Chin-Chen Pan

Immunohistochemical and molecular genetic profiling of acquired cystic disease-associated renal cell carcinoma.

Aims:  Acquired cystic disease‐associated renal cell carcinoma (ACD‐associated RCC) is a unique neoplasm that specifically develops in the background of acquired cystic disease of the kidney. The aim was to analyse nine ACD‐associated RCCs from three patients to determine their immunohistochemical and molecular characteristics using immunohistochemistry, comparative genomic hybridization (CGH) and fluorescence in situ hybridization (FISH).

Primary synovial sarcoma of the prostate.

Department of Functional and Applied Anatomy and Department of Legal Medicine, Medical School of Hannover, and Department of Thoracic Surgery, Heidehaus, Klinikum Hannover, Hannover, Germany 1. Tschernig T, Debertin AS, Paulsen F et al. Dendritic cells in the mucosa of the human trachea are not regularly found in the first year of life. Thorax 2001; 56; 427–431. 2. Delsol G, Chittal S, Brousset P et al. Immunohistochemical demonstration of leukocyte differentiation antigens on paraffin sections using a modified Amex (Modamex) method. Histopathology 1989; 15; 461–471. 3. Archimandritis A, Sougioultzis S, Foukas PG et al. Expression of HLA-DR, costimulatory molecules B7-1, B7-2, intercellular adhesion molecule-1 (ICAM-1) and Fas ligand (FasL) on gastric epithelial cells in Helicobacter pylori gastritis; influence of H. pylori eradication. Clin. Exp. Immunol. 2000; 119; 464–471. 4. Komar DA. Decay rates in a cold climate region: a review of cases involving advanced decomposition from the Medical Examiner’s office in Edmonton, Alberta. J. Forensic Sci. 1998; 43; 57–61. 5. Turcotte H, Laviolette M, Boutet M et al. Variability of inflammatory cell counts on bronchial biopsies of normal subjects. Lung 2003; 181; 9–21. 6. Jahnsen FL, Moloney ED, Hogan T et al. Rapid dendritic cell recruitment to the bronchial mucosa of patients with atopic asthma in response to local allergen challenge. Thorax 2001; 56; 823–826.

Constructing prognostic model incorporating the 2004 WHO/ISUP classification for patients with non-muscle-invasive urothelial tumours of the urinary bladder

Aim To construct a prognostic model for recurrence-free survival (RFS), progression-free survival (PFS) and cancer-specific survival (CSS) for patients who have undergone transurethral resection of non-muscle-invasive (pTa/pT1) urinary bladder urothelial tumours. Methods 1366 patients who had undergone transurethral resection of primary non-muscle-invasive urothelial tumours (pTa, 891 patients; pT1, 475 patients) confined to the bladder were retrospectively studied. Tumours were classified according to the 2004 WHO/International Society of Urologic Pathology grading system. Kaplan–Meier and stepwise Cox regression models were applied, and 200 bootstrap resamples were used to generate survival estimates and 95% CIs. A nomogram was developed that incorporated significant variables predicting survival. Results RFS, PFS and CSS probabilities for non-muscle-invasive bladder urothelial tumours were calculated. Incorporating salient prognostic factors (tumour grade, pT stage, patient age, status of intravesical instillation), the model satisfactorily predicted PFS (concordance index=0.79) and CSS (concordance index=0.87). Conclusions Robust nomograms were created to predict PFS and CSS. These data provide an overall perspective of disease outcomes which may aid in developing individualised follow-up programmes.

Pheochromocytoma and Adrenocortical Adenoma in the Same Gland

A right adrenal tumor was found incidentally during abdominal computed tomography exam in a 51-year-old female patient, who had had diabetes and hypertension for more than 10 years. The computed tomography scan was arranged for possible pancreatic lesion by a neurologist. Norepinephrine level was high in the plasma and urine. Vanillylmandelic acid level was elevated in the urine. Diurnal cortisol rhythm, plasma adrenocorticotropic hormone and urine free cortisol were all normal,but the plasma cortisol concentration could not be suppressed after a standard low-dose dexamethasone suppression test. Therefore, adrenal cortical adenoma with subclinical Cushings syndrome was highly suspected; however, further imaging studies, including magnetic resonance image and 131I-6beta-iodomethylnorcholesterol adrenal scintigraphy failed to discriminate an additional tumor. After right adrenalectomy, a small adrenal cortical adenoma and a large pheochromocytoma were noted. This is an extremely rare case of an adrenal incidentaloma consisting of both medullary and cortical tumors in the same gland.

CA125-producing Clear Cell Adenocarcinoma Arising From the Upper Ureter and Renal Pelvis

Clear cell adenocarcinomas similar to those found in the female genital organs can arise in the lower urinary tract of both women and men. Clear cell adenocarcinomas occurring in the upper urinary system are exceedingly rare. Here, we present a case of clear cell adenocarcinoma arising from the upper ureter and renal pelvis of a postmenopausal woman with a ureteral stone. The patient had elevated serum levels of cancer antigen (CA) 125 (103.80 U/mL) and CA19-9 (151.96 U/mL). The tumor showed typical features of tubulopapillary structures lined with clear-to-eosinophilic cytoplasm and frequent hobnail configuration. The tumor cells were immunoreactive for cytokeratin 7, cytokeratin 20, carcinoembryonic antigen and CA125, but negative for PAX-2 and alpha-methylacyl coenzyme A racemase. Given the presence of intestinal and squamous metaplasia of the adjacent urothelium, we propose that this clear cell adenocarcinoma developed through a metaplastic process. The tumor behaved so aggressively that the patient developed multiple metastases and died of the disease 5 months after radical nephroureterectomy.

Malignant Ganglioneuroma Arising from Mediastinal Mixed Germ Cell Tumor

Mixed germ cell tumors with non-germ cell malignant components rarely occur in the anterior mediastinum. We report a case of a 34-year-old man who presented with an anterior mediastinum mass. Mixed germ cell tumor was initially diagnosed based on the pathologic findings of germinoma on thoracoscopic biopsy and clinical findings of elevated serum alpha-fetoprotein and beta-human chorionic gonadotropin. The patient received preoperative chemotherapy and subsequent complete resection of the residual tumor. Pathologic examination of the excised specimen showed predominantly malignant ganglioneuroma and small residual foci of teratoma. To our knowledge, this is the first reported case of a malignant ganglioneuroma arising from mediastinal mixed germ cell tumor.

Sonographic Features of Primary Testicular Granulocytic Sarcoma

Granulocytic sarcoma or chloroma is a mass composed of immature myeloid cells of the granulocytic series. It infiltrates an extramedullary site and appears as a localized tumor mass. It has been reported in association with acute myeloid leukemia (AML), chronic leukemia, and other myeloproliferative and myelodysplastic disorders. Rarely, granulocytic sarcoma may be found in patients without hematologic evidence of leukemia, presenting a diagnostic challenge, as in the case we report here. To the best of our knowledge, there has been no previous report on the sonographic features of granulocytic sarcoma involving the testicle.

Nephrogenic adenoma arising in a renal cortical cyst.

Nephrogenic adenoma is an unusual lesion of the urinary tract first described by Davis in 1949 as a hamartoma. In 1950, Friedman and Kuhlenbeck subsequently characterized the lesion in more detail and named it nephrogenic adenoma. It appears to be a metaplastic response of the urothelium elicited by trauma and chronic irritation and is considered to be benign. A MEDLINE search of the literature from 1960 to the present revealed no previous documentation of a nephrogenic adenoma arising from a renal cortical cyst. Herein, we present such a case arising in a renal cortical cyst.