An Intrahepatic Cholangiocarcinoma with Focal Rhabdoid Features and SMARCA4-Deficiency

Intrahepatic cholangiocarcinoma with rhabdoid morphology is rare, and only three case reports have been published to date, none of which discuss the genetic changes in the rhabdoid component. We present a case of intrahepatic cholangiocarcinoma with focal rhabdoid features and SMARCA4-deficiency detected using immunohistochemistry. A Japanese man in his 60s without viral hepatitis was diagnosed with an avascular tumor in the liver, measuring 4.4 cm in the greatest dimension. The tumor was mostly composed of moderately differentiated adenocarcinoma, focal poorly differentiated adenocarcinoma, and an undifferentiated rhabdoid component. Immunohistochemical analysis showed an inclusion-like staining pattern for keratin AE1/AE3 and vimentin in the rhabdoid component. BRG1/SMARCA4 was detected in the differentiated component but not in the poorly- and undifferentiated components. Our novel findings reflecting the morphological and genetic heterogeneity of intrahepatic cholangiocarcinoma and will aid the research on drugs targeting the aberrant SWItch/Sucrose NonFermentable complex.

Pedunculated early colorectal cancer with nodal metastasis: a case report

Background Pedunculated polyps are more likely to be amenable to complete resection than non-pedunculated early colorectal cancers and rarely require additional surgery. We encountered a patient with a pedunculated early colorectal cancer that consisted of poorly differentiated adenocarcinoma with lymphatic invasion. We performed an additional bowel resection and found nodal metastasis. Case presentation A 43-year-old woman underwent colonoscopy after a positive fecal occult blood test. The colonoscopist found a 20-mm pedunculated polyp in the descending colon and performed endoscopic resection. Histopathologic examination revealed non-solid type poorly differentiated adenocarcinoma. The lesion invaded the submucosa (3500 μm from the muscularis mucosa) and demonstrated lymphatic invasion. In spite of the early stage of this cancer, the patient was considered at high risk for nodal metastasis. She was referred to our institution, where she underwent bowel resection. Although there was no residual cancer after her endoscopic resection, a metastatic lesion was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy, and there has been no evidence of recurrence 3 months after the second surgery. Conclusions Additional bowel resection is indicated for patients with pedunculated polyps and multiple risk factors for nodal metastasis, such as poorly differentiated adenocarcinoma and lymphatic invasion. We encountered just such a patient who did have a nodal metastasis; herein, we report her case history with a review of the literature.

A 60 Years Old Man with Adenocarcinoma of Colon and Lung with an Isolated Adrenal Metastasis: A Case Report

The incidence of synchronous colorectal and lung cancer associated with adrenal metastasis is relatively rare. We report of patient with tumour located in the right colic flexure adjoining ascending colon, mid and partly upper lobe of right lung. Pathological examination showed the colorectal and lung cancer were poorly differentiated adenocarcinoma. Right adrenal mass was adrenocortical metastatic carcinoma. Surgical treatment and postoperative adjuvant chemotherapy for the lung cancer were different from those for colorectal cancer with pulmonary metastasis. If possible, radical resection should be performed for each cancer when synchronicity is found. CBMJ 2020 January: Vol. 09 No. 01 P: 30-37

Gastric mucin phenotype indicates aggressive biological behaviour in early differentiated gastric adenocarcinomas following endoscopic treatment

Background The distribution of mucin phenotypes and their relationship with clinicopathological features in early differentiated gastric adenocarcinomas in a Chinese cohort are unknown. We aimed to investigate mucin phenotypes and analyse the relationship between mucin phenotypes and clinicopathological features, especially biological behaviours, in early differentiated gastric adenocarcinomas from endoscopic specimens in a Chinese cohort. Methods Immunohistochemical staining of CD10, MUC2, MUC5AC, and MUC6 was performed in 257 tissue samples from patients with early differentiated gastric adenocarcinomas. The tumour location, gross type, tumour size, histological type, depth of invasion, lymphovascular invasion, mucosal background and other clinicopathological parameters were evaluated. The relationship between mucin phenotypes and clinicopathological features was analysed with the chi-square test. Results The incidences of gastric, gastrointestinal, intestinal and null phenotypes were 21 %, 56 %, 20 and 3 %, respectively. The mucin phenotypes were related to histology classification (P < 0.05). The proportion of the gastric phenotype became greater during the transition from differentiated to undifferentiated (P < 0.05). Complete intestinal metaplasia was higher in the gastric and intestinal phenotypes than in the gastrointestinal phenotype (P < 0.05). Tumours with poorly differentiated adenocarcinoma were mainly of the gastric phenotype, which was significantly higher than that of purely differentiated tubular adenocarcinoma (P < 0.05), and the depth of invasion in the mixed type was deeper (P < 0.05). Neither recurrence nor metastasis was detected. Conclusions The mucin phenotype of early-differentiated gastric adenocarcinoma has clinical implications, and the gastric phenotype has aggressive biological behaviour in early differentiated gastric cancers, especially in those with poorly differentiated adenocarcinoma or papillary adenocarcinoma components.

Early Pedunculated Colorectal Cancer with Nodal Metastasis: A Case Report

Background: Among early colorectal cancers, pedunculated polyps have a higher complete resection rate than non-pedunculated cases and rarely require additional surgery. However, this time, we experienced a case of pedunculated colorectal cancer, which was histologically poorly differentiated adenocarcinoma. Lymphatic invasion was also found, so additional intestinal resection was performed and nodal metastasis was found.Case presentation: A 43-year-old woman underwent colonoscopy because of positive fecal occult blood. A 20 mm-sized pedunculated polyp was found in the descending colon, and endoscopic resection was performed. Histopathological examination revealed non-solid poorly differentiated adenocarcinoma, invading to the submucosa (3,500 μm from the muscularis mucosae) with lymphatic invasion. In spite of its early stage cancer, the risk of nodal metastasis was considered to be high, and bowel resection was additionally performed. Although there was no residual cancer in the site after endoscopic resection, a metastasis was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy. There was no evidence of recurrence after three months after the additional surgery. Conclusions: For pedunculated polyps, additional bowel resection was performed for patients with multiple risk factors for nodal metastasis such as poorly differentiated adenocarcinoma and positive lymphatic invasion. Then, we experienced a case of nodal metastasis, so we report it with a review of the literature.

Severe hypercalcaemia from ectopic intact parathyroid hormone secretion treated with continuous renal replacement therapy in a patient with two malignancies

We present a 61-year-old Caucasian woman with endometroid carcinoma as well as a poorly differentiated adenocarcinoma who developed severe hypercalcaemia in the setting of an elevated intact parathyroid hormone. The patient was hospitalised twice for her condition. During her first hospitalisation, she was diagnosed with an endometroid carcinoma and hypercalcaemia. With medical management, she had a normal calcium level on discharge. She presented 3 weeks later with hypercalcaemia and encephalopathy. This time her hypercalcaemia was refractory to medical management, and required continuous renal replacement therapy (CRRT) to normalise her serum calcium. Lung biopsy revealed a poorly differentiated adenocarcinoma, suspicious for pancreatic primary. Due to her poor prognosis, rapid elevation of calcium with each attempt to discontinue CRRT, and the poor options for treatment of her cancers, she elected to pursue hospice care.

Antioxidant, cytotoxicity, and anti-human lung cancer properties of Linum Usitatissimum seed aqueous extract in the in vitro condition: A pre-clinical trial study

IntroductionLinum usitatissimum seed or flax seed is known as a potential candidate as a remedy to treat various diseases in many traditional medicines around the world. In the current study, the antioxidant, cytotoxicity, and anti-human ling cancer properties of Linum Usitatissimum seed were investigated in the in vitro condition.Material and methodsAntioxidant activity of the plant was analyzed using radical scavenging activity and ferrous ion chelating assay. MTT assay was used to evaluation of anti lung cancer of the plant.ResultsThe plant extract scavenged DPPH as a free radical with an IC50 of 34.2±0.9 µg/mL. The plant also was rich in phenolic compounds with an amount of 294.8±2.3 mg GAE/g for total phenolic content. Cell viability of Linum Usitatissimum seed was very low against lung poorly differentiated adenocarcinoma (PC-14), lung moderately differentiated adenocarcinoma (LC-2/ad), and lung well-differentiated bronchogenic adenocarcinoma (HLC-1) cell lines without any cytotoxicity on the normal cell line. The best anti-human lung cancer properties of Linum Usitatissimum seed against the above cell lines was in the case of the PC-14 cell line. According to the above findings, the Linum Usitatissimum seed may be administrated for the treatment of several types of human lung cancer in humans.ConclusionsAccording to the results, the IC50 values of plant extract against lung poorly differentiated adenocarcinoma (PC-14), lung moderately differentiated adenocarcinoma (LC-2/ad), and lung well-differentiated bronchogenic adenocarcinoma (HLC-1) cell lines were found 392, 483, and 564 µg/mL, respectively

Gastric Mucin Phenotype Indicated Aggressive Biological Behavior in Early Differentiated Gastric Adenocarcinomas by Endoscopic Treatment

Background:The distribution of mucin phenotypes and its relationship with clinicopathological features in early differentiated gastric adenocarcinomas among the Chinese cohort is unknow. We aim to investigate the mucin phenotypes and analyze the relationship between mucin phenotypes and clinicopathological features, especially the biological behavior, in early differentiated gastric adenocarcinomas from endoscopic specimens in a Chinese cohort.Methods:Immunohistochemical staining of CD10, MUC2, MUC5AC, MUC6 was performed in 257 patients with early differentiated gastric adenocarcinomas. Tumor location, gross type, tumor size, histological type, depth of invasion, lymphovascular invasion, mucosal background and other clinicopathological parameters were evaluated. Analyzed the relationship between mucin phenotypes and clinicopathological features through chi-square test.ResultsThe incidence of ໿ gastric-, gastrointestinal-, intestinal- and null-phenotype was 21%, 56%, 20% and 3% respectively. The mucin phenotypes were related with histology classification (P༜0.05). The proportion of gastric-phenotype became greater during the transition from differentiated to undifferentiated (P༜0.05). Complete intestinal metaplasia in gastric- and intestinal-phenotype was higher than gastrointestinal-phenotype (P༜0.05). Those mixed with poorly differentiated adenocarcinoma were mainly of gastric-phenotype, which was significantly higher than that of purely differentiated tubular adenocarcinoma (P < 0.05), and the depth of infiltration of mixed type was deeper (P < 0.05). Neither recurrence nor metastasis were detected.ConclusionsThe mucin phenotype of early differentiated gastric adenocarcinoma is of clinical implication, and gastric-phenotype has aggressive biological behavior in early differentiated gastric cancers, especially in those mixed with poorly differentiated adenocarcinoma or papillary adenocarcinoma component.

Primary Duodenal Carcinoma with Embryonal Carcinoma Features in a Young Man

We present the case of a 35-year-old man with intractable nausea, vomiting, and severe anemia. A computed tomography (CT) scan of the chest, abdomen, and pelvis showed a circumferential lesion thickening of up to 3.5 cm at the level of the third portion of the duodenum. No aortocaval, retroperitoneal lymphadenopathy, nor secondary lesion was observed. Esophagogastroduodenoscopy (EGD) revealed a circumferential mass within the third portion of the duodenum. Histopathology of biopsy materials from the duodenal mass showed it most likely to be a poorly differentiated adenocarcinoma. The patient underwent a subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection. Histologically, tumor cells with basophilic cytoplasm and pleomorphic nuclei showed a solid pattern, and expressed CD30 and SALL4 immunohistochemically, leading to a diagnosis of embryonal carcinoma-like tumor. No other primary tumor could be identified, and the location of the tumor, mainly on the mucosal surface, suggested a duodenal origin. The UICC TNM staging was T3N2M0, stage IIB. This is a rare case of primary duodenal carcinoma with features of embryonal carcinoma.