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The American Journal of Surgical... Nov 2006Ovarian metastases of intestinal-type gastric adenocarcinomas are rare, and information on them is very limited compared with that on signet-ring cell carcinomas that...
Ovarian metastases of intestinal-type gastric adenocarcinomas are rare, and information on them is very limited compared with that on signet-ring cell carcinomas that result in the Krukenberg tumor. Four cases are reported herein. The patients averaged 55 years of age. In 3 patients, the ovarian metastases were identified several to 21 months after the diagnosis of the gastric primary, and the tumors were synchronous in the fourth. Two tumors were bilateral, 1 unilateral, and for 1, the laterality was unknown. The ovarian tumors were characteristically solid and cystic, with multinodular growth in 2. In 2 cases, the ovarian tumors had a pseudoendometrioid morphology with tubulo-glandular, cribriform, and papillary patterns; they also had focal trabecular and insular patterns. Prominent necrosis was present, including segmental and intraluminal "dirty" necrosis. In the other 2 cases, the ovarian tumors had a mucinous appearance, 1 being dominantly cystic with occasional goblet cells and the other with prominent foveolar-type cells. Nuclei ranged from deceptively bland to highly atypical. Surface implants were identified in 2 cases. Two ovarian tumors examined expressed cytokeratin 7 and 20 but not estrogen receptor. Three patients with follow-up information all died within 1 year of the ovarian metastases. Although information is limited, our results suggest that metastatic spread to the ovary by intestinal-type gastric adenocarcinoma is usually seen in patients older than those with Krukenberg tumors, with a known history of gastric carcinoma, and with concomitant widespread disease. Involvement of the ovary by intestinal-type gastric carcinoma produces a microscopic picture distinctly different from that of a Krukenberg tumor. These metastatic intestinal-type tumors may be confused with metastases from other gastrointestinal sites that are more frequently the cause of pseudoendometrioid or mucinous metastases, and like such tumors may be confused with primary ovarian endometrioid and mucinous neoplasms.
Topics: Adenocarcinoma; Adult; Aged; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Intestinal Neoplasms; Krukenberg Tumor; Middle Aged; Ovarian Neoplasms; Stomach Neoplasms
PubMed: 17063077
DOI: 10.1097/01.pas.0000213256.75316.4a -
The American Journal of Surgical... Feb 2006Ovarian involvement by metastatic colorectal adenocarcinoma, although not an uncommon occurrence, remains a diagnostic challenge. The gross and histologic features of...
Ovarian involvement by metastatic colorectal adenocarcinoma, although not an uncommon occurrence, remains a diagnostic challenge. The gross and histologic features of such metastases overlap those of primary ovarian epithelial neoplasms such as endometrioid or mucinous adenocarcinoma. The clinical and pathologic features of 86 cases of metastatic colorectal adenocarcinoma involving the ovary were reviewed. Patients ranged in age from 19 to 85 years (median, 51 years); 24% were younger than 40 years. Presenting symptoms included abdominal or pelvic pain (45 cases), rectal bleeding (13 cases), change in bowel habits (20 cases), and vaginal bleeding (5 cases). In 23 cases, an ovarian mass was the first manifestation of the disease. Ovarian involvement was bilateral in 49 cases and unilateral in 33 (including 20 cases in which the only involved ovary measured at least 10 cm in greatest dimension). Involved ovaries ranged from 2 to 24 cm (mean, 10.1 cm), and most featured both solid and cystic areas. Many involved ovaries featured smooth capsules without gross evidence of surface involvement by tumor. In general, the tumors had typical histologic features of metastatic colorectal adenocarcinoma, including a garland pattern and dirty necrosis. In 23 cases, foci with a benign or low malignant potential appearance were seen. Immunohistochemical studies showed that 29 of 29 tumors (100%) were positive for CK20; focal CK7 positivity was seen in 5 of 30 cases (17%). In 9 of the cases, an ovarian primary was diagnosed or favored initially, and 5 of these cases were initially treated as ovarian primaries. Metastatic colorectal adenocarcinoma should be considered in the differential diagnosis of an ovarian mass, even if the mass is large and unilateral or in a young patient, to secure proper treatment of these patients.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Endometrioid; Colorectal Neoplasms; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Middle Aged; Ovarian Neoplasms
PubMed: 16434891
DOI: 10.1097/01.pas.0000176436.26821.8a -
Hepatology Research : the Official... Oct 2005Clinical and pathological features were reviewed in 76 Japanese patients with non-alcoholic steatohepatitis (NASH). Forty-one were male and 35 were female with the mean...
Clinical and pathological features were reviewed in 76 Japanese patients with non-alcoholic steatohepatitis (NASH). Forty-one were male and 35 were female with the mean age of 49.7 years old (range 15-75 years old, males; 46.3, females; 53.7 years old). Fifty-four percent of patients were preobese with a body mass index (BMI) between 25 and 30, while 16% of the patients were non-obese, and only 30% of the cases were morbidly obese, indicating that Japanese have a greater tendency to develop insulin-resistance and fatty liver disease than Western people. Hyperlipidemia was found in 51%, diabetes mellitus in 38%, and hypertension in 33% of the patients. Abnormally elevated liver function tests were found in one-third to two-thirds of the patients and were characteristically mild with 2- to 3-fold elevation from the normal range in the majority of the cases. Histological features of the liver were similar or identical to those reported in English literature and were characterized by fatty change, perivenular and pericellular fibrosis in zone 3, hepatocyte ballooning and necrosis with occasional Mallory's body formation and polymorphonuclear leukocyte infiltration. Mallory's bodies were found in 39% of patients and were characteristically small and poorly formed compared with those in alcoholic hepatitis. Eosinophilic granular or dirty foggy aggregated, not sufficient to be identified as Mallory's bodies, were a rather characteristic cytoplasmic expression in NASH patients. Portal inflammation and fibrosis were not found in the early stage of NASH, but were found as the disease progresses with formation of C-C and/or P-C bridging fibrosis, and eventually resulting in liver cirrhosis.
PubMed: 16275057
DOI: 10.1016/j.hepres.2005.09.017 -
Harefuah Jun 2005Fournier's gangrene is recognized as a synergistic necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in...
BACKGROUND
Fournier's gangrene is recognized as a synergistic necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in women. The major sources of Fournier's Gangrene are dermatologic, anorectal and genitourinary infections. Although anorectum is remarkably rich in bacterial flora, transanal procedures are generally free of infectious or septic complications. Nevertheless, five cases of Fournier's gangrene post hemorrhoidectomy have been published.
OBJECTIVE
To report a case of Fournier's gangrene as a delayed complication of closed hemorrhoidectomy and to demonstrate the management of such complication.
PATIENT
A sixty-six years old male who had undergone an uncomplicated closed hemorrhoidectomy was readmitted to the hospital on postoperative day 7 for fever, perirectal erythema and tenderness accompanied by a dirty brown discharge from the wound. The patient was treated with fluid resuscitation and broad-spectrum antibiotics. Radical debridement of the perianal and scrotal region was performed accompanied by diverting colostomy. Four months later a reconstruction of the perianal area was performed by meshed split thickness skin graft and the colostomy was closed.
CONCLUSIONS
Fournier's gangrene is a rare immediate or delayed complication of hemorrhoidectomy. A review of the limited available literature suggests that neither the surgical technique nor the medical history of the patient have an influence on the development of such a rare and fatal complication.
Topics: Aged; Gangrene; Hemorrhoids; Humans; Intestinal Mucosa; Male; Postoperative Complications; Rectal Diseases
PubMed: 15999556
DOI: No ID Found -
The West Indian Medical JournalThe foot complications of diabetic patients are one of the commonest and most devastating of medical problems that occurs in the Caribbean. The scale of the problem is...
The foot complications of diabetic patients are one of the commonest and most devastating of medical problems that occurs in the Caribbean. The scale of the problem is reflected in the fact that, on average, 75% of the beds in the general surgical wards of the Queen Elizabeth Hospital in Barbados are occupied by patients with this problem. Of the patients admitted, a third lose a limb by amputation and another third of the patients lose toes or part of their feet and remain in hospital an average of two months as doctors struggle to prevent them losing their limbs. Half of the patients are in their 70s when they are admitted to hospital but 4 per cent are as young as thirty to forty years. It is clear to the surgeons who struggle to save the limbs of these patients that preventive care and early and aggressive intervention, when problems occur, are the best way to avoid prolonged hospitalization and loss of limb. The events that precipitate the problems often appear trivial to most people. a little nick cutting a nail or a callus, a crack under the toe, an ingrowing nail, stepping on a rock in the yard or, even more devastating, on a dirty or rusty nail. The diabetic's foot is more susceptible to injury, sepsis and gangrene because of an altered inflammatory response and an increased incidence of occlusive vascular disease and neuropathy. Injuries normally considered minor can threaten the limb in diabetics by rapid progression of necrosis along tissue planes. Prevention is of primary importance and patients need to be educated and to remind themselves over and over again to clean their feet daily, paying particular attention to the interdigital areas: looking at them to make sure that there is no swelling or cuts or change in colour. Looking is important since diabetics, especially those with neuropathy, cannot rely-on pain as a symptom of injury. Patients have to be trained to recognise and respond to the signs of injury and infection without relying on the signal of pain that they and the health care workers usually rely upon to assess the seriousness of most conditions. Diabetics should wear something on their feet at all times, in and out of the house. What is worn should have a good firm sole to prevent penetration. If a sandal is worn, it should be strapped on so that it does not slip off easily. If something goes wrong, or is noticed to be wrong with the feet, professional help should be sought the same day. Treatment and observation are needed on a daily basis. In order to try and save a limb, patients may need to have a series of minor operations and for those who are seen by surgeons early enough, four out of every five persons will have their limbs preserved. However, after the limb is saved, it is in greater danger for further problems and patients may require special shoes to prevent recurrence. The area of rehabilitation and prevention needs a great deal of improvement in the Caribbean for specialist orthotic advice and skills are scarce. Team work is essential for, by working together, patients, doctors, nurses, chiropodists and orthotic technicians can improve outcomes for the diabetic patient.
Topics: Arteriosclerosis; Caribbean Region; Diabetic Angiopathies; Diabetic Foot; Diabetic Neuropathies; Gangrene; Humans; Primary Prevention; Self Care; Sepsis; Shoes; Skin Care
PubMed: 15973811
DOI: No ID Found -
The American Journal of Surgical... Jun 2005We present the largest series of mucinous carcinoma involving the skin, describing the histopathologic, immunohistochemical, electron microscopic, and cytogenetic... (Comparative Study)
Comparative Study
Mucinous carcinoma of the skin, primary, and secondary: a clinicopathologic study of 63 cases with emphasis on the morphologic spectrum of primary cutaneous forms: homologies with mucinous lesions in the breast.
We present the largest series of mucinous carcinoma involving the skin, describing the histopathologic, immunohistochemical, electron microscopic, and cytogenetic findings. Our aim was fully to characterize the clinicopathologic spectrum and compare it with that seen in the breast. In addition, we wished to reevaluate the differential diagnostic criteria for distinguishing primary mucinous carcinomas from histologically similar neoplasms involving the skin secondarily, and study some aspects of their pathogenesis. We demonstrate that primary cutaneous mucinous carcinomas span a morphologic spectrum compatible to their mammary counterparts. Both pure and mixed types can be delineated morphologically, and some lesions have mucocele-like configurations. Most lesions seem to originate from in situ lesions that may represent, using mammary pathology terminology, ductal hyperplasia, atypical ductal hyperplasia, or ductal carcinoma in situ or a combination of the three. Inverse cell polarity appears to facilitate the progression of the changes similar to lesions in the breast. The presence of an in situ component defines the neoplasm as primary cutaneous, but its absence does not exclude the diagnosis; although for such neoplasms, full clinical assessment is essential. Mammary mucinous carcinoma involving the skin: all patients presented with lesions on chest wall, breast, axilla, and these locations can serve as clue to the breast origin. Microscopically, cutaneous lesions were of both pure and mixed type, and this correlated with the primary in the breast. Dirty necrosis was a constant histologic finding in intestine mucinous carcinomas involving the skin, and this feature may serve as a clue to an intestinal origin.
Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Breast Neoplasms, Male; Diagnosis, Differential; Female; Humans; Intestinal Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Skin Neoplasms
PubMed: 15897743
DOI: 10.1097/01.pas.0000159104.02985.6b -
Modern Pathology : An Official Journal... Jun 2005Six cases of an unusual variant of primary pulmonary adenocarcinoma resembling colorectal and sinonasal adenocarcinoma are presented. Pulmonary intestinal-type... (Comparative Study)
Comparative Study
Six cases of an unusual variant of primary pulmonary adenocarcinoma resembling colorectal and sinonasal adenocarcinoma are presented. Pulmonary intestinal-type adenocarcinoma occurs in elderly Caucasians and is associated with a histology characteristic of colorectal/enteric adenocarcinoma: a garland-like architecture with a 'gland in gland' periphery, central 'dirty' necrosis, and elongated stratified columnar cells, lacking significant goblet or signet ring differentiation. While a resemblance to intestinal adenocarcinoma by light microscopy is present, immunohistochemical studies comparing these carcinomas with metastatic colorectal adenocarcinoma clearly show a respiratory phenotype with the neoplastic cells expressing thyroid transcription factor-1 and cytokeratin 7 to the exclusion of cytokeratin 20, and failing to express CDX-2. Stains for a variety of epithelial mucins (MUC1, MUC2, MUC5AC) also support this observation. The differential diagnosis with other pulmonary adenocarcinomas, especially those with mucinous differentiation, is discussed.
Topics: Adenocarcinoma; Aged; Aged, 80 and over; CDX2 Transcription Factor; Cell Differentiation; Colonic Neoplasms; Female; Homeodomain Proteins; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratins; Lung Neoplasms; Male; Middle Aged; Mucin 5AC; Mucin-1; Mucin-2; Mucins; Nuclear Proteins; Thyroid Nuclear Factor 1; Trans-Activators; Transcription Factors
PubMed: 15605076
DOI: 10.1038/modpathol.3800358 -
Gan To Kagaku Ryoho. Cancer &... Jun 2004Advanced human pancreatic cancer is considered a chemoresistant disease. To date, no treatments have had a significant efficacy on the disease. Patients with pancreatic...
Advanced human pancreatic cancer is considered a chemoresistant disease. To date, no treatments have had a significant efficacy on the disease. Patients with pancreatic cancer, however, experienced an improvement in the related symptoms with gemcitabine. Thalidomide has been shown to have antiangiogenic and immunomodulatory effects, including the inhibition of vascular endothelial growth factor, basic fibroblast growth factor and tumor necrosis factor alpha. The reported biological consequences of COX-2 up-regulation include inhibition of apoptosis, increased metastatic potential and promotion of angiogenesis. These events may contribute to cell transformation and tumor progression. Antiangiogenesis represents a significant new strategy for cancer treatment; however, most tumors are biologically heterogeneous, especially in endothelial cell diversity. As vessels of most solid tumors are structurally and functionally abnormal, tumor vessels differ from normal blood vessels in their responses to antiangiogenic agents. Therefore, it is important to accept a wide range of different inhibitors, such as thalidomide and selective COX-2 inhibitors, with conventional cytotoxic agents. Here we show a case of advanced pancreatic cancer with remarkable improvement in tumor shrinkage, CA19-9, and a cessation of dirty exudate from umbilicus.
Topics: Administration, Oral; Aged; Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Celecoxib; Cyclooxygenase 2; Cyclooxygenase 2 Inhibitors; Cyclooxygenase Inhibitors; Deoxycytidine; Drug Administration Schedule; Humans; Infusions, Intravenous; Isoenzymes; Male; Membrane Proteins; Pancreatic Neoplasms; Prostaglandin-Endoperoxide Synthases; Pyrazoles; Sulfonamides; Thalidomide; Gemcitabine
PubMed: 15222121
DOI: No ID Found -
Diagnostic Cytopathology Mar 2004Clinical management of in situ carcinoma of the breast is different from invasive carcinomas. Thus, it is important to find cytomorphologic criteria to distinguish...
Clinical management of in situ carcinoma of the breast is different from invasive carcinomas. Thus, it is important to find cytomorphologic criteria to distinguish between these two entities. The current study is designed to assess whether, by applying strict cytologic criteria, the status of stromal invasion can be predicted. In this retrospective study, 223 consecutive nonpalpable tumors sampled by ultrasound-guided breast fine-needle aspirates with diagnosis of in situ and invasive carcinoma with histologic follow-up evaluation were retrieved. Ten cytologic parameters were evaluated, which included cellular clustering, eosinophilic differentiation, necrosis, tubular structures, dirty background, nuclear anisonucleosis, cellular pleomorphism, cribriform pattern, tubular structures, and stromal infiltration. Among all the parameters examined, stromal infiltration was the most powerful predictor of status of invasion. Stromal infiltration was significantly higher in invasive (88%) than in situ (11%), P < 0.0001. In contrast, cribriform pattern (16% vs 36%) and necrosis (19% vs 59%) were more frequently seen in situ than in invasive carcinomas with P-values of 0.0008 and <0.0001, respectively. This study demonstrates that stromal infiltration defined by strict criteria may predict the status of tumor invasion in breast fine-needle aspirates. The combination of stromal infiltration and cribriform pattern and necrosis in aspirates may provide an opportunity in introducing a "predictive index" to differentiate between an in situ versus an invasive process.
Topics: Adenocarcinoma; Biopsy, Fine-Needle; Breast Neoplasms; Carcinoma in Situ; Female; Humans; Neoplasm Invasiveness; Predictive Value of Tests; Retrospective Studies; Stromal Cells; Ultrasonography
PubMed: 14986299
DOI: 10.1002/dc.10425 -
Cancer Oct 2003Patients with transformed large cell lymphoma (TLCL), or Richter syndrome, and patients with small lymphocytic lymphoma/leukemia (SLL) in accelerated phase (SLL-AP)... (Comparative Study)
Comparative Study
BACKGROUND
Patients with transformed large cell lymphoma (TLCL), or Richter syndrome, and patients with small lymphocytic lymphoma/leukemia (SLL) in accelerated phase (SLL-AP) frequently undergo fine-needle aspiration (FNA) to elucidate the cause of massive lymphadenopathy and a worsening clinical condition. It is well known that patients with Richter syndrome have poor clinical outcomes as a result of the biologic aggressiveness of the transformed large cells that often are refractory to therapy. The objective of this study was to evaluate reliable criteria for recognizing SLL-AP and SLL in transformation that are needed to determine the appropriate clinical management of individual patients.
METHODS
FNA specimens from 20 patients with SLL, 26 patients with SLL-AP, and 13 patients with TLCL or Richter syndrome were identified based on the reported diagnosis. Patients were included only if they had histologically confirmed SLL that also satisfied the immunophenotypic criteria of CD5/CD23 coexpression with negative CD10 and < 55% prolymphocytes. On the basis of an initial blind review of routinely stained slides from the FNA specimens, the authors defined four groups based on a consensus review diagnosis: Group 1: typical SLL; Group 2: low-grade SLL-AP; Group 3: high-grade SLL-AP; and Group 4: TLCL. Cytomorphologic features, including the proportion of intermediate-to-large cells with prominent nucleoli and intermediate-sized plasmacytoid lymphoid cells, increased numbers of mitotic figures, the presence of apoptotic bodies and necrosis, and a myxoid/dirty background, were considered features that indicated an accelerated phase. Specimens that had more than two grades of diagnostic discrepancy compared with the original reported diagnosis were reexamined using a Ki-67 immunostaining labeling index to reach a final review diagnosis.
RESULTS
On the basis of the review diagnosis, the specimens were recategorized as follows: Group 1: 20 patients with typical SLL; Group 2: 13 patients with low-grade-SLL-AP; Group 3: 16 patients with high-grade SLL-AP; and Group 4: 10 patients with TLCL. The mean Ki-67 labeling index (%) was correlated with the morphologic progression of SLL as follows: Group 1: 11%; Group 2: 16%; Group 3: 34%; and Group 4: 48%. The follow-up by subsequent FNA or biopsy demonstrated large cell transformation in 25% of patients in Group 1, 25% of patients in Group 2, and 100% of patients in Group 3. Among the clinical parameters, increased value of serum beta2-microglobulin and lactic dehydrogenase (LDH) levels were found to be well correlated with the cytomorphologic progression of SLL/chronic lymphocytic leukemia.
CONCLUSIONS
Aspirates from patients who had signs and symptoms clinically suspicious for SLL-AP demonstrated a spectrum of cytomorphologic features, ranging from low-grade SLL-AP and high-grade SLL-AP to TLCL. The results showed that the Ki-67 labeling index, as determined by immunohistochemical studies in FNA specimens, and the levels of serum beta2-microglobulin and LDH are valuable diagnostic adjuncts for recognizing a subset of patients with SLL-AP or SLL in transformation who may require more aggressive therapy.
Topics: Adult; Aged; Biopsy, Needle; Cell Transformation, Neoplastic; Cohort Studies; Cytodiagnosis; Diagnosis, Differential; Disease Progression; Female; Humans; Immunohistochemistry; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment; Sensitivity and Specificity
PubMed: 14579296
DOI: 10.1002/cncr.11441