Acantholytic oral squamous cell carcinoma with clear cell change - a rare amalgamated variant

ABSTRACT Background Acantholytic squamous cell carcinoma (ASCC) is an uncommon histological variation of oral squamous cell carcinoma (OSCC), accounting for fewer than 4% of all occurrences. The tumor shows a slight masculine predisposition, with the lower lip being the most commonly affected location. ASCC is reported to have a diverse biologic behavior, which explains its ability to metastasize to distant places and, thus, its poor prognosis. Similarly, clear cell change in OSCC is a rare occurrence with an unknown etiology that suggests its aggressive nature. Method and Results Histopathology reveals central acantholytic cells with numerous duct-like features. The presence of distinct cytological atypia contributes to the diagnosis of SCC. Special stains and IHC aid in distinguishing tumor from other histopathologically similar entities. Conclusion The case of a 29-year-old male presented here with an updated literature review highlights the need for histological study of the unique and seldom seen oral ASCC with clear cell change, which can be ignored because of similarities with other entities. Because recurrence rates are so high for ASCC, amalgamated clear cell change makes it critical for proper treatment initiation with a definite diagnosis. To the best of our knowledge, this is the first documented occurrence. Our experience with the present case suspected a more aggressive behavior due to a high Ki-67 index, anticipating a poorer prognosis in the oral cavity considering the patient's young age.

Lesión granulomatosa en encía insertada-metástasis de carcinoma renal de células claras. Presentación de caso / Granulomatous Lesion in Inserted Gum-Metastasis of Renal Clear Cell Carcinoma. Case Presentation

Resumen: A nivel mundial el carcinoma renal constituye el 3% de todas las formas de cáncer en el cuerpo humano. Su comportamiento biológico es variable dependiendo de la biología de cada individuo; tiende a realizar metástasis a sitios contiguos como glándulas suprarrenales, hígado, pulmón, hueso, ganglios linfáticos sin embargo la presentación a distancia en cavidad bucal es poco frecuente más aún en encía insertada. Las lesiones granulomatosas del periodonto incluyen granulomas piógenos, granulomas de células gigantes entre otros. El objetivo principal de este caso clínico es describir las características clínicas e histopatológicas de las metástasis a cavidad bucal como lesiones granulomatosas. Se presenta el caso de una paciente femenina de 60 años de edad con antecedente de carcinoma renal de células papilares en riñón derecho tratado mediante nefrectomía en el año 2017, en el año 2019 presenta metástasis a pulmón izquierdo y a cavidad bucal. En la actualidad se encuentra bajo protocolo de tratamiento para metástasis de células claras renales.

Abstract: Worldwide, renal carcinoma constitutes 3% of all forms of cancer in the human body. Its biological behavior is variable depending on the biology of each individual; it tends to metastasize to contiguous sites such as adrenal glands, liver, lung, bone, lymph nodes, however, remote presentation in the oral cavity is less frequent, even in inserted gums. Granulomatous lesions of the periodontium include pyogenic granulomas, giant cell granulomas among others. The main objective of this clinical case is to describe the clinical and histopathological characteristics of oral cavity metastases as granulomatous lesions. The case of a 60-year-old female patient with a history of renal cell papillary carcinoma in the right kidney treated by nephrectomy in 2017 is presented, in 2019 she presented metastases to the left lung and oral cavity. It is currently under treatment protocol for renal clear cell metastases.

Bazo metastásico de un adenocarcinoma de endometrio. Presentación de un caso / Splenic metastasis from endometrial adenocarcinoma. A case presentation

Introducción: La metástasis esplénica de un carcinoma endometrial es un acontecimiento clínico raro, con solo 13 casos documentados en la literatura, revisada. La evolución de esta metástasis, en una paciente atendida, en nuestra Institución, fue el motivo para publicar este trabajo. Hay otras enfermedades oncológicas que en su evolución de progresión o recaída cursan con este tipo de cuadro clínico donde el tratamiento quirúrgico es fundamental y así complementar con tratamiento de quimioterapia. Se hizo una revisión en publicaciones cubanas no se encontró reporte del tema. Objetivo: Presentar un caso con un adenocarcinoma de endometrio tipo endometroide que metastiza al bazo con histología de células claras. Presentación: Paciente de 45 años, con diagnóstico de adenocarcinoma de endometrio con estadiamiento quirúrgico pT3A Nx Mo etapa IIIA Grado 2; este estadiamiento es el anterior a 2009, llevó su tratamiento quirúrgico y radioterapia complementaria, controlada por 21 meses. En consulta de seguimiento se diagnostica metástasis al bazo, por lo que se realiza esplenectomía y es tratada con quimioterapia; fue atendida por el equipo multidisciplinario de ginecología oncológica; las investigaciones realizadas estuvieron basadas en inmuhistoquimica, imageneología y tratamiento de soporte cuando lo necesitó. Conclusiones: La metástasis esplénica por un cáncer de endometrio es rara, es el primero reportado en Cuba, los estudios inmuhistoquímicos y de imágenes son fundamentales(AU)

Introduction: Splenic metastasis from endometrial carcinoma is a rare clinical event with only 13 documented cases in the literature reviewed. The evolution of a patient with this metastasis attended in our institution was the reason that motivated us to publish this work. There are other oncological diseases that are accompanied by this clinical picture during their evolution of progression where surgical treatment complemented with chemotherapy treatment is essential. A literature review was carried out in Cuban publications, but no reports on the topic were found. Objective: The aim of this work is to present an endometroid type case endometrium adenocarcinoma which metastasizes to the spleen with clear cell histology. Case presentation: Forty-five-year-old patient with diagnosis of endometrium adenocarcinoma with surgical stage pT3a Nx Mo stage IIIA Grade 2; this quantification was defined before 2009. The patient underwent surgical treatment which was complemented with radiotherapy and then followed for 21 months. In the follow-up consultation, spleen metastasis was diagnosed; so she underwent splenectomy and was treated with chemotherapy. She was treated by the multidisciplinary gynecologic oncology team; the investigations performed were based on immuhistochemistry, imaging, and supportive treatment whenever needed. Conclusions: Splenic metastasis from endometrial cancer is rare; it is the first case reported in Cuba. Immuhistochemical and imaging studies are essential(AU)

Hidradenoma nodular maligno / Malignant nodular hydradenoma

RESUMEN El Hidradenoma nodular maligno o Hidradenocarcinoma es un tumor poco frecuente, derivado de las glándulas sudoríparas ecrinas. Puede surgir de novo o por la transformación de su contraparte benigna. Estos tumores son de crecimiento lento, comportamiento agresivo, con alta incidencia de recurrencias y posibilidad de metástasis. Su prevalencia es en la población adulta, y su pronóstico, incierto. El tratamiento de elección de estos tumores es la escisión quirúrgica con márgenes amplios.

ABSTRACT The Malignant nodular Hydradenoma or Hydradenocarcinoma is a rare tumor, derived from the eccrine sweat glands, may arise de novo or by the transformation of its benign counterpart. These tumors are slow growing, aggressive behavior, with a high incidence of recurrences and the possibility of metastasis; its prevalence being in the adult population, and its prognosis is uncertain. The treatment of choice for these tumors is surgical excision with wide margins.

Regulation of epithelial function, differentiation, and remodeling in the epididymis / 亚洲男科学杂志(英文版)

The epididymis is a single convoluted tubule lined by a pseudostratified epithelium. Specialized epididymal epithelial cells, the so-called principal, basal, narrow, and clear cells, establish a unique luminal environment for the maturation and storage of spermatozoa. The epididymis is functionally and structurally divided into several segments and sub-segments that create regionally distinct luminal environments. This organ is immature at birth, and epithelial cells acquire their fully differentiated phenotype during an extended postnatal period, but the factors involved in this complex process remain incompletely characterized. In the adult epididymis, the establishment of an acidic luminal pH and low bicarbonate concentration in the epididymis contributes to preventing premature activation of spermatozoa during their maturation and storage. Clear cells are proton-secreting cells throughout the epididymis, but principal cells have distinct acid/base transport properties, depending on their localization within the epididymis. Basal cells are located in all epididymal segments, but they have a distinct morphology depending on the segment and species examined. How this structural plasticity of basal cells is regulated is discussed here. Also, the role of luminal factors and androgens in the regulation of epithelial cells is reviewed in relation to their respective localization in the proximal versus distal regions of the epididymis. Finally, we describe a novel role for CFTR in tubulogenesis and epithelial cell differentiation.

Acantoma de células claras abdominal. Lesión infrecuente en localización atípica / Abdominal clear cell acantoma. Uncommon lesion in atypical location

Introducción. El acantoma de células claras es una lesión tumoral benigna relativamente infrecuente que muestra unas características histológicas que permiten su diagnóstico. Método. Presentamos el caso de un acantoma de células claras abdominal, localización infrecuente, en un paciente de 72 años. Resultado. El diagnóstico fue establecido tras el pertinente estudio histológico pues la clínica inespecífica y la localización atípica impedían la realización de un correcto juicio clínico. Conclusiones. Pretendemos con la presentación del presente caso poner de manifiesto la histología tan peculiar de esta lesión al tiempo que, a través de una amplia revisión bibliográfica, mostramos distintas localizaciones y presentaciones atípicas de dicha entidad.(AU)

Introduction. Clear cell acanthoma is a relatively rare benign tumoral lesion showing histological features that allow diagnosis. Method. We report the case of abdominal clear cell acanthoma, unusual location in a patient of 72 years. Results. The diagnosis was established after the relevant histological study as nonspecific clinical and atypical location prevented the realization of a proper clinical trial. Conclusions. We intend with the presentation of this case highlight the peculiar histology of this lesion while, through an extensive literature review, we show different locations and atypical presentations of this entity.(AU)

Adenocarcinoma of the rete testis with prominent papillary structure and clear neoplastic cells: Morphologic and immunohistochemical findings and differential diagnosis.

Adenocarcinoma of the rete testis is rare, and its etiology is unknown. The defi nite diagnosis merely depends on the exclusion of other tumors and histological features. We fi rst describe a 38-year-old man with a carcinoma arising in the rete testis. The tumor was characterized by clear neoplastic cells and branching papillary growth. Focal stromal invasion and transition of normal rete epithelium to neoplastic cells were seen. The neoplastic cells were positive for epithelial membrane antigen, Ber-Ep4, vimentin, renal cell carcinoma marker, and CD10, while negative for Wilms’ tumor 1, thyroid transcription factor-1, estrogen receptor, prostate specifi c antigen, placental alkaline phosphate, CD117, and alpha-1-fetoprotein. According to the above features, we diagnosed this tumor as adenocarcinoma of the rete testis. To our best knowledge, this is the fi rst reported case of adenocarcinoma of the rete testis with prominently papillary structure and clear neoplastic cells. The rarity of adenocarcinoma of the rete testis and the unique features in our case cause diagnostic pitfalls. A complete clinicopathological study and thorough differential diagnosis are crucial for the correct result.

Degos’ Like Nonclear Cell Acanthoma: Could this be a New Entity.

Degos’ acanthoma is a tumor that is clinically and histologically distinct. Typically, the lesions are solitary, sharply delineated red nodules or plaques 1-2 cm in diameter, usually covered by a thin wafer like crust. On microscopy, the striking presence of pale and slightly enlarged epidermal cells is essential to clinch the diagnosis. Here we present a case where the clinical picture was that of Degos’ acanthoma with the absence of glycogen rich clear cells on histology.

Carcinoma de células claras variedad no hialinizante de parótida: comunicación de dos casos con diferente grado de diferenciación / Non-hyalinizing clear cell carcinoma of the parotid: report of two cases with different grade of differentiation

El carcinoma de células claras es una neoplasia rara de bajo grado que se desarrolla casi exclusivamente en glándulas salivales menores humanas. El objetivo de esta comunicación es analizar las características estructurales, histoquímicas e inmunohistoquímicas (IHQ) de dos casos de carcinoma de células claras de parótida y realizar el diagnóstico diferencial con otros tumores salivales primarios y metastásicos que presentan células claras. Cortes de ambos tumores fueron procesados para H/E, tricrómicos de Masson y Dane, Azul de toluidina, Azul alciano, PAS y PAS/diastasa; marcaciones IHQ para citoqueratinas de bajo y alto peso molecular, ki67, HMB45, p63 y proteína S-100. El patrón estructural de estos tumores estaba determinado por nidos y cordones de células claras delimitados por un estroma no hialinizado. En un tumor se observó una neoplasia maligna a células claras con manifiesta anaplasia. La expresión de ki67 fue importante. El otro tumor estaba constituido por células claras monomorfas sin signos manifiestos de atipia y casi nula expresión de ki67. Con PAS se demostró la presencia de glucógeno y no se observó un desarrollo importante del estroma colágeno en ambas neoplasias. En ambos casos resultó francamente positiva la inmunomarcación para citoqueratinas de bajo y alto peso molecular. Por el contrario resultó negativa para HMB45 y p63. La proteína S-100 tuvo su expresión en células aisladas. Se concluye que los casos presentados son de localización poco común (parótida) según lo descripto en la bibliografía; corresponden a la variedad no hialinizante ya que no está presente un importante estroma colágeno hialinizado, y ambos tumores son primarios de glándulas salivales, de origen epitelial, no melanocítico ni hematopoyético (linfomas) como lo demuestran las marcaciones IHQ.

The clear cell carcinoma is a rare neoplam of low level grade that develops almost exclusively in human minor salivary glands. The objective of this present work is to analyze the structural, histochemical and inmunohistochemical (IHQ) characteristics of two cases of parotid clear cell carcinoma and make a differential diagnosis with other primary and metastatic salivary tumors that clear cells show. Serial cuts of both tumors were processed for H/E, Masson and Dane trichromes, Toluidine blue, Alcian blue, PAS and PAS/diastase; IHQ marking of both high-and low-molecular weight cytokeratins, ki67, HMB45, p63 and S-100 protein. The structural pattern of these tumors were determined by nests and cords of clear cells delimited by a stroma non hyaline. In a tumor a malign neoplasia was observed in clear cells with anaplasia. The ki67 expression was important. The other tumor was constitued of clear monomorph cells without manifestation signs of atypia and almost no ki67 expression. With PAS was confirmed the presence of glycogen and not observed an important development of the collagen stroma in both neoplasms. Both cases resulted very positive the immunostaining of both high and low molecular weight cytokeratins. It resulted negative for the HMB45 and p63. The protein S-100 has it´s expression in isolated cells. We conclude that: the presented cases are very uncommon localization (parotid) as described by the literature; it matches a non hyalinizing variety because a very important hyalinized collagen stroma is not present, both primary tumors of salivary glands, of epithelial origin, non melanocytic, renal or hematopoietic lymphomas which shows immunostaining IHQ.

Metástasis tiroidea de un carcinoma de células renales: a propósito de un caso / Thyroid meatastases of a renal cell carcinoma: a case report

El carcinoma de células renales de células claras, es impredecible con comportamiento agresivo dentro de los tumores malignos, metastatiza en pulmón, hígado, piel, hueso, ganglios linfáticos, cerebro, cavidad nasal, encía, laringe y tiroides, pudiendo ocurrir antes o después del descubrimiento primario. Femenina 71 años, antecedente diagnóstico carcinoma de células renales en 1996. Intervalo libre de enfermedad 11 años. En 2008 se encuentra a la palpación tumor en lóbulo derecho del tiroides de 4 cm, móvil. Eco tiroideo: nódulo de 3,5 cm x 3,3 cm derecho. Punción con aguja fina: hallazgos compatibles con neoplasiafolicular. Se realiza: tiroidectomía total: carcinoma de células claras metastásico en ambos lóbulos del tiroides. El tumor metastásico tiroideo de un carcinoma renal es una entidad muy poco frecuente y asintomática, encontrándose como hallazgo en la necropsia. Ante un paciente con historia de cirugía por tumor renal y presencia de nódulo tiroideo se debe sospechar de metástasis

Carcinoma of the renal cells of clear cells has one of most essential landlord’s behaviors within the malignant tumors, metastases in lymphatic lung, liver, skin, bone, ganglia, brain, nasal cavity, larynx and thyroid, being able to happen before as much as after the discovery of the primary tumor. Feminine 71 years that diagnostic antecedent presents displays carcinoma of renal cells in 1996, free interval of disease 11 years. June 2008, being to the palpation in neck tumor 4 cm, moving body. Echo: Nodule of 3.5 cm x 3.3 cm. Puncture: Compatible findings with follicular neoplasia. Realized: Total thyroidectomy: Carcinoma of clear cells metastatic both lobes of the thyroid. The metastases thyroid tumor of renal carcinoma is an organization frequent little asymptomatic, being like finding in the post-mortem examination. Despite before a patient with history of surgery by renal tumor and presence of thyroid nodule one is due to suspect metastasis

Carcinoma renal de células claras en riñón ectópico presacro / Clear cell renal carcinoma in pre-sacrum ectopic kidney

A pesar de ser la ectopia renal una anomalía usual y el carcinoma de células claras la neoplasia renal más frecuente, existen muy escasos reportes de presentación simultánea de ambas condiciones. Se notificó una paciente, con estas características, que fue tratada quirúrgicamente y mantuvo una evolución satisfactoria

In spite of the fact that the renal ectopy is a common anomaly and the clear cell carcinoma is the more frequent renal neoplasm, there are not many reports on a simultaneous presentation of both conditions. There was the case of a female patient presenting these features and that was operated on with a satisfactory course

Fundamentos moleculares de la enfermedad de von Hippel Lindau / Molecular bases of von Hipperl Lindau's disease

La enfermedad de von Hippel Lindau es una rara entidad genética que se caracteriza por la predisposición al cáncer, especialmente angiomas de la retina, hemangioblastomas del sistema nervioso central y carcinoma renal de células claras. Los productos del gen presentan un mecanismo de acción peculiar, pues está relacionado con los procesos de adaptación del organismo a la hipoxia. En este trabajo se presenta una panorámica actualizada de esta enfermedad, con énfasis en los aspectos moleculares

The von Hippel Lindau's disease is uncommon genetic entity characterized by a predisposition to cancer, specially the retina angiomas, hemangioblastomas of central nervous system and the clear cells renal carcinoma. Gene products have a typical action mechanism since it is related to organism adaptation processes to hypoxia. In present paper an updated panorama of this disease emphasizing in molecular processes

Carcinoma parotídeo de células claras / Parotidean clear cells carcinoma

El carcinoma parotídeo de células claras es una neoplasia poco frecuente, con problemas de diagnóstico diferencial con una amplia variedad de tumores de las glándulas salivares, que contienen células claras, en mayor o menor proporción, como los tumores mixtos, mioepiteliomas, oncocitomas, carcinoma mucoepidermoide, carcinoma de células acinares, adenocarcinoma, polimorfo de bajo grado y carcinoma adenoide quístico. Es un carcinoma de bajo grado, localmente invasivo, siendo raras las metástasis a nivel de los ganglios linfáticos cervicales, y su pronóstico, en general, es bueno.

Parotidean clear cells carcinoma is a rare neoplasia with a differential diagnosis problem with a wide variety of salivary glands tumours, containing clear cells, in a greater or lower proportion, such as the mixed tumours: myoepitheliomas, oncocytomas, mucoepidermoid carcinoma, acinar cells carcinoma, adenocarcinoma, lower grade polymorphic carcinoma and cystic adenoid carcinoma. It is a lower grade carcinoma, locally invasive, metastasis are rare at the level of cervical lymph ganglia and its prognosis, in general, is good.

Expression of TβRⅡRH mRNA in PBMCs of patients with lupus nephritis / 中华风湿病学杂志

Objective To investigate the association of TGF-β receptor typeⅡ(TβRⅡ)mRNA with lupus nephritis (LN) and disease activity by testing its expression levelin peripheral blood mononuclear cells (PBMCs).Methotis Forty-four patients with LN were included in this study.They were all had active LN.Twepty-eight LN patients were taking glueocorticoids and/or immunosuppressive agents and sixteen had never taken steroids or immunosuppressive agents.The expression levels of T13R H mRNA were semi-quantitativelydetermined by reverse transcription-polymerase chain reaction(RT-PCR).Resuits The expression levels of TβRⅡ mRNA in PBMCs from LN patients(1.7±1.0)were lower than those of non-lupus nephritis(4.0±3.1) and healthy subiects(4.1±2.5),(P<0.01).The difference of the expression levels between patients who took and had never taken glucocorticoids and/or immunosuppressive drugs was significantly statistically(P<0.05).The expression levels of TβRⅡ mRNA in PBMCs of patients with LN were correlated significantly with the systemic lupus erythematosus disease activity index (SLEDAI)scores(r-0.309.P<0.05),titers of anti-dsDNA antibody(r=-0.401,P<0.01)and serum complement C3 level(r=0.621,P<0.01).Conclusion This study suggests that TβRⅡ may be involved in the development of LN,and the TβRⅡ mRNA expression levels in PBMCs from patients with SLE are significantly correlated with LN activity.Glucocortieoids or immunosuppressive drugs can increase the expression levels of TβRⅡ mRNA and ameliorate renal damage.