Skin Metastasis of Ovarian Cancer: Report of Three Cases

Three cases of skin metastases in patients with ovarian cancer are reported. The late onset of skin metastases in the course of the disease represents an advanced stage accompanied by Intraperitoneal spread and has a poor prognosis. Diagnosis and differentiation from herpes zoster and other skin tumors were based on histologic examination. Palliation of symptoms and partial local response were achieved by electron beam irradiation.

Cancer of the Appendix in Long-Standing Ulcerative Colitis: A Case Report

Cancer of the appendix was found in a 69-year-old female patient affected by long-standing ulcerative colitis (UC). On histological examination the cancer was a typical cystadenocarcinoma of the appendix. The appendiceal mucosa not invaded by the neoplastic process was normal. Histological examination of the colorectal mucosa did not show dysplasia or cancer. These findings suggest that appendiceal cancer and UC may be unrelated diseases. A surveillance program for early detection of cancer of the appendix in patients with longstanding UC does not seem mandatory.

Pancreatic Cystadenocarcinoma and Pregnancy: A Case Report

We report a case of cystadenocarcinoma occurring in a pregnant woman. After child birth, a subtotal pancreatectomy was performed, without rupture of the cyst. The patient is asymptomatic, 24 months after sugery. The presentation of cystadenocarcinoma in pregnancy has been reported in another single case. The possibility of hormonal dependence is discussed.

Multifocal Biliary Cystadenocarcinoma of the Liver: CT and Pathological Findings

Biliary cystadenocarcinoma is a rare tumor that originates from the hepatobiliary epithelium. Although this tumor can affect any portion of the biliary tree, intrahepatic location is more common. It is usually a slow growing tumor and often asymptomatic until it reaches a considerable size. The lesion is most often solitary and large when discovered; multiple lesions or metastases within the liver are very rare. A 63-year-old man was referred to our institute for weight loss, abdominal discomfort, worsening bulky symptoms in the right upper abdominal quadrant, and an increase in serum aminotransferases that had been present for several months. Spiral CT of the abdomen demonstrated two lesions, a larger one and a distant intrahepatic lesion, with a multiloculated cystic aspect, a thin peripheral capsule, multiple solid peripheral portions, and irregular septa enhancing in the portal phase after intravenous administration of iodinated contrast medium. The diagnosis of multifocal cystadenocarcinoma of the liver was confirmed by surgical laparoscopy and biopsy of the lesion. The patient was treated with chemotherapy.

Osteosarcoma of the Myometrium Synchronous with Bilateral Papillary Cystadenocarcinoma of the Ovary and Papillary Adenocarcinoma of the Cervix

We report an extremely rare case of a 60-year-old woman with myometrial osteosarcoma associated with bilateral papillary cystadenocarcinoma of the ovary and papillary adenocarcinoma of the cervix. The uterine osteosarcoma is the seventh case reported in the world, while it is the second case of syncronous triple primary tumors of the upper female genital tract. Clinical and pathological features of previously reported cases of uterine osteosarcoma and triple primary neoplasias of the upper female genital tract are critically reviewed.

Morphologic Heterogeneity of Cell Populations Isolated by Density Gradient Centrifugation from Serous Fluids of Ovarian Tumors

The cells of tumor fluid from patients with malignant and benign serous ovarian neoplasms were fractionated using Ficoll-Uropoline density gradient centrifugation. Density distribution and morphologic characteristics of cell fractions were analyzed. It was found that serous ovarian adenocarcinomas contained three to four types of morphologically malignant cells focused in low density layers. Borderline ovarian neoplasms showed the presence of one subpopulation of cells with some features of malignancy and cells with some atypical but non-malignant features. The fluids of serous cysts contained mainly normal epithelial cells representing different stages of morphological maturity and were focused in denser layers. The results allowed us to catalogue ovarian tumor cell subpopulations present in each density fraction of individual patients and confirmed that ovarian tumors could be diagnosed by morphologic identification of cells from tumor fluids.

Clinicopathological Features and Management of Appendiceal Mucoceles: A Systematic Review

Appendiceal mucoceles (AMs) are rare mucin-containing neoplasms with malignant potential. Lack of evidence-based data exists defining clinicopathological features for management. MEDLINE search between 1995 and 2015 was performed using search criteria "Appendix mucocele." Systematic review of patient-, pathologic-, and treatment-related characteristics was performed and data analyzed. Among 276 cases of non-perforated AMs, 163 (59%) patients were female, with variable and nonspecific presentation. Patients were treated with appendectomy (52.1%), right hemicolectomy (17.6%), partial cecectomy (17.2%), and ileocecetomy (13.1%). Pathologic evaluation revealed the following: cystadenoma/low-grade appendiceal mucinous neoplasm (54%), unspecified/benign (25%), retention cyst (14.1%), cystadenocarcinoma (4.2%), and mucosal hyperplasia (2.9%). All 11 (4.2%) patients with cystadenocarcinoma were female (P = 0.004), odds ratio for malignancy 1.07 times higher for women. Synchronous colonic malignancy was reported in three patients (27%) with cystadenocarcinoma (P = 0.007), odds ratio of 12.1. AMs have low risk for malignancy. Treatment should begin with appendectomy-only and subsequently guided by pathologic diagnosis.

Frequency of Her2/Neu Protein Expression in Ovarian Epithelial Cancers

OBJECTIVE

To detect the frequency of Her-2/neu protein expression in epithelial ovarian cancers by immunohistochemistry.

STUDY DESIGN

Descriptive cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Pathology, King Edward Medical University, Lahore, from July 2014 to May 2015.

METHODOLOGY

Fifty-six cases diagnosed as epithelial ovarian cancer on histopathology were included in this study. Immunohistochemistry was performed to observe the pattern of HER2/neu protein expression in these cases. Association with age was determined by Chi-square test with significance at p<0.05.

RESULTS

Out of these 56 cases, 38 (67.9%) were serous cystadenocarcinomas, 11 (19.6%) were endometrioid adenocarcinomas, 6 (10.7%) were mucinous cystadenocarcinomas and 1 (1.8%) was non-Brenner transitional cell carcinoma. The mean age of patients was 49.61 ±13.20 years with minimum and maximum ages of 21 years and 80 years, correspondingly. Twentyone (37.5%) out of 56 patients were found to overexpress Her-2/neu protein.

CONCLUSION

Her-2/neu protein overexpression was observed in 21 (37.5%) patients. No statistically significant association was seen between age and Her-2/neu protein overexpression.

Radiological and endoscopic imaging methods in the management of cystic pancreatic neoplasms

The management of cystic pancreatic neoplasm (CPN) is a clinical dilemma because of its clinical presentations and malignant potential. Surgery is the best treatment choice ; however, pancreatic surgery still has high complication rates, even in experienced centers. Imaging methods have a definitive role in the management of CPN and computed tomography, magnetic resonance imaging, and endoscopic ultrasonography are the preferred methods since they can reveal the suspicious features for malignancy. Therefore, radiologists, gastroenterologists, endoscopists, and surgeons should be aware of the common features of CPN, its discrete presentations on imaging methods, and the limitations of these modalities in the management of the disease. This study aims to review the radiological and endoscopic imaging methods used for the management of CPN.

Expression and clinical significance of Ki-67, E-cadherin, and mesothelin in serous borderline ovarian tumor

OBJECTIVE

This study aimed to investigate the expression of Ki-67, epithelial cadherin (E-cadherin), mesothelin, and their correlations with clinicopathological features of serous borderline ovarian tumors (SBOTs).

MATERIALS AND METHODS

Immunohistochemistry was conducted to investigate the expression of a cellular proliferation-related factor (Ki-67) and metastasis-related factors (E-cadherin and mesothelin) in 41 cases of SBOTs, 30 benign ovarian tumor tissues, and 30 malignant ovarian tumor tissues.

RESULTS

The results showed that the expression rate of Ki-67 (46.3%) in SBOTs was higher than that in benign tumors (6.7%), but lower than that in ovarian carcinomas (80%). SBOTs significantly differed from benign ovarian tumors (p < 0.01) and carcinoma (p < 0.01). The positive expression rate of Ki-67 was significantly correlated with FIGO stage and peritoneal implantation of SBOTs (p < 0.01). The expression rate of E-cadherin was significantly lower in ovarian carcinomas (56.7%) than in SBOTs (80.5%) and benign ovarian tumors (90%; p < 0.05). The mesothelin expression in ovarian carcinomas and SBOTs significantly differed from that in benign ovarian tumors (p < 0.01). The positive expression rate of mesothelin was related to the serum CA125 level (p < 0.05). The expression of Ki-67 was positively correlated with the expression of E-cadherin and mesothelin in SBOTs.

CONCLUSION

SBOTs generally behave in a benign manner. Ki-67, E-cadherin, and mesothelin may play an important role in the oncogenesis and progression of SBOT. Patients with Ki-67 and mesothelin overexpression and low E-cadherin expression should be followed up.

Spectrum of Cystic Epithelial Tumors of the Prostate: Most Cystadenocarcinomas Are Ductal Type With Intracystic Papillary Pattern

Cystic epithelial tumors arising from the prostate are rare, and their full histologic spectrum has yet to be defined. Herein, we present 8 examples of prostatic cystic tumors including 1 giant multilocular cystadenoma and 7 cystadenocarcinomas. We divided the cystadenocarcinomas into "giant multilocular" cystadenocarcinoma (3) and "microscopic" cystadenocarcinoma (4) because of their differing clinical presentations with clinically apparent cystic masses in the former. The cystadenoma was an 11 cm multilocular cystic pelvic tumor in a 55-year-old man who presented with lower urinary tract symptoms. The cystadenoma was lined predominantly by benign acinar cells and had a distinct basal cell layer. No recurrence occurred 3 months after resection. The 3 patients with giant multilocular cystadenocarcinomas were 62 to 82 years old, had large pelvic cystic masses (up to 16 cm), and 2 presented with obstructive urinary and lower intestinal tract symptoms. One giant multilocular cystadenocarcinoma had a markedly high cystic fluid prostate-specific antigen at >80,000 ng/mL. All 3 giant multilocular cystadenocarcinomas were ductal adenocarcinoma with exuberant intracystic papillary formations. One tumor was associated with a high-grade noncystic conventional (acinar) adenocarcinoma (Gleason score 9 [ISUP grade group 5]). Follow-up on the 3 giant multilocular cystadenocarcinoma cases (7 to 21 mo) showed multiple metastases in 1 patient but was attributed to the high-grade conventional adenocarcinoma component. In addition, we described 4 examples of microscopic cystadenocarcinomas that were small (≤1 cm) solitary or multiple cystic tumors identified on pathologic examination of the prostate. In 3 of 4 microscopic cystadenocarcinomas the lining was ductal adenocarcinoma with occasional to exuberant papillae and appeared similar to the smaller cysts in the giant multilocular cystadenocarcinomas. One of the 4 microscopic cystadenocarcinomas had an acinar adenocarcinoma lining with occasional papillae and was associated with a conventional adenocarcinoma. Follow-up of the 4 patients with microscopic cystadenocarcinoma (1 to 14 mo) showed no evidence of disease. Review of literature highlighted similarities between the findings in our cases and previously published prostatic cystadenocarcinomas, including the markedly high cystic fluid prostate-specific antigen level in giant multilocular cystadenocarcinomas and the typical ductal adenocarcinoma morphology with intracystic papillary pattern. In conclusion, cystic epithelial tumors of the prostate exhibit unique clinicopathologic features. Cystadenocarcinomas, whether the clinically apparent giant multilocular form or the incidentally identified microscopic type, represent a rare underrecognized pattern of prostatic adenocarcinoma mostly within the histologic spectrum of the ductal variant.

[Clinicopathological characteristics and prognostic factors of intrahepatic biliary cystadenocarcinoma]

OBJECTIVE

To analyze the clinicopathological characteristics and the factors affecting the prognosis of intrahepatic biliary cystadenocarcinoma (IBC).

METHODS

Forty-six patients with histologically confirmed IBC from January, 2000 to April, 2014 were included. The clinical characteristics of the patients with IBC were compared with those of 58 patients with intrahepatic biliary cystadenoma (IBCA). Kaplan-Meier analysis was used to identify the factors affecting the prognosis of IBC.

RESULTS

The 46 patients with IBC included 15 men and 31 women with a mean age of 57.0 ± 10.5 years. Compared with the patients with IBCA, IBC patients had an older mean age (57.0 ± 10.7 vs 44.3 ± 15.3 years, P=0.03) and a greater proportion of male patients (15/46 vs 8/58, P=0.02). The differential diagnosis between IBC and IBCA was difficult on the basis of preoperative laboratory and imaging findings. The median overall survival of IBC patients was 56 months with 1-, 3-, and 5-year survival rates of 85.9%, 65.2%, and 47.7%, respectively. Gender, surgical approach, tumor growth pattern and distant metastasis were all significant prognostic factors for the overall survival of the patients.

CONCLUSION

IBC is a rare cystic lesion occurring primarily in middle-aged men. Complete resection is recommended for curative treatment and close follow-up is essential especially for male patients and patients with tumors exhibiting an invasive growth.

CT imaging of ovarian yolk sac tumor with emphasis on differential diagnosis

Ovarian yolk sac tumors (YSTs) are rare neoplasms. No radiological study has been done to compare the imaging findings between this type of tumor and other ovarian tumors. Here we analyzed the CT findings of 11 pathologically proven ovarian YSTs and compared their imaging findings with 18 other types of ovarian tumors in the same age range. Patient age, tumor size, tumor shape, ascites and metastasis of two groups did not differ significantly (P > 0.05). A mixed solid-cystic nature, intratumoral hemorrhage, marked enhancement and dilated intratumoral vessel of two groups differed significantly (P < 0.05). The area under the ROC curve of four significant CT features was 0.679, 0.707, 0.705, and 1.000, respectively. Multivariate logistic regression analysis identified two independent signs of YST: intratumoral hemorrhage and marked enhancement. Our results show that certain suggestive CT signs that may be valuable for improving the accuracy of imaging diagnosis of YST and may be helpful in distinguishing YST from other ovarian tumors.

[SURGICAL TREATMENT OF TUMORS OF THE LEFT PANCREATIC ANATOMICAL SEGMENT]

The results of treatment of 231 patients, suffering tumoral affection of pancreatic left anatomical segment in period of 2009-2013 yrs were analyzed. Individualized approach, using modern technologies, was applied. Radical operations were performed in 129 patients, ageing 14-81 yrs old, including pancreatic distal resections in various modifications, central resection and tumoral enucleation. Possibilities of the extended pancreatic resection performance were studied in conditions of tumoral invasion of adjacent organs, regional vessels, as well as impact of such interventions on postoperative complications and lethality rate. While performing pancreatic subtotal distal resection with simultant resection of affected main venous vessels and adjacent organs the operative intervention risk is enhanced, but possibilities of a radical operations performance in previously considered inoperable patients are expanding.

Preoperative differential diagnosis between intrahepatic biliary cystadenoma and cystadenocarcinoma: A single-center experience

AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma.

METHODS: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up.

RESULTS: Preoperative levels of cancer antigen 125 (12.51 ± 9.31 vs 23.20 ± 21.86, P < 0.05) and carbohydrate antigen 19-9 (22.56 ± 26.30 vs 72.55 ± 115.99, P < 0.05) were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications.

CONCLUSION: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results.

Mediastinal recurrence from ovarian cystadenocarcinoma presenting as pleuro-pericardial cyst

A 56 year-old woman (treated for ovarian cystadenocarcinoma 9-yrs before) presented a slowly increasing dyspnea. CT-scan revealed a mediastinal cyst with typical radiological pattern compatible with benign pleuro-pericardial cyst. The cyst was removed via right thoracoscopy. Surprisingly, the pathology were indicative of cystic mediastinal recurrence from ovarian adenocarcinoma.

Syringocystadenocarcinoma papilliferum: a rare tumor with a favorable prognosis

Syringocystadenocarcinoma papilliferum (SCACP) is a rare adenexal carcinoma with only 21 cases reported in the literature. Most patients describe a long-standing mass with recent change, supporting the idea that SCACP arises from malignant transformation of pre-existing syringocystadenoma papilliferum (SCAP). Syringocystadenocarcinoma papilliferum is generally treated with wide surgical excision of the lesion and patients do exceeding well and require no systemic therapy.

Cytologic features of low-grade cribriform cystadenocarcinoma of the submandibular gland: a case report

BACKGROUND

Low-grade cribriform cystadenocarcinomas (LGCCC) are rare salivary gland tumors, classified into a variant of cystadenocarcinoma by the 2005 WHO classification. All previously reported cases arose from parotid glands, except for a case from a minor salivary gland. We report here for the first time a case of LGCCC arising from the submandibular gland.

CASE

A 65-year-old man presented with a 4-cm multicystic mass in the left submandibular gland. Smears from fine-needle aspiration cytology showed tumor cells, appearing solitarily or partly in clusters, with thick cytoplasm and central nuclei. Some clustering tumor cells showed large cytoplasmic vacuoles and peripherally dislocated nuclei. Although these findings indicated a possible mucoepidermoid carcinoma in the submandibular gland, the final diagnosis of the resected specimen was LGCCC.

CONCLUSION

LGCCC can arise not only from the parotid glands, but also in the submandibular glands. LGCCC is thought to be of low-grade malignancy; no reported cases have shown tumor metastasis and there are no patients who are known to have died of this disease. Thus, differential diagnosis of this tumor from other malignant salivary gland tumors is quite important; however, this might be difficult when based solely on cytological findings.

Tubulocystic carcinoma of the kidney with poorly differentiated foci: a series of 3 cases with fluorescence in situ hybridization analysis

We identified 3 consult cases of tubulocystic renal cell carcinoma with poorly differentiated areas. Two lesions measuring 9.5 and 3.8 cm were described as partly solid and cystic. One case was grossly a 14.0-cm cyst with a granular lining. Microscopically, all had classic areas of circumscribed tubulocystic renal cell carcinoma occupying 30%, 80%, and 90% of the tumor; 2 cases had small components of papillary renal cell carcinoma, and 1 case had a central large cystic component. In 2 cases, proliferations of small tubules infiltrated away from the main mass with typical features of collecting duct carcinoma. In the third case, a focus of poorly differentiated carcinoma was seen adjacent to the tubulocystic renal cell carcinoma. In 2 cases, tumor invaded perirenal tissue. The third case was organ confined with vascular invasion. One patient died 9 months postoperatively with metastases to the abdominal wall and femur. The second case developed a recurrence in the renal bed 3 years postoperatively. The third patient was lost to follow-up. Fluorescence in situ hybridization studies results showed some features overlapping with papillary renal cell carcinoma in both the tubulocystic and collecting duct-like components and with 1 exception showed identical cytogenetic findings between the 2 components. Morphologically, in 2 cases, the collecting duct-like areas were also indistinguishable from collecting duct carcinoma suggesting a relationship between the 2 entities. This is the first series and only the second report of tubulocystic renal cell carcinoma with poorly differentiated components and documents the increased the risk of aggressive behavior above that of usual tubulocystic renal cell carcinoma.

Cystic tumors of the pancreas: imaging and management

Cystic tumors of the pancreas are a subset of rare pancreatic tumors that vary from benign to malignant. Many have specific imaging findings that allow them to be differentiated from each other. This article (1) reviews the imaging features of the common cystic pancreatic lesions, including serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, and solid pseudopapillary tumor, and including the less common lesions such as cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas; and (2) provides comprehensive algorithms on how to manage the individual lesions, with recommendations on when to reimage patients.

Mammary analog secretory carcinoma of salivary gland origin with the ETV6 gene rearrangement by FISH: expanded morphologic and immunohistochemical spectrum of a recently described entity

Mammary analog secretory carcinoma (MASC) is a recently described tumor predominantly arising in the parotid gland. These tumors represent locally invasive malignancies with microcystic architecture, low-grade nuclei, and granular pink vacuolated cytoplasm. They display strong vimentin and S100 positivity and harbor an identical t(12;15)(p13;q25) to their breast counterpart, leading to a ETV6-NTRK3 fusion oncogene. These features help exclude the most important differential diagnostic considerations, namely, acinic cell carcinoma (AciCC) and low-grade cystadenocarcinoma, not otherwise specified. Here we present a series of 7 recent examples of MASC, which showed features not previously described. These 7 cases were observed in patients ranging in age from 14 to 77 years (mean, 40 y), occurred almost exclusively in male patients (6:1), and showed >50% (4 of 7 cases) involvement of the oral cavity, with only 2 arising in the parotid. The remaining case is the first reported in the submandibular gland. The tumors showed a variety of patterns including single macrocysts, combined macrocystic and microcystic spaces, and solid architecture. They showed prominent hobnailing in the cystic areas. Secretions within the cysts and tubular areas tended to be positive for periodic acid schiff, periodic acid schiff diastage and mucicarmine, the latter also showing occasional intracytoplasmic mucin droplets, a feature not previously recognized. One case showed prominent mucinous differentiation, which, coupled with high-molecular-weight keratins (HMWK) positivity, mimicked mucoepidermoid carcinoma (MEC). The tumors were generally positive for HMWK (6 of 7), S100 (5 of 7), vimentin, CK19, and other epithelial markers. The finding of duct involvement, proven with an incomplete p63-positive basal layer surrounding a minority of tumor cell nests and cysts, raised the possibility of a ductal epithelial origin for MASC. Alternatively, this could represent secondary ductal involvement by tumor. All cases showed rearrangement of the ETV6 gene by fluorescence in situ hybridization, confirming the diagnosis of MASC. These findings reinforce MASC as a unique low-grade salivary gland tumor entity with morphologic overlap with AciCC, MEC, and cystadenocarcinoma.

Syringocystadenoma papilliferum: Unusual location

Syringocystadenocarcinoma papilliferum (SCAP) is rare. We describe a 55-year-old man with a partially eroded lesion on the trunk that developed over one year. Histopathological examination revealed syringocystadenoma papilliferum. A wide excision was performed to remove the tumor. The patient has been well without relapse or metastasis for 8 months.

Abnormal cervical cytology in the diagnosis of uterine papillary serous carcinoma: earlier detection of a poor prognostic cancer subtype?

OBJECTIVE

Early detection of uterine papillary serous (UPSC), clear cell (CCC), and grade 3 endometrioid carcinomas (G3EC) - all poor prognostic variants of endometrial carcinoma (EC) - is of particular clinical relevance. The study objective was to assess the utility of liquid-based cytology (Pap) in the detection of high-grade EC.

STUDY DESIGN

A retrospective, two-institution analysis of patients diagnosed with UPSC, CCC, or G3EC with a preoperative Pap from 1999 to 2010 was conducted.

RESULTS

One hundred and one patients were evaluated; 51.5% had UPSC, 27.7% had CCC, and 20.8% had G3EC. Stage I/II disease was found in 69.3% of patients, and 46/101 patients (45.5%) had abnormal Paps. Significantly more patients with UPSC had abnormal Paps (65.7%) than those with CCC (25%) or G3EC (23.8%; p < 0.001). An abnormal Pap was the only presenting clinical finding in a significant number of asymptomatic UPSC patients (26.9%) compared with 4% of patients with CCC and G3EC (p = 0.005). On multivariate analysis, UPSC histology was the only variable associated with an abnormal Pap.

CONCLUSIONS

A high incidence of abnormal cervical cytology was observed in women with high-grade EC, particularly in UPSC patients. Although hypothesis generating, a proportion of asymptomatic UPSC patients had abnormal cytology, signifying that Pap smear screening may help detect the disease before the patient develops symptoms.

HMGA2: a biomarker significantly overexpressed in high-grade ovarian serous carcinoma

Ovarian carcinoma consists of a group of histologically heterogeneous diseases involving distinct tumorigenic pathways. High-grade papillary serous carcinoma of the ovary is commonly associated with p53 mutations. HMGA2, an oncofetal protein, is found to be overexpressed in ovarian cancer. To study the function of HMGA2 in ovarian cancer, it is important to know which subtypes of ovarian cancer are associated with HMGA2 overexpression. In this study, we collected six different types of ovarian cancer and examined HMGA2 expression by immunohistochemistry, along with HMGA1, p53 and Ki-67. We found that HMGA2 overexpression was significantly higher in high-grade papillary serous carcinoma (64%) and carcinosarcoma (60%) than in other types of ovarian cancers (7-23%). HMGA2 overexpression was moderately associated with dominant p53 mutations (R=0.51). In addition, the microRNA in situ analysis revealed that let-7b, the HMGA2-negative regulators, were significantly lost in high-grade serous carcinoma. Our findings suggest that HMGA2 is an important molecular change significantly related to high-grade papillary serous carcinoma and is less common in other histological types of ovarian cancer.

Hepatobiliary mucinous cystadenoma and cystadenocarcinoma: report of six cases and review of the literature

BACKGROUND/AIMS

The aim of this investigation was to describe the clinical features, diagnosis, pathologic characteristics, and optimal surgical management for patients with mucious hepatobiliary cystadenomas (HBCAs).

METHODOLOGY

From 2005 to 2008, our institutional experience for treating six patients with HBCAs was reviewed and reported. The clinical features, radiological characteristics and management were analyzed retrospectively.

RESULTS

Two of six patients were respectively misdiagnosed as hydatid cyst and simple cyst pre-operatively. The histopathologic examination showed HBCA in four patients and hepatobiliary cystadenocaiconoma (HBCAC) in two patients. Three HBCA patients and two HBCAC patients had undergone total excision treatment. In a median of 37.5 months follow-up visit, four have no evidence of recurrence and one HBCAC patient experienced a recurrence 31 months after surgery. Another HBCA patient who underwent fenestration initially with subsequent recurrence, died 15 months after the therapy.

CONCLUSIONS

Owing to its potential for malignant transformation into HBCAC, along with the consideration that it tends to recur after incomplete resection, radical excision treatment with adequate surgical margins is regarded as the most suitable mode of therapy for the HBCA.

Cystadenocarcinoma of the appendix: an incidental perioperatory finding in a patient with adenocarcinoma of the ascending and sigmoid colon: case report and review of literature

BACKGROUND

Primary adenocarcinomas of the appendix are uncommon, constituting 1% of all colorectal malignancies. Appendiceal malignancies often present atypically, thus creating diagnostic challenges. Although there are many pathology reports of primary cystadenocarcinoma of the appendix, only a limited number of cases have appeared in the radiological or surgical literature. We present a unique case of primary cystadenocarcinoma of the appendix occurring concurrently with adenocarcinoma of the colon, and overview the clinical and therapeutic difficulties posed by this rare entity.

CASE PRESENTATION

A mucocele of the appendix, due to mucinous cystadenocarcinoma, was documented as an incidental perioperatory finding in a 68-year-old female. The patient was admitted due to rectal haemorrhage and underwent colonoscopy with biopsy, X-ray, abdominal ultrasonography and CT scan. Degenerated adenomatous polyp of the ascending colon and mucinous adenocarcinoma of the sigmoid colon invading the parietal peritoneum of the uterine and vagina was diagnosed. At laparoscopy, a cystic appendiceal lesion was found, without perforation. The patient underwent right hemicolectomy, sigmoidectomy and hysterectomy associated with salpingo-oophrectomy.

CONCLUSIONS

Preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management, but is difficult to reach by imaging studies alone. Synchronous colon cancer may occur in patients with appendiceal mucoceles. In such patients, the colon should be investigated. Surgery is the recommended method of treatment.

Biliary cystadenoma and cystadenocarcinoma of the liver: 10 cases of a single center experience

BACKGROUND/AIMS

Biliary cystadenoma and cystadenocarcinoma constitute less than 5% of intrahepatic cysts originating from the bile duct. The aims of this study were to characterize the clinical and pathologic aspects of these lesions, and also to discuss the treatment and prognosis of them.

METHODOLOGY

We reviewed the clinical records of six patients with intrahepatic biliary cystadenoma and four patients with cystadenocarcinoma who had undergone operation from January, 1990 to January, 2006 at Hanyang University Medical Center.

RESULTS

Biliary cystadenoma mainly affected women compared to biliary cystadenocarcinoma. Both tumor have nonspecific symptom and were usually diagnosed by computed tomography and ultrasonography. These tumors were usually large, multilocular, and cystic in appearance. The pathologic findings revealed multiple cystic masses lined with cuboidal to columnar epithelium. The nature of cystic fluid was mostly mucous type. Of 10 patients in whom the lesions were completely excised, 8 patients are alive.

CONCLUSIONS

Surgical resection of the tumor, including a margin of surrounding normal liver parenchyma, was the only curative method. Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. Complete resection of a biliary cystadenoma and radical resection of a biliary cystadenocarcinoma seems to offer a chance for long-term survival.

[Expression of ZNF217 in human ovarian cystadenocarcinoma and its clinical significance]

OBJECTIVE

To explore the correlation of ZNF217 expression to the carcinogenesis and progression of human ovarian cancer.

METHODS

Immunohistochemistry and real-time RT-PCR were used to detect ZNF217 expression in human ovarian cystadenocarcinoma, ovarian cystadenoma and normal ovary tissues.

RESULTS

The expression levels of ZNF217 protein and mRNA in ovarian cystadenocarcinoma was significantly higher than those in matched ovarian cystadenoma and normal tissues (P<0.05). No significant difference was found in the expression between ovarian cystadenoma and normal ovarian tissues (P>0.05). The mRNA expression in the specimens was consistent with the protein expression of ZNF217 (P<0.05).

CONCLUSION

ZNF217 gene expression is closely correlated to the occurrence and clinical stages of ovarian carcinomas, suggesting that ZNF217 can be an important candidate gene responsible for the occurrence and progression of ovarian carcinomas.

[Effects of ARLTS1 gene on growth and apoptosis of epithelial ovarian cancer SKOV3 cells]

OBJECTIVE

To investigate the effect of ARLTS1 (ADP-ribosylation factor-like tumor suppressor gene 1) on the growth and apoptosis of ovarian cystadenocarcinoma cell line SKOV3.

METHODS

The recombinant plasmid pCMV-Tag 3B-ARLTS1 was constructed and transfected into SKOV3 cells by liposome protocol. The expression of ARLTS1 mRNA and its protein were examined by RT-PCR and Western blotting. Effects of ARLTS1 gene on growth and apoptosis of the transfected cells were evaluated by MTT assay and flow cytometry (FCM). The alterations of caspase-3 and bcl-2 protein levels were examined by Western blotting.

RESULTS

The stable transfection of pCMV-Tag 3B-ARLTS1 in SKOV3 cells were obtained and verified by RT-PCR and Western blotting methods. After transfected with ARLTS1, more SKOV3 cells were observed in S phase by FCM compared with those in the other two groups (P is 0.035 and 0.011, respectively). The 36.7% apoptotic index of ARLTS1 transfected cell was significantly higher than that of the other two groups (P < 0.001). The growth of ARLTS1 transfected cells was dramatically inhibited compared with cells transfected with Vector (P < 0.05). Western blotting indicated a significantly decrease in caspase-3 and bcl-2 protein levels in cells transfected with ARLTS1 compared with SKOV3 cells (P is 0.021 and 0.013, respectively).

CONCLUSION

ARLTS1 transfection can inhibit proliferation and induce apoptosis of SKOV3 cells in vitro and down-regulate the expression of caspase-3 and bcl-2. ARLTS1 gene may be a candidate tumor suppressor gene in ovarian cancer.

Paratubal endometrioid cystadenocarcinoma: case report and review

BACKGROUND

Paratubal masses are common, but paratubal carcinoma is an extremely rare entity.

CASE

We report a case of a 44-year-old nulliparous female who suffered from abdominal pain for three months. Abdominal and pelvic ultrasound revealed a 30 cm left adnexal mass originally. Laparotomy with bilateral salpingo-oophorectomy was performed. Final pathology indicated a heterogeneous tumor with benign, borderline, and endometrioid carcinoma areas. A repeat surgery was decided in order to complete hysterectomy, omentectomy, pelvic and paraaortic lymphadenectomy. Surgical staging did not reveal residual disease at pathological examination. After 36 months of follow-up, no recurrence has occurred.

CONCLUSION

To our knowledge, no case of paratubal invasive endometrioid adenocarcinoma has previously been described. This case has been managed according to the recommendations of ovarian cancer, which seems to be an acceptable option.

Predicting success of endoscopic aspiration for suspected pancreatic cystic neoplasms

CONTEXT

Analysis of pancreatic cyst fluid can play a role in the management of asymptomatic cystic neoplasms.

OBJECTIVE

Our aim was to determine whether cyst size or location can predict the success of cyst fluid collection and analysis.

DESIGN

Review of prospective management protocol.

SETTING

Tertiary care referral center.

PATIENTS

Three-hundreds and 70 patients with suspected pancreatic cystic neoplasms evaluated over 6 years.

INTERVENTIONS

Endoscopic ultrasound aspiration for up to 3 variables: cytology including extracellular mucin, CEA, and amylase.

MAIN OUTCOME MEASURES

The number of variables obtained were compared with cyst size and location.

RESULTS

The distribution of unilocular cystic lesions was: 125 (33.8%) head, 105 (28.4%) tail, 77 (20.8%) body, 37 (10.0%) uncinate and 13 (3.5%) multiple cysts. In addition, 13 (3.5%) patients had uncertain cyst location. There was no association between cyst location and number of variables obtained (P=0.148). An aspirate was obtained in 284 patients (76.8%) with a mean volume of 8.3 mL. There was a significant correlation between cyst size and volume aspirated (P<0.001). The number of variables obtained was significantly correlated with cyst size (P<0.001): 3 variables were obtained in 109 out of 284 (38.4%) with a median size of 3.0 cm. Logistic regression curves predict likelihood of success based on cyst size. An unsuccessful attempt at EUS aspiration for cysts occurred in 31 of the 284 cases (10.9%) with a median size of 1.5 cm.

CONCLUSIONS

Successful endoscopic ultrasound aspiration of pancreatic cysts is independent of cyst location, but correlates with size, which can be useful in deciding which patients should undergo endoscopic ultrasound and aspiration.

[Cystic neoplasms of the pancreas]

BACKGROUND

Cystic neoplasms of the pancreas represent between 5% and 10% of all pancreatic tumors. Due to their malignant potential, surgery is indicated. Because of the uncommon nature of this pathology, the aim of this study was to present a series of six patients who were operated on for a cystic tumor and to analyze the morphological characteristics, surgical experience and follow-up.

METHODS

This was a retrospective study. Clinical files were studied, as well as surgical and pathological registries from patients diagnosed with cystic neoplasms of the pancreas. Five females and one male were included with a mean age of 54 +/- 15 years. The main symptom was abdominal pain.

RESULTS

Clinical course and CT scan results were the criteria for suspecting the diagnosis. In 4/6 patients, the tumor was located within the body and tail of the pancreas. The most frequent intervention was distal pancreatectomy. There was no mediate operative mortality in a 30-day period. Histopathological diagnoses were three serum cystadenomas, two mucinous cystadenomas and one cystadenocarcinoma. After a 4-year follow-up, no tumor recurrences have been reported in the surviving patients.

CONCLUSIONS

The natural history of cystic neoplasms of the pancreas is generally benign, but complications may occur by direct invasion of neighboring structures. Clinical course, tomography, pancreatography and punction are fundamental for its treatment.

[Expression of COP9, JAK2, HSP and NADH in ovarian carcinoma tissues after taxol-chemotherapy and their significance]

OBJECTIVE

To study the expression of COP9, JAK2, HSP and NADH genes in ovarian carcinoma tissues after taxol-chemotherapy and their significance.

METHODS

The up-regulated genes of JAK2, HSP, NADH and the down-regulated gene of COP9, which were revealed by micro-array from our previous study were examined by RT-PCR and real-time-PCR in 33 cases of ovarian cancer who previously received taxol-based chemotherapy (group 1), and 21 cases of ovarian cancer who never received chemotherapy before operation (group 2).

RESULTS

The expression rate of COP9 gene in group 1 was detected markedly lower than that in group 2 (39% vs 95%, P < 0.01); whereas the expression rates of JAK2, HSP and NADH in group 1 were significantly higher that those in group 2 (91%, 97%, 94% vs 29%, 48%, 43%; all P < 0.05). And the expression of COP9, HSP and NADH genes had no significant differences among histological grades. However, a significantly higher expression of JAK2 gene was seen in grade 3 than in grade 1-2 (P < 0.01). No significant difference in the expression rates of the 4 genes was seen among various tumor types or chemotherapy courses (P > 0.05). Real-time PCR showed that the level of COP9 gene copies of group 1 was significantly lower than that of group 2 (568, 1866 respectively; P < 0.05). However, HSP, JAK2 and NADH genes had significantly higher copy numbers in group 1 than in group 2 (5766, 7653, 3200 in group 1 and 3341, 3094, 1522 in group 2, respectively; all P < 0.05). In the subgroup that received 6-10 chemotherapy courses, the copy concentrations of JAK2, HSP, NADH genes were higher than those in the subgroup that received 2-4 chemotherapy courses (all P < 0.05). In addition, we found a higher copy concentrations of JAK2, HSP, NADH genes in grade 3 than in grade 1-2 (all P < 0.05). Though no significant differences in gene copy concentrations of the 4 genes were seen among variable tumor types. In stage IV, the copy concentrations of HSP and NADH genes were higher than those in stage III (P < 0.01, P < 0.05 respectively), but the copy concentrations of COP9, JAK2 genes had no significant differences (both P > 0.05). There were positive correlations among JAK2, HSP and NADH genes (r = 0.56, 0.44, 0.57 respectively, all P < 0.01). COP9 gene was found to have a negative correlation with JAK2 gene (r = -0.48; P < 0.01), but not with HSP and NADH genes (r = -0.18, -0.06, respectively; both P > 0.05).

CONCLUSION

The down-regulation of COP9 gene and up-regulation of JAK2, HSP, and NADH genes are related to the mechanism of drug-resistance in ovarian cancer.

Papillary cystadenoma and cystadenocarcinoma of salivary glands: two unusual entities

Cystadenoma and cystadenocarcinoma are rare salivary gland tumours histologically characterized by prominent cystic and frequently papillary growth. We present two cases of cystadenoma of a minor salivary gland (upper lip) and parotid cystadenocarcinoma respectively, captured between 834 salivary gland tumors studied in our hospital from 1980 to 2004. The authors review the clinical, histological, and biological features of these two unusual tumours, and differential diagnosis with other salivary glands neoplasms. Both entities usually reveal papillary proliferation of the epithelial lining and are composed of cells that possess bland cytomorphologic features. Differentiation of tumour types depends largely on the identification of actual infiltration of salivary gland parenchyma or surrounding connective tissue by either cystic or solid epithelium in cystadenocarcinomas. Step sections of a borderline tumour may yield unequivocal evidence of invasion. The authors discuss the problematic diagnosis between these rare neoplasms and with other tumours and compare histological findings of these two entities.

Cystic tumors of the liver: a practical approach

Biliary cyst tumors (cystadenoma and cystadeno-carcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver, but differential diagnosis with multiloculated or complicated biliary cysts, atypical hemangiomas, hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography (CT) and magnetic resonance imaging (MRI) are often not diagnostic and in these cases fine needle aspiration (FNA) is used to confirm the presence of atypical biliary cells. FNA, however, lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation of cystadenoma from cystadenocarcinoma is impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma, it is important to exclude liver metastasis, of which colonic cancer is the most common primary site. Multiple biliary hamartomas (von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic, but occasionally a percutaneous biopsy may be required.

Expression of MTA2 gene in ovarian epithelial cancer and its clinical implication

In order to investigate the roles of MTA2 in the pathogenesis of ovarian epithelial cancer, the expression of MTA2 in 4 ovarian cell lines were detected by semi-quantitative RT-PCR and Western-blot assays. MTA2 expression in normal, borderline, benign and malignant epithelial ovarian tissues was immunohistochemically examined. The expression of MTA2 mRNA and protein was detected in all of 4 cell lines of ovarian epithelial cancer. The expression of MTA2 mRNA and protein was higher in strong migration cell lines than in weak migration ones. In borderline and malignant ovarian tissues tested, MTA2 staining was dramatically stronger than in normal and benign tissues (P < 0.01). The expression levels in malignant ovarian tissues were significantly higher than that in borderline epithelial ovarian tissues (P < 0.01). The expression of MTA2 was correlated with clinical stage, histopathological grade and lymph node metastasis. It was concluded that the high expression of MTA2 was associated with more aggressive behaviors of epithelial ovarian cancer. MTA2 provides a novel indicator of ovarian cancer.

Nonhepatocytic malignant mixed tumor of the liver in adults: report of a long surviving case

A primary nonhepatocytic malignant mixed tumor in the liver contains both epithelial and mesenchymal components, and the incidence in adults is extremely rare. A 45-year-old female was admitted because of abdominal fullness. Abdominal imaging studies revealed a huge cystic tumor with a mural nodule in the right lobe. A right trisegmentectomy and an invaded partial diaphragm resection were performed. Diagnosis was established after surgery. The patient is still alive 11 years after surgery, and to our knowledge is the longest surviving patient with a primary nonhepatocytic malignant mixed primary tumor of the liver.

Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer

BACKGROUND

Epithelial ovarian cancer presents at an advanced stage in the majority of patients. These women require chemotherapy and surgery for optimal treatment. Conventional treatment is to perform surgery first and then give chemotherapy. However, it is important to determine whether there is any advantage to using chemotherapy prior to surgery.

OBJECTIVES

To assess whether there is an advantage to treating women with advanced epithelial ovarian cancer with chemotherapy prior to debulking surgery (neoadjuvant chemotherapy) compared with conventional treatment where chemotherapy follows maximal debulking surgery.

SEARCH STRATEGY

RCTs were identified by searching The Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2006), MEDLINE (Silver Platter, from 1966 to 1st Sept 2006), EMBASE via Ovid (from 1980 to 1st Sept 2006), CANCERLIT (from 1966 to 1st Sept 2006), PDQ (search for open and closed trials) and MetaRegister (most current search Sept 2006).

SELECTION CRITERIA

Women with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians (FIGO) stage III-IV); randomized allocation to treatment groups which compared platinum-based chemotherapy before debulking surgery with platinum-based chemotherapy following debulking surgery.

DATA COLLECTION AND ANALYSIS

Data were extracted by three independent authors, and the quality of included trials was assessed by three independent authors.

MAIN RESULTS

One RCT was identified as meeting the inclusion criteria. This trial randomized 85 women and compared standard debulking surgery followed by eight cycles of platinum-based chemotherapy with pre-operative intra-arterial platinum-based chemotherapy and ovarian artery embolization followed by debulking surgery and seven cycles of platinum-based chemotherapy. There was no statistical difference in median overall survival (OS) between the two treatment groups. Three on-going RCTs were identified and their results are awaited.

AUTHORS' CONCLUSIONS

There is as yet no good evidence that neoadjuvant chemotherapy prior to debulking surgery for women with advanced epithelial ovarian cancer is superior to conventional debulking surgery and platinum-based chemotherapy.

Cystic neoplasms of the exocrine pancreas

The increasing use of radiological imaging has led to greater detection of small and asymptomatic cystic lesions of the pancreas. Most are resectable, but not all are neoplastic. This review provides an update on the histopathology, immunohistochemistry, molecular biology, pathogenesis and management of cystic neoplasms of the exocrine pancreas. These include the serous, the mucinous cystic, the intraductal papillary mucinous and the solid pseudopapillary neoplasms. Recently reported variants are described and very rare cystic variants of other pancreatic epithelial and mesenchymal neoplasms are briefly mentioned.

[Diagnosis and treatment of intrahepatic biliary cystadenocarcinoma-a report of 11 cases]

BACKGROUND & OBJECTIVE

Intrahepatic biliary cystadenocarcinoma (IBC) is a rare intrahepatic malignant tumor which is scarcely reported, and there is relatively little experience in the diagnosis and treatment. This study was to analyze the clinicopathologic features, diagnosis, and treatment of IBC.

METHODS

Clinical data of 11 patients with pathologically confirmed papillary IBC, treated between Mar. 1999 and Oct. 2006 with surgical operation in West China Hospital, were analyzed retrospectively. Of the 11 patients, 2 were men and 9 were women, with a median age of 54 (range 45-68).

RESULTS

The chief complaints of the IBC patients were pain and distention in the epigastrium. Four cases were determined by immunohistochemistry, and showed cytokeratin 7 (CK7) expression. Four patients showed infiltration of carcinoma cells in the surrounding liver tissues; 3 of them received palliative hepatectomy and 1 received radical excision; they survived for 12-23 months. The rest 7 showed carcinoma cells confined to the cyst wall, and received radical excision; 3 of them survived for over 3 years; of the rest 4 patients, 1 received operation again 10 months later because of tumor recurrence and was still alive 14 months after the second operation, 1 suffered from intrahepatic multi-metastasis 12 months after operation and received expectant treatment, 1 suffered from ascites 15 month after operation and died without further treatment, 1 was lost during follow-up.

CONCLUSIONS

IBC occurs mainly in elder women, and its malignant degree is lower than that of solid carcinoma. The prognosis of the patients with IBC confined to the cyst wall after complete tumor removal is better than that of the patients with IBC infiltrated into the liver.