1/10. Exfoliative cytology of a lymphoepithelioma-like carcinoma in a cervical smear. A case report.BACKGROUND: Lymphoepithelioma-like carcinoma of the cervix (LELC) is cytologically identical to its counterparts at other sites, such as the nasopharynx. LELC can be suspected on a cervical cytologic smear. The differential diagnosis includes nonkeratinizing squamous cell carcinoma with prominent stromal inflammation, carcinoma with intense stromal eosinophilia, glassy cell carcinoma, malignant lymphoma (especially lymphoepitheloid-Lennerts lymphoma) and metastatic Schmincke-Regaud tumor. CASE: A 55-year-old female presented with an ulcerated endophytic tumor in the cervix. Exfoliative cytology showed uniform, large tumor cells, often associated with inflammatory cells, with round or oval nuclei and one or more prominent nucleoli. The cytoplasm was finely granular to flocculent, and the nuclei were uniformly vesicular. The chromatin was peripherally marginated. The cell borders were indistinct. There was no evidence of dyskeratotic or keratinized cells, koilocytes or glandlike formations. These findings were highly suspicious for LELC and were confirmed by biopsy. flow cytometry showed dna aneuploidy, with a dna index of 1.08. in situ hybridization was negative for human papillomavirus 16 and 18. CONCLUSION: LELC of the uterine cervix has cytologic features that are sufficiently characteristic for a specific cytologic diagnosis. The diagnosis, nevertheless, has to be proven by histology.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/10. Dedifferentiation occurring in adenoid cystic carcinoma of the tongue.A 61-year-old man came to the University of Granada School of dentistry complaining of a mass involving his ventral tongue. Histopathologic examination of the excised specimen showed adenoid cystic carcinoma in which cribriform and tubular patterns were observed, juxtaposed with an undifferentiated carcinoma, large-cell type. No cervical lymph node metastasis was present, and the patient is alive and free of disease 5 years after treatment. To our knowledge, no similar cases have been reported thus far, though other salivary gland malignancies have been described in association with undifferentiated carcinoma, especially in the parotid gland. These neoplasms have been highly aggressive, and the adequacy of the primary surgical resection may be critical in determining the ultimate prognosis and survival.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
3/10. Primary large-cell neuroendocrine carcinoma of the parotid gland: immunohistochemical and molecular analysis of two cases.Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a newly proposed clinicopathologic entity; a few cases of LCNEC have been reported in other sites, such as the uterine cervix and the thymus. In the salivary glands, LCNEC is extremely rare and is not recognized as a specific entity in the world health organization classification. We retrospectively reviewed from our files 1675 cases of surgically resected primary parotid gland tumors and found 2 cases of LCNEC that fulfilled the criteria of pulmonary LCNEC. These cases occurred in 72- and 73-year-old men who had short histories of enlarging parotid gland tumors. The tumors were composed of large cells that exhibited organoid, solid, trabecular, and rosette-like growth patterns with a high mitotic rate and a conspicuous tendency for necrosis. The tumor cells were polygonal and characterized by a moderate nuclear:cytoplasmic ratio, coarse chromatin, and conspicuous nucleoli. Immunohistochemical examination revealed that the tumor cells were positive for six general neuroendocrine markers, cytokeratin, p53, bcl-2, epidermal growth factor receptor, and cyclin d1. Markedly reduced expressions of p21Waf1 and p27Kip1 were also noticed. The Ki-67 labeling index was more than 50% in both cases. One case showed loss of heterozygosity at TP53 accompanied by a p53 gene point mutation. loss of heterozygosity at chromosome 9p21 was detected in both cases; one was accompanied by a p16 gene silent point mutation. Both patients died of the disease, with recurrence 5 months and 4 years after surgery, respectively. These findings indicate that LCNEC is a rare but distinct salivary gland tumor with highly aggressive biologic behavior. Multiple alterations of cell cycle regulators and tumor suppressor genes may play an important role in presenting the biologic characteristics of this rare parotid gland tumor.- - - - - - - - - - ranking = 9keywords = gland (Clic here for more details about this article) |
4/10. Large cell carcinoma of the lung with a rhabdoid phenotype.A variant of large cell carcinoma showing a rhabdoid phenotype, which is rare among primary lung cancers, is presented. A 59-year-old man was admitted to hospital for an operation. Computed tomography scans showed a mass with a smooth border, invading the thoracic wall. A right upper lobe lobectomy was carried out with resection of a part of the thoracic wall. Pathological examination showed that the tumor was mostly composed of cells with prominent eosinophilic cytoplasmic globules and giant cells, which did not adhere to each other. Cytologically, the tumor cells contained nuclei with a reticular chromatin pattern and one to two prominent nucleoli, and hyaline-like and reticular inclusion bodies, which were immunohistochemically positive for vimentin, but not for alpha-smooth muscle actin, myoglobin or pan-actin. Radiological and laboratory examinations did not detect the presence of the tumor in other organs, indicating that the primary lesion was not situated elsewhere. Metastasis to the right adrenal gland was observed 1 year and 4 months after the operation; however, the patient has been free of the disease 3 years and 11 months after the second operation of an adrenalectomy. This case showed a relatively good prognosis, which is rare among rhabdoid tumors of various organs that generally have poor prognoses with rapid, fatal progression.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/10. Adrenal hemorrhage mimicking an abdominal aortic aneurysm.The adrenal gland is the most common site of extranodal spread from primary lung cancer. We report a case of adrenal hemorrhage secondary to metastasis in a patient with primary large cell carcinoma of the lung presenting as a suspected ruptured abdominal aortic aneurysm.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
6/10. Large cell neuroendocrine carcinoma of the ampulla of vater with glandular differentiation.Large cell neuroendocrine carcinoma of the ampulla of vater is extremely rare. A 55 year old woman presented with an ampullary tumour causing pancreaticobiliary obstruction and a pancreaticoduodenectomy was performed. Microscopically, the tumour was diagnosed as a CD117 positive large cell neuroendocrine carcinoma with glandular differentiation. Four months later the patient developed a general recurrence. The metastatic tumours showed CD117 negativity and pure neuroendocrine features. The patient died of disease six months after diagnosis. It is postulated that the two components originated from a common multipotential stem cell. The clinical behaviour of ampullary large cell neuroendocrine carcinomas appears to be highly aggressive, with early metastases and a fatal outcome.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
7/10. Large cell neuroendocrine carcinoma of the parotid gland: case report and literature review.A 74-year-old male presented with a large polinodular mass in the neck. Fine needle aspiration cytology (FNAC) showed an undifferentiated large cell carcinoma. Computed tomography (CT) showed a large parotid mass with multiple satelite nodules. The remaining radiological studies were normal. Radical parotidectomy was performed. The tumor was a large cell carcinoma with neuroendocrine features and positive immunostain for neuroendocrine markers. The patient received postoperative radiotherapy and was free of tumor eight months later. Only four cases of large cell neuroendocrine carcinoma (LCNEC) of the salivary gland have been communicated. All of them have involved the parotid gland. This tumor presents in elderly patients as a large infiltrating parotid mass. Fine needle aspiration cytology serves to recognize the carcinoma, but it fails in recognizing the neuroendocrine features of the tumor. The histopathological features of this tumor are the same as in other organs. Chromogranin and synaptophysin are useful immunohistochemical markers. A primary location of the tumor in another organ, specially the lung, should be ruled out. Surgery is the main treatment modality and can be complemented with postoperative radiotherapy. The prognosis seems to be poor. More studies are needed to better define the therapeutical alternatives and prognostic factors of these rare tumors.- - - - - - - - - - ranking = 6keywords = gland (Clic here for more details about this article) |
8/10. Composite adenocarcinoma and large cell neuroendocrine carcinoma of the rectum.Composite glandular-endocrine tumors of the gastrointestinal tract are rare neoplasms. Even more uncommon are the so-called amphicrine tumors, lesions in which dual epithelial and endocrine differentiation occurs in the same cell. We describe a patient who complained of rectal pain and bleeding with a mixed or composite adenocarcinoma and neuroendocrine carcinoma of the rectum. Histological examination revealed a distinct adenocarcinoma of conventional type with glandular structures admixed intimately with a neuroendocrine carcinoma. The latter component was deeply infiltrative, while the adenocarcinoma occupied the more superficial aspect of the tumor. What was interesting was the immunophenotype of the lesion: cytokeratin (CK) 20 expression was very focal in the adenocarcinoma component and negative in the neuroendocrine carcinoma, while CK 7 was expressed strongly in the adenocarcinoma and only focally in the neuroendocrine component. This cytokeratin profile suggests a possible origin from the anal transitional zone.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
9/10. Myasthenic (Eaton-Lambert) syndrome associated with pulmonary large-cell neuroendocrine carcinoma.A 66-year-old woman presented clinical findings of Eaton-Lambert (myasthenic) syndrome (ELS). Fifteen months later, large-cell pulmonary carcinoma was detected. After systemic chemotherapy and radiotherapy, the tumor regressed and neurologic function improved. Although ELS is usually associated with pulmonary small-cell carcinoma, a minority of tumors are of squamous or glandular differentiation. We believe this is the first case report of ELS associated with large-cell neuroendocrine carcinoma in the English language literature, and it illustrates the importance of an aggressive approach to diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
10/10. Fine-needle aspiration biopsy of large-cell undifferentiated carcinoma of the salivary glands: presentation of two cases, literature review, and differential cytodiagnosis of high-grade salivary gland malignancies.Primary undifferentiated carcinoma of the salivary glands is a rare, high-grade neoplasm which accounts for a very small number (1-5.5%) of malignant salivary gland tumors. The large-cell variant (LCU) is less well-characterized than the small-cell form. We report on the fine-needle aspiration (FNA) biopsy findings of 2 cases of LCU, one arising in the parotid gland, and the other in a buccal mucosa accessory salivary gland. The 2 cases were similar in composition: isolated and loosely cohesive large cells with abundant cytoplasm, and variability pleomorphic nuclei with prominent nucleoli. One case also featured multinucleated tumor giant cells and macrophage polykaryons; the latter has not previously been described in FNA biopsies of LCU. There was no evidence of squamous, myoepithelial, or widespread mucinous differentiation by morphological, cytochemical, or immunohistochemical analyses (focal rare mucin production identified on special stains in one case). The differential diagnosis is lengthy and consists of other high-grade primary salivary gland malignancies as well as metastatic lesions, including melanoma. The pattern of immunohistochemical reactivity (positive keratin, negative S-100, and HMB-45 antigens), and lack of conspicuous mucin production of significant lymphoidinfiltrate, were useful in establishing the correct diagnosis.- - - - - - - - - - ranking = 13keywords = gland (Clic here for more details about this article) |
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