Foci Of Anaplastic Carcinoma Research Articles

Benign Mucinous Tumor of Ovary with a Sarcoma-Like Mural Nodule: A Case Report

Sarcoma-like mural nodules occur predominantly in middle-aged women. Distinction of these lesions from true sarcomatous nodules and foci of anaplastic carcinoma is important because of the worse prognosis of these tumors in comparison with the favorable behavior of sarcoma-like mural nodules. In this report we describe the case of a 35-year-old woman with a mucinous ovarian tumor having a mural nodule in the wall.

Prognostic Factors for Thyroid Carcinoma Originating from Follicular Cells

Most thyroid carcinomas originating from follicular cells are differentiated carcinomas (DTC) that generally have an indolent character and show a favorable prognosis if treated appropriately. However, cases with certain clinicopathological characteristics are progressive and life threatening. In this special issue, scientific papers and reviews regarding the prognosis and prognostic factors of thyroid carcinoma patients were collated. The first paper is a review of prognostic factors of DTC based on data from the Kuma Hospital, a hospital specializing in thyroid care. Prominent prognostic factors of DTC are indicated here in an orthodox fashion. The second one demonstrated the difference in preoperative thyrotropin serum concentrations according to the pathological diagnosis: benign nodule, papillary microcarcinoma, and clinical papillary carcinoma. It is well known that clinical node metastasis detected on preoperative imaging studies affects the prognosis of papillary carcinoma patients, as indicated in the first paper. In the third paper, the prognosis of patients showing clinical lateral node metastasis on the side contralateral but not ipsilateral to the primary lesions was investigated. Such cases generally show indolent behavior. For surgery of papillary carcinoma, it remains debatable whether central node dissection is important. The fourth paper indicates frequent metastasis to the central compartment as well as risk factors of central node metastasis and concludes that total central node dissection is preferable for papillary carcinoma. Most prominent prognostic factors of papillary carcinoma can be evaluated based on pre- and intraoperative findings. However, pathological examination is also important because there are some aggressive variants such as the tall cell variant of papillary carcinoma. Furthermore, small foci of anaplastic carcinoma or squamous cell carcinoma may be detected, which significantly predict a dire prognosis. However, the fifth paper demonstrated a comparatively favorable prognosis of papillary thyroid carcinoma patients with squamous cell carcinoma compartments if they can successfully undergo locally curative surgery. Papillary carcinoma shows locoregional recurrence much more frequently than distant recurrence, and the organ in which papillary carcinoma is most likely to recur is the regional lymph node. However, papillary carcinoma recurrence can lead to various other locoregional lesions. The sixth paper investigated the clinical significance of subcutaneous or intrastrap muscular recurrence and showed that it is not fatal but is a predictor of distant recurrence and that careful follow-up is required for such patients. The three papers from the seventh to ninth focused on up-to-date topics. The seventh one demonstrated that recombinant human thyrotropin-aided radioiodine therapy is beneficial for patients with metastatic DTC. The authors showed that this strategy yielded a therapeutic benefit in 39% of patients who otherwise could not be efficiently treated with 131I therapy. The eighth paper reviewed the role of 18FDG-PET for the diagnosis, prognosis, and management of thyroid carcinoma. The ninth paper is also a review of the RET rearrangement in Chernobyl-related thyroid carcinoma. This theme is quite timely because of the Tohoku disaster in Japan in March 2011. As indicated above, this special issue includes papers investigating the prognosis of DTC patients from various standpoints. I hope that this special issue significantly contributes to the advancement of thyroid carcinoma therapy. Yasuhiro Ito Bryan McIver Nicola Besic Amit Agarwal

Malign mural nodules associated with serous ovarian tumor of borderline malignancy: a case report and literature review

Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare. A 54-year-old woman referred with abdominal swelling. Imaging studies revealed a huge mass localized in pelvis and lower abdomen and grade 1-2 left renal hydronephrosis. Preoperative Ca-125 was 798 U/ml. In exploratory laparotomy there was a 16 cm mass adherent to lateral abdominal wall and intestines. Adhesiolysis and de-bulking surgery were performed including bilateral pelvic, para-aortic lymphadenectomy, appendectomy and omentectomy. Left ureter was found to be dilated because of the infiltration of distal part by the tumor, so distal ureteral resection and neoureterocystostomy were performed. Final pathology revealed borderline serous ovarian tumor with mural nodules which were consisted of SLMNs, multiple and sharply demarcated from the adjacent tumor, and sarcomatous nodules showing infiltrative appearance in metastatic regions. Mural nodules showed a positive reaction for vimentin and SMA but were negative for cytokeratin and also necrosis, hemorrhage, and 10-15 mitoses in 10 high power fields were noted. She had postoperative chemotherapy and follow-up is going on without metastases in her first year. The existence of sarcomatous nodules combined with the SLMN necessitates a careful histologic analysis for treatment and the determination of prognosis. However, too few cases of mixed type mural nodules have been published to warrant a conclusion regarding their prognosis.

Sarcoma-like mural nodules in mucinous cystic tumors of the ovary revisited: a clinicopathologic analysis of 10 additional cases.

Ten mucinous cystic ovarian tumors that contained sarcoma-like mural nodules are described. The nodules were studied by conventional and immunohistochemical methods. The sarcoma-like mural nodules occurred predominantly in middle-aged women, were multiple and sharply demarcated from the adjacent mucinous tumor, had small size, and exhibited a heterogeneous cell population. Distinction of these lesions from true sarcomatous nodules and foci of anaplastic carcinoma is important because of the worse prognosis of the two latter tumors compared with the favorable behavior of the sarcoma-like mural nodules. Six of the eight patients with follow-up information were alive and clinically free of recurrence at a mean follow-up interval of 12 years. Two patients died of other causes (thyroid and breast carcinomas). The nature of the nodules is not clear. Sarcoma-like mural nodules probably represent a reactive and self-limited phenomenon within a neoplasia. Their coexpression of vimentin and cytokeratins is consistent with an origin from submesothelial mesenchymal cells, which undergo partial transformation into epithelial cells.

Mucinous tumors of the ovary: a clinicopathologic analysis of 75 borderline tumors (of intestinal type) and carcinomas.

With the exception of benign cystadenomas, mucinous ovarian tumors are rare and heterogeneous neoplasms. They have been classified as either borderline tumors or carcinomas for almost 30 years. Subsequently, the borderline tumors have been subclassified into endocervical-like and intestinal types. The diagnostic criteria for distinguishing borderline tumors of the intestinal type from mucinous carcinomas have varied, making difficult the interpretation of prognostic information. More recently, a further subdivision of the former tumors into forms with only epithelial atypia and variants with focal intraepithelial carcinoma has been proposed. Consequently, in this study of 41 mucinous borderline tumors of intestinal type and 34 mucinous carcinomas, the former were also subdivided into 30 cases with mild to moderate atypia only and 11 with areas of intraepithelial carcinoma. All 30 purely borderline tumors were stage I tumors, and all 15 with follow-up information (including one case with microinvasion) were clinically benign. All 11 mucinous borderline tumors that had foci of intraepithelial carcinoma were also stage I neoplasms, and none of the eight patients with follow-up data (including one with microinvasive carcinoma) recurred. Thirty-four invasive carcinomas were subclassified into 15 expansile and 19 infiltrative subtypes. All 15 carcinomas with only expansile invasion were stage I; none of the 11 with follow-up data recurred. Three of nine patients with stage I infiltrative carcinomas with follow-up information had a fatal recurrence. Eight of the remaining 10 infiltrative carcinomas had extended beyond the ovary at the time of diagnosis (stages II and III); of the six patients with follow-up data, four died of tumor and two were alive with disease. In stage I carcinomas nuclear grade and tumor rupture correlated with unfavorable prognosis, but less than infiltrative invasion. However, all three fatal tumors were infiltrative carcinomas that had ruptured, and two contained grade 3 malignant nuclei. Combination of infiltrative invasion, high nuclear grade, and tumor rupture is a strong predictor of recurrence for stage I mucinous ovarian tumors. Among the 19 infiltrative tumors, 13 contained foci of anaplastic carcinoma. Of the seven patients with stage I tumors and follow-up data, only one patient whose tumor had ruptured intraoperatively had a fatal recurrence. The presence of anaplastic components in stage Ia (intact) carcinomas did not have an adverse effect in their outcome, even when the undifferentiated carcinomatous elements appeared in the form of mural nodules.

Immunohistochemical study of sarcoma-like mural nodules in a mucinous cystadenocarcinoma of the ovary

We describe an ovarian mucinous cystadenocarcinoma with several sarcoma-like mural nodules (SLMN). The distinction between these lesions and foci of anaplastic carcinoma is important because of the poor prognosis of the latter. We have studied the potential value of immunohistochemistry in the differential diagnosis of these two lesions. In contrast to an anaplastic carcinoma, which was largely composed of keratin-positive cells, SLMN were negative or only focally positive. Therefore, in distinguishing SLMN from foci of anaplastic carcinoma, keratin strains may be added to other gross and microscopical differential features, such as size, demarcation, and presence or lack of obvious carcinomatous elements.

Pancreatic mucinous cystadenocarcinoma with pseudosarcomatous mural nodules. A report of a case with immunohistochemical study

A case of pancreatic mucinous cystadenocarcinoma (PMC) with two pseudosarcomatous mural nodules (PMN) is described. These nodules have not been previously described in this type of tumor. In ovarian mucinous tumors (OMT), similar nodules have been reported, the nature of which has been discussed in detail. Here the similarity between the tumor described here and ovarian tumors is stressed. The immunohistochemical study carried out disclosed in the nodules strong positive staining for vimentin and moderate positivity for keratin and epithelial membrane antigen. These findings, along with histologic details, favor the epithelial nature of the nodules. It was concluded that the nodules are foci of anaplastic carcinoma with high proliferative cell rate, which could explain the coexpression of vimentin and keratin.