Metastatic adenocarcinoma to the cervical lymph node: a significant proportion of cholangiocarcinoma in Thai patients.

OBJECTIVE: To determine distribution of the primary site of metastatic adenocarcinoma to the cervical lymph node in Thai population with histological correlation. MATERIALS AND METHODS: 72 Thai patients with metastatic adenocarcinoma to the cervical lymph node were retrospectively analyzed. Results: Thyroid gland (papillary carcinoma) was the commonest source of tumor (41%), followed by lung (25%), bile duct (17%) and breast (7%). Metastatic cholangiocarcinoma typically produced distinct glandular pattern, and frequently involved the right supraclavicular lymph node. Brush border of the gland-forming tumor cells was a consistent finding in metastatic cholangiocarcinoma, with 100% sensitivity and 97% specificity. CONCLUSIONS: Cholangiocarcinoma represents a significant portion of primary tumor in Thai patients with cervical nodal metastasis. This figure may hold true for countries where bile duct malignancy is endemic, and may be of clinical usefulness in identification of primary cancer.

Carcinoid tumor of the middle ear.

The patient was a 32 year-old man who was first seen in 2003 for 2 years hearing loss. On otoscopic examination, a whitish mass could be observed through the intact tympanic membrane. High resolution computed tomography showed a tumor like lesion in the middle ear with no evidence of bone destruction. A tympanomastoidectomy was performed. Light microscopy showed fragments of cellular tissue in which both glandular and trabecular growth pattern could be identified Immunohistochemical examinations showed positive staining of the tumor cells for cytokeratin and chromogranin. The diagnosis of carcinoid tumor should be considered in all cases of adenomatous neoplasms of the middle ear and mastoid. Conservative surgical excision is the treatment of choice, and local recurrence following complete excision is uncommon.

RET proto-oncogene expression of papillary thyroid carcinomas in Thai patients.

BACKGROUND: Ret proto-oncogene activation has been found in papillary thyroid carcinoma with different frequencies according to geographic location. The rate of expression ranges from 0-100 percent in the literature. This gene expression has also been studied in many Asian countries but it has never been studied in Thailand. OBJECTIVE: To study the frequency of the RET expression and their roles in predicting prognosis of papillary thyroid carcinoma among Thai patients treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: One hundred and one cases of papillary carcinomas were studied with immunohistochemistry for RET antibodies. All slides with routine staining were reviewed to classify cell variants and record other prognostic parameters such as size, multicentricity, extrathyroid invasion. The clinical data such as age and sex were also included for analyses. RESULTS: Forty-seven of the total 101 cases (46.5%) showed positive RET protein staining. The mean age among patients with RET negative neoplasms was 43.9 years compared with 39.8 years in RET positive group (p = 0.16). The average size of the tumors without RET expression was 2.5 cm, slightly larger than the RET positive tumors (2.1 cm)(p = 0.26). Extrathyroid invasion of the RET-positive tumors was found to be 33.2 percent while the RET negative neoplasms had 38.8 percent of this feature (p = 1). According to AMES score, the RET positive cases had only 11 percent of high-risk tumors, whereas the RET negative group comprised 23.1 percent of high-risk malignancies (p = 0.20). There was no significant difference in RET expression among cell variants (p = 1). CONCLUSION: The study of 101 papillary thyroid carcinomas at the King Chulalongkorn Memorial Hospital disclosed high frequency of RET expression (46.5%) and this is the only data among Thai patients that has ever been documented in the literature. Although, the gene expression in the tumor tends to be associated with good prognostic features but it was not distinct enough to be statistically significant.

Association between different variants of papillary thyroid carcinoma and risk-group according to AMES (age, metastasis, extent and size) classification system.

OBJECTIVE: To study the association between cell variants of papillary carcinoma and AMES (Age, Metastasis, Extent and Size) risk classification. MATERIAL AND METHOD: One hundred and twenty-one cases of papillary thyroid carcinomas were subclassified for cell type and risk-groups according to AMES classification system. Correlations between both variables are evaluated RESULTS: Among different cell variants of papillary carcinoma, solid cell pattern has the highest proportion of high-risk tumor classified by the AMES criteria, comprising 75% followed by tall cell subtype with 33.3% of high risk patients. Conventional papillary carcinoma has only 8.3% of high-risk group. Follicular and encapsulated variants as well as microcarcinoma (< 1 cm) are all categorized as low-risk neoplasms. CONCLUSION: The present study indicates that there is association between cell variants and AMES prognostic index. The authors, therefore, emphasize the importance of cell variants in predicting the prognosis of papillary carcinoma.

The association of co-expression of CD44v4/MMP-9 with different nodal status in high-grade breast carcinoma patients.

BACKGROUND: Breast carcinoma is one of the most common tumors in female patients, and its metastasis is a major cause of death. An experimental model has recently found the association of CD44 with MMP-9 that facilitates tumor cell invasion and metastasis. MATERIAL AND METHOD: The CD44v4 and MMP-9 were performed on tissue in paraffin blocks of 50 cases of high-grade breast carcinoma with node positive and 50 cases with node negative. RESULTS: Increased expression of MMP-9(60%) significantly observed in high-grade breast carcinoma patients with node positive (p = 0. 004), whereas CD44v4 displays no significant difference between the two groups (p-value = 0.81). Significant co-expression of CD44v4+ / MMP-9+ (46%) was observed and correlated with node-positive patients whereas the CD44v4+ / MMP-9- (54%) express in node-negative patient (p-value = 0.01). CONCLUSION: The solely expression of CD44v4 does not associate with node status. MMP-9 plays an important role to enhance breast carcinoma cell invasion and associates with lymph node metastasis. The combined expression of CD44v4 (overexpression) and derangement of MMP-9 expression was significantly associated with nodal status.

Extranodal malignant lymphoma of the upper aerodigestive tract: prevalence of Epstien-Barr virus (EBV) infection in King Chulalongkorn Memorial Hospital.

BACKGROUND: High frequency of Epstein-Barr virus (EBV) in the normal mucosa of the upper aerodigestive tract suggests that it may serve as a reservoir for the virus. Malignant lymphomas arising in this site may be associated with EBV. OBJECTIVES: To determine the prevalence of EBV infection in extranodal malignant lymphomas of the upper aerodigestive tract. SETTING: King Chulalongkorn Memorial Hospital, Thailand. DESIGN: Descriptive study. PATIENTS: 42 Thai patients who presented between 1998 and 2003. MATERIAL AND METHOD: The expression of EBV mRNAs (EBERs) of malignant lymphoma was studied by means of in situ hybridization in formalin-fixed, paraffin-embedded specimens. RESULTS: The recruited subjects were 26 males and 16 females, and their age ranged from 3 to 85 years with the mean of 51.43 years, in 4 of them human immune deficiency virus (HIV) infection was documented. Ten of 42 cases (23.81%) expressed EBER transcripts and were extranodal NK/T-cell lymphomas, nasal type (7 cases), plasmablastic lymphomas (2 cases) and diffuse large B-cell lymphoma (1 case). Three of 4 cases (75%) of known HIV-seropositive cases were EBV-positive (2 plasmablastic lymphomas and 1 diffuse large B-cell lymphoma). CONCLUSION: In the upper aerodigestive tract, EBV was present in some but not all malignant lymphoma. It was associated with extranodal NK/T-cell lymphoma, nasal type and B-cell lymphoma arising in HIV-infected patients, but it was not found in B-cell lymphoma arising in immunocompetent patients.

Congenital nasopharyngeal immature teratoma: a first case report in Thailand.

The authors report the very rare case of a congenital immature teratoma arising from the nasopharyx in a full term female neonate. The tumor also extended to the oral cavity, particularly the right tonsillar fossa without intracranial involvement leading to upper airway obstruction and secondary Escherichia coli pneumonia. The immature part of the tumor in the head and neck region is not a poor prognostic indicator and chemotherapy is useless. In the presented case, the mass was widely excised without postoperative complications. To the best of our knowledge, this is the first reported case in Thailand.

Extranodal malignant lymphoma of the upperaerodigestive tract in King Chulalongkorn Memorial Hospital according to WHO classification.

BACKGROUND: The Working Formulation commonly used to classify NHL in Thailand has been recognized as imperfect for primary extranodal lymphoma, especially in head and neck regions. OBJECTIVE: To study the clinicopathological and immunohistochemical features of extranodal malignant lymphoma of the upper aerodigestive tract according to WHO classification. SETTING: King Chulalongkorn Memorial Hospital. DESIGN: Descriptive study. PATIENTS: 77 Thai patients who presented between 1998 and 2003. METHODS: Routine histology was performed and stained with H&E and immunohistochemistry, and clinical characteristics were recorded. RESULTS: The patients included 42 males and 35 females, with an average age of 53.87 years. Tumor sites were as follows: Waldeyer ring (n = 42, 54.55%), sinonasal areas (n = 19, 24.67%), oral cavity (n = 9, 11.69%), hypopharynx (n = 4, 5.19%), and larynx (n = 3, 3.90%). Immunohistochemically, 57 tumors (74.02%) were of B-cell phenotype and 19 tumors (24.68%) were of T-cell phenotype. According to the WHO classification, 45 cases (58.43%) were large B-cell, 3 (3.90%) were Burkitt, 3 (3.90%) were marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT), 4 (5.19%) were follicular lymphoma, 1 (1.30%) was precursor B-lymphoblastic lymphoma, and 1 (1.30%) were mantle cell lymphoma. Among the T-cell lymphomas, 9 (11.69%) were of peripheral T-cell lymphoma, unspecified, 9 (11.69%) were extranodal NK/T cell lymphoma, nasal type, and 1 (1.30%) were anaplastic large-cell lymphomas. In nasal cavity, 8 tumors (42.11%) were extranodal NK/T-cell lymphoma, nasal type, 5 (26.32%) were diffuse large B-cell lymphoma, 4 (21.05%) were peripheral T-cell lymphoma, unclassified, and 1 (5.26%) was Burkitt lymphoma. CONCLUSION: Our data correspond with series from Japan, Hong Kong, and Korea, but there is a significant difference from Western population in T-cell lymphomas of sinonasal area especially extranodal NK/T cell lymphoma of nasal type and peripheral T-cell lymphoma, unspecified which had a higher frequency in Thailand, Japan, Hong Kong, and Korea.

Recurrent epistaxis from an intranasal glomus tumor: the 22nd case report.

The case of a 66-year-old Thai woman who was treated at King Chulalongkorn Memorial Hospital due to recurrent epistaxis for two years is presented. Her physical examination revealed a 0.7-cm tumor mass on the right nasal septum. A biopsy was subsequently done and the tissue was sent for pathological examination. The lesion was then diagnosed as "glomus tumor of the nasal septum". Histologically, the tumor was rather well-circumscribed and located in the submucosal region. The neoplastic cells were uniform, round to ovoid in shape and contained bland-looking, finely chromatic nuclei and moderate amount of cytoplasm with ill-defined cell borders. These cells were intervened by tortuous vascular structures. Immunohistochemically, the tumor cells were strongly reactive to smooth muscle actin and negative to cytokeratin and S-100 protein. A glomus tumor is rare in the sinonasal region. So far, there have been only 21 reported cases in the literature. Almost all cases of sinonasal glomus tumor are benign and are usually cured by complete excision.

Eosinophilic mucin rhinosinusitis: terminology and clinicopathological presentation.

Many terms related to allergic fungal rhinosinusitis (AFRS) such as eosinophilic mucin rhinosinusitis (EMRS), eosinophilic fungal rhinosinusitis (EFRS), and AFRS-like syndrome have been proposed. The authors define EMRS as patients with rhinosinusitis who demonstrate eosinophilic mucin on histopathological examination. EMRS patients who demonstrate fungal hyphae within the mucin are diagnosed as having EFRS and those who cannot demonstrate fungal hyphae within the mucin are diagnosed as having EFRS-like syndrome. EFRS patients who demonstrate an allergic response to the fungi are diagnosed as having AFRS and those who cannot demonstrate any allergic responses to the fungi are diagnosed as having non-allergic fungal rhinosinusitis (NAFRS). In the United States, the prevalence of AFRS in chronic rhinosinusitis patients who require surgery is 5-10 per cent. However, the prevalence of AFRS in Thailand is not known because AFRS has never been reported and studied in Thailand. This study shows the clinical and pathological entities of patients with EMRS in King Chulalongkorn Memorial Hospital from July 2001 to July 2002. From a total of two hundred and fourteen rhinosinusitis patients who required surgery, six were diagnosed as having EMRS. Two of six EMRS patients were diagnosed as having EFRS (both of them were also diagnosed as having AFRS) and four patients were diagnosed as having EFRS-like syndrome. In this study, the prevalence of AFRS is much less than in the United States because of the limited understanding of this disease, the lack of commercially available antigens for dematiaceous fungi, and the lack of awareness and knowledge of pathologists to diagnose eosinophilic mucin and fungi within the mucin. The terms related to AFRS are also discussed in this study.