1/7. Oncocytic adrenocortical carcinoma: a morphologic, immunohistochemical and ultrastructural study of four cases.We present the clinical, histologic, immunohistochemical, and ultrastructural findings of four cases of non-functioning oncocytic adrenocortical carcinomas. The patients' ages ranged from 39 to 71 years. There was no sex predilection. Large yellow-tan tumors (8.5 to 17.0 cm), well demarcated from the adjacent kidney, were seen with a thin rim of normal adrenal gland along one edge. One tumor invaded the inferior vena cava and extended up to the level of the right atrium, and another metastasized to bone. The other two tumors had similar morphologic features and therefore were considered carcinomas. Histologic sections of all four cases showed a diffuse proliferation of polygonal neoplastic cells with large nuclei containing prominent nucleoli and abundant granular and eosinophilic cytoplasm. Occasional mononuclear and binucleated giant cells were noted in one case. There were rare mitotic figures (less than one per 10 high power fields). All tumors were immunoreactive for cytokeratins (AE1/AE3 and CAM5.2). Inhibin was focally expressed by one tumor and its bone metastasis. Ultrastructurally, the cytoplasm of the neoplastic cells was packed with innumerable mitochondria. Cytologic atypia or mitotic rate cannot reliably predict the biologic behavior of oncocytic adrenocortical neoplasms. Large tumor size (4/4), extracapsular extension (3/4), blood vessel invasion (2/4), necrosis (4/4), and metastasis (1/4) are features of malignancy for oncocytic adrenocortical carcinomas. The treatment of these tumors is complete surgical excision.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Angiotropic lymphoma occurring in a lacrimal sac oncocytoma.This report describes a case of angiotropic variant of diffuse large B cell lymphoma within a benign oncocytoma of the lacrimal sac. The occurrence of this rare lymphoma within a benign neoplasm has not been documented previously. An 87 year old woman presented with a swelling over the area of the left lacrimal sac, which histological examination revealed to be an oncocytoma. Many small blood vessels within the tumour were filled with large cytologically atypical cells, which stained positively for leucocyte common antigen and a B cell antigen, CD20, confirming the presence of a large B cell non-Hodgkin's lymphoma of angiotropic type. Angiotropic lymphoma is a very rare and usually highly aggressive variant of non-Hodgkin's lymphoma, which classically involves the central nervous system and skin, but has been described within most organs. Its occurrence within a benign neoplasm is probably coincidental, although a close association between oncocytic epithelium and normal lymphoid cells is recognised in Warthin's tumour of salivary and lacrimal glands.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. Dural cerebellopontine angle metastasis from malignant parotid oncocytoma.Malignant oncocytoma of the parotid gland is a quite rare tumor, with only 40 cases with unequivocal histological diagnosis reported in the literature. No cases with intracranial metastasis have been described. The authors report a very unusual case of malignant parotid gland oncocytoma with a large dural extracerebellar metastasis occurring in the contiguous cerebellopontine angle six months after surgery for the primary tumor. Only a partial removal of the dural metastasis was possible because of the cranial nerve and vessel encasement within the mass. Surgery and irradiation resulted in one-year survival. Interestingly, no destruction and infiltration of the petrous and temporal bones were found both at radiological and surgical exploration. We may suggest that metastatic spread from the parotid region to the cerebellopontine angle occurred through the mastoid cells or by haematogenous diffusion through the meningeal branches to the posterior fossa dura from the occipital or ascending pharyngeal arteries.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. Extensive vascular invasion is a marker of risk of relapse in encapsulated non-Hurthle cell follicular carcinoma of the thyroid gland: a clinicopathological study of 18 consecutive cases from a single institution with a 11-year median follow-up.AIMS: To determine the prognostic value of certain clinicopathological features in a series of 18 consecutive cases of encapsulated follicular carcinoma (EFC) of the thyroid gland with long follow-up. methods AND RESULTS: Eighteen consecutive cases of EFC were retrieved from 1975 to 1993. Gender, age at onset, type of surgery, presence of capsular and/or vascular invasion, number of involved vessels, tumour size, and TNM/pTNM classification were evaluated and correlated with disease outcome. None of the cases presented with distant metastases. Extensive vascular invasion (defined as more than four capsular vessels involved) was present in two cases. After a median follow-up of 133 months, all patients were alive. Three cases had relapsed in lung and bone. In two out of these three cases, extensive vascular invasion was present. Radioiodine therapy was curative in two of three of the relapsed cases. CONCLUSIONS: EFC is a low-risk carcinoma, with no patients' deaths after a median follow-up of 11 years. Extensive vascular invasion should be considered as a risk factor for relapse. A conservative surgical approach is recommended. Since relapses may occur up to 14 years after the initial surgery, life-long follow-up is advisable.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/7. Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases.diagnosis of renal angiomyolipoma (AML) by fine-needle aspiration (FNA) may be difficult because cytological and radiological findings sometimes overlap with renal cell carcinoma (RCC) and liposarcoma. Five FNAs of AMLs were studied. Epithelioid and spindle stromal cells were arranged in loosely cohesive clusters and singly. The chromatin was evenly distributed and bland. Occasionally nuclear atypia was identified. Nuclei were oval to elongated, nucleoli were inconspicuous or absent, naked nuclei were present in three specimens, and intranuclear inclusions were present in two specimens. The cytoplasm was delicate and sometimes finely vacuolated. adipose tissue was observed in two specimens. Thick-walled vessels, mitoses, and necrosis were absent. Corresponding surgical material showed typical features of AML. In FNA, bland chromatin and inconspicuous nucleoli distinguish renal AML from RCC and liposarcoma. adipose tissue is not universally present. Cellular atypia in conjunction with overlapping radiological findings with RCC and liposarcoma are potential diagnostic pitfalls. Immunocytochemical (ICC) stains may elucidate the correct diagnosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. Fine needle aspiration (FNA)-induced necrosis of tumours of the thyroid.Two cases of necrosis of thyroid oxyphilic tumours following FNA are reported. The first patient received surgery 4 weeks after FNA and histological examination revealed an encapsulated and totally necrotic tumour 2 cm in diameter. In the second patient surgery was performed after 25 days. Histological examination showed a 0.7 cm diameter tumour consisting mainly of fibrous tissue with residual oxyphilic tumour cells only in a small peripheral rim. In both patients no capsular or vascular invasion and no blood vessel thrombosis were present. A review of the literature revealed that oxyphilic tumours are susceptible to post-FNA necrosis, which might be due to the compromised vascular supply after FNA in conjunction with the intrinsic energy deficiency of oncocytic tumour cells.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. Papillary Hurthle cell tumor of thyroid: report of a case with a cytomorphologic approach to diagnosis.BACKGROUND: Hurthle cells are founded often in fine needle aspirates of the thyroid from nonneoplastic and neoplastic lesions. Papillary Hurthle cell tumors of the thyroid are composed of oxyphilic cells with a prominent papillary component. Papillary Hurthle cell carcinoma is a relatively uncommon type of thyroid carcinoma. CASE: A 42-year-old man had two asymptomatic nodules (2.5 and 3.5 cm) in the left lobe and one (2.5 cm) in the right lobe of the thyroid. Fine needle aspiration biopsy of the tumor in the left lobe showed large cells in monolayers and papillary clusters with moderate to abundant eosinophilic, granular cytoplasm with sharp borders, a granular nuclear enlargement with pleomorphism and single nucleoli. Histologic examination showed capsular invasion and infiltration of vessels. CONCLUSION: The cytologic appearance of papillary Hurthle cell carcinoma is not specific but can be suspected on fine needle aspiration.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |