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.

High mast cell density associated with granulomatous formation in tuberculous lymphadenitis.

Mast cells are one of the main inflammatory cells involved in the pathogenesis of tuberculosis. Previous reports revealed that mast cells participated in both acute and chronic states of infection with Mycobacterium tuberculosis through direct contact or indirect enhancement by releasing mediators. The authors evaluated mast cell density on tissue sections of tuberculous lymphadenitis stained with 0.1% toluidine blue from 45 cases, all of which were retrieved from the surgical pathology files of King Chulalongkorn Memorial Hospital from 1999 to 2006. A number of mast cells were correlated semiquantitatively with granulomas which were formed by aggregation of epithelioid histiocytes, multinucleated giant cells, and caseous necrosis. We found that mast cell density was significantly increased in lymph nodes with greater granuloma involvement (p = 0.030) and multinucleated giant cell formation (p = 0.010). These findings indicate a significant correlation between mast cell density and the granulomatous formation responsible for M. tuberculosis.

Overexpression of p53 and neoplastic cell proliferation in undifferentiated nasopharyngeal carcinoma.

Abstract. The author investigated the p53 status in correlation with cellular proliferation in the undifferentiated subgroup, which is infrequently found in caucasians. The author evaluated formalin-fixed, paraffin embedded tissue blocks from sixty cases with undifferentiated carcinoma of the nasopharynx by p53 and Ki67 immunostaining. All samples were retrieved from the surgical pathology file at King Chulalongkorn Memorial Hospital from 2001-2005. The patients had a mean age of 47 years. Stage IV was the most common stage, found in 21 cases (35%). Forty-four tumors (73%) overexpressed p53 protein, which was significantly associated with high rate of tumor cell proliferation (r = 0.477, p < 0.001). The higher the amount of p53 stained, the higher the rate of tumor cell proliferation. However, there was no statistically significant association between p53 protein overexpression and clinical status, including tumor volume, nodal status, and metastatic condition. This observation may explain why some tumors are resistant to radiation and are poorly controlled when they recur in distant organs.

The association of stromal mast cell response and tumor cell differentiation in colorectal cancer.

BACKGROUND: Resembling other neoplasms, the colorectal carcinogenesis is still a riddle in various aspects. Mast cells, a type of inflammatory cells, may play a role in colonic cancer pathogenesis. It has recently been found to have an essential function in tumor development and its immunologic response. OBJECTIVE: To evaluate the relation between mast cell number and biology of colorectal adenocarcinoma. MATERIAL AND METHOD: The author collected 162 cases, diagnosed as primary adenocarcinoma of the colon at the King Chulalongkorn Memorial Hospital, between 2002 and 2003, for evaluating the role of mast cells in colorectal cancers. The hematoxylin and eosin stained sections were reviewed and classified into the tumor differentiation or grading, depth of tumor invasion, and status of regional lymph node metastasis, according to the World Heath Organization's (WHO) criteria. Mast cell number within and around the tumor was counted on the 0.1% toluidine blue stained sections. F-test was used to correlate between the mast cell quantity and aforementioned tumor parameters. RESULTS: The tumor differentiation consisted of grade 1 (34%), grade 2 (52%) and grade 3 (14%), with a mean of mast cell number of23, 32 and 40 cells/mm2, respectively. In addition, mast cell quantity in poorly differentiated tumors was significantly higher than those in well differentiated form (p = 0. 03). Therefore, mast cell number was not correlated with tumor depth (p = 0.28) and nodal status (p = 0. 75). CONCLUSION: This observation might indicate that mast cell function has a role in colorectal pathogenesis.

Histological variants of colorectal adenocarcinoma and clinicomorphological association.

OBJECTIVE: Besides TNM staging system, some special histological features of colonic carcinomas are associated with variable clinicopathological parameters. The objective was to provide new information of correlation between various histomorphological parameters together with available clinical data and each special feature MATERIAL AND METHOD: A retrospective study of 162 materials collected from subjects with first diagnosed as adenocarcinoma of colorectum in King Chulalongkorn Memorial Hospital over a period of 2 years from 2002 to 2003. RESULT: One hundred and forty-seven cases of prominent cribiform feature are related to patient age (p = 0.025) and infiltrative margin (p = 0.006). Thirty-two cases with mucinous component are associated with patient age (p = 0.009) and tumor depth (p = 0.015). Thirteen cases with signet ring cell morphology are correlated with nodal and distant organ metastasis (p = 0.023 and p = 0.020, respectively) as well as angiolymphatic invasion (p = 0.015). In addition the size of signet ring cell containing carcinomas is also related to location (p = 0.036). It is larger in proximal site and smaller in distal counterpart. The authors did not find any statistical significance in 9 cases of medullary carcinoma. Notably, our 33 cases showed biphasic or triphasic feature. CONCLUSION: Each distinct histological variant of colorectal adenocarcinoma is associated with some different clinicopathological variables,' mostly effecting clinical outcome. Pathologists should be concerned with special histological subtypes of colorectal adeonocarcinomas and communicate with physicians for proper management.

A retrospective study of colonic polyps in King Chulalongkorn Memorial Hospital.

To evaluate and classify polyps from colon in Thai patients, the authors retrospectively analyzed the 776 polyps from 696 subjects in King Chulalongkorn Memorial Hospital during the past five-year period from 1999 to 2003. All colonic polyps were included in the study. There were 461 (59%) male and 315 (410%) female with the mean age of 51 years. Non-neoplastic and neoplastic polyps were documented 50% each. Hyperplastic polyp was the most frequent diagnosis (39%), followed by tubular adenoma (36%). According to neoplastic polyp, 8%, 3%, and 14% cases were identified as high-grade dysplastic change, intramucosal carcinoma, and invasive carcinoma, respectively.

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.

Neurological deficit from metastatic low grade liposarcoma.

Myxoid liposarcoma is a malignant soft tissue tumor with a relatively indolent natural history. It commonly occurs in the extremities with extrapulmonary metastatic potential. Round cell liposarcoma, recently, is widely agreed to be the aggressive counterpart of the myxoid liposarcoma, mostly arising in adverse, local recurrence, and metastatic lesions. Metastatic liposarcoma with pure myxoid element is unusual. The authors report an extremely rare case of a 47-year-old Thai male patient having a metastatic pure myxoid liposarcoma to the thoracic vertebrae, one year after primary tumor documented on the left thigh. Histology of the primary and metastatic sites shows only myxoid pattern. Round cell feature was not documented. To the best of the authors' knowledge, this is the second case report of metastatic myxoid liposarcoma without round cell morphology.

Retrospective study of pathologically proven colitis in King Chulalongkorn Memorial Hospital.

To assess the basic clinicopathological information of colonic inflammation in Thai patients, the authors retrospectively analyzed the 249 biopsied cases with pathological diagnosis as colitis in King Chulalongkorn Memorial Hospital during the five-year period from 1998 to 2002. All subjects were included in this study, whether newly diagnosed or follow-up cases. There were 122 (49%) males and 127 (51%) females with the mean age of 51 years. Non-specific colitis was the most frequent histological diagnosis (72%), followed by infectious colitis (12%), in particular mycobacterial infection. The biopsy specimens were commonly obtained from the rectosigmoid colon (38%). Mucous bloody diarrhea (28%), watery diarrhea (26%), and lower gastrointestinal bleeding (19%) were the three most common symptoms at presentation in order of frequency.