Cystic Carcinoma Research Articles

Thyroglossal duct cyst carcinoma

Thyroglossal duct cyst carcinoma in a rare condition. Only around 250 cases of malignant thyroglossal cyst have been reported as far. We report a 45 years old women presenting with a painless swelling in the midline in the upper part of front of neck for 1 yr. This swelling moves with deglutition, multilobulated moves up on protrusion of tongue. FNAC revealed cystic lesion compatible with thyroglossal duct cyst. Ultrasonogram revealed mass is separated from thyroid gland. Patient underwent sistnmk's operation and tissue was sent for histopathological examination and report reveled papillary carcinoma of thyroglossal duct cyst.

Branchial Cleft Cyst Carcinoma: A Case Report

: Branchial cleft cyst carcinoma (BCCC) is an extremely rare malignancy originating from cells within the branchial cleft cyst wall. A 73-year-old man presented with a cystic mass with cellulitis mimicking abscess initially and recurred 3 years later as complex cystic lesion in right neck level II with multiple necrotic ipsilateral lymphadenopathy. The pathological diagnosis of cystic lesion was squamous cell carcinoma, suggesting possibility of originating from branchial cleft cyst. There was no identifiable primary cancer elsewhere by a thorough evaluation; eventually final diagnosis was branchial cleft cyst carcinoma to meet the modified criteria of Khafif et al. Up to the present time, there has been no evidence of recurrence. Although the BCCC is very rare, accurate diagnosis is important to plan proper treatment for patient. This report should help increase awareness of BCCC, which should be included in the differential diagnosis of a cystic neck mass.

The extent of surgery in thyroglossal cyst carcinoma

The optimal management of thyroglossal cyst carcinoma, particularly the extent of surgery required is controversial. The aim of this study was to evaluate the need for routinely adding total thyroidectomy to Sistrunk's operation in the management of this condition. The clinical records of 19 patients with a diagnosis of thyroglossal cyst carcinoma encountered in an 11-year period (2004-2015) were reviewed. All patients underwent total thyroidectomy in addition to Sistrunk's procedure. The rate of concomitant thyroglossal cyst and thyroid carcinomas was calculated and cancers were staged according to the AJCC-TNM staging system. Patients were divided into two groups: those with thyroglossal cyst carcinoma only (group A) and those with a synchronous or metachronous thyroid carcinoma as well (group B). The need for radioactive iodine ablation in group A was assessed. The ability to omit total thyroidectomy based on thyroglossal cancer size and a negative thyroid ultrasound was also evaluated. The rate of concomitant thyroid cancer was 63.2% (12/19). Based on stage, three out of the seven patients in group A required radioactive iodine ablation. Total thyroidectomy was ultimately justifiable in 78.9% (15/19) of cases. Omitting total thyroidectomy in T1 thyroglossal cyst cancers or based on a sonographically normal thyroid was associated with a 43% risk of missing thyroid malignancy. The routine addition of total thyroidectomy to Sistrunk's procedure seems to be appropriate for comprehensive loco-regional control especially that selecting a subset of patients in which it could be omitted is a difficult task.

Laparoscopic partial nephrectomy for multilocular cystic renal cell carcinoma in the isthmus part of a horseshoe kidney

Laparoscopic partial nephrectomy for multilocular cystic renal cell carcinoma in the isthmus part of a horseshoe kidney

Clinical Scenarios in Chronic Kidney Disease: Kidneys' Structural Changes in End-Stage Renal Disease.

Acquired cystic kidney disease (ACKD) and renal cell carcinoma (RCC) are the most important manifestations of end-stage kidneys' structural changes. ACKD is caused by kidney damage or scarring and it is characterized by the presence of small, multiple cortical and medullary cysts filled with a fluid similar to preurine. ACKD prevalence varies according to predialysis and dialysis age and its pathogenesis is unknown, although it is stated that progressive destruction of renal tissue induces hypertrophy/compensatory hyperplasia of residual nephrons and may trigger the degenerative process. ACKD is almost asymptomatic, but it can lead to several complications (bleeding, rupture, infections, RCC). Ultrasound (US) is the first level imaging technique in ACKD, because of its sensitivity and reliability. The most serious complication of ACKD is RCC, which is stimulated by the same growth factors and proto-oncogenes that lead to the genesis of cysts. Two different histological types of RCC have been identified: (1) RCC associated with ACKD and (2) papillary renal clear cell carcinoma. Tumors in end-stage kidneys are mainly small, multifocal and bilateral, with a papillary structure and a low degree of malignancy. At US, RCC appears as a small inhomogeneous nodule (<3 cm), clearly outlined from the renal profile and hypoechoic if compared with sclerotic parenchyma. In some cases, tumor appears as a homogeneous and hyperechoic multifocal mass. The most specific US sign of a small tumor in end-stage kidney is the important arterial vascularization, in contrast with renal parenchymal vascular sclerosis.

Conservatively managed thyroglossal duct cyst carcinoma with lymph node metastasis: Long-term result

Thyroid papillary carcinomas of thyroglossal duct cysts (TGDCs) are quite uncommon. Despite the identification of risk factors, the treatment course is controversial. A 34-year-old woman suffering sudden growth of a mass in the neck was clinically diagnosed TGDC. Ultrasonography and computed tomography (CT) showed irregular heterogeneous mass, with a large cystic component consisting of calcification and 7 × 6 mm solid smoothly contoured mass close to the left isthmus. Thyroid scintigraphy exposed normal thyroid gland uptake and a small cold nodule near the isthmus. Fine-needle aspiration cytology revealed signs of well-differentiated papillary TGDCs carcinoma. Sistrunk's procedure with an anterior neck dissection was performed. Postoperative histopathological examination revealed well-differentiated papillary carcinoma arising from thyroglossal cyst and lymph node metastasis. No further treatment was carried out and she was followed-up without recurrence for 44 months. A conservative procedure should be performed in well-differentiated papillary carcinoma of the TGDC.

ASPECTE CLINICO-MORFOLOGICE PARTICULARE ÎNTR-UN CAZ DE ADENOM PAROTIDIAN CU CELULE BAZALE

The basal cell adenoma (BCA) is a rare tumor entity of the salivary glands. It represents an adenoma monomorphic form, first mentioned by Kleinasser and Klein in 1967. (13) The most frequent location is at the level of the parotid gland. It presents itself usually as a tumorous firm mass, mobile, with slow increase. Microscopically, the tumour contains monomorphic basal cells with the absence of myoepithelial cells. Histologically, it is characterised by the presence of hilar stroma presence, soft, and with the absence of the myxoid or chondroid stroma. It presents similarities with the mixed tumour, but also with the adenocarcinoma with basal cells and with the cystic adenoid carcinoma. Therefore, questions may arise regarding the diagnostic and treatment. It tends to be multifocal and the rate of relapse after the surgical excision is high. Taking into consideration all these aspects, in this paper we would want to show a case of adenoma with basal cells with parotid localization which presented a series of clinical-morphological particularities in parallels with the data existing in the specialized literature.

Upper neck papillary thyroid cancer (UPTC): A new proposed term for the composite of thyroglossal duct cyst-associated papillary thyroid cancer, pyramidal lobe papillary thyroid cancer, and Delphian node papillary thyroid cancer metastasis

Thyroglossal duct cyst (TGDC) is a common congenital anomaly, but TGDC carcinoma is rare. Thyroglossal duct cyst carcinoma management is controversial, especially that of the orthotopic thyroid gland. We aim to provide an insight into the pathologic basis of this management controversy through the review of 28 TGDC cancer cases, thus far the largest such series to our knowledge. Retrospective. Twenty-eight cases recorded as TGDC cancer in the hospital database were reviewed; their initial clinical diagnosis from medical chart review (DX1) and final pathological review diagnosis (DX2) through pathology slides review by our pathologist (blinded to DX1) were compared. The thyroid gland management and pathology were evaluated. In the 28 TGDC carcinoma (hospital-recorded diagnosis) patients, DX1 and DX2 were respectively reported as 53% and 14% TGDC carcinoma, 11% and 29% as pyramidal lobe primary, and 4% and 25% as metastatic Delphian node. Thirty-two percent of cases were in the indeterminate category, in both DX1 and DX2, but included different patients. Thyroidectomy was performed in 54% of the cases, papillary thyroid cancer (PTC) was reported in 37% of these thyroid glands. Concurrent thyroid gland malignancy was reported in all Delphian node and pyramidal lobe PTC patients. The diagnosis of TGDC cancer comprises a heterogeneous group that includes true TGDC cancer, pyramidal lobe primary, Delphian node metastasis, and indeterminate cases. We propose a new terminology of upper neck papillary thyroid carcinoma (UPTC) to denote this heterogeneous group and recommend a rational algorithm for management. Correct pathologic subcategory and thyroid ultrasonography are essential for optimal management of thyroid gland in UPTC cases. 4. Laryngoscope, 126:1709-1714, 2016.

CT differential diagnosis of cystic nephroma and multilocular cystic renal cell carcinoma

To study the CT findings of cystic nephroma (CN) and multilocular cystic renal cell carcinoma (MCRCC) and to improve the accuracy of preoperative diagnosis of these two diseases. The CT findings of nine CN cases and 19 MCRCC cases confirmed by pathology were blindly reviewed and compared with their pathological results. Fisher's exact test and independent-samples T test were applied to statistically analyze some of the CT features of the CN and MCRCC lesions. The thickness of cystic walls and partitions in the nine CN cases ranged from 0.5 to 5 mm. Cystic walls and partitions were slightly thicker in some parts without visible mural nodules. Varying amounts of solid tissue could be found in all the 19 MCRCC tumors, and the cystic walls and partitions were found partially thickened ranging from 3 mm to 13 mm. Eight cases were with mural nodules (nodule diameter: 4.5-16 mm). Nine cases of CN tumors were lobulated and 7 protruded into the renal sinus. Three out of the 19 MCRCC presented shallow lobulation, and 7 tumors protruded into the renal sinus. The CT contrast-enhancement scanning displayed moderate delayed enhancement in the cystic walls and partitions in 8 cases. The enhanced scanning revealed that all the nine cases showed enhancement of the cystic walls and partitions, while 8 cases of them had mild to moderate delayed enhancement. The cystic walls, partitions and nodules were enhanced in 19 MRCC cases, among them 17 cases displayed obvious enhancement in the cortical phase. Among the differences of CT findings between MC and MRCC, the shallow lobulation, protruding into the renal sinus, mural nodules, cystic wall and partition thickness, and net growth in the cortical and nephrographic phase were statistically significantly different (P<0.05 for all). CT scan can provide significant evidence for CN and MCRCC diagnosis. CN cases usually present relatively thin and even cystic walls and partitions without mural nodules and with shallow lobulation and protruding into the renal sinus. The enhancement is mild to moderate, dynamic and delayed, while the opposite CT findings may indicate a higher possibility of MCRCC.

Use of molecular diagnostics to distinguish glandular odontogenic cyst and mucoepidermoid carcinoma

Use of molecular diagnostics to distinguish glandular odontogenic cyst and mucoepidermoid carcinoma

AB114. Analyses of 77 multilocular cystic renal cell carcinoma cases from a single center

ObjectiveMultilocular cystic renal cell carcinoma (MCRCC) is a distinct subtype of clear cell renal cell carcinoma. Different from other types of renal cancers, MCRCC has a favorable outcome. The real incidence of MCRCC using the new diagnostic criteria is yet unclear. Large scale study is therefore needed to further identify the characteristics of MCRCC.MethodsA total of 77 MCRCC cases were identified following the 2004 WHO diagnostic criteria in our institute. Their clinical and radiographical characteristics, surgical management, pathological features, and outcomes were retrospectively reviewed.ResultsThe incidence of MCRCC in our renal cell carcinoma (RCC) patients was 1.8% (77/4,189). After a median follow-up period of 51 months, no tumor recurrence or metastasis was found.ConclusionsThe incidence of MCRCC in RCC patients is low. Most cases showed no symptoms, and accurate diagnosis is difficult before surgery. MCRCC carries an excellent prognosis after surgical treatment, regardless of the tumor size. Partial nephrectomy should be considered as the preferable surgical approach for the management of MCRCC. The follow-up interval after surgery can be longer.

Clinical value of stereotactic body radiotherapy for the treatment of metastatic pancreatic cancer

Objective To discuss the clinical value of stereotactic radiotherapy for the treatment of metastatic pancreatic cancer. Methods Data of 17 patients with metastatic pancreatic cancer were retrospectively studied. All patients were admitted to Air Force General Hospital from January 2006 to December 2014. Lung carcinoma was the most common primary tumor (n=7), followed by cystic carcinoma (n=3), esophageal cancer (n=1), gastric carcinoma (n=1), renal carcinoma (n=1), colon carcinoma (n=1), acute myeloid leukemia (n=1), left chest fibrous histiocytoma (n=1), and upper extremity synovial sarcoma (n=1). There were 8 patients choosing the therapy of body gamma knife, 5 choosing the therapy of IMRT, 3 choosing the therapy of 3DCRT and 1 choosing the therapy of TOMO. Metastases median maximum diameter was 3.6 cm (range, 1.6-1.7 cm), median target volume was 37.1 mm3 (range, 11.1-72.1 mm3) and median GTV dose was 50 Gy (range, 40-70 Gy). Patients treatment time was 14 to 22 days, 5 fractions/week and median single dose was 3 Gy. Results Of all the patients of this group, 4 patients qualified as complete remission (CR), 8 patients reached the standard of partial remission (PR), and 2 patients maintained the situation of stable disease (SD). The total percentage of therapeutic efficiency was 70.1 % (12/17). As for the analgesic therapy, 3 patients qualified as CR, 5 patients reached the standard of PR, and 1 patient maintained the situation of MR (minimal response). The total percentage of analgesic therapeutic efficiency was 100 %. The local control rates for six-month and 1 year were both 100 %, and the overall survival rates for 1 year and 2 years were 35.3 % and 5.9 %. No Grade 3 or more acute and late radiation reaction was observed. Conclusion The majority of patients with pancreatic metastatic carcinoma have lost the opportunity to have surgery, but the stereotactic radiation therapy can improve the quality of life and local control rate with small toxicity and acceptable complications. Key words: Pancreatic neoplasms; Metastatic/Stereotactic; Radiotherapy; Prognosis

Clinicopathologic features of cystic hypersecretory lesion of the breast

To study the clinicopathologic features, immunophenotype and differential diagnosis of cystic hypersecretory lesion (CHL) of the breast. Clinicopathologic and follow-up data of six cases of breast CHL in 2010-2013 were collected and reviewed.Immunohistochemical and mucinous staining was performed. All six patients were female, age ranged from 37 to 71 years (average 49.3 years). Three cases were cystic hypersecretory hyperplasia (CHH), the other three cases were cystic hypersecretory carcinoma (CHC). Clinically the lesions presented as either breast mass or mammographic calcification.Grossly, the cystic hypersecretory lesions were poorly circumscribed, with multiple colloid containing cysts on the cut surface. Microscopically, the remarkable feature was numerous enlarged cysts which contained densely eosinophilic homogeneous secretion similar to the colloid seen in thyroid follicles, and calcification was seen in the cyst in one case. The secretion was D-PAS and mucicarmine positive. The lining epithelium of the cysts was uniformly flat, cuboid or columnar, and arranged in a monolayer. The cells may be arranged in turfs, solid or micropapillary patterns in CHH.In cases with dysplasia, the epithelium showed cytological and structural atypia, but the usual morphology of atypical dutal hyperplasia such as arcades, rigid bridges or cribriform pattern was less common. The three CHC included two invasive ductal carcinomas (IDC) and one ductal carcinoma in situ (DCIS).In CHL, there was immunoreactivity to S-100 protein, CK5/6 and CK14.Of the three CHCs, ER and PR were expressed in only one IDC.No HER2 expression was identified in the two invasive CHCs.One patient was lost to follow-up, and the rest were uneventful at 18 months. CHL of the breast is a rare pathological entity. Multiple colloid-filled cysts is a unique histological feature. The epithelium of CHL may show usual hyperplasia, dysplasia or carcinoma.

Abstract P2-03-08: Mutational landscape of metaplastic breast carcinomas

Abstract Introduction: Metaplastic breast carcinoma (MBC) is an aggressive histologic type of breast cancer, which preferentially displays a triple-negative phenotype. These tumors are characterized by the presence of malignant cells exhibiting differentiation towards squamous epithelium or mesenchymal elements, including spindle, chondroid, osseous and rhabdoid differentiation. Unlike other rare histologic types of breast cancer such as adenoid cystic and secretory carcinomas, which are underpinned by the MYB-NFIB and ETV6-NTRK3 fusion genes respectively, pathognomonic genetic alterations have not been identified in MBC. It has been suggested, however, that the frequency of PIK3CA somatic mutations would be significantly higher in MBCs than in other forms of triple-negative disease. Here we sought to characterize the mutational landscape of MBCs by means of high-depth whole exome sequencing analysis. Material and Methods: Twenty-one triple-negative MBCs were retrieved from the authors’ institutions. Representative sections from frozen blocks were microdissected to ensure tumor cell content greater than 50%. DNA samples extracted from microdissected tumor and matched peripheral blood leukocytes were subjected to high-depth (250x) whole exome sequencing on an Illumina GAIIx or HiSeq2000. Somatic point mutations were called using MuTect and somatic insertions and deletions (indels) were called using Strelka, Varscan2 and Haplotype Caller. Potentially pathogenic mutations were predicted using computational algorithms including PolyPhen-2, Mutation Taster, Mutation Assessor, CHASM and FATHMM. Significantly mutated genes were identified using MutSigCV. Pathway and network enrichment analysis of mutations was performed with Ingenuity Pathway Analysis and HOTNET. The genomic landscape of MBCs was compared with that of triple-negative breast cancers (TNBCs) analyzed as part of The Cancer Genome Atlas project. Results: A mean of 135 somatic non-synonymous point mutations and indels were identified per MBC. The most frequently mutated gene was TP53, found in 12/21 cases (57%), and the only significantly mutated gene as defined by MutSigCV (q&amp;lt;0.01). The repertoire of somatic mutations found in MBCs was qualitatively similar to that of TNBCs of no special type, and recurrently mutated genes were altered at similar frequencies in MBCs and TNBCs of no special type. When somatic mutations were annotated in pathways and networks, MBCs were found to have potentially pathogenic mutations affecting genes directly related to the PI3K pathway, including pathogenic non-synonymous mutations affecting PIK3CA, PIK3R1, PIK3R2, PIK3C2B, PIK3C2G and PTEN, significantly more frequently than TNBCs of no special type (10 out of 21 MBCs vs. 11 out of 62 TNBCs; Fisher's exact test p-value=0.0099). Conclusion: The majority (57%) of MBCs harbored non-synonymous mutations affecting TP53. While the frequencies of mutations affecting recurrently mutated genes in MBCs are similar to those found in other forms of TNBCs, MBCs significantly more frequently harbor mutations affecting PI3K pathway-related genes than TNBCs of no special type. Citation Format: Charlotte KY Ng, Britta Weigelt, Salvatore Piscuoglio, Y Hannah Wen, Maria R De Filippo, Luciano G Martelotto, Rachael Natrajan, Raymond Lim, Edi Brogi, Larry Norton, Anne Vincent-Salomon, Jorge S Reis-Filho. Mutational landscape of metaplastic breast carcinomas [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-03-08.

The clinical analysis of adrenal tumor combined with renal carcinoma in 42 patients

Objective To summarize the clinical characteristics of adrenal tumors combined with renal carcinoma and to extend the clinical understanding of the situation. Methods To analyze the data of 1 100 patients with adrenal tumors hospitalized in Peking University First Hospital from Jan. 1994 to Mar. 2012 retrospectively, in the series there were 42 combined with renal carcinoma. Results There were 27 males, 15 females, aged 29 to 83 years, mean 60.5 years old. In 42 renal carcinomas, there were 29(69.0%)clear cell carcinomas, 5(11.9%)cystic renal carcinomas, 2(4.8%)clear cell with granulosa cell hybrid carcinomas, 1 renal lymphoma, 1(2.4%)spindle cell tumor, 1 acidophilic cell adenoma, and 1 undifferentiated type of renal cell carcinoma and pathologically not clear in 2 cases(4.8%). Clinical manifestations were not specific. In 42 adrenal tumors, 20 situated in the left, and 17 right, and 5 were bilateral. 35 cases were considered primary adrenal tumors, in which 3 were diagnosed primary hyperaldosteronism, 32 were non-functional tumors. Other 7 were non-functional matastatic carcinomas. 25 patients underwent resection of adrenal tumors, and pathology revealed 22(88.0%)were primary, in which 12(54.6%)were cortical adenomas, 7(31.9%)hyperplasia, 1(4.5%)pheochromocytoma, 1(4.5%)ganglioneuroma, 1(4.5%)adenoma with hyperplasia; 2(8.0%)metastatic tumors, and 1(4.0%)non-Hodgkin's lymphoma. The mean diameter of primary adrenal tumors was 1.9 cm, while that of metastatic carcinoma was 3.84 cm. 25 underwent abdominal ultrasonography, 40 underwent computed tomography(CT)scan, 6 underwent magnetic resonance imaging(MRI)scan, positive rate was 72.0%, 97.5%, and 100.0% respectively. 25 patients who underwent surgery were followed up, 17 survived for 8 months-6 years, 4 died, in which 1 metastatic carcinoma died of intraoperative bleeding, 1 died of adrenal lymphoma, 2 died because of other disease, 4 were lost to follow-up. Conclusions The most common type of renal carcinoma combined with adrenal tumors was clear cell carcinoma, while majority of the adrenal tumors were primary with non-specific clinical manifestations and function. The adrenal tumors might be located in the same or the opposite side of renal carcinoma, also might be bilateral which were more common in metastatic carcinomas and always bigger than primary ones. CT/MRI scans were important in judging the nature of the tumors and pathology was the gold standard. The non-functioning primary adrenal tumors could be safely followed up, and the isolated metastatic carcinoma should be resected. Prognosis depends mainly on that of renal carcinoma. (Chin J Endocrinol Metab, 2015, 31: 342-345) Key words: Adrenal tumor; Renal carcinoma; Primary; Metastatic carcinoma

309 Cystic renal cell carcinoma – favourable prognosis regardless of tumour size or T-stage confirmed in large population-level study at ten years follow up

309 Cystic renal cell carcinoma – favourable prognosis regardless of tumour size or T-stage confirmed in large population-level study at ten years follow up

Clinical and pathological feature and prognosis for multilocular cystic renal cell carcinoma

Objective To investigate the clinicopathological features of multilocular cystic renal cell carcinoma (MCRCC). Methods The clinicopathological data of 27 patients with MCRCC diagnosed and treated in Fudan University Shanghai Cancer Center from 2002 to 2012 were retrospectively analyzed. There were 19 males and 8 females with non–specific clinical manifestation. CT scan showed a polycystic mass with enhanced cystic wall and septum in enhancement scanning. Of which, 21 cases of Bosniak Ⅲ and 6 cases of Bosniak Ⅳ. MRI revealed a mass with long T1 and T2 signal with clearly separated–liked enhanced mass in enhancement scan. Ten cases of tumor located in the left renal, 16 cases in the right renal, 1 case in the double kidney. The mean of tumor diameter was 4.4 (1.0–8.0) cm. Eleven patients underwent radical nephrectomy while the other 16 cases received nephron sparing surgery. Results The pathological staging showed pT1aN0M0 in 19 cases, pT1bN0M0 in 6 cases, and pT2N0M02 cases. In immunohistochemical study, tumor cells from 18 cases were positive for CD10, 17 positive for vimentin, 27 positive for EMA, 20 positive for CK7, while all negative for CD68. During 5–145 months of follow–up, none of patients showed any evidence of recurrence and metastasis, with non–tumor–related mortality. Conclusions MCRCC as a rare type of kidney cancer has low pathological stage and good prognosis, and should be treated with surgery if the diagnosis of MCRCC is suspected and confirmed. Key words: Multilocular cystic renal cell carcinoma; Clinicopathological features; Prognosis

Glandular Odontogenic Cyst of Maxilla: A Case Report

GLANDULAR ODONTOGENIC CYST OF MAXILLA: A CASE REPORT Alen Palancioglu, Cemil Isler, Merva Soluk Tekkesin, Mehmet Yaltirik, Zerrin Cebi, Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkey; Department of Tumour Pathology, Institute of Oncology, Istanbul University, Istanbul, Turkey Glandular odontogenic cyst (GOC) is a rare aggressive developmental cyst of the jaw. GOC occurs more commonly in middle-aged people and has a predilection for the anterior mandible. Radiographically, the lesion presents as either a unilocular or multilocular radiolucency and has high recurrence rate. Histopathologically, the cyst is lined by stratified squamous epithelium that exhibits focal thickenings in which the epithelial cells become a swirled appearance. The cells of the epithelium lining are cuboidal, often with cilia. The clusters of mucous cells are also present. There is considerable overlap between the histomorphologic features of the GOC and the cystic low-grade mucoepidermoid carcinoma, which makes its diagnosis challenging. Because of its potentially aggressive nature and tendency for recurrence, long-term follow-up is essential. This case report represents radiologic-pathologic features and surgical treatment of GOC of the anterior maxilla in a 31-years-old male patient.

Microbubbles: from cancer detection to theranostics

Microbubbles have proven to be useful as diagnostic agents for ultrasound[1,2]. However, they have the potential for a far wider range of uses, both in unmodified form (thus minimising regulatory barriers) and in new forms[3]. These future uses may be divided into diagnostic and therapeutic categories. Routine diagnostic uses of microbubbles relevant to oncology are mainly in the liver, where they have been endorsed by NICE for the characterisation of focal liver lesions[4]. The key attribute here is the fact that malignancies do not have the functioning sinusoidal system that accounts for the late retention of microbubbles in the normal liver and in solid focal lesions - in this application, microbubbles are as effective as CT with contrast but less costly. Many similar oncological uses exploit microbubbles' exquisite ability to define both the macro- and microvasculature of tissue. Examples include characterising BI-RADS 3 and 4a breast masses, distinguishing pancreatic adenocarcinoma (hypoperfused) from focal pancreatitis (well perfused) and distinguishing complex-appearing real cysts from cystic carcinomas. A potentially important extension is to develop targeted microbubbles that attach preferentially to cell surface molecules of interest[5]. Since conventional microbubbles of micron diameter cannot escape from the blood pool, the initial target is the blood vasculature. Ligands to VEGF1 can be attached to microbubbles; numerous preclinical studies have shown these to be effective ways to image malignant neovascularisation and the first human trial in prostate cancer has been completed[6]. A difficulty has been the relatively poor binding power of the targeted microbubbles, especially in the non-immunogenic form suitable for human use. The same strategies that are used for molecular imaging in nuclear medicine and MR can be deployed: improve the specific binding or wait for clearance of the unbound agent from the blood stream. Another approach makes use of the fast time resolution of ultrasound and tries to recognise which microbubbles are fixed and which are moving, thus enabling the bound population to be selectively imaged. Efforts have also been made to detect differences in the echoes from free versus bound microbubbles. An important advance in allowing access to tissue beyond the endothelium is the development of nanodroplets, made by cooling and pressurising microbubbles - at around 200nm in diameter, they are able to cross the endothelium, especially where its is leaky[7]. Sonication with acceptable ultrasound intensity can then be used to reform the original microbubbles, with their ligands intact. This opens the way to imaging tissues beyond the endothelium. The simplest approach to therapy employing microbubbles is to make use of their mechanical vibrations[8] and this has been used to accelerate thrombus breakdown to promote revascularisation of the middle cerebral artery[9]. An interesting approach uses low ultrasound frequencies and intensities along with microbubbles to ‘massage’ the endothelium or other surfaces (remote palpation), relying on the effect of acoustic radiation force impulses (ARFI) to move microbubbles along the ultrasound beam[10]. This allows temporary opening of tight endothelial junctions, for example to open the blood-brain barrier and improve the penetration of co-administered i.v. drugs. Co-administration obviates some of the regulatory barriers to modified microbubbles and has been used to augment chemotherapy of pancreatic cancer with gemcitabine[11]. Further such trials are anticipated. Microbubbles might also be used to augment high intensity focussed ultrasound (HIFU) which would speed up the method, thus removing one of the main barriers to its wider use. The most direct approach to treatment with microbubbles is to tag them with active drugs such as chemotherapeutic agents; breaking these microbubbles with high MI pulses releases the agent so that high concentrations can be achieved locally. This has been shown in small animals to minimise the cardiotoxicity of adriamycin in breast cancer[12]. This therapeutic avenue could be combined with the nanodroplets method and with remote palpation to access tumours. Thus, the diagnostic and therapeutic possibilities for microbubbles are extensive; clinically useful approaches in oncology can be anticipated in the not too distant future.

Carcinoma of the cystic duct presenting as obstructive jaundice

Cystic duct carcinoma is a rare disease. We present here a case of 33-year-old female patient who presented with obstructive jaundice. An abdominal ultrasound and computed tomography scan showed dilatation of intrahepatic biliary radicals with abrupt narrowing of the common bile duct and markedly distended gall bladder suggestive of obstructive pathology. Following an exploratory laparotomy, a markedly distended gall bladder, cystic duct specimen and infrapyloric lymph nodes were sent for histopathological examination. Histopathological examination revealed a well-differentiated adenocarcinoma of the cystic duct with no lymph node metastasis.