURPOSE OF INVESTIGATION

Significant progress has been made in recent years in the understanding of the mechanisms postulated by the gonadotropin theory of ovarian carcinogenesis. In the present study we compare FSH concentrations between serum and fluid from cysts or the rectouterine pouch of patients with epithelial tumors and non-neoplastic lesions.

METHODS

We enrolled 277 patients. They were divided into five groups: I (n = 44)--ovarian cancer patients, II (n = 16)--borderline tumors, III (n = 40)--benign epithelial cystadenomas, IV (n = 137)--non-neoplastic lesions and V (n = 22)--admitted for "second-look" laparoscopy.

RESULTS

There were any significant differences between FSH concentrations in serum and tumor fluid in patients with ovarian cancer (36.46 vs 28.11 mIU/ml) and borderline epithelial tumors (31.5 vs 22.7 mIU/ml). For benign cystadenomas the respective concentrations were 28.96 mIU/ml in serum and 6.93 mIU/ml in tumor fluid in these groups p < 0.0000001. The same highly significant differences were found in non-neoplastic lesions (24.97 vs 4.77 mIU/ml), p < 0.0000001. Patients who underwent "second-look" laparoscopy demonstrated significant differences (p < 0.05) as FSH concentration in serum and peritoneal fluid when neoplastic cells were not disclosed, but the difference was not significant (p = 0.752) when fluid from the rectouterine pouch was positive for carcinoma cells.

CONCLUSIONS

The results of our study can reflect an ineffective tumor: blood barrier and easy diffusion of gonadotropins into the tumor tissue. Local reduction of FSH levels through administration of GnRH analogs may in some clinical situations produce clear therapeutic benefits for the management of ovarian malignancies.

[Comparative study of appendical mucocela and pseudomyxoma peritonei. About 25 cases]

AIM

to study the clinicopathological features of the different types of appendical mucocele and to compare them with those of pseudomyxoma peritonei.

METHODS

25 cases of appendical mucocele were operated in the Cap-Bon region in Tunisia during a period of 13 years from 1994 to 2006.

RESULTS

9 retentionnal cysts, 13 mucinous cystadenomas, one serrated adenoma, one hyperplasia of the mucosa and one cystadenocarcinoma were diagnosed. Five cystadenomas as well as the only case of cystadenocarcinoma were associated with pseudomyxoma peritonei. Pseudomyxoma peritonei occurred 20 years later than in simple appendiceal mucocèle and complicated 5 cases of cystadenoma with low grade dysplasia and 1 case of cystadenocarcinoma.

CONCLUSION

Preoperative diagnosis of appendical mucocele and pseudomyxoma peritonei should be made on scannographic features in order to assess the adequate surgical management.

Adenocarcinoma in a retrorectal cystic hamartoma: a case report and literature review

Retrorectal cystic hamartomas are rare congenital lesions derived from the vestigial portion of the embryonic hindgut. These lesions present in a vague manner and so mimic the presentation of more common mass lesions in the pelvic region. They most frequently afflict middle-aged women, causing vague pelvic pains, discomfort with defaecation or sitting, and altered bowel function. Malignant transformation within these lesions is extremely rare. We describe a case of adenocarcinoma within a retrorectal cystic hamartoma, initially manifesting in a 54-year-old woman and recurring over a'5-year period. A computed tomography (CT) scan and pathology reports are included in the study, and findings at operations are discussed. We also include a comprehensive review of the literature.

von Hippel-Lindau disease: epididymal cystadenoma targeted by metastatic events

Cases of renal clear cell carcinoma in patients with von Hippel-Lindau disease often exhibit extensive metastasis. Several investigators have shown these tumors to specifically invade central nervous system hemangioblastomas, which are commonly associated with the disease. We report on multiple metastatic events within a single von Hippel-Lindau disease-associated tumor outside the central nervous system, epididymal cystadenoma. The multiplicity of these metastatic events suggests the epididymal cystadenoma as a preferential site of metastasis for von Hippel-Lindau disease-associated renal clear cell carcinoma.

[Thirty-eight kilograms ovary cystoadenoma. Case report and literature review]

A clinical case of a patient with a giant tumoration of the ovary appears, that went to the external consultation declaring progressive picture of abdominal distension, postprandial fullness and general weakness. The diagnosis was elaborated as much by clinical and paraclinical methods (USG and RX) as well as by pathological anatomy; and the handling consisted firstly of puncture-drainage and later by laparotomy with the extraction of the same one. The gross weight of the tumoration was of 38 kg and the histopathologic study was of cystoadenoma serum giant of the left ovary. Evolution of the patient was satisfactory having a favorable prognosis, returning normally to her habitual activities.

[Biliary cystadenoma with mesenchymal stroma]

The data available in the literature and the authors' observation of hepatic adenoma polycysticum developed in a 34-year-old female are given. A comprehensive morphological (histological and immunohistochemical) study has shown that the cystic wall is lined with the cylindrical epithelium that has a positive reaction with cytokeratins 7, 18, 19, and 20, CA 19-9. The underlining tissue resembles ovarian tissue and positively reacts with vimentin, estrogen, and progesterone.

Giant multilocular prostatic cystadenoma presenting with obstructive aspermia

Giant multilocular prostatic cystadenoma (GMPC) is a rare benign tumor involving the prostate gland. Microscopically, it masquerades phyllodes tumor or transitional zone hyperplasia. We report one case of GMPC arising from the prostate central zone (CZ), presenting with long-standing aspermia associated with seminal vesicle fibrous obliteration.

Relative frequency of intra-oral minor salivary gland tumors: a study of 380 cases from northern California and comparison to reports from other parts of the world

BACKGROUND

The relative frequency of individual intra-oral minor salivary gland tumors (IMSGT) is not well documented in the literature. The aim of this study was to determine the relative frequency and distribution of IMSGT in an oral pathology biopsy service and to compare the data with similar studies from different parts of the world.

METHODS

Files from the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, California served as a source of material for this study. Files were systematically searched for all cases of IMSGT during a 20-year period. Tumors were classified according to the 2005 WHO classification of salivary gland tumors.

RESULTS

IMSGT were identified in 380 (0.4%) cases of 92 860 accessed. This is the largest series of IMSGT from one source reported in recent years. Of the 380 tumors, 224 (59%) were benign and 156 (41%) were malignant. Of the benign tumors, pleomorphic adenoma (PA) was the most common (39.2%), followed by cystadenoma (6.3%), canalicular adenoma (6.1%), ductal papillomas (4.4%), basal cell adenoma (1.6%), and myoepithelioma (1.3%). Of the malignant tumors, mucoepidermoid carcinoma was the most common (21.8%), followed by polymorphous low-grade adenocarcinoma (7.1%), adenoid cystic carcinoma (6.3%), adenocarcinoma, not otherwise specified (NOS; 2.1%), acinic cell carcinoma (1.6%), clear cell carcinoma, NOS (1.0%), and carcinoma ex PA (0.5%).

CONCLUSIONS

Studies related to the relative frequency of individual IMSGTs from different parts of the world are difficult to compare because many studies are outdated, the number of cases is small, the list of tumors is limited, and new entities are not included. To determine the true relative frequency, more studies should be conducted, on a large number of cases from one source, by experienced pathologists in the field of salivary gland tumors.

Increased chromosomal stability in cultures of ovarian tumours of low malignant potential compared to cystadenomas

Cell cultures of ovarian cystadenomas transfected with SV40 large T antigen are not immortal because they invariably reach a phenomenon called crisis, which is triggered in part by telomere attrition. Recovery from crisis may be an integral component of the malignant transformation process. We reported earlier that such ovarian cystadenoma cell cultures undergo severe changes in DNA ploidy as they approach crisis and that such changes are an important determinant of crisis independent of telomere attrition. Here, we show that in sharp contrast to these benign ovarian tumours, the DNA content of ovarian tumours of low malignant potential (LMP) was remarkably stable as they approached crisis, suggesting that telomere attrition was the main determinant of this mortality checkpoint. Lack of a ploidy-based crisis was not due to loss of expression of a functional SV40 large T antigen protein. We conclude that ovarian LMP tumours are characterised by increased numerical chromosomal stability compared to cystadenomas. This might account for the fact that most LMP tumours are diploid or near diploid in vivo. This fundamental difference in chromosomal stability between ovarian cystadenomas and LMP tumours also suggests potential differences in predisposition to progression to malignancy between these two ovarian tumour subtypes.

Expression of estrogen and progesterone receptors and inhibin-alpha in hepatobiliary cystadenoma: an immunohistochemical study

To further characterize the immunohistochemical features of hepatobiliary cystadenoma with mesenchymal stroma, a battery of stains was performed on nine typical cases. All nine tumors had been resected from female patients who ranged in age from 30 to 59 years. Freshly cut sections were stained with antibodies to estrogen receptor (ER), progesterone receptor (PR), alpha-smooth muscle actin (SMA), inhibin-alpha, and cytokeratins (CK) 7, 8, 18, and 19. Nuclear staining of the mesenchymal stromal cells for ER and PR was present in all and seven out of nine cases, respectively. A strong cytoplasmic staining of the mesenchymal stromal cells for SMA was seen in all cases. A patchy pale cytoplasmic staining of the tumor epithelium for ER and PR was seen in five out of nine and four out of nine cases, respectively. Immunoreactivity of luteinized stromal cell for inhibin-alpha was documented in three out of nine cases. All tumors (nine out of nine) demonstrated strong cytoplasmic positivity of the epithelial lining of the cysts to CK7, CK8, CK18, and CK19, typical of biliary-type epithelium. The expression of ER, PR, and inhibin-alpha in the ovarian-like stroma supports the likely hormonal dependence of this tumor and probably explains its almost exclusive occurrence in women.

Inflammatory pseudotumour of the liver: the residuum of a biliary cystadenoma?

Inflammatory pseudotumour is a rare form of a liver mass. We report the case of a 28-year-old man presenting with obstructive jaundice, in whom an inflammatory pseudotumour arose with the resolution of a mucus secreting cystic liver lesion. The initial features suggested an intrahepatic cystadenoma or cystadenocarcinoma, which on its involution left a solid mass. Histopathology showed an inflammatory pseudotumour with no evidence of malignancy. A similar case has been reported recently, with the development of an inflammatory pseudotumour following collapse of a liver cyst seen on imaging. These two cases may shed some light on the origins of these rare liver lesions.

Intracystic hemorrhage in a mediastinal cystic adenoma causing parathyrotoxic crisis

BACKGROUND

We report a case of intracystic hemorrhage in a mediastinal cystic parathyroid adenoma causing parathyrotoxic crisis.

METHODS AND RESULTS

A 30-year-old man presented with a large neck mass, dyspnea, and abdominal pain. The patient's serum calcium and parathormone levels were elevated. Radiography showed a right tracheal deviation, ultrasonography identified a thyroid nodular goiter extending to the mediastinum with a large (4.0 cm x 5.6 cm) cystic mass adjacent to the lower left thyroid pole. After IV fluid, pamidronate, and furosemide were administered, the patient underwent total thyroidectomy, and excision of the cyst and a small mass (2 cm x 2 cm) adjacent to the upper right thyroid lobe. Histopathologic examination revealed a double parathyroid adenoma and identified the mediastinal lesion as a cystic adenoma with intracystic hemorrhage.

CONCLUSIONS

Intracystic hemorrhage in a functional mediastinal cystic parathyroid adenoma is an extremely rare cause of parathyrotoxic crisis. Aggressive medical treatment should be immediately instituted, and surgery should be performed as soon as hypercalcemia is controlled.

Multilocular cystadenoma and cystadenocarcinoma of the prostate

BACKGROUND

Multicystic prostatic tumors are rare, with only a few reported cases of prostatic cystadenoma and cystadenocarcinoma in the scientific literature.

METHODS

A retrospective review of our tumor registry over the last 25 years identified 2 rare cystic tumors of the prostate: 1 multilocular cystadenoma and 1 multilocular cystadenocarcinoma.

RESULTS

The first case illustrates the clinical and pathologic features of prostatic multilocular cystadenoma. A 42-year-old man presented with a 16-cm suprapubic mass causing displacement of adjacent visceral organs. Pathologic examination after prostatectomy confirmed it to be a multilocular cystadenoma of the prostate. The patient's postoperative course was uneventful, and his serum prostate-specific antigen level remained at < or =0.04 ng/ml throughout the course of his disease. In the second case, we present an 80-year-old male presenting with a 12-cm cystic mass of the prostate. His serum prostate-specific antigen level remained at > or =9.0 ng/ml throughout the course of his disease. The tumor had an aggressive local growth pattern, with invasion into perirectal adipose tissue. This patient underwent a pelvic exenteration, followed by adjuvant systemic chemotherapy and complete androgen blockade. Despite aggressive treatment, he had 3 recurrences over 4 months but remains alive with disease at 23-month follow-up.

CONCLUSIONS

Cystadenocarcinoma of the prostate is locally aggressive and should be included in the differential diagnosis of cystic lesions of the prostate.

Hepatobiliary cystadenoma: a case report and a review of the literature

BACKGROUND

Hepatic cystic lesions are rare; however, their management and treatment is dependent on early recognition and diagnosis.

METHODS

In this report, the authors discuss a 72-year-old woman who presented to their clinic for treatment of a hepatocystadenoma.

RESULTS

The history, physical examination, and diagnostic modalities lead to surgical intervention despite an unclear diagnosis.

CONCLUSIONS

This case illustrates an unusual hepatic lesion in which the diagnosis was not known until the time of laparotomy. However, diagnostic modalities were important in establishing the need for surgical intervention. The authors offer a pertinent review of the literature and discuss current treatment modalities.

A series of 64 cases of pancreatic cystic neoplasia from an institutional study of China

AIM: To recognize cystic neoplasia of the pancreas and thus to identify a panel of curable diseases.

METHODS: Sixty-four cases of cystic neoplasia of the pancreas, including 28 cases of intraductal papillary mucinous neoplasia (IPMN), 12 cases of serous cystic neoplasia (SCN), 11 cases of mucinous cystic neoplasia (MCN), 11 cases of solid pseudo-papillary neoplasia (SPN), and 2 cases of solid tumor with cystic degeneration were examined immunohistochemically for their expression of MUC1, MUC2, MUC4, MUC5AC, and MUC6, as well as other related antigens.

RESULTS: Adenoma type of IPMN and borderline lesions exhibited high expressions of MUC2, and MUC5AC. In contrast, IPMN with invasive carcinoma component showed MUC1 immunoreactivity. SCN was mainly positive for MUC1 and MUC6, while negative for MUC2, MUC4 and MUC5AC. Noninvasive MCN, regardless of its cellular atypia degree, was positive for MUC5AC and negative for MUC1. MUC1 expression was only observed in patients with an invasive component. No mucin expression was found in SPN.

CONCLUSION: Mucin profile may, in conjunction with histologic study, provide important information on tumor types and patient treatment of cystic neoplasia of the pancreas.

Impact of FDG-PET/MRI image fusion on the detection of pancreatic cancer

BACKGROUND

This study assessed the value of image fusion with (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) in patients suspected of having pancreatic cancer.

METHODS

32 patients (12 women, 20 men; age 24-79 years; mean 56.6 years) were included. All patients underwent whole-body FDG-PET examinations and contrast-enhanced MRI. Image fusion used a semiautomatic voxel-based algorithm. Separate reading, side-by-side analysis and evaluation of fused PET/MRI images were performed. Results were correlated to histopathology (n = 30), or clinical follow-up (n = 2).

RESULTS

15/32 patients had pancreas cancer and 17/32 patients benign disease. The sensitivity and specificity for cancer detection by FDG-PET were 93 and 41% for visual and 86 and 58% for semiquantitative analysis whereas MRI achieved 100 and 76% respectively. Topographical assignment of PET foci by image fusion was superior to side-by-side analysis in 11/39 (28%) foci (in 8/32 patients). However, a true impact on therapeutic strategy was observed only in 1/8 patients as the presence of multiple metastases, irresectable primaries or medical reasons for inoperability prevented a curative setting.

CONCLUSION

Compared to side-by-side analysis, PET/MRI image fusion improves the anatomical assignment and interpretation of FDG foci. The therapeutic benefit for the patient however is limited in patients with multiple lesions or incurable primaries.

Mediastinal, cystic and functional parathyroid adenoma in patients with double parathyroid adenomas: a case report

Primary hyperparathyroidism is usually caused by single adenoma. Ectopic adenomas are a frequent cause of recurrent or persistent hyperparathyroidism. Parathyroid cysts are rarely seen and most of them are non functional. This case report describes a patient with double adenoma, one is solid and cervical, the other is cystic and located in mediastinum; both of them are functional.

Serum mesothelin in epithelial ovarian carcinoma: a new screening marker and prognostic factor

The aim of this study was to determine the relationship between mesothelin and clinical pathological characteristics and whether mesothelin can be used as a biomarker for the detection and prognosis of epithelial ovarian carcinoma, or not.

PATIENTS AND METHODS

Pre-operative mesothelin and CA125 levels from normal populations, patients with benign ovarian tumors and patients with ovarian carcinomas were measured. The histopathological characteristics and serum meosthelin, and CA125 levels influencing clinical outcome were evaluated comparatively.

RESULTS

Mesothelin levels were higher in cancer patients than in those with benign ovarian tumors or in normal populations. Mesothelin, also significantly increased from early to advanced stages. Elevated mesothelin before therapy and advanced stage, revealed poorer overall survival (OS) for cancer patients. Elevated mesothelin before therapy also revealed poorer OS in cancer patients with optimal debulking surgery and in advanced-stage cancer patients.

CONCLUSION

Mesothelin might be a new tumor marker for the differential diagnosis of epithelial ovarian carcinoma and a prognostic factorfor the outcome of epithelial ovarian carcinoma patients.

Biliary cystadenoma with mesenchymal stroma: Report of a case and review of the literature

Biliary cystadenomas are rare, cystic neoplasms of the biliary ductal system that usually occur in middle-aged women. They cannot be safely differentiated from cystadenocarcinomas before operation and should always be considered for resection. Cystadenomas have a strong tendency to recur, particularly following incomplete excision, and a potential of malignant transformation. Therefore, complete resection is the therapy of choice and thorough histopathologic evaluation is imperative. A case of benign biliary cystadenoma with mesenchymal stroma is presented along with a review of the relative literature addressing the clinical presentation, histology, histogenesis, differential diagnosis, imaging features, treatment and prognosis of this interesting and rare entity.

Pre-operative differentiation of pediatric ovarian tumors: morphological scoring system and tumor markers

OBJECTIVE

To investigate the importance of morphological scoring systems in differentiation of ovarian tumors in childhood.

METHODS

Morphological assessment using DePriest's index was performed for all patients with histopathological confirmation of ovarian tumor, with evaluation of tumor markers, from January 1997.

RESULTS

Fifty-three girls (age range 13 months to 19 years) were surgically treated for 59 ovarian tumors, including six bilateral. All lesions with cystic appearance on ultrasonography were benign, 23 of 35 semisolid, and four of ten solid tumors were also benign. Stage of malignant disease was as follows: stage I, ten; stage II, two; stage III, six. Sensitivity, positive predictive value and accuracy by DePriest's and Ueland's indexes for benign tumors (score <7) were: 0.88, 0.79; 0.89; and 0.94, 0.84; 0.93; respectively. Elevated levels of tumor markers were observed in 17 patients, including four patients with endocrine manifestations. In 24 patients ovaries were successfully preserved, including two patients with foci of immature teratoma in a dermoid cyst.

CONCLUSION

Ultrasonographic assessment with morphological analysis recommended by DePriest and Ueland is a very useful procedure for differentiating benign from malignant ovarian tumors in children. Tumor markers and endocrinological investigation are also useful for preoperative evaluation.