Cases reported • Cystadenoma

1/133. Mucin Hypersecreting Intraductal Papillary Neoplasm of the pancreas.

Mucin Hypersecreting Intraductal Papillary Neoplasm is a rare neoplasm that arises from ductal epithelial cells. This entity is distinct from the more commonly known Mucinous cystadenoma or Mucinous cystadenocarcinoma. Despite this distinction, it has been erroneously categorized with these more common cystic neoplasms. Characteristic clinical presentation, radiographic, and endoscopic findings help distinguish this neoplasm from the cystadenomas and cystadenocarcinomas. Histopathologic identification is not crucial to the preoperative diagnosis. This neoplasm is considered to represent a premalignant condition and, therefore, surgical resection is warranted. prognosis, following resection, is felt to be curative for the majority of patients. We present two cases of Mucin Hypersecreting Intraductal Papillary Neoplasm and discuss their diagnosis and surgical therapy.

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2/133. Primary smooth muscle tumor of the liver encasing hepatobiliary cystadenoma without mesenchymal stroma.

We describe a 59-year-old Japanese woman with a large mass of her liver encasing cystic components. Radiologic imaging showed the mass to be hypervascular, and surgical resection disclosed a white tumor. The solid portion was immunohistochemically characterized as a smooth muscle tumor. The cystic components were multilocular and lined with columnar epithelium, consistent with a hepatobiliary cystadenoma. The epithelium strongly stained for CA19-9. The subepithelial space was occupied by collagenous connective tissue interspersed with a small number of spindle-shaped cells. The cystic lesions lacked the mesenchymal stroma between the epithelium and connective tissue layer. There have been no previous reports of a hepatic smooth muscle tumor encasing a hepatobiliary cystadenoma. Because of the pathogenesis of the cystadenoma, it is possible to assume that the smooth muscle tumor also arose from the cells composing the biliary duct in association with the development of the cystadenoma.

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3/133. Lymphoepithelial cyst of the pancreas. No evidence for Epstein-Barr virus-related pathogenesis.

Compared to pseudocyst formation after prior pancreatitis, true cysts of the pancreas are rare. Pancreatic cysts with irregular wall components or a mucinous content raise the suspicion for the presence of a cystic neoplasm, and surgical resection is recommended. A case of a patient with a history of prostate cancer is described in whom a cyst of the pancreatic tail was discovered incidentally. Based on the radiographic features, which did not support the presence of a serous cystadenoma, a spleen-preserving distal pancreatectomy was performed. Histologic features were characteristic for a lymphoepithelial cyst (LEC) of the pancreas, lined with thinned squamous epithelium surrounded by benign lymphoid tissue. Since LECs of the parotid gland, which are associated with acquired human immunodeficiency, are frequently related to Epstein-Barr virus (EBV) infection, EBV in situ hybridization was performed and did not reveal evidence for EBV. Twenty-eight instances of pancreatic LECs have been reported, primarily affecting adult males, without evidence of increased numbers of EBV-positive cells. The pathogenesis, differential diagnosis, and clinical implications of lymphoepithelial pancreatic cysts are discussed.

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4/133. Intra-epidermal and intra-dermal sebocrine adenoma with cystic degeneration and hemorrhage.

BACKGROUND: The ducts of eccrine glands may give rise to intra-epidermal, confluent epithelial and intra-dermal adenomas known as hidroacanthoma simplex, eccrine poroma, and dermal duct tumor, respectively. An apocrine and sebaceous counterpart of the eccrine poroma has been described by several authors as adnexal, poroma-like adenoma with apocrine and sebaceous differentiation or sebocrine adenoma. methods: Using clinical history and routine histologic techniques, we describe a new lesion with features similar to sebocrine adenoma but representing the intra-epidermal and intra-dermal counterparts with cystic degeneration and hemorrhage. Briefly, an 84-year-old female presented with a 6 mm dark tan papule on the neck that clinically appeared as an unusual macular seborrheic keratosis with underlying hemorrhage. RESULTS: Histopathological examination showed a benign dermal cystic appendage tumor with pale polygonal cells, occasional non-keratinizing ducts, sebaceous differentiation and central hemorrhage with fibrin deposits. Serial sections did not reveal any epidermal connection. However, epithelioid cells with large nuclei in an intra-epidermal pagetoid pattern were focally seen. CONCLUSION: These findings represent a new cystic, hemorrhagic variant of sebocrine adenoma.

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5/133. Clinical features and imaging diagnosis of biliary cystadenocarcinoma of the liver.

Biliary cystadenocarcinoma of the liver is a relatively rare disease. Herein, we reported a case of biliary cystadenocarcinoma with a review of the literature. A 71-year-old female was admitted with the chief complaint of epigastralgia. The imaging studies revealed a biliary cystadenocarcinoma in the left hepatic lobe with suspicion of direct invasion to the left and middle hepatic veins and inferior vena cava. However, there was no direct invasion of the tumor to these veins in operation findings, and an extended left hepatic resection was performed without resection of inferior vena cava. The tumor was histologically diagnosed as biliary cystadenocarcinoma of the liver. diagnosis of biliary cystadenocarcinoma is usually difficult preoperatively, however, a diagnosis was possible with the use of imaging studies. It was suggested that this tumor originated from a benign cystadenoma because of the existence of a transitional zone between normal cells and atypical cells in the cystic wall. Systematic hepatectomy was recommended as the initial treatment in consideration of the features of cystadenocarcinoma.

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6/133. Sialadenoma papilliferum of the hard palate: report of 2 cases and immunohistochemical evaluation.

This study reports on the clinical and histologic features of 2 previously unreported cases of sialadenoma papilliferum. Immunohistochemical analysis of one of the cases demonstrated that the ductal cell component shows both epithelial and myoepithelial differentiation.

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7/133. Fine needle aspiration cytology of hepatobiliary cystadenoma with mesenchymal stroma.

BACKGROUND: Hepatobiliary cystadenomas (HBCs) with mesenchymal stroma (MS) are rare cystic neoplasms occurring exclusively in women. Hepatobiliary cystadenoma consists of a mucin-producing cyst lining epithelium underlined by a dense MS cell layer. In the current study, the authors review the fine needle aspiration cytology of HBC with MS and identify characteristic cytologic features that suggest such an uncommon neoplasm on aspirates. methods: A search of the histopathology files at the University of texas Medical Branch at Galveston for the interval of January 1992 through December 2000 yielded four cases of HBC having both cytologic and histologic specimens. The cytologic features of the aspirates were reviewed and correlated with the clinical history, radiologic findings, and the histopathology of the excised specimens. RESULTS: All four patients were middle-aged women (mean age, 48.5 years) who presented with epigastric pain radiating to the back, due to large cystic lesions in the right liver lobe (three patients) or the left liver lobe (one patient). Aspiration cytology revealed chronic inflammatory exudate in all cases, along with occasional aggregates of bland, cuboidal-columnar epithelial cells (in three cases), which rarely arranged in papillary clusters. No significant atypia, evidence of malignancy, or MS cells were identified on the aspirates. HBC with MS was confirmed histologically on the excised specimens in all cases. CONCLUSIONS: By ensuring adequate sampling and correlating with consistent clinical and radiologic findings, a diagnosis of HBC or cystic hepatobiliary neoplasm can be suggested on the basis of aspiration cytology.

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8/133. Acinar cystadenoma of the pancreas: a previously undescribed tumor.

A 58-year-old diabetic woman died as a result of an acute myocardial infarction caused by coronary atherosclerosis and thrombosis. A 9 cm multiloculated cystic lesion was found incidentally in the body and tail of the pancreas. The microcysts and locules were lined by one or two layers of normal-appearing acinar cells. In some locules there were clusters of acinar structures containing eosinophilic material. The cuboidal cells lining the locules had morphologic and immunohistochemical features of acinar cells. The lesion was interpreted as an acinar cystadenoma, the benign counterpart of the well-established acinar cystadenocarcinoma of the pancreas. Acinar cystadenoma should be included in the differential diagnosis of cystic tumors of the pancreas.

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9/133. Cystic granulosa cell tumor of the ovary--a case report.

A case of cystic granulosa cell tumor of ovary in a 32 year old woman is described. The patient presented with abdominal mass without any signs and symptoms of hyperestrinism and virilization. Ultrasonographically and grossly a diagnosis of benign cystadenoma was considered. Histopathology confirmed the diagnosis of cystic granulasa cell tumor.

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10/133. Unilocular acinar cell cystadenoma of the pancreas an unusual acinar cell tumor.

We report an unusual case of acinar cell cystadenoma of the pancreas in a 52-year-old man treated for pulmonary adenocarcinoma. The lesion, located in the body of the pancreas, was revealed incidentally by abdominal computed tomography during follow-up for a pulmonary neoplasm. A left pancreatectomy was performed. The unilocular cystic lesion measured 5 cm and was lined by a single layer of columnar acinar cells with eosinophilic granular cytoplasm, faintly stained by periodic acid-Schiff. Immunohistochemical analysis showed the lining cells were positive for cytokeratin and trypsin, and electronic microscopy showed that they contained zymogen granules. Acinar cell tumors of the pancreas are rare and include acinar cell carcinomas, acinar cell cystadenocarcinomas, and acinar cell adenomas. We report a case of cystic acinar cell tumor of the pancreas with benign gross and histologic features that could be added to the list of cystic neoplasms of the pancreas as acinar cell cystadenoma.

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