Adenocarcinoma arising in a Warthin’s tumor

SummaryCarcinoma ex pleomorphic adenoma is a well-recognized entity, while, in rare cases carcinomas may arise from the epithelial component of Warthin’s tumor. We present a case of adenocarcinoma arising in a Warthin’s tumor located in the left parotid gland in a 49-years-old patient. Chest X-ray, laboratory investigation and thyroid scintigraphy were normal. A ultrasonography and computerized axial tomography showed multiple nodules. A fine needle aspiration biopsy showed typical features of Warthin’s tumor. The histology showed the presence of a metastatic adenocarcinoma, that was thyroglobulin and calcitonin negative. The patient underwent a total left parotidectomy, was carefully followed-up, and at a 7 years check-up visit no other primary malignant lesion has manifested

S100A8 calcium-binding expression in radicular and dentigerous cysts and in keratocystic odontogenic tumors

Introduction: Recently the term Keratocystic Odontogenic Tumor (KCOT) has been recommended for Odontogenic Keratocysts (OKC) to address the neoplastic nature of the lesion compared to radicular and dentigerous cysts. S100 are calcium-binding proteins involved in cell differentiation and inflammation, with a potential role in neoplastic transformation. Aim: The aim of this study was to evaluate whether S100A8 protein expression is different in KCOT compared to radicular cysts (RC) and dentigerous cysts (DC). Methods: A total of 84 consecutive odontogenic cysts, 34 RC, 25 DC, and 25 KCOT, were analyzed in this study. Results: Epithelial cells in KCOT cases were not immunoreactive for S100A8 except focally in cases associated with inflammation, while RC cases showed a variable positivity of all the epithelial layers from the basal to the superficial in 19/34 cases and DC cases showed a weak positivity of the intermediate and superficial layers in 7/25 cases. Conclusion: The lack of S100A8 protein expression seems to be observed more frequently in KCOT compared to RC and DC. This difference might be related to their neoplastic nature and a potential aggressive biological behavior for odontogenic cystic lesions

The Italian multicentre dosimetric study for lesion dosimetry in 223Ra therapy of bone metastases: Calibration protocol of gamma cameras and patient eligibility criteria

Purpose The aims of this work were to explore patient eligibility criteria for dosimetric studies in 223Ra therapy and evaluate the effects of differences in gamma camera calibration procedures into activity quantification. Methods Calibrations with 223Ra were performed with four gamma cameras (3/8-inch crystal) acquiring planar static images with double-peak (82 and 154 keV, 20% wide) and MEGP collimator. The sensitivity was measured in air by varying activity, source-detector distance, and source diameter. Transmission curves were measured for attenuation/scatter correction with the pseudo-extrapolation number method, varying the experimental setup. 223Ra images of twenty-five patients (69 lesions) were acquired to study the lesions visibility. Univariate ROC analysis was performed considering visible/non visible lesions on 223Ra images as true positive/true negative group, and using as score value the lesion/soft tissue contrast ratio (CR) derived from 99mTc-MDP WB scan. Results Sensitivity was nearly constant varying activity and distance (maximum s.d. = 2%). Partial volume effects were negligible for object area ⩾960 mm2. Transmission curve measurements are affected by experimental setup and source size, leading to activity quantification errors up to 20%. The ROC analysis yielded an AUC of 0.972 and an optimal threshold of CR of 10, corresponding to an accuracy of 92%. Conclusion The minimum calibration protocol requires sensitivity and transmission curve measurements varying the object size, performing a careful procedure standardisation. Lesions with 99mTc-MDP CR higher than 10, not overlapping the GI tract, are generally visible on 223Ra images acquired at 24 h after the administration, and possibly eligible for dosimetric studie

18F-fluorodeoxyglucose positron emission tomographic scan in solid-type p-stage-I pulmonary adenocarcinomas: What can produce false-negative results?

OBJECTIVE: False-negative (FN) uptake of 18F-fluorodeoxyglucose (FDG) can be divided into those cases related to technological limitations of positron emission tomography (PET) and those related to inherent properties of neoplasms. Our goal was to clarify possible factors causing FN PET results in patients with solid-type pulmonary adenocarcinomas (PAs). METHODS: From January 2007 to December 2014, of the 255 patients with p-stage-1 non-small-cell lung cancer observed and treated (surgically) in our institution, we retrospectively reviewed the PET/computed tomography (CT) records, the clinical information, the preoperative thin-section CT images, and the pathological features [classified by the International Association for the Study of Lung Cancer/ American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) subtyping criteria] of 94 consecutive solid-type p-stage-1 PAs. Univariable and multivariable logistic analyses were used to identify and weigh the independent predictors of the PET findings using the following variables: body weight, blood glucose level, tumour size, tumour location, and histological classification. RESULTS: There were 58 men and 36 women (mean age = 68.7 \ub1 8.9 years, range 42-85). Considering the maximum standardized uptake value (SUVmax) >2.5 as a 'PET-positive' result, 77 lesions (81.9%) proved PET positive and 17 lesions (18.1%), PET negative (with SUVmax < 2.5). Overall, the median SUVmax value was 5.7 [interquartile range (IQR) 2.8-10.3]. Higher SUVmax values (P < 0.001) were observed in those PAs larger than 2 cm in their major axis (median SUVmax = 9.0; IQR 4.6-14.6); in PAs < 2 cm, the median SUVmax was 4.1; IQR 2.2-5.9. When clustering the cohort in two histological classes (class A, colloid/mucinous/lepidic versus class B, micropapillary/ solid/acinar/papillary), the radiometabolic patterns were significantly different (median SUVmax = 2.8; IQR 1.7-4.9 in class A vs median = 7.4 IQR 4.5-13.9 in class B, P < 0.001). Significant PET FN rates were reported in (i) PAs measuring < 2 cm in their major axis (27.9%), (ii) lesions located in the lower zones of the lung (31.0%), and (iii) class A tumours (37.5%). In the multivariable logistic analysis, histological type (IASLC/ATS/ERS aggregated clusters) proved to be the only independent relevant factor for determining whether PET results were negative or positive (OR:7.23, 95% CI: 2.05-25.43, P = 0.002). CONCLUSIONS: The IASLC/ATS/ERS pattern significantly influences FDG uptake in solid-type p-stage-1 PAs. The fact that colloid/mucinous/ lepidic adenocarcinomas have a notable tendency to produce negative findings on PET scans warrants particular attention

Assessment of the interlaboratory variability and robustness of JAK2V617Fmutation assays: A study involving a consortium of 19 Italian laboratories

To date, a plenty of techniques for the detection of JAK2V617Fis used over different laboratories, with substantial differences in specificity and sensitivity. Therefore, to provide reliable and comparable results, the standardization of molecular techniques is mandatory.A network of 19 centers was established to 1) evaluate the inter- and intralaboratory variability in JAK2V617Fquantification, 2) identify the most robust assay for the standardization of the molecular test and 3) allow consistent interpretation of individual patient analysis results. The study was conceived in 3 different rounds, in which all centers had to blindly test DNA samples with different JAK2V617Fallele burden (AB) using both quantitative and qualitative assays. The positivity of samples with an AB < 1% was not detected by qualitative assays. Conversely, laboratories performing the quantitative approach were able to determine the expected JAK2V617FAB. Quantitative results were reliable across all mutation loads with moderate variability at low AB (0.1 and 1%; CV = 0.46 and 0.77, respectively). Remarkably, all laboratories clearly distinguished between the 0.1 and 1% mutated samples. In conclusion, a qualitative approach is not sensitive enough to detect the JAK2V617Fmutation, especially at low AB. On the contrary, the ipsogen JAK2 MutaQuant CE-IVD kit resulted in a high, efficient and sensitive quantification detection of all mutation loads. This study sets the basis for the standardization of molecular techniques for JAK2V617Fdetermination, which will require the employment of approved operating procedures and the use of certificated standards, such as the recent WHO 1st International Reference Panel for Genomic JAK2V617F