Giant cell tumor-like lesion of the urinary bladder: a report of two cases and literature review; giant cell tumor or undifferentiated carcinoma?

<p>Summary</p> <p>Giant cell tumor, excluding its prototype in bone, is usually a benign but local aggressive neoplasm originating from tendon sheath or soft tissue. Malignant behavior is uncommon. Visceral organ involvement including urinary bladder is rare. Giant cell tumors in visceral organs usually accompany epithelial tumors and the clinical behavior of giant cell tumor in urinary bladder is similar to its bone counterpart. Here, we report two cases of giant cell tumor located in urinary bladder in comparison with nine reported cases in the English literature. Concurrent noninvasive urothelial carcinoma was also described in all these previous reports and only one patient with follow-up died of disease. One of the two cases we present had no concurrent urothelial tumor at the time of diagnosis but had a history of a low grade noninvasive urothelial carcinoma with three recurrences. The histology of these two cases was similar to the giant cell tumor of bone and composed of oval to spindle mononuclear cells with evenly spaced osteoclast-like giant cells. Immunohistochemically, the giant cells showed staining with osteoclastic markers including CD68, TRAP, and LCA. Immunohistochemical expression of vimentin, CD68, LCA, and smooth muscle actin in mononuclear cells supported a mesenchymal origin with histiocytic lineage. The histologic and immunohistochemical properties in our cases as well as their clinical courses were consistent with a giant cell tumor. Consequently, tumors in urinary bladder showing features of giant cell tumor of bone may also be considered and termed "giant cell tumor".</p

Histologic features of spindle cell lipoma and problems in the differential diagnosis

AMAÇ: İğsi hücreli lipomun histolojik ve tipik immunhistokimyasal özelliklerini araştırmak ve diğer subkutan yerleşimli benzer histolojik ve immunhistokimyasal özellikleri olan neoplazmlarla ayırıcı tanısını yapmaktır. YÖNTEMLER: İstanbul Eğitim ve Araştırma Hastanesi patoloji laboratuarında lipom tanısı almış 3100 olguda son Dünya Sağlık Örgütü Yumuşak Doku Tümörleri Sınıflamasına göre alt tipler belirlendi ve bunların içinden 22 İHL çalışmaya alındı. 22 iğsi hücreli lipom olgusunda klinik (yaş, lokalizasyon, cinsiyet, nüks), morfolojik özellikler (tümör boyutu, alt tip, histoloji, mast hücre varlığı ve immunhistokimya), tümörlerin natürü ve ayrıcı tanı problemleri değerlendirildi. BULGULAR: 3100 lipomun alt tiplere göre dağılımı şu şekildeydi: 2864 klasik lipom (%90), 293 anjiyolipom (%9), 1 kondroid lipom (%0.03), 1 miyolipom (%0.03 ve 22 iğsi hücreli lipom (% 0.7). 22 iğsi hücreli lipomların 9’u fibröz, 3’ü miksoid, 1’i anjiyomatoid ve 9’u nonfibröz alt tipti. Erkek kadın oranı 18/4 olarak belirlendi. Olguların 2’si sırt, 3’ü omuz, 1’i ön kol, 1’i oral olup 15’ü baş-boyun bölgesinde lokalize idi. Ortalama tümör çapı 3.2 cm olup en büyük ve küçük çaplar 1 cm ve 6.1 cm olarak ölçüldü. Fibromatöz alt tipte belirgin olmak üzere Toluidin blue boyasıyla her olguda mast hücresi mevcuttu. Mast hücre sayısı on büyük büyütme alanında ortalama 23 olarak bulundu. S–100 tüm iğsi hücrelerde negatif ve yağ hücrelerinde pozitif olarak tespit edildi. CD34 olguların 21’inde pozitif, 1’inde negatif bulundu. Hiçbir olguda nüks izlenmedi. SONUÇ: İğsi hücreli lipom, subkutan lokalizasyonlu, iyi sınırlı, iğsi hücreli komponenti CD34 pozitif, mast hücrelerinden zengin bir tümör olup birçok subkutan tümörle ayırıcı tanı yapılmasını gerektiren nadir bir antitedir.OBJECTIVE: To investigate the histologic and immunohistochemical properties of spindle cell lipoma and to make its differential diagnosis from other subcutaneous neoplasms having similar histologic or immunohistochemical charecteristics. METHODS: 3100 cases of lipoma diagnosed in the Pathology Laboratory of İstanbul Educational and Research Hospital were reclassified according to the recent classification of Soft Tissue Tumors by World Health Organization and 22 spindl cell lipomas were included in the study. Clinical (age, gender, location, and recurrences) and morphologic features (tumor size, subtype, histology, presence of mast cells, and immunohistochemistry) as well as tumor nature and problems in differential diagnosis were evaluated. RESULTS: The histologic subtypes of 3100 lipomas were as follows: 2864 classical lipoma (90 %), 293 angiolipoma (9 %), 1 chondroid lipoma (0.03 %), 1 myolipoma (0.03 %) and 22 spindl cell lipoma (% 0.7). Of the 22 spindl cell lipoma 9 were fibrous, 3 myxoid, 1 angiomatoid and 9 non-fibrous subtypes. Male to female ratio was 18: 4. 2 cases were localized in dorsal region, 3 in shoulders, 1 in forearm, 1 in oral cavity and 15 in head and neck. Average tumor diameter was 3.2 cm ranging from 1 to 6.1 cm. Mast cells highligtened by Toluidin blue were seen in all cases, most prominently in the fibrous subtype. Mast cell count in 10 high power field was 23. S&amp;#8211;100 was negative in all spindle cells while lipomcytes were positive. CD34 was positive in 21 cases and negative in 1 case. No case recurred. CONCLUSION: Spindl cell lipoma is a subcutaneous, well-circumscribed tumor rich in mast cells with a CD34+ spindle cell component and is an uncommon entity requiring differential diagnosis with several subcutaneous tumors

The Correlation of CD24 Expression with Tumor Stage and Grade in Urothelial Carcinomas of the Urinary Bladder

Amaç: B lenfosit belirteci olarak bilinen CD24, intrasellüler sinyal iletiminde, hücre-hücre ve hücre-matriks arasındaki haberleşmenin düzenlenmesinde de önemli rol almaktadır. Son 10 yılda CD24 salınımı ile birçok tü- mörün ilerlemesi ve prognozu arasında ilişki bulunmuştur. Bu çalışmadaki amacımız, CD24 salınımının mesane ürotelyal karsinomlarında, en önemli morfolojik prognostik parametreler olan tümör evresi ve diferansiyasyon derecesi ile karşılaştırmak ve etkinliğini tartışmaktır. Yöntemler: Ocak 2005- Ekim 2008 yılları arasında, S.B. İstanbul Eğitim ve Araştırma Hastanesi patoloji laboratuvarında mesane transüretral rezeksiyon biopsi (TUR-B) materyali olarak gönderilmiş ve ürotelyal karsinom tanısı almış 79 olgu çalışmaya alınmıştır. Tüm olgular Hematoksilen-Eosin histokimyasal boyamasıyla tekrar değerlendirildi ve Dünya Sağlık Örgütü (WHO)-2004 sınıflamasına göre derecelendirildi. Patolojik evre TNM sınıflamasına gore yapıldı. Tüm olgulara ait kesitlere immunhistokimyasal boyama olarak CD24 boyandı, semikantatif olarak CD24 salınımı pozitif hücrelerde değerlendirildi. Bulgular: CD24 salınımı ile invaziv (pT1-2) ve invaziv olmayan (pTa) olgular arasında istatistiksel olarak anlamlı bir farklılık bulundu (p<0,01). Normal ürotelyal epitelde ve tümöre komşu normal epitelde CD24 immünreaksiyonu, genelde apikalde zayıf sitoplazmik ve/veya membranöz boyanma şeklinde izlendi (skor 0 ve 1). Düşük dereceli ürotelyal tümörlerde ve normal ürotelyum epitelinde görülen apikal boyanma, invaziv tümörlerde kaybolmuştu ve nonpolarize kuvvetli sitoplazmik ve mebranöz boyanma izlendi. pTa (invaziv olmayan) ürotelyal karsinomlarda immün reaksiyon genelde zayıf ve daha çok apikal boyanma şeklinde izlendi, pTa yüksek dereceli olgularda da benzer boyanma izlenmekle beraber, pozitif olgularda immün reaktivite daha yaygın ve apikal boyanma polaritesi kaybolmasıyla birlikteydi. Düşük ve yüksek dereceli olgular arasında, CD24 immun reaksiyonu ile istatiksel olarak anlamlı farklılık bulunmuştur (p<0,05). Sonuç: Çalışmamızda ürotelyal karsinomlarda özellikle apikal lokalizasyonlu sitoplazmik boyanmanın kaybı ile stromal invazyon arasında ilişki tespit ettik ve sonuç olarak; CD24 ün sitoplazmik aşırı salınımını tümör invazyonu için önemli bir belirteç olarak kullanılabileceğini düşünüyoruz. Ayrıca gelecekte immunoterapinin (anti-CD24 antikoru), mesane kanserlerinde ve CD24 salınımı yapan diğer kanserlerde kullanılabilabilir olacağını ve bu konuda ileri araştırmalara ihtiyaç duyulduğunu düşünmekteyiz.Objective: Initially, CD24 was idendified as a B cell marker, in addition to a role of CD24 for the intracellular signaling, and it is also participates in the regulation of cell to cell and cell to matrix interactions. CD24 has been implicated in the progression of several types of cancer and has been identified as a prognostic factor in the last 10 years. We focused our atten- tion on possible associations between CD24 expression and stage-grade of tumors in bladder urothelial carcinoma as important morphologic-prog- nostic paramaters. Methods: A total of 79 patients with bladder urothelial carcinomas were included in this study and these 79 patients underwent transurothelial resection biopsy at the Istanbul Education and research Hospital between 2005-2008. Hematoxylin-eosin stained sections from each case were ree- valuated histopathologically according to the WHO-2004 grading system. The TNM system was used for pathologic staging. Selected slides were also studied by immunohistochemistry and a semiquantitative scoring for CD24 expression based on the percentage of positive cells was performed. Results: We found that CD24 expression was associated with invasive and noninvasive (pTa) tumors. Normal urothelial epithelium and the adjacent non neoplastic urothelium in cancer specimens demostra- ted weak immunreactivity for CD24 and well-confined localization in the apical cytoplasm or apical membranes . The most distinctive feature of CD24 expression was that the invasive cancer cells lost the apical polarity of CD24. The invasive cancer cells showed a nonpolarized cytop- lasmic staining for CD24. The stage pTa tumor cells displayed weak stai- ning in CD24 expression and most staining showed on apical localization. Conclusion: This study provides the basis of future investigations of CD24 as a potential serum marker or target of antibody-based therapeutics in bladder urothelial carcinom

The relationship between positron emission tomography-computed tomography imaging and histopathological features of thyroid incidentalomas detected during follow-up for primary malignancy

WOS: 000470851300023PubMed ID: 31169225Aim of the Study: While the rate of thyroid incidentaloma detected on positron emission tomography (PET) was reported as 4%, the malignancy rate was 14%u50%. We evaluated the thyroid nodules which were detected by PET-computerized tomography (CT) in cancer patients and analyzed the pathological results of those thyroid nodules diagnosed by fine needle aspiration biopsy (FNAB) and their correlation with the maximum standardized uptake (SUVmax) value and PET imaging features. Materials and Methods: FNAB were performed for 40 thyroid incidentalomas. We analyzed the relationship between the histopathological findings and radiological features by Pearson's correlations and Chi-square-Fisher's exact tests to evaluate the factors associated with SUVmax. Results: The median SUVmax values were 5.4 for thyroid nodules. Totally, 14 malignancies were detected by FNAB (35%).The sensitivity and specificity of SUVmax value for diagnosis of malignancy were 87.5% and 52%, respectively. Positive and negative predictive values were 36.8% and 92.8%. The most common malignant and benign pathologies were classic variant papillary carcinoma and benign colloidal nodule. The median SUVmax was the higher in colon cancer thyroid metastasis and oncocytic neoplasia (SUVmax 14.5 and 13.6, respectively). Histopathological type was not related with nodule size but positively associated with categorical SUVmax(r = 0.318, P = 0.04) and negatively correlated with both the density of the thyroid nodule in PET-CT (r = 0.0042, P = 0.01) and density of nodule in ultrasound (USG) (r = 0.305, P = 0.05). Margin of the thyroid nodule in USG (P = 0.007) and internal component of the nodule in PET (P = 0.03) were found to be important factors to differentiate benign or malignant lesion. Conclusion: If the thyroid nodule is detected with flouro-2-deoxy-D-glucose uptake, to differentiate benign nodule from malignant, cytological examination is noteworthy to diagnose the more aggressive type of thyroid nodule and also thyroid metastasis from primary cancer

The relationship between PET-CT images and histopathological features of thyroid incidenteloma, detected during follow-up of primary malignancy

Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) -- JUN 03-07, 2016 -- Chicago, ILWOS: 000404711503032Aim of the Study: While the rate of thyroid incidentaloma detected on positron emission tomography (PET) was reported as 4%, the malignancy rate was 14%–50%. We evaluated the thyroid nodules which were detected by PET computerized tomography (CT) in cancer patients and analyzed the pathological results of those thyroid nodules diagnosed by fine needle aspiration biopsy (FNAB) and their correlation with the maximum standardized uptake (SUVmax) value and PET imaging features. Materials and Methods: FNAB were performed for 40 thyroid incidentalomas. We analyzed the relationship between the histopathological findings and radiological features by Pearson’s correlations and Chi square Fisher’s exact tests to evaluate the factors associated with SUVmAmerican Society of Clinical Oncolog