Lymphoepithelioma – a tumour rarely observed in children (3 cases)

Lymphoepithelioma rarely develops in children. In its early stage it may manifest itself only as enlarged cervical lymph nodes, which is likely to cause difficulties in the initial diagnosis. Radiotherapy is the treatment of choice, however, chemotherapy has also been used. The paper describes three cases of children treated for lymphoepithelioma at the Department of Children Hematology and Oncology in Lublin between 1991 – 2001. In all cases, the diagnosis was based on histopathological examinations of the tumour or lymph node biopsies. The methods of treatment used were different in each case and the longest disease free survival was 3 years. Therefore it seems necessary to design a uniform protocol of treatment for children with lymphoepithelioma.The first child was treated only to radiotherapy. This choice was based on lack of results of well conducted trials of cytostatic treatment. The good result of our treatment confirmed the data presented by other with the use of radiotherapy alone.In the second case, in case of large tumour, paralysis of cranial nerves, this patient was refered to combined treatment (radio-chemotherapy). In this case the partial remission was achived.In the third case, chemotherapy (cisplatin + 5-fluorouracil) resulted in perfect remission of the primary tumour and metastases to the lymph nodes while radiotherapy allow to achive complete control of the primary tumour and metastases to lymph nodes.     

Clear cell sarcoma, cellular mesoblastic nephroma and metanephric adenoma: cytological features and differential diagnosis with Wilms tumour

Wilms' Tumour (WT) is the most common kidney tumour in childhood, this fact and the embryonic complexity of WT create, whenever one of its three classical components predominates in cytologic smears, difficulties in the differential diagnoses with other less common entities. In the present study, we review the cytological and immunohistochemical characteristics of three children renal tumours, a Clear Cell Sarcoma of the Kidney (CCSK-case1), a Cellular Mesoblastic Nephroma (CMN-case2) and a Metanephric Adenoma (MA-case3) and compare them, for differential diagnostic purposes, with smears of blastematous, mesenchymal and epithelial predominant WTs, previously diagnosed in our Department. In all cases a mass was detected in the abdomen (2 and 8 year old children-cases 1 and 3, respectively), and pre-birth in case 2 (the tumour was detected during pregnancy). Fine needle biopsy was performed followed by routine cytologic examination. The presence of moderate amount of blue pale cytoplasm in neoplastic cells (case1), the presence of tightly cohesive, bland, spindle tumour cells (case2) and the identification of small, well differentiated epithelial tubules with psammoma bodies in case 3, were the main morphologic characteristics that we think represent the most important elements for distinguishing our cases from a WT. Immunoreactivity was only helpful in case 1 as we found a characteristic dot-like pattern positivity for vimentin, in the absence of immunoreactivity for the other markers that are usually positive in WT. Summing up, these three cases demonstrate that cytopathologists should be aware of the occurrence of uncommon renal neoplasms in childhood and should be acquainted with their characteristics, in order to avoid false diagnoses.     

The role of PET-CT in detecting unknown primary tumour in patients with cervical lymph node metastases

PET-CT examination was conducted with 440 patients treated at the Department of Head and Neck Surgery, National Institute of Oncology, Budapest, between January 1, 2006 and December 31, 2010. Out of them 77 patients were selected with whom no examination of any sort (physical, pan-endoscopy, or any of the conventional imaging techniques) succeeded in identifying the primary tumour. In each case the primary examination (aspiration cytology and histology) verified cervical metastases, most of them being squamous cell carcinoma. The significance of PET-CT was retrospectively evaluated in cases of unknown primary tumour with verified cervical metastases. We tested the sensitivity of PET-CT in detection of the primary malignant tumour, and possible distant metastases or a second primary in order to plan an optimal treatment schedule for the patient. Patients with whom the examinations specified in the treatment protocol (physical examination, pan-endoscopy, conventional imaging, biopsy) had failed to diagnose the primary tumour were referred to PET-CT. In each case 18F-FDG tracer was used. In 21/77 patients (27%), the PET-CT yielded unequivocal evidence for the primary tumour confirmed by histology, as well. With 10 others (13%), the precarious diagnoses by various imaging techniques were confirmed by the PET-CT. False positive findings with PET-CT that were not verified either by histology or control examination tests occurred but in 10 patients (13%). Concerning the primary tumour, false negative result was obtained only with 3 patients (4%). It should be noted that their retrospective evaluation proved diagnostic errors, the primary tumours were visible in all the scans. With 33 patients (43%) PET-CT furnished no additional information compared to the previous examinations. In 10 patients, asymptomatic distant metastases and in 3 patients synchronous tumours were diagnosed. We also acknowledge that the significance of PET-CT using 18F-FDG is unquestionable in the detection of unknown primary tumours. It is strongly recommended to re-include the detection of unknown primaries in the approved national indication list of PET-CT. (Note, until January 1, 2008 it had been included!) PET-CT is capable of detecting a primary tumour, after all unsuccessful diagnostic examinations till then, in 25-40% of the cases. One cannot disregard the role and significance of PET-CT in the detection of asymptomatic synchronous tumours, or distant metastases. These benefits make PET-CT a suitable tool for the refinement of individually tailored treatment strategies leading to better therapeutic results and more favourable cost-benefit ratio.     

Immunological Reactivity in Patients with Carcinoma of Colon

Sixty cases of colonic carcinoma have been investigated for antitumour immunoreactivity. The tests employed were blood lymphocyte reactivity and complement-dependent serum cytotoxicity against cultured tumour cells, and immunofluorescence for membrane staining of viable tumour cells and cytoplasmic staining of dried tumour cells in films. Nineteen cases were positive by one or more tests and the most frequent positive response, lymphocytotoxicity, was detected in 8 of the 24 cases tested in this way. The lymphocytotoxicity persisted in a case tested three times over a year. Immunoreactivity against tumour cell surface, as by lymphocyte or serum cytotoxicity or membrane immunofluorescence, was restricted to colonic carcinomas but there was an additional element of individual specificity; cross-reactivity with other tissues and tumours was not observed. Lymphocytes from regional lymph nodes were non-reactive even in a case with positive blood lymphocyte cytotoxicity against the carcinoma cells.     

Tumeur pseudopapillaire et solide du pancréas : à propos d’un cas

Solid pseudopapillary tumour of the pancreas is a rare tumour that electively affects young women. Its clinical presentation is variable: it may be discovered incidentally or by the appearance of an epigastric mass or signs of biliary compression. Its prognosis is excellent after surgical resection. Imaging findings are essential, as they are sufficient to suggest the diagnosis without the need of a puncture-biospy. ¹⁸F-FDG PET-CT may indicate hypermetabolic space-occupying lesion highly suggestive of aggressive tumour, while it tallies with a low malignancy tumour. These features may make PET-CT interpretation more erratic if these particular properties are ignored. We report the case of a 17-year-old woman who presented a solid and pseudopapillary tumour of the pancreas. The diagnosis was reached through various imaging tests (ultrasound, CT and PET-CT) in context of the medical history and was confirmed by the sample pathological analysis.     

TEP/TDM au FDG et hibernome : à propos d’un cas

Hibernoma is a rare benign tumour of soft tissue, generally asymptomatic, usually discovered in young adults. It is a form of lipoma that originates from brown adipose tissue. Its diagnosis is based on histology, the main differential diagnoses being lipoma and liposarcoma. Its appearance on FDG PET/CT has being described only in few case reports. We report here the case of a 68-year-old patient with ENT cancer in whom an adipose tumour in the left axilla has been discovered on CT performed for staging. The diagnosis of hibernoma was suggested in the report of FDG PET/CT examination and was consistent with results of other imaging modalities. On MRI, contrast enhancement was observed after gadolinium contrast injection, which was not typical for a lipoma. On PET/CT, the FDG uptake by the adipose tumour was very intense (SUVmax = 16), which is characteristic for hibernoma that derives from brown adipose tissue. Imaging was unable to distinguish between hibernoma and liposarcoma. The diagnosis of benign mixed hibernoma-lipoma was ascertained on histopathology after complete resection of the tumour. Elements favouring hibernoma over liposarcoma are present in this observation: high avidity for FDG (SUVmax > 10) and a fluctuating intensity of uptake, SUVmax of the tumour increasing from 16 to 48 within 16 months in the presented case. A high SUVmax on FDG PET in an adipose tumour on CT seems to be more suggestive of a benign tumour, hibernoma, than of its malignant counterpart, liposarcoma.     

Marker chromosomes associated with tumour growth potential in plants

Abstract. The tumour growth potential of single-cell clones derived from the habituated tobacco strain Tabac anergié was analysed by: (1) culture on a medium which prevents the growth of normal cells, (2) graft tests, and (3) detailed chromosome analyses. Basal medium (BM) was more suitable for screening tumour cells than the hormone-free medium of Murashige and Skoog. Experiments using BM have pointed to the existence of different degrees of tumour growth potential. This is also indicated by graft tests which show variations of tumour growth potential at the intractional and interclonal levels. The chromosome analyses show a lack of correlation between chromosome number and tumour growth potential, but a good correlation between the latter and the number of marker chromosomes specific to tumour cells: the least-square regression line (y=13.76x+4.4) shows that the size of tumours is proportional to the number of marker chromosomes per cell. Moreover, the transition from a weak tumour state to a high tumour state by screening the tumour cells containing marker chromosomes on BM, reinforces the relationship between marker chromosomes and tumour development. These findings are relevant to the problem of the transformation of plant tissues, either by chromosome translocation, as is the case in many malignant cells, or with the exogenous T-DNA of the plasmid Ti carried by the bacterium Agrobacterium tumefaciens.     

Fine Needle Aspiration of Sister Mary Joseph''s Nodule

A case of Sister Mary Joseph's nodule (umbilical metastasis) is described from a primary adenocarcinoma of the transverse colon. Needle aspiration cytology made the diagnosis which was confirmed by immunocytochemical localization of CEA, B72.3, EMA, and cytokeratin in the tumour cells. Extensive mucus production in the tumour cells was demonstrated by alcian blue and mucicarmine stains.     

Positron emission tomography (18FDG-PET) in the detection of medullary thyroid carcinoma metastases

INTRODUCTION: Medullary thyroid carcinoma (MTC) is usually more advanced at presentation than differentiated thyroid cancers and often has distant metastases. The primary treatment of MTC is total thyroidectomy and regional lymph node dissection. The efficacy of these procedures has been limited by the aggressiveness of the disease and metastatic spread at the time of surgery. Persistently elevated levels of calcitonin (CT) and carcinoembryonic antigen (CEA) or their increase postoperatively are indicative for residual or recurrent disease. Conventional imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging and MIBI scintigraphy usually fail to find the source of calcitonin. Better imaging properties have been shown by DMSA scintigraphy, somatostatin receptor scintigraphy or by positron emission tomography (PET). The aim of the study was to evaluate the diagnostic accuracy of PET for the localisation of occult MTC in patients after surgery with increased concentrations of CT, in whom conventional imaging procedures have not been successful. MATERIAL AND METHODS: The PET investigation using (18)F-fluoro- 2-deoxy-D-glucose combined with computed tomography ((18)FDG-PET/CT) was performed at the Department of Nuclear Medicine (Oncology Centre in Bydgoszcz) between January and October 2004. In five patients with postoperative calcitonin ranging from 164 to > 2000 ng/l (normal < 10 ng/l) no tumour lesions were found using other imaging methods. RESULTS: In four of five cases, responsible lesions with a higher metabolism of FDG, indicating MTC tissue (remnants or metastases), were localised. In one patient no focus of FDG accumulation was found despite high CT concentration. PET detected tumour manifestations in the neck and the mediastinum in two patients, in the lung and the left adrenal gland in one case and in the neck and the liver in another patient. As a result of surgery for the removal of a residual tumour or metastases the accuracy of diagnosis was confirmed by histopathology in all four cases and a decrease in CT and CEA levels was observed in 3/4 cases. The metabolic imaging findings by PET/CT ensured that the surgery on these patients was successful. CONCLUSIONS: For the detection of occult residual or metastatic MTC lesions, (18)FDG-PET is a valuable procedure in imaging diagnostics.     

Renal papillary adenoma in a cotton-topped tamarin (Saguinus oedipus)

The second case of a renal tumour in a tamarin is described. The incidentally discovered unilateral tumour developed in an adult female cotton-topped tamarin. It did not cause clinical symptoms and was classified as a papillary adenoma based on its morphological characteristics.     

Neoplasia in the Siberian weasel (<Emphasis Type="Italic">Mustela sibirica</Emphasis>): two case reports of fibrosarcoma and interstitial cell tumour

Two cases of neoplasia occurred in two adult Siberian weasels (Mustela sibirica) in a game reserve in southern Lower Saxony, Germany. The first case, a male weasel, showed an enlargement of the right testicle, which was surgically removed. The tumour was classified as an interstitial cell tumour. One year after surgery, the male weasel died by accident and revealed tumour lesions of uncertain histogenesis within the abdominal cavity and the spleen at necropsy. The second case, a female animal, became suspicious by a dermal mass in the upper left hind limb, which was also surgically excised. Pathological examinations revealed a fibrosarcoma that recurred twice after removal of the original mass. These two cases of neoplasia in the Siberian weasel are demonstrated with regard to clinical aspects and discussed on the basis of their pathomorphological features.     

Diagnosis of a peripheral neuroectodermal tumour by fine needle aspiration

One case of malignant peripheral neuroectodermal tumour successfully diagnosed by cytology is presented. Although a Papanicolaou stained smear could not lead to a diagnosis more specific than a malignant small cell tumour, ancillary analytic methods performed on the cytologic material including immunocytochemistry and electron microscopy yielded the correct diagnosis of peripheral neuroectodermal tumour. This case demonstrates that a precise categorization of small round cell tumours may be achieved by cytology as long as some material is kept for immunocytochemical and ultrastructural studies.     

Ectopic gonadotropin in a case of anaplastic large-cell carcinoma of the lung

A case of ectopic gonadotropin production by a bronchogenic carcinoma is presented. Eleven similar cases have been previously reported. Urine gonadotropin titres appeared related to the size of the tumour mass since they decreased with response to treatment and increased when the tumour started progressing again. The hormone is most probably elaborated and secreted by the tumour cells.     

An oestrogen-producing seminoma responsible for gynaecomastia.

In feminising testicular tumours, oestrogens can be either secreted by the tumour itself or produced by normal Leydig cells in response to paracrine and/or endocrine stimulation by hCG. Typical hormonal Leydig cell tumour patterns include: plasma oestradiol levels > 300 pmol/l on day 3 following an hCG injection, reduced plasma testosterone, and normal plasma hCG and gonadotrophin levels. Except for elevated plasma oestradiol levels, opposite results are observed in seminomas. We report a case of oestrogen-secreting seminoma mimicking a Leydig cell tumour. A 24-year-old Caucasian patient had complained of gynaecomastia for 6 months before admission. Hormonal pattern was typical of Leydig cell tumour. A 1.4 cm tumour was found in the left testis and confirmed on sonography. Considering the likely diagnosis of Leydig cell tumour, the patient was treated by tumourectomy. Surprisingly, pathological examination revealed a pure seminoma. Perifusion experiments showed that the tumour was able to secrete significant amounts of oestradiol. In addition, hCG induced a two-fold increase in oestradiol production from perifused tumour explants. Immunohistochemistry revealed that the tumour was composed of nests of seminoma cells intermingled with lymphoid infiltrates. Tumour cells also expressed aromatase, the hCG/LH receptor and the Leydig cell marker relaxin-like factor, but were betahCG-negative. These results demonstrate that a pure seminoma of the testis is able to synthesise and secrete oestrogens. They also illustrate that the body of proof favouring the diagnosis of feminising Leydig cell tumour of the testis is not rigorously specific.     

Fine needle aspiration cytodiagnosis of anaplastic carcinoma and malignant haemangioendothelioma of the thyroid in an endemic goitre area

Between 1970 and 1987, 20,028 fine needle aspirates (FNA) of the thyroid have been examined in the Department of Pathology of the University of Innsbruck, Austria. During this period 92 cases of anaplastic carcinoma and 16 cases of malignant haemangioendothelioma (MHE) of the thyroid were diagnosed. Forty-three out of these 108 highly malignant tumours of the thyroid underwent FNA pre-operatively (39.1%). Thirty-seven FNA contained numerous cells of a highly malignant tumour. Five specimens (11.8%) contained only necrotic material and inflammatory cells. In one case of an anaplastic carcinoma no malignant cells could be demonstrated in FNA. We conclude that pre-operative FNA of highly malignant thyroid tumours may contribute substantially to subsequent clinical management.     

Stereotactic biopsy and cytological diagnosis of solid and cystic intracranial lesions

Cytological smears from 115 consecutive cases of stereotactic biopsies of intracranial lesions were reviewed. Ninety-five lesions were solid and 20 cystic. Material from 90 solid and 13 cystic lesions was sent both for cytological and histological examination. In 66 of the solid lesions, the cytological diagnosis was confirmed by histology (five were benign lesions and 61 malignant tumours: 56 primary brain tumours, three metastases and two lymphomas). In 24 cases with discrepant cytology and histology, the histology was inconclusive or insufficient in 14 cases, while cytology established the diagnosis of astrocytoma grade II (seven cases), metastases (two cases), gliosis (one case) and benign (four cases). Necrosis of tumour type was observed cytologically in six patients representing glioblastoma (two cases), anaplastic astrocytoma (one case), lymphoma (one case) and normal brain (two cases) histologically. Three cases reported cytologically as benign were primary brain tumour (two cases) and gliosis (one case). One smear of a glioblastoma was insufficient for cytological diagnosis. Cystic lesions were cytologically benign in 17 cases and malignant in three cases. Histology from the cyst wall confirmed the malignant diagnosis in three cases and showed tumour in six more cases, a benign process (two cases), changes induced by radiotherapy for arteriovenous malformation (one case) and insufficient material (one case). In conclusion, cytology from solid brain lesion allows an accurate diagnosis and subtyping of tumours in a majority of cases, and can thus be used to choose type of therapy. In cystic brain tumours, however, examination of the cystic fluid, is often inconclusive and a biopsy from the cyst wall should be performed if there is clinical or radiological suspicion of tumour.     

Tumour cell recruitment of the JB-1 and L 1210 ascites tumour determined directly by double labelling with [14C]- and [3H]-thymidine

Tumour cell recruitment of the JB-1 and L 1210 ascites tumour has been demonstrated directly by a double-labelling method with [14C]- and [3H]-thymidine (TdR). After [14C]-labelling of all proliferating tumour cells by multiple injections of [14C]TdR, recruitment of resting cells was stimulated by removal of the majority of tumour cells, i.e. by maximum aspiration of ascitic fluid. The number of recruited resting cells in the remaining tumour that re-enter the cell cycle after stimulation was demonstrated directly by a single injection of [3H]TdR given at different times after stimulation. The increase in the percentage of purely [3H]-labelled cells, i.e. recruited cells, with increasing time after stimulation, shows that recruitment is not a synchronous but a continuous process, the maximum of which occurs earlier in the case of the L 1210 than the JB-1 tumour. This suggests that there seems to be a relationship between the time required for maximum recruitment and the corresponding cell cycle parameters of the unperturbed tumour. There is a transitory increase of the growth fraction to about 100% and a considerable shortening of the cycle time at the maximum of recruitment.     

Prognostic factors in renal cell carcinoma

We studied 569 cases of renal cell carcinoma in the files of the Department of Pathology of the Norwegian Radium Hospital from 1964 to 1974. A nephrectomy had been performed in all cases. Clinical information on sex, age, survival time and metastases was traced. The histological slides were examined and tumour growth pattern, cell type, cell shape, nuclear atypia, abnormal nucleoli, nuclear grade, vascular invasion and tumour demarcation were all evaluated. Besides well-known prognostic factors such as tumour stage, presence or absence of metastases and vascular invasion, nuclear grade was found to be a useful prognostic factor. Younger patients were found to do better than older, and women better than men. Smaller tumours carried a better prognosis than larger and clear cell tumours had a better prognosis than those composed of eosinophilic or basophilic cells. The presence of spindle cells was a bad prognostic omen.     

Angiogenesis measured by expression of CD34 antigen in lymph nodes of patients with non-Hodgkin's lymphoma

Angiogenesis is important in development, maintenance and progression of haematological malignancies. Some clinical observations have indicated that in non-Hodgkin's lymphoma (nHL) tumour microvessel density (MVD) may correlate with tumour staging and outcome. The aim of the study was to examine relationship between MVD as a parameter of tumour angiogenesis measured by expression of CD34 and the grade of nHL histological malignancy as determined by REAL classification. 40 lymph node samples of patients with newly diagnosed nHL (17 women, 23 men; aged 48-70 yrs, median age 64 yrs; stage III and IV) and treated at the Department of Haematology, Wroc?aw Medical University in 1999-2002 were fixed in 10% buffered formalin and embedded in paraffin. In all the studied cases, sections were incubated with antibodies against CD34. The slides were stained with hematoxylin and eosin and evaluated histopathologically. Patients were divided into two groups according to histological malignancy: indolent nHL (19 patients) and aggressive nHL (21 patients). Mean MVD measured by expression of CD34 in aggressive and indolent nHL groups amounted to 19.45 +/- 11.24 vessels/0.375 mm2 and 21.7 +/- 12.4 vessels/0.375 mm2, respectively. Statistical analysis of microvessel staining demonstrated no correlation between tumour MVD and grade of histological malignancy in lymph nodes of nHL patients. Nevertheless, angiogenesis observed in nHL provides rationale for use of angiogenesis inhibitors in lymphoma therapy.