Sabato 27 ottobre 2012 - Pacini Editore
Sabato 27 ottobre 2012 - Pacini Editore
Sabato 27 ottobre 2012 - Pacini Editore
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of skin. Clinicopathologic analysis of 13 cases. Am J Surg Pathol<br />
2005;29:9<strong>27</strong>-34.<br />
Chaundhry IH, Calonje E. Dermal non-neural granular cell tumour (socalled<br />
primitive polypoid granular cell tumour): a distinctive entity<br />
further delineated in a clinicopathological study of 11 cases. Histopathology<br />
2005;47:179-85.<br />
GASTrOEnTErICO<br />
Lung sarcomatous carcinoma metastatic to a<br />
villous adenoma of the colon. report of a case<br />
G. Abbona1 , D. Bellis1 , M. Risio2 , L. Viberti1 1 Dipartimento dei Servizi, Anatomia Patologica, ASLTO1, Ospedale Martini,<br />
Torino; 2 Anatomia Patologica IRCC Candiolo<br />
The phenomenon of tumor-to-tumor metastasis has been described<br />
in the literature in over 100 cases reports. Virtually any<br />
benign or malignant tumor can be a recipient: renal cell carcinoma<br />
is the most common tumor recipient of metastasis; on<br />
the other end carcinoma of the bronchus is the most consistent<br />
metastatic donor.<br />
We report the first case of a lung sarcomatous carcinoma metastasizing<br />
to a villous adenoma of the colon.<br />
A 65 year old male presented to medical attention with shortness<br />
of breath. Imaging studies showed a pulmonary mass infiltrating<br />
the mediastinum. The fine needle biopsy of the lesion revealed<br />
a fusocellular neoplasm with massive necrosis. On immunohistochemistry<br />
the neoplastic cells showed focal positivity for<br />
CK 7, but were negative for TTF1, p63, CK 5/6 and synaptophysin.<br />
A diagnosis of poorly differentiated carcinoma of the<br />
lung with sarcomatous features was made. Two months later at<br />
colonscopy, a polypoid intraluminal lesion measuring 2 cm was<br />
resected. Histology showed typical features of villous adenoma<br />
with high grade dysplasia (intramucosal adenocarcinoma). One<br />
histologic section exhibited a small focus of malignant rounded<br />
and fusated neoplastic cells, infiltrating the superficial lamina<br />
propria between the adenomatous glands, citomorphologically<br />
very similar to the cells of lung carcinoma. Serial sections failed<br />
to demonstrate point of origin from the adenomatous epithelium.<br />
Immunohistochemical studies clearly delineated two neoplastic<br />
components in the polyp. The adenomatous cells were strongly<br />
positive to CK 20 and CDX-2, while CK7 was negative. Meanwhile<br />
the small focus of malignant rounded and fusated cells<br />
showed complete negativity to antibodies CK 20, CDX-2, TTF1<br />
and synaptophysin. However these cells were positive to vimentin,<br />
keratin AE1-AE3 and focally to CK7. The distinctly dimorphic<br />
histological and immunohistochemical appearances were<br />
the best clue to suspect the metastatic nature of the fusocellular<br />
component of the polyp.<br />
Metastasis of a malignant neoplasm to a benign tumor is an<br />
infrequent event. Adenomatous polyps of the colon have been<br />
only described on seven occasions acting as host tumors. In these<br />
cases, gastric carcinoma was the most common donor neoplasm<br />
(4 cases), followed by cutaneous melanoma (2 cases) and breast<br />
carcinoma (1 case); lung tumor has never been reported as donor<br />
neoplasm.<br />
The vast majority of malignant lesions found in adenomatous<br />
polyps in the colon are the consequences of malignant transformation<br />
from benign neoplastic colonic adenomatous tissue. The<br />
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-<strong>27</strong> OttOBRE <strong>2012</strong><br />
Giovedì, 25 <strong>ottobre</strong> <strong>2012</strong><br />
Sala Brunelleschi – ore 15,00-18,00<br />
Habeeb AA, Salama S. Primitive nonneural granular cell tumor (socalled<br />
atypical polypoid granular cell tumour). Report of 2 cases with<br />
immunohistochemical and ultrastructural correlation. Am J Dermatopathol<br />
2008;30:156-9.<br />
Habeeb AA, Weinreb I, Ghazarian D. Primitive non-neural granular<br />
cell tumour with lymph node metastasis. J Clin Pathol 2009;62:847-9.<br />
possibility that colonic adenomatous polyps could be recipient of<br />
metastatic tumors should be considered whenever a distinct dimorphic<br />
pattern is encountered. This could change the treatment<br />
and may require an appropriate workup.<br />
Much debate has ensued over the phenomenon of tumor-to-tumor<br />
metastasis. Some attribute the event to a casual occurrence, where<br />
other offer more likely hypotheses. The highly active, richly<br />
vascularized and inflamed stroma of the host tumors has been<br />
claimed to be a fertile microenviroment for tumor metastasis.<br />
These theories are probably only part of a complex mechanism<br />
that at present is poorly understood.<br />
references<br />
Bismar TA, et al. Metastatic foci of signet ring cell carcinoma in a tubular<br />
adenoma of the colon. Arch Pathol Lab Med 2003;1<strong>27</strong>:1509-12.<br />
Bohn OL, et al. Tumor-to-tumor metastasis: renal cell carcinoma metastatic<br />
to papillary carcinoma of thyroid-report of a case and review of<br />
the literature. Head and Neck Pathology 2009;3:3<strong>27</strong>–330.<br />
Grignon DJ et al: Malignant melanoma with metastasis to a colonic polyp.<br />
Am J Gastroenterol.1988;83:1298-300.<br />
Moody P et al: Tumor-to-tumor metastasis: pathology and neuroimaging<br />
considerations. Int J Clin Exp Pathol. <strong>2012</strong>; 5: 367–373.<br />
Ozuner G. Colonoscopic detection of a malignant melanoma metastatic to<br />
a tubular adenoma of the colon: report of a case. Dis Colon Rectum<br />
2002;45:1681-4.<br />
Rodríguez Salas N, et al. Colonic anastomosis and colonic polyp mucosal<br />
metastasis of signet ring cell gastric adenocarcinoma. Clin Transl<br />
Oncol 2010;12:238-9.<br />
Sella A, et al. Renal cell cancer: best recipient of tumor-to-tumor metastasis.<br />
Urology 1987;30:35-8.<br />
Tiszlavicz L. Metastasis of a stomach carcinoma in a solitary adenomatous<br />
cecal polyp. Zentralbl Allg Pathol 1990;136:<strong>27</strong>7-82.<br />
Uriev L, et al. Signet ring cell infiltration in tubular adenoma of ascending<br />
colon. Pathol Res Pract 2004;200:707-12.<br />
Wiltz O, et al. Breast carcinoma metastatic to a solitary adenomatous<br />
polyp in the colon. Arch Pathol Lab Med 1984;108:318-20.<br />
Liver collagen proportionate area and septal<br />
thickness/nodule size: a comparison for predicting<br />
decompensation in cirrhosis<br />
S. Bruno1 , T.V. Luong2 , F. Grillo1 , G. Isgrò3 , E. Tsochatzis3 ,<br />
A. Hall2 , A.P. Dhillon2 , A.K. Burroughs3 1 University of Genova, Histopathology, DISC, Azienda Ospedaliera e<br />
Universitaria San Martino-IRCCS, Genova; 2 Department of Histopathology,<br />
Royal Free Hospital, London, UK; 3 The Royal Free Sheila Sherlock<br />
Liver Centre and University Department of Surgery UCL and Royal Free<br />
Hospital, London, UK<br />
Introduction. Cirrhosis is the end stage of chronic liver disease<br />
and WHO 1977 1 defined it as “a diffuse process, characterized by<br />
fibrosis and conversion of the normal architecture into structurally<br />
abnormal nodules.”<br />
Liver biopsy is the gold standard for grading and staging of liver<br />
disease. Cirrhosis may be classified as either compensated or<br />
decompensated according to the absence or presence of clinical
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