scholarly journals Multiple Relapses of Parathyroid Carcinoma with Severe Systemic Complications - Case Report and Literature Review

2021 ◽  
Vol 28 (4) ◽  
pp. 441-446
Author(s):  
Andreea ILIESIU ◽  
◽  
Ana-Maria CIONGARIU ◽  
Bogdan SOCEA ◽  
Mihail-Constantin CEAUSU ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Parathyroid Carcinoma ◽  
Primary Tumour ◽  
Malignant Lesion ◽  
Immunohistochemical Analysis ◽  
Surgical Excision ◽  
Positive Staining ◽  
Ki 67 ◽  
Systemic Complications ◽  
Parathyroid Tumours

Parathyroid carcinoma is an exceptionally uncommon endocrine neoplasm, accounting for less than 1% of parathyroid tumours and also a rare cause of primary hyperparathyroidism. Although this malignant lesion is usually slowly progressive, it is frequently associated with local recurrences and also with metastases involving the local lymph nodes or distant sites. We present a 59-year-old male patient who developed a parathyroid carcinoma metastasis involving the anterior mediastinal lymph nodes and thymus remnants, 3 years after the primary tumour was identified and treated by surgical excision followed by chemo and radiotherapy. The patient presented with severe, symptomatic hyperparathyroidism and a gamma scan revealed increased uptake hyperfixation in the paratracheal lymph nodes. A lymphadenectomy was performed and the gross examination of the specimen showed a pinkish – white, firm, poorly circumscribed mass. The microscopic examination revealed an epithelial proliferation with a predominantly nodular/solid growth pattern, composed of cells exhibiting moderate nuclear pleomorphism, prominent nucleoli and high mitotic activity, involving two lymph nodes and thymus remnants. Upon immunohistochemical analysis, the proliferation showed positive staining for GATA 3, as well as a high Ki 67 index, whereas TTF 1 and thyroglobulin were negative in the tumour cells. Thus, the diagnosis of metastatic parathyroid carcinoma was established. The aim of this paper is to gain further knowledge about the histopathological and immunohistochemical features, as well as about the clinical behaviour of parathyroid malignant lesions, especially considering their rarity.

scholarly journals Balloon Cell Malignant Melanoma in a Young Female: A Case Report and Review of the Literature

2016 ◽  
Vol 9 (1) ◽  
pp. 262-266 ◽  
Author(s):  
Yui Hattori ◽  
Kazuhiro Sentani ◽  
Takuya Hattori ◽  
Yoshimi Matsuo ◽  
Mikio Kawai ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Lymph Nodes ◽  
Immunohistochemical Analysis ◽  
Histopathological Analysis ◽  
Lumbar Region ◽  
Ki 67 ◽  
Complete Replacement ◽  
Clinical Appearance ◽  
Balloon Cells ◽  
Balloon Cell

Balloon cell malignant melanoma (BCMM) is a very rare malignant melanoma subtype. The clinical appearance of BCMM varies; it may be nodular, ulcerated, polypoid, papillomatous and often non-pigmented. The tumor cells histologically appear large, polygonal or round and contain abundant granular or vacuolated cytoplasm. We herein report the case of a 32-year-old female who presented with a focal eccentric pigmented mass in the left lumbar region of 15 mm in diameter that had been present for several years. She underwent tumor excision. The histopathological analysis showed epithelioid melanocytes with clear cytoplasm. An immunohistochemical analysis revealed that the cells were positive for HMB-45 and S-100 protein and negative for cytokeratin. The balloon cell component stained negative for Fontana-Masson. A month later, the patient underwent excision of the bilateral inguinal lymph nodes and metastatic BCMM was revealed. The lymph node metastases showed the complete replacement of lymph nodes by balloon cells. A diagnosis of BCMM (Breslow depth 10 mm, Clark level V) without ulcer was rendered. Staining with Ki-67 was positive in almost 44% of the balloon cells.

Clinical and Pathologic Characterization of Mucosa-Associated Lymphoid Tissue Lymphoma of the Head and Neck

1998 ◽  
Vol 107 (9) ◽  
pp. 801-806 ◽  
Author(s):  
Neil Bhattacharyya ◽  
Robert A. Frankenthaler ◽  
Marshall E. Kadin ◽  
Hilary I. Gomolin ◽  
Arthur M. Lauretano
Keyword(s):  
Head And Neck ◽  
Malt Lymphoma ◽  
Lymphoid Tissue ◽  
Immunohistochemical Analysis ◽  
Surgical Excision ◽  
Response To Treatment ◽  
Positive Staining ◽  
Low Grade ◽  
Primary Therapy ◽  
Histologic Diagnosis

Mucosa-associated lymphoid tissue (MALT) has recently been recognized as a possible site of origin for low-grade lymphomas of the B-cell type. Though relatively rare, these MALT lymphomas may arise within several sites in the head and neck, and often present diagnostic and therapeutic challenges. We review 4 cases of primary MALT lymphoma of the head and neck, treated with surgical excision (3 cases), irradiation (2 cases), and chemotherapy (1 case), to further characterize this new subtype of head and neck malignancy. The mean time from onset of symptoms to histologic diagnosis was 15 months. Fine needle aspiration identified an atypical lymphoid infiltrate in only 1 of 3 patients. Immunohistochemical analysis was essential in establishing the diagnosis of MALT lymphoma in all 4 of the cases, and demonstrated characteristic negative staining for CD3, CD5, and CD43, positive staining for CD20, and monotypic staining for either κ or Λ; light chain immunoglobulin markers. All patients achieved complete remission after primary therapy, and all remain free of disease with follow-up ranging from 6 to 54 months (mean 33 months). The diagnosis of MALT lymphoma should be considered in cases of atypical lymphoid infiltrates in the head and neck, and increased awareness coupled with detailed immunohistochemical analysis is essential to securing an accurate diagnosis. Clinical remission of MALT lymphoma may be achieved with several modalities, but further study will be required to determine the long-term response to treatment.

Filamin A and Parafibromin Expression in Parathyroid Carcinoma

2021 ◽  
Author(s):  
Sara Storvall ◽  
Helena Leijon ◽  
Eeva M Ryhänen ◽  
Tiina Vesterinen ◽  
Ilkka Heiskanen ◽  
...  
Keyword(s):  
Parathyroid Carcinoma ◽  
Mitogen Activated Protein Kinase ◽  
Proliferation Index ◽  
Filamin A ◽  
Ki 67 ◽  
Mapk Signalling Pathway ◽  
Calcium Sensing ◽  
Mitogen Activated Protein ◽  
Benign Tumours ◽  
Parathyroid Tumours

Objective: Parathyroid carcinoma (PC), atypical parathyroid tumors (APT) and parathyroid adenoma (PA) present with hypercalcemia. Diminished calcium-sensing receptor (CaSR) expression is reported in PC but is rare in benign tumours. Filamin A (FLNA) binds to the CaSR and activates the mitogen-activated protein kinase (MAPK) signalling pathway. FLNA is related to tumour aggressiveness in several cancers, but its role in parathyroid neoplasia is unknown. Design: We examined FLNA, CaSR and parafibromin expression in PCs (n = 32), APTs (n = 44) and PAs (n = 77) and investigated their potential as diagnostic and/or prognostic markers. Methods: Tissue microarray slides were immunohistochemically stained with FLNA, CaSR and parafibromin. Staining results were correlated with detailed clinical data. Results: All tumours stained positively for CaSR, with two tumours (one PC and one APT) showing diminished expression. Carcinomas were characterized by increased cytoplasmic FLNA expression compared to APTs and PAs (p = 0.004). FLNA expression was not correlated with Ki-67 proliferation index or loss of parafibromin expression. Cytoplasmic FLNA expression was also associated with higher serum calcium, PTH concentrations and male sex (p = 0.014, p = 0.017 and p = 0.049, respectively). Using a combined marker score, we found that parathyroid tumours with low FLNA expression and positive parafibromin staining were extremely likely to be benign (p < 0.001). Conclusion: Cytoplasmic and membranous FLNA expression is increased in parathyroid carcinomas compared to benign tumours. A combined FLNA and parafibromin expression score shows potential as a prognostic predictor of indolent behaviour in parathyroid neoplasms.

scholarly journals When an old pigmented lesion becomes serious: the problematic diagnosis of low-grade skin malignancies – Bednar tumor with fibrosarcomatous transformation

2021 ◽  
Vol 4 (1) ◽  
pp. 16-23
Author(s):  
Adrian Dumitru ◽  
Ana Ciongariu ◽  
Cătălin Aliuş ◽  
Dan Dumitrescu ◽  
Sergiu Andrei Iordache ◽  
...  
Keyword(s):  
Dendritic Cells ◽  
S100 Protein ◽  
Immunohistochemical Analysis ◽  
Dermatofibrosarcoma Protuberans ◽  
Distant Metastases ◽  
Surgical Excision ◽  
Low Grade ◽  
Ki 67 ◽  
P53 Expression ◽  
Pigmented Lesion

Abstract Bednar tumor is a rare cutaneous neoplasm, regarded as a variant of dermatofibrosarcoma protuberans with melanotic colonization and it usually affects young and middle-aged adults or children. This lesion is considered a low-grade malignant tumor, which can be associated with multiple local recurrences after surgical excision. Although a rare phenomenon, these lesions may undergo fibrosarcomatous transformation, which implies a poorer prognosis of the disease, as the tumor has a more locally aggressive behavior and patients might also develop distant metastases. We present the case of a 53-year-old female patient, with no significant medical history, who presented with a subcutaneous nodule on her upper back, for which a wide surgical excision was performed. The gross examination of the specimen showed a solitary protuberant grey-white nodule with a bluish shade and flecked with pigment. The microscopic examination revealed a malignant proliferation with a predominantly fascicular growth pattern, composed of spindle cells with highly pleomorphic nuclei and high mitotic rate, as well as the presence of dendritic cells with abundant melanin. Upon immunohistochemical analysis, the proliferation showed negative staining for CD 34 and AE 1/3, whereas the scattered dendritic cells stained positive with S100 protein. Ki 67 was positive in 15% of the tumor cells and the absence of p53 expression was noted. Thus, the diagnosis of Bednar tumor with fibrosarcomatous transformation was established. The aim of this paper was to gain further knowledge about the histopathological and immunohistochemical features, as well as about the treatment of Bednar tumor, especially considering its rarity.

scholarly journals The Role of Immunohistochemical Markers for the Diagnosis and Prognosis of Adrenocortical Neoplasms

2021 ◽  
Vol 11 (3) ◽  
pp. 208
Author(s):  
Anna Angelousi ◽  
Georgios Kyriakopoulos ◽  
Fani Athanasouli ◽  
Anastasia Dimitriadi ◽  
Eva Kassi ◽  
...  
Keyword(s):  
Transcriptome Analysis ◽  
Cox Regression ◽  
P53 Protein ◽  
Immunohistochemical Analysis ◽  
Ki 67 ◽  
Diagnosis And Prognosis ◽  
Immunohistochemical Markers ◽  
Small Series ◽  
Morphological Criteria ◽  
Survival And Development

Adrenal cortical carcinoma (ACC) is a rare cancer with poor prognosis that needs to be distinguished from adrenocortical adenomas (ACAs). Although, the recently developed transcriptome analysis seems to be a reliable tool for the differential diagnosis of adrenocortical neoplasms, it is not widely available in clinical practice. We aim to evaluate histological and immunohistochemical markers for the distinction of ACCs from ACAs along with assessing their prognostic role. Clinical data were retrospectively analyzed from 37 patients; 24 archived, formalin-fixed, and paraffin-embedded ACC samples underwent histochemical analysis of reticulin and immunohistochemical analysis of p27, p53, Ki-67 markers and were compared with 13 ACA samples. Weiss and Helsinki scores were also considered. Kaplan−Meier and univariate Cox regression methods were implemented to identify prognostic effects. Altered reticulin pattern, Ki-67% labelling index and overexpression of p53 protein were found to be useful histopathological markers for distinguishing ACAs from ACCs. Among the studied markers, only pathological p53 nuclear protein expression was found to reach statistically significant association with poor survival and development of metastases, although in a small series of patients. In conclusion, altered reticulin pattern and p53/Ki-67 expression are useful markers for distinguishing ACCs from ACAs. Immunohistopathology alone cannot discriminate ACCs with different prognosis and it should be combined with morphological criteria and transcriptome analysis.

scholarly journals Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer

2013 ◽  
Vol 5 (2) ◽  
pp. 45-49
Author(s):  
Ian C Bennett ◽  
Magdalena Biggar ◽  
Clement Wong ◽  
Michael Law
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Differentiated Thyroid Cancer ◽  
Intraoperative Ultrasound ◽  
Surgical Excision ◽  
Ultrasound Guided ◽  
Cervical Lymph Nodes ◽  
Intraoperative Localization

ABSTRACT As a result of sensitive thyroglobulin assays and widespread use of cervical ultrasound, endocrine surgeons are encountering patients with impalpable suspicious or frankly metastatic cervical lymph nodes in the follow-up phase after treatment for welldifferentiated thyroid cancer. The surgical excision of impalpable disease of recurrent or persistent thyroid cancer can represent a significant challenge which may require some means of intraoperative localization to ensure that affected nodes are removed. Surgeon-performed intraoperative ultrasound (IOUS) can be used for guiding excision of suspicious but impalpable cervical nodes. The IOUS-guided excision technique is described. The successful application of IOUS to localize and guide resection of impalpable nodal recurrences of papillary thyroid carcinoma in two patients is reported. The utilization of IOUS to guide resection of impalpable pathological nodes in the context of thyroid carcinoma is a safe and practical technique which avoids the need for additional localization procedures and unnecessary potential morbidity for the patient. How to cite this article Biggar M, Wong C, Law M, Bennett IC. Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer. World J Endoc Surg 2013;5(2):45-49.

scholarly journals Effect of Trehalose Supplementation on Autophagy and Cystogenesis in a Mouse Model of Polycystic Kidney Disease

Nutrients ◽  
2018 ◽  
Vol 11 (1) ◽  
pp. 42 ◽  
Author(s):  
Li-Fang Chou ◽  
Ya-Lien Cheng ◽  
Chun-Yih Hsieh ◽  
Chan-Yu Lin ◽  
Huang-Yu Yang ◽  
...  
Keyword(s):  
Drinking Water ◽  
Kidney Disease ◽  
Mouse Model ◽  
Polycystic Kidney Disease ◽  
Renal Cyst ◽  
Pure Water ◽  
Immunohistochemical Analysis ◽  
Positive Staining ◽  
Wild Type ◽  
Polycystic Kidney

Autophagy impairment has been demonstrated in the pathogenesis of autosomal dominant polycystic kidney disease (ADPKD) and could be a new target of treatment. Trehalose is a natural, nonreducing disaccharide that has been shown to enhance autophagy. Therefore, we investigated whether trehalose treatment reduces renal cyst formation in a Pkd1-hypomorphic mouse model. Pkd1 miRNA transgenic (Pkd1 miR Tg) mice and wild-type littermates were given drinking water supplemented with 2% trehalose from postnatal day 35 to postnatal day 91. The control groups received pure water or 2% sucrose for the control of hyperosmolarity. The effect on kidney weights, cystic indices, renal function, cell proliferation, and autophagic activities was determined. We found that Pkd1 miR Tg mice had a significantly lower renal mRNA expression of autophagy-related genes, including atg5, atg12, ulk1, beclin1, and p62, compared with wild-type control mice. Furthermore, immunohistochemical analysis showed that cystic lining cells had strong positive staining for the p62 protein, indicating impaired degradation of the protein by the autophagy-lysosome pathway. However, trehalose treatment did not improve reduced autophagy activities, nor did it reduce relative kidney weights, plasma blood urea nitrogen levels, or cystatin C levels in Pkd1 miR Tg mice. Histomorphological analysis revealed no significant differences in the renal cyst index, fibrosis score, or proliferative score among trehalose-, sucrose-, and water-treated groups. Our results demonstrate that adding trehalose to drinking water does not modulate autophagy activities and renal cystogenesis in Pkd1-deficient mice, suggesting that an oral supplement of trehalose may not affect the progression of ADPKD.

scholarly journals Clear Cell Carcinomas of the Mullerian System: Does the Pathogenesis Vary Depending on Their Nuclear Grade and Their Association with Endometriosis? An Immunohistochemical Analysis

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmad Alduaij ◽  
Katrine Hansen ◽  
Tahreem A. Karim ◽  
Cunxian Zhang ◽  
Michelle M. Lomme ◽  
...  
Keyword(s):  
Clear Cell ◽  
Immunohistochemical Analysis ◽  
Nuclear Grade ◽  
High Grade ◽  
Ki 67 ◽  
High Nuclear Grade ◽  
Positive Immunostaining

Clear cell carcinomas (CCC) of the mullerian system are considered high grade tumors, but morphologically, the cells of CCC show both low and high grade features. The aims of the current study were to categorize CCC into low and high nuclear grade types, correlate their association with endometriosis, and then observe possible variations in pathogenesis based on their expression of p53 and Ki-67. We studied 41 pure mullerian CCCs and designated each as either a high (HNG) or low (LNG) nuclear grade tumor. Morphologically, 17 (41%) CCCs were LNG and 24 (59%) were HNG. Nine (38%) HNG and 2 (12%) LNG tumors showed positive immunostaining with p53. Endometriosis was associated with 8 (47%) LNG tumors and 8 (33%) HNG CCCs. Of the 11 cases with p53 alteration, 4 (1 LNG and 3 HNG) were associated with endometriosis. Conclusions: HNG CCCs, irrespective of their association with endometriosis, have alterations of p53. In general, LNG ovarian and endometrial CCCs, irrespective of their association with endometriosis/adenomyosis, are less likely to show p53 alteration. It appears that mullerian CCCs may have variable pathogenesis depending on their nuclear grade and association with endometriosis. A larger study is needed to validate these findings.

scholarly journals Unusual Occurrence of Rare Lipid-Rich Carcinoma and Conventional Invasive Ductal Carcinoma in the One Breast: Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Katarina Machalekova ◽  
Karol Kajo ◽  
Marian Bencat
Keyword(s):  
Lymph Nodes ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma ◽  
Frozen Section ◽  
Histological Grade ◽  
Resection Margins ◽  
Axillary Lymph Nodes ◽  
Positive Staining ◽  
Axillary Lymph ◽  
Palpable Mass

A 56-year-old woman noticed a palpable mass in her left breast during self-examination. Patient was admitted to our hospital and malignant bifocal tumour was diagnosed by ultrasonography, digital mammography, magnetic resonance, and core-cut biopsy. The patient underwent planned conservative surgery (biquadrantectomy) with a sentinel node examination, but after results of the frozen section with positive resection margins and positive sentinel lymph nodes subsequent mastectomy with axillary lymph node dissection were realized. Histology in the resection specimen revealed two isolated and distinct tumours. One of the lesions represented conventional invasive ductal carcinoma of histological grade 3, and the second tumour was evaluated as invasive lipid-rich carcinoma, containing tumour cells with clear and foamy cytoplasm. Lipids in neoplastic cells were detected by Oil Red O staining and ultrastructural examination. Immunohistochemical analysis of both carcinomas was almost identical with negative steroid receptors, positive staining of HER-2, and p53 and with high proliferation activity (Ki-67). Mastectomy specimen contained residual foci of invasive ductal carcinoma and dissected axillary lymph nodes were free of metastasis. Patient underwent first cycles of chemotherapy with paclitaxel and Herceptin together with local radiotherapy and two month after surgery is without any evidence of the disease.

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