Inflammatory Pseudotumor Presenting as a Facial Swelling

We present a case of inflammatory pseudotumor (IPT) presenting as a facial swelling after an accidental hit on a right side of a face. As swelling did not resolve, dental examination and teeth extraction were done by a dentist presuming the swelling was misdiagnosed with infection of dental origin. Swelling grew even bigger and patient was referred to Department of Maxillofacial Surgery. CT scan of the face and FNA of the lesion was ordered. A homogenous tumor mass in the right infraorbital region in front of anterior wall of the maxillary sinus was seen on CT. The result of the FNA was reactive hyperplasia of the lymph node. Since the lesion was easily accessible surgical exploration and complete extirpation was done. Pathohistological analysis indicated a low grade B-cell Non Hodgkin lymphoma. PCR showed policlonality of B cells discarding the diagnosis of lymphoma. Pathohistological review showed diffuse intramuscular, perineural and perivascular infiltration with small lymphocytes without formation of germinative centers. Imunohistochemistry was positive for CD20 and CD3. Taking into account all features the diagnosis of IPT was established. Diagnosis of IPT is a diagnosis by exclusion, combining clinical, radiological and pathohistological characteristics. Lack of clear histologic criteria makes differential diagnosis extremely difficult. Our case is unique regarding localisation of head & neck IPT, no case presenting on the face in infraorbital region has been described in the literature. Although IPT is very rare in general and especially on the face, one should be aware of it when considering differential diagnosis of facial swelling

Shear-wave sonoelastographic features of invasive lobular breast cancers

Aim To evaluate shear-wave elastographic (SWE) and related gray-scale features of pure invasive lobular breast carcinoma (ILC) and compare them with invasive ductal breast cancers (IDC). Methods Quantitative SWE features of mean (El-mean), maximum (El-max), minimum (El-min) elasticity values of the stiffest portion of the mass, and lesion-to-fat elasticity ratio (E-ratio) were measured in 40 patients with pure ILC and compared with 75 patients with IDC. Qualitative grayscale features of lesion size, echogenicity, orientation, and presence of distal shadowing were determined and compared between the groups. Results ILC were significantly larger than IDC (P = 0.008) and exhibited significantly higher El-max (P = 0.015) and higher El-mean (P = 0.008) than IDC. ILC were significantly more often horizontally oriented, while IDC were significantly more often vertically oriented (P < 0.001); ILC were significantly more often hyperechoic than IDC (P < 0.001). Differences in stiffness between ILC and IDC determined by quantitative SWE parameters were present only in small tumors (≤1.5 cm in size), ie, small ILC had significantly higher El-max (P = 0.030), El-mean (P = 0.014), and El-min (P = 0.045) than small IDC, while tumors larger than 1.5 cm had almost equal stiffness, without significant differences between the groups. Conclusion Specific histopathologic features of ILC are translated into their qualitative sonographic and quantitative sonoelastographic appearance, with higher stiffness of small ILC compared to small IDC. Gray-scale and sonoelastographic features may help in diagnosing ILC

Sonoelastografske karakteristike lezija dojke visokog rizika i duktalnog karcinoma in situ - probno istraživanje

The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.Cilj ove studije bio je izmjeriti kvantitativne vrijednosti tvrdoće lezija dojke visokog rizika i duktalnog karcinoma in situ (DKIS) pomoću shear-wave sonoelastografije. Retrospektivno smo analizirali patohistološke, ultrazvučne i elastografske podatke (maksimalna, srednja i minimalna tvrdoća, omjer tvrdoće lezije i masnog tkiva (E-omjer), veličina lezije) 228 bolesnica upućenih tijekom četvorogodišnjeg razdoblja na naš odjel radi biopsije dojke širokom iglom. Patohistološki su među 230 lezija dojke dijagnosticirane 34 lezije dojke visokog rizika, 29 duktalnih karcinoma in situ te 167 invazivnih duktalnih karcinoma dojke. Lezije visokog rizika pokazale su niže vrijednosti svih elastografskih parametara u usporedbi s duktalnim in situ i invazivnim karcinomima, no u usporedbi s DKIS jedino je E-omjer pokazao značajnu razliku tvrdoće (3,7 prema 6; p<0,001). Sve su se sonoelastografske vrijednosti značajno razlikovale pri usporedbi duktalnih in situ i invazivnih karcinoma. Nađena je značajna povezanost veličine i tvrdoće lezije (r=0,36; p<0,001). Tvrdoća mjerena shear-wave sonoelastografijom dobro korelira s patohistološkim nalazom lezija dojke koje se mogu otkriti ultrazvukom. Vrijednosti tvrdoće lezija visokog rizika su značajno niže od onih kod malignih lezija. Također smo pokazali da DKIS, uz ultrazvučni nalaz tipičnih mikrokalcifikata u najvećem broju slučajeva, ima i značajno manje vrijednosti tvrdoće od invazivnih karcinoma

TRENDS IN STAGE AND AGE CHARACTERISTICS OF THE FEMALE BREAST CANCER TREATED IN 11-YEAR PERIOD AT UNIVERSITY HOSPITAL »DUBRAVA«

U retrospektivnoj studiji analizirali smo i usporedili faktore lokalne proširenosti raka dojke, odnosno veličinu tumora i status regionalnih limfnih čvorova u razdoblju od 1997. do 2007. Također smo uspoređivali zastupljenost pojedinih dobnih skupina i prosječnu dob bolesnica u promatranom razdoblju. Studijom su obuhvaćene samo one bolesnice kod kojih je dijagnoza postavljena na otvorenoj kirurškoj biopsiji, a bilo je moguće odrediti lokalnu proširenost tumora u vrijeme postavljanja dijagnoze (pT i pN stadij), ukupno 1202 bolesnice. Prosječna veličina tumora u vrijeme postavljanja dijagnoze bila je 2,2 cm, a kretala se između 1,7 cm (2005.) i 2,4 cm (1997., 1999.). Učestalost metastaza u pazušnima limfnim čvorovima varirala je između 37% (2001.) i 50% (2000. i 2006.). Prosječno u 6% svih slučajeva rak dojke dijagnosticiran je u neinvazivnom (in situ)stadiju. Srednja dob bolesnica bila je 56,8 godina, a prema promatranim godinama kretala se između 54,3 (1999.) i 59,1 (2004.) godina. Nije bilo statistički značajne razlike u odnosu prema stadiju bolesti ili dobi bolesnica u vrijeme postavljanja dijagnoze u cijelome promatranom razdoblju. Isto tako nije bilo statistički značajnih razlika u proširenosti bolesti u vrijeme dijagnoze kod bolesnica mlađih i starijih od 50 godina.In a retrospective study we analyzed and compared the factors of local spread of breast cancer, namely tumor size and status of regional lymph nodes and patient age in the period from 1997 to 2007. The study includes only those patients in whom the diagnosis was made in an open surgical biopsy and it was possible to determine the local extent of disease at the time of diagnosis (pT and pN stage), a total of 1202 patients. We also compared the findings in patients younger and older than 50 years. The average tumor size at diagnosis was 2.2 cm and ranged between 1.7 cm (2005) and 2.4 cm (1997, 1999). The percentage of metastases in regional lymph nodes varied between 37% (2001) and 50% (2000 and 2006). The average of 6% of all cases of breast cancer was diagnosed in non-invasive (in situ) stage. The mean patient age was 56.8 years and for the observed age ranged between 54.3 (1999) and 59.1 (2004) years. There was no statistically significant difference in relation to disease stage or patient age at diagnosis observed throughout the entire period of time. There was also no statistical difference in stage of disease at the time of diagnosis in patients younger and older than 50 years

Povezanost proteina nm23 i ketapsina D sa kliničkim i patološkim značajkama oralnog karcinoma pločastih stanica

The most important prognostic factor in oral squamous cell carcinoma (OSCC) is the presence of metastases in regional lymph nodes. Study group comprised of 107 patients with OSCC and control group comprised of 77 specimens of unchanged oral mucosa. The purpose of this study was to determine the immunohistochemical expression of cathepsin D and nm23 protein in OSCC and to compare it to the other clinical and histological features and to the occurrence of regional metastases, in order to assess their prognostic value. In contrast to normal epithelium a diff use expression of cathepsin D and nm23 protein in OSCC has been found. By comparing the expression of cathepsin D and nm23 protein in tumor cells and in tumor stroma and the type of reaction to the pT, the degree of diff erentiation, mode of invasion and tumor stroma the following has been found: a signifi cant connection between nm23 protein in tumor cells with the degree of diff erentiation, nm23 protein with the characteristics of the tumor stroma and mode of invasion and cathepsin D with the degree of tumor diff erentiation. The results of this research highlight the important role of tumor stroma in metastatic potential of OSCC.Svrha ovog istraživanja bila je imunohistokemijski utvrditi izraženost proteina nm23 i katepsina D u oralnim pločastim karcinomima, usporediti ju s patohistološkim nalazima, pojavom područnih presadnica i procijeniti njihovu vrijednost u prognozi bolesti. Ispitivano je 107 tkivnih uzoraka bolesne i 77 zdrave ustne sluznice. Uočena je pojačana difuzna izraženost proteina nm23 i katepsina D u bolesnom tkivu. Usporedbom proteina nm23 i katepsina D u tumorskim stanicama i tumorskoj stromi, te tipa reakcije s pT, stupnjem diferencijacije, načinom invazije i izraženošću tumorske strome, nađena je znakovita povezanost izraženosti proteina nm23 u tumorskim stanicama sa stupnjem diferencijacije, proteina nm23s izraženošću tumorske strome i načinom invazije, te katepsina D sa stupnjem diferencijacije tumora. Najvažniji prognostički pokazatelj u oralnim pločastim karcinomima su metastaze u područnim limfnim čvorovima. Rezultati istraživanja pokazuju važnost tumorske strome za metastatski potencijal ostnog ustnog pločastog karcinoma

Povezanost proteina nm23 i ketapsina D sa kliničkim i patološkim značajkama oralnog karcinoma pločastih stanica

The most important prognostic factor in oral squamous cell carcinoma (OSCC) is the presence of metastases in regional lymph nodes. Study group comprised of 107 patients with OSCC and control group comprised of 77 specimens of unchanged oral mucosa. The purpose of this study was to determine the immunohistochemical expression of cathepsin D and nm23 protein in OSCC and to compare it to the other clinical and histological features and to the occurrence of regional metastases, in order to assess their prognostic value. In contrast to normal epithelium a diff use expression of cathepsin D and nm23 protein in OSCC has been found. By comparing the expression of cathepsin D and nm23 protein in tumor cells and in tumor stroma and the type of reaction to the pT, the degree of diff erentiation, mode of invasion and tumor stroma the following has been found: a signifi cant connection between nm23 protein in tumor cells with the degree of diff erentiation, nm23 protein with the characteristics of the tumor stroma and mode of invasion and cathepsin D with the degree of tumor diff erentiation. The results of this research highlight the important role of tumor stroma in metastatic potential of OSCC.Svrha ovog istraživanja bila je imunohistokemijski utvrditi izraženost proteina nm23 i katepsina D u oralnim pločastim karcinomima, usporediti ju s patohistološkim nalazima, pojavom područnih presadnica i procijeniti njihovu vrijednost u prognozi bolesti. Ispitivano je 107 tkivnih uzoraka bolesne i 77 zdrave ustne sluznice. Uočena je pojačana difuzna izraženost proteina nm23 i katepsina D u bolesnom tkivu. Usporedbom proteina nm23 i katepsina D u tumorskim stanicama i tumorskoj stromi, te tipa reakcije s pT, stupnjem diferencijacije, načinom invazije i izraženošću tumorske strome, nađena je znakovita povezanost izraženosti proteina nm23 u tumorskim stanicama sa stupnjem diferencijacije, proteina nm23s izraženošću tumorske strome i načinom invazije, te katepsina D sa stupnjem diferencijacije tumora. Najvažniji prognostički pokazatelj u oralnim pločastim karcinomima su metastaze u područnim limfnim čvorovima. Rezultati istraživanja pokazuju važnost tumorske strome za metastatski potencijal ostnog ustnog pločastog karcinoma

Renal Cell Carcinoma with Concurrent Urothelial Carcinoma of Urinary Bladder and Non-Hodgkin Lymphoma

We report a case of a 71-year-old male with multiple primary malignancies involving kidney and urinary bladder, combined with synchronous lymphoma. The patient was admitted to the hospital because of painless gross hematuria. Examination revealed tumor of the right kidney and papillary tumor in the urinary bladder and enlarged lymph nodes along aorta and inferior vena cava. Transurethral resection of bladder tumor (TUR), radical nephrectomy of the right kidney and retroperitoneal lymphadenectomy were performed. Pathohistologic evaluation, together with immunohistochemistry, gave the patient the final diagnosis of renal cell carcinoma (RCC), urothelial carcinoma of the urinary bladder and B- small cell Non-Hodgkin lymphoma (B-CLL)

Canonical Wnt/β-catenin signaling pathway is dysregulated in patients with primary and secondary myelofibrosis

INTRODUCTION: β-Catenin is a central effector molecule of the canonical wingless-related integration site (Wnt) signaling pathway. It is important for maintenance of stem cell homeostasis and its aberrant activation has been implicated in a wide array of malignant hematological disorders. There are few reports suggesting its dysregulation in Philadelphia chromosome-negative (Ph-) myeloproliferative neoplasms (MPNs). ----- PATIENTS AND METHODS: We analyzed β-catenin mRNA expression in bone marrow (BM) aspirates of 29 patients with primary (PMF) and 4 patients with secondary, post Ph- MPN, myelofibrosis (SMF) using quantitative real-time polymerase chain reaction (qRT PCR). The control group consisted of 16 BM aspirates from patients with limited-stage aggressive non-Hodgkin lymphoma without BM involvement. We compared relative gene expression with clinical and hematological parameters. ----- RESULTS: Relative expression of β-catenin differed significantly among groups (P = .0002), it was significantly higher in patients with PMF and SMF than in the control group, but did not differ between patients with PMF and SMF. A negative correlation was found regarding hemoglobin level in PMF (P = .017). No association according to Janus kinase 2 (JAK2) V617F mutational status or JAK2 V617F allele burden was detected. ----- CONCLUSION: Our results show for the first time that β-catenin mRNA expression is increased in patients with PMF and SMF and its upregulation might potentiate anemia. A number of inflammatory cytokines associated with PMF are capable of mediating their effects through increased β-catenin expression. Accordingly, β-catenin can induce expression of a number of genes implicated in processes of cell cycle control, fibrosis, and angiogenesis, which are central to the PMF pathogenesis. Therefore, β-catenin might represent an interesting new therapeutic target in these diseases

Positron emission tomography-computed tomography and 4-hydroxynonenal-histidine immunohistochemistry reveal differential onset of lipid peroxidation in primary lung cancer and in pulmonary metastasis of remote malignancies

The Aim of the study was to reveal if PET-CT analysis of primary and of secondary lung cancer could be related to the onset of lipid peroxidation in cancer and in surrounding non-malignant lung tissue

Fine-Needle Aspiration Cytology of Apocrine Hidradenoma

An apocrine hidradenoma is a benign adnexal neoplasm, usually covered by intact skin, but may show superficial ulceration and serous discharge. This feature is raising the possibility of malignancy as it was in our case of macroscopically suspicious tumour. We described cytomorphologic features of cutaneous nodule that might be a lead to the cytologic diagnosis of hidradenoma, but primary or secondary malignant tumour has been ruled out first