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Cancer metastasis remains responsible for the vast majority of cases of cancer-related morbidity and mortality. Metastasis, by its definition, is the spread of cancer from the primary site to the distant tissues. Advancing the scientific and clinical understanding of cancer metastasis is a high priority. The prerequisite requirement for pathological consistency may be compromised during metastasis. The present study reports the case of a cancer patient with different pathological types. The patient presented with pain in the neck and right hip, as well as weight loss. He underwent whole-body positron emission tomography-computed tomography, which identified a mass in the lung and abnormal metabolism of the bone. Biopsies of the ilium and lung were performed and he was shown to have lung adenocarcinoma and bone squamous carcinoma. The morphology and immunohistochemical patterns were completely different, while each lesion harbored an identical genetic profile. The bone lesion was identified to be a metastasis from the lung cancer. The patient was prescribed an epithelial growth factor receptor inhibitor, which resulted in a partial response in the lung mass and alleviation of the patient's bone pain. Through this case study, we advocate the importance of using genetic testing in addition to pathological assessment.

Objective: To analyze the characteristics of the clinicopathology and genotypes in patients with gastrointestinal stromal tumor (GIST)., Methods: The clinicopathological and genotypic data of 179 patients with GIST, who underwent treatment and genetic testing in the Hostital of West China from September 2009 to February 2009 were collected retrospectively., Results: The tumor sites of the cases were located in stomach (88 cases, 49.2%), small intestine (70 cases, 39.1%), colorectum (7 cases, 3.9%) and the other sites (14 cases, 7.8%) respectively. 94.4%, 74.9% and 93.3% of GIST patients were positive for CD117, CD34 and DOG-1 immunophenotypes respectively. C-kit and PDGFRα mutations were found in 151 cases (84.4%) and 8 cases (4.5%) except for the wild types of the rest 20 cases (11.2%). Among all the c-kit mutation, 92.2% mutation types in exon 11 were deletion mutation, point mutation and hybrid mutations, and in exon 9 the mutation types were just involving A502&#95;Y503dup (n = 6) and Y403&#95;F504ins (n = 14), while the mutation type were K642Q in exon 13 (n = 1) and N822K in 17 (n = 2). There were 6 patients with the mutation types of PDGFRα in exon 18, and 3 of them were type of D842V. In the GIST genotyping, DOG-1 positive rate in PDGFRα mutation patients were significantly lower than that in c-kit mutation and wild type patients (P = 0.007). In the various type of c-kit mutations, the positive rate of CD34 in point mutation patients were significantly lower than that in other mutation types (P < 0.001). The rate of high-risk patients in point mutation and insertion mutation patients were lower than that in deletion mutation and deletion + insertion mutation patients (P = 0.006)., Conclusion: The most common localizaions of GISTs are the stomach and small intestine. The most frequent mutation type of GIST is c-kit exon 11. The individualized treatment is required for GIST patients because its high mutation rate and types.

Objective: To investigate the prognosis and influencing factors of patients with adrenocortical carcinoma., Methods: Thirty-five patients (20 males and 15 females) with biopsy-diagnosed adrenocortical carcinoma were followed retrospectively. Cox proportional hazards regression analysis was performed to identify factors that influenced the prognosis of the patients., Results: Three patients were classified as stage I, 15 as stage II, 12 as stage III, and 5 as stage IV. Fourteen patients were still alive and 21 died at the end of the follow-up. The patients had a median survival time of 33 months, with a survival rate of 77.1%, 62.5%, and 38.3% for the first year, second year, and fifth year respectively. The univariate analysis found no significant differences in survival rates with gender, tumor location (left or right adrenal), diameter (> or = 10 cm or <10 cm) of tumor, functionality of tumor, smoking, hypertension and hypokalemia (P > 0.05). The multivariate analysis revealed that being male, younger than 50 years, non-smoking and early-stage of tumor were significant protective factors for the survival of patients with adrenocarcinoma. Patients at stage III and stage II had 52 and 3 times higher mortality than those at stage I, respectively., Conclusion: Clinical stage and age are the main factors that influence the survival of patients with adrenocortical carcinoma. Patients younger than 50 years and those with an earlier stage of tumor would have a better prognosis.

Aim: To investigate whether the clinicopathologic features of infantile hemangioendothelioma (IHE) of the liver in a Chinese population are similar to the features observed in other races., Methods: The clinical data, radiological findings, histopathological changes and outcome of 12 cases of IHE diagnosed by the Department of Pathology, West China Hospital over the last 10 years were analyzed retrospectively. Immunohistochemical studies were carried out using antibodies against CD31, CD34, Factor VIII, cytokeratin 8 and cytokeratin 18., Results: The 12 patients were aged from fetal to 5 years (three males and nine females). The tumor was presented with different clinical manifestations, mainly as an asymptomatic, palpable, upper abdominal mass, except for the two fetuses who were detected antenatally by ultrasound. In one patient, this presentation was accompanied by an initial severe pneumothorax. No symptoms of congestive heart failure were present and neither congenital abnormalities nor vascular tumors in the skin or other organs were found. Laboratory abnormalities included leukocytosis (40%), anemia (60%), thrombocytosis (60%), hyperbilirubinemia (16.7%), abnormal liver function (50%) and increased α-fetoprotein (80%). Based on radiological findings and gross specimens, the tumor presented as a solitary lesion or a multifocal space-occupying lesion. The tumor size ranged from 5.0 cm × 3.5 cm × 2.0 cm to 13.8 cm × 9.0 cm × 7.7 cm, and the 0.2-1.1 cm nodules were diffusely distributed within the multifocal tumor. Seven cases were surgically resected, three cases underwent biopsy and the two fetuses were aborted. Histologically, nine cases were classified as type I and three as type II, presenting aggressive morphologic features, immature vessels, active mitosis and necrosis. An inflammatory component, predominantly eosinophilic granulocytes, sometimes obscured the nature of the tumor. Ten patients are alive after a follow-up of 1-9 years. Based on immunohistochemistry, the endothelial cells in all cases were positive for CD31, CD34 and polyclonal factor VIII antigen, whereas the scattered hyperplasia bile ducts were positive for cytokeratin 8 and cytokeratin 18., Conclusion: The clinical manifestations of IHE are non-specific. There is no significant correlation between histological type and prognosis. The clinicopathologic features of IHE in Chinese patients may provide a clue to further evidence-based studies.

Objective: To detect the expression of beta-catenin and Estrogen Receptor in desmoid-type fibromatosis., Methods: Nuclear beta-catenin expression was detected by immunohistochemistry in 77 lesions with desmoid-type fibromatosis and 171 other spindle cell lesions, including superficial fibromatosis (n = 18), nodular fasciitis (n = 36), keloid (n = 16), scar (n = 10), granulation tissue (n = 9), synovial sarcoma (n = 38), neufibroma (n = 13), solitary fibrous tumor (n =12), gastrointestinal stromal tumor (n = 10), low-grade myxofibrosarcoma (n = 3), low-grade fibromyxoid sarcoma (n = 3), and smooth muscle tumor (n = 10). In addition, the immunohistochemical expressions of ER-alpha, ER-beta and Ki-67 were examined in all of the lesions with desmoid-type fibromatosis. The nuclear immunohistochemical staining for nuclear beta-catenin and ER-beta was graded as high level ( > or = 25% of cells), low level (5%-25%) or none., Results: High-level nuclear beta-catenin staining was detected in a very limited subset of tissue types, which included 70.1% of lesions with desmoid-type fibromatosis (54/77) and 6.3% of lesions with keloid (1/16). No high-level nuclear beta-catenin staining was seen in any of the other lesions. None of the lesions with desmoid-type fibromatosis expressed ER-alpha. However, 62 (80.5%) of the lesions with desmoids-type fibromatosis were positive in ER-beta, which included 52 (67.5%) with high-level expression, and 10 (13%) with low-level expression. The Spearman correlation analysis suggested that the expression of beta-catenin was positively correlated (r = 0.867, P < 0.05) with the expression of ER-beta. The lesions with desmoid-type fibromatosis had very low Ki-67 positive rate. The recurrence of desmoids-type fibromatosis was not correlated independently with beta-catenin, ER-beta or Ki-67., Conclusion: High-level nuclear beta-catenin staining serves as a useful diagnostic tool for desmoid-type fibromatosis. The high expression of ER-beta in desmoid-type fibromatosis provides a biological mechanism for the antiestrogenic compounds to treat fibromatosis. There might exists an interaction between beta-catenin and ER-beta. Beta-catenin, ER-beta or Ki-67 can not predict the prognosis of desmoid-type fibromatosis.

Objective: To study the clinicopathologic features and immunophenotype of solid papillary carcinoma (SPC) of breast., Methods: Clinical and pathologic features of 21 cases of SPC, with or without stromal invasion, were analyzed. Immunohistochemical study (LSAB method, for cytokeratins, myoepithelial markers, chromogranin A, synaptophysin, Ki-67, estrogen receptor, progesterone receptor, c-erbB-2 and pS2) and alcian blue staining were performed., Results: All the patients were females with a mean age of 66.1 years. The clinical features were similar to those of classic papillary tumor. Metastasis was not observed in patients who had undergone axillary lymph node dissection. Histologically, the tumor displayed solid papillary growth pattern, with mucin production demonstrated in 19 cases. The tumor cells were oval, polygonal, spindled or signet ring-like and contained mildly to moderately pleomorphic nuclei. The mitotic count measured less than 5 per 10 high-power fields in 15 cases. Seven cases contained foci of invasive carcinoma which showed similar cytologic features as those of the in-situ component. Immunohistochemical study showed that the tumor cells expressed CK8 but not basal cell cytokeratin. Positivity for smooth muscle actin-alpha, calponin and p63 was demonstrated in the myoepithelial layers of fibrovascular cores, as well as around the expanded ductolobular units. Most cases also showed cytoplasmic positivity for chromogranin A (88.2%) and synaptophysin (82.4%). The proliferation index, as highlighted by Ki-67 immunostain, was 8.1%. The tumor expressed estrogen receptor, progesterone receptor and pS2. The staining for c-erbB-2 oncoprotein was negative. Follow up of 16 patients showed no evidence of recurrence or metastasis., Conclusions: SPC predominantly affects elderly females and has distinctive pathologic features and immunophenotype. Some cases of SPC are associated with mucinous and neuroendocrine components. Follow-up data suggest that SPC often carries an indolent clinical behavior and favorable prognosis.

Objective: To investigate the clinicopathologic and immunohistochemical features of secretory meningiomas., Methods: Nine secretory meningiomas were examined. From each specimen, sections were cut and stained with hematoxylin-eosin, periodic acid-Schiff (PAS) stain, and periodic acid-Schiff stain with diatase(PAS-D ). Immunohistochemical markers including oestrogen receptor (ER), progesterone receptor (PR), carcinoembryonic antigen (CEA), cytokeratin (CK), epithelial membrane antigen (EMA), and MIB-1 were detected with streptavidin peroxidase (SP) immunohistochemical staining methods. One case was observed by electron microscopy (EM)., Results: The 9 secretory meningiomas were located at sphenoid ridge, left parietal lobe or frontal lobe. Severe peritumoral edema was observed in 5 cases. Seven cases were followed up for 6 to 88 months; none of them showed evidence of recurrence. Histologically, the conspicuous feature was the eosinophilic inclusions. The finding of pericytic proliferation on examination was helpful to making a diagnosis. In all 9 cases, the tumor cells were positive for PR, but in 6 cases the inclusions were negative. ER was negative in 8 cases. CEA,CK, EMA expressed in the inclusions and the surrounding cells in 7 cases. In 1 case the positive rate for MIB-1 was 5%, but in the other 8 cases the positive rates were not more than 2%. The intercellular lumens and intracellular mucosa were observed under EM., Conclusion: Secretory meningioma is a rare subtype of meningioma that shows glandular epithelium differentiation. It is a meningioma of the low-risk type in terms of incidence, recurrence and prognosis.

Background: Melanotic schwannoma is a rare variant of schwannoma composed of melanin-producing cells with ultrastructural features of schwann cells. The description of the course of the tumors differs somewhat, but it is generally considered as a benign lesion. We investigated the clinicopathologic features, immunophenotypes, and ultrastructural features of 13 patients with nonpsammomatous melanotic schwannoma (NPMS)., Methods: Tumor specimens of each patient were sectioned and stained with hematoxylin-eosin, Fontana-Masson, Prussian blue, and periodic acid-Schiff (PAS). Immunohistochemical markers such as S-100, Leu-7, HMB-45, Melan-A, CK, EMA, vimentin, GFAP, laminin, collagen IV and MIB-1 were detected with the Envision immunohistochemical staining method. Four of the cases were observed by electron microscopy., Results: Of the 13 patients, 8 were male and 5 female, aged from 11 to 92 years (mean, 38.6 years). The tumor sites included the spinal nerve root (5 patients), cranial nerve (1), greater omentum (1), subcutaneous tissue (3), mesentery (1), bone (1) and mediastinum (1). Eleven patients were followed up for over 2 years, with a mean of 5.9 years. One patient (9.1%) with a primary tumor in the greater omentum developed another primary tumor of the same type in the subcutaneous tissue of the abdominal wall after the first operation. Local recurrence of the tumor was seen in 2 patients (18.2%). One patient (9.1%) showed the local recurrence and metastasis. Seven patients (63.6%) showed no evidence of the recurrence or metastasis. Grossly, all tumors were well-circumscribed and the gross findings were suggestive of melanin-containing tumors. The tumor was composed of spindled and epithelioid cells with abundant intracytoplasmic melanin pigments. Nuclei were round and contained delicate, evenly distributed chromatins as well as small, distinct nucleoli. In some areas, the nucleoli were large and prominent. Rare mitoses were seen in most lesions except the larger omentum lesion. The pigment was shown to be positive for the Fontana-Masson and negative for Prussian blue and PAS. Immunohistochemical staining for S-100, Leu-7, HMB-45, Melan-A, and vimentin were strongly positive. Linear immunoreactions of both laminin and collagen IV was detected in all patients. Ultrastructurally, numerous elongated tumor-cell processes, duplicated basement membrane and melanosomes were observed in all developmental stages., Conclusions: Histologically, melanotic schwannoma is a rare variant of schwannoma composed of melanin-producing cells with ultrastructural features of schwann cells. Distinguishing between this tumor and malignant melanoma is of paramount importance in planning of management. Immunohistochemically, combined use of laminin and collagen IV is valuable in distinguishing melanotic schwannoma from malignant melanoma. Wide local resection and additional radiotherapy should be advocated. Further studies including cytogenetic or molecular biology are still required to better delineate melanotic schwannoma from malignant melanoma. Appropriate long-term follow-up is needed for all melanotic schwannomas.

Objective: To investigate the pulmonary protective effects of short-term leukocyte depletion with a modified filter located at the CPB venous line in canine., Methods: Sixteen healthy hybrid canines were randomly allocated to the LD-1 group, with an LD-1 filter installed in the CPB venous-line for a 5-minute leukocyte depletion at the beginning of the CPB, and to the control group. Blood samples were taken for routine test respectively at 9 time-points, namely pre-CPB, at 5, 10, 40, 70 min of the CPB, 5 min after aortic cross-clamp being off, at the discontinuation of the CPB, 5 min after protamine being administered, and 2 h after the CPB. Oxygen index (OI), pulmonary pathology and levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in plasma were measured at pre-CPB, 5 min after protamine being administered and 2 h after the CPB respectively. The levels of IL-6 and IL-8 in the bronchial alveolar lavage fluid (BALF) were measured at 2 h after the CPB. RESULTS; In LD-1 group, white blood cell (WBC) counts were significantly less than those in control group at 5 min of the CPB (P < 0.05), the filtration rate of WBC was (65.72 +/- 9.36)%. The WBC counts showed no significant difference in either group from 40 min of the CPB to 2 h after the CPB. OI was higher in LD-1 group than that in control group (P < 0.05) at 5 min after protamine being administered and 2 h after the CPB. There was significantly less WBC infiltration and alveolar edema of the lung in LD-1 group than that in control group at 5 min after protamine being administered and 2 h after the CPB. There were no significant differences of IL-6 and IL-8 in plasma between the two groups at 5 min after protamine being administered (P > 0.05), but the levels of IL-6 and IL-8 were much lower in the LD-1 group than those in the control group at 2 h after CPB. At 2 h after the CPB, IL-6 level in the BALF showed no significant difference in each group (P > 0.05); however, the level of IL-8 was lower in LD-1 group than that in control group (P < 0.05)., Conclusion: The LD-1 filter in the CPB venous-line in canine model used for short-term leukocyte depletion filtration could reduce WBC counts significantly, decrease the levels of IL-6 and IL-8 in plasma, attenuate inflammatory response in the lung after CPB, so it has protective effect on canine lung.

Objective: To evaluate the clinical value of HER2 overexpression in breast cancer and its prognostic implication in patients with lymph node negative breast carcinoma., Methods: The following electronic database were extracted using appropriate inclusive and exclusive standards: Cochrane library, PUBMED, Embase (1984 - 2003), OVID, CMCC and CNKI. Excel and RevMan 4.2 were used for statistical analysis., Results: Fifty-six articles were extracted to calculate the positive rate of HER2 overexpression. The pooled positive rate was 23.14% [19.54%, 26.73%], with positive immunohistochemistry (IHC) rate of 23.13% [19.49%, 26.77%] and positive FISH rate of 20.90% [15.54%, 26.25%]. Seven articles were used to evaluate prognostic predication of HER2 expression. It was concluded that in patients with lymph node negative breast carcinoma, HER2 overexpression (both IHC and FISH) independently predicted a poor prognosis based on disease-free survival (DFS) and overall survival (OS) with a P < 0.05. For DFS, the pooled RR was 1.38 [1.07, 1.80] with 1.16 [1.02, 1.31] for IHC and 1.98 [1.56, 2.52] for FISH. For OS, the pooled RR was 1.58 [1.16, 2.14] with 1.37 [1.14 to 1.64] for IHC and 2.33 [1.45 to 3.75] for FISH. HER2 overexpression effectively predicted DFS/OS of patients without adjuvant therapy and OS of patients with the therapy, but not for DFS, with the pooled RR of 1.46 [1.02, 2.09] and 1.11 [0.95, 1.31] for DFS, respectively and the pooled RR of 1.93 [1.44 to 2.58] and 1.25 [1.01, 1.56] for OS, respectively., Conclusions: In patients with lymph node negative breast carcinoma, the positive rate of HER2 overexpression is 23.14%. HER2 overexpression indicates a poor prognosis and adjuvant therapy after surgery should be recommended.

Objective: The aim of this study involving general pathologists was to assess interobserver reproducibility in the pathologic diagnosis of borderline ductal proliferative breast diseases., Methods: Ten general pathologists independently reviewed 43 specimens chosen to represent the spectrum of borderline ductal proliferative breast lesions. All slides were blindly reviewed without given standardized criteria, and were classified as either mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. According to the years of training, these 10 general pathologists were divided into the experienced group and the less trained group. Interobserver agreement was statistically analyzed using Kappa statistic. Then, by comparing all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists in terms of Page standard, we acquired the diagnostic accuracy and ascertained the undue diagnosis., Results: The ten general pathologists' interobserver reproducibility in the diagnosis of borderline ductal proliferative breast diseases was rather low, especially that in their diagnosis of atypical hyperplasia. The reproducibility and accuracy were slightly higher in the experienced pathologists than in the less trained pathologists. Some pathologists made over-diagnosis or under-diagnosis of the lesions to different degrees. However, when the categories of diagnostic terms were simplified, the interobserver reproducibility increased., Conclusion: The use of standardized criteria is an important approach to increasing the diagnostic reproducibility and accuracy.

Objective: To study the clinicopathologic and immunohistochemical features of solitary fibrous tumor (SFT) and its biologic behaviour., Methods: Clinicopathologic data of 26 cases were collected and analyzed. Among them, immunohistochemical staining (Envision method) for CD34, vimentin, CD99, bcl-2, S-100, SMA, HBME-1, EMA and Ki67 were performed in 23 cases., Results: The 17 male and 9 female patients were between 15 and 66 years of age (mean, 44). Their SFTs were located in nose and nasopharynx, cranial cavity, soft tissue, mediastinum, and parietal and visceral pleura. The main clinical manifestations were local mass and pressure symptom. The characteristic microscopic features included patternless growth pattern, alternating hyper- and hypo-cellular areas, blunt spindle cells within keloid-like hyalinization, and hemangiopericytoma-like regions. Positive immunohistochemical staining: vimentin 100%(23/23), CD34 82%(19/23), bcl-2 87%(20/23), CD99 100%(23/23), SMA 30%(7/23). All cases were negative for S-100, HBME-1 and EMA. Follow-up information on 13 cases revealed that 3 patients had had relapse and died, the other 10 patients were alive without evidence of recurrence., Conclusion: SFT is a rare mesenchymal spindle cell tumor which may be found in various parts of human body and needs to be distinguished from other spindle cell tumors by differential diagnosis. The immunophenotype can be of help in this connexion. About 10% to 23% SFTs have malignant behaviour, manifesting as local recurrence or metastasis. The behavior of SFT is unpredictable, which requires careful, longterm follow-up.