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1/9. Immunohistochemical and ultrastructural study of a papillary cystadenocarcinoma arising from the sublingual gland.

    Immunohistochemical and ultrastructural findings in a rare case of papillary cystadenocarcinoma arising from the left sublingual gland of a 55-year-old Japanese man are reported. Histologically, the tumor tissue was found to be composed of various-sized cystic cavities in which papillary epithelial projections with thin fibrovascular cores were observed. The papillary projections consisted of a single layer to several layers of high columnar epithelial cells. Invasion to the surrounding fibrous tissue and into the lymphatics was observed, thus suggesting an aggressive potential in the present case. The possibility of the involvement of myoepithelial cells could be excluded based on the immunohistochemical and ultrastructural findings. The immunohistochemical and ultrastructural findings also suggested that this type of salivary gland tumor, at least the present case, may arise from striated or excretory ducts. There was positive immunostaining for tumor markers CA19-9 and CA125. However, the biological role of these carbohydrate antigens in salivary gland tumors is unclear at present. Further investigations are, therefore, called for to solve this issue.
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2/9. Oncocytic biliary cystadenocarcinoma is a form of intraductal oncocytic papillary neoplasm of the liver.

    Biliary cystadenocarcinoma with oncocytic differentiation was first reported in 1992. This is a report of a second case. The patient (a 71-year-old man) was admitted to our hospital complaining of abdominal fullness. Multicystic lesions were identified in the left hepatic lobe radiologically. The patient died of peritoneal dissemination of carcinoma 20 months later. At autopsy, the tumor of the left hepatic lobe was found to be composed of adjoining multiple cystic lesions and a solid lesion with infiltration of the hepatic hilus and peritoneal dissemination. Histologically, the multicystic lesions were covered by papillary neoplastic epithelial cells with an eosinophilic granular cytoplasm resembling that of oncocytes and a fine fibrovascular core. The cyst wall was fibrous, but there was no mesenchymal stroma. In the solid lesion and infiltrated areas, acidophilic and granular carcinoma cells formed small glandular or solid cord patterns with much mucin secretion (mucinous carcinoma). Immunohistochemically, carcinoma cells of both components were found to contain many mitochondria and showed the phenotypes of hepatocytes and cholangiocytes. Interestingly, the intrahepatic biliary tree also was invaded by carcinoma cells. This may be a case of intraductal oncocytic papillary neoplasm of the left hepatic lobe followed by secondary cystic dilatation of the affected bile duct.
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3/9. Papillary cystadenocarcinoma arising from minor salivary glands in the anterior portion of the tongue: a case report.

    Papillary cystadenocarcinoma is a rare malignant neoplasm of the salivary gland. We report a case of papillary cystadenocarcinoma arising from the minor salivary gland in the anterior portion of the tongue of a 72-year-old male patient with a history of adenocarcinoma of the colon and prostate. Further, we discussed histopathological and clinical features of this lesion, and reviewed the literature.
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4/9. Cytomorphologic features of papillary cystadenocarcinoma of the parotid.

    The fine-needle aspiration cytology findings in four cases of recently classified cystadenocarcinoma of the parotid gland are reported. In three cases a recurrent tumor was aspirated. Smear preparations in all four cases were cellular, with numerous papillary projections, single cells, and sheets of cells in varying proportion in a proteinaceous to mucoid background. The background mucin was in varying proportions. The cells were cuboidal to tall columnar with basal nuclei and mild pleomorphism. The cytoplasm was dense in three cases with variable amounts of mucin. In one case (Case 4) the epithelial cells resembled mucin-secreting goblet cells, while in another case (Case 1) the cytoplasm showed multiple vacuolations. mitosis was rare. lymphoid tissue was seen in one case while macrophages and giant cells were seen in two cases. Epidermoid differentiation was absent in all four cases. Pathologic evaluation of the resected tumor confirmed the cytologic diagnosis. Clinical and radiologic evaluation failed to reveal any other potential primary site. Papillary cystadenocarcinomas of the parotid are rare but can be accurately diagnosed on FNAC. However, they need to be differentiated from mucoepidermoid and papillary acinic cell tumors.
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5/9. Fine-needle aspiration of apocrine hidrocystoma--a potential mimic of papillary neoplasms metastasizing to the skin.

    We report the cytologic features of a histologically confirmed apocrine hidrocystoma as seen in fine-needle aspirates. The main cytologic features were the presence of sparse pseudopapillae with mild to moderate atypia in a background of an amorphous navy blue material reminiscent of that seen in aspirates of colloid nodules of the thyroid gland. The pseudopapillae were mistaken for malignant metastatic deposits. It is suggested that the presence of pseudopapillae in aspirates obtained from cutaneous nodules might be a clue for a tentative diagnosis of benign tumors of epidermal adnexae, with the proviso that a primary malignant tumor be ruled out first.
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6/9. Papillary cystadenocarcinoma of the prostate.

    We report a papillary adenocarcinoma with cystic formation in the prostate of a 64-year-old man, who presented with gross hematuria and pollakisuria. Immunohistochemically, the origin of this tumor was considered to be the prostate gland. Interestingly, this tumor grew into the muscle layer of the bladder with large glandular formation but no stromal changes.
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7/9. Papillary serous cystadenocarcinoma arising in benign glandular inclusion cysts in pelvic and inguinal lymph nodes.

    BACKGROUND: Benign glandular inclusion cysts occurring within lymph nodes have been well described in the literature. However, the malignant potential of these glands is unknown. One previous case report described an adenoacanthoma arising within one of these glands. CASE: A 65-year-old woman was previously diagnosed with papillary serous cystadenocarcinoma in the inguinal and pelvic lymph nodes. She had no tumor involving the ovaries or peritoneal surfaces at the time of initial diagnosis. She presented to us 9 years later with a recurrence of this tumor in the obturator fossa and along the vaginal sidewall. Treatment consisted of surgery, radiation, and chemotherapy. CONCLUSION: Although rare, mullerian tumors can occur in the lymph nodes without simultaneous ovarian or peritoneal involvement, and most likely arise de novo within lymph node inclusion cysts.
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8/9. High-grade papillary cystadenocarcinoma of the tongue.

    AIMS: Salivary gland tumours of the tongue are rare. The most common type is low-grade mucoepidermoid carcinoma followed by adenoid cystic carcinoma. Papillary cystadenocarcinoma of salivary glands are uncommon lesions with low-grade mucoepidermoid carcinoma followed by adenoid cystic carcinoma. Papillary cystadenocarcinoma of salivary glands are uncommon lesions with low-grade histological and clinical features. We report a high-grade papillary cystadenocarcinoma in an 80-year-old man who presented with a tongue mass and metastatic disease in the neck. methods AND RESULTS: He was treated with partial glossectomy and bilateral neck dissection but developed local and regional recurrences 6 months later. The tumour had a prominent cystic appearance and had areas of necrosis. The cyst lumen was occupied by numerous papillae lined by pseudostratified columnar cells with a high nuclear-cytoplasmic ratio. The cytoplasm was eosinophilic, the nuclei were pleomorphic and exhibited irregular nuclear membranes, vesicular chromatin and prominent eosinophilic nucleoli. The mitotic activity was high and there were occasional abnormal mitotic figures. Metastatic carcinoma was present in four lymph nodes. The differential diagnosis of this unusual lesion includes cystadenoma, salivary duct carcinoma and metastases. CONCLUSIONS: This case and a review of the literature indicates that papillary cystadenocarcinomas of salivary gland origin exhibit a wider morphologic spectrum than described in the latest world health organization (WHO) classification which defines these lesions as low-grade neoplasms.
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9/9. Papillary serous carcinoma of the uterine cervix: a clinicopathologic study of 17 cases.

    The clinical and pathologic features of 17 cases of papillary serous adenocarcinoma of the cervix (PSCC) were studied in women who ranged in age from 26 to 70 years. There was a bimodal age distribution, with one peak occurring before the age of 40 years and the second peak after the age of 65. The presenting symptoms were abnormal vaginal bleeding (11 patients), abnormal exfoliative cervical cytology (four patients), or watery vaginal discharge (two patients). On pelvic examination, eight patients had a polypoid or exophytic cervical mass and two patients had an ulcerated or indurated cervix; no abnormality was detected in seven patients. Two tumors were stage Ia, 12 were stage Ib, two were stage II, and one was stage III. Nine patients were treated by radical hysterectomy and one by simple hysterectomy; six of these patients received postoperative radiotherapy. The other patients received primary radiotherapy. On microscopic examination, all of the tumors had a complex papillary architecture with epithelial stratification and tufting. Six tumors were grade 2/3 and 11 were grade 3/3. All of the tumors had >10 mitotic figures per 10 high-power fields. An intense acute and chronic inflammatory infiltrate was typically present within the cores of the papillae and in areas of stromal invasion. Occasional psammoma bodies were present in three cases. Five of 12 tumors stained positively for p53, with six and nine of 12 tumors, respectively, immunoreactive for carcinoembryonic antigen and CA-125. Seven tumors were mixed with another histologic subtype of cervical adenocarcinoma, most commonly low-grade villoglandular adenocarcinoma. Fifteen patients were followed from 6 months to 11 years (mean 56 months). Six patients died of extensive metastases within 5 years of diagnosis; an additional patient experienced tumor recurrence with malignant ascites 2 years after diagnosis. The most common metastatic sites were pelvic and periaortic lymph nodes; other sites included cervical lymph nodes, lung, peritoneum, liver, and skin. Eight patients were alive without evidence of tumor at last follow-up. Age <65 years, stage >I, tumor size >2 cm, tumor invasion >10 mm, the presence of lymph node metastases, and elevation of serum CA-125 were associated with a poor prognosis. Tumor grade or composition (pure or mixed) did not correlate with patient outcome. Papillary serous adenocarcinoma of the cervix resembles microscopically its counterparts elsewhere in the female genital tract and peritoneum. The tumors can behave aggressively with supradiaphragmatic metastases and a rapidly fatal course when diagnosed at an advanced stage, but the outcome for patients with stage I tumors is similar to that of patients with cervical adenocarcinomas of the usual type.
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