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Annals of Hepatology 2015We report the case of a 37-year-old woman with no relevant medical history. She was admitted to the hospital for epigastric pain related with food intake for 4 days; the... (Review)
Review
We report the case of a 37-year-old woman with no relevant medical history. She was admitted to the hospital for epigastric pain related with food intake for 4 days; the pain did not improve with symptomatic management. A laparoscopic cholecystectomy due to acute lithiasic cholecystitis was performed. However, after 4 days, postoperative painless jaundice was evident; thus, endoscopic retrograde cholangiopancreatography was performed, which revealed an amputation of intrapancreatic common bile duct, as well as secondary intra- and extrahepatic bile duct dilatation. Brushing of the distal portion of the common bile duct revealed a well-differentiated adenocarcinoma. Therefore, a Whipple procedure with pylorus preservation was performed. Pathologic diagnosis of a papillary in situ adenocarcinoma with two microscopic foci of microinvasion was established. The pathologic Tumor-Node-Metastasis (TNM) stage was pT1, pN0, pM0, R0. The patient is asymptomatic and disease-free 24 months after surgery. In general, adenocarcinomas of the extrahepatic bile ducts are uncommon and have a poor prognosis. However, symptomatic patients with early disease stages are even rarer and can be cured surgically.
Topics: Adenocarcinoma, Papillary; Adult; Bile Duct Neoplasms; Carcinoma in Situ; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy, Laparoscopic; Common Bile Duct; Female; Humans
PubMed: 25864226
DOI: No ID Found -
Journal of Medical Case Reports Apr 2023Polymorphous adenocarcinoma is the third most common malignant salivary gland tumor. Within polymorphous adenocarcinoma, cribriform adenocarcinoma of salivary glands is...
BACKGROUND
Polymorphous adenocarcinoma is the third most common malignant salivary gland tumor. Within polymorphous adenocarcinoma, cribriform adenocarcinoma of salivary glands is a rare subtype and resembles papillary thyroid carcinoma histopathologically. Diagnostically, cribriform adenocarcinoma of salivary glands is challenging for pathologists and surgeons alike as initial presentation and cytologic nuclear features can be easily confused with papillary thyroid carcinoma arising from a thyroglossal duct remnant or lingual thyroid.
CASE PRESENTATION
A healthy 64-year-old Caucasian woman presented to a community otolaryngologist with a 4-year history of progressive postnasal drip, globus sensation, and eventual dysphonia. Flexible fiberoptic laryngoscopy showed a large, smooth, vallecular lesion filling the oropharynx. Computed tomography imaging of the neck showed a rounded heterogeneous mass centered within the right aspect of the oropharynx measuring 4.2 × 4.4 × 4.5 cm. Fine needle aspiration biopsy was suspicious for papillary carcinoma due to microscopic findings of malignant cells, nuclear grooves, and a powdery chromatin pattern. In the operating room, the tumor was resected en bloc using a lateral pharyngotomy approach with partial resection of the right lateral hyoid. A limited cervical lymphadenectomy was performed to facilitate the lateral pharyngotomy approach and two out of three lymph nodes demonstrated regional metastatic disease. Nuclear grooves, nuclear membrane notching, and occasional intranuclear pseudoinclusions were identified, which are overlapping histopathological characteristics of papillary thyroid carcinoma and cribriform adenocarcinoma of salivary glands. It was negative for thyroglobulin and thyroid transcription factor-1, which was in keeping with cribriform adenocarcinoma of salivary glands rather than papillary thyroid carcinoma.
CONCLUSION
It is difficult to distinguish cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma solely by cytology, and the distinct characteristics of regional lymph node metastasis coupled with nuanced histologic differences should be emphasized in the evaluation of patients presenting with neck lymphadenopathy and an unknown primary or tongue mass. If sufficient fine needle aspiration biopsy material is available, thyroid transcription factor-1, thyroglobulin, or molecular testing may prove useful in differentiating cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma. A misdiagnosis of papillary thyroid carcinoma may lead to inappropriate treatment including unnecessary thyroidectomy. Therefore, it is critical for both pathologists and surgeons to be aware of this uncommon entity to avoid misdiagnosis and subsequent mismanagement.
Topics: Female; Humans; Middle Aged; Thyroglobulin; Thyroid Cancer, Papillary; Salivary Glands, Minor; Adenocarcinoma; Thyroid Neoplasms; Transcription Factors
PubMed: 37069616
DOI: 10.1186/s13256-023-03875-4 -
Journal of the American Academy of... Sep 2017Aggressive digital papillary adenocarcinomas (ADPA) are malignant tumors of sweat glands having recurrence/metastatic potential.
BACKGROUND
Aggressive digital papillary adenocarcinomas (ADPA) are malignant tumors of sweat glands having recurrence/metastatic potential.
OBJECTIVE
We sought to describe the clinical/histopathological characteristics of a series of ADPA.
METHODS
This is a retrospective case series of 19 ADPA.
RESULTS
The tumors occurred in 17 men and 2 women (mean age: 47 years). They involved digits (15), big toe (3), and palm (1), and measured from 3 to 30 mm. They were mostly solid and cystic, with papillary projections and tubular structures. Atypia was mostly mild to moderate. Tumors tested positive for p63, keratin 7, keratin 77 (eccrine duct-specific), PHLDA1, and epithelial membrane antigen in most cases, and for carcinoembryonic antigen, smooth muscle actin, S100 protein, estrogen, progesterone, and androgen receptors in 50%. Mean Ki67 proliferation index was 15%. Local recurrence was observed in 4 cases. One patient had axillary lymph node metastasis. Histopathologic parameters were not predictive of evolution. Conservative surgical treatment, performed in 7 of 19 cases, did not result in more recurrences than amputation.
LIMITATIONS
The study was retrospective and the number of cases is small.
CONCLUSION
ADPA are histologically variable, but papillary projections are always present. Keratin 77 expression suggests an eccrine origin. P63 is helpful to exclude metastasis. Conservative surgery may be sufficient in some cases.
Topics: Adenocarcinoma, Papillary; Adult; Female; Humans; Male; Middle Aged; Retrospective Studies; Sweat Gland Neoplasms; Young Adult
PubMed: 28495496
DOI: 10.1016/j.jaad.2017.02.028 -
Histopathology Feb 2022Elastin and collagen are the main components of the lung connective tissue network, and together provide the lung with elasticity and tensile strength. In pulmonary... (Review)
Review
Elastin and collagen are the main components of the lung connective tissue network, and together provide the lung with elasticity and tensile strength. In pulmonary pathology, elastin staining is used to variable extents in different countries. These uses include evaluation of the pleura in staging, and the distinction of invasion from collapse of alveoli after surgery (iatrogenic collapse). In the latter, elastin staining is used to highlight distorted but pre-existing alveolar architecture from true invasion. In addition to variable levels of use and experience, the interpretation of elastin staining in some adenocarcinomas leads to interpretative differences between collapsed lepidic patterns and true papillary patterns. This review aims to summarise the existing data on the use of elastin staining in pulmonary pathology, on the basis of literature data and morphological characteristics. The effect of iatrogenic collapse and the interpretation of elastin staining in pulmonary adenocarcinomas is discussed in detail, especially for the distinction between lepidic patterns and papillary carcinoma.
Topics: Adenocarcinoma of Lung; Adenocarcinoma, Papillary; Collagen; Diagnosis, Differential; Elastin; Histocytochemistry; Humans; Lung Neoplasms; Pleura; Pulmonary Alveoli
PubMed: 34355407
DOI: 10.1111/his.14537 -
Annals of Diagnostic Pathology Aug 2019Invasive micropapillary adenocarcinoma (MPC) is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and...
CONTEXT
Invasive micropapillary adenocarcinoma (MPC) is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival.
OBJECTIVE
Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it.
DESIGN
Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS).
RESULTS
Cluster analysis revealed three subgroups with the following diagnoses: "MPC", "combined papillary and MPC", and "others". The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the "MPC" and "combined papillary and MPC" groups.
CONCLUSIONS
Our study provides objective diagnostic criteria to diagnose MPC of lung.
Topics: Adenocarcinoma, Papillary; Adult; Aged; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pathologists; Pathology, Surgical; Reproducibility of Results
PubMed: 31132651
DOI: 10.1016/j.anndiagpath.2019.04.008 -
Acta Otorrinolaringologica Espanola 2019
Review
Topics: Adenocarcinoma, Papillary; Adult; Female; Humans; Nasopharyngeal Neoplasms; Neoplasm Grading; Tomography, X-Ray Computed
PubMed: 30075860
DOI: 10.1016/j.otorri.2018.04.007 -
Seminars in Diagnostic Pathology Mar 2017Some biliary diseases mimic pancreatic diseases pathologically as well as pathogenetically. Such diseases can be called "biliary diseases with pancreatic counterparts"....
Some biliary diseases mimic pancreatic diseases pathologically as well as pathogenetically. Such diseases can be called "biliary diseases with pancreatic counterparts". Biliary intraepithelial neoplasm (BilIN), intraductal papillary neoplasm of bile ducts (IPNB), hepatobiliary mucinous cystic neoplasm (hMCN), and IgG4-inflammatory pseudotumor represent the biliary counterparts of pancreatic intraepithelial neoplasm (PanIN), intraductal papillary mucinous neoplasm of pancreas (IPMN), pancreatic MCN, and mass forming type 1 autoimmune pancreatitis (AIP), respectively. BilIN and PanIN represent pre-invasive intraepithelial stages of nodular sclerosing cholangiocarcinoma and pancreatic ductal adenocarcinoma, respectively. IPNB and IPMN are grossly visible, predominant papillary, intraductal neoplasms that may progress to invasive carcinoma. Morphologically similar MCNs with subepithelial ovarian-like stroma occur in both the hepatobiliary system as well as the pancreas. IgG4-inflammatory pseudotumor, usually of the lymphoplasmacytic type, and mass forming type 1 AIP represent IgG4-related disease in the biliary tree and pancreas respectively. The biliary tract, which is associated with the peribiliary glands, including the pancreatic acini, can be regarded as an incomplete pancreas, so several diseases mimicking pancreatic diseases may be expected to occur in the biliary tract (biliary diseases with pancreatic counterparts).
Topics: Adenocarcinoma, Papillary; Aged; Bile Duct Neoplasms; Cholangiocarcinoma; Cystadenocarcinoma, Mucinous; Female; Granuloma, Plasma Cell; Humans; Liver Neoplasms; Male; Middle Aged; Pancreatic Neoplasms
PubMed: 28109714
DOI: 10.1053/j.semdp.2016.12.013 -
The American Journal of Dermatopathology Dec 2016Aggressive digital papillary adenocarcinoma (ADPA) is a rare sweat gland neoplasm with a high recurrence rate and metastatic potential. In this study, the authors... (Review)
Review
Aggressive digital papillary adenocarcinoma (ADPA) is a rare sweat gland neoplasm with a high recurrence rate and metastatic potential. In this study, the authors describe a case that originally appeared to benign spiradenoma, but took an ominous course eventually resulting in the diagnosis of ADPA. A 73-year-old woman developed a gradually growing nodule on the second toe of her left foot, which she had first noticed 4 years previously. An excisional biopsy was performed followed by histological examination. The authors initially considered the tumor to be a benign spiradenoma and did not perform reexcision. However, she experienced local recurrence 24 months later, and multiple pulmonary metastasis 31 months later. On histological examination, both the primary and locally recurrent tumors were found to be composed of discrete and well-circumscribed solid nodules, lacking cystic space. All tumors (the primary tumor, locally recurrent tumor, and lung metastases) presented with a pattern of fused back-to-back tubular structures and myoepithelial differentiation confirmed by immunohistochemical examination. On the basis of these findings, the authors finally diagnosed ADPA with multiple pulmonary metastases. The patient underwent chemotherapy, but died of disease 49 months later. This case highlights the importance of high clinical suspicion of ADPA when digital lesions present.
Topics: Adenocarcinoma, Papillary; Aged; Antineoplastic Agents; Biopsy; Disease Progression; Fatal Outcome; Female; Humans; Immunohistochemistry; Lung Neoplasms; Neoplasm Recurrence, Local; Sweat Gland Neoplasms; Time Factors; Toes; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27870729
DOI: 10.1097/DAD.0000000000000703 -
BMJ Case Reports Jun 2019We report a 35-year-old woman with complaints of nasal obstruction and mild post-nasal drip for 6 months. She did not improve with medical treatment. Clinical...
We report a 35-year-old woman with complaints of nasal obstruction and mild post-nasal drip for 6 months. She did not improve with medical treatment. Clinical examination had no positive finding. She was evaluated with a CT scan and MRI that revealed a polypoid mass lesion in nasopharynx without any adhesion to adjacent tissue. Endoscopic examination of nasopharynx revealed an exophytic nasopharyngeal mass in anterior wall of nasopharynx that complete macroscopic transnasal endoscopic resection was performed. The histopathological examination reported thyroid-like low-grade nasopharyngeal papillary adenocarcinoma that was confirmed on immunohistochemical staining. After complete macroscopic resection of the mass, patient was regularly followed-up for 6 years and there was no evidence of recurrence. This example has the educational tips of the optimal therapeutic strategies for primary nasopharyngeal adenocarcinomas with long follow-up.
Topics: Adenocarcinoma, Papillary; Adult; Aftercare; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Nasopharyngeal Neoplasms; Nasopharynx; Thyroid Gland; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31177192
DOI: 10.1136/bcr-2018-226949 -
Surgical Oncology Clinics of North... Jan 2016Well-differentiated thyroid cancer is increasing in incidence but the disease-specific mortality remains very low. The only effective adjuvant treatment is radioactive... (Review)
Review
Well-differentiated thyroid cancer is increasing in incidence but the disease-specific mortality remains very low. The only effective adjuvant treatment is radioactive iodine ablation. Guidelines regarding the use and dosage of radioactive iodine depend on pathologic features of the primary and metastatic tumor that define risk. Long-term treatment includes thyroid-stimulating hormone suppression and surveillance with serum thyroglobulin and radiologic assessment for nodal recurrence.
Topics: Adenocarcinoma, Follicular; Carcinoma; Carcinoma, Papillary; Combined Modality Therapy; Humans; Postoperative Care; Thyroid Cancer, Papillary; Thyroid Neoplasms
PubMed: 26610773
DOI: 10.1016/j.soc.2015.08.002