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Gastrointestinal autonomic nerve tumors form an uncommon subcategory of stromal tumors of the intestinal tract although their histologic appearance is similar to other gastrointestinal stromal tumors. Our aim was to evaluate our experience in the diagnosis and therapy of these kinds of tumors. Two patients were admitted to the Pediatric Surgery Clinic in Niš with abdominal pain and a palpable mass in the abdomen. After excision, the tumor tissue was sampled, sent for histopathological diagnosis, and examined by light microscopy, immunohistochemistry, and electron microscopy. Postoperatively, both patients recovered without complications. The patient with the tumor bulk in the mesentery of the small bowel had no evidence of tumor progression 6 years after surgery. In the second case, a giant tumor was present along the greater curvature of gaster. Even with a tumor of this size, there were no signs of progression 10 years after surgery. Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the curative approach to date, and long-term survival is possible even with large tumors.
In this article, we present the case of a 57-yearold man with cervical and mediastinal tumor mass, normal blood count as well as virusological status. Cervical tumor tissue biopsy revealed cells positive for CD34, CD13, LCA, CD33, and CD163 but negative for T-cell and B-cell markers, NK-cell markers, plasmacytic markers and anaplastic large cell lymphoma markers. These features were consistent with myeloid sarcoma of the neck with involvement of the mediastinum. We discussed differential diagnosis and therapy of isolated myeloid sarcoma and suggest that clinical presentation, cell morphology, complete immunophenotype, and specific genotypic lesions in some cases, must be evaluated.
Uterine leiomyoma with massive lymphoid infiltration is a rare morphologic phenomenon. We describe the first case of uterine leiomyoma with lymphoid infiltration observed in a patient after chemotherapy for sigmoid cancer. We performed immunohistochemical analysis with a panel of antibodies to several markers. Detection of CD20, CD3, Ki67, CD68 and Epstein-Barr virus nuclear antigen assisted in the differential diagnosis and partial elucidation of the pathogenesis. In addition, we examined the lysosome-associated membrane proteins LAMP-1 and LAMP-2 for the first time in this lesion. Their expression was elevated, indicating enhanced autophagy, an indirect sign of degenerative changes in this benign tumor characterized by massive lymphoid infiltration.
Content available remote Synovial sarcoma of carotid space
Synovial sarcomas are malignant tumors of mesenchymal origin, extremely rarely located in the area of the head and neck. Histologically they can be monophasic, biphasic or poorly differentiated with numerous differential diagnostic dilemmas. A 54-year-old male with synovial sarcoma of the carotid space is presented. The patient refused suggested postoperative radiotherapy and, nine months after the primary surgery, local relapse was verified. Following surgical resection of the local relapse, postoperative radiotherapy treatment was utilized. Ten months after the second surgery, secondary deposits in the lungs were radiographically confirmed, and local recurrence was noticed again. Treatment was continued with symptomatic therapy and eleven months later patient died. Synovial sarcomas of the carotid space are extremely rare, with complex surgical approaches and pathohistological differential diagnostic dilemmas. Diagnosis requires determination of the immunophenotype of the tumor cells, whereas therapy requires an aggressive surgical approach and postoperative radiotherapy.
Horner's syndrome is most often caused by a tumour compressing the sympathetictrunk. Spindle cell lipoma (SCL) is a rare tumour, corresponding to just 1.5% of the benigntumours of soft tissues. Its most common localisation is subcutaneous tissue in theupper part of the body. This paper presents a rare case of Horner's syndrome caused bya SCL of the neck.A 42-year-old male patient was admitted to the ENT Ward of the Mazovian SpecialHospital in Siedlce because of a neck tumour on the left side. Laryngological examinationrevealed only a hard tumour with a limited mobility on the left side of the neck. Oph-thalmological and neurological consultations indicated Horner's syndrome. Fine-needleaspiration biopsy gave no clear diagnosis. The patient was qualified for surgery. Thetumour was radically excised and sent for histopathological examination. Thefinal his-topathological diagnosis was: SCL. Symptoms of the Horner's syndrome disappearedwithin 3 weeks after the surgery.The discussed case should be noted because of untypical SCL localisation within thecervical perivascular space, and also because of presence of symptoms of Horner's synd-rome caused by compression of the tumour on the sympathetic trunk that disappearedfollowing the surgical treatment.
Content available remote Multiple primary malignant neoplasms - case report
The synchronous occurence of primary carcinomas of endometrium and ovary is well recognized. Malignant peripheral nerve sheath tumours (MPNSTs) may also rarely occur in patients diagnosed with malignancies of the female genital tract. We report a rare case of synchronous primary carcinomas of endometrium and ovary, followed by a metachronous retroperitoneal MPNST. Ascites cytology and endometrial biopsy, followed by hysterectomy and bilateral adnexectomy, were performed to remove the synchronous tumors. Histology was suggestive of synchronous endometrial endometrioid carcinoma and ovarian mucinous adenocarcinoma. After the removal of the retroperitoneal tumor, a MPNST was diagnosed by immunohistochemistry. The patient developed two consecutive vaginal tumors diagnosed as metastases of the previously diagnosed endometrial carcinoma. Although synchronous tumors of endometrium and ovary were relatively early staged and consequently had a favorable prognosis, subsequently occuring implants along the lower genital tract and the metachronous MPNST added up to a poor prognosis.
Content available remote OCT 4 immunohistochemistry in postpubertal cryptorchidism
Patients with cryptorchidism are at an increased risk for germ cell testicular cancer. OCT 4 has been shown to be a sensitive and specific marker for some types of germ cell testicular cancer. We undertook this study to establish whether OCT 4 immunohistochemistry is a useful tool in the pathohistologic evaluation of postpubertal patients with cryptorchidism. Seventeen postpubertal patients underwent orchidectomy for cryptorchidism at our center since 1997. Immunohistochemical staining with OCT 4 was performed on these samples. Characteristic OCT 4 nuclear staining was positive in two patients. One patient was correctly diagnosed on previous pathohistological evaluation, while OCT4 immunohistochemical staining revealed previously unidentified intratubular germ cell neoplasia in the other patient. OCT 4 immunohistochemistry can be useful in diagnosing a testicular germ cell tumor in patients with cryptorchidism. If we consider a low number of postpubertal patients with cryptorchidism a benefit of immunohistochemical staining with OCT4, this could favor the use of OCT 4 staining in work-up of cryptorchidism.
The “Polish Research on Gastric Cancer” project has been continued since 1986. The main aim of this project, which is a multicenter and interdisciplinary research, is enhancing the treatment results of gastric cancer patients by developing and promoting the use of optimal methods for diagnosis and treatment, both surgical as well as combined. One of the more important achievements of the project is the development and publication of a document named “Polish Consensus on Treatment of Patients with Gastric Cancer”, whose first version was published in 1998. Following versions were updated adequately to changing trends in the proceedings in patients with gastric cancer. A scientific symposium on “Polish Consensus on Treatment of Gastric Cancer – update 2016” was held in 3-4 June 2016 in Cracow. During the symposium a panel session was held during which all authors publicly presented the Consensus assumptions to be discussed further. Moreover, the already mentioned session was preceded by a correspondence as well as a working meeting in order to consolidate the position. It has to be underlined that the directions and guidelines included in the Consensus are not the arbitrarily assumed rules of conduct in a legal aspect and as such every doctor/team of doctors is entitled to make different decisions as long as they are beneficial to a patient with gastric cancer. The Consensus discusses as follows: a) recommended qualifications (stage of advancement, pathological, lymph node topography and the extent of lymphadenectomy, division of cancer of the gastroesophageal junction), b) rules for diagnostics including recommendations regarding endoscopic examination and clinical evaluation of the advancement stage, c) recommendations regarding surgical treatment (extent of resection, extent of lymphadenectomy, tactics of proceedings in cancer of the gastroesophageal junction), d) recommendations regarding combined treatment with chemotherapy or radiotherapy, e) place of endoscopic and less invasive surgery in the treatment of gastric cancer. This publication is a summary of the arrangements made in the panel session during the abovementioned scientific symposium in Cracow in 2016.
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