Sarcomatoid transitional cell carcinoma is a rare entity, in which a malignant, overtly epithelial component coexists with areas having a sarcoma-like appearance. Histological distinction of sarcomatoid carcinomas from carcinosarcomas is often difficult and immunohistochemistry is a helpful diagnostic adjunct in the correct diagnosis. In the present report, we describe an uncommon case of sarcomatoid transitional cell carcinoma of the renal pelvis, associated with giant cell tumor-like features. Immunoperoxidase staining for cytokeratin was positive in spindle cell component, indicating an epithelial origin. The carcinomatous component showed a diffuse membranous reactivity for E-cadherin, whereas the reactivity was sporadic and weaker in the sarcomatoid component, suggesting that the decrease of E-cadherin expression might be associated with the acquisition of sarcomatous morphology. Osteoclast-like multinucleated giant cells were positive for CD68 and negative for p53 oncoprotein, suggesting that they represent a non-neoplastic component that is reactively induced in the tumor stroma.
Adenocarcinoma of the appendix is rarely encountered and is usually discovered at the pathology examination of the surgical specimen. Adenocarcinoma of the vermiform appendix is a rare neoplasm and constitutes <0.5% of all gastrointestinal neoplasms. There is no symptom of appendiceal cancer, and it is very difficult to diagnose preoperatively. Most female patients are diagnosed as having a gynecologic disease. Second primary synchronous and metachronous neoplasms, especially in the gastrointestinal tract, are found in up to 35% of patients with appendix adenocarcinoma. We report a case of adenocarcinoma in a 56-year-old woman misdiagnosed as having right ovarian carcinoma, and we review the literature.
Antiphospholipid syndrome (APS) is the association between antiphospholipid antibodies, venous and arterial thrombosis and pregnancy morbidity. Although the kidney may be affected in APS, the treatment of renal involvement is yet to be elucidated. This report describes the clinical and laboratory features of four patients with primary APS nephropathy, and the beneficial effect of immunosuppressive therapy accompanied by warfarin and angiotensin-converting enzyme inhibitor. We also briefly discuss the possible mechanisms of the beneficial effects of immunosuppressives on primary APS nephropathy.
A case of a very rare combination of diffuse sclerosing variant of papillary thyroid carcinoma (DSPC) and primary squamous thyroid carcinoma (PSC) is presented. A 25-yr-old woman with right-sided neck mass and hypothyroidism was admitted. US showed that the right lobe of the thyroid gland was enlarged with irregular margins and heterogen echogenity and there were multiple small punctate echogenic foci in the central portion. A scintigraphy with 99mTc showed decreased uptake in the right lobe. FNA of the right lobe induced us to consider the presence of follicular neoplasm. Chest roentgenogram was normal. Total thyroidectomy with right-sided modified radical neck dissection was performed. Findings related to Hashimoto's thyroiditis and abundant psammoma bodies were observed in the frozen sections. Histopathologic findings demonstrated the coexistence of DSPC and PSC in both lobes and 16 lymph nodes metastases and soft tissue infiltration. Radioiodine was administered to ablate residual thyroid tissue. She was given T4 suppression therapy. At the 44th month of follow-up, she remains well without recurrences and metastases. The coexistence of DSPC and thyroiditis or PSC is still under debate. Very few cases with the combination of papillary thyroid carcinoma and PSC have been reported previously, thus we discuss the clinico-pathologic features and possible explanation for this unusual coexistence of malignancies.
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