Jose L. Mira

Thyroid transcription factor-1 and cytokeratins 7 and 20 in pulmonary and breast carcinoma.

OBJECTIVE To evaluate the immunohistochemical expression of a lung epithelial gene transcription factor, thyroid transcription factor-1 (TTF-1), in lung and breast carcinoma in pulmonary cytologic preparations and to correlate the results with the expression of cytokeratin 7 (CK7) and 20 (CK20). STUDY DESIGN Cell blocks of cytologic specimens were immunostained with antibodies to TTF-1, CK7 and CK20. Specimens included 41 primary lung carcinomas (21 adenocarcinomas, 8 squamous cell carcinomas and 12 small cell undifferentiated carcinomas) and 6 metastatic breast adenocarcinomas. RESULTS The lung adenocarcinomas showed nuclear reactivity for TTF-1 in 76% (16/21) of the cases and a staining combination of CK7+/CK20- in 95% (20/21) of the cases. Only one case was CK7+/CK20+. All the breast carcinomas were nonreactive to TTF-1, and all were CK7+/CK20-. The squamous cell carcinomas and small cell undifferentiated carcinomas showed TTF-1 positivity in 38% (3/8) and 83% (10/12), respectively.

Primary gastric choriocarcinoma: a case report and review of the literature.

Choriocarcinoma is a rapidly invasive, widely metastatic human chorionic gonadotropin (HCG)-producing neoplasm, usually intrauterine and gestational. Primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. We report a case of primary gastric choriocarcinoma associated with adenocarcinoma in a 36-year-old woman. The patient presented with gastrointestinal bleeding and a gastric mass clinically suspicious of gastric adenocarcinoma. Histopathologic evaluation proved the tumor to be a choriocarcinoma, with a minor component of a poorly differentiated adenocarcinoma. The patient was treated with a standard nongestational choriocarcinoma chemotherapy regimen. An impressive initial response was evidenced by clinical reduction of the tumor volume and drop of the serum beta-HCG levels after the first cycle. However, the tumor rapidly recurred in the abdomen and disseminated to the lungs, which were documented by new elevation of serum beta-HCG levels and computed tomographic scans despite continuing with 3 more cycles of chemotherapy. The patient died 6 months after diagnosis.

Metastatic female adnexal tumor of probable wolffian origin : A case report and review of the literature

Female adnexal tumor of probable wolffian origin is a rare neoplasm that can present diagnostic difficulties. We report herein a case of a 60-year-old woman with female adnexal tumor of probable wolffian origin arising within the leaves of a broad ligament and, 5 years later, presenting with metastasis to the liver. The morphologic, immunohistochemical, ultrastructural, and DNA ploidy findings of the original and metastatic tumor, differential diagnoses, and the results of the English-language literature review are presented.

Leiomyoma of the Male Urethra A Case Report and Review of the Literature

We describe the case of a 48-year-old quadriplegic black man with history of C4-C5 cervical spine and cord injury secondary to a fall, who presented to the University of Cincinnati Medical Center Urology Service with obstructive symptoms at urination. A bulbous urethral stricture was diagnosed and subsequently resected with primary urethral reanastomosis. On pathologic examination, the surgical specimen contained an epithelioid leiomyoma at the site of the urethral stricture. Although leiomyomas of the female urethra are relatively common, we identified only 2 previously reported cases of leiomyomas of the male urethra in the English-language medical literature. To the best of our knowledge, we describe the third case of leiomyoma of the male urethra, the first of the epithelioid type.

Ceruminous gland adenoid cystic carcinoma with contralateral metastasis to the brain.

We present the case of a 38-year-old man with an adenoid cystic carcinoma originating from the ceruminous glands of the external ear canal. The patient subsequently presented with a contralateral brain mass that was also diagnosed as adenoid cystic carcinoma. To our knowledge, contralateral metastasis to the brain of a patient with an adenoid cystic carcinoma of the ceruminous glands has not been reported previously. This rare neoplasm should be considered in the differential diagnosis of poorly differentiated carcinomas metastatic to the central nervous system in patients with occult malignant neoplasms.

Concomitant well-differentiated adenocarcinoma and leiomyosarcoma of the uterus.

We describe a case of a concomitant well-differentiated endometrial endometrioid adenocarcinoma and leiomyosarcoma of the uterus in a 66-year-old woman who presented with a 6-month history of vaginal bleeding. The patient underwent total hysterectomy for endometrial carcinoma diagnosed by endometrial biopsy. Gross examination of the specimen revealed an endometrial mass bulging into the endometrial cavity and an underlying well-circumscribed nodule separated from the endometrial mass by a myometrial band. Frozen section performed at the time of the total hysterectomy rendered a diagnosis of malignant mixed-müllerian tumor. Histologic examination of the permanent sections revealed well-differentiated endometrial endometrioid adenocarcinoma clearly separated from a high-grade leiomyosarcoma. Differential diagnosis included malignant mixed-müllerian tumor. However, no admixture of carcinomatous and sarcomatous elements was present. There were no heterologous elements. To the best of our knowledge, no similar case has been described in the English literature.

Multilobated large B-cell lymphoma diagnosed cytologically. A case report.

BACKGROUND Fine needle aspiration (FNA) biopsy can be used to reliably classify most conditions involving lymph nodes or, at least, significantly reduce the differential diagnosis. CASE A 70-year-old male presented with an ulcerated mass arising from the left tonsillar fossa and involving the anterior and posterior pillars. A biopsy of the tonsillar mass performed at an outside hospital was interpreted as a large cell undifferentiated carcinoma. Subsequently the patient developed systemic lymphadenopathy. A bone scan showed intense uptake within the medial tibial plateau of the left knee. FNA biopsy of the right axillary mass was interpreted at University of Cincinnati Medical College as a large cell lymphoma, multilobated type. Histologic and immunohistochemical studies of the lymph node confirmed the presence of multilobated B-cell lymphoma. Lymphoma chemotherapy was initially successful but was discontinued due to toxicity. The patient died two months after the initial cytologic diagnosis of lymphoma. CONCLUSION Multilobated lymphomas are an unusual variant of non-Hodgkins lymphomas (mostly B-cell type). Cytology and immunocytochemistry are useful diagnostic procedures that can help to diagnose this relatively uncommon type of lymphoma and significantly reduce the possibility of misdiagnosis.