Secondary Adenocarcinoma Research Articles

Distribution and incidence of atypical glandular lesions in cervical cytology focusing on the association with high-risk human papillomavirus subtypes.

Adenocarcinoma in situ (AIS) is considered a precursor of adenocarcinoma. Cervical adenocarcinoma has been associated with human papillomavirus (HPV), while other subtypes of AIS and endocervical adenocarcinoma have no precursor lesions and are not associated with HPV. Cervical cytology and HPV genotyping are important in the detection of these different subtypes. Notably, endometrial lesions and infiltration with secondary adenocarcinoma may lead to misdiagnosis of endocervical lesions. The aim of the present study was to avoid misdiagnosis of squamous cell changes and endometrial lesions as endocervical lesions in cervical screening. A total of 210,510 female cytological samples were analyzed between the beginning of January 2020 and the beginning of January 2021. The samples were processed for conventional cytological techniques, and for molecular detection and subtyping of high-risk HPV (HPV-HR) according to the advice and measurements of BD Biosciences (117,765 samples) and the PapilloCheck® HPV test (5,579 samples). The present study was carried out in Germany using the Munich classification III. II-g (Bethesda classification: atypical glandular cells not otherwise specified) was detected in 0.12% of cases under the age of 35 years. Another peak was noticed within the 41-60-years age group (0.11%). In the 41-50-years age group, a peak for II-e (Bethesda classification: Endometrial cells) (1.5%) was identified. An association was revealed between HPV16, HPV18 and HPV45 with cervical intraepithelial neoplasia III, AIS, endocervical adenocarcinoma and squamous cell carcinoma, in addition to other HPV-HR subtypes, such as HPV33/58, as well as 52, 56/59/66 in the different age groups. In patients aged <35 years, 0.03% of cases were vaccinated cases against HPV. In the 35-40-years age group, there was only one vaccinated case (0.0045%); in the 41-50-years age group, there were 11 vaccinated cases (0.031%); and in the 51-60-years age group, there was one vaccinated case (0.002%). No patients aged >60 years were vaccinated against HPV in the analyzed cohort. In conclusion, most cases of HPV-associated glandular dysplastic changes and neoplasia occurred in sexually active women aged between 35 and 60 years. In addition, endocervical adenocarcinoma may occur at any age with or without an HPV infection.

Oropharyngeal adenocarcinoma as a rare presentaton secondary to gastric adenocarcinoma: a case study

&lt;p class="abstract"&gt;Adenocarcinoma of oropharynx is a rarely encountered entity. It may be primary or secondary as metastasis from a distant site. Secondary adenocarcinoma of base of tongue is even more uncommon, few cases have been reported in the literature till date including one from stomach as a primary site. We are presenting a case of secondary adenocarcinoma of base of tongue metastasised from stomach after one and half years of successful treatment consisting of surgery and adjuvant chemotherapy.&lt;/p&gt;

De Novo Secondary Adenocarcinoma in the Colon Used as Urinary Diversion Not in Contact with the Fecal Stream: Systematic Review and Meta-analysis.

A systematic review with a meta-analysis was performed to determine the prevalence and risk factors for secondary de novo adenocarcinoma in the colon used as a urinary diversion not exposed to the fecal stream. The systematic review of the literature identified 47 patients with secondary adenocarcinoma in a colonic urinary diversion not exposed to the fecal stream. The diagnosis of secondary adenocarcinoma was determined due to the presence major local symptoms and because the cancer in half of the patients was detected at an advanced stage. Diagnosis at an earlier stage was associated with long-term cancer-free survival. The authors concluded that cystoscopy-colonoscopy screening as suggested by the American Gastroenterology Society for the general population should be applied to patients who have colon urinary diversion not exposed to the fecal stream. For patients with active high-grade inflammation, difficulty with self-catheterization, or symptoms, cystoscopy should be performed earlier. Resection of the tumor at an early stage offers better clinical outcomes with longer survival rates.

Use of Gene Expression Analysis for Discrimination of Primary and Secondary Adenocarcinoma of the Liver

Background: Due to late diagnosis and resistance to chemotherapy, most patients with cholangiocarcinoma have an unfavorable prognosis. Despite the use of immunohistochemistry (IHC) in clinical routine, differentiation between intrahepatic cholangiocarcinoma (ICC) and secondary adenocarcinomas of the liver is frequently not clear, leading to false diagnosis and treatment decisions. Methods: Oligonucleotide microarrays (Affymetrix Hu133A^©) were used for gene expression analysis of ICC (n = 11) and secondary adenocarcinomas (colorectal metastases; n = 6). By two-dimensional cluster analysis a specific gene expression profile of these tumors was established and confirmed by real-time polymerase chain reaction and IHC. Results: A total of 338 genes were significantly dysregulated (gene expression/fc ≥2; dysregulation in ≥60%) in both tumor groups. Using two-dimensional cluster analysis a fast, clear, and reproducible differentiation between ICC and colorectal metastases was possible in all cases. As potential biomarkers for differentiation, twelve genes (ICC: KRT7, DBN1, LCTB, LIF, STK17A, PIGF; metastases: TDGF1, HOXA9, TFF3, MYB, ABP1, BCL11A) were detected and will be used for further investigations. Conclusions: A specific gene expression profile for discrimination of primary and secondary adenocarcinoma of the liver could be established. In addition, marker genes for both cancers and their potential use as discrimination markers in clinical routine were also described partially for the first time.

Endometriosis of Extra-Abdominal Soft Tissues: A Tertiary Center Experience.

While endometriosis, defined as the presence of endometrial tissue in extrauterine sites, is most frequently encountered within the peritoneal cavity, a small but significant proportion of cases occur at extra-abdominal soft tissue sites, particularly in relation to previous abdominal surgery. We reviewed the cases of endometriosis of soft tissue sites seen at a tertiary soft tissue center. All cases of extra-abdominal soft tissue endometriosis diagnosed at this institution over a 13-year period were reviewed, and clinical and pathologic findings were recorded. Forty-five patients had diagnoses of soft tissue endometriosis and there were 34 diagnostic biopsies and 26 surgical excision specimens. All but 1 case were abdominal wall lesions, with 1 located in the upper arm. A total of 33 patients presented with lesions in scars of previous operations (31 in Pfannenstiel incisions for Caesarean sections, presenting with a median interval of 6 years (range 1-16 years) following surgery). The lesions ranged in size from 1 to 8 cm (median 3.5 cm). One case showed decidualized stroma with trophoblast cells, while 2 had secondary adenocarcinoma arising from endometriosis. Eighteen cases were tested for β-catenin expression immunohistochemically, of which 5 showed at least focal nuclear positivity in the surrounding fibrous tissue (although not within glands or stroma). Soft tissue endometriosis is seen most commonly in surgical scars, particularly following Caesarean sections. Spontaneous endometriosis also most commonly occurs in the abdominal wall, although can occur exceptionally at unusual sites, such as extremities. Secondary changes, including carcinomas, can arise from endometriosis. The differential diagnosis of these lesions includes fibromatosis, which may be erroneously diagnosed on small, nonrepresentative core biopsy specimens.

Glandular cardiac myxoma

Cardiac myxoma is the most common primary neoplasm of the heart and arises from the endocardium as a polypoid mass, which is commonly seen in the left atrium. Glandular cardiac myxomas are extremely rare cardiac myxomas that contain glandular structures and the pathogenesis of the glandular differentiation is unknown. The present case study reports a case of glandular cardiac myxoma. The tumor was located in the left atrium without invasion of the myocardium. Microscopically, the myxoma contained well-formed mucinous glands in a background of classic cardiac myxoma. Immunohistochemically, the mucinous glandular cells were strongly positive for cytokeratin 7 (CK7) and partially positive for calretinin, but negative for CD34, CK20, D2-40, WT-1, and TTF-1. In conclusion, glandular cardiac myxoma is very rare and it is important to recognize this entity correctly so that it is not misinterpreted as secondary adenocarcinoma.

Unexpected pathological lesions of appendix: an analysis of 3000 surgical specimens from Sri Lanka

Background: Unexpected pathological lesions are not infrequent findings in surgical specimens of appendix. Appendiceal malignancies are commonly encountered as incidental lesions. Objective: To analyze the unexpected appendiceal pathological lesions encountered in surgical specimens in a sample of Sri Lankan patients. Methods: A retrospective review of 3000 consecutive appendicectomy specimens and appendices in colectomy specimens received at the Department of Pathology, Faculty of Medicine, University of Peradeniya from 2001 to 2014. Results: There were 2907 appendicectomy specimens and 93 colectomy specimens with an appendix. In appendicectomy specimens, there were 9 (0.3%) primary neoplasms of which 8 were malignant, 2 (0.06%) secondary carcinoma deposits, 7 (0.24%) endometriosis, 7 (0.24%) granulomatous inflammation, 2010 (69.1%) acute appendicitis and the rest (30%) were unremarkable. In the appendices of colectomy specimens, there were 4 (4.3%) primary neoplasms, all of which were malignant, 7 (7.5%) secondary carcinoma deposits, 1 (1.1%) granulomatous inflammation, 11 (11.8%) acute appendicitis and the rest (75.2%) were unremarkable. Of the 3000 specimens, 13 (0.4%) had a primary appendiceal neoplasm: 9 (0.3%) mucinous neoplasms, 3 (0.1%) NET G1 (carcinoids) and 1 (0.03%) sessile serrated adenoma. Of the mucinous neoplasms, 1 was an adenoma, 3 were low grade appendiceal mucinous neoplasms and 5 were adenocarcinomas. Caseous tuberculoid granulomata were present in 5/8 (62.5%) granulomatous appendicitis. Conclusions: The commonest unexpected finding in the appendicectomy sample was primary malignant tumours (0.3%) and the commonest malignant tumour group was mucinous neoplasms. Secondary adenocarcinoma is the commonest pathology in the appendices of colectomy specimens. Most granulomatous appendicitis cases were suggestive of tuberculosis.

Urinary Bladder Adenocarcinoma Metastatic to the Abdominal Wall: Report of a Case with Cytohistologic Correlation.

We report a case of adenocarcinoma metastatic to the abdominal wall in a 71-year-old man with a history of primary bladder adenocarcinoma. CT-guided core biopsy was performed; imprints and histologic sections showed malignant glands lined by tumor cells with hyperchromatic nuclei and prominent nucleoli, infiltrating through skeletal muscle. Immunohistochemistry revealed positivity for CK7, membranous/cytoplasmic β-catenin, caudal-type homeobox transcription factor 2 (CDX2), and α-methylacyl coenzyme A racemase and negativity for CK20, p63, prostate-specific antigen (PSA), and prostate-specific acid phosphatase (PSAP). These findings were interpreted as metastatic adenocarcinoma, consistent with bladder primary. Primary bladder adenocarcinoma is a rare malignancy arising within glandular metaplasia and is associated with cystitis cystica and cystitis glandularis. Predisposing factors include bladder exstrophy, schistosomiasis, and other causes of chronic bladder irritation. This tumor is divided into intestinal, clear cell, and signet ring cell subtypes. Treatment involves radical cystectomy with pelvic lymph node dissection, and prognosis is unfavorable. Primary bladder adenocarcinoma should be differentiated from urachal adenocarcinoma, which arises from urachal remnants near the bladder dome, and secondary adenocarcinoma, or vesical involvement by adenocarcinoma from a different primary. CK7, CK20, CDX2, thrombomodulin, and β-catenin can help distinguish primary bladder adenocarcinoma from colonic adenocarcinoma; PSA and PSAP can help distinguish primary bladder adenocarcinoma from prostate adenocarcinoma.

Synovial sarcoma of the penis: A case report

s / Urological Science 26 (2015) 294e300 298 MP3-3: SYNOVIAL SARCOMA OF THE PENIS: A CASE REPORT Chao-An Chen , Kam-Fai Lee , Kuo-Cai Huang , Kuo-Hsiung Chiu , TzuHsin Yang , Yin-Lun Chang , Jian-Hui Lin , Yung-Chin Huang , Dong-Ru Ho , Chih-Shou Chen , Wei-Yu Lin . Division of Urology, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Anatomic Pathology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan Purpose: Primary synovial sarcoma of the penis is extremely rare. We report a case of synovial sarcoma initially discovered as a painless penile mass with no image evidence of distal metastasis. Synovial sarcoma was reported in the final pathology. Materials and Methods: A 59-year-old male patient is a case of panic disorder under alprazolam treatment for 4 years. He came to our outpatient department for gradual enlargement of penile mass in recentmonths. He is a married man without circumcision. The mass was painless, spherical, and movable over penile base, without skin abnormality or infection signs. Computed tomography revealed a 3.2 cm hypodense mass lesion over left side of corpus cavernosum without enlargement of pelvis or retroperitoneal lymph nodes. Partial penectomy with bilateral inguinal lymph node dissection was performed. Synovial sarcoma within tunica abluginea (pT2) was reported in the final pathology. Results: To our knowledge; this is the first case of primary synovial sarcoma of penis in Taiwan. MP3-4: ADENOCARCINOMA OF URINARY BLADDERe A CASE REPORT Ping-Hao Tsai, Heng-Chieh Chiang, Pao-Hwa Chen. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan This 78 years old manwho was under regular follow-up post transurethral rsection of prostate gland. During last cystoscope, tumor biopsy was done and the pathologic report reveal possibility of urothelial carcinoma with glandular differentiation, which primary adenocarcinoma or secondary adenocarcinoma involvement especially colorectal origin may be consideration on July, 2015. Afterward, we arranged MRI for tumor staging and it reveals T3N0M0, Stages III. Then, after explain to patient, transurethral resection of bladder tumor was performed on Aug, 2015. The final pathologic report reveals adenocarcinoma arising from urinary bladder. We also arranged colon scope which reveals negative finding. PET scan reveals no uptake for gastrointestinal tract. As exclude colorectal origin of adenocarcinoma, patient is under radiotherapy and chemotherapy for adneomcarcinoma currently. MP3-5: ASSOCIATION BETWEEN HUMAN GLUTATHIONE S-TRANSFERASE OMEGA RS4925 POLYMORPHISM AND BLADDER CANCER Zhon-Min Huang , Jow-Yu Sheu , Min-Che Tung , Chia-Chang Wu, Yuan-Hung Wang . Divisions of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan; Divisions of Urology, Shuang Ho Hospital, Taipei Medical University New Taipei City,

Primary and secondary adenocarcinomas associated with anal fistulae

The purpose of this study was to evaluate the clinical features, pathology, and etiology of adenocarcinoma in patients with anal fistulae. We identified seven patients diagnosed with adenocarcinoma associated with anal fistulae from a retrospective chart review. Five patients were diagnosed with primary adenocarcinoma associated with anal fistulae. Two patients were diagnosed with secondary adenocarcinoma associated with anal fistulae originating from rectal cancer on the proximal side. The primary adenocarcinomas included cancers arising from long-standing anal fistulae fulfilling established diagnostic criteria in two patients, and cancer arising from short-duration anal fistulae in three patients. Excision of the fistula was performed based on the initial diagnosis of the anal fistula for all five patients. Increased suspicion of cancer was due to the existence of gelatinous material in the anal fistula in three patients and induration in the resected specimens in two patients. The etiologies of the secondary adenocarcinomas associated with anal fistulae included implantation in the anal fistula from rectal cancer and fistula formation originating due to the progression of rectal cancer. Anal fistulae are commonly seen in the coloproctology clinic, but special attention to similar conditions associated with malignant disease is needed.

Tumor mutation status of Hodgkin lymphoma survivors with secondary lung adenocarcinoma.

9600 Background: In a multi-institutional, retrospective study of 1976 patients treated for Hodgkin's lymphoma (HL) from 1969-2007, 55 patients developed second primary lung cancers a median of 19.5 years after treatment. Of these 55 cases, 32 were identified as lung adenocarcinoma (ACA). The development of targeted therapies in recent years has made the detection of specific genomic alterations important for disease prognosis and treatment in lung ACA. The prevalence of certain genomic alterations (EGFR, ALK, and KRAS) is highly correlated with smoking history. We hypothesize that the prevalence of genomic alterations also may differ in patients with a significant exposure to radiation. Methods: This observational retrospective case series includes 6 patients treated with mediastinal radiation for HL who subsequently developed lung ACA. All patients were treated at Ohio State University Wexner Medical Center. Patients were identified by searching billing diagnosis codes in the electronic medical record and by query of the physicians in the department of thoracic oncology at our institution. IRB approval was obtained. Results: The average age at diagnosis of HL was 25 years (range 18-46) and the average age at diagnosis of lung cancer was 58 (range 52-73). All patients were treated with radiation therapy; two patients were treated additionally with chemotherapy. None of the patients received HDT-ASCT. The average time from diagnosis of HL to diagnosis of lung cancer was 33 years. Of our six cases, 2 were positive for EGFR mutations and the other four were triple negative (-EGFR, -ALK, -KRAS). Three were never smokers, one had a 1.5 pack year history, and two had 10 pack year histories. Lung cancer stages at diagnosis were 1B (n=2), 2B (n=1), 3A (n=2), 4 (n=1). Conclusions: To our knowledge, this is the first report of mutational status of second primary lung ACA following radiation therapy for Hodgkin disease. Although the number of patients is small, the higher prevalence of the EGFR mutation in this sample suggests that ACA related to radiation therapy may have a similar mutational profile to that of never smokers. Further investigation is needed to define the disease characteristics of lung ACA in HL survivors.

Transitional cell carcinoma in orthotopic ileal neobladder 12 years after radical cystectomy

Some cases of secondary adenocarcinoma developing in the replaced bowel segment of urinary diversions have been reported so far. Secondary adenocarcinoma develops 20 years after surgery in about 0.5% of those in whom an ileal segment is used. There have been several reports in the literature describing extensions of transitional cell carcinoma (TCC) from the distal urether into an ileal conduit. Histology of loop tumor in 50% was TCC. The site of tumors in the majority of cases is the area at the uretheral orifices or the stoma. We presented a rare case of transitional cell carcinoma in an orthotopic ileal neobladder 12 years after radical cystoprostatectomy and ileal neobladder with the substitution by the procedure Camey II. A 65-year-old man with high-grade urothelial carcinoma of neobladder underwent partial resection of neobladder and right nephroureterectomy. Pathological analysis revealed high-grade urothelial carcinoma to the ileal neobladder (G II, Stage T2b). The patient died of laryngeal cancer a year after the surgery. Surgery of tumors in orthotopic neobladders is possible if diagnosed in time. In the presented case surgery resulted only in a decrease in the capacity of the neobladder without having an effect on the continence itself.

A Rare Case of Hematuria from Colonic Adenocarcinoma Spreading to the Bladder via the Stented Ureter

Background The direct extension of advanced tumors from adjacent organs to the bladder is not uncommon. Secondary bladder involvement through hematogenous and/or lymphatic metastases and implant of cells by tumors involving higher urinary tract via the ureter are rare. Therefore, the histological resemblance between primary bladder adenocarcinoma and colorectal adenocarcinoma can be a dilemma for pathologists. Methods A 67-year-old female underwent total right hemicolectomy for ascending colon adenocarcinoma. After a 20-month follow-up the lesion was removed (which was histopathologically similar to the previous colon cancer) and the patient underwent ureteral stenting because of a mass in the right internal iliac nodes with homolateral hydronephrosis. Subsequently intermittent gross hematuria urged on performing cystoscopy detecting a non-papillary mass situated above the right ureteral orifice, previously revealed on ultrasonography and CT scan. Results A TURBT was performed. Histopathologically the mass, partially covered by intact urothelium, consisted of tubular and pseudoglandular structures intermixed with solid foci of mucin-producing signet-ring-cells-type adenocarcinoma, very similar to the original colon cancer. The tumor base was healthy. Immunohistochemically stains for cytokeratin 7 (CK7) and cytokeratin 20 (CK20) presented multifocal positivity, suggesting the colorectal origin of the neoplasm. Conclusions In order to optimize the therapeutic options, it is important to distinguish the primary disease of the bladder from other causes of hematuria, and achieve a correct differentiation between primary enteric-type adenocarcinoma of the bladder and secondary colorectal adenocarcinoma involving the bladder, these entities being morphologically indistinguishable. Therefore, in patients with history of colonic adenocarcinoma, the presence of a subsequent bladder tumor should be considered as an eventuality of a secondary disease.

Urothelial carcinoma with abundant myxoid stroma

Urothelial carcinomas with abundant myxoid stroma have thus far been only briefly reported in a couple of textbooks yet not in the peer-reviewed literature. Thirteen cases of urothelial carcinoma with myxoid features were collected over 9 years. Cases with any distinct adenocarcinoma component were excluded from the study. The mean age of the patients was 64 years (range, 45-84 years). Nine of the 13 were male. All cases involved the bladder with one of the cases involving a bladder diverticulum. Treatment included transurethral resection of the bladder only in 6 patients, transurethral resection of the bladder with subsequent intravesical bacillus Calmette-Guérin treatment in 4 patients, radical cystectomy only in 2 patients, and neoadjuvant chemotherapy followed by cystectomy in 1 patient. In all cases, the myxoid stroma was associated with invasive urothelial carcinoma. The 2 most common patterns of cancer with myxoid stroma were small- or medium-sized nests seen in 10 cases followed by filiform cancer seen in 4 cases. Other patterns of invasive cancer associated with myxoid stroma were short cords and individual cells. The percentage of invasive urothelial carcinoma that had myxoid stroma ranged from 5% to 95% (mean, 50%). An unusual finding was the presence of invasive low-grade urothelial carcinoma associated with myxoid stroma in 5 cases, 4 of which had an overlying low-grade papillary urothelial carcinoma component. All cases were uniformly positive for cytokeratin 7 and negative for CDX2 with 5 cases also positive for cytokeratin 20. Urothelial carcinoma associated with the extracellular myxoid matrix was positive for MUC5 in 3 cases and for MUC2 in 2 cases. Two of the MUC5-positive cases were also positive in the urothelium for polyclonal CEA. Histochemical stains for Alcian blue with and without hyaluronidase, periodic acid-Schiff, and mucicarmine showed positivity in the areas of myxoid differentiation. The current study describes a rare variant of urothelial carcinoma that may be confused with primary or secondary adenocarcinoma of the bladder, which can have therapeutic and prognostic implications.

Diagnosis of epithelial mesothelioma using tree-based regression analysis and a minimal panel of antibodies

Immunohistochemistry with panels of antibodies is a standard procedure to distinguish between malignant mesothelioma and metastatic adenocarcinoma. Most studies assess only the sensitivity and specificity for single antibodies, even when the paper concludes by recommending an antibody panel. It was the aim of this study to use a novel statistical approach to identify a minimal panel of antibodies, which would make this distinction in the majority of cases. Two hundred consecutive cases of pleural malignancy (173 pleural mesotheliomas of epithelial type and 27 cases of secondary adenocarcinoma) were investigated using a standard panel of 12 antibodies (CAM5.2, CK5/6, calretinin, HBME-1, thrombomodulin, WT-1, EMA, CEA, CD15, B72.3, BG8, and TTF-1). Regression and classification tree-based methods were applied to select the best combination of markers. The modelling procedures used employ successive, hierarchical predictions computed for individual cases to sort them into homogeneous classes. Labelling for calretinin and lack of labelling for BG8 were sufficient for definite correlation with a diagnosis of malignant mesothelioma. CD15 provided further differentiating information in some cases. A panel of three antibodies was sufficient in most cases to diagnose, or to exclude, epithelial mesothelioma. Calretinin exhibits the strongest correlative power of the antibodies tested.

The use of Urovysion™ fluorescence in situ hybridization in the diagnosis and surveillance of non-urothelial carcinoma of the bladder

Urovysion™ fluorescence in situ hybridization (FISH) is a sensitive and specific test used to diagnose urothelial carcinoma in urine. It detects aneuploidy of chromosomes 3, 7 and 17, and loss of both 9p21 loci in malignant urothelial cells. We evaluated Urovysion™ FISH in non-urothelial carcinoma involving bladder to determine its possible application to their diagnosis and surveillance. Paraffin blocks from 31 non-urothelial bladder carcinomas, 12 pure urothelial carcinomas and 2 urothelial carcinomas with squamous differentiation were tested according to Vysis-Abbot Laboratories' recommended standards. Cases included 15 primary squamous carcinoma, 2 urothelial carcinoma with squamous differentiation, 4 primary adenocarcinoma, 5 colonic, 4 prostatic and 1 cervical adenocarcinoma. Total 60% of squamous, 83% of pure urothelial, 100% of urothelial carcinoma with squamous differentiation and 100% of primary and secondary adenocarcinomas hybridized successfully; 2/10 (11%) squamous carcinomas and 11/14 (79%) primary and secondary adenocarcinomas were Urovysion™ FISH-positive with primary adenocarcinomas accounting for 75% (3/4), colonic, 80% (4/5), prostatic, 75% (3/4) and cervical, 100% (1/1) positivity. Total 70% (7/10) of pure urothelial carcinomas and 100% (2/2) of urothelial carcinomas with squamous differentiation were Urovysion™ FISH-positive. In conclusion, we found that chromosomal abnormalities tested for by Urovysion™ FISH may be seen in non-urothelial carcinomas of bladder. These false-positive results were frequent in primary and secondary adenocarcinoma and rare in squamous carcinoma. This has significant implications for the accurate diagnosis and management of patients with urinary tract cancer. Urovysion™ FISH cannot be used to definitively diagnose squamous carcinoma or adenocarcinoma nor can it be used to differentiate the two from urothelial carcinoma. However, it may be useful as a surveillance tool in established primary and secondary bladder adenocarcinoma. Cytopathologists and urologists should correlate Urovysion™ FISH results with cytomorphology and clinical information.

A case of relapsing secondary bladder adenocarcinoma after right colonic cancer

A 71-year-old woman was referred to a surgical oncology clinic after CT raised suspicion for a bladder neoplasm. She had previously undergone right hemicolectomy and received adjuvant chemotherapy for pT3N1MX cancer of the cecum. A retroperitoneal recurrence had been deemed unsuitable for surgical resection, and had instead been treated with chemoradiation therapy. Follow-up CT raised suspicion for a possible bladder neoplasm. CT, physical examination, urinalysis, cystoscopy with biopsy, pathological analysis and immunohistochemical analysis. Adenocarcinoma of the cecum metastatic to the bladder. The patient underwent open bladder resection with total excision of the neoplasm and was administered adjuvant chemotherapy consisting of irinotecan and cetuximab. Subsequent recurrences at the same site were treated with transurethral resection, while chemotherapy was still in progress. At 7 months' follow-up, the patient remained alive, with no evidence of further recurrence.

Clinicopathological analysis of colorectal cancer liver metastasis and intrahepatic cholangiocarcinoma: Are they just apples and oranges?

Backgrounds/aims Intrahepatic cholangiocarcinoma and colorectal cancer liver metastasis are the most primary and secondary adenocarcinoma of the liver, respectively. A large-scale long-term comparative study of these two cohort patient is lacking. Methods A total of 166 colorectal cancer liver metastasis patients and 206 intrahepatic cholangiocarcinoma patients who had undergone curative liver resection were retrospectively analysed. Among 206 intrahepatic cholangiocarcinoma, there were 47 intraductal growth type-intrahepatic cholangiocarcinoma and 159 non-intraductal growth type-intrahepatic cholangiocarcinoma. The demographics, clinicopathological data, immunohistochemical study and survival were analysed. Results The intrahepatic cholangiocarcinoma patients were more female-predominated, associated with hepatolithiasis, symptomatic, jaundiced, and with larger tumour size compared with those of colorectal cancer liver metastasis. Prognostic factors of intrahepatic cholangiocarcinoma were pathologic staging, histologic pattern and section margin; whereas prognostic factors of colorectal cancer liver metastasis were rectal origin, differentiation, section margin and bilobar distribution. CK7 and CK20 differentiated majority of intrahepatic cholangiocarcinoma from colorectal cancer liver metastasis, while CDX2 and MUC5AC helped to differentiate inconclusive cases. The 1-, 3-, 5- and 10-year survival rates of colorectal cancer liver metastasis were 77%, 31%, 20% and 14%, compared to 53%, 21%, 13% and 7% of intrahepatic cholangiocarcinoma ( p = .0001). Furthermore, the survival of colorectal cancer liver metastasis was comparable to staged II intrahepatic cholangiocarcinoma ( p = .8866) and intraductal growth type-intrahepatic cholangiocarcinoma ( p = .1915). Conclusions Demographics, precipitating factor, clinical manifestations, and prognostic factors of colorectal cancer liver metastasis and intrahepatic cholangiocarcinoma differed remarkably. High incidence of CDX2 and MUC2 expression in colorectal cancer liver metastasis and intraductal growth type-intrahepatic cholangiocarcinoma might explain their similar cytoarchitecture and survival.

Endoscopic Ultrasonography-Guided Interstitial Implantation of Iodine 125 Seeds Combined with Chemotherapy in the Treatment of Unresectable Abdominal Carcinoma: A Prospective Study

Objective: To evaluate the clinical value of endoscopic ultrasonography-guided interstitial implantation of radioactive iodine 125 seeds in pancreatic cancer as well as other abdominal malignancies. Methods: Totally 25 cases of advanced pancreatic cancer and three metastases (a cholangiocarcinoma, a carcinoma of gastric cardia and an unknown secondary adenocarcinoma) underwent EUS-guided interstitial iodine seeds implantation. Expected number of implanted seeds was calculated with CT-based TPS system.

Diagnostic Surprise in an Evisceration Specimen

Diagnostic surprise in an evisceration specimen. Aims and purpose: To report a rare ocular tumor discovered incidentally after evisceration of a painful blind eye. Methods: Observational case report. Results: A 67-year-old Caucasian lady presented for elective evisceration of chronically irritable phthisical right eye. A history of bilateral retinal detachment surgery 34 years prior followed by phthisis of the right eye was noted. The patient was a smoker but otherwise fit and well. Intra-operatively, the ocular contents were felt to be unusual with hard deeply pigmented lumps being present in the eviscerated tissue. The specimen was sent for histopathology. This was reported as a primary adenocarcinoma of the retinal pigment epithelium after expert histological opinion. The possibilities of a secondary adenocarcinoma with possible primary sites as lung, breast or kidney were ruled out by immuno-histochemical techniques. The patient underwent extensive systemic screening including a whole body CT scan. Exhaustive investigations have not found any other tumor site. Conclusion: In the absence of a recognizable source of metastasis, a diagnosis of primary ocular adenocarcinoma has been made with retinal pigment epithelium being the possible site of origin. Literature review shows that primary ocular adenocarcinoma arising from neuroepithelium is a rare but recognized occurrence especially in longstanding blind eyes. This case highlights the importance of routine histopathological examination of eviscerated ocular contents, especially in long standing blind eyes.