Histological Evidence Of Malignancy Research Articles

AMELOBLASTIC CARCINOMA IN MANDIBLE - CASE REPORT

Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits histologic characteristics of ameloblastoma. The term "ameloblastic carcinoma" is used to describe those ameloblastomas in which there is histologic evidence of malignancy. In this report, we describe a case of a 41-year-old female patient who sought dental care complaining about the mobility of the right lower second premolar tooth. On intraoral examination, firm swelling that extended from the ipsilateral lateral incisor to the molar was observed. A panoramic radiography showed an osteolytic lesion with irregular margins with a "moth-eaten" aspect in the mandible. Incisional biopsy was performed, and the material was sent for histopathologic analysis, which revealed ameloblastic carcinoma. The patient was referred to the head and neck surgery service where mandibulectomy with neck dissection was performed. The patient is under clinical follow-up for 9 years without recurrence.

Propensity score-matching analysis comparing safety outcomes of appetite-stimulating medications in oncology patients.

Anorexia and weight loss are common complications in the elderly, advanced cancer population. Appetite stimulants are commonly used therapies for oncology patients with weight loss, yet their safety comparison remains unknown. This was a two-center, retrospective, study conducted in New York City at Mount Sinai Beth Israel and New York University Langone from January 2016 to July 2019 in adult patients with histologic evidence of malignancy who were taking either megestrol acetate or mirtazapine as an appetite-stimulating medication. Endpoints included safety concerns of mortality, QTc prolongation, venous thromboembolism, fall, somnolence, xerostomia, and hallucinations. Effectiveness of weight gain or maintenance of weight was not assessed. A propensity score-matching analysis was performed using a logistic regression analysis to assess thetwo comparable groups. The study included 350 patients (69.56 ± 13.31years) with the most common malignancies being gastrointestinal, breast, and hematologic with metastasis present in over half the patients. Adverse events were commonly seen in the oncology population. After a propensity score-matched analysis, all safety outcomes associated with mirtazapine compared to megestrol acetate were similar; all-cause mortality (7%, n = 7 vs. 12%, n = 12, p = 0.23), QTc prolongation (31%, n = 31 vs. 31%, n = 31, p = 1.00), thromboembolism (11%, n = 11 vs. 11%, n = 11, p = 1.00), somnolence (29%, n = 30 vs. 22%, n = 23, p = 0.34), xerostomia (27%, n = 28 vs. 18%, n = 19, p = 0.24), and hallucinations (17%, n = 18 vs. 8%, n = 8, p = 0.06), respectfully. There were no safety differences seen when evaluating both agents.

Study of Clinical Profile and Management of LABC- our Experience

Introduction and Objective: Worldwide, breast carcinoma is among the most common carcinoma in females. It is commonly seen site-specific carcinoma in females. Due to lack of education, breast carcinoma patients present in later stages of the disease to healthcare facilities, especially in developing nations. Patients with Locally advanced carcinoma breast (LABC) are commonly seen in developing nations and its treatment multidisciplinary approach. This study is our experience of clinical profile and LABC in a rural setup.
 Methodology: This is a retrospective and prospective study done in the medical college. Data was taken from 72 cases that were operated on at the institute from July 2018 to June 2021 and diagnosed with LABC. Patients who had histological evidence of malignancy were undergone surgery and other treatment modalities like neoadjuvant chemotherapy, adjuvant chemoradiation, and hormonal therapy.
 Results: Seventy-two patients diagnosed with LABC over three years were included in the study. The mean age was 51 years. The tumor size was more than 5cm in 60 (83.3%) patients. Involvement of axilla was present in 62 (86.1%) patients. All patients were diagnosed with histopathology after core needle biopsy. Neoadjuvant chemotherapy was given to 62 (86.1%) patients. Most of the patients (65) were undergone MRM as surgery, while the remainder (7) were undergone breast conservation therapy. Very few patients had postoperative complications, but with limited follow-up until this study, 5 (6.9%) patients had a recurrence of their study.
 Conclusion: In developing nations high percentage of Locally advanced breast carcinoma at presentation result in poor prognosis, high rate of metastasis, and mortality. Awareness and education about breast health and multimodality treatment of LABC will have long-term effects to decrease morbidity and mortality and improve outcomes.

S3045 Acute Ileitis Secondary to Escherichia Coli

Introduction: Ileitis is classically associated with Crohn's disease or typical bacterial pathogens such as Yersinia spp. We present a case of acute terminal ileitis due to enteropathogenic Escherichia coli (EPEC), initially misdiagnosed as malignancy on imaging. Case Description/Methods: A 47-year-old man with no significant past medical history presented with three days of low-grade fever and abdominal pain without diarrhea. Initial exam was remarkable for fever to 100.4 degrees and peri-umbilical tenderness to palpation without guarding or rebound tenderness. SARS-CoV-2 testing was negative. Abdominopelvic CT revealed a 4 cm terminal ileum mass and regional lymphadenopathy (maximum 3 cm) concerning for a neuroendocrine tumor with adjacent lymph node metastasis. Subsequent colonoscopy revealed gross inflammation in the terminal ileum (Figure 1). Stool PCR and small bowel biopsies were both positive for EPEC, and there was no histologic evidence of malignancy. The patient completed five days of ciprofloxacin and metronidazole with resolution of symptoms. Follow up CT six weeks later showed resolution of ileitis and lymphadenopathy. Discussion: Terminal ileitis is isolated inflammation of the ileum without involvement of the ileocecal valve or colonic mucosa. Ileitis typically presents as acute onset of right lower quadrant abdominal pain associated with or without diarrhea and is often self-limited, especially in cases of bacterial ileitis. Multiple etiologies have been attributed to the development of terminal ileitis. Noninfectious causes primarily include inflammatory bowel disease, spondyloarthropathies, ischemia, malignancy, and medication-induced. Infectious ileitis is most commonly secondary to Yersinia spp., Salmonella spp., Campylobacter, Cytomegalovirus, or Mycobacterium tuberculosis, among others. Escherichia coli (E. coli) is not known to be a causative organism of ileitis. Infectious diarrhea is most commonly identified by PCR testing of a stool sample for common organisms. As this is a relatively new diagnostic test, it is possible that historical cases of ileitis were caused by E. coli, but were not identified due to limitations of available testing. To our knowledge, there have been only two prior pediatric case reports and no adult case reports of terminal ileitis associated with E. coli in the absence of inflammatory bowel disease. It is important to consider alternative causes of terminal ileitis, as misdiagnosis may result in significant delays in management and inappropriate treatment..

Immunoglobulin (Ig) G4-related sclerosing cholangitis in patients resected for presumed perihilar cholangiocarcinoma: a 10-year experience.

BackgroundThis study aimed to investigate the incidence of immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC) in patients resected for perihilar cholangiocarcinoma (PHC) in a designated hospital from 2010 to 2019. We also aimed to evaluate the diagnostic dilemma of IgG4-SC clinically.MethodsBetween January 2010 and December 2019, all patients who underwent radical resection due to presumed PHC were included. Independent pathologists scored bile duct samples based on the International Consensus Pathology Criteria for IgG4-related Disease (ICPD).ResultsOf the 289 patients who underwent radical resection of primary liver cancer, 26 (9%) were diagnosed as benign, without histological evidence of malignancy, among them, 23 had sclerosing inflammation, 1 had cystadenoma, and 2 had xanthogranulomatous cholangitis. Additionally, 18 had a definitive diagnosis of IgG4-SC. The misdiagnosis rate was 19% (54/289), of which, 26 patients had benign disease, and 28 patients had malignancies.ConclusionsIt is difficult to distinguish IgG-SC from PHC. The misdiagnosis has resulted in a large number of ineffective hepatectomies. Improving the detection rate of serum IgG4 (sIgG4) may therefore avoid misdiagnosis, surgery, and life-threatening complications.

RARE PRESENTATION OF MEDIASTINAL ABSCESS SUPERINFECTION IN AN INFLUENZA B PATIENT

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Influenza is generally a self-limited infection, however complicated with bacterial superinfection, it has been associated with increased morbidity and mortality[1]. We present the first case report in the literature of an immunocompetent Influenza B patient complicated with methicillin-sensitive Staphylococcus aureus (MSSA) mediastinal abscess and necrotizing pneumonia. CASE PRESENTATION: A 33-year-old male patient with past medical history of asthma presented to ED with myalgias, productive cough with rusty sputum and intermittent low-grade fever for 2 weeks. Initial vitals showed temperature of 100.6 F, heart rate of 106 bpm, respiratory rate of 24 with normal blood pressure and oxygen saturation. Physical examination was unremarkable. Initial workup revealed leukocytosis with WBC of 18 k/ul. CXR showed asymmetric enlargement of the right hilum with suspicion of central mass and to further analyze CT Chest with IV contrast was done showing consolidation in the right lower lobe (RLL) with mass-like consolidation in right hilum with mediastinal extension. (Figure 1) Patient was treated empirically with Piperacillin/Tazobactam, Vancomycin and Azithromycin. Nasopharyngeal swab for Influenza B PCR came back positive and blood cultures grew MSSA after which antibiotics were de-escalated to Oxacillin. His hospital course was complicated by clinical deterioration and repeat CT Chest revealed RLL Necrotizing Pneumonia and anterior mediastinal abscess. (Figure 2) He had emergent median sternotomy with radical thymectomy and debridement of mediastinal tissues. No histological evidence of malignancy was present, and cultures grew MSSA. He improved clinically and was discharged on IV oxacillin course for 6 weeks. His follow up CT chest showed complete resolution of mediastinal and resolving RLL infiltrate. DISCUSSION: Pneumonia is considered the most common complication of influenza. It could be primary viral pneumonia or secondary to bacterial superinfection due to epithelium disruption and alteration in host immunity response. Mediastinal abscess has not been reported before in the literature as post influenza complication. Our case is first in literature for such life-threatening complication and the key to success is early imaging detection, keeping high level of suspicion when the patient is not responding appropriately to the initial therapy and aggressive surgical and medical management. CONCLUSIONS: Clinical deterioration or inappropriate response to antibiotic therapy in post influenza bacterial pneumonia should raise the suspicion for uncommon complications such as mediastinal abscess and should be investigated with advanced imaging, CT chest with IV contrast or MRI. Reference #1: Martin, C.M., et al., Asian influenza A in Boston, 1957-1958. I. Observations in thirty-two influenza-associated fatal cases. AMA Arch Intern Med, 1959. 103(4): p. 515-31. DISCLOSURES: No relevant relationships by Saira Afzal, source=Web Response No relevant relationships by Mahmoud Alwakeel, source=Web Response No relevant relationships by kuttetoor Gopalakrishna, source=Web Response No relevant relationships by Talha Saleem, source=Web Response

Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis.

Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been banned by the European Commission. In this systematic review we summarize the evidence for different antibiotic prophylaxis regimens. We searched MEDLINE®, Embase® and Cochrane Database for randomized controlled trials (inception to October 2019) assessing antimicrobial interventions in prostate biopsy. Primary outcome was infectious complications. Exclusion criteria were simultaneous interfering interventions. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the certainty of evidence. Protocol was registered with PROSPERO (CRD42015026354). Overall 59 randomized controlled trials (14,153 participants) and 7 different antimicrobial interventions were included. Antibiotic prophylaxis reduced infectious complications compared to no prophylaxis (RR 0.56, 95% CI 0.40-0.77, p=0.0005, I2=15%, participants 1,753, studies 11). A short-term prophylaxis (single shot to 3 days) was inferior to a long-term prophylaxis (1 to 7 days) with fluoroquinolone (RR 1.89, 95% CI 1.37-2.61, p=0.0001, I2=0%, participants 3,999, studies 17). Fosfomycin trometamol was an alternative to fluoroquinolone with reduced rates of infectious complications (RR 0.49, 95 CI 0.27-0.87, p=0.02, I2=54%, participants 1,239, studies 3). Empiric prophylaxis was inferior to targeted prophylaxis (RR 1.81, 95% CI 1.28-2.55, p=0.0008, I2=48%, participants 1,511, studies 6). Standard prophylaxis was inferior to augmented prophylaxis (using multiple rather than single agent) using a fixed model (RR 2.10, 95% CI 1.53-2.88, p <0.0001, I2=71%, participants 2,597, studies 9), but not using a random model (p=0.07). No difference was observed in infectious complications based on route or timing of antimicrobial prophylaxis. The certainty of evidence was rated as low/very low. In countries where fluoroquinolones are allowed as antibiotic prophylaxis, a minimum of a full 1-day administration as well as targeted therapy in case of fluoroquinolone resistance is recommended. In countries with a ban on fluoroquinolones, fosfomycin is a good alternative, as is augmented prophylaxis, although no established standard combination exists to date.

P1719 A rare complication of homozygous sickle cell disease and high output cardiac failure

Abstract Introduction/Background Sickle cell disease (SCD) is an autosomal recessive blood disorder characterised by chronic anaemia and abnormally shaped red blood cells. SCD impacts multiple organ systems causing effects on morbidity and mortality, including cardiovascular (CV). Long term SCD can have a significant impact on the heart through multiple pathways, including chronic anaemia, microvascular dysfunction and the development of hypertension and chronic kidney disease, leading to the development of a high-output state and adverse cardiac remodelling. We report a rare case of homozygous SCD with the development of high output cardiac failure complicated by the development of associated pulmonary hypertension. Case summary A 58 yr old female patient (Height 158cm, weight 51.25kg, cardiac index 4.01 L/min/m²) with known homozygous SCD (HbSS) undergoing regular transfusions for chronic anaemia was admitted following a routine transthoracic echocardiogram (Figure 1a &amp; 1b) due to the presence of a moderate sized global pericardial effusion, severe tricuspid regurgitation, dilated right heart with impaired longitudinal function, and good left ventricular (LV) systolic function (LVEF Simpson’s biplane = 62 +/- 5%). In the months preceding this, the patient described progressive dyspnoea associated with decreasing workload and orthopnoea. On clinical examination there was evidence of right sided heart failure. Blood results demonstrated a longstanding anaemia (Hb 57 g/L) with MCV 109.6. NT-proBNP was 10233 ng/L. Cardiac magnetic resonance imaging demonstrated LV dilatation with hyperdynamic function, severe LV hypertrophy, and impaired longitudinal function (global longitudinal strain -9.7%). Cardiac output was elevated at 6.5 L/min. There was no late gadolinium enhancement and T2* mapping did not demonstrate cardiac iron loading (29.6ms). Right heart catheterisation confirmed pulmonary hypertension (pulmonary artery pressure 55/33, mean 46mmHg) due to left heart disease (PC wedge pressure (24/30, mean 24mmHg). The pericardial effusion was drained and the aspirate demonstrated a cellular infiltrate reflecting pericardial inflammation (moderate pus cells, no growth after 48hrs, total protein = 56 g/L, no histological evidence of malignancy). Additionally, the patient underwent intravenous diuresis and blood transfusion with improvement in clinical status. Discussion We report a rare cause of pulmonary hypertension due to elevated left ventricular end-diastolic pressure as a result of long-term high cardiac output in a patient who has established homozygous SCD. Long-term adverse cardiac remodelling in SCD is well described. Pulmonary hypertension is a rare multifactorial complication of this process and the precise mechanisms remain unclear. It confers a poor prognosis and the only current treatment is the management of the underlying condition. Pulmonary hypertension should always be considered in SCD patients with clinical and cardiac imaging evidence. Abstract P1719 Figure 1

What is the cost benefit ratio of sending adeno-tonsillar tissues for histology: does adenoid/tonsillar tissue in children undergo malignant transformation?

Due to the enormous amount spent on histology of adenoid and tonsillar samples from children with adeno-tonsillectomy with no confirmed result of malignancy, it has become expedient to reconsider sending such tissues for histologyThe objective of this study was to determine the necessity of sending tissues of adenoid and tonsils for histology by means of ascertaining the prevalence of malignancy among children with adeno-tonsillectomy. This was a retrospective study done in three private hospitals that provide care for children in Enugu. Data was obtained from the medical records of 72 patients who had undergone tonsillectomy and/or adenoidectomy from September 2011 to May 2018. All the surgical cases done had their samples sent immediately for histology. A total of 72 adeno-tonsillar tissues were taken for histology of which all showed lymphoid hyperplasia with none showing any form of malignancy. Age group ranged from 6 months-18 years with 57 males and 15 females. Histology of the adeno-tonsillar tissue specimen was done among all the children with each costing 9000 Naira (26 US dollars). There were 3 tonsillectomies, 1 adenectomy and 68 adeno-tonsillectomies done. Indications for surgery were mainly upper airway obstruction for 69 cases and recurrent tonsillectomy for 3 cases. Histology revealed lymphoid hyperplasia for all cases. None of the patients in our study had histologic evidence of malignancy. Routine histopathologic examination in adeno-tonsillectomy specimens among children may be dispensable as it showed a negative cost-benefit ratio.

A242 SIGMOID PERFORATION: A RARE CASE OF REFRACTORY CELIAC DISEASE TYPE II

Celiac disease is an autoimmune enteropathy caused by gluten ingestion in genetically susceptible individuals. Treatment consists of a gluten-free diet (GFD). Non-responders typically have an incidental source of gluten ingestion; however, 1% develops refractory celiac disease (RCD). RCD is defined as persistent or recurrent malabsorption, villous atrophy despite a strict GFD for 6–12 months. It is further classified as type I (RCD I) and type II (RCD II) by immunophenotyping. RCD I has a normal population of intraepithelial lymphocytes (IELs), while RCD II has aberrant IELs, which have T-cell clonality. RCD II is associated with EATL and is considered a pre-malignant condition, and more difficult to treat. - A 68-year old gentleman with a background including hypothyroidism, small bowel obstruction with lysis of adhesions, and family history of CD presented with acute-onset abdominal pain. CT abdomen showed free air and stranding in the proximal jejunum. Exploratory laparotomy found a spontaneous jejunal perforation and proximal stricturing. 20 cm of small bowel was resected. Histology review showed monoclonal T-cell receptor arrangement. He presented 2 months later with weight loss, diarrhea, and hypoalbuminemia. Gastroscopy showed scalloping of the duodenal mucosa and flattened villi; colonoscopy was normal. Biopsies showed villous atrophy with intraepithelial lymphocytosis, lymphocytic gastritis, and lymphocytic colitis. He was given supplemental nutrition and intravenous corticosteroids, but did not improve. Small bowel enteroscopy demonstrated a purulent-appearing anastomosis with fistulous opening; biopsies showed severe villous atrophy, and the anastomosis demonstrated mucosal ulceration with inflammatory exudate. Following repeat colonoscopy, he had a perforation and underwent exploratory laparotomy, lysis of adhesions, and small bowel and sigmoid resection. Biopsies confirmed ulcerative jejunoileitis consistent with RCD II. He continued to be non-responsive to corticosteroid therapy. Though there was no histologic evidence of malignancy, he continued to do poorly, and died. This patient’s serum sample was collected for antigen analysis, versus patients with classic celiac disease. - RCD II is a rare entity, emphasizing the importance of immunophenotyping in diagnosis; this has significant prognostic implications. Treatment data relies primarily on case reports; there is a paucity of randomized control trials. Therapy typically results in clinical and histological improvement, but does not prevent progression to EATL. This case highlights the difficulty of diagnosis of RCD II. It is one of the first cases to present with sigmoid perforation and to demonstrate both lymphocytic gastritis and lymphocytic colitis in RCD II. In addition, it is a pilot study of the serum analysis in RCD II patients. None

Small Bowel Intussusception Secondary to Inflammatory Fibroid Polyp of the Ileum

Introduction: Inflammatory fibroid polyps (IFP) are rare, benign, tumor-like lesions that can develop anywhere in the gastrointestinal tract. Most frequently, they are localized in the gastric antrum. Ileum is the most common site where these polyps cause small bowel obstruction. Most IFPs are polypoid masses smaller than 5 cm, although sizes up to 20 cm have been reported. Case report: We report a case of a 56-year-old man presented with progressive abdominal pain for 7 days. He denied any nausea and vomiting but did have foul smelling bloody diarrhea. His abdomen was soft, slightly distended, tympanic to percussion, and tender in left lower quadrant. Bowel sounds were hyperactive. CT scan revealed a tubular, elongated, both intraluminal and extraluminal ileal mass causing mild partial obstruction and short segment intussusception. The patient underwent resection; gross examination showed a large solid tan-white elongated mass protruding into the small bowel lumen on one side and pushing the serosal surface on the other side. The large luminal portion of the protruding tumor measured 15.0 x 5.5 x 4.0 cm, and the extraluminal portion measured 5.5 x 4.0 cm. The total length was 20.5 cm. Multiple sections showed a well demarcated, non-encapsulated, polypoid, fibrohistiocytic mass, composed of hypocellular stroma with proliferation of widely spaced bland spindled and stellate-shaped cells emdedded in a collagenous fibromyxoid stroma. The intervening stroma demonstrated prominent vascularity, diffuse eosinophils, and few scattered plasma cells with foci of benign lymphoid aggregates. No mitoses or necrosis was present. There was no other histologic evidence of malignancy. The histopathologic features, as well as the immunoperoxidase stains, were consistent with a benign, non-neoplastic tumor-like mass, consistent with a Giant Inflammatory Fibroid Polyp-Tumor Like (Vanek Tumor). Discussion: The present lesion is the largest inflammatory fibroid polyp reported to date. The ileal location is rare. Even if inflammatory fibroid polyps are benign lesions, surgical treatment is the only option when they present with intestinal intussusception. Preoperative diagnosis of inflammatory fibroid polyps is often difficult, and confirmation can only be obtained by histological and immunohistochemical examination.Figure

Application of The Paris System to atypical urine cytology samples: correlation with histology and UroVysion® FISH.

To evaluate whether atypical urine cytology cases may be stratified more objectively using The Paris System (TPS) and whether reclassified cases correlate with histology and UroVysion® results. Atypical urine cytology cases subjected to UroVysion® testing over a period of 6 years were reviewed. Each case was reclassified according to TPS and correlated with histology and UroVysion® results. A total of 91 cases were identified; 70.3% were reclassified as 'negative for high-grade urothelial carcinoma (HGUC)' and 14.3% as 'atypical urothelial cells (AUC)'. The histological correlation was available in 45 cases. In the 'negative for HGUC' category, 67.9% had no histological evidence of malignancy, but 17.9% were diagnosed as HGUC. In the 'AUC' category, histology revealed urothelial carcinoma in 70% of the cases (of these, 71.4% were high grade). There was no histological evidence of malignancy in 30% of cases; notably, all of which were from patients under surveillance. The sensitivity and specificity of UroVysion® were 85.7% and 33.3% in the 'AUC' group and 62.5% and 100% in the 'negative for HGUC' group. The Paris System is an objective template for reporting urine cytology specimens, and is particularly useful in identifying HGUC cases and refining the category of 'AUC'.

Follicular proliferative lesion arising in struma ovarii.

Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as “proliferative stromal ovarii” or “follicular proliferative lesion arising in the stromal ovarii” would be appropriate.

A definition of “uncomplicated bone metastases” based on previous bone metastases radiation trials comparing single-fraction and multi-fraction radiation therapy

The most recent systematic review of randomized trials in patients with bone metastases has shown equal efficacy of single fraction (SF) and multiple fraction (MF) palliative radiation therapy in pain relief. It is important to determine the patient population to which the evidence applies. This study aims to examine the eligibility criteria of the studies included in the systematic review to define characteristics of “uncomplicated” bone metastases.Inclusion and exclusion criteria of 21 studies included in the systematic review were compared. Common eligibility criteria were documented in hopes of defining the specific features of a common patient population representative of those in the studies.More than half of the studies included patients with cytological or histological evidence of malignancy. Patients with impending and/or existing pathological fracture, spinal cord compression or cauda equina compression were excluded in most studies. Most studies also excluded patients receiving retreatment to the same site.“Uncomplicated” bone metastases can be defined as: presence of painful bone metastases unassociated with impending or existing pathologic fracture or existing spinal cord or cauda equina compression. Therefore, MF and SF have equal efficacy in patients with such bone metastases.

A Rare Cause of Chronic Diarrhea and Weight Loss

A78-year-old woman was evaluated for fatigue, unintentional weight loss of 38 pounds, and diarrhea over the past year. She appeared in no acute distress. Her blood pressure was 120/80 mm Hg and her heart rate was 76 beats/min. She was 61 inches tall and weighed 96 pounds, with a body mass index of 18 kg/m. An abdominal examination was significant for mild epigastric tenderness to palpation. The patient would have approximately 7 nonbloody watery bowel movements during the day with occasional nocturnal diarrhea. Her bowel movements were not affected by fasting. She had associated lower abdominal pain and intermittent epigastric pain. Prior work-up included negative stool studies for Clostridium difficile, ova and parasites, culture, and Gram stain. Laboratory studies showed a normal hemoglobin level, mean corpuscular volume, thyroid-stimulating hormone level, alanine aminotransferase level, total bilirubin level, albumin level, and C-reactive protein level. She had an abnormal alkaline phosphatase level of 130 IU/L (38–126 IU/L), an aspartate aminotransferase level of 52 IU/L (15–41 IU/L), a g-glutamyl transpeptidase level of 49 IU/L (<41 IU/L), and a lipase level of less than 3 U (15–70 U/L). A colonoscopy and upper endoscopy showed no gross or histologic evidence of malignancy, celiac disease, or microscopic colitis. A contrast-enhanced computed tomographic scan of the abdomen and pelvis showed cirrhosis, an obstructing distal pancreatic duct calculus, and complete fatty replacement of the pancreas, which was highly suggestive of lipomatous pseudohypertrophy (Figure A). An endoscopic ultrasound was performed and confirmed the diagnosis and excluded an underlying pancreatic adenocarcinoma (Figure B). The patient denied alcohol use. Viral hepatitis serologies, iron saturation level, ceruloplasmin level, autoimmune serologies, and a-1 antitrypsin level all were normal. The most likely etiology of the patient’s cirrhosis was nonalcoholic steatohepatitis. The patient denied previous episodes of pancreatitis, but the presumptive etiology of the distal pancreatic duct calculus was chronic pancreatitis. Pancreatic enzyme replacement therapywas initiated and the patient reported resolution of her symptoms 2 days later. At our patient’s follow-up visit 1 month after initiation of pancreatic enzyme replacement therapy, her weight increased to 101 pounds and her symptoms resolved. Lipomatous pseudohypertrophy is a rare idiopathic clinical entity that has been described only in case reports and case series. Based on a small case series and literature review, Altinel et al determined that this condition occurs with equal frequency in males and females, with approximately 70% of cases diffusely involving the pancreas. Histologically, adipose pseudotumor replacement of pancreatic exocrine tissue is seen. Because of its low prevalence, the etiology of lipomatous pseudohypertrophy has yet to be determined. Varying presentations have been described including large pancreatic tumors subsequently diagnosed as lipomatous

Clinicopathological and Extensive Immunohistochemical Study of a Type II Pleuropulmonary Blastoma

Pleuropulmonary blastoma (PPB) is a rare malignant dysontogenetic neoplasm primarily affecting younger children, even in newborns with an unfavorable outcome. PPB is histologically composed of a primitive, variably mixed blastematous and sarcomatous components, and exclusively subclassified as type I (purely cystic), type II (both cystic and solid elements) and type III (completely solid) by increasing histological evidence of malignancy. At present, well-documented cases or cases of truly precise presentation of either pathological or immunohistochemical findings in PPB are rare. The authors report one case of PPB in a 44-month-old child presenting as a solid and cystic mass with special emphasis on its radiological, histopathological and immunohistochemical aspects. The histological diagnosis was PPB, which would belong to the type II category.

Obstructing apple core lesion of the rectum: A case report of inflammatory pseudotumor masquerading as colorectal carcinoma

Inflammatory pseudotumor is a rare lesion which can occur, typically in children and young adults, in many different organ systems. The tumor often clinically behaves like a cancer but without histological evidence of malignancy. This case study of a 14year-old boy is the first report in the literature of an inflammatory pseudotumor presenting as an obstructing apple core lesion, mimicking a rectal carcinoma. A six-week course of non-steroidal, anti-inflammatory drugs (NSAIDs) led to complete resolution of the mass, and following resection of a residual stricture, the patient has been recurrence-free for seven years.

Maladie de Gorham et anomalies vasculaires osseuses agressives

Gorham's disease is a rare condition of unknown etiology, which is characterized by intra-osseous vascular abnormalities leading to osteolysis and sometimes, extension to adjacent tissues. Although there is no histological evidence of malignancy, the lesions display an aggressive potential responsible of osteolysis with pathological fractures and respiratory failure. The extension of the disease varies from one location to multiple bone lesions throughout the skeleton and the clinical presentations depend on the sites of involvement. In the ISSVA (International Society for the Study of Vascular Abnormalities) classification, its affiliation to the group of vascular tumors or vascular malformations is still debated. To date, there is no standard treatment defined for this disease. The proposed treatments are inhibitors of bone resorption (bisphosphonates) and interferon alpha therapy or anti-angiogenic molecules. Radiation therapy and surgery may also have a place in the therapeutic strategy.

Carcinoma ex pleomorphic adenoma of the submandibular gland with renal metastases composed exclusively of metastasizing pleomorphic adenoma

Carcinoma ex pleomorphic adenoma is a rare neoplasm of the submandibular gland with a poor prognosis. Metastatic deposits of carcinoma ex pleomorphic adenoma are either composed exclusively of malignant elements or contain mixed benign and malignant components. We describe the case of a 63-year-old man with carcinoma ex pleomorphic adenoma of the submandibular gland and metastases to the kidney, lungs, and L2 vertebral body. The patient had previously undergone two surgical resections for a left submandibular tumor. A right partial nephrectomy was performed, and histological examination of the resected specimen revealed a benign pleomorphic adenoma with no histological evidence of malignancy. This pattern of metastasizing pleomorphic adenoma has been described previously. We subsequently excised the left submandibular gland; the final pathological diagnosis was carcinoma ex pleomorphic adenoma. This unusual case suggests that carcinoma ex pleomorphic adenoma and metastasizing pleomorphic adenoma may represent different stages of a common biologic pathway for the malignant transformation of pleomorphic adenoma.

An intracapsular carcinoma ex pleomorphic adenoma with lung metastases composed exclusively of benign elements: Histological evidence of a continuum between metastasizing pleomorphic adenoma and carcinoma ex pleomorphic adenoma

Malignant mixed tumors of the salivary glands, encompassing carcinoma ex pleomorphic adenoma (ca ex PA), carcinosarcoma and metastasizing pleomorphic adenoma (mPA), are rare neoplasms. Ca ex PA arises in a pre-existing pleomorphic adenoma (PA). When the malignant component does not breach the capsule of the parent PA, the lesion is termed intracapsular ca ex PA, a neoplasm which is thought to have no metastatic potential. Metastatic deposits of ca ex PA are composed exclusively of malignant elements or mixed benign and malignant components. We describe the case of a 62-year-old female with an intracapsular ca ex PA of the buccal mucosa with subsequent metastases to the lung. The metastatic deposits resembled benign PA with no histological evidence of malignancy. This pattern of spread is described with mPA, an entity that caused controversy in the past regarding its exact classification as a benign or malignant tumor. The possibility that ca ex PA originates from a mPA, with intracapsular ca ex PA representing an intermediate lesion in a histological continuum, is discussed.