Nonossifying Fibroma of the Rib Resected by Video-Assisted Thoracoscopic Surgery with Preservation of Periosteum

Nonossifying fibromas are not uncommon, but those described in the rib are unique. We report the case of a 15-year-old patient with symptoms of chest wall pain for 5 days who underwent a video-assisted thoracoscopic rib resection for a 2.5-cm rib mass. Unexpectedly, pathological results revealed a nonossifying fibroma of the rib. The results showed excellent cosmesis and new bone formation because of the preservation of the overlying periosteum.

Micropapillary Lung Cancer with Breast Metastasis Simulating Primary Breast Cancer due to Architectural Distortion on Images

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.

Primary Signet Ring Cell Carcinoma of the Lung: A Case Report / 결핵및호흡기질환

Signet ring cell carcinoma (SRCC) of the lung is a rare variant of pulmonary adenocarcinoma. Because the majority of SRCCs seen in the lung are metastatic tumors from stomach, colon, or breast, the differentiation of primary SRCC from metastatic SRCC is important but may be problematic. Recently, immunohistochemical studies are known to be valuable in determining primary sites of SRCC. Herein, we presented a case of primary signet ring cell carcinoma of the lung in a 67-year-old man. Even though radiographic findings of our case were more suggestive of metastatic orgin of SRCC in the lung, we could finally conclude that lung was the primary site of SRCC in this case with the help of immunohistochemical studies (TTF-1 and CK7 positive and CK 20 negative) and other diagnostic work up.

A Case of Bilateral Oncocytomatosis in Chronic Renal Failure / 대한신장학회잡지

Renal oncocytoma is a uncommon benign tumor originating from the intercalated cells of the collecting duct, which occurs with an overall incidence of 3% to 7% among all renal tumors. Bilateral, multicentric renal oncocytoma is rare, especially in chronic renal failure. We report a case of 59-year-old woman with bilateral oncocytoma with renal failure. She presented nausea and vomiting for one month, and had no previous past medical history. Abdominal sonography and computed tomography revealed variable sized homogenous mass on both kidneys. Microscopic examination showed large polygonal cells with abundant eosinophilic and granular cytoplasm. Surrounding renal parenchyma revealed marked atrophy and sclerosis with a few intact glomeruli and tubules. We could exclude renal cell carcinoma because tumor cells were negative for CK7, CK20, vimentin, and Hale's colloidal iron staining, and did not show perinuclear halo and mitosis.

Multiple Organ Involvement of Lymphoepithelioma-Like Carcinoma in the Kidney and the Ureter / 대한비뇨기과학회지

A lymphoepithelioma-like carcinoma is a tumor with morphological features identical to an undifferentiated nasopharyngeal carcinoma that occurs outside the nasopharynx. This kind of tumor has been found in the salivary gland, stomach, lung, thymus, bladder, prostate, vagina and skin, but is particularly rare in the urinary tract. We report a case of a lymphoepithelioma-like carcinoma, which are usually found simultaneously in the kidneys and ureter. This is the first case of multiorgan involvement of this tumor.

Pararenal Leiomyosarcoma of the Inferior Vena Cava

A complete surgical resection is the only proven therapeutic modality that prolongs the survival in patients with leiomyosarcoma of the inferior vena cava (IVC). Reconstruction of the IVC is not always necessary but is often required to facilitate venous drainage of the kidney for the tumors at the pararenal area of the IVC. Controversy exists in postoperative adjuvant therapy. Recently, we experienced four cases of pararenal leiomyosarcoma of the IVC, of which treatment consisted of a complete resection of the tumor, ringed polytetrafluoroethylene (PTFE) graft interposition, and bilateral renal vein reconstructions in all patients. Postoperative radiation therapy was instituted in 3 of 4 patients. One patient who did not receive the postoperative radiation therapy was treated with adjuvant chemotherapy. The kidneys were preserved in all patients and no deep vein thrombosis (DVT) or venous insufficiency of the lower extremity veins developed. Distant metastasis to the lung was noted in one patient at 18 months after surgery, who was not received the postoperative radiation therapy but chemotherapy. In conclusion, a complete resection of the tumor, IVC reconstruction, and bilateral renal vein reconstruction followed by adjuvant radiation therapy is recommended for the treatment of pararenal leiomyosarcoma of the IVC.

Granulosa Cell Tumor Arising in the Paratesticular Area: A case report

Granulosa cell tumor of the testis is extremly rare in adult males and granulosa cell tumor occurring in the paratesticular area has not been reported. We report a paratesticular granulosa cell tumor in a 34-year-old man who presented with a 5.5 cm sized scrotal mass. The tumor was present in the paratesticular area near the head of epididymis. It was located in the tunica and completely separated from the testis by thick fibrous tissue. Microscopically, the tumor exhibited solid, microfollicular, and trabecular patterns. The tumor cells had ovoid to elongated nuclei with longitudinal intranuclear grooves and one or two nucleoli and scanty cytoplasm. Mitoses were relatively frequent with an average number of 9/10 HPFs. The tumor extended into the visceral tunica vaginalis and showed multiple lymphatic tumor emboli. Immunohisto chemical stains revealed diffuse strong positivity for inhibin, vimentin, and keratin and diffuse weak positivity for estrogen and progesteron receptor. Placental alkaline phosphatase (PLAP) and epithelial membrane antigen (EMA) were negative. On electron microscopic examination, tumor cells were polygonal and had large indented nuclei. The cytoplasm contained a moderate number of small round mitochondria, abundant rough and smooth endoplasmic reticula, and a few lipid droplets. Small aggregates of intermediate filaments and intercellular junctions were observed. The patient was alive and well 5 months after orchiectomy. This is the first case of adult granulosa cell tumor arising in the paratesticular area.

Signet Ring Cell Carcinoma of the Prostate A report of two cases

Primary signet ring cell carcinoma of the prostate is extremely rare and about 18 cases have been reported in the literature. We report two cases of primary signet ring cell carcinoma of the prostate, arising in 79-year-old and 65-year-old men. Both cases were the poorly differentiated adenocarcinoma of the prostate with many signet ring cells. Signet ring cells were positive for prostatic specific antigen and prostatic acid phosphatase but negative for neutral and acid mucins. In summary, the signet ring cell carcinoma of the prostate is a rare variant of poorly differentiated adenocarcinoma of the prostate. The orgin of the prostate should be considered in cases of metastatic signet ring cell carcinoma, particularly when the signet ring cells are negative for neutral and acid mucins. Prostatic specific antigen and prostatic acid phosphatase should also be performed to confirm the primary signet ring cell carcinoma of the prostate.

Biomarkers in chemoprevention for upper aerodigestive tract tumors

A chemopreventive approach to cancers of the upper aerodigestive tract (including those of head and neck and lung) to reduce the incidence and mortality rates for these cancers has become an important strategy because therapies such as surgery, radiation, and chemotherapy have only marginally improved the five-year survival rate over the last two decades. However, chemopreventive trials have been hampered by serious feasibility problems, including high cost, the requirement of large numbers of patients, and long-term follow-up necessary to determine cancer incidence, which served as the study end point. Thus, the use of biomarkers, the identification of which would serve as an intermediate end point of the study has recently emerged as a subject of great interest. To try to understand the process of tumorigenesis from normal tissues through the premalignant tissue stage to malignant lesions, there has recently been a search for genetic and/or phenotypic changes that qualify as candidates for biomarkers. These candidates include genomic markers, certain specific genetic markers (such as oncogenes, growth factors and their receptors, and tumor suppressor genes), cell proliferation markers, and cell differentiation markers. This review covers genomic markers (including micronuclei and specific chromosomal alterations) and specific genetic markers (such as the ras gene family, the myc family, erb B1, int-2/hst-1, and the p53 tumor suppressor gene). As a consequence of genetic alteration, we also reviewed cell proliferation markers such as proliferating cell nuclei antigen (PCNA) and the squamous cell differentiations markers, including keratins, involucrin, and transglutaminase 1. These biomarker candidates are important adjuncts to the development of the new chemopreventive agents and to the rational design of future intervention trials. However, it should be emphasized that these biomarkers must first be validated in clinical trials; only then can they replace cancer incidence as the sole end point in chemoprevention trials.