RESUMO
An unusual case of post-radiation primary intranodal leiomyosarcoma of the cervical lymph node is presented. The patient was a 32-year-old white man who was treated in 1986 with hemiglossectomy and right neck dissection, followed by radiation therapy, for squamous cell carcinoma of the tongue. Six years later, he presented with an enlarged left cervical lymph node which on biopsy showed a high grade spindle cell malignant neoplasm. Immunohistochemistry and electron microscopic study verified the smooth muscle origin of the tumour. Extensive work-up for a second primary lesion was negative. Primary intranodal leiomyosarcoma is extremely rare. We briefly discuss the histological differential diagnosis of spindle cell lesions of lymph nodes, leiomyosarcoma of the vessel wall and radiation-associated sarcoma.
Assuntos
Leiomiossarcoma/patologia , Doenças Linfáticas/patologia , Neoplasias Induzidas por Radiação/patologia , Adulto , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pescoço , Neoplasias/patologiaRESUMO
Salivary duct carcinoma is an uncommon and relatively unknown clinically aggressive adenocarcinoma of salivary origin that histologically demonstrates a remarkable resemblance to invasive carcinoma of the breast. We report the clinicopathologic features of 13 cases that were also examined by image analysis for DNA ploidy. The results were then analyzed collectively with the less than 100 cases of salivary duct carcinoma reported in the English-language literature to define the characteristics of this unusual neoplasm. The 12 men and one woman averaged 68 years of age (range, 49 to 90 years). All tumors arose in the parotid (10 cases) or submandibular glands (three cases). Nine tumors were aneuploid, three diploid, and one was indeterminate because of insufficient tissue. Follow-up (median, 24 months) was available in 12 cases: three patients died of disease, six were alive without disease, and three died of other causes. Combining our cases with those in the literature, a total of 104 cases, confirms that salivary duct carcinoma is a highly malignant neoplasm with distinctive clinical and pathologic features. It arises almost exclusively in the major salivary glands (96% of cases), is three times more common in men, and usually occurs in patients over 50 years of age (range, 22 to 91 years). One-third of patients experience local recurrences, 59% develop positive regional lymph nodes, 46% have systemic metastases (lungs and bones), and 65% die of their disease, usually within 4 years of diagnosis. Determination of tumor ploidy has no prognostic significance. The presence of distant metastasis was the only clinicopathologic feature that was statistically associated with prognosis (p = 0.02); all patients with systemic metastasis died of disease.
Assuntos
Adenocarcinoma/patologia , Neoplasias Parotídeas/patologia , Neoplasias da Glândula Submandibular/patologia , Adenocarcinoma/genética , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneuploidia , DNA de Neoplasias/análise , DNA de Neoplasias/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice Mitótico , Neoplasias Parotídeas/genética , Prognóstico , Razão de Masculinidade , Neoplasias da Glândula Submandibular/genéticaRESUMO
Salivary duct carcinoma is an infrequent highly aggressive salivary gland tumor that is histologically similar to ductal carcinoma of the breast. We studied 13 cases by immunohistochemistry for the presence of estrogen and progesterone receptors, cathepsin D, and c-erbB-2 protein to determine whether the similarity to breast carcinoma extended beyond the light microscope to the molecular level and, if so, whether these markers might have therapeutic or prognostic value. Twelve of 13 cases contained sufficient amounts of tumor tissue for evaluation. Of these 12 cases, one (8%) was positive for estrogen receptors, none was positive for progesterone receptors, five (42%) were positive for cathepsin D, and three (25%) were positive for c-erbB-2 protein. Expression of cathepsin D and c-erbB-2 protein does not appear to have prognostic significance in salivary duct carcinoma. The 8% incidence of immunopositivity for estrogen receptors and absence of progesterone receptors in salivary duct carcinoma is considerably less than that seen in breast cancer. Nevertheless, because the occurrence of systemic metastasis in salivary duct carcinoma is such an ominous development largely unresponsive to chemotherapy, antihormonal therapy, such as used in breast cancer, might be considered on a trial basis for those tumors that are estrogen receptor-positive when conventional therapeutic modalities fail.
Assuntos
Adenocarcinoma/química , Neoplasias Parotídeas/química , Neoplasias da Glândula Submandibular/química , Idoso , Idoso de 80 Anos ou mais , Catepsina D/análise , Feminino , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Proteínas Oncogênicas Virais/análise , Receptor ErbB-2 , Receptores de Estrogênio/análise , Receptores de Progesterona/análiseRESUMO
This paper describes the pathobiology of some of the more common skull base tumors. In addition to clinicopathologic features, emphasis is placed upon methods of diagnosis utilizing immunoperoxidase stains and molecular markers that may or may not impact upon prognosis.
Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Cranianas , Adenoma/epidemiologia , Adenoma/metabolismo , Adenoma/patologia , Adolescente , Adulto , Angiofibroma/epidemiologia , Angiofibroma/metabolismo , Angiofibroma/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Condrossarcoma/epidemiologia , Condrossarcoma/metabolismo , Condrossarcoma/patologia , Cordoma/epidemiologia , Cordoma/patologia , Cordoma/terapia , Estesioneuroblastoma Olfatório/epidemiologia , Estesioneuroblastoma Olfatório/metabolismo , Estesioneuroblastoma Olfatório/patologia , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/metabolismo , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/patologia , Meningioma/epidemiologia , Meningioma/metabolismo , Meningioma/patologia , Pessoa de Meia-Idade , Cavidade Nasal , Neoplasias Nasofaríngeas/epidemiologia , Neoplasias Nasofaríngeas/metabolismo , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasais/epidemiologia , Neoplasias Nasais/metabolismo , Neoplasias Nasais/patologia , Paraganglioma/epidemiologia , Paraganglioma/metabolismo , Paraganglioma/patologia , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologia , Neoplasias Cranianas/epidemiologia , Neoplasias Cranianas/metabolismo , Neoplasias Cranianas/patologia , Neoplasias de Tecidos Moles/epidemiologiaRESUMO
The clinical diagnosis of laryngoceles simultaneously occurring with squamous cell carcinoma of the larynx is infrequent; however, when specimens from patients with laryngeal cancer have been examined closely, the two entities have been associated in 4.9% to 28.8% of cases. Despite this apparent relationship, the literature has failed to address the potential impact of a concurrent laryngocele on surgical decision making. Also, the wide variation in the reported rates of simultaneous occurrence of these two entities is unexplained. We performed whole-organ histopathologic analysis on a laryngeal specimen with bilateral external laryngoceles associated with squamous cell carcinoma and correlated this to computed tomography findings. Based on this information and other reports concerning the pattern of spread of carcinoma within laryngoceles, it appears that supraglottic laryngectomy is oncologically sound in the presence of a laryngocele as long as the usual criteria for this procedure are met.
Assuntos
Carcinoma de Células Escamosas/complicações , Doenças da Laringe/complicações , Neoplasias Laríngeas/complicações , Idoso , Carcinoma de Células Escamosas/patologia , Dilatação Patológica , Feminino , Humanos , Cartilagens Laríngeas/patologia , Doenças da Laringe/patologia , Neoplasias Laríngeas/patologia , Prega Vocal/patologiaRESUMO
The clinicopathologic features of two cases of paragangliomas of the larynx are presented along with immunohistochemical, ultrastructural and DNA image analysis. The world literature is also critically reviewed in order to develop a more accurate clinicopathologic profile of the tumor. The results indicate that paragangliomas of the larynx occur in patients averaging 47 years of age and are 3 times more common in women. Most (82%) arise from the supraglottic larynx and manifest clinically as hoarseness. They are typically benign and rarely functional. Almost all alleged malignant paragangliomas of the larynx are in reality atypical carcinoids that have been misdiagnosed. Features that distinguish paragangliomas from other similar tumors are discussed.
Assuntos
Neoplasias Laríngeas , Paraganglioma , Adulto , Feminino , Humanos , Neoplasias Laríngeas/epidemiologia , Neoplasias Laríngeas/patologia , Laringe/patologia , Masculino , Pessoa de Meia-Idade , Paraganglioma/epidemiologia , Paraganglioma/patologiaRESUMO
Extramedullary plasmacytoma is a malignant plasma cell dyscrasia that is most commonly found in the head and neck. Progression to disseminated disease in the form of multiple myeloma occurs in 17% to 32% of cases. Herein, we describe a patient with extramedullary plasmacytoma of the thyroid gland in whom a serum monoclonal gammopathy resolved with surgery and irradiation of the primary. Although rare, this diagnosis should be considered in patients presenting with obstructive thyromegaly and autoimmune thyroiditis.
Assuntos
Paraproteinemias/etiologia , Plasmocitoma/complicações , Neoplasias da Glândula Tireoide/complicações , Idoso , Terapia Combinada , Feminino , Humanos , Plasmocitoma/diagnóstico , Plasmocitoma/patologia , Plasmocitoma/terapia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapiaRESUMO
This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the anterior tongue and floor of mouth.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Bucais/patologia , Neoplasias da Língua/patologia , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/secundário , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Soalho Bucal , Neoplasias Bucais/mortalidade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Células Neoplásicas Circulantes , Prognóstico , Estudos Retrospectivos , Neoplasias da Língua/mortalidadeRESUMO
The monoclonal antibody OKT3 was previously shown to be superior to conventional high-dose steroid therapy for reversal of acute rejection of renal allografts. Furthermore, OKT3 was effective in reversing acute renal or hepatic allograft rejection that was resistant to treatment with steroids, anti-thymocyte globulin, or both. Our analysis demonstrates that OKT3 is also effective in pediatric patients in reversing acute rejection of renal allografts (rescue treatment) or hepatic allografts (primary or rescue treatment).
Assuntos
Anticorpos Monoclonais/uso terapêutico , Facilitação Imunológica de Enxerto , Transplante de Rim , Transplante de Fígado , Depleção Linfocítica , Adolescente , Criança , Pré-Escolar , Estudos de Avaliação como Assunto , Feminino , Rejeição de Enxerto , Humanos , Terapia de Imunossupressão , Masculino , Linfócitos T/imunologiaRESUMO
64 healthy infants, 2-3 months old, were randomly assigned to one of three vaccination groups which either diphtheria-pertussis-tetanus (DPT) vaccine, Haemophilus influenzae type b capsular polysaccharide polyribosyl-ribitol phosphate (PRP) vaccine, or PRP+P (with pertussis adjuvant) vaccine in three doses at intervals of two months. Local and systemic reactions occurred most frequently after DPT vaccination and least frequently for PRP alone. Data for 60 infants from whom complete sera sets were available indicated that 70 percent of the infants who received three doses of PRP+P showed two fold or greater increases in titers of antibody to PRP with final values above the level assumed to give protection against invasive H. influenzae type b disease (>0.15 ug/ml). In contrast, less than 10 percent of infants who received PRP vaccine alone showed 2-fold or greater increases (Summary)