Tumor-like Conditions Research Articles

Expression of HAb18G is associated with tumor progression and prognosis of breast carcinoma

HAb18G is a recently identified hepatoma-associated antigen and its association with tumor growth, invasion, and angiogenesis has been studied in a variety of tumors. However, its role in the tumor progression of breast cancer has not been explored. HAb18G expression was examined by immunohistochemistry in pathological sections of 1,637 breast tissue samples and by in situ hybridization in 41 cases of invasive breast carcinomas (BC). While not detected in any cases of tumor-like conditions or benign tumors of breast, and only rarely in normal tissue (4.4%), HAb18G expression was gradually up-regulated from atypical ductal hyperplasia (27.3%), to ductal carcinoma-in situ (59.8%), and to BC (61.4%) (P<0.01). Its expression in BC was correlated positively with C-erbB-2 expression and histologic grade (P<0.001), and negatively with the expression of estrogen and progesterone receptors (P<0.001). Significant differences of expression were also identified among the subgroups of BC examined: in decreasing order from invasive micropapillary carcinoma, ductal carcinoma, lobular carcinoma, papillary carcinoma, medullary carcinoma, to mucinous adenocarcinoma (P=0.001), corresponding to their known clinical aggressiveness. In an expanded group of 186 BC patients with proper follow up, our previous findings were confirmed: HAb18G expression was significantly associated with local recurrence, distant metastasis and tumor mortality (P<0.01). We also demonstrated that up-regulated tumor expression of HAb18G was a significant predictor of reduced disease progression-free survival rate and a shorter overall survival, independent of systemic therapies. In conclusion, this study suggests that HAb18G expression is associated with BC progression and prognosis. Further evaluation of this new marker in breast cancer is indicated.

Immunohistochemical study of mucin expression in periampullary adenomyoma

Benign tumors and tumor-like conditions in the ampullary area are uncommon, and there are extremely rare cases of adenomyoma (AM) and adenomyomatous hyperplasia (AMH). Surgical treatment is necessary if these lesions cause biliary obstruction. In addition, the differential diagnosis of AM and AMH from carcinoma is often difficult by standard endoscopic biopsy and cytopathological analysis that may show differential findings, resulting in unnecessary surgeries sometimes being performed. Immunohistochemical (IHC) analysis of periampullary AM and AMH was performed. For both types of lesions, epithelial glandular cells (EGCs) showed diffuse expression of MUC6 and focal expression of HIK1083, mainly in the inner region, and focal expression of MUC5AC, mainly at the surface. The EGCs showed no expression of MUC1 or MUC4, both of which were identified as malignant tumor markers in our previous series of mucin expression studies in pancreatobiliary tumors. The expression of CK7, which was diffusely positive in normal periampullary mucosa, was decreased in the EGCs of AM and AMH. A combined evaluation of IHC findings may be effective in the detection of AM and AMH, and also in distinguishing benign periampullary lesions, such as AM and AMH, from ampulla of Vater adenocarcinoma, thus avoiding excessive surgery.

What’s New in the AFIP Fascicle on Salivary Gland Tumors: A Few Highlights from the 4th Series Atlas

After a 12 year interval from the previous fascicle, a new fascicle on Tumors of the Salivary Glands in the new fourth series of the AFIP Atlas of Tumor Pathology was published in 2008. The data, presentation, illustrations, tables, and physical characteristics of the newest fascicle have been updated and improved. There have only been a few alterations and additions to the classification of tumors and tumor-like non-neoplastic conditions of salivary gland. Three of the most significant are discussed in this paper. Sialoblastoma has been reclassified as malignant; inflammatory pseudotumor has been reclassified as neoplastic and re-identified as inflammatory myofibroblastic tumor; and sclerosing polycystic adenosis is a new entity among tumor-like conditions.

Tumors of the kidneys and urinary bladder

The aim of this course is to provide the practicing pathologist and pathologist in training with a comprehensive update on the pathology of tumors of the kidneys and urinary bladder through a series of lectures given by experts on these subjects. The first half of the course will deal with the pathology of common and uncommon neoplasms of the epithelium of the renal tubules, pathology of mesenchymal and mixed renal neoplasms, and with the staging and grading of renal cell carcinoma. The second half will turn to the urinary bladder and will cover tumor-like conditions, the diagnosis of urothelial carcinoma from urine and other important aspects of urothelial carcinoma including classification, staging and reporting, and common and uncommon variants.

Unusual Localization of Castleman's Disease: Case Report in the Nasopharynx

Castleman’s disease, a benign lymphoproliferative disease of unknown etiology, rarely occurs as a nasopharyngeal mass. Instead, thedisease may appear as a local or generalized tumor-like condition, usually in the mediastinum, andit can also involve both the lymph nodes and non nodal tissue. Since the nasopharyngeal roof is the residence of the pharyngeal tonsil (adenoids), which is rich in lymphoid tissue, the appearance of Castleman’s disease is predictable. The presentation is variable and diagnosis is not easy. It may present as an asymptomatic involvement of one lymph node group or as a multicentric disease with systemic feature. Here, we report a 34 year old female patient with histopathologically proven hyaline-vascular type of Castleman’s disease, who presented with nasopharyngeal mass and was treated with a complete excision without complication. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:79-83)

Total knee arthroplasty for massive joint destruction in a patient with rheumatoid arthritis complicated with fibrous dysplasia

We report the case of a patient requiring total knee arthroplasty (TKA) due to massive knee bone deformities caused by rheumatoid arthritis (RA) complicated with polyostotic fibrous dysplasia. Reconstruction of the knee with large osseous defect was achieved with conventional TKA by impaction bone grafting. Benign tumor-like conditions such as fibrous dysplasia may be treated with conventional TKA instead of endoprosthesis, custom-made knee prosthesis, or osteoarticular allografting.

Splenic Peliosis Mimicking a Solid Tumor

A splenic mass was found in an asymptomatic 76-year-old woman who had been treated with steroids for autoimmune hepatitis. The lesion was found to be hyperechoic on ultrasound examination, hypovascular on angiography, low attenuating on postcontrast computed tomography, isointense to splenic parenchyma on precontrast T1- and T2-weighted images, and showed inhomogeneous enhancement on gadolinium-enhanced T1-weighted images. Splenic peliosis should be considered when diagnosing tumorlike conditions of the spleen because of its potential to cause splenic rupture.

Glioblastoma-secreted factors induce IGFBP7 and angiogenesis by modulating Smad-2-dependent TGF-β signaling

Insulin-like growth factor-binding protein 7 (IGFBP7) is a selective biomarker of glioblastoma (GBM) vessels, strongly expressed in tumor endothelial cells and vascular basement membrane. IGFBP7 gene regulation and its potential role in tumor angiogenesis remain unclear. Mechanisms of IGFBP7 induction and its angiogenic capacity were examined in human brain endothelial cells (HBECs) exposed to tumor-like conditions. HBEC treated with GBM cell (U87MG)-conditioned media (-CM) exhibited fourfold upregulation of IGFBP7 mRNA and protein compared to control cells. IGFBP7 gene regulation in HBEC was methylation independent. U87MG-CM analysed by enzyme-linked immunosorbent assay contained approximately 5 pM transforming growth factor (TGF)-beta1, a concentration sufficient to stimulate IGFBP7 in HBEC to similar levels as U87MG-CM. Both pan-TGF-beta-neutralizing antibody (1D11) and the TGF-beta1 receptor (activin receptor-like kinase 5, ALK5) antagonist, SB431542, blocked U87MG-CM-induced IGFBP7 expression in HBEC, indicating that TGF-beta1 is an important tumor-secreted effector capable of IGFBP7 induction in endothelial cells. HBEC exposed to either U87MG-CM or IGFBP7 protein exhibited increased capillary-like tube (CLT) formation in Matrigel. Both TGF-beta1- and U87MG-CM-induced Smad-2 phosphorylation and U87MG-CM-induced CLT formation in HBEC were inhibited by the ALK5 antagonist, SB431542. These data suggest that proangiogenic IGFBP7 may be induced in brain endothelial cells by TGF-betas secreted by GBM, most likely through TGF-beta1/ALK5/Smad-2 pathway.

Benign Tumors and Tumorlike Conditions of the Lung

Benign tumors and tumorlike conditions of the lung are encountered in the pathologic evaluation of asymptomatic and symptomatic lung nodules. Since many of these lesions are uncommon, they can be diagnostically challenging. To review the current classification of benign lung tumors, with emphasis on histopathology and useful ancillary studies. The current World Health Organization classification system for lung neoplasms and review of relevant publications. Despite improved imaging techniques, benign lung nodules are encountered in wedge biopsy and resection specimens. Histopathology, immunohistochemistry, and molecular techniques ensure accurate pathologic diagnosis and have shed light on the histogenesis of these unusual lesions.

Benign tumors and tumorlike conditions of the lung.

Abstract Context.—Benign tumors and tumorlike conditions of the lung are encountered in the pathologic evaluation of asymptomatic and symptomatic lung nodules. Since many of these lesions are uncommon, they can be diagnostically challenging. Objective.—To review the current classification of benign lung tumors, with emphasis on histopathology and useful ancillary studies. Data Sources.—The current World Health Organization classification system for lung neoplasms and review of relevant publications. Conclusions.—Despite improved imaging techniques, benign lung nodules are encountered in wedge biopsy and resection specimens. Histopathology, immunohistochemistry, and molecular techniques ensure accurate pathologic diagnosis and have shed light on the histogenesis of these unusual lesions.

Microparticulate Cortical Allograft: An Alternative to Autograft in the Treatment of Osseous Defects

Benign bone tumors are commonly diagnosed and treated. Following tumor removal, the defect in the bone can be filled with auto- or allografts, (degradable) bone substitutes or non-degradable polymethylmethacrylate. The ideal substitute for this purpose should provide immediate structural support and readily incorporate into bone over a short period of time. Experimentally, microparticulate allograft has been shown to incorporate quickly in metaphyseal and metadiaphyseal cortico-cancellous defects in primates [1]. Using a combination of small allogeneic cortical graft particles (< 250 µm), bone defects were filled following intralesional excision in 97 consecutive patients with benign and low grade malignant tumors and tumor-like conditions of bone. The clinical results and rate of radiographic incorporation and osseous consolidation were recorded and analyzed. These patients underwent 104 procedures in which osseous defects were packed with microparticulate allograft. The follow-up was from 23 to 49 months. There were 94 (90.3%) closed defects and 10 (9.7%) open defects. The average size of the grafted defect was 42.8 cm3 (0.48 - 315.0 cm3). Internal fixation was used in 11 of the 104 procedures (10.6 %). Radiographically, incorporation was observed in 91% of patients and consolidation in 60%. There were eleven failures (10.6 %), eight (72 %) due to tumor recurrence. Seven of eight patients with tumor recurrence underwent a second resection and grafting procedure that resulted in allograft incorporation and defect healing. There were two deep infections requiring debridement with retention of the graft; both resolved with satisfactory healing.Both incorporation and consolidation were observed in over 90% of patients with a low rate of complications. The use of small-particle cortical allograft proved to be an effective alternative to autogenous bone graft in patients with metaphyseal and metadiaphyseal surgical bone defects.

Radiological and histomorphological correlation of bone tumors and tumor-like diseases (author's transl)

In the diagnosis of bone tumors and tumor-like lesions the radiographic examination plays a dominant role in the phase before performing a biopsy, with the support of this examination important facts are available for the further diagnostic procedure, for planning the biopsy and also for getting the preliminary guiding principles how the therapy has to be performed. In order to interpret a radiograph of a diseased bone optimally it is necessary to know the histomorphological background of an X-ray feature. This more particularly as the reaction of bone to a pathological process is limited to only 2 radiographic images: osteolysis or/and osteosclerosis. On the basis of the histological pattern and the dynamic micromorphological process the picture of osteolysis and osteosclerosis is analysed. The periosteal reaction is also considered in this manner. After the representation of these general principles a detailed tabulated synopsis is given about the correlation between the histological and roentgenological findings of all benign and malignant bone tumors and tumor-like conditions.

Benign vascular tumors and tumor-like proliferations

Appropriate nomenclature of benign vascular tumors and tumor-like conditions is problematic due to overlapping histologic features, limited understanding of the pathogenesis, and controversy regarding classification. Benign vascular anomalies are categorized into malformations, neoplasms, reactive proliferations, or ectasias based on their clinical behavior, currently accepted etiologies, and histopathology. We address controversies in the classification of some entities and also discuss recent immunohistochemical developments that have raised questions regarding the origin of certain vascular tumors. This comprehensive review focuses on the clinical presentation, behavior, associated conditions, histopathological findings, and differential diagnoses of benign vascular tumors and tumor-like conditions.

Lymphoepithelial Carcinoma of the Parotid Glands and Its Relationship With Benign Lymphoepithelial Lesions

The salivary glands, despite their relatively simple morphology, give rise to more than 30 histologically distinct benign and malignant tumors. Salivary gland neoplasms comprise less than 2% of all tumors in humans and 3% of all head and neck tumors. They arise in the parotid gland in 80% of cases, and approximately 80% are benign and 20% are malignant. Among them are lymphoepithelial lesions, rare lesions of the salivary glands and especially of the parotid gland that are characterized by lymphocytic infiltration associated with an epithelial proliferation. They are divided into benign, which is considered as a tumorlike condition, and malignant, which is a rare carcinoma of the salivary glands. This article provides a review of the current knowledge on lymphoepithelial carcinoma with a look at its association with benign lesions and on the importance of making the correct diagnosis for the appropriate treatment.

Lymphoepithelial Carcinoma of the Parotid Glands and Its Relationship With Benign Lymphoepithelial Lesions

The salivary glands, despite their relatively simple morphology, give rise to more than 30 histologically distinct benign and malignant tumors. Salivary gland neoplasms comprise less than 2% of all tumors in humans and 3% of all head and neck tumors. They arise in the parotid gland in 80% of cases, and approximately 80% are benign and 20% are malignant. Among them are lymphoepithelial lesions, rare lesions of the salivary glands and especially of the parotid gland that are characterized by lymphocytic infiltration associated with an epithelial proliferation. They are divided into benign, which is considered as a tumorlike condition, and malignant, which is a rare carcinoma of the salivary glands. This article provides a review of the current knowledge on lymphoepithelial carcinoma with a look at its association with benign lesions and on the importance of making the correct diagnosis for the appropriate treatment.

Cardiovascular tumor-like conditions

Tumors of the heart may be neoplastic or nonneoplastic. The latter are the topic of this section and include hamartomas, heterotopias, cysts and inclusions, age-related growths, reactive proliferations, thrombotic lesions, and infections or infestations. Their importance lies not only in the fact that they can mimic true neoplastic lesions but also that they can, of their own accord, produce obstructions, arrhythmias, embolization, heart failure, and sudden death.

Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography

The approach to the radiographic diagnosis of bone tumors consists of analyzing the lesion in an organized fashion, with attention to the specific radiographic features of tumor location, margins, and zone of transition; periosteal reaction; mineralization; size and number of lesions; and presence of a soft-tissue component. Patient age is also an important clinical factor in the diagnosis of bone tumors, because various lesions have predilections for specific age groups.

Eosinophilic granuloma arising from the pelvis in children: A report of three cases

Eosinophilic granuloma (EG) is a benign tumor-like condition which is characterized by a clonal proliferation of Langerhans-type histiocytes and defined as a local form of Langerhans cell histiocytosis (LCH). The radiographic appearances of EG are quite different depending on the phase of the disease and the site of involvement. A status of EG in the bone is divided into acute and chronic phases. Radiologically acute phase of EG is difficult to differentiate from a malignant bone tumor such as Ewing's sarcoma or acute osteomyelitis. Chronic phase of EG may mimic a chronic osteomyelitis or a benign bone tumor. We report 3 children's cases of EG in the pelvis which showed quite different radiological features and clinical courses. A 6-year-old boy (Case 1) had an osteolytic lesion with slightly defined margins in the right acetabulum. A 4-year-old boy (Case 2) had a radiologically similar-looking lesion in the left acetabulum. These lesions resembled radiologically chronic osteomyelitis (Brodie's abscess) or a benign bone tumor and healed spontaneously after biopsy. A 2-year-old boy (Case 3) had an osteolytic lesion with ill-defined margin in the ilium. It was difficult to differentiate from a malignant tumor such as Ewing's sarcoma, or acute osteomyelitis. The lesion became enlarged after needle biopsy. In spite of an additional curettage, the osteolytic lesion remained in the left pelvis in 1 year. Treatment for EG is controversial. Curettage of the affected site and bone grafting is usually accomplished. However, some EG heal spontaneously. It is of great importance to understand the natural course of EG and this knowledge will give us the opportunity to avoid unnecessary treatment. EG with poor osteolytic margins may progress further after biopsy. EG with well-defined margins may heal spontaneously after biopsy only.

Poster 258: The Diagnostic Dilemma of Tumor-Like Conditions of the Temporomandibular Joint: A Case Series

Tumor-like conditions of the temporomandibular joint (TMJ) are rare pathological findings whose signs and symptoms are often nonspecific. Uncommon incidence and confusing clinical and imageological information may contribute to misdiagnosis and eventually lead to either overtreatment or insufficient, ineffective therapeutics.

Vascular Disease of the Spleen

A wide range of vascular disorders can affect the spleen. Although clinical presentation is often nonspecific, early diagnosis and treatment are mandatory in most conditions. Noninvasive imaging techniques are well suited to meet these objectives. Familiarity with normal macroscopic and microscopic vascular anatomy is a prerequisite to understand the pathophysiology of vascular disorders of the spleen. This article deals with diseases of the splenic vasculature (aneurysms, arteriovenous fistula, splenic vein thrombosis, collateral circulation in portal hypertension) as well as vascular disorders affecting the splenic parenchyma (splenic infarct, Gamna-Gandy bodies). Primary vascular tumors and tumor-like conditions of the spleen will be discussed very briefly.