Signet-ring cell carcinoma of the breast. The mucinous variant of infiltrating lobular carcinoma?

Five cases of the type of mammary carcinoma that has been designated "signet-ring cell carcinoma" are presented. This tumor is characterized by the presence of numerous cells containing intracellular mucin, without large amounts of extracellular mucin as is seen in colloid (gelatinous, mucinous) carcinoma of the breast. Although such cells may be seen in many mammary carcinomas, they are never as frequent as in the variant described. Ultrastructurally, the most characteristic finding is the presence of numerous intracellular lumina containing material which appears to represent the mucin identified with the light microscope. This finding differs from that in colloid carcinoma, in which the scantier intracellular mucin occurs in the form of intracytoplasmic membrane-bound vesicles. The five tumors in the present series were all associated with either in situ lobular carcinoma or a "sinus catarrh"-like pattern of nodal metastases, or both. On the basis of these light and electron microscopic data, the signet-ring cell carcinoma is suggested as a variant of infiltrating lobular carcinoma, clinically and pathologically distinct from colloid carcinoma.     

Clinical pathology analysis of esophageal sarcomatoid carcinoma

Objective: The purpose of this study was to study the clinical, imaging characters and pathological characteristics of esophageal sarcomatoid carcinoma. Methods: We reviewed 23 cases of esophageal sarcomatoid carcinoma from Janu-ary 2006 to December 2013 in four hospitals. The data of patients who were esophageal sarcomatoid carcinoma operated were retrospectively analyzed. Al cases had completed upper gastrointestinal barium images materials and 14 of these cases had completed CT images materials. Upper gastrointestinal barium images and CT imaging features include tumor location, size, shape, and strengthen, etc. The biological parameters of lesions including the express of cytokeratin AE1/AE3, 34βE12, p63, Vimentin, desmin, Actin, S-100 and Ki-67 detected by immunhistochemical UltraSensitiveTM S-P method (n=23), and the patients’ data of contrastographic picture (n=23), imaging characters of CT scan (n=14), and their relationship were studied. Results:Upper gastrointestinal barium images, CT imaging and gastrointestinal fiberscopy revealed lobulated intraluminal fil ing defect 0.4 cm to 5.7 cm × 3.5 cm × 1.3 cm (mean=3. 7 cm) in the mid (n=14), lower (n=7) and upper (n=2) intrathoracic esophagus. Among 23 cases of esophageal sarcomatoid carcinoma, 19 patients were of mushroom type, 2 patients was of ulcer type, and 2 patients were of medul a type;19 patients were pedunculated, and 4 patients were no pedunculated (2 patients was of ulcer type). The tumor surface was relatively smooth and esophageal compliance was maintained. The pathological changes of esophagus such as lightly locked, rigid wal no-manifest partly, esophageal lumens expand partly, major fil ing sublobe defect could be shown through contrast medium. Normal esophagus was no unpack obviously over pathological changes. Enhanced computed tomography showed tumors in the intrathoracic esophagus and 8 lymph nodes metastases in 3 cases. Histological y, carcinomatous and sarcomatous components coexist. Microscopical y, the tumor comprised poorly dif erentiated squamous cellcarcinoma and spindle-shaped cells resembling leiomyosarcoma. Immu-nohistochemical y, spindle-shaped sarcomatous cells displayed weekly positive reaction to cytokeratin AE1/AE3. Transitional zone was seen between sarcomatous and carcinomatous elements in 5 cases. The 17 lymph nodes metastases in 5 cases (53 lymph nodes) among 23 cases esophageal sarcomatoid carcinoma (187 lymph nodes) were observed. Conclusion:The clinical and radiologic features of esophageal sarcomatoid carcinoma overlap with those of other esophageal neoplasms. There are the radiologic imaging changes such as a large, intraluminal, polypoid mass, major fil ing sublobe defect and pedicle skin flap tumor in esophageal lumen, esophageal lumen extension partly, dissepiment rigidity wal no obviously, etc. Histological y, carcinomatous and sarcomatous components coexist and the biphasic pattern is the key diagnostic feature. However, esophageal sarcomatoid carcinoma has a more favorable prognosis than other malignant esophageal neoplasms. Immunohistochemical staining seems necessary to distinguish these lesions from other esophageal neoplasms.     

Does pT2b prostate carcinoma exist? Critical appraisal of the 2002 TNM classification of prostate carcinoma

BACKGROUND: Clinicopathologic staging of prostate adenocarcinoma provides a method for assessing the extent of tumor and predicting patient prognosis. The American Joint Committee on Cancer (AJCC) TNM staging system has undergone recent revisions for T2 prostate tumors. T2 tumors currently are subclassified as T2a (less than one-half of one lobe involvement), T2b (greater than one-half of one lobe involvement), and T2c (bilateral involvement). Despite general acceptance of the system, controversy and uncertainty still exist with regard to the application of the TNM staging system, particularly the use of the T2 staging subclassification. METHODS: The study population was comprised of 369 patients with prostate carcinoma who were treated with radical retropubic prostatectomy. Radical prostatectomy specimens were evaluated histologically by complete embedding and whole-mount processing. Tumor specimens were staged initially using the 1998 AJCC TNM system and then reevaluated according to the 2002 TNM staging guidelines. RESULTS: The weights of the prostate specimens ranged from 14-149 g (median, 38 g). Prostate tumor specimens were multifocal in 312 patients (85%). The majority of the specimens were classified pathologically as T2 (n = 276 [75%]). Using the 2002 TNM staging criteria, 54 of the tumor specimens (15%) were classified as pT2a, 222 (60%) were pT2c, 75 (20%) were pT3a, and 18 (5%) were pT3b. No pathologic T2b tumor specimens were identified. CONCLUSIONS: Taking into consideration the average weight of the prostate specimens (38 g), as well as the predominance of tumor multifocality, it would be unusual to identify tumors involving greater than one-half of 1 lobe (approximately an 8-cm(3) tumor) without involving the other lobe. The authors question the existence of a true pT2b tumor.     

Estramustine phosphate in the treatment of endometrium carcinoma

Estramustine phosphate (EMP) is a combination ofestrogen and nitrogen mustard, used in the trCatment ofprostatic carcinoma in the past, with its anti-androgeneffects of the estrogen and cytotoxic achon of nitrogenmustard.[l] Recent stlldies show it not only has cytotoxiceffect on prostatic cancer cells, but also can lead the drugto target cells, i.e., cancer cells, especially the ER positivecancer cells, by the affinity of the drug and ER, andfinally produce a specific cytotoxic effect. It …     

Can therapy of hepatitis C affect the development of hepatocellular carcinoma?

Chronic inflammation induced by viral infections and their role in carcinogenesis is well recognized. Two hepatotropic viruses, hepatitis B and hepatitis C (HCV), have been linked worldwide to the development of hepatocellular carcinoma (HCC). Although orthotopic liver transplant offers the best chance for cure and long-term survival, the demand for organs far outweighs the supply. The incidence of HCC in the United States has increased over the past 3 decades. HCV-induced cirrhosis is believed to play a significant role in the rising rate of HCC. Therefore, primary measures to prevent HCC in HCV-infected patients are urgently needed. Numerous studies of the HCV HCC patient have considered primary treatment with interferon-based therapy. However, secondary prevention currently seems to carry more promise. This article evaluates and assesses various treatments for primary and secondary chemoprevention in the setting of HCV.     

A useful agent for chemoprevention of hepatocellular carcinoma?

Hepatocellular carcinoma (HCC) is a major health problem worldwide, involving more than 620,000 new cases yearly, with chronic HBV and HCV infection being the most common causes. Because most patients are diagnosed in an advanced state which is usually not amenable to curative therapy, prevention should be the main focus for reducing the HCC incidence and its related morbidity and mortality. Strategies of HCC prevention can focus on each single risk factor, with antiviral therapy against chronic hepatitis B and hepatitis C as well as suppression of the progression of common liver diseases being the most important and effective measures. Bicyclol, a drug that can improve liver function and inhibit HBV replication, may be a useful agent for the chemopreventive of HCC, as indicated by a recent study by Zhu et al. Bicyclol can act on the initiation and promotion stages of hepatocarcinogenesis by preventing malignant transformation of hepatic cells. It may also enhance the liver's capacity of detoxification and inhibit DNA mutations. More clinical studies are needed to further demonstrate the efficacy and molecular mechanisms of this agent on HCC chemoprevention.     

Presentation of carcinoma larynx and laryngopharynx— An analysis of 840 cases

Clinical records of 840 cases of carcinoma larynx and laryngopharynx were studied. These patients were admitted in Nehru Hospital, Postgraduate Institute of Medical Education & Research, Chandigarh during the period 1971–1986. Maximum number of patients (308) presented in the 5th decade of life. About 1,3rd of patients (302) belonged to Uttar Pradesh State of India. History of smoking was present in 668 patients (79.59%). The commonest site of involvement was supraglottis (264 patients). 508 patients (60.48%) presented in stage IV. Metastasis to the neck nodes was present in 571 patients (67.85%). 349 patients (41.54%) had healed pulmonary tuberculosis lesions while another 76 patients (9.09%) had active tubercular lung lesion. 96 patients (11.42%) had associated tuberculosis of cervical lymph nodes. Squamous cell carcinoma was the commonest histopathological variety in 97.73% patients. 203 patients were treated with combination of surgery and radiotherapy, curative radio therapy (5500 rads) was given in 196 patients and 441 patients had advanced disease, hence only palliative radiotherapy was given.     

Role of chemotherapy in stage Ⅱb nasopharyngeal carcinoma

The efficacy of neoadjuvant chemotherapy and adjuvant chemotherapy on stage Ⅱb nasopharyngeal carcinoma (NPC) remains unclear. Conventional two-dimensional radiotherapy combined with concurrent chemotherapy can improve the overall survival, progression-free survival, recurrence-free survival, and distant metastasis-free survival of patients with stage Ⅱb NPC. Intensity-modulated radiotherapy without concurrent chemotherapy also provides good outcomes for patients with stage Ⅱb NPC. This article summarizes the features of stage Ⅱb NPC and reviews the role of chemotherapy in this subgroup of NPC.     

Collision tumor of the kidney composed of clear cell carcinoma and collecting duct carcinoma：report of a case with unusual morphology and clinical follow-up

We report the case of a 67-year-old female who presented with a large renal mass. Gross examination of the nephrectomy specimen demonstrated a 6-cm renal mass that invaded into the renal sinus and perinephric fat. Histologic examination revealed two distinct tumor types. The first type was a conventional （clear cell） renal cell carcinoma that was of low nuclear grade and comprised the minority of the overall tumor. The second type was a high-grade collecting duct carcinoma with glandular/tubular differentiation and composed the majority of the tumor. Immunohistochemical studies demonstrated distinctive patterns of the two tumor types, thus confirming two distinct lineages. Five months postoperatively, the patient developed metastasis to the lungs and right hilar lymph node region. A fine needle aspiration of a lung nodule demonstrated a metastatic, poorly differentiated carcinoma, similar to the collecting duct carcinoma component in the kidney. Collision tumors of the kidney are rare with fewer than 10 cases reported in the literature. Our report further expands the spectrum of this rare phenomenon.     

Identification of ABCG2⁺ cells in nasopharyngeal carcinoma cells

Tumor stem cells are a small subset of tumor cells with the ability of self-renewal and differentiation and are regarded as a cause of tumor growth and recurrence. Previously we have shown that stem-like label-retaining cells (LRCs) can be detected in nasopharynx, tongue, esophagus and xenograft tumors formed by nasopharyngeal carcinoma (NPC) cell lines (5-8F, 6-10B and TMNE). The present study aimed to identify ABCG2? cells in 5-8F NPC cells and compare their tumorigenic potential with ABCG2? cells, expecting that we can obtain insight into the mechanism of the differential phenotypes of ABCG2? and ABCG2? cells. By using magnetic cell sorting (MACS) method, we isolated ABCG2? cells and ABCG2? cells from 5-8F cells. Among these two subpopulations and unsorted 5-8F cells, the rate of ABCG2? cells at G1 phase was highest, while the rate of ABCG2? cells at S phase was highest, indicating that ABCG2? cells were mostly quiescent. However, ABCG2? cells showed lower cloning efficiency and tumorigenicity than ABCG2? cells. We also used Affymetrix U133 plus 2.0 human whole genome expression chip to identify the gene expression profile of ABCG2? and ABCG2? cells and found that both subpopulations expressed some stem cell associated genes, e.g., PSCA, ABCG2 and ALPI were expressed in ABCG2? cells, and K19, integrin α6, integrin β4, CD44 and K14 were expressed in ABCG2? cells, suggesting there were stem cells in both ABCG2? and ABCG2? cells. Our data demonstrated that there exist ABCG2? cells in NPC cells, but ABCG2 alone is not sufficient for isolating cancer stem cells in 5-8F NPC cells.     

Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm,Sweden: An epidemic of viral‐induced carcinoma?

In the county of Stockholm, between 1970 and 2002, we have previously reported a 3‐fold parallel increase in the incidence of tonsillar squamous cell carcinoma (SCC) and the proportion of human papillomavirus (HPV) positive tonsillar SCC. Here, we have followed the above parameters in all patients (n = 120) diagnosed with tonsillar SCC during 2003–2007 in the same area, and also in correlation to our previous data. Ninety‐eight pretreatment biopsies were available and presence of HPV DNA and HPV‐16 E6 and E7 RNA were tested by polymerase chain reaction (PCR) and RT‐PCR. Incidence data were obtained from the Swedish Cancer Registry. Data reported from 1970 to 2002 were also obtained for comparison. HPV DNA was present in 83 of 98 (85%) of the tonsillar SCC biopsies from 2003 to 2007 and 77 of these were HPV‐16 positive. HPV‐16 E6 and E7 RNA were found in 98% of 52 analyzed HPV‐16 positive cases. The proportion of HPV‐positive cancers had significantly increased both from 1970 to 2007 (p < 0.0001) as well from 2000 to 2007 (p < 0.01), with 68% (95% confidence interval (CI), 53–81) 2000–2002; 77% (95% CI, 63–87) 2003–2005; and 93% (95% CI, 82–99) 2006–2007. The incidence rate of HPV‐positive tumors almost doubled each decade between 1970 and 2007, in parallel with a decline of HPV‐negative tumors. In conclusion, the incidence of HPV‐positive cancers is still increasing in the County of Stockholm, suggesting an epidemic of a virus‐induced carcinoma, with soon practically all tonsillar SCC being HPV positive, as in cervical cancer. © 2009 UICC     

Does clearing of axillary lymph nodes contribute to accurate staging of breast carcinoma?

The major prognostic indicator in carcinoma of the breast is the presence of metastases in axillary lymph nodes. However, 25% of patients with negative axilliary nodes by standard pathologic techniques are dead of metastatic breast carcinoma within 10 years. "Clearing" of the axillary fat has been shown to increase the yield of lymph nodes. Forty-two pathologic Stage I and II breast carcinoma specimens were cleared following routine pathologic examination to determine whether stage was changed by the clearing procedure. A total of 857 lymph nodes were recovered from 42 patients by routine techniques. Clearing increased the number of nodes found by 30%, to 1114. In the 31 node-negative patients an additional 178 nodes were identified, increasing the mean number of nodes per patient from 20 to 26. The number of additional nodes found per specimen ranged from 0 to 19. None of the additional nodes identified contained metastases. In the node-positive patients, 79 additional nodes were found by clearing, including 33 with metastases. No change in stage resulted, although the mean number of nodes per patient was increased from 22 to 30. Although an occasional positive lymph node may be overlooked by manual dissection, the rarity of this event makes routine clearing of the axillary contents impractical for carcinoma of the breast except in a research setting. Whether this conclusion applies equally to other tumors and other lymph node groups requires further study.     

Screening caused rising incidence rates of ductal carcinoma in situ of the breast

The purpose of this study was to examine trends in incidence and detection of ductal carcinoma in situ (DCIS) of the breast in southern Netherlands in the period 1984–2006 and assess the effect of mass screening. All patients with primary DCIS registered between 1984 and 2006 in the population-based Eindhoven Cancer Registry were included (n = 1,767). These data were linked to data from the population-based screening programme. The incidence of DCIS of the breast increased from 3/100,000 to almost 34/100,000 person-years in women aged 50–69 years in southern Netherlands since 1984. Mass screening was responsible for this increase. A stable 60% of DCIS was screen-detected. Over 11% of breast cancer patients have DCIS. In conclusion, the incidence of DCIS increased markedly in southern Netherlands with a clear effect of mammography screening since 1992.     

Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma?

BACKGROUND: Several studies have recently reported on the importance of quality of life (QOL) in predicting the survival of patients with lung carcinoma. To confirm these reports, the relationship between survival and QOL, as measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire and Duke-UNC Social Support Scale, was examined within a group of 206 patients with advanced nonsmall cell lung carcinoma treated in a randomized clinical trial conducted by the Cancer and Leukemia Group B (CALGB 8931). METHODS: Patients completed the EORTC instrument and the Duke-UNC Social Support Scale at baseline in the clinic. The Cox proportional hazards model was used to determine the incremental contribution QOL provided in predicting survival beyond the effect of known clinical prognostic variables. RESULTS: Clinical factors that were jointly predictive of poorer survival included low performance status, nonadenocarcinoma histology, presence of dyspnea, weight loss greater than 5%, albumin level less than 3.5 mg/dL, and adrenal metastases. Univariate analyses showed that patient-reported EORTC subscales describing increased pain, appetite loss, fatigue, lung carcinoma symptoms, poorer overall QOL, and poorer physical functioning predicted significantly poorer survival. Multivariate analyses showed that, after adjustment for clinical factors, overall QOL was not a significant predictor of survival. Rather, the only EORTC subscale of prognostic importance was the pain subscale, in which a 40-point increase was associated with a 27% increase in the hazard rate. CONCLUSIONS: This study did not confirm the prognostic importance of overall QOL. Rather, after adjustment for significant clinical factors, a patient-provided pain report had the greatest prognostic importance.