Deep Tissue Invasion Research Articles

Successful treatment of multiple intracerebral aspergillosis with voriconazole alone in an Egyptian diabetic patient with autoimmune hemolytic anemia

Aspergillosis is a common fungus that lives in soil and decaying vegetation. Inhalation of the spores causes infection mostly in immunocompromised patients. Invasive aspergillosis has an extremely high mortality, and a definitive diagnosis requires histopathological evidence of deep tissue invasion or positive culture; however, this evidence is often difficult to obtain due to the critical nature of the patients in these situations. The sensitivity of culture in this setting is also low. The galactomannan test is a recent antigen–antibody serologic test that depends on detecting an antigen which is a molecule found in the cell wall of aspergillus species. A positive result supports the diagnosis of invasive aspergillosis. We present a case of multiple intracerebral brain abscesses in an immunosuppressed patient due to an aspergillus species diagnosed by the galactomannan test with an excellent response to the treatment with the novel voriconazole alone, without any surgical intervention, and the purpose is to alert the physicians, neurologists, and infectious disease specialists to consider the intracranial aspergillosis among the differential diagnosis of the acute onset encephalitis especially in immunocompromised patients as early diagnosis and treatment may be life-saving.

The Impact of Trophoblast Cell-Surface Antigen 2 Expression on the Survival of Patients with Gastrointestinal Tumors: A Systematic Review.

Trophoblast cell-surface antigen 2 (TROP-2) is a transmembrane glycoprotein expressed in epithelial cells that has been associated with malignant progression in most carcinomas. Accordingly, the genetic complexity of gastrointestinal tumors necessitates the investigation of new biomarkers with potential prognostic value. The aim of this systematic review is to assess the effect of TROP-2 on the overall survival of patients who underwent surgery for gastrointestinal malignancy. The present systematic review was designed using the PRISMA and AMSTAR guidelines. We searched the Pubmed, EMBASE and CENTRAL databases from their inception to September 2023. Ten studies that enrolled 2293 patients were included for qualitative analysis. Six studies evaluated patients with colorectal cancer, two studies included patients with gastric carcinoma, patients with pancreatic cancer were included in one study and one study included hepatobiliary cancer patients. TROP-2 was positive in 1005/2293 samples of the immunohistochemically evaluated biopsies and was associated with poor overall survival in all studies. High intensity was also associated with more aggressive histopathological characteristics, such us deep tissue invasion, lymph node metastasis and cell atypia. The prognostic value of TROP-2 was shown to be enhanced in patients with advanced disease and poor histological differentiation. TROP-2 was expressed at high levels in gastrointestinal tumors, which was associated with both tumor development and pathological aggressiveness. Therefore, TROP-2 could be used as a biomarker to determine clinical prognosis and as a potential therapeutic target in malignancies of the gastrointestinal tract, but further studies need to validate it.

Carcinoma Cuniculatum with Bone Invasion Mimicking a Viral Wart

Carcinoma cuniculatum is a rare variant of low-grade and well-differentiated squamous cell carcinoma. It is a locally invasive tumor, although it has low metastatic potential. It was originally described in the plantar region but may exceptionally appear in other locations. It predominates in middle-aged men and presents clinically as an exophytic, solitary, painful tumor, with insidious growth. Histologically, this tumor simulates a variety of benign dermatoses and may require several biopsies for the correct diagnosis. It is often misdiagnosed as a viral wart, due to the clinical similarity and the indolent course. The treatment of choice is surgical excision due to the high risk of recurrence and locally aggressive behavior. Amputation can be performed in cases of deep tissue invasion. We present a case of carcinoma cuniculatum in which the late diagnosis favored the invasion of the underlying bone, resulting in amputation of the affected finger.

Kaposiform hemangioendothelioma: A facial exophytic presentation

Kaposiform Hemangioendithelioma (KHE) is a rare, locally aggressive endothelial derived tumor of childhood, often associated with high morbidity and mortality. Whereas common localisation of presentation is represented by skin of the extremities with deep tissue invasion, we present a unique case of a facial exophytic KHE of a 5-year-old female, with no clinical nor radiological signs of deep tissue invasion, showing no signs of complication and treated with surgical excision.

Analysis of the occurrence and distribution of primary and recurrent basal cell carcinoma of head and neck coupled to the assessment of tumor microenvironment and Sonic hedgehog signaling.

Often, basal cell carcinoma (BCC) displays local aggressiveness, and when developed in the head and neck presents with deep tissue invasion and recurrence. Previous studies have pointed out the necessity of systematic assessment of primary and recurrent BCC based on a better understanding of the biology and function of its microenvironment. Although hedgehog-dependent tumor cells signaling to the underlying stroma, and vice versa, have been demonstrated to be implicated in the pathogenesis of BCC, little is known about peculiarities of the tumor microenvironment and the above-mentioned signaling in the head and neck. The occurrence and distribution of 79 primary and recurrent BCCs developed in the head and neck region were estimated. The data were coupled with the immunohistochemical assessment of type IV collagen, laminin, alpha-smooth muscle actin (α-SMA), and Sonic hedgehog (Shh). The frequency of the mixed BCCs and the predominance of the nose and cheek region affection by primary and recurrent tumors were demonstrated. Furthermore, the increase of peritumoral and entire stromal α-SMA immunoreactivity in the mixed recurrent BCC was confirmed using statistics. We found the increase of strong levels of Shh immunoexpression in the aggressive variants of BCC – infiltrative, mixed, and micronodular. Surprisingly, we confirmed the upregulation of Shh paralleled by the downregulation of α-SMA immunoexpression in the superficial subtype of the tumor. Our results suggest the necessity of further studies assessing the nature of the tumor along with the peculiarities of signaling in BCCs of head and neck.

Streptococcal Serine-Rich Repeat Proteins in Colonization and Disease.

Glycosylation of proteins, previously thought to be absent in prokaryotes, is increasingly recognized as important for both bacterial colonization and pathogenesis. For mucosal pathobionts, glycoproteins that function as cell wall-associated adhesins facilitate interactions with mucosal surfaces, permitting persistent adherence, invasion of deeper tissues and transition to disease. This is exemplified by Streptococcus pneumoniae and Streptococcus agalactiae, which can switch from being relatively harmless members of the mucosal tract microbiota to bona fide pathogens that cause life-threatening diseases. As part of their armamentarium of virulence factors, streptococci encode a family of large, glycosylated serine-rich repeat proteins (SRRPs) that facilitate binding to various tissue types and extracellular matrix proteins. This minireview focuses on the roles of S. pneumoniae and S. agalactiae SRRPs in persistent colonization and the transition to disease. The potential of utilizing SRRPs as vaccine targets will also be discussed.

Adenocystic Carcinoma of Salivary Gland: A Literature Review

Adenoid cystic carcinoma is a rare salivary gland tumor that has a consistent slow growth rate and hasdestructive biological behavior because of its deep peripheral tissue invasion and higher recurrence rate andtendency of distant metastasis. The involvement of adjacent vital structures may lead to death. Its clinicalpresentation also causes difficulty in diagnosis. Surgical resection following radiotherapy is the maintreatment modality of Adenoid cystic carcinoma. Even after successful therapy of the primary tumor, thereis a high rate of local recurrence and in contrast to other epithelial malignancies, it has a very poor prognosis.The survival rate is good for the initial 5 years but it falls after 5 years follow up.

LEMIERRE'S SYNDROME: A FORGOTTEN DISEASE

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lemierre’s Syndrome is a largely forgotten disease in the era of antibiotics, with an incidence of 1 in 1 million per year. It is characterized by thrombophlebitis of the internal jugular (IJ) vein and bacteraemia of oral cavity anaerobes, in a young otherwise healthy adult. It was highly prevalent and often fatal prior to the introduction of antibiotics; however cases have since declined significantly, with a recent resurgence (1). CASE PRESENTATION: A 21-year-old female with no previous history presented with high grade fevers and progressive shortness of breath for 2 days. She reported a recent sore throat that failed to improve with oral Azithromycin. She denied any intravenous (IV) drug use or recent dental work. She was febrile at 103 F, with a HR: 128bpm, RR: 28 bpm & oxygen saturation: 86% on room air, requiring supplemental oxygen. Oropharyngeal exam was normal with a central uvula without any erythema, tonsillar exudates, or palpable cervical adenopathy. Labs were normal except for a leucocytosis of 13 k/mm3 and thrombocytopenia of 31 k/mm3. CT chest showed bilateral lung nodules with basilar, sub-pleural predominance & early cavitation consistent with septic emboli (Fig 1). CT neck showed a venous thrombus extending from the right palatine tonsillar vein into the right IJ vein, consistent with Lemierre's syndrome (Fig 2). Blood cultures grew Prevotella intermedia after 4 days of inoculation. She was started on broad spectrum antibiotics with de-escalation to oral amoxicillin/clavulanic acid and metronidazole for 6 weeks. Therapeutic anticoagulation was stopped after development of a haemothorax. DISCUSSION: Lemierre's syndrome is a triad of oropharyngeal infection with bacteremia, thrombophlebitis of IJ vein and distant metastatic abscesses, typically preceded by a sore throat which results in deep tissue invasion by highly thrombogenic oral anaerobes. The most frequent metastatic site is the lungs, but any organ may be involved (2). Most common pathogen responsible is Fusobacterium, an obligate anaerobic, gram-negative bacilli, but very limited literature is published regarding Provetella spec. associated Lemierre's syndrome (2). Incidence has significantly declined after the introduction of Penicillin, however, there has been a resurge, presumably due to a trend against prescribing antibiotics for sore throat (2-3). Diagnosis is usually clinical with supporting radiological evidence and growth of a typical causative organism, usually from blood. It is often mistakenly diagnosed as primary bacteremia from an infected organ or tonsillitis. Treatment consists of prolonged antibiotics and management of its complications. CONCLUSIONS: Lemierre's syndrome should be considered in any patient with unrelenting sore throat and anaerobic bacteremia. Prompt initiation of targeted antibiotics would prevent metastatic complications and thus reduce overall healthcare costs. Reference #1: Bilateral Lemierre's syndrome: a case report and literature review. Moore BA Et al. Ear Nose Throat J. 2002 Apr;81(4):234-6, 238-40, 242 passim. Reference #2: Lemierre’s syndrome: forgotten, but not absent. Bahall M, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-221203 Reference #3: Lemierre’s syndrome: current perspectives on diagnosis and management. Katrine M Johannesen et al. Infection and Drug Resistance 2016:9 221–227 DISCLOSURES: No relevant relationships by Nelson Agudelo Higuita, source=Web Response No relevant relationships by Maham Khan, source=Web Response No relevant relationships by Miranda McGhee, source=Web Response No relevant relationships by Aejaz Ul Haq, source=Web Response

An evaluation of neglected tumors: Giant basal cell carcinomas

Aim: Giant basal cell carcinomas (GBCCs) which constitute approximately 1% of basal cell carcinoma are aggressive tumors characterized by deep tissue invasion, high risk of metastasis, and poor prognosis. We aimed to analyze demographics, treatment, and outcome of patients with GBCCs in this study. Material and Methods: Between 2017 and 2020, nine patients applied to Department of Plastic and Reconstructive Surgery and underwent surgical treatment for GBCC were included in the study. Age, sex, localization, tumor size, treatment and comorbid diseases of the patients were reviewed retrospectively.Results: Six patiens were male and three patients were female. The mean age was 68.6 ±3.8 years, ranging from 62 to 78 years. The tumors were located on cheek (n=4), frontotemporal region (n=2), cheek nose lower eyelid junction (n=1), scalp(n=1) and dorsum of the hand (n=1). The largest of the lesions was 8x10 cm and the smallest was 4x6 cm.The defect sizes following tumor removal ranged from 24 to 80cm2 with an average of 43,6 cm2. Nodular GBCC was the most common histological subtype (n=6), followed by superficial (n=2) and morpheaform (n=1). Two patients were skin grafted after excision of GBCC whereas cheek rotation flaps (n=2), cervicofacial flaps (n=3) and pedicled forehead flaps (n=2) were utilized for reconstruction.Conclusion: Since health insurance covers oncologic surgery and there is an extreme ease to reach a health professional in our country, the most common reason to still encounter GBCC seems like negligence. GBCCs are rare, but they need proper interventions when detected. Aggressive surgery should not be avoided for better outcomes.

1723 Esophageal Granular Cell Tumour: An Unusual Polypoid Lesion

INTRODUCTION: Esophageal granular cell tumours (GCTs) account for 1% of all Esophageal tumors and up to two-third occur in the distal third of Esophagus. Since first reported in 1931 approximately 400 cases have been reported so far. We report a case of Esophageal GCT incidentally found on endoscopic evaluation for resistant GERD. CASE DESCRIPTION/METHODS: A 42-year-old Hispanic male was seen for evaluation of refractory GERD and occasional dysphagia to solids of 3-month duration. There were no alarm symptoms or use of NSAIDs. Physical examination and labs were unremarkable. EGD was performed that showed a 4mm yellowish, sessile, subepithelial nodule with intact mucosa in the distal Esophagus (Figure 1). Biopsy showed clusters of polygonal cells with abundant granular cytoplasm that was Periodic acid–Schiff (PAS) positive suggestive of GCT. Immunohistochemical staining was positive for S100, CD 68, CD56 and Vimentin, thus conforming the diagnosis of GCT (Figure 2). EUS performed subsequently showed a 4mm, submucosal, hypoechoic, homogenous mass with no extension into muscularis propria (Figure 3); completely removed by hot snare technique with pathological conformation. Patient was discharged home with close endoscopic surveillance. DISCUSSION: Granular Cell Tumors (GCTs) arise from Schwann cells of the nerve sheath with incidence of about 0.03% and has a predilection towards skin, oral cavity and breasts. Of all GCTs, 6-8% occur in the GI tract with esophagus (65%) being the most common site. It has predilection towards females and African Americans between 40-60 years of age. Generally asymptomatic and found incidentally during endoscopy. However, GERD and dysphagia are associated with GCTs of more than 2 cm in size. EUS is invaluable in differentiating GCTs from other subepithelial tumors, determining size, depth and invasion. Biopsy/FNA can be performed during the initial endoscopy or during EUS. Definitive diagnosis is by histopathology and immunohistochemical staining. The treatment of esophageal GCTs is controversial. Conservative management is recommended for tumors <1 cm, asymptomatic, no deep tissue invasion or malignancy. However, resection is warranted for symptomatic tumors, >1 cm size, with deep tissue invasion or malignancy. Endoscopic removal is preferred over surgery for tumors without deep tissue infiltration or malignant. Endoscopic and histologic surveillance every 1-2 years is recommended.

1601 Cecal Granular Cell Tumour: An Uncommon Site of an Uncommon Tumour

INTRODUCTION: Granular Cell Tumors (GCTs) are tumors arising from Schwann cells of the nerve sheath. They occur at an incidence of about 0.03% and have a predilection for the skin, oral cavity, and breasts. Only 6-8% of all GCTs occur in the GI tract with the esophagus (65%) being the most common site, followed by the colorectum (25%). Less than 20 cases of cecal GCTs have been reported so far. Owing to its rarity, we report a case of an asymptomatic cecal GCT found incidentally during screening colonoscopy. CASE DESCRIPTION/METHODS: A 58-year-old male with no known past medical history presented to the Gastrointestinal (GI) clinic for screening colonoscopy. History was negative for alarm symptoms, including no family history of GI cancers. He had no prior Upper endoscopy or colonoscopy. Physical examination and labs were unremarkable. Colonoscopy revealed an 8mm yellowish, sessile, subepithelial nodule with normal overlying mucosa in the cecum (Figure 1). Biopsy showed clusters of cells with granular cytoplasm that was Periodic acid–Schiff (PAS) positive suggestive of GCT (Figure 2). Immunohistochemical staining was positive for S100, CD 68, calretinin thus confirming the diagnosis of GCT (Figure 3). The patient has since been scheduled for Endoscopic ultrasound (EUS) for further evaluation. DISCUSSION: Colorectal GCTs account for up to 25% of all GI GCTs, with most affecting the right sided colon (cecum and ascending colon). Mostly benign and solitary, but about 2% are known to have malignant potential with poor prognosis. More common in females and in African Americans between ages 40-60 years. Generally asymptomatic and found incidentally during a screening colonoscopy, however in a few cases, patients have presented with hematochezia, abdominal pain, and change in bowel habits. EUS is invaluable in differentiating GCTs from other subepithelial tumors, in determining the size, and depth of invasion. Definitive diagnosis is by histopathology and immunohistochemical staining. There is no general consensus on the management of colorectal GCTs. Conservative management is recommended for tumors < 1cm, asymptomatic, with no deep tissue invasion or malignancy. However, resection is warranted for symptomatic tumors, tumors >1 cm in size, deep tissue invasion or malignancy. Endoscopic removal is preferred over surgery for tumors without deep tissue infiltration or malignancy. Endoscopic and histologic surveillance every 1-2 years is recommended.

Analysis of nicotinamide N-methyltransferase in oral malignant melanoma and potential prognostic significance.

Oral malignant melanoma (OMM) is an aggressive tumour, and shows deep tissue invasion at initial presentation. The prognosis is worse than that for cutaneous melanoma (CM), and the overall 5-year survival rate is 10-25%. A study of the molecular mechanisms involved in the development of OMM is necessary to identify new prognostic markers. In this study, we evaluated the possible role of nicotinamide N-methyltransferase (NNMT) in OMM. We carried out immunohistochemical analyses to evaluate the expression of NNMT in 15 OMM and 15 CM, measuring the percentage of positive cells and the value of NNMT expression intensity. Furthermore, we explored the relationship between NNMT levels and the prognostic parameters of patients with OMM. NNMT was significantly more expressed in CM compared with OMM, whereas higher staining intensity for NNMT was observed in OMM cases (P<0.05). In addition, a significant relationship was found between NNMT staining intensity and the presence of ulceration (P<0.05). Furthermore, univariate analysis showed a negative effect of NNMT expression on the disease-free survival rate (P<0.05). This study is the first to report the expression of NNMT in OMM and to compare OMM enzyme levels with those detected in CM. Data obtained seem to suggest the presence of potential molecular differences between these two tumours.

Aggressiveness of solid pseudopapillary neoplasm of the pancreas: A literature review and meta-analysis.

Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors considered to be benign although 10% to 15% of SPNs have been reported to be aggressive. Due to its rarity, there have only been a few cases reported regarding the clinical course of patients with aggressive SPNs. The goal of this study is to describe the clinical course of patients diagnosed with aggressive SPNs. A PubMed search was done looking for articles describing the clinical course of patients diagnosed with SPN that locally invaded, recurred, or metastasized. Institutional experience was also added to the pooled data. Patient information was extracted from the articles. Survival and recurrence curves were plotted and factors associated with survival and recurrences were analyzed. A total of 59 patients were identified to have aggressive SPN. Seven patients were males and 52 were females and the mean age was 37.44 ± 2.21 years. Systemic metastasis constituted 81.4% while recurrence and deep tissue invasion were found in 11.9% and 6.8% of the patients, respectively. Disease-free survival was 45 ± 6.28 months and disease-specific survival was 152.67 ± 12.8 months. In survival analysis, age, gender, tumor size, tumor location, combined resection, type of recurrence, and stage IV on diagnosis were not significant factors in predicting survival. However, an unresectable tumor (hazards ratio [HR] = 4.871, 95% confidence interval [CI] 1.480-16.03, P = .009), and metastasis within 36 months (HR = 6.399, 95% CI: 1.390-29.452, P = .017) were identified as independent variables in predicting survival. SPNs of the pancreas carry a favorable course. Despite having aggressive properties, patients can still survive for more than 10 years as long as the tumor can be resected completely.

ESOPHAGEAL ACTINOMYCOSIS IN RECIPIENT AFTER HEART TRANSPLANTATION

In this article, we reported a clinical case of late posttransplant complication – esophageal actinomycosis in 58-yr-old woman 8 months after heart transplantation. Recipient had presented with a complaint of dyspeptic phenomena. Patient’s examination did not show any features. Blood results were fine but tacrolimus concentration was increased (24 ng/ml). Esophagogastroduodenoscopy identified signs of esophageal candidiasis, biopsy was taken. Histological examination revealed esophageal actinomycosis. According to other investigations we did not find any signs of antinomycosis in other organs. Taking into account the results of obtained research, there was no evidence of deep tissue invasion and no indications for surgical treatment, conservative management was chosen. Three months of antibacterial treatment (Doxycycline) was effective. Considering long-term management of this complication in out-patient department it is important to accomplish strictly the protocol of posttransplant follow-up, the same as it allows to diagnose in time. Conservative management of esophageal actinomycosis diagnosed on early stage can be effective.

Sclerodermiform basal cell carcinoma: how much can we rely on dermatoscopy to differentiate from non-aggressive basal cell carcinomas? Analysis of 1256 cases

Background:The behaviour of each basal cell carcinoma is known to be different according to the histological growth pattern. Among these aggressive lesions, sclerodermiform basal cell carcinomas are the most common type. This is a challenging-to-treat lesion due to its deep tissue invasion, rapid growth, risk of metastasis and overall poor prognosis if not diagnosed in early stages. ObjectiveTo investigate if sclerodermiform basal cell carcinomas are diagnosed later compared to non-sclerodermiform basal cell carcinoma Method: All lesions excised from 2000 to 2010 were included. A pathologist classified the lesions in two cohorts: one with specimens of non-aggressive basal cell carcinoma (superficial, nodular and pigmented), and other with sclerodermiform basal cell carcinoma. For each lesion, we collected patient’s information from digital medical records regarding: gender, age when first attending the clinic and the tumor location. Results:1256 lesions were included, out of which 296 (23.6%) corresponded to sclerodermiform basal cell carcinoma, whereas 960 (76.4%) were non-aggressive subtypes of basal cell carcinoma. The age of diagnosis was: 72.78±12.31 years for sclerodermiform basal cell and 69.26±13.87 years for non-aggressive basal cell carcinoma (P<.0001). Sclerodermiform basal cell carcinomas are diagnosed on average 3.52 years later than non-aggressive basal cell carcinomas. Sclerodermiform basal cell carcinomas were diagnosed 3.40 years and 2.34 years later than non-aggressive basal cell carcinomas in younger and older patients respectively (P=.002 and P=.03, respectively). Study Limitations:retrospective design. Conclusion:The diagnostic accuracy and primary clinic conjecture of sclerodermiform basal cell carcinomas is quite low compared to other forms of basal cell carcinoma such as nodular, superficial and pigmented. The dermoscopic vascular patterns, which is the basis for the diagnosis of non-melanocytic nonpigmented skin tumors, may not be particularly useful in identifying sclerodermiform basal cell carcinomas in early stages. As a distinct entity, sclerodermiform basal cell carcinomas show a lack of early diagnosis compared to less-aggressive subtypes of BCC, and thus, more accurate diagnostic tools apart from dermatoscopy are required to reach the goal of early-stage diagnosis of sclerodermiform basal cell carcinomas.

Clinical and pathological features of solid pseudopapillary neoplasm (SPN) of the pancreas: A retrospective review of cases at Mayo Clinic.

e15757 Background: SPN is a rare neoplasia of the pancreas, defined by the World Health Organization (WHO) as an epithelial low-grade malignant neoplasm, with a high-grade malignant transformation potential. Literature in this subject is scarce and limited only to small retrospective series. Methods: This is a retrospective study aiming to characterize patients with the diagnosis of SPN at Mayo Clinic between 1992 and 2016. Demographics, clinical and pathological features, recurrence rate and overall survival were recorded. Malignant SPN was defined as per the WHO 2010 classification (Perineural invasion, angioinvasion or deep tissue invasion) and compared to Benign SPN. Results: 44 patients with SPN were identified. 39 patients (88.6%) were female. Median age at diagnosis was 27.5 (Range: 13-64). The most frequent presentation was abdominal pain (52.6%), whereas 36.8% were diagnosed based on incidental imaging findings. Majority (60.4%) of the tumors were located at the pancreatic tail, and 48.5% were solid-cystic lesions. Vascular and lymph node involvement were infrequent. 15 cases (30.23%) were classified as malignant. Tumor size was associated with malignant behavior (Table). Three patients had a metastatic presentation. All but 1 patient were treated with surgery. R1 resection was more frequent in malignant SPN, and 2 patients experienced disease recurrence. Two Stage IV patients were treated with surgery and experienced long term survival, one of them without evidence of disease. There was only 1 death recorded. Conclusions: SNP presents predominantly on young women. The prognosis is excellent even in presence of malignant features, and a complete surgery remains as the main treatment. [Table: see text]

Clinicopathologic Review of 31 Cases of Solid Pseudopapillary Pancreatic Tumors: Can We Use the Scoring System of Microscopic Features for Suggesting Clinically Malignant Potential?

A solid pseudopapillary tumor (SPT) is a pancreatic neoplasm of low malignant potential. The potentially malignant pathologic features of SPTs were regarded as angioinvasion, perineural invasion, deep invasion of the surrounding acinar tissue, and nuclear pleomorphism. We retrospectively reviewed 31 cases of SPTs (25 female and 6 male patients, with an average age of 35 ± 14 years). The mean follow-up period was 132.0 ± 55.9 months. To evaluate the clinical impact of above pathological parameters, we analyzed their correlation with actually observed clinical malignancy. In three cases, the SPTs were clearly clinically malignant: one patient had recurrences three times, one showed lymph node metastases, and one deep soft tissue invasion around the gastroduodenal artery. Tumor infiltration to the peripancreatic soft tissue was observed in 17 cases (54.8%). The pathologic features considered suggestive of malignant potential were angioinvasion (25.8%), perineural invasion (6.5%), presence of mitosis in 10 high-power fields (16.1%), and moderate nuclear pleomorphism (19.4%). The presence of at least three of these features was not correlated with clinically confirmed malignant behavior (P = 0.570). Microscopic pathologic features of SPTs cannot be reliably associated with aggressive clinical behavior. Moreover, the absence of these microscopic features cannot exclude clinical malignancy.

Dermatofibrosarcoma protuberans-a rare neoplasm.

Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade tumour which accounts for about 6% of all soft tissue sarcoma. It is typically a superficial cutaneous tumour characterized by high rates of local recurrence but with low risk of metastasis (1). In about half of DFSP cases, the tumour is located on the trunk, followed by 30-40% of cases located in the proximal portion of the limbs, and 10-15% of cases in the head and neck (2). Clinical diagnosis can be made based on tumour’s clinical appearance, thus, the role of imaging diagnosis is limited. Despite its superficial location and slow growing feature, large lesions of DFSP may demonstrate deep tissue invasion and atypical manifestations, therefore, resulting in misdiagnosis. Since only several reports are available in the literature with a focus on imaging findings of DFSP (2-6), we report a case of DFSP with the aim of enhancing our knowledge of this unusual tumour.

Squamocellular Carcinoma of the Skin: Clinicopathological Features Predicting the Involvement of the Surgical Margins and Review of the Literature

Background: The new AJCC classification has highlighted some particular risk factors for squamous cell carcinoma (SCC) relevant for prognosis. Incomplete excision is not infrequent in SCC. The aim of this study is to examine features that can predict an incomplete excision on the basis of the new AJCC classification and to review the literature on this topic. Materials and Methods: 81 SCC patients were included. All patients were submitted to excisional biopsy with a margin of at least 4 mm from the clinical edges as recommended. Histological characteristics of the lesions analysed were maximum diameter, grading, site, Breslow thickness, Clark level, deep tissue invasion (neural, bone, muscle), presence of ulceration and positivity of the margins. Results: The average Breslow thickness was 3.93 mm. Out of the 81 patients included, 14 showed involved margins. The 2 parameters that were implicated in predicting involvement of the margins in the multivariable model were Breslow thickness and location of the lesion on the ear or lip. Grading was not associated with involvement of margins. Conclusion: According to the new AJCC classification, this study could be useful to plan the most suitable surgical technique in order to avoid the risk of incomplete surgery.

Giant Basal Cell Carcinoma

Giant basal cell carcinomas (GBCCs) are a strange and aggressive variety of basal cell carcinomas (BCCs); they are characterized by deep tissue invasion, rapid growth, high risk of metastasis, and a poor prognosis. GBCCs represent 0.4%-1% of all BCCs. The pathogenesis of GBCC is sometimes linked to a spontaneous mutation in the PTCH gene, mapped to the q22.33 locus of chromosome 9. The key factor in the development of GBCC, in at least 30% of the cases, is the delay in seeking medical attention (7.5 ± 3.1 years). This is associated to a poor socioeconomic level, deficient hygiene, mental illness, advanced age, and the fact that BCCs are painless lesions. The authors present a Mexican female with a 2-year ulcer diagnosed as a GBCC in the year 2000, its initial therapeutic approach, and her follow-up during the next 12 years.