Sabato 27 ottobre 2012 - Pacini Editore

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418 15 Weiss SW, Goldblum JR. Malignant vascular tumor. In: Weiss SW, Goldblum JR, eds. Enzinger and Weiss’s Soft Tissue Tumors. 4 th ed. St. Louis, Mo: The CV Mosby Co 2001. pp. 917-54 16 Meis-Kindblom JM, Kindblom LG. Angiosarcoma of soft tissue: a study of 80 cases. Am J Surg Pathol 1998;22:683-97. 17 Cerilli LA, Wick MR. Immunohistology of soft tissue and osseous neoplasms. In: Dabbs DJ, ed. Diagnostic immunohistochemistry. Philadelphia, Pa: Churchill Livingstone 2002, pp. 59-112. 18 Cahan WG, Woodard HQ, Higinbotham NL, et al. Sarcoma arising in irradiated 1948. Single pancreatic metastasis from renal cell carcinoma: a case report E. Pacella1 , C. Di Somma2 , S. Boccardo3 , A. Calabrese3 , B. Spina3 1 University of Genoa, Histopathology, DISC, Azienda Ospedaliera ed Universitaria San Martino-IRCCS-IST, Genoa, Italy; 2 Department of Surgery, Azienda Ospedaliera ed Universitaria San Martino-IRCCS-IST, Genoa, Italy; 3 Unit of Histopathology and Cytopathology Azienda Ospedaliera ed Universitaria San Martino-IRCCS-IST, Genoa, Italy Introduction. The most common sites of RCC metastases are lungs, lymph nodes, bone, liver, brain, ipsilateral adrenal gland, contralateral kidney, and pancreas 1 . Pancreatic metastases are rare, with a reported incidence varying from 1.6% to 11% in autopsy studies of patients with advanced malignancy. Of the primary tumors that can metastasize to the pancreas, renal cell carcinoma (RCC) is the most common, followed by lung cancer, breast cancer, colon cancer, and melanoma 2 3 . Most cases of RCC metastasis to the pancreas present as metachronous lesions, often many years after resection of the primary tumor. The average time to presentation for pancreatic metastasis from RCC is 9.2 years after the initial resection 7 . Autopsy data have shown that 2% of patients with RCC have pancreatic metastases at the time of their death 8 . Although metastasis to the pancreas is most commonly associated with disseminated systemic disease 4 5 , RCC typically spreads to the pancreas as an isolated lesion. However, in many cases single pancreatic metastases only seems to anticipate the onset of multiple metastatic spread, even after many years 6 . 69% of patients with isolated pancreatic metastasis were completely asymptomatic at presentation. Patients may be completely asymptomatic, or they may develop symptoms of epigastric abdominal pain or acute pancreatitis secondary to pancreatic ductal obstruction from the metastatic lesion. Metastases to the pancreas are typically identified in different ways: during the initial staging work-up for treatment of the primary tumor; trough routine follow-up imaging after the primary tumor has been treated; or the patient initially presents symptoms related to the pancreatic lesion: however the early signs and symptoms of isolated pancreatic metastases are often non-specific. The diagnosis of pancreatic metastasis is usually made on radiological or endoscopic criteria, since most patients do not present related symptoms: through imaging techniques, RCC metastatic disease to the pancreas can often be distinguished from pancreatic ductal adenocarcinoma. Metastases to the pancreas can be multicentric and typically do not cause peripancreatic lymphadenopathy; these findings can be used to distinguish metastases from pancreatic ductal adenocarcinoma. Pancreatic metastases do not appear to show a predilection for a particular part of the pancreas 9 10 . Three types of metastatic involvement of the pancreas have been described in the literature. The most common type of all metastases and in particular of RCC metastases, reported in 50%-73% of cases, is that of a solitary, localized, well-defined mass. A second pattern of multiple pancreatic lesions has been reported in 5%-10% of cases, and a CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012 third pattern of diffuse metastatic infiltration causing generalized enlargement of the organ in 15%-44% of cases 11-14 . Since the ‘RCC typically extends to the pancreas as an isolated lesion, it is often susceptible to surgical treatment 17 and surgical resection of metastatic disease is appropriate in certain clinical scenarios, depending on the virulence of the primary tumor, the extent of metastatic disease, and the functional status of the patient. The specific type of surgical resection will depend on the location of the tumor within the pancreas. Standardized pancreatic resection adapted to the location of the tumor, in terms of partial pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy, is generally recommended for the management of isolated pancreatic metastases. Five-year survival rates after surgical resection of RCC metastasis to the pancreas are 53-75%, whereas patients who choose not to undergo surgical resection or who have widely disseminated disease have a 5-year survival rate of 5-30% 7 15 16 . Materials and methods. We present the case of 58 years old woman subject to nephrectomy for cancer of the left kidney; the lesion was analyzed at our Unit of Histopathology and Cytopathology San Martino-IRCCS-IST of Genoa, and was diagnosed as renal cell carcinoma, clear cell type. Two years later, a single pancreatic metastasis is diagnosed by imaging techniques and the patient is submitted to resection of the tail of the pancreas. To macroscopic examination the lesion correspondig to a yellowish nodule of 2.8 cm, well circumscribed (“pushing” borders), with focal hemorrhage, necrosis and cystic degeneration. Results. Microscopically the lesion was composed of compact and alveolar growth of large polygonal cells with clear cytoplasm, distinct but delicate cell boundaries, uniform round nuclei and inconspicuous nucleoli. Hhistomorphological characteristics of the kidney cancer and pancreatic lesion were compared and found to be equal. The diagnosis of metastatic RCC was confirmed by histopathological analysis: the neoplastic cells were positive for immunohistochemical staining for CD10 and RCC, confirming the morphological findings. CD10, 20X EE, 10X EE, 2X RCC, 20X Conclusions. When metastasis to the pancreas occurs, it is most commonly associated with widespread disease dissemination. RCC is the most common primary tumor to present with isolated solid metastasis to the pancreas, often making it susceptible to surgical treatment. However, in many cases single pancreatic metastases only seems to anticipate the onset of multiple metastatic spread, even after many years. Five years survival rates after surgical resection of RCC metastases to the pancreas are better than those of patients who choose not to undergo surgical resection or who have widespread disease. references 1 Ritchie AW, Chisholm GD. The natural history of renal carcinoma. Semin Oncol 1983;10:390-400. 2 Minni F, Casadei R, Perenze B, et al. Pancreatic metastases: observations of three cases and review of the literature. Pancreatology 2004;4:509-20. 3 Moussa A, Mitry E, Hammel P, et al. Pancreatic metastases: a multicentric study of 22 patients. Gastroenterol Clin Biol 2004;28:872-6. 4 Thadani A, Pais S, Savino J. Metastasis of renal cell carcinoma to the pancreas 13 years postnephrectomy. Gastroenterol Hepatol (NY) 2011;7:697-9. 5 Rumancik WM, Megibow AJ, Bosniak MA, et al. Metastatic disease to the pancreas: evaluation by computed tomography. J Comput Assist Tomogr 1984;8:829-34. 6 Kassabian A, Stein J, Jabbour N, et al. Renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. 7 Showalter SL, Hager E, Yeo CJ. Metastatic disease to the pancreas and spleen. Semin Oncol 2008;35:160-71. 8 Bennington JL. Proceedings: cancer of the kidney—etiology, epidemiology, and pathology. Cancer 1973;32:1017-29.
PoStER 9 Klein KA, Stephens DH, Welch TJ. CT characteristics of metastatic disease of the pancreas. Radiographics 1998;18:369-78. 10 Ng CS, Loyer EM, Iyer RB, et al. Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. AJR Am J Roentgenol 1999;172:1555-9. 11 Ascenti G, Visalli C, Genitori A, et al. Multiple hypervascular pancreatic metastases from renal cell carcinoma: dynamic MR and spiral CT in three cases. Clin Imaging 2004;28:349-52. 12 Scatarige JC, Horton KM, Sheth S, et al. Pancreatic parenchymal metastases: observations on helical CT. AJR Am J Roentgenol 2001;176:695-9. 13 Ferrozzi F, Bova D, Campodonico F, et al. Pancreatic metastases: CT assessment. Eur Radiol 1997;7:241-5. 14 Muranaka T, Teshima K, Honda H, et al. Computed tomography and histologic appearance of pancreatic metastases from distant sources. Acta Radiol 1989;30:615-9. 15 Kavolius JP, Mastorakos DP, Pavlovich C, et al. Resection of metastatic renal cell carcinoma. J Clin Oncol 1998;16:2261-6. 16 Ritchie AW, deKernion JB. The natural history and clinical features of renal carcinoma. Semin Nephrol 1987;7:131-9. 17 Law CH, Wei AC, Hanna SS, et al. Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment and outcome. Ann Surg Oncol 2003;10:922-6. Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: report of a case D. Tacchini, L. Vassallo, M.A.G.M. Butorano, S. Tripodi Department of Human Pathology and Oncology, Anatomic Pathology Section, University of Siena, Italy Background. Mucinous tubular and spindle cell carcinomas (MT- SCCs) of the kidney are rare epithelial neoplasms with a relatively good prognosis a long as they remain low-grade. We present a case of mucinous tubular and spindle cell carcinoma of the renal medullary in 80 year old woman. Literature was reviewed in order to investigate histological features for correct diagnosis. Methods. Biopsy samples were routinely processed and stained (HE). Morphological diagnosis was confirmed by immunohistochemistry (CKAE1/AE; CK7; Pas; Alcian-Pas; CD10; CD117; ASM1; Vimentina; HMB45; MELAN A; CK HMW; CK19; CK8; CK18; Colloidal Iron. Proliferative activity evaluated with Ki-67). Results. On gross examination, a well circumscribed nodule (2,5 cm in greatest axis) in the renal medullary was noted. Microscopic examination showed tightly packed, small, elongated tubules with a bland morphology and with transition to spindle cells component. In addition some tubules in non neoplastic parenchyma showed intraluminal calcifications. Unusual feature included foamy macrophages and clear cells immerged in a mucinous stroma. Mitoses were rare. High-grade areas were not demonstrated. Immunohistochemical analysis showed positive staining for epithelial membrane antigen (EMA) and CK7. Alcian blue staining revealed abundant mucin in the intervening fibrous stroma. Ki-67 index was low (< or = 5%). Conclusion. MTSCCs are rare kidney malignancies and are predominantly of low grade. Prognosis is relatively good. However, patients with high-grade tumours should undergo proper follow-up. A correct histological diagnosis is important to direct therapy. reference 1 Grigore A, Toma L, Stoicea M, et al. Rare renal tumor--mucinous tubular and spindle cell carcinoma. Rom J Morphol Embryol 2012;53:167-71. 2 Song HJ, Ma J, Zhou HB, et al. Mucinous tubular and spindle cell carcinoma of kidney: a clinicopathological study. Zhonghua Bing Li Xue Za Zhi 2011;40:444-8. 3 Sarsik B, Sımşır A, Karaarslan S, et al. Mucinous tubular and spindle cell carcinoma of kidney and problems in diagnosis. Turk Patoloji Derg 2011;27:116-26. 4 Takagi K, Yamada Y, Uno M, Komeda H, Fujimoto Y. A case of mucinous tubular and spindle cell carcinoma of the kidney. Hinyokika Kiyo. 2010 Mar;56(3):159-62. 419 5 Yang G, Breyer BN, Weiss DA, MacLennan GT. Mucinous tubular and spindle cell carcinoma of the kidney. J Urol. 2010 Feb;183(2):738- 9. Epub 2009 Dec 21. 6 Yasufuku T, Shigemura K, Fujisawa M. Mucinous tubular and spindle cell carcinoma. Int J Urol 2009;16:425-6. Diagnostic utility of podoplanin (D2-40) expression in prostate gland and seminal vesicles L. Ventura1 , G.L. Gravina2 , F. Marampon2 , M. Capulli3 , C. Festuccia3 , F. Liberati4 1 2 U. O. C. di Anatomia Patologica, Ospedale San Salvatore, L’Aquila; Divisione di Radioterapia e Radiobiologia, Dipartimento di Scienze Cliniche Applicate e Biotecnologie, Università, L’Aquila; 3 Dipartimento di Scienze Cliniche Applicate e Biotecnologie, Università, L’Aquila; 4 U. O. di Anatomia Patologica, Ospedale San Camillo De’ Lellis, Rieti, Italy Background. Podoplanin is a transmembrane mucoprotein strongly and selectively expressed by lymphatic endothelial cells 1 . The monoclonal antibody D2-40, directed against human podoplanin, has been proved to be useful in detecting lymphovascular invasion by neoplasms and in quantifying lymphatic vessel density in different tumors 1 . It represents an excellent marker of vascular neoplasms with lymphatic differentiation, mesothelial and germ cell tumors, but it results always negative in adenocarcinomas. Podoplanin expression was also demonstrated in various normal cells, such as osteocytes, chondrocytes, follicular dendritic cells, type I alveolar cells, myoepithelial cells of the breast 1 and basal cells in the prostate 2 3 (Tab. I). The aim of this study is to investigate the distribution and features of of D2-40 immunoreactivity in tissues from different prostatic specimens and its potential diagnostic utility. Material and methods. After routine diagnostic histopathology examination and reporting, significant paraffin blocks from 50 selected patients, who underwent needle core biopsy (20 cases), trans-urethral resection (7 cases), simple prostatectomy (7 cases) and radical prostatectomy (16 cases), were cut to obtain additional slides immunostained with a monoclonal antibody directed against human podoplanin (clone D2-40, DAKO A/S, Glostrup, Denmark). The selected cases included tissues from the different zones of the gland and the main prostatic diseases, such as adenocarcinoma, PIN, prostatitis, adenosis, hyperplasia and glandular atrophy. Results. A strong cytoplasmic immunoreactivity of lymphatic endotelial cells was observed in all cases and used as an internal positive control. Prostatic basal cells were also constantly positive, but with a slightly less intensity than that observed in endothelial cells. A weak positive signal characterized perineurial and Schwann cells of the peripheral nerves, as well as ganglion cells within intra- and extraprostatic nervous ganglia. Smooth muscle fibers and stromal fibroblasts showed mild immunoreactivity. Basal cells of seminal vesicle epithelium showed moderate positivity, with a patchy pattern of expression (Tab. II). Blood vessels endothelium, normal and hyperplastic luminal cells, as well as PIN and adenocarcinoma cells were always negative. Conclusions. As a specific marker of lymphatic endothelium 1 , podoplanin has been used for detecting lymphovascular invasion and quantifying lymphatic vessels density in prostate carcinoma. Recent contributions underlined its utility as a basal cell marker, to avoid potential pitfalls in misinterpretation of lympatic invasion 2 and in evaluating atypical small acinar proliferation 3 . Our results confirm the value of D2-40 in highlighting lympatics and basal cells, and its role as a negative marker of adenocarcinoma and other glandular lesions. The use of D2-40 in combination with other basal cell markers may be indicated in order to identify a wider spectrum of basal cells. The positivity of peripheral nerves and nervous ganglia may be useful in highlighting the invasion of these structures by ad-
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Periodico bimestrale - POSTE ITALIA
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212 Key words: EGC, Prognosis, Trea
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214 Tab. VI. univariate analysis: 5
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216 the surgeons perform a pancreat
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238 Patobiologia della parete aorti
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240 10 Luo BH, Carman CV, Springer
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patHOlOGiCa 2012;104:267-358 COMUnI
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COmuNiCaziONi ORali Solitary T-cell
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COmuNiCaziONi ORali Tab. I. CYTOLOG
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COmuNiCaziONi ORali The aim of the
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COmuNiCaziONi ORali Immunohistochem
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Pathologica 2012;104:359-420 POSTEr
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PoStER references 1 Gerber DE, Minn
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PoStER In our case the endofibrotic
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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
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Page 221 and 222: PoStER Results. At gross examinatio
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Page 227: PoStER Introduction. Angiosarcoma i
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