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Endolymphatic sac tumour (ELST) is a rare low grade malignant epithelial tumour of the petrous temporal bone, thought to arise from papillary epithelium of the endolymphatic sac. They may occur sporadically or in association with Von-Hippel Lindau disease. ELST is extremely rare neoplasm with benign histopathological appearance and clinically destructive behaviour. Because of the rarity of this tumour, it can easily be confused with other tumours such as paraganglioma, middle ear adenoma, metastatic carcinomas or choroid plexus papilloma. We report here a rare case of ELST with review of literature and discuss the differentiating features of ELST from its mimickers, showing a papillary configuration. [ABSTRACT FROM AUTHOR]

The diagnosis of bone lesions is a fundamental part of the study of skeletal remains, both in the archeological and forensic context. On the one side, the literature proved the relevance of radiography for the detection of bone lesions; on the other side, the careful macroscopic observation of the morphology of bone lesions is often underestimated. For this study, we examined and performed plain radiography on 14 skeletons of the CAL Milano Cemetery Skeletal Collection diagnosed with rheumatoid arthritis, diabetes, multiple myeloma, metastatic cancer, and osteomalacia to compare the macroscopic morphology and radiographic visualization of bone lesions. At least 200 osteolytic lesions and 65 areas of proliferative bone reaction (either spongiosclerotic or periosteal) were studied. We realized "comparative sets" of macroscopic pictures and radiographic imaging of the same skeletal elements to allow comparisons of detection and recognition of bone lesions. As a result, while trabecular lesions may be lost through naked eye observation, many lesions can also be unperceived on radiographs due to contrast, including periosteal reactions, osteolytic lesions, and spongiosclerosis. The aim of this research was to investigate the strengths and pitfalls of digital radiography and macroscopic analysis and to demonstrate the synergy of a complementary approach between the two methods for lesion analysis in dry bone. [ABSTRACT FROM AUTHOR]

Manual detection and characterization of liver cancer using computed tomography (CT) scan images is a challenging task. In this paper, we have presented an automatic approach that integrates the adaptive thresholding and spatial fuzzy clustering approach for detection of cancer region in CT scan images of liver. The algorithm was tested in a series of 123 real-time images collected from the different subjects at Institute of Medical Science and SUM Hospital, India. Initially the liver was separated from other parts of the body with adaptive thresholding and then the cancer affected lesions from liver was segmented with spatial fuzzy clustering. The informative features were extracted from segmented cancerous region and were classified into two types of liver cancers i.e., hepatocellular carcinoma (HCC) and metastatic carcinoma (MET) using multilayer perceptron (MLP) and C4.5 decision tree classifiers. The performance of the classifiers was evaluated using 10-fold cross validation process in terms of sensitivity, specificity, accuracy and dice similarity coefficient. The method was effectively detected the lesion with accuracy of 89.15% in MLP classifier and of 95.02% in C4.5 classifier. This results proves that the spatial fuzzy c-means (SFCM) based segmentation with C4.5 decision tree classifier is an effective approach for automatic recognition of the liver cancer. [ABSTRACT FROM AUTHOR]

Metastatic tumors to the breast are rare but constitute a major diagnostic dilemma. Of these, non-mammary carcinomatous metastases to the breast are particularly challenging and, without a clinical history, may be extremely difficult to distinguish from primary breast carcinoma (PBC). We specifically studied metastatic tumors of pulmonary origin, as the lung is one of the major primary sites for carcinomatous metastasis to breast. Sixteen metastatic lung tumors to the breast were identified in our archives between 1996 and 2017 including 12 non-small cell lung carcinomas (NSCLC), one large-cell neuroendocrine, one atypical carcinoid, and two small-cell carcinomas. Adenocarcinoma was the most frequent amongst the NSCLCs (11/14). We retrieved the clinical information of these cases and reviewed the pathological characteristics to provide practical tools for pathologists to aid in their identification. Even in the absence of a clinical history of lung cancer, metastatic pulmonary adenocarcinoma to the breast should be considered in at least one of the following scenarios: (1) single or multiple well-circumscribed lesions of the breast that lack an in situ component and that are accompanied by distant metastases but negative axillary lymph nodes, (2) breast tumors that are triple negative yet not high-grade, or (3) breast tumors presenting as stage 4 disease and/or having an unusually aggressive clinical course on standard breast therapy. Accurate and timely diagnosis of these tumors is mandatory because of treatment and prognostic implications. [ABSTRACT FROM AUTHOR]

We conclude that patients presenting with level 5 lymphadenopathy should be investigated with heightened clinical vigilance. Our results suggest that up to 80 % will harbour clinically significant pathology requiring further medical treatment, three quarters of which will be malignancy. We report an observational study of histological outcomes of level 5 lymph node biopsies from a regional histopathology department across 5 years. 184 subjects were identified as having a biopsy of a lymph node from the level 5 region within the study period. One hundred and fifty six cases (84.8 %) had clinically significant pathology on final histology requiring further medical treatment. Lymphoma accounted for the highest number of cases (n = 72, 39.1 %), followed by metastatic carcinoma (n = 65, 35.3 %) and granulomatous change (n = 17, 9.2 %). Gender and laterality were not shown to be independent predictors of pathology significance ( p > 0.05). [ABSTRACT FROM AUTHOR]

Purpose: To determine the maximal tolerated dose (MTD) of the combination of weekly temsirolimus and every other week vinorelbine in patients with advanced or refractory solid tumors. Methods: Patients were treated with intravenous temsirolimus on days 1, 8, 15, and 22 and intravenous vinorelbine on days 1 and 15. Cycles were repeated every 28 days. Results: Nineteen patients were enrolled in the study. Tumor types included lung (5), prostate (2), neuroendocrine of pancreas (1), bladder (2), uterus (3), cervix (4), and vagina (2). All patients had received prior chemotherapy. Four patients were enrolled to dose level I, nine to dose level II, and six to dose level III. Six patients were inevaluable and replaced. Fifty-seven total cycles were administered. There was 1 dose-limiting toxicity at level II (grade 3 anorexia/dehydration) and 2 at level III (grade 3 hypokalemia; grade 4 neutropenia). Two patients died at dose level III; one was study-related with grade 4 neutropenia. Grade 3/4 toxicities observed during the first cycle included neutropenia (2), anemia (1), anorexia (1), dehydration (1), hyperglycemia (1), hypertriglyceridemia (1), and hypokalemia (1). Best response included two patients (prostate and non-small cell lung cancer) with partial response and eight patients with stable disease with median duration of best response of 3.2 months. Conclusions: Temsirolimus 25 mg given days 1, 8, 15, and 22 in combination with vinorelbine 20 mg/m given days 1 and 15 every 4 weeks was found to be the MTD. This dose combination is considered feasible in phase II trials. [ABSTRACT FROM AUTHOR]

The thyroid gland is an uncommon site for metastatic disease but cases have been well-documented in the literature, particularly in autopsy series. A retrospective review of surgical pathology and autopsy pathology database for patients with metastatic carcinoma to the thyroid was performed at the University of Massachusetts Medical Center between January 1993 to January 2013. We identified a total of 10 patients with metastatic carcinoma to the thyroid; 6 were in surgical pathology specimens out of a total of 1,295 thyroid carcinoma (0.46 %) and 4 were diagnosed at autopsy out of a total of 2,117 (0.19 %) autopsy cases during this period. Cases with direct extension of the tumor into the thyroid from local primary sites such as larynx, esophagus or soft tissues of the neck were excluded. The primary tumors in these cases comprised of four lung carcinomas, three colorectal carcinomas, a renal cell carcinoma, a pleural malignant mesothelioma, and an unknown primary. Therefore, it is important to keep intrathyroidal metastases in the differential diagnosis when evaluating a thyroid nodule, particularly in patients with a previous history of malignancy. Furthermore, a literature review reveals over 1,400 cases have been previously reported, with the most common malignancies from the kidney (34 %), lung (15 %), gastrointestinal tract (14 %), and breast (14 %). [ABSTRACT FROM AUTHOR]

CD5 expression is considered a key marker for the diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). We report an unusual case of CD5-negative (CD5−) SLL with a concurrent CD5-positive (CD5+) adenocarcinoma of unknown primary involving the same lymph node. An 83-year-old woman with a history of CD5− B cell lymphoma diagnosed on a core biopsy of a cervical lymph node presented with jaundice and was found to have a 2.5-cm pancreatic mass. A fine needle aspiration of the mass revealed a CD5− monotypic B cell population. A subsequent excisional biopsy of a cervical lymph node showed morphologic findings typical for SLL, including the presence of multiple proliferation centers. However, the neoplastic lymphocytes were negative for CD5 by both flow cytometric analysis and immunohistochemistry. Interestingly, multifocal metastatic adenocarcinoma was identified and was positive for CD5. Lack of CD5 expression often leads to the exclusion of CLL/SLL, particularly in small biopsy samples. However, rare cases of CD5− CLL/SLL have been reported. In addition, CD5 is not an exclusive marker for lymphoid cells; its expression has been observed in several non-hematopoietic neoplasms. This report briefly reviewed and discussed CD5− CLL/SLL and CD5+ carcinoma reported in the literature. [ABSTRACT FROM AUTHOR]

Osteosarcoma (OS) is known to have several morphological appearances, small cell osteosarcoma and epithelioid osteosarcoma being two well recognized patterns. The former can be mistaken for a Ewing sarcoma/primitive neuroectodermal tumour (ES/PNET), whereas the latter mimics metastatic carcinoma. Herein we present an osteosarcoma in a 17-year-old girl that was diagnosed as an ES/PNET on biopsy; however, the resected specimen revealed a very unusual morphology mimicking a metastatic carcinoma with a sex cord stromal tumour-like pattern. [ABSTRACT FROM AUTHOR]

We describe two cases of acute myeloid leukemia with an unusual histological pattern mimicking metastatic non-hematopoietic neoplasm, leading to diagnostic difficulties. Both patients presented with pancytopenia and absence of circulating blasts. Bone marrow aspirations were not successful. Bone marrow core biopsies contained neoplastic cells arranged in cohesive sheets or single file patterns with prominent myxoid stroma resembling metastatic carcinoma. The accompanying bone marrow touch imprints showed clusters of immature cells with monocytoid features. The cell lineage was further revealed by immunohistochemical analysis of bone marrow core biopsy sections. The neoplastic cells showed strong reactivity for myeloperoxidase, CD33, CD43, CD45, and CD68, indicating a myeloid cell origin with monocytic differentiation. One patient (age, 39 years) received standard chemotherapy for acute myeloid leukemia, which resulted in remission of bone marrow disease. The other patient (age, 85 years) died with multiple organ failure before treatment. Failure to recognize these unusual histological features of acute myeloid leukemia could result in misdiagnosis from bone marrow biopsy. [ABSTRACT FROM AUTHOR]

This study sought to establish the recommended phase II dose and efficacy of temozolomide (TMZ) with concurrent radiotherapy in patients with brain metastases. Patients were stratified by prior systemic therapy (≤1 vs. ≥2) and enrolled in cohorts of escalating doses of daily TMZ for 14 days (group A: 75, 95, 115, 135, or 150 mg/m, group B: 75, 90, 105, 120, or 135 mg/m). Endpoints included safety and clinical activity. For group A (≤1 prior chemotherapy) no dose limiting toxicity was seen at 75 and 95 mg/m. Five of eight patients experienced dose limiting toxicities at 115 mg/m, thus the recommended phase II dose was 95 mg/m. Arm B (≥2 prior chemotherapy regimens) was closed due to poor enrollment. In the phase II portion, 17 patients in group A were treated. There were 0 patients with complete radiographic response, three with a partial response, ten remained stable, and four demonstrated early progression. The 3 and 6 month progression-free survival (PFS) rates were 41 and 18% with a median PFS time of 2.4 months. Overall survival at 3 and 6 months was 53 and 41%, respectively, with a median survival time of 4.1 months. The maximum tolerated dose of daily TMZ with concurrent WBRT was 95 mg/m. Despite dose escalation, outcomes did not appear to be improved in the sample treated. [ABSTRACT FROM AUTHOR]

A 45 years old male patient presented with an asymptomatic right mandibular mass that extended from the angle to the premolar area. It had been present for 3 months at the time of the initial presentation. Panoramic radiograph revealed an ill-defined unilocular radiolucency. Previous dental treatment included molar extractions and antibiotic therapy. Considerable bleeding was encountered during incisional biopsy. [ABSTRACT FROM AUTHOR]

Background: The occurrence of an abscess in conjunction with a tumor in the brain is very rare. Only presumptions exist about their origin and manner of dissemination. Preoperative discrimination between a brain tumor with cystic degeneration and a brain abscess within a tumor may be difficult or even impossible. The purpose of this report is to demonstrate the difficulty of such discrimination using conventional CT diagnostics alone. Methods: Two patients with abscess formation in association with metastatic carcinoma in the cerebellum are presented and compared with similar cases in the literature. The etiology and the route of dissemination are discussed. Results: In our first patient with previously diagnosed lung carcinoma and a CT showing suspected cerebellar metastasis only, an abscess caused by Propionibacterium acnes was found in the cerebellum and treated surgically. No tumor was recognised during the operation. Post-mortem examination six weeks later revealed the coexistence of remnants of a chronic abscess as well as metastatic lung carcinoma at the operation site. The second patient presented with an enhanced, ring-like cystic cerebellar lesion. During surgery, a purulent exudate with a coagulase-negative type of Staphylococcus species was found within the metastatic carcinoma of unknown origin. Both were radically excised and the patient recovered well. Neither patient had a history of previous infection and the pathway for abscess formation in both patients remained unclear. About 30 cases of abscesses associated with intracranial neoplasms were found in the literature. Including our own report, only three cases of abscesses within metastatic carcinoma have been published. Conclusions: Modern diagnostic tools reported to differentiate more reliably between an abscess and a tumor are diffusion-weighted MR and proton MR spectroscopy techniques. Brain imaging using CT alone may not reliably demonstrate both coexisting lesions or differentiate between them. It is important to know that a metastatic brain lesion can occur in association with a brain abscess and that tissue sampling for pathological as well as microbiological testing is of crucial importance for optimal therapy for both lesions. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) has been found to make a valuable contribution to the diagnosis of the etiology of ureteral obstruction when routine urography and pyelography have not been diagnostic. We believe CT can replace more invasive techniques such as antegrade pyelography and even retrograde pyelography in the evaluation of many of these cases. This presentation will summarize our experience with the use of CT to evaluate the etiology of ureteral obstruction, indicate those disease processes likely to be encountered, emphasize the limitations of the technique, and indicate the place CT has in the study of these patients. [ABSTRACT FROM AUTHOR]

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A case of frontal meningioma harbouring a metastasis from a previously treated breast carcinoma, and a case of metastatic carcinoma into a frontal glioma are reported. [ABSTRACT FROM AUTHOR]

Our report describes the uncommon case of a 61 year old female patient who underwent a left parietooccipital craniotomy and extirpation of a malignant tumor. Histological examination revealed a metastatic carcinoma of mammary origin intimately intermingled with a calcified oligodendroglioma WHO II. The preexisting oligodendroglial part had been detected four years before, but since then had been misinterpreted as a glious scar resulting from a previous brain trauma. Three years before neurosurgical intervention, the patient had undergone a left side mastectomy. The histological finding at that time was a solid breast tumour WHO T1N0. The occurence of cerebral mixed neoplasias and possible causal factors are discussed. [ABSTRACT FROM AUTHOR]

Background: Among 167 patients with endometrial carcinoma, 21 (12.6%) appeared to have a concomitant ovarian malignancy. Three groups were defined by tumor histology. Group A was defined as endometrial and ovarian carcinomas of dissimilar histology. Group B was defined as both carcinomas with the same histologic type, but with benign and/or borderline malignant lesions adjacent to the ovarian malignancy. Group C was defined as the same carcinomas without benign or borderline lesions. Methods: Based on these 3 groups the endometrial carcinomas with synchronous ovarian malignancies were analyzed histo- and clinico-pathologically. Results: Four of the 21 cases (19.0%) were placed into group A, 7 of the 21 (33%) in group B, and 10 of the 21 (47.7%) in group C. Groups A and B, which were diagnosed as double primary cancers based on histological features, had a frequency of 52.4%, whereas group C, which was diagnosed as mostly metastatic, had a frequency of 47.6%. The highest frequency of deep myometrial invasion was found in group C. The highest incidence of lymph node metastasis was in group B. Enlarged ovaries with malignant lesions appeared in 100% of group A patients, in 88.9% of group B patients and in 16.7% of group C patients. In contrast, the frequency of normal-sized ovaries was highest in group C at 83.3%. There were no statistical differences in age, chief complaints and peritoneal cytology. The survival rates for groups A, B, and C were 75%, 66.7%, and 33.3%, respectively. The survival curve for group C was comparatively lower than those for groups A and B. Conclusion: These data suggest that the histological findings of benign and/or borderline malignant lesions in ovarian tumors, in addition to ovarian size, are useful in the differentiation between independent and metastatic carcinomas of the endometrium. [ABSTRACT FROM AUTHOR]

case of metastasis of lung carcinoma to mandibular gingiva in 46 year old man has been presented here. The patient suffered discomfort due to growth in the lower left molar region with occasional hemorrhage and increased mobility of his lower left molars. After extraction of the teeth curettage was performed and histopathological examination revealed similar findings to those found in the lung tumor. This case report emphasizes the need to recognize that the gingival masses similar to benign or inflammatory lesions may represent an initial sign of underlying distant malignant tumors. [ABSTRACT FROM AUTHOR]

Five cases of metastatic prostatic carcinoma are presented. In each case, skeletal metastases were extensive, but the calvaria was not involved, resulting in a headless appearance. The mechanism for this scintigraphic manifestation is presented, and its value is emphasized. [ABSTRACT FROM AUTHOR]