Primary Papillary Adenocarcinoma Research Articles

Femoral metastasis of papillary carcinoma of the ovary -A rare incidental finding

Epithelial ovarian cancer normally spreads transcoelomically via the peritoneal cavity and then, in more advanced stages, to the intra-abdominal lymph nodes and the liver and lung parenchyma. Bone metastasis is an extremely rare initial presentation in patients with primary carcinoma of the ovary and is associated with poor prognosis. Herein we report a rare case of femoral metastasis of papillary carcinoma of the ovary in a 49-year-old female, who presented to the orthopaedics clinic with complaints of pain and swelling around the left knee joint since 2 months. X ray and MRI of left leg showed a diffuse soft tissue swelling and osteolytic lesions in the lower femur around the condyles with focal cortical destruction. Fine needle aspiration biopsy of the lesion was suggestive of metastatic adenocarcinoma. Subsequent ultrasonography of the lower abdomen showed a hypoechoic shadow in the left ovary. Local surgical excision with left oopherectomy was performed. After histopathologic and immunohistochemical examination from both the sites, a final diagnosis of primary papillary adenocarcinoma of the ovary with femoral metastasis was given. She was treated with 6 cycles of adjuvant combination chemotherapy of Paclitaxel 150 mg/m2and Cisplatin 50 mg/m2 and a good response was seen. This case is unique in presentation of bony femoral metastasis with silent epithelial ovarian carcinoma. Keywords: Bone, Femur, Metastasis, Ovarian cancer, Immunohistochemistry.

LUNG NODULE WITH PAPILLARY FEATURES ON BIOPSY: A DIAGNOSTIC DILEMMA

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Papillary adenocarcinoma (PA) is a rare sub type of adenocarcinoma of the lung. It can have histological and immunohistochemistry features like papillary thyroid carcinoma (PTC). We report a case of lung nodule found to have features suggestive of PTC on biopsy. CASE PRESENTATION: A 69-year-old female with a history of COPD and colon cancer presented to the pulmonologist for follow up of a solitary lung nodule in the right upper lobe, which was first diagnosed two years back. It had shown a recent increase in size from 8 mm to 12 mm, with spiculated pattern on imaging. Biopsy of the lung nodule was highly suspicious for PTC, with positive TTF1, papillary features, intranuclear cytoplasmic inclusions, nuclear grooves, negative CK20, CDX2 immunostain. She denied any symptoms of hypo/hyperthyroidism, weight loss, fatigue, cough, dyspnea, neck radiation exposure. She had a 37.5 pack-year smoking history. Family history was non-contributory. Vital signs and physical examination were unremarkable. Thyroid function tests including TSH, fT3, fT4 were within normal limits. With findings suggestive of PTC on biopsy, initial concern was for metastatic disease. Thyroid ultrasound showed 0.7cm cystic nodule in the right lobe, and two solid nodules of 0.9cm, 0.8cm on the left. FNAC of the nodules showed benign pathology. Tumour board was consulted, and they recommended MRI of the neck with contrast which revealed mildly enlarged thyroid with sub centimetric nodules, without lymphadenopathy, making our suspicion for metastatic PTC very low. Ectopic thyroid tissue carcinoma, PA of the lung were now being considered as differentials. Lung biopsy slides were sent to Mayo clinic for a second opinion, which revealed neoplastic cells with lining of papillary structures, with positive immunochemistry for napsin-A and TTF1, and negative for Pax-8, confirming the diagnosis of primary PA. DISCUSSION: PA accounts for 7-12% of lung adenocarcinomas, with a predilection for female smokers. It mimics PTC, as they can have similar histological features of pseudo-inclusions, intra-nuclear grooves. In such cases, immunohistochemistry aids in the diagnosis. Although, our patient had a nodule which morphologically resembled PTC, the history of solitary lung nodule, in the absence of significant findings on imaging and biopsy made the diagnosis of PTC unlikely. CONCLUSIONS: Most common etiology for lung nodule showing papillary features is metastatic disease. The combination of positive TTF1, napsin-A, and negative Pax-8 is a reliable tool to differentiate primary lung adenocarcinoma from metastatic tumors. Understanding the existence of papillary thyroid carcinoma-like primary pulmonary papillary adenocarcinoma will avoid misdiagnosis or unnecessary investigations. Reference #1: Zhu YZ, Li WP, Wang ZY, Yang HF, He QL, Zhu HG, Zheng GJ. Primary pulmonary adenocarcinoma mimicking papillary thyroid carcinoma. J Cardiothoracic Surg. 2013; 17; 8:131 Reference #2: El-Maqsoud NM, Tawfiek ER, Abdelmeged A, Rahman MF, Moustafa AA. The diagnostic utility of the triple markers Napsin A, TTF-1, and PAX8 in differentiating between primary and metastatic lung carcinomas. Tumour Biol. 2016; 37(3):3123-34 Reference #3: Karmakar S, Nath A, Neyaz Z, Agarwal V, Ahsan S. Primary papillary adenocarcinoma of lung: Report of two cases. Lung India. 2017; 34(3):299-302 DISCLOSURES: No relevant relationships by Shujaa Faryad, source=Web Response No relevant relationships by Pallavi Pradeep, source=Web Response

Non-Resolving Lung Infiltrate: A Rare Case of Papillary Adenocarcinoma of the Lung

Lung carcinoma is one of most common and leading cause of cancer related mortality in United States. The main sub-types of lung cancer are non-small cell lung carcinoma (NSCLC) and small cell carcinoma (SCLC). About 85% of lung cancers are of the non-small cell type, of which more than 50% are adenocarcinomas. Primary papillary adenocarcinoma (PA) is a subtype of adenocarcinoma with predominance of papillary structures that replace the underlying alveolar architecture supported by fibro-vascular cores with complicated secondary and tertiary branches. PA is a relatively rare type that can present a diagnostic challenge when it presents as a non-resolving infilitrate as seen in this case. It is more common in woman and non-smokers. The subtype of adenocarcinoma is key factor for therapeutic choice of chemotherapy. The case reviewed here is a rare presentation of a middle aged chronic smoker Man with past medical history of chronic obstructive pulmonary disease (COPD) who was treated several times for recurrent episodes of worsening dyspnea attributed to an infectious etiology, but without any significant improvement which led to further testing and trans-bronchial biopsy which reveled PA of the lung. Tissue diagnosis is therefore warranted in patients with a non-resolving lung infiltrate.

Primary Papillary Adenocarcinoma of Urinary Bladder: A Case Report

A 50 year old male presented with painless haematuria and nocturia since 3 months.Routine examination revealed mild anaemia and raised ESR.Ultrasonography of Kidneys,Bladder and Prostate showed an irregular mass in urinary bladder.An abdominal contrast enhanced computed tomography scan showed a 4cm mass in the posterior wall of urinary bladder.Cystoscopy and Transurethral resection of the mass was done.Histopathology revealed it as Adenocarcinoma with muscle invasion.Surgical intervention in the form of cysto-prostatectomy ,bilateral pelvic lymph node dissection, bilateral uretero-sigmoidostomy was done.A soft nodular exophytic growth was found in the posterior wall of urinary bladder.Histopathology and Immunohistochemistry confirmed it as Primary Papillary Adenocarcinoma.All other visceral sites were adequately excluded for primary adenocarcinoma.We are reporting this case as Primary papillary adenocarcinoma of urinary bladder, which is a rare neoplasm.

Primary Papillary Adenocarcinoma of Urinary Bladder: A Case Report

Primary Papillary Adenocarcinoma of Urinary Bladder: A Case Report

Brain metastasis as initial presentation of papillary adenocarcinoma of the lung: case report

The authors describe the case of a 33-year-old patient with history of seizures alone without any previous symptom, being diagnosed with brain metastases from primary papillary adenocarcinoma of the lung. Emphasis is given to the diagnostic investigation for brain metastasis and prognostic evaluation of papillary adenocarcinoma of the lung, and a brief literature review on such diseases is performed.

Primary Papillary Adenocarcinoma of the Fallopian Tube with Ovarian Metastasis

Primary Papillary Adenocarcinoma of the Fallopian Tube with Ovarian Metastasis

Concomitant pulmonary and thyroid tumors identified by FDG PET/CT and immunohistochemical techniques

BackgroundThe exact diagnosis of double primary papillary adenocarcinoma of thyroid and lung is even rarer, to our knowledge no report in the literature by [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography/X-ray CT(FDG PET/CT) with surgical specimens immunohistochemistry(IHC). We report a patient with abnormal FDG PET/CT in thyroid and lung, this unusual presentation may lead to misdiagnosis without surgical specimens IHC.Case presentationA 56-year-old man with coughing three months. FDG PET/CT was performed, and resection specimens of lung and thyroid were detected by hematoxylin eosin staining (HE) and IHC. PET/CT: lung tumor SUVmax: 3.69, delay: 5.17; and thyroid tumor SUVmax 19.97. HE reveal papillary adenocarcinoma, but histological differentiation of primary pulmonary adenocarcinoma from metastatic adenocarcinoma is sometimes difficult because of their phenotypic similarities. So IHC was performed, the IHC of lung tumor: cytokeratin 20 (CK20)(-), thyroglobulin(Tg)(-), cytokeratin7(CK7)(+), thyroid transcription factor-1 (TTF-1)(+); thyroid tumor: CK7(+), TTF-1(+), thyroglobulin (+), CK20(-). Therefore, the final diagnosis was double primary adenocarcinomas of thyroid and lung.ConclusionFDG PET/CT has preliminary diagnostic capacity of multiple primary tumors; the final diagnosis should be adopted for specimens after tumor-specific markers IHC to obtain. Consequently, effective therapeutic approaches can be designed and conducted.

Primary Papillary Mucinous Adenocarcinoma of the Ureter Mimicking Genitourinary Tuberculosis

Primary adenocarcinomas of the renal pelvis and ureter are rare and account for less than 1% of all malignancies at this site. We report a case of primary papillary mucinous adenocarcinoma of the ureter that clinically mimicked genitourinary tuberculosis. Early diagnosis is important for the better outcome.

Metastatic Versus Primary Oncocytic Papillary Adenocarcinoma of the Endometrium: A Report of a Case and Review of the Literature

We report a case of an oncocytic papillary adenocarcinoma of the endometrium in an 89-year-old female with vaginal bleeding. Imaging studies revealed lesions in the uterus, kidneys, pancreas, gluteus, and an enlarged portacaval lymph node. Diagnostic workup included an endometrial biopsy which showed malignant, oncocytic cells in a predominantly papillary pattern. These cells stained positive for epithelial markers (pan-cytokeratin, CK7, epithelial membrane antigen) and weakly for estrogen receptor. The cells were negative for cytokeratin 903, CAM 5.2, progesterone receptor, CD10, RCC Marker, CA-125, c-kit, and vimentin. Consultation with experts in Gynecologic and Genitourinary pathology returned a diagnosis of "adenocarcinoma compatible with metastatic renal cell carcinoma"--an intriguing possibility worthy of further exploration. To our knowledge, there are no reports in the literature of metastatic oncocytic papillary renal cell carcinoma to the endometrium. The clinical and pathologic features of oncocytic papillary endometrial lesions, including primary and metastatic processes, are reviewed.

Neoplasias espontâneas em ratos Wistar de um centro de criação de animais de laboratório do Estado do Rio de Janeiro, Brasil

Este estudo foi realizado com o objetivo de verificar a prevalência e as características anatomopatológicas de neoplasias espontâneas encontradas em ratos Wistar, provenientes do biotério do Centro de Criação de Animais de Laboratório, FIOCRUZ, Rio de Janeiro. Foram necropsiados 1.964 ratos Wistar, no período entre agosto de 2002 e janeiro de 2007, após eutanásia em câmara de gás carbônico. Amostras teciduais foram colhidas, fixadas em formol tamponado a 10% e processadas pelas técnicas habituais para inclusão em parafina. Foram realizados 38 diagnósticos de neoplasmas, sendo 36 ratos acometidos, o que representa uma prevalência de 1,8%. Dos 36 animais, apenas seis (16,7%) eram machos e um (2,8%) jovem. As neoplasias diagnosticadas com as respectivas ocorrências foram: carcinoma mamário (42,1%), fibroadenoma mamário (13,2%), hemangiossarcoma (7,9%), adenoma da glândula hipófise (7,9%), adenoma mamário (5,3%), fibrossarcoma (5,3%), adenocarcinoma papilífero pulmonar primário (2,6%), epitelioma sebáceo (2,6%), ganglioneuroblastoma na glândula adrenal (2,6%), leiomioma uterino (2,6%), mesotelioma (2,6%), osteossarcoma osteoblástico (2,6%) e papiloma (2,6%). No presente estudo a prevalência de neoplasias espontâneas foi bastante inferior à encontrada em estudos similares, com predomínio dos tumores malignos. O epitelioma sebáceo e os carcinomas mamários mucinoso e simples cístico-papilar com ocorrência espontânea foram descritos pela primeira vez em ratos Wistar.

Fallopian tube malignancies: A retrospective clinical pathological study of 17 cases

SummaryThe aim of this study is to present a retrospective clinical pathological study of 17 cases of tubal malignancies. The 17 cases were diagnosed and treated in our department between July 1985 and July 2005. Clinical information and pathological data were obtained by review of hospital records. Carcinomas were staged according to the FIGO criteria; assignment of stage was made on the operative data and the pathological findings. Four patients had Stage I tumour (23.5%), six had Stage II (35.4%), five patients had Stage III (29.4%) and two had Stage IV (11.7%). The histological type of all our specimens was primary papillary adenocarcinoma of the fallopian tube. Initially, all patients were subjected to surgery. Primary fallopian tube cancer (PFTC) is a rare gynaecological malignancy, similar to ovarian cancer, but with poorer prognosis. The PFTC should be considered in the differential diagnosis of any pelvic mass. The treatment was surgical followed by adjuvant chemotherapy.

A Huge Primary Peritoneal Papillary Adenocarcinoma Which Demonstrated Imaging Findings Similar to Those of Extrahepatic-Growing Type Hepatic Tumor: Report of a Case

We herein report a 69-year-old woman who presented with a huge intra-abdominal tumor which demonstrated imaging findings similar to those of extrahepatic-growing type hepatic tumor, but turned out to be primary peritoneal papillary adenocarcinoma. Computed tomography showed a well-demarcated mass, measuring 12.0 cm in diameter, which came in contact with the lateral segment of the liver and invaded the diaphragm and abdominal wall. Distant lymph node metastasis was also detected. A fine-needle aspiration biopsy of the tumor showed poorly differentiated adenocarcinoma of unknown origin. After chemotherapy with 5-fluorouracil and cisplatin, the maximal diameter of the tumor decreased to 6.0 cm. The patient then underwent a tumorectomy together with a lateral segmentectomy of the liver, a splenectomy, a partial resection of the diaphragm and abdominal wall, and a left oophorectomy. Histological and immunohistochemical examinations demonstrated the tumor to be primary peritoneal papillary adenocarcinoma.

Laryngeal Metastasis from a Pulmonary Papillary Adenocarcinoma: A Case Report

Metastases to the larynx from distant primaries are very rare. The present article reports a case of metastatic papillary adenocarcinoma of the larynx of lung origin. The patient was a 59-year-old female non-smoker, who had a history of adenocarcinoma of the right lung. For the laryngeal tumor, we performed a partial laryngectomy following biopsy. The tumor of the larynx was a papillary adenocarcinoma resembling the lung tumor, both demonstrating positive immunohistochemical staining for pulmonary surfactant apoprotein. The findings emphatically indicated the laryngeal tumor to be metastasis from the primary papillary adenocarcinoma of the lung. The present case report presents the clinical findings, course of disease and histopathological findings with brief reviews of the literature.

Distribution and Biological Effects of Inhaled 239 Pu(NO 3 ) 4 in Cynomolgus Monkeys

Twenty male cynomolgus monkeys were exposed by inhalation either to an aerosol of 239Pu(NO3)4 to produce projected initial lung burdens of either 40, 10, or 4 kBq or to a carrier aerosol as a control. Animals died or were sacrificed at 0.01, 1, 3, 6, 12, 24, 40, and 99 months after inhalation, and the distribution and biological effects of the 239Pu were determined. The 239Pu cleared efficiently from the lungs so that less than 0.05 kBq remained at 99 months after exposure to 40 kBq. Total skeletal 239Pu activity was nearly constant after the first year, but the fraction of the body burden in skeleton at sacrifice increased with time up to 99 months because of clearance from other organs. Plutonium in the liver increased to a peak at 1 year and then decreased to about 10% of the peak value at 99 months. Plutonium in the testes was localized in the interstitial tissue with only 0.01 to 0.002% of the projected lung burden remaining in testes at 99 months after inhalation. Three animals exposed to 40 kBq of 239Pu died of radiation-related pulmonary pneumonitis and fibrosis. A primary papillary adenocarcinoma of the lung was identified in one animal exposed to 40 kBq initial lung burden and sacrificed 99 months after inhalation. The frequency of chromosome aberrations in blood lymphocytes was significantly elevated only in monkeys with projected deposits of 40 kBq of 239Pu. There was no change in aberration frequency in other exposure groups as a function of inhaled activity, time after exposure, or calculated total dose to the lungs. Only in monkeys that had marked radiation-induced pathological changes in the lung did the frequency of chromosome-type aberrations increase significantly, to a value about twice the control level. In cynomolgus monkeys, chromosome aberration frequency in blood lymphocytes is not a good indicator of radiation dose or damage from inhaled soluble plutonium.

Primary papillary adenocarcinoma of the middle ear

Primary adenocarcinoma of the middle ear is a rare tumour, be it primary or metastatic (Rosenwasser 1941). Schuller et al (1983) mentioned only 13 cases reported previously and added 4 of their own. We present a case of primary papillary adenocarcinoma of the middle ear in an elderly male which is its most uncommon histological variety. The patient was treated with radical mastoidectomy and post operative external radiotherapy.

Posthysterectomy carcinoma of the fallopian tube presenting as vaginal adenocarcinoma: A case report

The clinical and pathological features of a case of adenocarcinoma of the fallopian tube with a unique presentation are described. The 68-year-old patient presented with vaginal bleeding 25 years after a vaginal hysterectomy. Pelvic examination revealed a 0.5-cm nodule of tumor involving the mucosa of the vaginal apex. At laparoscopy, the left fallopian tube was dilated and adherent to the vaginal vault. Pathological examination of the upper vaginectomy and bilateral salpingo-oophorectomy specimen revealed a primary papillary adenocarcinoma of the left fallopian tube that had invaded directly into the mucosa of the vaginal apex. Vaginal involvement, either at the time of presentation or subsequently in the course of the disease, is very rare in patients with carcinoma of the fallopian tube.

Synchronous Multiple Primary Malignant Tumors accompanied by Glioblastoma

A case of synchronous multiple primary malignant tumors accompanied by glioblastoma is reported. The patient, a 27-year-old woman, was admitted with nausea, vomiting, and a slight consciousness disturbance. Five months before, she had noticed a lump in both breasts, and 1 month later, an abnormal shadow was noted on chest X-ray. Computed tomography scan showed a cystic lesion with ring-like enhancement in the left frontal lobe. Chest X-ray and the tomogram showed a tumor shadow in the right upper lung field. The brain tumor was totally removed. Histologically, it was glioblastoma (first primary focus). One month following brain surgery, a bilateral mastectomy with lymph-node dissection was performed. Histopathological examination revealed ductal carcinoma without metastasis to lymph-node, and they were diagnosed as bilateral primary breast carcinomas (second and third primary foci). Lung tumors gradually progressed in spite of chemotherapy, and she expired due to respiratory insufficiency. Histopathological examination of the autopsied lungs revealed primary papillary adenocarcinoma of apical portion of the upper lobe of right lung with numerous small hematogenously disseminated metastatic tumor nodules in entire lobes of both lungs (fourth primary focus). Moreover, an occult sclerosing carcinoma of papillary type was found in the thyroid (fifth primary focus). There have been no previous reports on five synchronous primary malignant tumors in which one of the primary sites was within the brain.

Primary adenocarcinoma, papillary, of fallopian tube

A primary papillary adenocarcinoma of the Fallopian tube was found in a 74-year-old nulliparous woman. There was no evidence of metastases or spread at the time of operation. The clinical manifestations were similar to those of an ovarian cyst.