Mixed Cell Tumor Research Articles

Malignant-functioning neuroendocrine tumors of the pancreas: A survival analysis

Malignant-functioning pancreatic neuroendocrine tumors (mFpNETs) are rare. Research analyzing the presentation, biological behavior, and patient outcomes of these tumors is limited. We used the Surveillance, Epidemiology, and End Results database to identify patients with malignant insulinomas, gastrinomas, glucagonomas, vasoactive intestinal peptide secreting tumors (VIPomas), somastatinomas, and mixed islet cell tumors (MICTs). The primary endpoint of this study was to identify factors affecting survival. We identified 401 patients with mFpNETs. Between histologic subtypes, there were significant differences in sex and age, and in tumor size, grade, location, and stage. Median survival time for insulinomas was 12.7 years; gastrinomas, 10.2 years; glucagonomas, 7.7 years; VIPomas, 7.9 years; and MICTs, 3.4 years. Multivariable analysis showed that histology (insulinoma, gastrinoma, and VIPoma; P = .009), absence of distant metastases (P = .002), age < 50 years (P = .001), surgical intervention (P = .001), and stage I/II disease (P = .011) were independently associated with prolonged survival. Subgroup analysis demonstrated that removal of the primary tumor in stage IV mFpNETs was associated with significantly prolonged survival (P = .01). mFpNETs are rare tumors that commonly present at an advanced stage despite hormonal secretion. Primary tumor resection is associated with longer survival in stages I-III as well as stage IV tumors.

Survival from uveal melanoma in Western Australia 1981-2005.

The survival rates for patients diagnosed with uveal melanoma in Australia are unknown. Few long-term studies of uveal melanoma are available, and it is unclear whether their results are applicable to the Australian population. Retrospective population-based study. Patients diagnosed with uveal melanoma between 1981 and 2005 in Western Australia. Three hundred eight cases were included. Relative survival and Cox regression were performed. Variables tested for their predictive ability included patient age and sex, tumour-specific variables, and treatment modality. All-cause survival rates and relative survival rates of patients with diagnosed uveal melanoma. Relative survival rates for the entire cohort were 88.2%, 81.4% and 71.4% at 3, 5 and 10 years, respectively. Predictors of worse survival included mixed-cell tumour morphology (hazard ratio [HR] = 2.1; P-value = 0.002), tumour location at the ciliary body (HR = 1.7; P-value = 0.029) and tumour apical height more than 5 mm (HR 1.9, P-value = 0.026). Of all patients who underwent enucleation, those diagnosed in 1998-2005 died twice as fast (HR = 2.3; P-value = 0.004). In the 17 patients with metastasis, the median survival time from date of diagnosis of metastasis was 3.1 months. These survival estimates are comparable to those reported for the USA, and more optimistic than those reported for most European-based studies. Tumour apical height, tumour site, tumour morphology and having an enucleation in certain calendar periods of diagnosis were independent predictors of survival. Survival prognosis for patients with diagnosed metastatic uveal melanoma is very poor.

Selective cell elimination in vitro and in vivo from tissues and tumors using antibodies conjugated with a near infrared phthalocyanine.

Cell cultures and tissues often contain cellular subpopulations that potentially interfere with or contaminate other cells of interest. However, it is difficult to eliminate unwanted cells without damaging the very cell population one is seeking to protect, especially established tissue. Here, we report a method of eliminating a specific subpopulation of cells from a mixed 2D or 3D cell culture in vitro and a mixed-population in vivo tumor model by using antibody-photosensitizer conjugates (APC) with a near infrared (NIR) phthalocyanine-derivative (IRdye700DX, IR700) combined with NIR light exposure with minimal damage to non-targeted cells. Thus, APC combined with NIR light exposure holds promise as a method of removing specific cells from mixed cell cultures and tumors.

Modeling luminal breast cancer heterogeneity: combination therapy to suppress a hormone receptor-negative, cytokeratin 5-positive subpopulation in luminal disease.

IntroductionMany Luminal breast cancers are heterogeneous, containing substantial numbers of estrogen (ER) and progesterone (PR) receptor-negative cells among the ER+ PR+ ones. One such subpopulation we call “Luminobasal” is ER-, PR- and cytokeratin 5 (CK5)-positive. It is not targeted for treatment.MethodsTo address the relationships between ER+PR+CK5– and ER–PR–CK5+ cells in Luminal cancers and tightly control their ratios we generated isogenic pure Luminal (pLUM) and pure Luminobasal (pLB) cells from the same parental Luminal human breast cancer cell line. We used high-throughput screening to identify pLB-specific drugs and examined their efficacy alone and in combination with hormone therapy in mixed-cell tumor models.ResultsWe show that pLUM and MCF7 cells suppress proliferation of pLB cells in mixed-cell 3D colonies in vitro and that pLUM cells suppress growth of pLB cells in mixed-cell xenografts in vivo. High-throughput screening of 89 FDA-approved oncology drugs shows that pLB cells are sensitive to monotherapy with the epidermal growth factor receptor (EGFR) inhibitors gefitinib and erlotinib. By exploiting mixed-cell 3D colonies and mixed-cell solid mouse tumors models we demonstrate that combination therapy with gefitinib plus the anti-estrogen fulvestrant constitutes a robust treatment strategy.ConclusionsWe propose that response to combination endocrine/EGFR inhibitor therapies in heterogeneous Luminal cancers may improve long-term survival in patients whose primary tumors have been preselected for appropriate biomarkers, including ER, PR, CK5 and EGFR.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-014-0418-6) contains supplementary material, which is available to authorized users.

Mixed dendritic cell tumours with follicular-fibroblastic dendritic cell features of lymph node

Mixed dendritic cell tumours with follicular-fibroblastic dendritic cell features of lymph node

Analysis of the contribution of immunologically-detectable HER2, steroid receptors and of the “triple-negative” tumor status to disease-free and overall survival of women with epithelial ovarian cancer

We assessed associations between steroid receptors including: estrogen-alpha, estrogen-beta, androgen receptor, progesterone receptor, the HER2 status and triple-negative epithelial ovarian cancer (ERα-/PR-/HER2-; TNEOC) status and survival in women with epithelial ovarian cancer. The study included 152 women with primary epithelial ovarian cancer. The status of steroid receptor and HER2 was determined by immunohistochemistry. Disease-free and overall survival were calculated and compared with steroid receptor and HER2 status as well as clinicopathological features using the Cox Proportional Hazards model. A mean follow-up period of 43.6 months (interquartile range=41.4 months) was achieved where 44% of patients had serous tumor, followed by mucinous (23%), endometrioid (9%), mixed (9%), undifferentiated (8.5%) and clear cell tumors (5.3%). ER-alpha staining was associated with grade II–III tumors. Progesterone receptor staining was positively associated with a Body Mass Index≥25. Androgen receptor positivity was higher in serous tumors. In stand-alone analysis of receptor contribution to survival, estrogen-alpha positivity was associated with greater disease-free survival. However, there was no significant association between steroid receptor expression, HER2 status, or TNEOC status, and overall survival. Although estrogen-alpha, androgen receptor, progesterone receptor and the HER2 status were associated with key clinical features of the women and pathological characteristics of the tumors, these associations were not implicated in survival. Interestingly, women with TNEOC seem to fare the same way as their counterparts with non-TNEOC.

Injury Signals Cooperate with Nf1 Loss to Relieve the Tumor-Suppressive Environment of Adult Peripheral Nerve

Schwann cells are highly plastic cells that dedifferentiate to a progenitor-like state following injury. However, deregulation of this plasticity, may be involved in the formation of neurofibromas, mixed-cell tumors of Schwann cell (SC) origin that arise upon loss ofNF1. Here, we show that adult myelinating SCs (mSCs) are refractory to Nf1 loss. However, in thecontext of injury, Nf1-deficient cells display opposing behaviors along the wounded nerve; distal totheinjury, Nf1(-/-) mSCs redifferentiate normally, whereas at the wound site Nf1(-/-) mSCs give rise toneurofibromas in both Nf1(+/+) and Nf1(+/-) backgrounds. Tracing experiments showed that distinct cell types within the tumor derive from Nf1-deficient SCs. This model of neurofibroma formation demonstrates that neurofibromas can originate from adult SCs and that the nerve environment can switch from tumor suppressive to tumor promoting at a site of injury. These findings have implications for both the characterization and treatment of neurofibromas.

Four years of experience in the management of testicular germ cell tumors at a Urology department of Health Center Vranje

Objectives: The aim of this paper is to performed a retrospective descriptive study between the years 2009 and 2013 analyzing 24 patients treated for testicular cancer at a Urology department of Health Center Vranje, including in the analysis tumor incidence, the patient?s age, patient?s time before treatment, histological type and their typical characteristics, oncological treatment, tumor progression and mortality rate. There were 13 rights sided and 11 left sided tumor presented and all of them unilateral. The average age of the patients was 36 years old in the group of patients with seminoma, 28 years old with mixed tumors, 26 years old average with embryonal carcinoma. One patient presented himself with fibrous histiocytoma was 14 year old and one patient with laydig cell tumor was 65 years old in the time of diagnosis. Two patients who were diagnosed with testicular lymphoma were 69 year old in average. Hystopathological findings revealed: 11 cases of seminoma, 5 cases of mixed cell tumors, 4 cases with embryonal carcinoma, 2 case with non Hodgkin?s lymphoma and one case of laydig cell tumor and one case of fibrous histiocytoma. The entire patient underwent standard chemo therapy with cis platinum for testicular cancer. One of the patients with mixed tumor underwent RPLND (retroperitoneal lymph node dissection) but soon died after administration of chemotherapy - PEB (cisplatin, etoposide and bleomycin). All of the patient, except the four of them with who we lost contact and the one deceased are decease free and attend regular follow ups to this day.

Routine sperm banking for testicular cancer patients should be performed both before and after orchidectomy

Background: Despite some groups recommending that sperm banking for testicular cancer patients prior to orchidectomy results in improved overall semen quality, it remains common practice for this to occur post operatively, prior to any chemotherapy. Having seen anecdotal evidence of patients being rendered azoospermic and thus sterile by unilateral orchidectomy, we investigated further. Methods: Forty men listed for orchidectomy banked a single sample before surgery and were then given the opportunity to bank further samples post operatively. Results: Post orchidectomy, overall sperm concentration ( p = 0.01) and motility ( p &lt; 0.05) were lower compared to before surgery and two men had azoospermia. However, the overall picture was misleading as in 13 individuals their sperm output was increased ( n = 13) after surgery. Both cases of post operative azoospermia were amongst the patients with seminoma although at least 50% of patients with teratoma had severe oligozoospermia post surgery. Conclusions: Despite the relatively high frequency of normal sperm counts amongst seminoma patients, there was no significant difference in total sperm output or sperm quality between these men and those with teratoma or mixed cell tumours. As overall sperm quality was lower after surgery and some patients had totally compromised fertility, our centre has changed its policy to encouraging sperm banking prior to surgery. However, we maintain that generalisation of this population is unwise and patients should also attend after surgery to optimise the quality of their samples in the sperm bank.

Abstract B7: Annexin V inhibits local but not systemic murine fibrosarcoma growth by blocking phosphatidylserine

Abstract Introduction: Phosphatidylserine (PS), a phospholipid expressed on the cytoplasmic surface of plasma membrane, becomes externalized during apoptosis and regulates immune activation. During our previous studies, we found that live tumor cells can express PS on the cell surface. We hypothesized that PS expression allows tumors to escape immune destruction, and blocking PS with annexin V (AnV) would retard tumor growth. Materials and methods: CMS5 fibrosarcoma tumor cells were engineered to secrete AnV. Balb/c mice were inoculated subcutaneously with 105-106 CMS5 cells. Tumor growth was determined. Data was analyzed using student t-test. Results: WT tumors grew significantly faster than AnV secreting tumors, with average size of 0.876 cm3 compared to 0.320 cm3 (p&amp;lt;0.05) in immune competent but not in SCID mice. To test whether AnV secreting tumors are intrinsically altered we inoculated mice with a mixture of 25% AnV secreting and 75% WT tumor cells. Growth of mixed cell tumors was identical to AnV secreting tumors, and was significantly smaller than WT tumors, 0.876 cm3 compared to 0.324 cm3 (p&amp;lt;0.05). To determine whether the effect of AnV was local or systemic mice were inoculated with tumor cells on each flank. Regardless of the type of tumor on the opposite side, WT tumors grew significantly faster than AnV secreting tumors with average size of .684 cm3 versus 0.345 cm3 (p&amp;lt;0.05). Conclusion: We demonstrated blocking tumor PS with AnV retards local tumor growth. The effects of AnV require an intact immune system. These findings suggest that PS promotes tumor tolerance and blocking PS with AnV may be used in future immunotherapy studies.

A clinicopathologic analysis of primary orbital yolk sac tumor

Objective On rare occasions, yolk sac tumor may arise from extragonadal sites. Orbit is an unusual location for the primary development of this tumor. The presence of intracranial yolk sac tumor on biopsy always makes the diagnosis challenge for pathologists. Herein we report a case of intracranial primary yolk sac tumor in left orbital apex. The clinicopathology of this tumor and its differential diagnosis are discussed. Methods The clinical manifestation of a patient with primary yolk sac tumor occurring in left orbital apex was presented retrospectively. Resected orbital mass was routinely paraffin⁃embedded and stained with hematoxylin and eosin. Dako Envision immunohistochemical staining system was used to detect the tumor antigen expressions, including alpha ⁃fetoprotein (AFP), cytokeratin, placental alkaline phosphatase (PLAP), CD30, CD34, CD45, CD99, CD117, synaptophysin (Syn) and chromogranin A (CgA). Results A 2⁃year⁃old boy presented with 3⁃month history of ptosis of eyelid and exophthalmos on left eye. Magnetic resonance imaging (MRI) scan revealed a lesion occupied the left orbital apex with infiltration of surrounding normal structure, including left posterior ethmoid sinus, the wall of left maxillary sinus and sphenoid. However, there was no evidence of tumor infiltrating in brain parenchyma. Craniotomy was performed and the tumor was removed by en bloc resection. Grossly, the biopsy specimen received in small pieces was 1.20 cm × 1.00 cm × 1.00 cm when aggregated. No fibrous capsule, necrosis, haemorrhage and gross calcification were found in the tissue fragments. Histological examination revealed that the tumor was arranged in a reticular pattern. The cells were relatively large with a clear cytoplasm and vesicular nuclei. Scattered mitotic figures were noted. Schiller ⁃ Duval bodies and periodic acid ⁃ Schiff (PAS) positive (eosinophilic bodies) were evident in the tumor tissue. Immunohistochemical staining showed that the tumor cells were diffusely positive for cytokeratin (AE1/AE3) and focal positive for AFP, CD99 and CD117, but negative for PLAP, CD30, S ⁃ 100, CD45 and CD34. There was no evidence of mixture of other germ cell tumor component in this tumor by serial sections. Based on clinical presentation and histological findings, a final histological diagnosis of pure primary orbital yolk sac tumor, WHO grade Ⅳ, was made according to the criteria of WHO classification. The patient has not received chemotherapy and attended follow⁃up for 3 months, without any neurological deficit or signs of recurrence. Conclusion Despite the lower incidence, intracranial yolk sac tumors usually develop in the midline at the pineal or suprasellar regions occurring in children with distinctive histological features and immunohistochemical phenotypes. In general, intracranial yolk sac tumors are known to entail poor prognosis even after multidisciplinary treatment of operation, radiotherapy, and chemotherapy. It is noted that intracranial yolk sac tumor should be differentiated histologically from other types of germ cell tumors and mixed germ cell tumor. DOI：10.3969/j.issn.1672⁃6731.2012.01.019

Clinical analysis of 15 cases of malignant ovarian germ cell tumors with lung metastasis

To investigate the clinical characteristics, diagnosis, treatment and prognosis of malignant ovarian germ cell tumors (MOGCT) with lung metastasis. Fifteen patients of MOGCT with lung metastasis treated in Peking Union Medical College Hospital from Jan. 1982 to Dec. 2010 was retrospectively analyzed. (1) Clinical characteristics: the average onset age of these 15 patients is (23 ± 11) years old (6 - 48 years). The majority of these patients presented with abdominal pain (8/15) or irregular vaginal bleeding (4/15) as their initial symptoms. The primary tumor located in the left ovary in 8 cases, right ovary in 6 cases, and both sides in only 1 case. Metastatic lesions were confined to the lung in 12 patients, while the other 3 patients were found to have multi-site distant metastasis. (2) DIAGNOSIS:all 15 cases included 9 pure non-gestational ovarian choriocarcinoma (NGOC), 3 MOGCT containing choriocarcinoma component (one mature teratoma with choriocarcinoma component, one endodermal sinus tumor with embryonal carcinoma and choriocarcinoma components, one choriocarcinoma with dysgerminoma component), 2 embryonal carcinoma, one immature teratoma. Only one patient in these 15 cases was correctly diagnosed before surgery. (3) Time of lung metastasis:of 12 MOGCT with choriocarcinoma component, 11 patients were found to have lung metastasis in the course of their primary treatment, only 1 had lung metastasis 2 months after the synthetic treatment finished. Three MOGCT patients without choriocarcinoma component were all found to have lung metastasis when tumor relapsed in the advanced stages of the disease. (4) TREATMENT:all 15 patients received multi-agent chemotherapy combined with surgery. The mean courses of chemotherapy for these patients were 16 courses (5 - 43 courses). (5) PROGNOSIS: of these 15 cases, complete remission was obtained in 10 patients of NGOC or mixed ovarian germ cell tumors with choriocarcinoma component, 3 patients (one NGOC, one endodermal carcinoma and one immature teratoma, respectively) died in the course of treatment as result of tumor progression, 2 progressed cases (one NGOC and one endodermal carcinoma respectively) abandoning therapy were lost to follow up. MOGCT with lung metastasis are more often to found in NGOC patients. These patients could obtain high complete remission rate after standard multi-agent chemotherapy combined with surgery. The prognosis of MOGCT with lung metastasis containing choriocarcinoma component are better than that of those without containing choriocarcinoma component.

Chromatophoroma in a crevice kelpfish (Gibbonsia montereyensis)

A captive adult crevice kelpfish, Gibbonsia montereyensis, developed a cutaneous mass, approximately 9 × 7 mm on the right side of the head in an area of nonscaled skin. Following surgical debulking, examination of both impression smears and histologic sections of the tumor revealed a predominant population of round to spindloid to polygonal cells with a moderate amount of lightly basophilic cytoplasm. The cytoplasm was filled with round, variably-sized reddish-brown granules that often obscured the nucleus. Nuclei were round to ovoid with coarsely granular chromatin. There was minimal anisocytosis and anisokaryosis. The cytoplasmic granules in histologic sections were weakly positive by the Fontana-Masson method, and staining was eliminated with melanin bleach. Immunohistochemical staining was strongly positive with a murine monoclonal antibody for melan A. As the specificity of melan A for melanophores is not clearly defined in nonmammalian species, the tumor was examined by transmission electron microscopy. Melanophores were not detected. Instead, neoplastic cells were filled with numerous intracytoplasmic organelles with triple-limiting membranes composed of concentric lamellae; these structures were most compatible with pterinosomes, which are the pigment-containing organelles of cells called xanthophores and erythrophores. As both of these organelles are ultrastructurally indistinguishable and as kelpfish skin is known to contain both xanthophores and erythrophores, a diagnosis of a mixed pigment cell tumor or chromatophoroma was made. As the tumor was grossly reddish-brown, the possibility of a neoplastic population of only erythrophores could not be excluded. Pigment cell tumors, arising from cells of the embryonic neural crest, are common in reptiles and bony fish.

Clinicopathological analysis of mixed germ cell tumors in pineal region

Objective The purpose of our study was to summarize the clinical features and pathological composition of mixed germ cell tumors in pineal region,and to discuss the related therapeutic strategies.Methods We performed a retrospective analysis in 14 cases of mixed germ cell tumors in pineal region with open surgical resection and detailed pathology.Results All the 14 cases were male,and the average age was 17.3 years.The ingredient of germinoma existed in 13 cases,and the other ingredients were either simple mature teratoma,or multiple high - grade malignant germ cell tumors.The increased level of serum tumor markers on the whole suggested the existence of relevant ingredients in the tumor.Conclusion There is no significant specificity in the clinical manifestations of mixed germ cell tumors in pineal region.The ingredient of germinoma exists in most cases,so comprehensive and accurate preoperative qualitative diagnosis is difficult.It seems more reasonable to acquire complete pathologic diagnosis through surgical resection before a pertinent combined therapy.The “diagnostic” radiotherapy should be prudent in case of normal level of serum tumor markers and mixed tumor density or signal on image. Key words: Neoplasms, germ cell; Germinoma; Neoplasms, embryonal and mixed; Pineal region; Pathology, surgical

Imaging of gynecological disease (6): clinical and ultrasound characteristics of ovarian dysgerminoma

To describe the clinical history and ultrasound findings in patients with ovarian dysgerminoma. This was a retrospective study of patients with a histological diagnosis of ovarian dysgerminoma who had undergone preoperative ultrasound examination. The patients were identified from the databases of 11 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed all available electronic ultrasound images (gray-scale images and color/power Doppler images were available for 18 patients and 14 patients, respectively) and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings (here called pattern recognition). Twenty-one patients with ovarian dysgerminoma were identified (including one woman with bilateral masses). Twenty patients had a primary ovarian dysgerminoma (including the one with bilateral masses) and one patient had a recurrence of dysgerminoma in her retained ovary. One of the 21 patients was pregnant. All tumors except one were pure dysgerminomas, one being a mixed germinal cell tumor with 30% dysgerminoma component. Median age was 20 (range, 16-31) years. Information on clinical symptoms was available for 18 patients. In four patients, the tumor was detected incidentally, whereas 14 patients presented with one or more of the following symptoms: acute pain (n = 4), chronic pain (n = 8), bloating (n = 8), menstrual disorders (n = 5) and infertility problems (n = 1). One (5%) patient had ascites. Using the IOTA terms and definitions, all but one dysgerminoma were moderately (43%) or very well (50%) vascularized solid tumors. One tumor was multilocular-solid. According to pattern recognition, most dysgerminomas were highly vascularized, purely solid tumors with heterogeneous internal echogenicity divided into several lobules, had a smooth and sometimes lobulated contour and were well-defined relative to the surrounding organs. The ultrasound finding of a highly vascularized, large, solid, lobulated adnexal mass with irregular internal echogenicity in a woman 20-30 years old should raise the suspicion of ovarian dysgerminoma.

Bilateral Testicular Mixed Germ Cell‐sex Cord‐stromal Tumours in a Stallion

An 18-year-old Friesian stallion was examined approximately one week after reportedly presenting scrotal swelling due to torsion of the spermatic cords. Upon presentation no scrotal swelling was noted, the testes were normally oriented, and no abnormalities of the spermatic cords were noted. However, both testes were smaller than expected for a mature stallion and deep palpation revealed that the consistency of the testes was nodular. Ultrasonographic evaluation of the testes revealed diffuse heterogeneous parenchyma with multiple hypoechoic nodular areas. Grossly, the testicular parenchyma was effaced by multiple gray-tan nodules of varying consistency interspersed with gray-white bands of tissue. Microscopic analysis revealed multiple pleomorphic neoplastic foci disseminated throughout both testes. Histological and immunohistochemical features were atypical and consistent with the diagnosis of bilateral testicular mixed germ cell-sex cord stromal tumours. Bilateral testicular tumours and testicular mixed cell tumours are extremely rare in stallions and this is the first report of bilateral testicular mixed germ cell-sex cord-stromal tumours in a stallion. Our findings indicate that certain ultrasonographic characteristics are suggestive of testicular tumour and that immunohistochemistry markers can be used to better characterize testicular neoplasms in stallions.

Multi‐focal cerebral oligoastrocytoma in a puppy

A nine-month-old puppy was presented for investigation of seizures. Neurological deficits were found localising to the prosencephalon, mesencephalon and myelencephalon. Magnetic resonance imaging identified multiple, large lesions involving both cerebral hemispheres. Management with antiepileptic and immunomodulatory drugs was instituted; however, the seizures became progressively refractory and the puppy was euthanased. Histopathology following post-mortem examination found a mixed glial cell tumour with discrete areas where neoplastic cells appeared oligodendroglial or astrocytic. Primary intracranial neoplasia is a rare cause of neurological disease in young dogs. Moreover, this case is unusual in terms of both the mixed glial nature of the neoplasm and also its multi-focal distribution.

Clinicopathologic features of 234 cases with borderline ovarian tumors

To determine the clinicopathologic characteristics and prognostic factors that may be used to predict the poor outcome of patients with borderline ovarian tumors. All cases with borderline ovarian tumors treated in the West China Second University Hospital from January 2001 to June 2007 were analyzed retrospectively for clinicopathologic features, treatment parameters and outcome of treatment. Univariate and multivariate analyses were used to assess independent prognostic factors using the logistic regression model. The median age of 234 patients was 40.1 years with a range of 14 to 80 years. There were 101 (43.2%), 94 (40.2%), 19 (8.1%), 12 (5.1%), 8 (3.4%) cases of serous, mucinous, mixed, endometrioid and clear cell tumors, respectively. Out of 234 cases, 182 (77.8%) underwent laparotomy and 45 (19.2%) underwent laparoscopy. Seven women underwent laparoconversion. Fertility sparing surgery was performed on 119 cases (50.9%) and radical surgery was performed on 115 cases (49.1%). Totally 161 (68.8%) patients had stage I, 19 (8.1%) had stage II, 54 (23.1%) had stage III, and none had stage IV disease. Sixty-four women received postoperative chemotherapy. The median follow-up was 40 months with a range of 8 to 78 months. Recurrence was found in 26 cases (11.1%) during follow-up, and no tumor-related death was reported. The logistic regression model showed that surgery procedure (OR = 2.304, P = 0.024), cyst rupture (OR = 2.213, P = 0.038), stage (OR = 4.114, P < 0.01), microinvasion (OR = 2.291, P = 0.046) and peritoneal implants (OR = 2.101, P = 0.016) were the five independent prognostic factors affecting recurrence. Although patients with borderline ovarian tumors have an excellent prognosis, the risk of recurrence remains in some patients. Emphasis should be put on these patients with high risk factors and preventive strategies should be taken to prevent their progression.

Osteoclastic and pleomorphic giant cell tumors of the pancreas diagnosed via EUS-guided FNA: unique clinical, endoscopic, and pathologic findings in a series of 5 patients

Osteoclastic and pleomorphic giant cell tumors of the pancreas are rare entities that have been typically described only in single case reports. We report on our experience with a series of 5 patients with pancreatic giant cell tumors seen at our institution. This was a retrospective study involving a search of the study institution's medical records from 2001 to 2007 for patients diagnosed with giant cell-containing neoplasms of the pancreas. Five patients (2 women, 3 men) were identified. Age range was 59 to 81 years, with a mean of 70.2 years. None were current or former smokers. None had a history of alcohol abuse or preexisting pancreatitis of any kind. On EUS, tumors tended to be large, with a mean diameter of 47 mm (range 20-70 mm). All tumors had a heterogeneous echotexture and a distinct appearance when compared with the typical appearance of adenocarcinoma when viewed via EUS. The diagnosis of giant cell tumor of the pancreas, as well as the subtype, was made via EUS-guided FNA of the pancreatic lesion. Patients with pleomorphic giant cell tumors of the pancreas had a poor clinical course with a rapid decline, whereas those with mixed or osteoclastic giant cell tumors tended to have a better outcome, with a greater long-term survival. One patient is still alive more than 18 months after diagnosis. Retrospective study. Giant cell tumors of the pancreas have unique clinical, endoscopic, and cytologic features. The risk factors for these lesions may be different from those associated with pancreatic adenocarcinoma. Some giant cell tumor subtypes may carry a more favorable prognosis than pancreatic adenocarcinoma, and awareness and recognition of these differences can affect patient care.

Angiomyolipom der Leber

A 66-year-old woman, known for 4 years to have a space-occupying lesion in the liver thought to be a lipoma, was admitted because the increasing size of the mass. She was hypertensive and had recurrent supraventricular tachycardia, but was otherwise asymptomatic and physical examination was unremarkable. Laboratory tests were within normal limits. Abdominal ultrasound demonstrated a well-circumscribed, echodense space-occupying lesion. Magnetic resonance imaging revealed a hyperintense encapsulated tumour with contrast-medium enhancement. Because the imaging tests were equivocal, a segmental liver resection was performed to exclude malignancy. Histological examination revealed an angiomyolipoma of the liver. Angiolipoma is a benign mixed-cell tumour that very rarely affects the liver but must be included in the differential diagnosis of hepatic space-occupying lesions. Its manifestations may be highly variable and histological examination is required if there is any uncertainty about possible malignancy. If the biopsy is diagnostic of a benign lesion, expectant observation with regular monitoring is indicated.