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Multicentric giant cell tumor is a rare variant of giant cell tumor. In this case, we report a case of a 15-year-old female patient with synchronous type of multicentric giant cell tumor.
BACKGROUND: Both alcohol consumption and cigarette smoking are risk factors for esophageal cancer. The purpose of this study was to clarify whether the fragile histidine triad (FHIT) is their target gene in esophageal carcinogenesis as well as in multicentric carcinogenesis. PATIENTS AND METHODS: The expression of FHIT was immunohistochemically examined in the squamous cell carcinoma as well as in the normal esophageal epithelium of 55 cases with esophageal cancer. RESULTS: The median drinking indices (DIs) were 546 and 1092 (p<0.01) in cases with positive FHIT expression and those with a diminished expression in the esophageal epithelium, respectively. Furthermore, the incidences of intra-esophageal multiple cancer were 44% and 13%, respectively (p<0.05). Regarding the expression in cancer lesions, the median DIs were 280 and 721 in positive and diminished cases, respectively (p=0.081). CONCLUSION: A loss of FHIT expression is associated not only with alcohol-induced esophageal carcinogenesis, but also with multicentric carcinogenesis.
We report a case of Ki-1 lymphoma that developed in a 16-year-old youth who had suffered from multicentric reticulohistiocytosis for 10 years. Over the past 3 years he had had a peculiar sclerosing lesion of the leg for which oral prednisone 5 mg daily was tried for one year, with a moderate effect. He developed a marked swelling of the inguinal lymphadenopathy on the same side as the affected leg lesion, which also developed a prominent swelling of the skin surrounding the sclerosed area. Immunohistochemical analysis of the lymph node biopsy revealed the features of Ki-1 lymphoma. This is the first case of association of multicentric reticulohistiocytosis with Ki-1 lymphoma.
A 49-year-old woman with primary Sjögren's syndrome a few years previously was admitted to our hospital complaining of tongue and skin eruptions, swelling of the face and neck and for examination of liver injury and hypereosinophilia. A blood test revealed leukocytosis with eosinophilia, mild liver injury, polyclonal hypergammaglobulinemia, and positive results for anti-nuclear antibody, anti-SS-A antibody and anti-SS-B antibody. Chest CT scan showed multiple nodular opacities with cavities in peripheral regions of both lungs. Biopsy specimens from the right lower lobe obtained by video-assisted thoracoscopy revealed marked infiltration of plasma cells and lymphocytes in alveolar lumina, lymph follicles with germinal centers in other areas of the pulmonary parenchyma, and lymphocytes infiltrate in alveolar wall adjacent bronchi and bronchioles. The histological diagnosis was pulmonary involvement of multicentric Castleman's disease. This was a rare case of Sjögren's syndrome accompanied by pathological findings of multicentric Castleman' s disease showed multiple nodular opacities in chest CT scans.
Multicentric tumours (MT) represent a potential limit to the treatment by conservative surgery of cancer of the breast. In order to determine which anatomical-clinical features of breast cancer would indicate the highest risk of MT, we studied 100 patients with MT and 452 patients with unicentric tumours (UT), all of whom had been subjected to radical mastectomy during the period 1980 to 1988. Statistical analysis showed a significant difference between the two groups of parameters for bilateral breast cancer (with regard both to metachronous and synchronous lesions), for primary tumours of over 2 cm in size, for both lobular and invasive ductal histotypes and for involvement of the nipple-areola complex. Therefore, if the indications in favour of conservative surgery are applied accurately in combination with radiation therapy, the clinical and biological significance of multicentricity is minimized.
Multiple foci of osteosarcoma are found in several pathological conditions: skip metastases, late bone metastases from osteosarcoma, so called metachronous osteosarcoma and multicentric osteosarcoma. The authors describe five cases with multicentric osteosarcoma of the skeleton. These lesions differ from classic osteosarcoma for their clinical and radiographical features. They generally arise in younger patients and are always sclerotic on X-rays and histological evaluation. Our data, as reported in literature, underline the poor prognosis of this disease.
A multicentre evaluation of the blood gas-electrolyte-haematocrit-analyser BGE (Fa. Instrumentation Laboratory), following as far as possible the ECCLS guidelines for multicentre evaluation of blood gas analysers, was performed by three laboratories. The rules of the evaluation protocol were extended to the electrolyte and haematocrit determinations. The BGE proved to be easy to operate and maintain. The stability of the measuring system was good. The within-run imprecision of all electrodes was excellent. The same applies to the between-day imprecision, except for the calcium measurements. The systematic deviation of the gas electrodes was very small. Comparison studies revealed clinically significant deviations only for ionized calcium. Some suggestions for further improvements are made.
Multicentric pigmented Bowen's disease (MPBD) is a bowenoid atypia in the genitocrural region with peculiar clinical appearances. A 36-year-old Japanese female patient showed a variety of lesions. Clinically the lesions on the external genitalia consisted of brown-black papillomatous eruptions, black discrete or confluent papules, and whitish macerated papules. Histologically only black papules showed bowenoid atypia, but whitish papules also showed transient bowenoid atypia. Electron microscopically, in all three kinds of the lesions, spherical particles with a diameter of about 50 nm were scattered or gathered together in the nuclei of the keratinocytes beneath the horny layer. These particles were morphologically similar to human papilloma virus. Based upon clinical, histologic and electron microscopic observations, MPBD may be regarded as a new entity, and a term such as multicentric pigmented viral papulosis may be rather preferable than MPBD.
A case study of multicentric reticulohistiocytosis is presented with extensive immunohistochemical studies of the infiltrate in both paraffin and cryostat sections. These studies showed that the cells are of monocyte/macrophage origin. B- and T-cell gene rearrangement analysis of multicentric reticulohistiocytosis was also performed and showed a germline configuration.
A mathematical model of the growth of multicentrical tumors under conditions of the tumor cells interactions with cytotoxic T-lymphocytes (CTL), natural resistant factors and cells and migration CTL between tumor focuses is presented. For any finite number of the tumor focuses at the comparatively low intensity migration of CTL the dynamic stability conditions among multicentrical tumors and the immune system were obtained.
Light-microscopic, immunohistochemical, and ultrastructural studies were performed on biopsy material from 15 young homosexual men with AIDS-associated mucocutaneous Kaposi's sarcoma; 19 Kaposi's sarcoma lesions in different developmental stages were investigated. These lesions showed multicentrically arising and proliferating vascular endothelia forming thick-walled and thin-walled capillaries and larger vessels, as well as spindle-shaped cells forming fascicles and bundles around them. Different amounts and organization of these two major cellular components were found in all stages of evolution of Kaposi's sarcoma lesions. Immunohistochemical and electron-microscopic techniques suggested that the spindle-shaped cells were of pericyte origin in different stages of maturation or, more rarely, lymphatic endotheliocytes. The skin lesions of AIDS-associated Kaposi's sarcoma occurred as a result of multicentric angioneoplasia of rather slow progression, together with the proliferation of pericyte-like mesenchymal cells, possibly representing a stromal reaction to the vascular proliferation. Both blood and lymphatic vessels seemed involved in this process. In early stages, scattered lymphocytic infiltration was an additional feature. Mitotic figures and cytologic atypia were not seen more frequently in early AIDS-associated Kaposi's sarcoma than in proliferating granulation tissue.
Meetings between investigators participating in multicentre clinical trials are rarely held. Evidence is presented from a computerised system of multicentre trial management that there are advantages to both physicians and companies in improving communication and holding regular meetings.
As part of a European multicentre prospective study involving the measurement of a number of haemostatic factors, a quality assessment (QA) scheme was organized. This paper describes the preparation, design and results of the first QA exercise, involving 16 European laboratories and 10 haemostatic assays. The design allowed the investigation, for each assay, of the variability between duplicates and the variability between days within each centre, and of the agreement between centres. A graphical presentation of each centre's performance in comparison to that of others was adopted, which preserved the confidentiality of each centre's results. The factor VIII clotting activity assay (VIII:C) and the rocket immuno-electrophoresis assays of von Willebrand factor related antigen (vWF R:Ag), antithrombin III, protein C and histidine-rich glycoprotein showed the highest between-duplicate and between-day coefficients of variation (CVs), whereas the clotting assays of activated partial thromboplastin time and fibrinogen had the lowest CVs. CVs for the enzymatic assays using synthetic substrates of antithrombin III, plasminogen and alpha-2-antiplasmin were between these extremes. The between-centre CVs were high for both the VIII:C and vWF R:Ag assays. The QA exercise showed that, in multicentre studies involving the measurement of haemostatic factors, it is feasible to undertake analysis locally at each centre.
A 10-wk-old girl with growth failure and increasingly severe watery diarrhea underwent rectal biopsy which revealed diffuse mucosal fibrosis. Subsequent histologic study of mediastinal and subcutaneous masses established the diagnosis of multicentric infantile myofibromatosis. The patient died at 16 wk of age with tumor nodules in several visceral and parietal structures. The small and large intestines contained continuous, diffuse and nodular, mucosal and submucosal fibrosis. Twelve previously reported cases of multicentric infantile myofibromatosis involved the gastrointestinal tract; four had prominent gastrointestinal clinical manifestations. In two, diarrhea was prominent. The present case demonstrates the potential value of rectal biopsy in the diagnosis of infantile myofibromatosis with gastrointestinal manifestations.
We have described the case of a 73-year-old female patient affected by multicentric Castleman's disease and complicated by Kaposi's sarcoma. Histologically the specimens of nodal biopsy showed combined patterns, both the hyaline-vascular type and the plasma cellular one. We have discussed the relationship between classic Castleman's disease and the multicentric type and the meaning of its association with Kaposi's sarcoma. Both diseases may present in immunologically depressed patients, but it is unknown whether Kaposi's sarcoma is a consequence of immunologic alterations caused by Castleman's disease or whether both processes are due to a primitive disorder of immunologic regulating factors.
In the Department of Gynecology and Obstetrics 131 modified radical mastectomies were carried out in patients with invasive breast cancer eligible for breast conserving therapy between 1978 and 1981. The technique of plastination was used for the first time in a complete histological investigation of the breast specimens. In all cases segmental resections with a rim of crossly normal tissue around the primary of at least 2 cm were simulated. Residuals of the primary in vicinity of the resection margin were found in 19.1% and multicentric tumor foci in 24.4% of all cases in the remaining breast. In 8.4% of the patients the residuals extended more than 3 cm beyond the resection margin. The volumes of the residuals were significantly larger than the volumes of the multicentric foci (p = 0.004). According to these results a 2 cm rim of grossly normal tissue should be resected with the primary tumor. A reexcision is to be recommended in cases with resection margins that are histologically not free of tumors. Considering the difficulty of a total histologic examination of the whole resection margin a boost dose should be supplemented. The extension of the residuals requires a boost field covering one third up to one half of the normal sized breast.
Following lymphography, a 41-year-old woman developed arthritis and papules of multicentric reticulohistiocytosis three years after the beginning of a carcinoma of the cervix, now inoperable and with vulvar metastases. Two further inevitable x-ray investigations with different contrast media led to exacerbation of the disease within 24 hours. 12 month after onset, all symptoms of multicentric reticulohistiocytosis receded spontaneously, and further investigations with contrast media were well tolerated. We assume that iodine compounds may be the cause--directly or indirectly--for provocation and enhancement of histiocytic proliferation.
Human papillomavirus deoxyribonucleic acid (DNA) was identified by Southern blot hybridization in 21 of 24 patients with multicentric anogenital lesions and in 46 of 61 individual lesions. Type 6/11 was present in nine patients, type 16 in one, an undetermined type in one, and more than one type in ten patients. Mixed types were present in eight of 46 virus-positive individual lesions. Abnormal mitotic figures were found in 16, 87, and 75% of lesions associated with type 6/11, type 16, and mixed types, respectively. Colposcopic presentation or location of lesions was not predictive of viral types. The relatively high rate of mixed human papillomavirus types in multicentric lesions and in single lesions, and the lack of absolute correlation between viral types and abnormal mitotic figures, suggest that lesions should be removed to prevent viral transmission and possible progression to carcinoma.