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Comprehensive molecular analyses revealed that papillary renal cell carcinoma (PRCC) is a heterogenous entity. Papillary renal neoplasm with reverse polarity (PRNRP) is a subset of PRCC with characteristic histomorphologies such as low-grade nuclear features, inverted nuclear location, eosinophilic cytoplasm, and indolent clinical behavior. We tried to define the molecular, clinicopathological, histologic, and immunohistochemical features of PRNRP by comparing them with type 1 PRCC (PRCC1) and type 2 PRCC (PRCC2). A cohort of 30 PRNRP, 23 PRCC1, and 26 PRCC2 cases was used. Targeted sequencing of 90 cancer-related genes including KRAS was performed in 26 PRNRP tumor samples. PNA-mediated clamping PCR of KRAS was performed using paired normal and tumor DNA from 30 PRNRP, 23 PRCC1, and 26 PRCC2 cases. Tissue microarray slides were made in three cores per tumor, which were stained with cytokeratin 7 (CK7), alpha-methylacyl-CoA racemase (AMACR), epithelial membrane antigen (EMA), E-cadherin, vimentin, and CD10. Recurrent mutations in KRAS were detected in 28 of the 30 PRNRPs. However, there were no KRAS mutations in any PRCC1 or PRCC2 cases. PRNRP exhibited distinct clinicopathological features: small tumor size, lower pathologic T stage, and no disease-specific death during the follow-up period. Histologically, peritumoral lymphoid aggregation, prominent papillary architecture (>80% of tumor), hyalinized papillae, inverted nuclear location, and lower nuclear grade were observed. PRNRP was usually positive for CK7, AMACR, EMA, and E-cadherin, and negative for CD10. The findings suggest that PRNRP is a subtype of papillary renal neoplasm that is different from PRCC1 or PRCC2 in terms of molecular, clinicopathological, histological, and immunohistochemical features.

Bilateral variations in the formation and branching of brachial plexus are rare. Variations between median and musculocutaneous nerves were observed on both sides during the dissection of an 87-year-old Korean female cadaver, whose cause of death was cholangiocarcinoma. The variations found were bilateral, in which each musculocutaneous nerve did not pierce the coracobrachialis muscle. The musculocutaneous nerve was rudimentary in the right arm and all branches arose from the median nerve separately, which corresponds to previous classification type 0-2. In the case of the left arm, the musculocutaneous nerve originated from the lateral cord, but had connections between median and musculocutaneous nerves below the coracobrachialis muscle, which corresponds to previous classification type 1-B-2. To the best of our knowledge, the bilateral variations between median and musculocutaneous nerves in this case have different features from other previous reports. Awareness of the possible variations between median and musculocutaneous nerves is important to both anatomists and clinicians.

Extraosseous osteosarcoma originating from paratesticular soft tissue is an extremely rare type of malignant tumor. With the exception of the present study, only one other case of osteosarcoma originating from paratesticular soft tissue has previously been reported. A 52-year-old man presented with a painless scrotal swelling and palpable mass. The patient underwent left orchiectomy with the diagnosis of testicular tumor. Pathological examination was suggestive of osteosarcoma without any different histological components. The postoperative course of the patient was uneventful, and the patient is currently free of disease.

This study aimed to investigate the effect of pituitary adenylate cyclase-activating peptide (PACAP) on the pacemaker activity of interstitial cells of Cajal (ICC) in mouse colon and to identify the underlying mechanisms of PACAP action. Spontaneous pacemaker activity of colonic ICC and the effects of PACAP were studied using electrophysiological recordings. Exogenously applied PACAP induced hyperpolarization of the cell membrane and inhibited pacemaker frequency in a dose-dependent manner (from 0.1 nM to 100 nM). To investigate cyclic AMP (cAMP) involvement in the effects of PACAP on ICC, SQ-22536 (an inhibitor of adenylate cyclase) and cell-permeable 8-bromo-cAMP were used. SQ-22536 decreased the frequency of pacemaker potentials, and cell-permeable 8-bromo-cAMP increased the frequency of pacemaker potentials. The effects of SQ-22536 on pacemaker potential frequency and membrane hyperpolarization were rescued by co-treatment with glibenclamide (an ATP-sensitive K(+) channel blocker). However, neither N (G)-nitro-L-arginine methyl ester (L-NAME, a competitive inhibitor of NO synthase) nor 1H-[1,2,4]oxadiazolo[4,3-α]quinoxalin-1-one (ODQ, an inhibitor of guanylate cyclase) had any effect on PACAP-induced activity. In conclusion, this study describes the effects of PACAP on ICC in the mouse colon. PACAP inhibited the pacemaker activity of ICC by acting through ATP-sensitive K(+) channels. These results provide evidence of a physiological role for PACAP in regulating gastrointestinal (GI) motility through the modulation of ICC activity.

We analyzed six cystectomized specimens diagnosed as transitional cell carcinoma by immunohistochemical evaluation to determine the presence of c-erbB2, transforming growth factor-alpha (TGF-alpha), c-myc, c-fos, and c-fms. Representative sections of flat lesions with atypia (e.g., reactive atypia, dysplasia, and carcinoma in situ) and invasive neoplasms (transitional cell carcinoma, TCC) were selected for each cystectomy specimen according to the new WHO/ISUP classification. The average percentage of cells found positive for c-erbB2 were 16.3%, 45.5%, 46.1% and 67.7% in the reactive atypia, dysplasia, carcinoma in situ, and invasive TCC, respectively. The average percentage of cells found positive for TGF-alpha were 9.7%, 13.3%, 13.5%, 30.3%, respectively. The cells were negative for the oncoproteins c-myc and c-fos. The average percentage of cells found positive for the oncoprotein c-fms was 10.6%, 15.5%, 16.7%, and 45.5% respectively. The results of this study indicated that various oncoproteins are expressed differently. c-erbB2, TGF-alpha and c-fms expression was gradually increased during tumorous progression of the urothelium from reactive atypia to invasive carcinoma. The presence of c-erbB2, TGF-alpha and c-fms is an important marker for detection of an early precursor lesions of invasive carcinoma. However, c-myc and c-fos were not expressed in the urothelial reactive atypia and dysplasia and did not correlate with tumor progression.

A giant hidradenocarcinoma presented by a 75-year-old female is reported. The patient had a malignant transformation within a nodular hidradenoma involving the right postauricular area, which was treated by mass removal and a right radical neck dissection with a free-flap covering. Malignant hidradenocarcinoma is the least common adnexal tumor of uncertain origin. They are usually malignant from their inception, but some develop from a benign counterpart. To the authors' knowledge, only three cases have been reported previously. Two histologically distinct components were seen in this tumor: (i) typical nodular hidradenoma, which constituted a small part of the tumor; and (ii) carcinoma with areas of transition. The secretory cells of hidradenocarcinoma showed decapitation secretion on light and electron microscopic observations, which is evidence of apocrine differentiation. Histologically, this case was concluded as a hidradenocarcinoma arising from a long-standing nodular hidradenoma. A literature review is presented and the histological, immunohistochemical and ultrastructural features are described.

Malignant mixed mullerian tumors (MMMT) are unusual neoplasms occurring mostly in the uterus. In the ovary, they are very rare and represent fewer than 1% of all ovarian malignancies; in the salpinx, they are even rarer than those of the ovary. We report a carcinosarcoma of the left adnexa having features of neuroendocrine differentiation in a 69-year-old female. The tumor contained both adenocarcinoma and squamous cell carcinoma having dear cell change admixed with an undifferentiated malignant mesenchymal component. The sarcoma components consisted of spindle cells, small-round cells and bizarre giant cells mimicking rhabdomyoblast. Almost all of the carcinomatous glandular components and some foci of the squamous cell and undifferentiated carcinomatous components were focal positive for S-100 protein, chromogranin, neuron specific enolase, synaptophysin and Leu-7. Electron microscopy revealed membrane-bound neurosecretory granules in the cytoplasm of some glandular epithelial cells. Histologically, the tumor involved the left adnexa, abdominal peritoneum, surface of the bladder dome, omentum and left external iliac lymph node (stage IIIc).

Background: Of the many prognostic factors for breast cancer, the relationship between an infil tration of inflammatory cells and the prognosis is debatable. Of the chemokines affecting cancer’s inflammatory reactions, chemokine (C-X-C motif) ligand 16 (CXCL16) has attracted attention for its prognostic value in many cancers, including colorectal cancer and renal cell carcinoma. But the situation for breast carcinoma is unknown. The aim of this study was to examine the relationship between the prognostic factors and the CXCL16 expression in patients with breast carcinoma. Methods: The patients (n= 106) diagnosed with invasive ductal cancer of the breast were enrolled. We reviewed the clinicopathological factors of these patients, hematoxylin and eosin stains were prepared and estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2/ neu) and CXCL16 immunostaining was performed. Results: The ER expression was significantly correlated with age and inflammation. A CXCL16 expression was noted in 81.1% of the cases. No association was evident between a CXCL16 expression and any other parameter, including the survival rate. Multivariate analysis did not implicate ER, HER2/neu or CXCL16 as an independent prognostic factor, but the tumor size was independent predictive factor for the patient outcome. Conclusions: An inflammatory reaction mediated by CXCL16 is not associated with the prognosis of breast cancer or any clinicopathological factors.

Mantle cell lymphoma, blastoid variant (B-MCL), is a very rare type of non-Hodgkin's lymphoma exhibiting an aggressive clinical course. We describe a case of B-MCL showing generalized lymphadenopathy and leukemic conversion in a 62-yr-old man. The case was diagnosed and subclassified as B-MCL on the basis of cyto-morphology and immunophenotype. Microscopic examination of the peripheral blood (PB) showed a spectrum of cells ranging from small mature lymphocytes to medium- and large-sized lymphocytes with blast-like chromatin and prominent nucleoli. The lymphoma cells were monoclonal B cells with moderately intense surface IgM. They were CD5 positive, cyclin D1 positive, CD10 negative, and CD23 negative. The flow cytometric immunophenotyping and DNA ploidy analysis of the PB and material obtained by aspiration cytology supported the diagnosis of B-MCL. These findings underline the utility of aspiration cytology in diagnosing B-MCL when cytomorphologic examination is combined with flow cytometric analysis of immuno-phenotype and demonstration of proliferation markers.

Background Epithelial-myoepithelial carcinoma is an extremely rare disease that usually occurs in the parotid gland but can occur in a variety of sites such as the nasal cavity, paranasal sinus, and base of the tongue. Case presentation We report a rare case of epithelial-myoepithelial carcinoma, which developed in the subglottic region. A 78-year-old Korean woman visited our hospital complaining of hoarseness, which had developed 1 month previously. Flexible laryngoscopy showed a round mass that blocked approximately 80 % of the tracheal diameter. Complete excision of the mass was carried out under general anesthesia, using a transoral approach. Epithelial-myoepithelial carcinoma was diagnosed following immunohistochemical analysis. Conclusions We report a rare case of epithelial-myoepithelial carcinoma that occurred in the subglottic region. To the best of our knowledge, only one other case has been reported since this disease was first identified approximately 40 years ago.