1/22. Atypical melanocytic proliferation associated with squamous cell carcinoma in situ of the esophagus.We present the case of a 64-year-old woman who underwent a transhiatal esophagectomy subsequent to the presence of high-grade dysplasia of the esophageal squamous epithelium in repeated biopsies. In the resection specimen chronic esophagitis and multifocal carcinoma in situ of the squamous epithelium were diagnosed, associated with a diffuse intraepithelial proliferation of melanocytic cells. While melanocytic hyperplasia (melanocytosis) has previously been recognized as an occasional reactive lesion that can accompany esophageal inflammation and invasive squamous carcinoma, the present case was unusual because of its cytonuclear and architectural atypia in the melanocytic cell population, resembling features of a melanoma in situ in the absence of manifest invasive malignant melanoma. The disappearance of the melanocytic lesion during follow-up supports its nonneoplastic nature, however. This case illustrates that 'malignant features' in esophageal melanocytosis should be interpreted with caution.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/22. Neural invasion in intraductal carcinoma of the breast.Although perineural invasion in a malignancy favors the diagnosis of invasive over in situ carcinoma, we report a case of cribriform intraduct carcinoma of the breast showing perineural invasion. The in situ nature of the lesion is supported by the finding of an intact actin-positive myoepithelial cell layer around the cribriform growths and the preservation of lobular architecture.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/22. Squamous cell carcinoma in situ involving mesonephric remnants of the uterine cervix.Squamous cell carcinoma in situ (CIS) involving mesonephric remnants of the uterine cervix is a very rare lesion, the existence of which is still controversial. A second case of this lesion is reported. It was found in a cone biopsy specimen from an 40-year-old patient. Besides, in surface epithelium and within cervical glands, a structure of CIS was seen in conjunction with mesonephric tubules in deeper cervical stroma. The mesonephric nature of these tubules and of tubule-appearing epithelium within islands of CIS was supported by immunohistochemical positivity for CD10 and vimentin. The lesion strongly simulated invasive carcinomas, such as adenosquamous carcinoma and adenoid basal carcinoma (epithelioma) of the cervix.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/22. Mucinous adenocarcinoma of the renal pelvis associated with transitional cell carcinoma in the renal pelvis and the bladder.We report a case of mucinous adenocarcinoma of the renal pelvis associated with bladder carcinoma in situ (CIS). Transitional cell carcinoma (TCC) of the renal pelvis and CIS were also observed adjacent to the adenocarcinoma. Immunohistochemical assessment of the pelvic adenocarcinoma revealed positive expressions for mucin, epithelial membrane antigen, cytokeratin 7, cytokeratin 19 and carcinoembryonal antigen, but not vimentin or chromogranin. Based on the histopathological examinations, the adenocarcinoma of the renal pelvis in the present case may have a similar biological nature to conventional TCC and probably originated by development of pre-existing TCC of the renal pelvis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/22. Pelvic sidewall adenocarcinoma after definitive therapy for cervical adenocarcinoma in situ.BACKGROUND: Traditionally, hysterectomy is considered definitive therapy for cervical adenocarcinoma in situ (AIS) in women beyond childbearing. CASE: A 45-year-old gravida 2, para 2 patient presented with cervical dysplasia and on pathology review of the large loop excision procedure cervical adenocarcinoma in situ was diagnosed. She underwent extrafascial hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed adenocarcinoma in situ with negative margins. Twenty-eight months later, she presented with right lower extremity deep venous thrombosis. A computed tomography (CT) scan of the abdomen and pelvis showed a pelvic sidewall mass. A CT-guided biopsy of the mass was consistent with invasive adenocarcinoma of the endocervical type. She underwent combination therapy with weekly cisplatin and extended field radiation therapy. CONCLUSION: This case depicts another example of the unpredictable nature of cervical AIS. Despite undergoing definitive surgery, a residual focus of disease may remain leading to invasive adenocarcinoma. Close follow-up is required of all patients diagnosed with AIS because the disease is poorly understood.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/22. Detecting oral cancer: a new technique and case reports.The VELscope is an important aid in patient assessment, and when added to a well-thought out clinical assessment process that takes into consideration the age of the patient and risk factors that include tobacco, alcohol, and immunologic status, it increases the clinician's ability to detect oral changes that may represent premalignant or malignant cellular transformation. False positive findings are possible in the presence of highly inflamed lesions, and it is possible that use of the scope alone may result in failure to detect regions of dysplasia, but it has been our experience that use of the VELscope improves clinical decision making about the nature of oral lesions and aids in decisions to biopsy regions of concern. Where tissue changes are generalized or cover significant areas of the mouth, use of the scope has allowed us to identify the best region for biopsy. As with all clinical diagnostic activities, no single system or process is enough, and all clinicians are advised to use good clinical practice to assess patients and to recall and biopsy lesions that do not resolve within a predetermined time frame. Lesions that are VELscope-positive and absorb light need to be followed with particular caution, and if they do not resolve within a 2-week period, then further assessment and biopsy are generally advised. It is much better to occasionally sample tissue that turns out to be benign than to fail to diagnose dysplastic or malignant lesions. In our fight to protect patients from cancer, the VELscope improves our odds for early detection, hopefully resulting in fewer deaths from oral cancer.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/22. Minimal breast cancer: a clinical appraisal.Eighty-five patients with a diagnosis of minimal breast cancer were evaluated. The predominant lesion was intraductal carcinoma, and axillary metastases occurred in association with minimal breast cancer in seven of 96 cases. One death occurred due to minimal breast cancer. Bilateral mammary carcinoma was evident in 24% and bilateral minimal breast cancer in 13% of the patients. The component lesions of minimal breast cancer have varied biologic activity, but prognosis is good with a variety of operations. The multifocal nature of minimal breast cancer and the potential for metastases should be recognized. Therapy should include removal of the entire mammary parenchyma and low axillary nodes. The high incidence of bilateral malignancy supports elective contralateral biopsy at the time of therapy for minimal breast cancer.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/22. Malignant transformation of esophageal columnar epithelium.This report describes two patients with esophageal columnar epithelium (Barrett's esophagus) in which microinvasive adenocarcinoma developed. Case 1 had multiple foci of carcinoma in situ contiguous with epithelium resembling gastric and intestinal mucosa. Case 2 had signet-ring type adenocarcinoma. Surveillance for malignant transformation in columnar esophageal epithelium should be routinely performed, and because of its focal nature, multiple biopsies and cytologic examination should be carried out. The presence of carcinoma in situ should lead to consideration of excision of the affected esophagus.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/22. Distinctive immunohistochemical labeling of epithelial and mesenchymal elements in laryngeal pseudosarcoma.A laryngeal squamous cell carcinoma in situ with an underlying spindle cell nodule (pseudosarcoma) was immunohistochemically labeled with antibodies to tissue-specific intermediate filament proteins, including desmin, vimentin, and cytokeratin. Two distinct populations of cells were found within the lesion: cytokeratin-positive cells, corresponding to the carcinomatous component of the tumor, and vimentin-positive spindle cells in the subepithelial nodule. In view of the strict specificity of antivimentin and anticytokeratin for cells of mesenchymal and epithelial origin, respectively, it is proposed that the two components of the pseudosarcoma in our case are not morphologic variants of the same tumor, and that the subepithelial nodule represents a mesenchymal lesion. These results can, however, not be extrapolated to other cases since in some the spindle cell component may represent metaplastic epithelial cells. In view of the difficulties encountered in reaching a correct diagnosis in these lesions, it is recommended to use intermediate filament typing to elucidate the nature of the spindle cells in this controversial tumor.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/22. Oral dysplasia and in situ carcinoma: clinicopathologic correlations of eight patients.Eight patients with multiple oral dysplastic epithelial lesions were followed by clinical examinations and serial biopsies for periods varying from four to 22 years. The dysplasias and in situ carcinomas were characterized by persistence, recurrence, and eventual progression to invasive squamous cell carcinoma. It could not be determined whether dysplasia and in situ carcinoma were separate clinical-pathologic entities with similar end points or whether they were part of a continuum in a spectrum of epithelial neoplasia. The need for close clinical observation and local excision was emphasized because of the multiplicity of lesions and because of the protracted clinical course. Treatment of these patients was problematic because of similarities of the disease to lichen planus. It is possible that they had a premalignant disease process that mimicked lichen planus, or that they had an unusual form of lichen planus for which criteria have not been established. The progressive nature of the disease was exemplified by one death, one patient with cervical metastasis, and one with generalized remote metastatic disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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