Histologic Diagnosis Of Carcinoma Research Articles

The pathologic diagnosis of carcinoma in various tissues.

Carcinoma is defined as cancer arising from the epithelial cells that line an organ or tissue. The most common carcinoma in males arises in the prostate and breast in females; while the most significant cause of cancer related mortality in the United States is carcinoma of the lung. Cancers typically begin as a clonal proliferation of cells that have acquired distinct mutations, which then progress to invasive carcinoma as the cells breach the underlying basement membrane associated with the tissue of origin. This transition to invasive carcinoma carries with it the potential to invade blood vessels or lymphatic channels and metastasize to lymph nodes or distant tissues resulting in increased morbidity and mortality. The histologic diagnosis of carcinoma is rendered based on both the cytologic and architectural features of the tumor, as well as the location of the proliferating cells and the interaction with the surrounding stromal elements.

Diagnosis, characteristics, and treatment of breast carcinomas within benign fibroepithelial tumors.

Breast carcinoma arising in a benign fibroepithelial tumor is rare, and is usually discovered incidentally during examination of the breast mass. We evaluated the clinicopathological features, treatment, and prognosis of seven women with breast carcinomas within benign fibroepithelial tumors, diagnosed and treated at a single institution between 2011 and 2015. Seven women, aged 21-64years, visited our hospital complaining of a breast mass detected by self-checking or screening examination. All patients had well-demarcated movable breast masses. Ultrasonography showed circumscribed masses suggesting benign tumors in all cases, and mammography revealed well-defined, high-density masses, with or without calcification. The masses progressed in two patients. A preoperative histological diagnosis of carcinoma was made following needle biopsy in four patients. Tumorectomy, breast-conserving surgery, and mastectomy were performed in three, two, and two patients, respectively. One patient underwent lymph node dissection and another underwent sentinel node biopsy. Histologically, the masses were diagnosed as invasive ductal carcinoma, ductal carcinoma in situ or lobular carcinoma in situ, arising in a benign phyllodes tumor, fibroadenoma, or fibroadenomatoid mastopathy. Lymph node metastasis was detected in two patients. There was no recurrence in any of the patients. Although a carcinoma within a preexisting benign fibroepithelial tumor is extremely rare, it is important to be aware of the possibility of invasive and metastatic disease.

The role of immunohistochemistry in the detection of vascular invasion in specimens of endoscopic submucosal dissection

INTRODUCTION: Endoscopic submucosal dissection (ESD) of early neoplasias of the gastrointestinal tract (GIT) has been increasingly applied as an alternative to invasive surgical procedures, with the aim to preserve the patient's organ and quality of life, although it does not allow the histopathological analysis of lymph nodes. Previous studies demonstrated that the presence of neoplastic emboli in lymphatic (lymphatic vascular invasion [LVI]) or blood vessels (blood vascular invasion [BVI]) is considered a positive predictive factor for the occurrence of lymph node metastasis. The assessment of vascular invasion carried out only by routine hematoxylin and eosin staining (HE) may yield both falsepositive and false-negative results. D2-40 is a specific monoclonal antibody to the lymphatic endothelium. Thus, it is useful for identifying LVI and distinguishing if tumor embolization is found in blood or lymphatic vessels. OBJECTIVE: To determine the role of immunohistochemistry (IHC) in the assessment of ESD specimens by comparing the detection of LVI and BVI by HE and IHC with D2-40 and CD34 immunolabeling. METHOD: We conducted the IHC study using D2-40 and CD34 markers (pan-endothelial) in 30 cases of ESD with histological diagnosis of carcinoma in order to assess the presence of LVI and BVI. RESULTS: The detection of LVI was more prevalent than BVI. Three out of six cases with LVI were false-positive by HE and six were false-negative by IHC. Regarding BVI, five cases were identified and one was false-negative by IHC. CONCLUSION: Our results indicated that the histopathological analysis of ESD specimens by exclusively routine HE staining does not allow proper evaluation of BVI or LVI.

1048P - Radiation-Induced Malignancy Following Definitive Radiotherapy for Nasopharyngeal Carcinoma

ABSTRACT Purpose To analyze the clinicopathological characteristics, treatment modalities, and potential prognostic factors of radiation-induced malignancy (RIM) in patients with nasopharyngeal carcinoma (NPC). Methods We reviewed institutional electronic medical records of 39,118 patients with NPC treated by definitive radiotherapy between February 1964 and 2003. A total of 228 patients with confirmed RIM were included in this study. Results The median latency between radiotherapy for NPC and the diagnosis of RIM was 9.5 years (range, 3.1 to 30.2 years). Squamous cell carcinoma was the most common histologic type, followed by fibrosarcoma, osteosarcoma, and adenocarcinoma. Median progression-free survival and overall survival (OS) of the 216 patients who underwent treatment were 18.7 months (95% CI, 12.8 to 24.5) and 32.0 months (95% CI, 23.8 to 40.1), respectively. Five-year OS rates were 36.9% and 20.2% for carcinoma and sarcoma, respectively (P = 0.004). The 5-year OS rates were 45.4%, 21.8%, and 0% for the surgery (140 patients), radiotherapy (44 patients), and chemotherapy (32 patients) groups, respectively (P = 0.000). The independent prognostic factors associated with improved OS were histologic diagnosis of carcinoma and complete surgical resection. Conclusion Histologic type and treatment modality were the significant prognostic factors for patients with RIM. Complete resection apparently offers the best chance for long-term survival. In select patients with locally advanced and unresectable RIM, reirradiation should be strongly considered as a curative option. Disclosure All authors have declared no conflicts of interest.

Primary malignant neoplasms of orofacial origin: a retrospective review of 256 cases in a Nigerian tertiary hospital

A retrospective review of cases histologically diagnosed as malignant lesions of the orofacial region in 1992–2003 from the records of the Department of Oral Pathology and Biology, Lagos University Teaching Hospital, Nigeria was carried out. All cases were subjected to analysis of age, gender, site distribution and histologic types. Malignant tumours constituted 18% of all the biopsies of orofacial lesions seen within the period. The mean age of patients was 42.2 ± 21.5 years (range: 2.5–85). There were 177 (69%) epithelial tumours of which squamous cell carcinoma was predominant, 47 (18%) sarcomas and 32 (13%) lymphomas. Squamous cell carcinoma (44%) was the most common malignant orofacial tumour. Osteosarcoma (32%) and Burkitt's lymphoma (56%) was the predominant sarcoma and lymphoma, respectively. Patients with a histologic diagnosis of carcinoma were older than those with sarcomas and lymphomas ( P < 0.01), and those with a histologic diagnosis of malignant lymphoma were significantly younger than those with sarcomas ( P < 0.01). Almost 25% of patients with carcinomas were below the age of 40 years. Malignant orofacial tumours are not uncommon in the studied environment, with a sizable proportion of carcinomas occurring before the age of 40 years.

The cytological and clinical value of the thyroid “follicular lesion”

Background: The main limitation of fine-needle aspiration (FNA) is its limited distinction between neoplastic and benign lesions. We summarize our experience with thyroid nodules that were defined as follicular lesions by comparing the clinical and cytological features of the thyroid follicular lesions that were examined histologically to define the most reliable criteria of malignancy. Methods: The medical records of all patients who underwent thyroid aspiration at Rabin Medical Center from 1999 to 2000 were reviewed for a diagnosis of follicular lesion that warranted surgery (N = 58). The cytology and pathology reports of the patients who met these criteria were reviewed and compared with the original reports. Results: The incidence of malignancy in follicular lesions of the thyroid is about 26%. There was a significant correlation between a histologic diagnosis of carcinoma and the cytologic findings of nuclear grooves ( P = .041), solid arrangement ( P = .019), hypercellularity ( P = .01), and hypercellularity to colloid amount ratio ( P = .016). Nodular size was predictive of malignancy. No correlation was found between patient age or gender and tendency toward malignancy. Conclusions: The combination of cytological characteristics and the size of the nodule aspirate are predictive values of malignancy. We believe that every follicular lesion should be excised to obtain a definitive histological diagnosis based on capsular or vascular invasion.

A cervical smear review in women developing cervical carcinoma with particular reference to age, false negative cytology and the histologic type of the carcinoma.

A review of all available cervical smears from 96 women who subsequently developed invasive cervical carcinoma was undertaken. The aim of the study was to determine the incidence of confirmed negative smears prior to the histologic diagnosis of carcinoma and investigate the relationship between the duration and grade of smear abnormality, the patients' age and the histologic types of cervical carcinoma. The results indicate that only 10% of women had confirmed negative smears, the majority occurring more than 7 years before the diagnosis of carcinoma. In contrast, 89% of young women (under 40 years of age) had a significant abnormality (moderate dyskaryosis or worse) up to 6 years before diagnosis. There is evidence to suggest that the preinvasive phase of cervical carcinoma may be shorter in younger women and that the less common types of cervical carcinoma occur more frequently in this group. The combination of inadequate clinical follow up and false negative cytology may have allowed a significant proportion of these women to develop invasive cervical carcinoma. Possible reasons for false negative smears have been identified and methods aimed at decreasing their frequency are discussed.

Inhibition of sensitized leukocyte's in vitro reactivity by circulating immune complexes in prostate cancer.

Circulating immune complexes in the sera of patients with confirmed histological diagnosis of carcinoma of the prostate, were found to interfere in the sensitized leukocyte's in vitro reactivity to prostate cancer associated antigen as evaluated by tube leukocyte adherence inhibition assay, thereby suggesting an inhibitory role of such serum factors in host's anti tumor cell mediated immune responses.

The Interpretation of the Radionuclide Subtraction Scan in Pancreatic Carcinoma

Summary In the present study an attempt has been made to indicate the different types of radionuclide subtraction scan patterns that can occur in carcinoma of the pancreas. A follow up was made of 44 consecutive patients with established clinical or proven histological diagnosis of carcinoma of the pancreas from a total series of 800 who were presented for radionuclide subtraction scanning. The study does not attempt to analyse results in pancreatic carcinoma but merely to indicate the type of scan presentations which can occur. It was interesting to find that more than one third of the patients studied presented with an uptake of 75Se Selenomethionine in the tumour region and only a small number of the series revealed the tumour by a filling defect in an otherwise normal pancreatic scan. Despite the differing scan presentations of carcinoma of the pancreas it was generally not possible on the scan alone to differentiate a benign from a malignant lesion. but in each case the scan was clearly abnormal and when taken within the clinical context could well represent a carcinoma.

The Current Role of Exfoliative Cytopathology in the Routine Diagnosis of Bronchogenic Carcinoma: A Five-Year Study of 152 Consecutive, Unselected Cases

@Although the sensitivity of exfoliative cytopathology in the diagnosis of bronchogenic carcinoma has been reported to be as low as 44 per cent,' most cytologists find malignant cells in the sputum or bronchial aspirates from three of every four patients with lung cancer, more or less.24 Most reports contain selected series of cases, since patients who have not had cytologic examinations usually are excluded; likewise patients in whom the quantity or quality of the smears is not adequate also may be omitted. Thus it is difficult to ascertain the full role of exfoliative cytodiagnosis of carcinoma of the lung in routine hospital practice. The purpose of this study was to determine this role by a retrospective analysis. Material and Method The results of all types of microscopic diagnostic modalities utilized in 152 consecutive unselected and histologically proved bronchogenic carcinomas in patients admitted to the Veterans Administration Hospi tal at Ann Arbor, over a five-year period (1954-1959) were reviewed and tabulated. The series included six cases in which the neoplasm was an unexpected or incidental finding at necropsy thereby precluding ante mortem diagnostic studies. One hundred and twenty-six (82.9 per cent) of the patients had some form of cytologic smear examination-sputum, bronchial aspirate, or pleu ral fluid. Usually multiple specimens were examined; the mean was about three specimens per patient. However, in many instances the cytologic study was limited to the examination of a single specimen. Four smears were prepared from each specimen and were processed in accordance with the standard Papanicolaou technique. Ninty-six (63.2 per cent) of the patients were subjected to broncho scopy; for the purpose of this study, bronchoscopy was interpreted as positive only when a histologic diagnosis of carcinoma was made by bronchial biopsy. Eighty-nine patients (58.6 per cent) had anterior scalene lymph node biopsies, performed according to the technique of Daniels.7 The lymph nodes were obtained from the right side when a lesion was present in the right lung or the left lower lobe; left scalene lymph node biopsies were reserved for lesions in the left upper lobe or lingular segments. The number of lymph nodes in these specimens varied from 0 to 20 with a mean of six. Histologic examinations of tissue from suspected metastases were made in 18 cases. These tissues included lymph nodes (other than scalene), liver, skin, bone, or central nervous system. Thus a total of

Carcinoma of the thyroid at autopsy.

A number of writers 2-4 have commented on the relatively low incidence of carcinoma of the thyroid in autopsy material in comparison with the frequency with which the diagnosis is made on thyroid glands which are surgically removed. It has been suggested that either the histologic diagnosis of carcinoma is incorrect in some of these cases or the histologic appearance is not matched by biologic aggressiveness. Such assumptions have naturally led to the viewpoint that certain therapeutic measures commonly employed in the treatment of malignant tumors are unnecessary. The purpose of this report is to give the actual incidence of carcinoma of the thyroid in patients studied at autopsy in a general private hospital. The thyroid glands were routinely removed by residents; they were encouraged to take blocks of tissue from nodules and scars for microscopic examination. The accompanying Table lists all of the 32 carcinomas of the thyroid encountered

Diagnosis of gastric malignancy by blind gastric biopsy.

Two cases have been reported in which a histologic diagnosis of carcinoma of the stomach was made by means of biopsy by the Wood's tube.