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PubMed2005

Distinguishing primary and metastatic conventional renal cell carcinoma from other malignant neoplasms in fine-needle aspiration biopsy specimens.

CONTEXT: Differentiation of conventional renal cell carcinoma from other malignant neoplasms can be difficult, particularly with the limited sampling in fine-needle aspiration biopsies. Many studies have discussed the features of renal cell carcinoma in fine-needle aspiration biopsy specimens, but the significance of the cytologic features is not known. OBJECTIVE: To define the significant cytologic findings that aid in differentiating renal cell carcinoma from other malignant neoplasms in fine-needle aspiration biopsy specimens. DESIGN: Fine-needle aspiration biopsies from 35 patients with proven primary or metastatic conventional renal cell carcinoma and from 145 patients with proven primary or metastatic non-renal cell carcinoma malignant neoplasms were assessed for the presence or absence of the following cytologic features: the heterogeneous cell population, hemosiderin deposits, small cytoplasmic vacuoles, large cytoplasmic vacuoles, low nuclear-cytoplasmic ratio, prominent nucleoli, intranuclear inclusions, irregular nuclear membranes, and smooth nuclear membranes. Statistical analysis was performed to identify the features significant in distinguishing conventional renal cell carcinoma from non-renal cell carcinoma malignancies. RESULTS: The presence of the heterogeneous cell population, hemosiderin deposits, small cytoplasmic vacuoles, and low nuclear-cytoplasmic ratio were each highly significant in conventional renal cell carcinoma when compared with non-renal cell carcinoma malignant neoplasms (P < .001) using univariate exact analysis. Features that were identified as being predictive of conventional renal cell carcinoma using multivariable logistic regression analysis included heterogeneous cell population, small cytoplasmic vacuoles, and hemosiderin deposits (P < .05). CONCLUSIONS: The presence of the heterogeneous cell population, small cytoplasmic vacuoles, hemosiderin deposits, and a low nuclear-cytoplasmic ratio aids in differentiating conventional renal cell carcinoma from other malignant neoplasms, including morphologically similar entities such as hepatocellular carcinoma, in fine-needle aspiration biopsy specimens.

Biomarkers, Tumor↗
PubMed1998

Colorectal neoplasms: a retrospective study.

A total of 254 cases of colorectal neoplasms were studied. A male predominance was noted with both benign and malignant neoplasms (M:F of 4.6:1 and 1.1:1 respectively). The peak incidence was in the fifth decade. The rectum was the commonest site for both benign and malignant neoplasms (75% and 63% respectively) followed by the sigmoid colon (11% and 16% respectively). Right-sided cancers presented commonly as fungating masses (74%) while left sided cancers were predominantly of the ulcerating/infiltrating pattern (81%). The commonest benign neoplasm was tubular adenoma (39%) while the commonest malignant neoplasm was adenocarcinoma (90%) followed by squamous cell carcinoma (4%). Advanced stage on presentation was noted with these cancers, especially the mucinous adenocarcinoma variant. This may be explained by the usual late presentation of patients to orthodox doctors in our environment.

Adolescent↗
PubMed1999

A clinicopathologic and immunohistochemical study of 22 intraductal papillary mucinous neoplasms of the pancreas, with a review of the literature.

Intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas are rare lesions. We undertook this study to analyze these tumors by focusing on the diagnostic criteria and correlating the histologic features with clinical prognosis. Twenty-two cases of IPMN were retrieved from the Endocrine Tumor Registry of the Armed Forces Institute of Pathology. Blocks or unstained slides were available for histochemical and immunohistochemical studies (including proliferative markers and cell cycle regulators) and K-ras oncogene mutations in 15 cases. Patient follow-up was obtained in all of the cases. IPMN occurs in both genders with a slight male predominance, with a mean age at presentation of 64.4 years (range, 48-85 yr). The patients presented with abdominal pain. The neoplasms were radiologically and grossly cystic, usually (18 cases of 22) located in the head of the pancreas. Histologically, the tumors consisted of intraductal papillary proliferations protruding into and expanding the pancreatic ducts. Invasion into the surrounding pancreatic parenchyma was detected in 15 cases. Chronic pancreatitis was present in all of the cases. p27 immunoreactivity always exceeded the immunoreactivity of cyclin E. K-ras oncogene mutations were detected in two cases. Patients were treated with a complete surgical resection (n = 7) or a Whipple procedure (n = 13). Only 2 of 22 patients died of disease (3 died immediately postoperatively and 3 died of unrelated causes), whereas the remaining 14 patients were alive at last follow-up, without evidence of disease, an average of 58.2 months after initial presentation. IPMNs are rare, distinctive neoplasms, with complex intraductal papillae, that can be easily separated from in situ ductal adenocarcinoma and mucinous cystic neoplasms. The high ratio of p27 protein to cyclin E supports the excellent prognosis of these neoplasms, despite the presence of invasion and K-ras oncogene mutation.

Aged↗
PubMed2000

Upper tract urothelial neoplasms: incidence and survival during the last 2 decades.

PURPOSE: Upper tract urothelial cancer is rare but studies in the 1970s showed that its incidence was increasing. We evaluated national trends of the incidence and survival of upper tract urothelial neoplasms from 1973 to 1996. MATERIAL AND METHODS: We obtained information on upper tract urothelial neoplasms from 1973 to 1996 from the National Cancer Institute Surveillance, Epidemiology and End Results program. To provide a time comparison we evaluated upper tract urothelial cancer from 1973 to 1984 and 1985 to 1996. We also calculated overall disease specific survival stratified by cancer stage, patient race and gender for the study period overall. RESULTS: A total of 9,072 cases of upper tract urothelial cancer were identified in the Surveillance, Epidemiology and End Results program from 1973 to 1996, including 5,379 of the renal pelvis and 3,678 of the ureter. Comparing age adjusted annual incidence rates revealed an increase in ureteral neoplasms from 0.69 to 0.73/100,000 person-years but no change in the incidence of renal pelvic tumors, while the rate of in situ neoplasms increased from 7. 2% to 23.1%. Overall disease specific 5-year survival was significantly different in regard to tumor stage (95.1% in situ, 88. 9% localized, 62.6% regional and 16.5% distant lesions). Disease specific annual mortality was greater in black than in white individuals and in women than in men (7.4% versus 4.9% and 6.1% versus 4.4%, respectively). CONCLUSIONS: There appears to have been a slight increase in the national incidence of ureteral tumors in the last 23 years. Fortunately we also detected a slight improvement in the overall disease specific survival of patients with upper tract neoplasms.

Aged↗
PubMed2000

[The role of laparoscopy in the identification of peritoneal carcinosis from abdominal neoplasms. Analysis of our initial experience].

BACKGROUND: The authors reviewed the experience on the use of laparoscopy performed since January 1997 in malignant neoplasms at their institution. The aim of the study was to evaluate the real effectiveness of this procedure in the staging of abdominal neoplasms which were considered resectable at preoperative examinations and in particular in the detection of peritoneal metastases not evidenced with traditional imaging techniques. METHODS: Twenty-eight patients with malignant neoplasms: colo-rectum (15), stomach (5), pancreas (4), gallbladder (2), cardias (1), liver (1), were studied. All the patients were preoperatively examined with abdominal computed tomography (CT). In the 2 patients with gallbladder neoplasm a MR cholangiography was also performed. An explorative laparoscopy with peritoneal washing was then performed in all the patients. The diagnostic and therapeutic choices were subsequently done on the basis of laparoscopy results. RESULTS: Therapeutic approach was modified in 21% of cases, as a result of the detection of peritoneal metastases which were not evidenced with imaging examinations. On the contrary, peritoneal washing was not responsible of any preoperative evaluation. CONCLUSIONS: Laparoscopy performed in patients with abdominal neoplasms allows the detection of peritoneal micrometastases not previously evidenced through preoperative CT, thus modifying the therapeutic approach.

Abdominal Neoplasms↗
PubMed1998

[Parapharyngeal space neoplasms].

OBJECTIVE: To study parapharyngeal space (PPS) neoplasms which are rarely seen clinically. METHODS: A retrospective review was made of 59 patients with PPS neoplasm operated on from 1986 to July, 1997 in our institution. RESULTS: Neurogenic tumors were the most common neoplasms, which constituted about 60 percent in the primary parapharyngeal space neoplasms. High-resolution computed tomography or magnetic resonance imaging was essential for diagnosis and presurgical planning. The transcervical approach was the preferred procedure for 75% benign parapharyngeal tumors. Middle mandibulotomy was used in 3 cases, including 2 small tumors confined to the superior aspect of the PPS and 1 carotid body tumor which extended to the skull base. Lateral skull base approach was utilized for 1 schwannoma originating in the jugular foramen with extension into the PPS. CONCLUSIONS: We believe that transoral approach can be used for small tumors and transparotid approach may be especially indicated for removal of deep lobe parotid tumors with extension to the PPS. Middle mandibulotomy is a safe and efficacious approach for the removal of special PPS neoplasms.

Adenoma, Pleomorphic↗
PubMed2002

[Potential use of cysteine endopeptidase inhibitors in radiodiagnostics of laryngeal and tongue neoplasms].

The methods applied up to now do not allow to define the border between the tumor and healthy tissue especially in advanced cases. Microlaryngoscopy facilitates the evaluation of the infiltration superficially, but does not allow for estimation its deeper penetration. CT and MRI often do not answer the question concerning the tumor spread as well. That is why the monoclonal antibodies marked with isotopes directed against specific antibodies of different neoplasms are applied in diagnostic. In the neoplasm development the great role play endopeptidases. They degrade the intercellular matrix and basement membrane and by this way made possible the neoplasm invasion. The high level of the endopeptidase in patients with neoplasm is a bad prognosis. The disposition of endopeptidase in neoplasm tissue is characteristic and gives opportunity to localise the border of healthy tissue thanks their inhibitors application. The inhibitor of cysteine endopeptidase obtained from hen egg and marked by J 125 was used in our study. The reaction between the cysteine endopeptidase inhibitor and malignant cells received directly from patients with tongue and laryngeal carcinoma and cells cultivated in vitro from the carcinoma.

Antibodies, Monoclonal↗
PubMed2003

[Clinical characters, diagnosis and treatment of parapharyngeal region neoplasms: a report of 115 cases].

OBJECTIVE: The aim of this study was to analyze the clinical characters, diagnosis and treatment of primary neoplasms in the parapharyngeal regions. METHODS: A total of 115 cases of primary neoplasms in the parapharyngeal regions were included in this study. RESULTS: Disorders of swallowing, breath or speaking were the common symptoms of neoplasms in parapharyngeal regions. The majority of neoplasms parapharyngeal regions were benign. 46 cases were from the deep lobe of the parotid, and 42 cases were neurogenic. CT or MRI provides useful information such as their sizes, shapes and extents. The relationship between the tumor and vessel was shown using super-selective angiography. All the tumors were resected completely by extra-oral approach through the posteroinferior incision of the mandible. The follow-up was carried out from 1 to 10 years, and the data indicated that 2 patients died, 18 cases were lost, and others had no recurrence. CONCLUSION: CT and/or MRI are essentially useful for diagnosis and presurgical planning. Super-selective angiography can be used if the lesions involved carotid artery. Posteroinferior incision of the mandible is a simple, effective and safe approach for excision of neoplasms parapharyngeal regions.

Adolescent↗
PubMed2006

[Pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasms (IPMN)].

Pancreatic Intraepithelial Neoplasia (PanIN1-3) and Intraductal Papillary Mucinous Neoplasms (IPMNs) putative precursors of and associated to pancreatic cancer represent a distinct, however pathologically heterogenous entity. Recently a new classification and nomenclature was established. We analysed the clinicopathologic and cytogenetic characteristics of six patients with PanIN and two with IPMN undergoing curative surgical resection. The most valuable tool in the diagnosis of these preinvasive neoplasms is ERCP combined with brush cytology. Conventional laboratory blood tests, tumor markers (CEA, CA19-9) were within normal values and imaging modalities were informative in only one third of the cases, however, not pathognostic. Based on our hypothesis that tumor ploidy pattern correlates with biological behaviour, malignant potential and prognosis, we measured the nuclear DNA content, ploidy, synthetic (S) phase or proliferative fractions of each neoplasm by flow cytometry. Each neoplasm demonstrated diploid stemline, with a low mean S-phase or proliferative fraction (3,77%) and mean DNA index (DI) of 0.96. The diploid DNA pattern and the low proliferative activity are consistent with the nonaggressive biological behavior of intraepithelial and intraductal neoplasms and, in part, explain their favorable prognosis.

Adenocarcinoma, Mucinous↗
PubMed1990

Hürthle-cell neoplasms of the thyroid gland.

The difference in biologic behavior of Hürthle-cell neoplasms as reported in several series may be explained by the use of different diagnostic pathologic criteria, and the selection of patients with neoplasms of varying clinical stages (treatment at the time of initial diagnosis versus treatment for advanced disease, or initial diagnosis at an advanced stage). On the basis of all of the available evidence, it appears that Hürthle-cell neoplasms exhibit a biologic behavior similar to that of corresponding follicular neoplasms although these latter tumors may have a slightly higher propensity to metastasize. Survival and cure rates are lower than those for papillary cancer and are comparable to those for follicular carcinoma. DNA analysis may be of some help in predicting clinical behavior; aneuploid neoplasms are more often associated with the pathologic features of malignant tumors and may follow a more aggressive clinical course. At present, however, we are unaware of specific surgical strategies that are based upon DNA analysis. Tumor size and morphometric analysis of cytological features have not been particularly valuable for estimating the clinical course of these tumors.

Adenoma↗
PubMed1989

Focal impairment of growth in hepatocellular neoplasms of C57BL/6 mice: a possible explanation for the strain's resistance to hepatocarcinogenesis.

C57BL/6 mice are relatively more resistant to hepatocarcinogens than C3H and C57BL/6 x C3H F1 (hereafter called B6C3F1) mice; however, the basis for this strain-dependent difference is not clear. In order to address this issue, male C57BL/6 mice were treated i.p. with 5 mg/kg diethylnitrosamine when 15 days old and the histological features of induced hepatocellular neoplasms were assessed at intervals over the ensuing 80 weeks. In many respects the natural history of the tumors was similar to that previously reported for hepatic neoplasms in B6C3F1 mice; they invaded hepatic vein branches while still microscopic (18 weeks after diethylnitrosamine) and developed into metastasizing trabecular carcinomas by 80 weeks. However, the tumors in the C57BL/6 mice were unique in their early focal development of cells containing inclusions of secretory protein within the endoplasmic reticulum. At 12 weeks after diethylnitrosamine, more than 90% of the neoplasms contained inclusions. Over the ensuing months, the inclusions increased in size and number and the regions containing them became more sharply defined. In mice killed 48 weeks after carcinogen, the extent of inclusion formation was correlated with [3H]thymidine labeling indices. Mean labeling indices were higher in the inclusion-poor than in the inclusion-rich areas: 5.4% versus 1.5% for the 36 neoplasms smaller than 1 mm in diameter and 14% versus 6% for the 18 neoplasms larger than 1 mm. Thus, we suggest that the focal slowing of hepatocellular tumor growth in C57BL/6 mice contributes to the strain's apparent resistance to hepatocarcinogenicity. However, the impairment does not appear to block tumor progression and the ultimate development of trabecular carcinomas. In addition, the data indicate that, independent of the presence or absence of inclusions, larger tumors have higher labeling indices, and presumably higher growth rates, than smaller ones. While the reason for the association between cytoplasmic inclusions and the low labeling indices is not known at present, at the very least the inclusions serve as unique markers for the growth retardation.

Animals↗
PubMed1980

Comparison of bone scans and radiography for detecting bone neoplasms in dogs exposed to 238PuO2.

Radioisotopic bone scans and radiography were used to detect bone neoplasms in 144 dogs that inhaled alpha-particle-emitting 238PuO2 particles. Radiography was used routinely to survey the skeleton of the dogs. Nineteen dogs developed bone neoplasms; 17 of these were studied with bone scans and radiography; both methods showed a high degree of success in detecting bone neoplasms. Predominant regions of occurrence have been the lumbar region of the spine and the humerus. The bone scanning method used gamma-camera detection of IV injected 99mTc-labeled methylene diphosphonate. All neoplasms detected radiographically also were identified by bone scans. In addition, 3 lesions confirmed histologically as osteosarcomas were detected by bone scanning, but were missed by radiography. Bone scanning was a more sensitive means for the detection of bone neoplasms than were routine radiographic procedures.

Animals↗
PubMed1993

Second cutaneous neoplasms after acute lymphoblastic leukemia in childhood.

Two cases of second cutaneous neoplasms, one with adenoid cystic carcinoma of the skin and the other with basal cell carcinoma, both occurring 7 years after treatment for childhood acute lymphoblastic leukemia (ALL) are reported. Although such cutaneous neoplasms are generally reported in patients over 40 years of age, our cases, which were diagnosed at the ages of 9 and 14, are the first report of the occurrence of such cutaneous neoplasms following ALL. The neoplasms arose from the scalp of two patients who had received cranial irradiation for central nervous system prophylaxis. The possible link between leukemia therapy incorporating irradiation and the pathogenesis of second cutaneous neoplasms in the scalp is discussed.

Carcinoma, Adenoid Cystic↗
PubMed1993

Sequential analysis of the pathogenesis of plutonium-induced pulmonary neoplasms in the rat: morphology, morphometry, and cytokinetics.

Light microscopy, morphometry, and cytokinetic techniques were used to examine the dynamics of plutonium-induced pulmonary proliferative lesions and neoplasms in rats at several intervals to 450 days after inhalation exposure to aerosols of 239PuO2. Maximal increases in alveolar and bronchiolar epithelial cell labeling were seen at 30 days; decreasing subsequently, the levels remained elevated above control indices. Focal proliferative epithelial lesions developed in the lung by 180 days and before the onset of pulmonary neoplasms. Pulmonary neoplasms, predominantly adenocarcinomas and squamous cell carcinomas, were initially observed at 308 days. The proliferative lesions progressed through a succession of morphological changes leading to the development of neoplasms. The volume density (fraction) and epithelial surface area of foci of alveolar epithelial hyperplasia increased progressively between 180 and 450 days after exposure, in contrast to the other proliferative lesions. We conclude that plutonium-induced pulmonary neoplasms develop through a succession of focal proliferative lesions that represent developmental preneoplastic lesions. Progressive increases in volume and epithelial surface area of the alveolar epithelial hyperplasias suggest that they may be more at risk for neoplastic transformation than the other histological types of proliferative foci.

Adenocarcinoma↗
PubMed1995

Multiple primary neoplasms. Considerations on 42 cases.

During the years 1977-1993, 2,108 cases of gynecologic primary neoplasms were observed in the Department of Gynecology and Obstetrics of La Sapienza University in Rome. Forty-two cases were multiple primary cancers. Of these, 27 had multiple primary neoplasms involving only gynecologic sites, 15 had a neoplasm involving also another site; 3 patients had triple primary neoplasms. The most frequent neoplasm associations observed in our case series were: breast-ovary; endometrium-ovary; breast-cervix; endometrium-bowel (sigma-colon).

Adult↗
PubMedDate not supplied

Expression of CD44 in duct cell carcinomas and in intraductal neoplasms of the pancreas.

The expression of alternatively spliced CD44 isoforms, especially so-called variant exons v5 and v6, has been shown to correlate with the progression of a number of human cancers examined the expression of standard CD44 and CD44 variants with exons v5 and v6 in 28 cases of human pancreatic tumors (16 cases of invasive duct cell adenocarcinoma and 12 cases of intraductal neoplasms) by immunohistochemistry using exon specific monoclonal antibodies. The expression of standard CD44 was frequently observed in both invasive duct cell carcinomas and intraductal neoplasms. The expression of CD44 variants (v5 and v6) was also seen in almost all duct cell carcinomas. In contrast, intraductal neoplasms infrequently expressed CD44-v5 and -v6, particularly v6 exon. Expression of CD44-v5 and v6 was a common characteristic of invasive cancer, while it was not so prominent in intraductal neoplasm. These findings may be related to the invasiveness of duct cell carcinoma and/or the benign biological behavior of intraductal neoplasm of the pancreas.

Carcinoma, Ductal, Breast↗
PubMed1997

[Gas gangrene due to Clostridium septicum in a patient with an occult colonic neoplasm. A case report and review of the literature].

A case of gaseous gangrene by Clostridium septicum associated with colorectal cancer is presented. The patient evolved rapidly towards septic shock and death. Autopsy showed occult neoplasm and pelvic and retroperitoneal myonecrosis. An exceptional finding was that of myocarditis in which thick gram-positive bacilli were identified. A review of the literature was carried out regarding the pathogenesis and clinical manifestations of this disease. The association of colonic neoplasm and Clostridium septicum may be related with the sensitivity of the cells of this neoplasm to the toxins of the microorganisms. The usefulness of this cytotoxicity is being tested in the therapeutic reduction of tumoral mass. With respect to clinical attitude, all the authors agree on the need for clinical suspicion as to the possible existence of occult colon neoplasm in individuals with septic shock by gaseous gangrene with no obvious entry site. Diagnosis is performed by imaging techniques with barium enema and if this is normal colonoscopy is carried out. Emergency treatment consists in laparotomy with resection of the neoplasm and debridement of the area accompanied by hyperbaric oxygen and antibiotics.

Adenocarcinoma↗
PubMed1996

[Automatic image analysis of argentophil protein granule quantitative measurement on nucleolus area of limbus epithelial neoplasms].

OBJECTIVE: To study the pathological diagnostic significance of argentophil protein (AgNOR) quantitative analysis at nucleolus area of limbus epithelial neoplasms. METHODS: Automatic image analysis system was used for argentophil protein granule measurement in the pathologic diagnosis of 45 cases with limbus epithelial neoplasms, including benign hyperplasia, atypical hyperplasia, carcinoma in situ and squamous cell carcinoma. RESULTS: In various lesions, there were the differences in the distributive pattern, size and area of AgNOR granules, which were closely related to the nature of the neoplasms (benign or malignant) and its cell differentiation. CONCLUSION: Automatic image analysis of AgNOR quantitative measurement on limbus epithelial neoplasms may indicate the proliferative activity and cell differentiation in various lesions, help to differentiate benign or malignant neoplasms and effectively enhance the level of pathologic diagnosis.

Carcinoma in Situ↗