Bozo Kruslin

A Giant Hemorrhagic Adrenal Pseudocyst

Objective: To report a rare case of a giant hemorrhagic adrenal pseudocyst and highlight the importance of this entity to clinicians. Case Presentation: A 57-year-old woman presented with a 1-year history of abdominal pain and distension. Ultrasonography and multislice computed tomography revealed a giant cystic (partially solid) mass over the left suprarenal region measuring 20 × 17 × 15 cm. A complete endocrine workup failed to detect any hormonal hypersecretion. Intervention: The patient was treated with tumor excision through transabdominal pararectal approach. Histopathological examination revealed a hemorrhagic adrenal pseudocyst. Conclusion: To our knowledge the case presented here appears to be one of the largest hemorrhagic adrenal pseudocysts reported so far. Radiological and clinical features of the tumor are nonspecific and histopathological examination is essential to establish definitive diagnosis. An open, laparotomic adrenalectomy is the preferred surgical technique for better control of such a large mass with active bleeding inside.

Periacinar clefting and p63 immunostaining in prostatic intraepithelial neoplasia and prostatic carcinoma

The aim of the present study was to correlate the presence and extent of retraction clefting and the expression of p63 in neoplastic glands and glands with prostatic intraepithelial neoplasia (PIN) in needle core biopsies. We analyzed needle core biopsies from 28 patients with PIN and 41 patients with adenocarcinoma. Neoplastic glands and those with PIN were analyzed on high power field (400x) and classified in three groups according to the extent of clefting. Immunohistochemical staining was performed following Microwave Streptavidin ImmunoPeroxidase (MSIP) protocol on DAKO TechMate Horizon automated immunostainer. Periacinar retraction clefting was significantly more prominent in prostatic carcinoma compared to PIN (p<0.0001) and non-neoplastic glands (p<0.0001). There was no difference between normal glands and PIN regarding clefting (p=0.8064). p63 was positive around the whole circumference in 12 out of 28 cases with PIN, and discontinuously positive in remaining 16 PIN cases suggesting initial disruption of the basal cell layer. p63 immunostaining was also positive in all nonneoplastic glands, and negative in all carcinomas. We conclude that retraction clefting was associated with cancer and lack of basal cells, but not with PIN. The relationship between clefting and p63 immunostaining in prostatic cancer should be further analyzed.

CD138-positive plasmacytoid urothelial carcinoma of urinary bladder with focal micropapillary features

Both the plasmacytoid and micropapillary types of urothelial carcinoma of the urinary bladder are uncommon, distinct clinical and pathological findings. To date, several reports in the English medical literature have been published on either of these variants. CD138 is commonly used as a marker for tumors of plasma cell origin. However, few authors have described positive immunoreactivity of plasmacytoid cells in urothelial carcinoma. Mixed histological differentiation is thought to be a phenotype of locally aggressive and advanced urothelial carcinoma. Therefore, a precise histopathological diagnosis should be made and awareness of all the entities is crucial. We report a case of CD138-positive plasmacytoid urothelial carcinoma of the bladder with focal micropapillary features. To our knowledge this is the first case of these two rare subtypes of urothelial carcinoma combined in a single cystectomy specimen.

C-reactive protein, not cardiac troponin T, improves risk prediction in hypertensives with type A aortic dissection

Abstract Background: The aim of the study was to evaluate prognostic role of inflammatory biomarkers, cardiac troponin T (cTnT) and D-dimer in type A acute aortic dissection (AAD) and to examine whether they might help in risk stratification beyond values of International Registry of Acute Aortic Dissection (IRAD) score. Methods: Baseline biomarkers were determined in 54 consecutive predominantly hypertensive patients with type A AAD and evaluated for in-hospital mortality. Results: After multivariable adjustment, the independent predictors of outcome were age (OR = 1.09; 95% CI 1.02–1.18), treatment strategy (OR = 0.11; 95% CI 0.02–0.06) and C-reactive protein (CRP) either as binary (OR = 7.06; 95% CI 1.34–37.36) or continuous variable (OR = 1.10; 95% CI 1.01–1.21). cTnT did not independently influence mortality. Receiver- operating characteristic (ROC) curve analysis showed significant link between CRP and outcome (area under the ROC curve, AUC = 0.79; p < 0.01). Values of CRP > 9.8 mg/l had 83% sensitivity and 80% specificity for predicting in-hospital mortality. Addition of CRP to IRAD score improved prediction of short-term outcome, AUC increased from 0.74 to 0.89 (p = 0.004). Conclusion: Admission CRP has independent prognostic value in type A AAD and the addition of CRP to IRAD score improved discriminative capacity of in-hospital mortality irrespective of symptom duration and treatment strategy.

Carcinosarcoma de novo of the parotid gland with unusual sarcomatous component

da paro-tida, o qual continha adenocarcinoma e sarcoma de ductos salivares que se assemelhava ao histiocitoma fibroso malig-no (HFM). Ate onde sabemos, existe somente um relato na literatura em que o HFM foi descrito como um componente do carcinossarcoma de glândula salivar, estando associado ao carcinoma espinocelular.