Sabato 27 ottobre 2012 - Pacini Editore

More documents

Recommendations

Info

376 frequency of the reference allele and q the frequency of the variant). Genotype and allele frequencies between case and controls were compared with Fisher’s exact test, using 2x2 contingency tables. Only p values G polymorphism with hepatocellular carcinoma risk: a meta-analysis. Arch Med Res 2011;42:149-55. A solitary polypoid gastric metastasis in renal cell carcinoma: an event to be considered M. Onorati, P. Uboldi, G. Petracco, S. Romagnoli * , F. Di Nuovo Pathology Unit, Garbagnate Milanese, AO “G. Salvini” Garbagnate Milanese, Italy. * Department of Health Sciences, AO S. Paolo, University of Milan, Medical School, Italy Introduction. The incidence of gastric metastases is 2,6%. Their most common endoscopic appearance is a “volcano-like” polypoid mass covered by normal mucosa that may show a central ulceration. Although all primary neoplasms can metastasize to the stomach, most of them originate from melanoma or breast and lung cancer. Metastases from primary neoplasms of the kidney, have also been describe. Renal cell carcinoma (RCC) is known to spread hematogenously and isolated metastasis to the stomach is a rare event. In this report, we describe a gastric recurrence of clear-cell renal carcinoma in a patient who underwent nephrectomy 19 years ago. The case shows that metastatic involvement of the stomach should be suspected in any patient with a previous history of RCC, presenting with gastrointestinal symptoms, although many years after nephrectomy for neoplasm. We also pursued a brief review of the literature to update the number of cases described until now. Methods and results. We report an unusual case of a patient with gastric polipoyd metastasis from a RCC. A 82 year-old man was admitted to our hospital in Garbagnate Milanese with persisting CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-<strong>27</strong> OttOBRE <strong>2012</strong> rectal bleeding. On admission severe anaemia was present. He had a history of weight loss, epigastric pain and weakness. Because of the symptoms and signs, the patient underwent a colonoscopy and a gastroscopy. While colonoscopy was negative, gastroscopy showed a 30 mm, irregular, polypoid bleeding lesion with superficial erosions in the upper part of the corpus near the lesser curvature. The lesion was snared with loop biopsy because they did not suspect his histological nature and to prevent post-polipectomy bleeding. The excision biopsy of the lesion was fixed in formalin and stained with Haematoxilin and Eosin. Microscopically, the polypoid lesion, covered by ulcerated mucosae, revealed nests of neoplastic cells with a solid pattern of growth. The neoplastic population showed a peculiar cytological characteristic represented by cells with abundant clear cytoplasm. The nuclei were round, hyperchromatic with prominent nucleoli. In the absence of clinical information cytokeratin-7 was performed to exclude/confirm a gastric origin. Subsequently clinicians informed us that the patient had a past medical history of left nephrectomy for a clearcell RCC in 1992 and a colic resection for a poorly differentiated adenocarcinoma of the rectum in 1997. A second set of antibodies were tested (CD10, EMA, Vimentin, CK20, and CDX2) on the basis of recent clinical information. The neoplastic cells were strongly stained with CD10, Cam 5.2 and EMA and Vimentin. The diagnosis was consistent with metastasis from clear-cell RCC also on the basis of the clinical notice. Endoscopic margins were free of disease. CT scan of the chest, abdomen and pelvis showed no evidence of other metastatic sites. Conclusion. RCC account for 3% of all adult malignancy and it is more than twice as common in males than females with the majority of cases occurring in the sixth decade of life. Although the localizing findings of hematuria, pain and a flank mass are the classic triad of presenting symptoms, many patients with renal cell carcinoma lack any of these and have systemic symptoms such as fever, malaise or anemia. Metastases at the time of diagnosis occur in 25%-33% of patients since this neoplasm is frequently presenting as metastasis of unknown primary site, sometimes in unusual sites. The extent of spread of RCC is notoriously unpredictable with well-documented cases of spontaneous regression of metastases, prolonged course and recurrence 10 years or more after nephrectomy in more than 10% of patients who survive so long. Gastric metastases from RCC following radical excision of the primary tumour is extremely rare. Despite the strong potential for hematogenous metastases of RCC and due to its rarity, stomach metastases are often not suspected as a cause of gastrointestinal bleeding. This case highlights the importance of clinical information to better treat the patients with metastases. Investigation for such metastatic tumors should be performed routinely in the follow-up of patients who have been treated for RCC. To date about 53 cases of gastric metastases from RCC, included the present one, have been reported. The most complete article was published in 2011 by Eslick et al describing 44 cases. They argue that in their series females are younger than males and that overall patients age is younger than that previously reported in other case series (66 years vs 73 years). Moreover they argue that on average there is a long interval between nephrectomy and presentation with gastric metastases. They confirmed, as Greendike et al stated, that in 25% of new patients with renal cell carcinoma, there is radiologic evidence of metastases at presentation. They highlighted that, although RCC is resistant to chemotherapy and the prognosis of patients with remote metastasis is extremely poor, more recent developments have occurred in the treatment of gastric cancer; therefore the distinction between the two entities is fundamental. Our case demonstrates how important is the dialogue between clinicians and pathologists in order to obtain a rapid and accurate diagnosis of lesions which don’t show any apparent unusual presentation (a gastric polyp in the present case), but are histopathologically unlikely to be primitive in origin. Although the nature of polypoid mass was unknown, the choice of the endoscopic polipectomy seemed to be
PoStER the better one because the margins were free. Infact, the correct diagnosis was useful to avoid total gastrectomy (surgical stress) in a old patient thus preventing a worsening of patient’s quality of his life. Moreover, our case underlines the importance of an accurate follow-up in patients with a past history of RCC, which should not exclude the gastrointestinal tract. references 1 Eslick G, et al. Gastric metastasis in renal cell carcinoma: a case report and systematic review. J Gastrointest Canc 2011;42:296-301. 2 Garcia-Campelo R, et al. Renal cell carcinoma: complete pathological response in a patient with gastric metastasis of renal cell carcinoma. Anti-Cancer Drugs 2010;21(suppl. 1):S13-5. 3 Kibria R, et al. Upper gastrointestinal bleeding revealing the stomach metastases of renal cell carcinoma. J Gastrointest Can. 2009;40:51-5.4. 4 Pezzoli, et al. Gastrointestinal bleeding from gastric metastasis of renal cell carcinoma, treated by endoscopic polypectomy. Endoscopy 2007:39:E52. 5 Picchio M, et al. Gastric metastasis from renal cell carcinoma fourteen years after radical nephrectomy. Acta chir belg 2000;100:228-30. 6 Riviello C, et al. Unusual gastric and pancreatic metastatic renal cell carcinoma presentation 10 years after surgery and immunotherapy: A case report and a review of literature. 2006;12:5234-36. 7 Sugasawa H, et al. Isolated gastric metastasis from renal cell carcinoma 19 years after radical nephrectomy. Int J clin Oncol 2010;15:196-200. 8 Yamamoto D, et al. Metastatic gastric tumor from renal cell carcinoma. Gastric Cancer 2009;12:170-3. Extramedullary hematopoiesis: rare localization in the gastric fundus F. Pitto1 , M. Bruzzone1 , P. Cognein2 , P. Calamaro1 , F. Sarocchi1 , A. Guadagno1 , F. Grillo1 , L. Mastracci1 1 University of Genoa, IRCCS San martino, IST, U.O. Anatomia Patologica, DISC; 2 IRCCS San martino, IST, UOC Gastroenterologia ed endoscopia digestiva Introduction. Extramedullary hematopoiesis (EMH) is the presence of myeloid, erythroid and/or platelet precursors outside the bone marrow. The most common sites of EMH are liver, spleen and lymph nodes. Less commonly it is possible to find foci of EMH elsewhere in the body, i.e. breast, kidney, thymus, adrenal gland, pleura, central nervous system1 amongst others. Gastrointestinal localizations of EMH are extremely rare and only 3 previous cases describe gastric EMH in the literature. Materials and methods. We report a case of a 35 year old man with Beta Thalassemia (Cooley’s disease) and HCV positivity, presenting with severe anemia and gastric pain. Endoscopy showed in the gastric fundus a protruding mass of about 4 cm with a central ulceration spontaneously bleeding (Fig. 1). CT Fig. 1. Endoscopic image of polyp. 377 confirmed a solid gastric mass close to the cardias, partially calcified and protruding into the lumen, with a polypoid shape and a maximum diameter of 40 mm as well as multiple abdominal and thoracic adenopathies. EUS showed a hypoechoic mass deriving from the muscular layer with well-defined borders. All the techniques suggested the possibility of a Gastro-Intestinal Stromal Tumor. The surgeon deemed the patient at high risk for surgical intervention due to a previous splenectomy and related intraabdominal adhesions, so the polypoid mass was endoscopically removed for definitive diagnosis. Results. Histology revealed that the core of the polypoid mass was composed of expanded lamina propria with numerous erythroid and myeloid precursor cells between the gastric foveolae and gastric glands (Fig. 2). These elements had hyperchromatic, angulated nuclei and small to moderate amounts of eosinophilic cytoplasm; some had multiple nucleoli (Figg. 3-4). Immunohistochemical analysis showed these cells to be negative for cytokeratin and positive for glycophorine and myeloperoxidase. These morphologic and immunohistochemical features are in keeping with foci of extramedullary haematopoiesis composed of red and white line cell precursors, lacking megakaryocytes. Discussion. EH is a compensatory mechanism for insufficient medullary haematopoiesis occurring in patients with various haematological disorders, including haemoglobinopathies. The previous reported cases all regarded men, two affected by myelofibrosis 2-3 and the third 4 by chronic myelogenous leukemia; Fig. 2. EE, 4x. Fig. 3. EE 20x.
Page 1 and 2:
Periodico bimestrale - POSTE ITALIA
Page 3:
VENTANA iScan HT Riconcepire le imm
Page 6:
Information for Authors including e
Page 10 and 11:
08.30 - 10.30 10.30 - 11.30 Sala DO
Page 12 and 13:
202 gli attuali approcci multidimen
Page 14 and 15:
204 of Florence, University of Pisa
Page 16 and 17:
206 rare tumors with various biolog
Page 18 and 19:
208 died of disease. Incomplete res
Page 20 and 21:
210 were included in order to explo
Page 22 and 23:
212 Key words: EGC, Prognosis, Trea
Page 24 and 25:
214 Tab. VI. univariate analysis: 5
Page 26 and 27:
216 the surgeons perform a pancreat
Page 28 and 29:
218 Tab. I. RB-ILD DIP LCH olitis (
Page 30 and 31:
220 ciation of Medical Oncology (AI
Page 32 and 33:
222 and CD56 are the best immunosta
Page 34 and 35:
224 by the general pathologist [1.8
Page 36 and 37:
226 na illuminazione, da un vulvolo
Page 38 and 39:
228 9 Lynch PJ, Moyal-Barocco M, Bo
Page 40 and 41:
230 Procedure di analisi del linfon
Page 42 and 43:
232 are classified as G1 NETs, foll
Page 44 and 45:
234 31 Nugent SL, Cunningham SC, Al
Page 46 and 47:
236 mas and leukemias, whereas the
Page 48 and 49:
238 Patobiologia della parete aorti
Page 50 and 51:
240 10 Luo BH, Carman CV, Springer
Page 52 and 53:
242 zienti asintomatici, la sede pi
Page 54 and 55:
244 Anatomia patologica e citopatol
Page 56 and 57:
246 Fig. 1 logico o cell-blocks, co
Page 58 and 59:
248 In ductal carcinoma the cytolog
Page 60 and 61:
250 techniques have resulted in the
Page 62 and 63:
252 Predictive factors in colorecta
Page 64 and 65:
254 to che ha l’obiettivo di perm
Page 66 and 67:
256 Quanto ai mediatori, in caso di
Page 68 and 69:
258 L’incidenza media complessiva
Page 70 and 71:
260 Anatomia Patologica scegliere q
Page 72 and 73:
262 assessment of adequacy, because
Page 74 and 75:
264 paese ed il nostro SSN, di fatt
Page 77 and 78:
patHOlOGiCa 2012;104:267-358 COMUnI
Page 79 and 80:
COmuNiCaziONi ORali Solitary T-cell
Page 81 and 82:
COmuNiCaziONi ORali differences in
Page 83 and 84:
COmuNiCaziONi ORali Tab. I. CYTOLOG
Page 85 and 86:
COmuNiCaziONi ORali BrAF mutation a
Page 87 and 88:
COmuNiCaziONi ORali The aim of the
Page 89 and 90:
COmuNiCaziONi ORali Tab. I. R-MSFTs
Page 91 and 92:
COmuNiCaziONi ORali Fig. 1. skin us
Page 93 and 94:
COmuNiCaziONi ORali complications.
Page 95 and 96:
COmuNiCaziONi ORali Immunohistochem
Page 97 and 98:
COmuNiCaziONi ORali advanced pathol
Page 99 and 100:
COmuNiCaziONi ORali Fig. 4. tCRGd+c
Page 101 and 102:
COmuNiCaziONi ORali LOH analysis of
Page 103 and 104:
COmuNiCaziONi ORali Tab. I. distrib
Page 105 and 106:
COmuNiCaziONi ORali in the leading
Page 107 and 108:
COmuNiCaziONi ORali Conclusions. Sp
Page 109 and 110:
COmuNiCaziONi ORali kidney) is unpr
Page 111 and 112:
COmuNiCaziONi ORali 7 Ellis I. Qual
Page 113 and 114:
COmuNiCaziONi ORali A case of intra
Page 115 and 116:
COmuNiCaziONi ORali progress, recur
Page 117 and 118:
COmuNiCaziONi ORali Fig. 3 referenc
Page 119 and 120:
COmuNiCaziONi ORali Results. Expres
Page 121 and 122:
COmuNiCaziONi ORali GEnITALE MASCHI
Page 123 and 124:
COmuNiCaziONi ORali agnostic challe
Page 125 and 126:
COmuNiCaziONi ORali Fig. 1. ultraso
Page 127 and 128:
COmuNiCaziONi ORali evaluation that
Page 129 and 130:
COmuNiCaziONi ORali PLAP in normal
Page 131 and 132:
COmuNiCaziONi ORali or identificati
Page 133 and 134:
COmuNiCaziONi ORali references 1 Ro
Page 135 and 136: COmuNiCaziONi ORali patients who ha
Page 137 and 138: COmuNiCaziONi ORali Tab. II. TCGC-S
Page 139 and 140: COmuNiCaziONi ORali and hindgut ori
Page 141 and 142: COmuNiCaziONi ORali plastic disease
Page 143 and 144: COmuNiCaziONi ORali antibodies prio
Page 145 and 146: COmuNiCaziONi ORali edema following
Page 147 and 148: COmuNiCaziONi ORali Fig. 3. fibroma
Page 149 and 150: COmuNiCaziONi ORali microarray anal
Page 151 and 152: COmuNiCaziONi ORali True 3q chromos
Page 153 and 154: COmuNiCaziONi ORali To our knowledg
Page 155 and 156: COmuNiCaziONi ORali segment, at the
Page 157 and 158: COmuNiCaziONi ORali defined as “n
Page 159 and 160: COmuNiCaziONi ORali TESTA COLLO Lym
Page 161 and 162: COmuNiCaziONi ORali references 1 Sa
Page 163 and 164: COmuNiCaziONi ORali of the paranasa
Page 165 and 166: COmuNiCaziONi ORali general dental
Page 167 and 168: COmuNiCaziONi ORali P16 immunohisto
Page 169 and 170: Pathologica 2012;104:359-420 POSTEr
Page 171 and 172: PoStER references 1 Gerber DE, Minn
Page 173 and 174: PoStER In our case the endofibrotic
Page 175 and 176: PoStER Fig. 1. Kaplan-meier surviva
Page 177 and 178: PoStER believed the use of atypical
Page 179 and 180: PoStER references 1 Goepel JR. Beni
Page 181 and 182: PoStER MALT lymphoma of the rectum:
Page 183 and 184: PoStER 3 Ciulla A, Castronovo G, To
Page 185: PoStER for protein expression of PA
Page 189 and 190: PoStER Grossly, an irregular villou
Page 191 and 192: PoStER Expression of ror-1 in pancr
Page 193 and 194: PoStER (see Fig. 1) placental site
Page 195 and 196: PoStER Tissue were fixed in 10% for
Page 197 and 198: PoStER invaded focally adjacent tun
Page 199 and 200: PoStER bination chemotherapy the pr
Page 201 and 202: PoStER 21 to 55 years in age, the l
Page 203 and 204: PoStER Results and conclusion. We a
Page 205 and 206: PoStER Identification of cancer ste
Page 207 and 208: PoStER Epidemiological and biomolec
Page 209 and 210: PoStER Fig. 1. ductal invasive Brea
Page 211 and 212: PoStER Fig. 2. Fig. 3. Fig. 4. Conc
Page 213 and 214: PoStER monly develops in elderly ad
Page 215 and 216: PoStER haematoxylin and eosin and V
Page 217 and 218: PoStER Fig. 4. High mitotic rate (a
Page 219 and 220: PoStER Fig. 6. focal sebaceous and
Page 221 and 222: PoStER Results. At gross examinatio
Page 223 and 224: PoStER strated that HPV is present
Page 225 and 226: PoStER Fig. 1. EE primary intestina
Page 227 and 228: PoStER Introduction. Angiosarcoma i
Page 229 and 230: PoStER 9 Klein KA, Stephens DH, Wel
Page 231 and 232: Pathologica 2012;104:421-423 InDICE
Page 233: iNDicE DEgli aUtoRi Orsaria M., 319
show all

Sabato 27 ottobre 2012 - Pacini Editore

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?