Ayman Gaafar

Prostatic remnants in mature cystic teratoma of the ovary

Mature cystic teratomas of the ovary containing prostatic remnants are reported in 2 women aged 31 and 20 years. Both cases showed the expected histology of mature teratomas with a mixture of ecto- and endodermal structures lying in a fibrous stroma. In both cases, the foci of prostate tissue were composed of typical prostatic glands arranged in acinar structures. One case displayed a transitional cell-lined duct resembling the urethra. Prostate glands showed intense positive immunostaining with prostatic specific antigen and prostatic acidic phosphatase. Focal images suggesting high-grade prostatic intraepithelial neoplasia were detected in 1 case. The literature on this unusual finding in these common tumors is reviewed and commented on.

Renal mucinous and tubular spindle cell carcinoma: a clinicopathological study of 4 cases.

The clinical and histological findings of four cases of renal mucinous tubular and spindle cell carcinoma (MTSCC) are reported. Two cases were incidentally discovered during the radiological study of other diseases, and the other two presented with haematuria. Radical nephrectomy was done in the four cases. All the tumours showed the typical histology and immunohistochemistry described in this newly recognised entity. The patients remain free of disease after 3, 8, 10 and 48 months of follow up. The literature related to the diagnosis of this tumour is thor oughly reviewed. Also, the proposed histopathogenetic theories for this tumour are also briefly commented on. The new 2004 WHO classification system of renal tumours is based on morphologic criteria and supported by common genetic findings. 12 Among other rare entities, it includes a variant of renal carcinoma termed mucinous tubular and spindle cell carcinoma (MTSCC). This tumour type had been previously diagnosed as papillary renal carcinoma, metanephric adenoma, unclassified or sarcomatoid carcinoma, 5,8,11,13 and seems to portend a favourable clinical outcome. We report the clinicopathological findings of four additional cases of this rare newly recognised tumour, highlighting its varied histological patterns and differential diagnosis. The cases were col lected retrospectively from consultation of our archive in the last 3 years.

Middle-ear carcinoid tumor with distant metastasis and fatal outcome

Hematol Oncol Stem Cell Ther 1(1) January 2008 hemoncstem.edmgr.com 53 The term carcinoid, karzinoid (carcinomaslike), was first mentioned in the literature in 1907 by Oberndorfer.1 Since its recognition as a distinct entity it has been quite a controversial tumor, especially with respect to its biological behavior. In fact, although traditionally considered a benign neoplasm, distant metastases and tumorsrelated deaths were very soon sporadically recorded.1 Carcinoids are exceedingly rare neoplasms in the middle ear2 and are usually referred to as adenoma/ carcinoid tumors because they are considered benign glandsforming neoplasms with an overt tendency to des velop neuroendocrine and mucinous differentiations.3,4 Most literature reviews and textbooks on pathology highlight the benign clinical course of this entity. Some authors, however, have reported in recent years both los cal recurrences and extracranial lymph node metastases in the neck.5s8 Interestingly, no visceral metastases have been reported so far.9 The case reported here represents a unique example of middle ear carcinoid with regional lymph node and liver metastasis that led to the patient’s death after 11 years of follow up.

Sclerosing mucoepidermoid carcinoma of the thyroid gland: cytohistological findings of a case

Hematol Oncol Stem Cell Ther 1(1) January 2008 hemoncstem.edmgr.com 62 Mucoepidermoid carcinoma is an extremely rare thyroid neoplasm with only a handful of cases reported so far.3,4,23,25,26 Although it has been considered a lowsgrade carcinoma, rare highsgrade cases have also been described.4,25 A sclerosing variant of thyroid mucoepidermoid carcinoma associated with eosinophilia (SMEC) has also been reported.1s3,7s9,11,19s22 Overall, the histogenesis of mucoepidermoid carcinos mas in the thyroid is unclear and remains under debate. Authors hypothesize whether they originate from solid cell nests, the ultimobranchial body remnants, or from follicular cells. The first option is favored by most,3,11,13,20 based upon the histological and immunohistochemical similarities between these neoplasms and ultimobrans chial body remnants. The cytological and histological features of a new case of SMEC diagnosed on core bis opsy (CB) and treated with radical surgery are reported here. The tumor showed the expected mucoepidermoid histology, but showed intense atypia, prominent inflams matory infiltrate and extensive desmoplasia. To the best of our knowledge, there are very few reports describing the cytological findings of this entity.5,11

Carcinoma verrucoso del pene. Estudio anatomopatológico de 2 casos

SUMMARY Introduction: Penile carcinoma is a rare tumour, repre- senting about 1% of all male tumours. The verrucous subty- pe is quite infrequent, displays specific prognostic implica- tions and needs very strict criteria for its diagnosis. Patients, methods and results: Two cases of this entity in patients of 85 and 77 years-old are reported. Partial penec- tomy was performed in both cases. Conclusions: Pathologi- cal features and differential diagnosis of this entity are reviewed. The strict application of histological criteria is very important to perform an adequate diagnosis and prog- nosis.

La médula renal normal y patológica

Resumen Antecedentes La medula renal constituye un intrincado sistema de tubulos, vasos sanguineos e intersticio poco conocido por la mayor parte de los patologos generales. Metodos Amplia revision de la literatura sobre la medula renal y de archivo de toda su patologia. Resultados Se pormenorizan datos de interes para el patologo sobre el desarrollo normal y patologico, la anatomia microscopica, histologia e inmunohistoquimica, la fisiologia, la patologia de la diferenciacion medular (displasia renal multiquistica, enfermedades poliquisticas renales autosomicas dominante y recesiva, enfermedad quistica medular) la patologia inflamatoria (pielonefritis xantogranulomatosa, malacoplaquia), las displasias, y las neoplasias (oncocitoma, tumor oncocitico atipico, carcinoma renal de celulas cromofobas, carcinoma de los tubulos colectores, carcinoma urotelial, otros carcinomas, fibroma renomedular y tumores metastaticos) de esta topografia. Conclusiones El conocimiento compendiado de la genesis, del funcionamiento y de la patologia medular renal, tanto del desarrollo, como inflamatoria y neoplasica, redundara en un mayor interes por esta zona del rinon que habitualmente pasa desapercibida para el patologo asistencial.

El adenocarcinoma de próstata en los años 1999 y 2006. Diferencias en el estudio comparativo de biopsias transrectales y de prostatectomías radicales

SUMMARY Background: The increase in number of prostate cancer diagnoses in the last decade is accompanied by a similar increase in the number of radical prostatectomy specimens. We analyse the histological differences between patients treated with radical surgery in 1999 and in 2006. The evolution in the indications for surgery is also evaluated. Methods: Histological data in core biopsies and radical prostatectomies of cases diagnosed in 1999 and 2006 have been compared. Only cases with complete histological information have been included in the study. Bi/unilateral tumour invasion, number of tumour foci, total millimetres of cancer, high-grade PIN, Gleason index, and perineurial invasion have been evaluated in core biopsies. Pathological staging, Gleason index, high-grade PIN, margin status, apex invasion, perineurial and vascular permeation, extraprostatic extension and seminal vesicle invasion have been analysed in radical prostatectomies. The statistical study included χ2 , Student’s t, and Mann-Whitney test. Results: The study includes 24 radical prostatectomies in 1999 and 50 in 2006. The pathological staging is significantly lower in 2006 than in 1999 (p=0.032). Similarly, organ-confined disease is more frequent in 2006 (p=0.034). Extraprostatic extension and seminal vesicle invasion by prostate adenocarcinoma are significantly lower in 2006 (p=0.090 y p=0.011, respectively). Conclusions: Prostate adenocarcinoma patients treated with radical surgery in 2006 are at a lower stage compared with 1999 cases.

Adenocarcinomas renales sincrónicos, de células claras y de células cromófobas

Resumen Caso clinico Se presenta el caso de un paciente de 78 anos de edad al que se descubren dos neoplasias epiteliales independientes y sincronicas en el mismo rinon El tumor dominante, el que llevo al paciente al medico y por el cual se realizo la nefrectomia corresponde a un carcinoma de celulas claras tipico. El tumor secundario, localizado a 4 cm. del tumor principal, fue detectado en el estudio macroscopico de la pieza quirurgica y corresponde a un carcinoma de celulas cromofobas. El patron de inmunohistoquimica es el caracteristico y esperado en cada tumor, y confirma la especificidad de cada uno de ellos. Discusion Se revisa y se discute la literatura actual relacionada con la coexistencia de diversos tumores de la misma o de distinta estirpe histologica en el rinon.

Parámetros histológicos predictivos de la invasión de las vesículas seminales en el cáncer de próstata

Resumen Antecedentes La invasion de las vesiculas seminales es un dato histologico de mal pronostico en el cancer de prostata. En la mayor parte de los casos es un hallazgo accidental ya que los pacientes con signos clinicos o histologicos de enfermedad extraprostatica no se tratan mediante cirugia en la mayor parte de protocolos al uso. Nuestra intencion es cuantificar este hallazgo histologico en una serie homogenea de prostatectomias radicales y correlacionarlo con los hallazgos en las biopsias previas. Metodos Durante un periodo de 8 anos (1998-2005), 363 pacientes con cancer de prostata fueron tratados mediante prostatectomia radical en el Hospital de Basurto. Los pacientes fueron seleccionados para la cirugia en funcion de la combinacion de la estadificacion clinica, niveles de PSA serico y datos obtenidos de la biopsia previa. Los datos obtenidos en las prostatectomias se correlacionaron (rho de Spearman) con varios hallazgos histologicos procedentes de las biopsias. Resultados Se detecto invasion seminal en 37 pacientes (10,2%). La invasion microscopica de las vesiculas seminales se correlaciono con los milimetros totales de cancer (media 20 mm, ρ=0,397), con el numero de focos de tumor (media 3,8, ρ=0,383), con la invasion de ambos lados prostaticos (ρ=0,256), con el indice de Gleason >7 (ρ=0,306), con la invasion perineural (ρ=0,318), y con el PIN de alto grado (ρ=0,142) en las biopsias, y con el indice de Gleason >7 (ρ=0,357), con el PIN de alto grado (ρ=0,211), con la extension extraprostatica (ρ=0,480), y con la invasion de margenes quirurgicos (ρ=0,287), invasion perineural (ρ=0,847), y afectacion del apex (ρ=0,307), en las prostatectomias. Conclusiones La invasion de las vesiculas seminales es un hallazgo frecuente en las piezas de prostatectomia radical, incluso despues de una seleccion correcta de pacientes para cirugia. Este hallazgo histologico se correlaciona con parametros de volumen tumoral, con la invasion bilateral, y con otros parametros de mal pronostico en el cancer de prostata.

Carcinoma basaloide escamoso del pene. Presentación de un caso

SUMMARY Introduction: Penis malignant epithelial tumors are very infrequent in developed countries. Basaloid squamous cell carcinoma is one of the most infrequent and aggressive varieties of penile carcinomas. Patients and methods: A case of basaloid squamous cell carcinoma of the penis in a 75 year old man is reported. Results: Main histological fea- tures of this rare and aggressive subtype of penile carcino- ma are: tumor nests composed of basal-type cells with hyperchromatic nuclei and scanty cytoplasms presenting peripheral palisading centered by squamous cells with evi- dent keratinization. Discussion and conclusions: Current literature is reviewed ad commented putting special empha- sis on the possible relationship with human papillomavirus (HPV) type 16 infection.