Histological progression of small intrapulmonary metastatic tumor from primary lung adenocarcinomaAokage, Keiju; Ishii, Genichiro; Yoshida, Junji; Hishida, Tomoyuki; Nishimura, Mitsuyo; Nagai, Kanji; Ochiai, Atsushi
doi: 10.1111/j.1440-1827.2010.02596.xpmid: 21091834
The histopathology of small metastases is thought to reflect the early metastatic process. To clarify the morphological features of early metastatic tumor progression, we analyzed the histological heterogeneity of many small intrapulmonary metastases. Histological typing based on the World Health Organization classification (bronchioloalveolar carcinoma, acinar, papillary, and solid subtype) was used to evaluate 234 metastases from the primary lung adenocarcinomas of 139 patients. The predominant subtype of metastasis 3 mm or less in diameter was bronchioloalveolar carcinoma when the primary lesion was diagnosed as predominant bronchioloalveolar carcinoma, acinar, and papillary subtype. When the histology of the primary tumor was predominantly a solid subtype, the predominant subtype of metastatic tumor was also a solid subtype. However, analysis of metastases that were more than 3 mm showed that the predominant subtype of the metastasis reflected the predominant subtype of the primary tumor. Furthermore, we evaluated the number of subtypes in primary and metastatic tumors. As the metastasis grew larger, the number of subtypes in the metastatic lesion increased and came close to the number composed in the primary lesion. These findings suggest that implanted cancer cells display lepidic growth in the early metastatic phase and recapitulate the morphological heterogeneity of the original tumor as the metastasis enlarges.
Idiopathic segmental ureteritis, misdiagnosed as ureteral cancer preoperatively: A case report with literature reviewJoo, Mee; Chang, Sun Hee; Kim, Hanseong; Lee, Keon Cheol; Ro, Jae Yun
doi: 10.1111/j.1440-1827.2010.02598.xpmid: 21091836
A 53‐year‐old man presented with right flank pain for 6 days. Computerized tomography revealed a 3 cm long segment of ureteral narrowing with wall thickening and hydronephrosis, suspicious for ureteral cancer. Under the clinical diagnosis of ureteral carcinoma a right nephroureterectomy was performed. The wall of the distal ureter, 2.5 cm from the bladder cuff, had a luminal‐narrowing, firm mass‐forming lesion with abrupt transition from the adjacent ureter. Histologically, the resected ureteral mass showed transmural fibrosing, chronic inflammation with numerous plasma cells, epithelioid granulomas, and obliterative phlebitis. Histological findings were consistent with idiopathic segmental ureteritis (ISU) with differential diagnoses of IgG4‐related sclerosing disease, including lymphoplasmacytic inflammatory pseudotumor (IPT) and idiopathic retroperitoneal fibrosis. IgG4 immunostaining in this case was barely positive, excluding the possibility of IgG4‐related IPT. Although the majority of luminal obliterated segmental lesions of the ureter are neoplastic in nature, non‐neoplastic inflammatory processes as seen in this case may occur in the ureter, causing diagnostic confusion with true neoplasms. Herein we report a rare case of ISU that was clinically misdiagnosed as malignancy preoperatively. ISU of the current case may be an IgG4‐unrelated subtype of IPT.
Dermatofibrosarcoma protuberans of the breast skinKim, Taeeun; Choi, Yoon‐La; Park, Ha‐Young; Song, Ji‐Young; Shin, Jung Hee; Nam, Seok Jin; Ahn, Geunghwan
doi: 10.1111/j.1440-1827.2010.02599.xpmid: 21091837
A case of a 26‐year‐old woman with dermatofibrosarcoma protuberans of the breast skin is described. She had noticed a palpable mass with redness 15 years previously, but it had begun to grow rapidly with swelling and redness two months before presenting. Ultrasonography and biopsy demonstrated a possibility of sarcoma of the breast. Wide excision was performed to confirm the diagnosis. Histologically, the tumor was composed of a uniform population of fibroblasts in a distinct storiform pattern. CD34 immunostaining showed diffuse reactivity. Platelet‐derived growth factor β break‐apart fluorescence in situ hybridization analysis showed a split‐signal pattern which supported the diagnosis of dermatofibrosarcoma protuberans in the skin of the breast. It is important to diagnose a soft tissue lesion accurately when it occurs in the breast.
Atypical soft tissue perineurioma in the tongue of a young girlAdachi, Shiro; Doi, Reiko; Mitani, Kenji; Iwamoto, Yoriko; Furumoto, Ayumi; Yamashita, Maki; Cho, Hironori
doi: 10.1111/j.1440-1827.2010.02602.xpmid: 21091838
Perineuriomas are uncommon benign peripheral nerve sheath tumors that include soft tissue, sclerosing, reticular, and intraneural variants. Soft tissue perineuriomas arise in a wide anatomic distribution and mostly in patients older than 20 years of age. We report an atypical perineurioma in a 7‐year‐old girl. The tumor, located in the tongue, was uniformly hypercellular. The tumor cells were spindle‐shaped with a slender, elongated, bipolar, wavy cytoplasmic process formation and wavy elongated nuclei, and the architecture was composed of predominantly short fascicles with areas exhibiting a vague storiform pattern. Although the tumor cells generally appeared bland, the tumor showed worrisome features including an infiltrative pattern and occasional mitotic figures. Psammoma bodies were observed in the periphery of the tumor. Immunohistochemically, the cells were positive for epithelial membrane antigen, vimentin, claudin‐1, and GLUT‐1, but negative for S‐100 protein, CD34, and type IV collagen. The authors document a case of soft tissue perineurioma with atypical histological features that occurred in the tongue of a child.
Fluorescent in situ hybridization heating pretreatment: The key is temperature controlTojo, Marta; Couso, Elena; Vázquez‐Boquete, Angel; Pérez‐Becerra, Raquel; García‐Caballero, Tomás; Forteza, Jerónimo; Fraga, Máximo
doi: 10.1111/j.1440-1827.2010.02600.xpmid: 21140588
Fluorescent in situ hybridization (FISH) is a very useful tool for diagnostic and prognostic purposes in pathology. However, many laboratories still experience troubles when applying FISH to paraffin material. To overcome these difficulties, different pretreatments which include enzymatic digestion have been described. Usually, previous to digestion, a heating step is performed. The aim of this study was to compare the efficiency of the heating step with different buffers and different heating methods. We conclude that the main factor in the heating pretreatment is the temperature control, irrespective of the buffer used. Best results are obtained with any buffer by heating the slides to 99°C for 15 min followed by 10 min at room temperature.