Solid Pseudopapillary Tumor of the Pancreas in a 25-Year-Old Female: A Rare Entity of Pancreatic Tumors

Solid pseudopapillary neoplasms (SPMs) of the pancreas are extremely rare tumors of the pancreas that typically affect young women and have a favorable prognosis. Herein, we report a 25-year-old female with solid pseudopapillary tumor of the pancreas who presented with atypical epigastric pain. The patient underwent pancreatoduodenectomy (Whipple procedure). She remained asymptomatic and showed no signs of disease after one year of follow-up. This type of pancreatic tumors is amenable to cure after complete surgical resection, even in cases with capsular invasion, unlike any other malignant tumors of the pancreas.

Inherited SLP76 deficiency in humans causes severe combined immunodeficiency, neutrophil and platelet defects

The T cell receptor (TCR) signaling pathway is an ensemble of numerous proteins that are crucial for an adequate immune response. Disruption of any protein involved in this pathway leads to severe immunodeficiency and unfavorable clinical outcomes. Here, we describe an infant with severe immunodeficiency who was found to have novel biallelic mutations in SLP76. SLP76 is a key protein involved in TCR signaling and in other hematopoietic pathways. Previous studies of this protein were performed using Jurkat-derived human leukemic T cell lines and SLP76-deficient mice. Our current study links this gene, for the first time, to a human immunodeficiency characterized by early-onset life-threatening infections, combined T and B cell immunodeficiency, severe neutrophil defects, and impaired platelet aggregation. Hereby, we characterized aspects of the patient's immune phenotype, modeled them with an SLP76-deficient Jurkat-derived T cell line, and rescued some consequences using ectopic expression of wild-type SLP76. Understanding human diseases due to SLP76 deficiency is helpful in explaining the mixed T cell and neutrophil defects, providing a guide for exploring human SLP76 biology.

Management of malignant and borderline phyllodes tumors of the breast: our experience

PURPOSE

Phyllodes breast tumors (PT) range from benign lesions to malignant ones that may give distant metastasis. Preoperative diagnosis is difficult, while the treatment of borderline and malignant disease remains controversial.

METHODS

Eighteen patients in 3 clinics were included in the study. Lumpectomy with large margins was performed in 15 patients, while mastectomy was performed in 3 patients. Lymph node excision was carried out in 3 patients with malignant tumors. Radiation therapy (RT) was delivered after a second lumpectomy in cases of local recurrence. Chemotherapy was used only in 2 patients with aggressive recurrent tumors.

RESULTS

Borderline behavior was reported in 4 patients. Lumpectomy was performed in these cases, with local recurrence in 2 of them. Malignant behavior was reported in 14 patients. Lumpectomy was performed in 10 patients and mastectomy in 3. Local recurrence was reported in 5 cases and in 2 patients recurrence after a 2nd operation was also reported.

CONCLUSIONS

Borderline PT were treated conservatively and the prognosis was excellent, while malignant subtypes needed mastectomy in about 25% of the cases, The local recurrence rate was high, but the disease free survival (DFS) and the overall survival (OS) were also very high (94%).

Malignant Myoepithelioma of the Breast Clinically and Histologically Masquerading as Angiosarcoma: Cytological Findings and Review of the Literature

BACKGROUND

Malignant myoepithelioma of the breast is an exceptionally rare, aggressive tumor with a diverse morphology, the cytological features of which have only occasionally been described.

CASE REPORT

Our case comprises a 74-year-old woman who was admitted to our hospital with an erythematous, inflammatory-like mass of her left breast with nipple ulceration, and clinically fixed to the chest wall. The woman underwent fine-needle aspiration and biopsy. The aspirates consisted mainly of loose aggregates of large, highly pleomorphic, polygonal epithelioid cells as well as aggregates of spindle cells with prominent, easily detectable mitoses and single, multinucleated pleomorphic giant cells. The cytological diagnosis was consistent with high-grade malignancy. Histologically, the lesion consisted broadly of eosinophilic epithelioid cells with globoid cytoplasm in a reticulated, angiomatoid pattern and of spindle (sarcomatoid) cells in a storiform pattern, highly suspicious of angiosarcoma. A final diagnosis of malignant myoepithelioma was made.

CONCLUSION

We present the cytological findings in comparison with the unusual histological features of a malignant myoepithelioma of the breast. A high degree of suspicion with a keen eye for morphological details coupled with relevant immunohistochemistry will aid in arriving at the correct diagnosis.

Malignant myoepithelioma of the breast: A case report and review of the literature

Malignant myoepithelioma of the breast is an extremely rare tumor composed entirely or almost entirely of malignant spindle cells with myoepithelial differentiation. Only a limited number of case reports have been descibed to date; therefore the biological behavior and treatment outcomes of this rare tumor have not been clearly determined. Herein, we present a case of a 74-year-old woman who was admitted with inflammatory-like cancer of the breast, presenting with invasion of the chest wall and axillary lymph node metastasis at the time of diagnosis. The histological examination revealed a tumor composed of epithelioid and spindle cells with moderate to marked nuclear atypia, with foci of hemorrhage and necrosis. The tumor cells were immunoreactive for vimentin, p63, p53, CD10, cytokeratin (CK)8/18, CKAE1-3 and S-100. Finally, a diagnosis of myoepithelial carcinoma of the breast was established. Neoadjuvant chemotherapy was first administered and proved to be ineffective. Due to locoregional progression that was associated with the development of an abscess and subsequent excessive bleeding, a palliative mastectomy was performed. Postoperatively, one more cycle of systemic chemotherapy was administered. However, the patient experienced an early relapse to the chest wall and succumbed to septic shock due to persistent local infection. The aggressiveness and chemoresistance of the tumor in this case was consistent with the existing bibliography.

Primary thyroid lymphoma: The two ends of the spectrum

We describe two different cases of prinary thyroid lymphoma (PTL). PTL is a rare malignancy. Nevertheless, it frequently presents diagnostic and therapeutic challenges. The first patient, a 79-year-old female, presented with a large, painless thyroid mass accompanied by severe obstructive symptoms of the upper respiratory and gastrointestinal track. The second patient (67-year-old female) presented with nodular goiter. Thyroidectomy - performed on the first patient for alleviation of obstructive symptoms - revealed the presence of a diffuse large B-cell lymphoma. Although she was administered standard chemotherapy she deceased four months later. In the second patient, primary thyroid lymphoma was an incidental finding following thyroidectomy performed for nodular goiter. These two cases illustrate the variable course of PTL, the possibility of which should be kept into consideration in clinical practice.

An epidemic of acute postinfectious glomerulonephritis in Armenia

AIM

To evaluate the presentation and course of acute postinfectious glomerulonephritis (APGN), which has increased dramatically in Armenia after serious deterioration in the living conditions.

STUDY DESIGN

Observational study, based on case notes, of a large homogeneous group of patients hospitalised for APGN at one centre over a five year period (1992-6).

PATIENTS

474 patients aged < 16 years with a diagnosis of APGN.

RESULTS

The annual number of patients increased tenfold from 19 (average 1992/3) to 196 in 1995. Sixty two per cent were in the age group 4-9 years and 65% were boys. Upper respiratory infections, scarlet fever, and skin infections preceded APGN in 51%, 23%, and 13%, respectively. All patients had haematuria (93% gross), 84% had oedema, and 72% had hypertension. C3 was initially decreased in 95% of the patients examined. Renal function was impaired (serum creatinine > 100 mumol/l) in 29%. Four patients with renal failure had crescentic glomerulonephritis at biopsy; of these, three required temporary haemodialysis. Main extrarenal complications were heart failure (10%) and convulsions (3%). One patient died and five (3%) did not recover completely.

CONCLUSIONS

APGN in children is associated with considerable initial morbidity, and long term outcome is not uniformly benign. Outbreaks of APGN may occur anytime in countries such as Armenia that are suffering from a sudden decline in socioeconomic conditions.

The role of middle ear muscles in the development of resistance to noise induced hearing loss

The role of middle ear muscles (MEMs) in the development of increased resistance to noise induced hearing loss (NIHL) was studied using monaural chinchillas. Animals with severed MEMs as well as those with intact MEMs were exposed to an octave band noise (OBN) centered at 0.5 kHz at 95 dB for six hours/day for ten consecutive days. Results indicated that animals with severed MEMs showed greater initial threshold shifts (TS) than the animals with intact MEMs. Both the groups showed a decrease in TS over the ten days of exposure. The subjects were given five days of recovery and then re-exposed to the same noise at 106 dB for 48 h. Permanent threshold shifts (PTS) in each group was compared against those in a control group exposed to the noise only at the higher level. Interestingly, both the 'conditioned' groups incurred substantially less PTS than the control group exposed only to the higher level.

Aneurysms of the temporal bone

Aneurysms of the internal carotid artery in the temporal bone are rare lesions which can present clinically as a growth in the middle ear cleft. Hemorrhage, occurring spontaneously or iatrogenically, is a primary concern. This study describes morphological and embryological characteristics of the internal carotid artery in relationship to the protympanum and temporal bone. Concepts of pathogenesis and pathology are discussed, with reference to the neurosurgical and otolaryngologic literature. Clinical characteristics, including methods of surgical repair, are presented using three illustrative case reports. Methods of surgical repair include: 1) reinforcement; 2) ligation; and 3) primary excision and reanastomosis.