Anaplastic (undifferentiated) carcinoma of pancreas, an uncommon variant: Diagnosed on endoscopic-guided fine needle aspiration

Anaplastic carcinoma of pancreas (ACP) are rare pancreatic neoplasms. They are well known to be associated with more aggressive tumor behavior and less favorable prognosis than usual pancreatic ductal adenocarcinoma. Endoscopic-guided fine needle aspiration (EUS-FNA) is now a widely accepted modality in diagnosis of pancreatic lesions. However, only a few reports are available describing cytological features of anaplastic carcinoma. Here, we report two cases of ACP diagnosed on EUS-FNA.

Spectrum of thyroid neoplasms: A one year study at tertiary referral center

Background: Thyroid cancer accounts for approximately 1% of total cancer cases Thyroid neoplasms are most common malignant lesions in endocrine system Their incidence is rapidly increasing in recent times, partially attributed to increased awareness and earlier detection of asymptomatic tumors They present clinically as nodular or diffuse mass lesions of thyroid similar to non- neoplastic lesions A wide spectrum of neoplasms is encountered and histopathology evaluation is crucial to establish diagnosis This study is done to present spectrum of thyroid neoplasms with varied histomorphology at a tertiary care center Aim: To study the spectrum of thyroid neoplasms at MNJ Institute of Oncology for over a period of one year with special mention of interesting cases and overview of diagnostic pitfalls encountered Materials and methods: All thyroidectomy specimens submitted to Department of Pathology for a period of one year, from October 2017 to September 2018 were included in study Routine processing and staining along with ancillary techniques where ever necessary were used to arrive at diagnosis Results: A total of 104 thyroidectomy specimens were included in the present study Thyroid cancer was common in females The most commonly encountered malignancy was Papillary carcinoma, seen in 30-40 years age group Anaplastic carcinoma was seen in 60-70 years age group Conclusion: Papillary carcinoma was most commonly encountered thyroid malignancy followed by medullary and anaplastic carcinoma Follicular adenoma was the most common benign neoplasm We have encountered almost the entire spectrum of thyroid neoplasms including the rare variants

Tiroiditis de Riedel, una entidad fácilmente confundible con carcinoma anaplásico tiroideo / Riedel's thyroiditis, an entity easily confused with anaplastic thyroid carcinoma

INTRODUCTION: Riedel´s thyroiditis is a thyroid inflammation with invasive fibrosis. CASE REPORT: Female 84 years old, studied by dysphagia to liquids and dysphonia, with cervical mass poorly demarcated and immobile. Computed Tomography (CT) (CT) showed tumor that diverted the trachea and esophagus compressed. Fine Needle Aspiration (FNA) obtained cells with atypia. Thyroidectomy was performed, appreciating a stony tumor which included the right recurrent laryngeal nerve. Given the high suspicion of thyroid malignancy tracheostomy it was performed. The pathology report as fibrosing Riedel thyroiditis. DISCUSSION: This is the less common type of chronic thyroiditis. Etiology is unknown. The normal thyroid parenchyma is replaced by fibrous connective tissue. Clinically usually a hard mass, fast growing, why is confused with thyroid carcinoma and Hashimoto's thyroiditis. It´ss more common in women and is usually bilateral. The CT or MRI (Magnetic Resonance Imaging) help assess the extent. Puncturing the mass could give us the diagnosis but is often difficult. Treatment to relieve symptoms or rule out malignancy is surgery. The prognosis is usually good. CONCLUSIONS: Riedel´s thyroiditis is an entity with histopathologic diagnosis essential

Diagnosis and treatment of anaplastic carcinoma of the pancreas / 中华消化外科杂志

Objective To investigate the diagnosis and treatment of anaplastic carcinoma of the pancreas.Methods The clinical data of 10 patients with anaplastic carcinoma of the pancreas who were admitted to the Zhongshan Hospital from January 1999 to June 2010 were retrospectively analyzed.Computed tomography was carried out preoperatively and surgical plan was designed according to the site of tumors.Chemoradiotherapy was applied postoperatively.Patients were followed up till March 2012 by phone call and out-patient examination.The clinical and imaging features,pathological characteristics,treatment and follow-up data were analyzed.The clinical and pathological features were analyzed by descriptive statistics.The continuous data were described as (x) ± s,and categorical data were presented by frequency and precentage.Results The tumors located at the head of the pancreas were observed in 5 patients,tumor located at the neck of the pancreas in 1 patient,and tumors located at the body and tail of the pancreas in 4 patients.Two patients underwent pancreaticoduodenectomy (PD),2 underwent PD + extended lymph node dissection,1 underwent PD + portal vein reconstruction,1 underwent pancreatectomy,4 underwent resection of body and tail of pancreas and splenectomy.The size of the tumors ranged from 2.0 cm × 2.0 cm × 2.0 cm to 14.0 cm × 12.0 cm × 9.0 cm.Duodenal and biliary invasion was observed in 4 patients,superior mesenteric vein-portal vein invasion in 1 patient,splenic artery invasion in 1 patient.Neural invasion was observed in 8 patients,including 4 patients with lymph node metastasis.The results of immunohistochemical staining showed that 10 patients were with positive expression of cytokeratin 7,and 1 patient was with positive expression of vimentin.Nine patients were followed up,2 patients did not receive postoperative chemoradiotherapy,6 received chemotherapy with Gemicitabine and 1 received interventional treatment.The survival time of the 9 patients ranged from 8 to 20 months,and the median survival time was 12 months.Eight patients died of tumor recurrence and metastasis.Conclusions Pancreatic anaplastic carcinoma is a distinct rare variant of pancreatic ductal adenocarcinoma.Pancreatic anaplastic carcinoma has high malignancy,definite diagnosis depends on pathological examination,and the surgical plan should be made according to the result of imaging examination.Conventional radiotherapy and chemotherapy are ineffective for the treatment of this disease.

Transformación anaplásica tardía de bocio multinodular / Late anaplastic transformation Of multinodular goitre

Introducción: el Cáncer tiroideo se caracteriza por su baja incidencia, comportamiento maligno infrecuente y baja mortalidad. La mayoría de ellos procede de bocios multinodulares de larga duración por lo que es muy importante tener en cuenta factores que constituyen riesgos potenciales como: tiempo de establecimiento de la enfermedad, tamaño, así como las características particulares personales y la evolución de la entidad en cada caso. Si tenemos en cuenta el gran avance tecnológico que constituye la Biopsia Aspirativa con Aguja Fina (BAAF), que nos permite no solamente evitar su transformación neoplásica maligna, sino que también podemos prolongar la vida con la calidad que humanamente se requiere que es en definitiva la meta principal de la Salud Pública Cubana. Objetivo: destacar la importancia del adecuado seguimiento evolutivo del Bocio multinodular como elemento significativo en la prevención de su transformación maligna. Presentación del caso: Paciente femenina de 80 años de edad con aumento de volumen de la región anterior del cuello y antecedentes patológicos personales de Bocio Multinodular (BMN) con tratamiento inconstante e irregular de años de evolución, quien no solamente pudo haber mejorado la calidad de su vida sino que no la hubiera truncado, considerando las condiciones atenuantes en la forma de presentación que tuvo su caso. Al examen físico: Aumento de la región anterior del cuello, palpándose masa de superficie irregular, consistencia firme, dolorosa, de aproximadamente 6x5 cm que había aumentado considerablemente en los últimos meses sin fecha precisada. La paciente fue ingresada por el gran agobio respiratorio y la toma del estado general, pudiéndose realizar únicamente la Biopsia Aspirativa con Aguja Fina (BAAF). Desde su ingreso presenta evolución tórpida con incremento del compromiso respiratorio requiriendo la práctica de la traqueotomía que sólo ayuda como medida de soporte al estadio terminal de esta enfermedad neoplásica maligna. (Carcinoma Anaplásico del Tiroides). A pesar de ello la paciente fallece y los familiares autorizan la necropsia. Conclusiones: los BMN deben tener seguimiento evolutivo que permita precisar una tiroidectomía a tiempo como prevención en enfermedades benignas del Tiroides, por los cambios malignos que pueden producirse cuando la glándula es irradiada. La tiroidectomía a tiempo permite evitar no solamente la transformación maligna que puede producirse, sino también previene las metástasis que ocurren en los Carcinoma Anaplásicos.

Introduction: the thyroid carcinoma is characterized by low incidence, low malignant behaviour as well as low mortality. The most of they are developed from multinodular goitres of long duration so is important to be into account the risk factors such as: time of the establishment of the disease, size and the particular and personal characterists and the evolution of the each case. If we take into account the great technological advance of the BAAF from its performance in the past century to be united to the National Health System of our country ,we have to say that the multinodular goitres in any group of age are easily manageable and accessible which may us to avoid the malignant transformation besides we can do that the life continues with the quality humanely requested . Finally, this is the first goal of the Cuban Public Health. Objective: to highlight the importance of an appropriate follow-up of multinodular goitre as a significant element in the prevention of its multinodular malignant transformation. Case presentation: an 80 year- old, female patient presents an increase of the volumen of the anterior section of the neck, with pathologic antecedents of a multinodular goitre which the evolution has been characterized by an irregular and non systematic treatment along of years .She could have better quality of life as well as to avoid to death taking into account the wild conditions of that disease was presented herself. Physical examination: It has been observed an increase of the anterior area of the neck. On palpation ,it was felt a mass of irregular surface , painful and of a hard consistency with 6x5cms. approximately that had increased notably in the course of the last months . On the admission, the patient presented a serious respiratory process and poor general status so we only achieved a Fine Needle Aspirative Biopsy (FAAB).She continuos with reapiratory compromised so a surgical racheotomy was ejecuted that only help her as a way of supporting in the patient terminal stage in this malignant disease (Anaplastic Carcinoma of Thyroid). Despite the recommended procedure the patient died. The family accepted the autopsy. Conclusions: the multinodular goitres have to exam periodically in order to just may to do the tiroidectomy as the preventive measure in benign diseases of thyroid and avoid the malignant changes that could occurred when the gland is irradiated.The tiroidectomy ejecuted at just time avoid the malignant transformation as well as the metastasis in Anaplastic Carcinoma Thyroid.

A Case of Anaplastic Carcinoma of the Pancreas Mimicking a Gastrointestinal Stromal Tumor / 대한내과학회지

Anaplastic carcinoma of the pancreas is an extremely rare but aggressive, rapidly progressive tumor. It often presents with invasion of adjacent organs and distant metastases. Most cases are inoperable and confirmed by autopsy. A correct diagnosis of stomach invasion by anaplastic carcinoma of the pancreas is important due to the risk of bleeding, perforation by rapid tumor growth, and a poor prognosis. However, an accurate diagnosis is difficult as a result of the various clinical presentations, symptoms, and radiological findings. We herein report a case of anaplastic carcinoma of the pancreas in a 78-year-old woman who presented with stomach invasion mimicking a gastrointestinal stromal tumor.

Anaplastic transformation of metastatic papillary thyroid carcinoma at shoulder mimicking soft tissue sarcoma.

A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibility of anaplastic transformation should be kept in the differential diagnosis of rapidly enlarging painful mass in a known case of metastatic thyroid carcinoma to prevent misdiagnosis.

RE: Role of Duplex Doppler US for Thyroid Nodules: Looking for the "Sword" Sign

Duplex Doppler US may be useful for the detection of thyroid malignancies that show either anarchic winding or penetrating "sword like" neoangiogenic vessels. It may be helpful in selecting nodules that should undergo fine needle aspiration biopsy.

Anaplastic Thyroid Carcinoma Initially Presented with Abdominal Cutaneous Mass and Hyperthyroidism

A 63-year-old female was admitted to our hospital with a tender abdominal wall mass about 15 cm in diameter, which she had for 1 month. About 1 week earlier, the patient had also perceived a mass in the neck area. Computed tomography revealed huge thyroid and periumbilical masses. The thyroid hormone levels were consistent with a hyperthyroid state. Pathological examination of the thyroid mass was compatible with anaplastic thyroid carcinoma (ATC) and the abdominal cutaneous mass was shown to be metastatic ATC. Despite palliative radiotherapy and chemotherapy, the patient died of respiratory failure on her 63rd day of hospitalization. This case demonstrates that abdominal cutaneous metastasis and hyperthyroidism can occur as initial manifestations of ATC. To our knowledge, this is the first reported case.

Anaplastic Carcinoma of the Pancreas

Local invasion or distant metastasis is frequently seen in patients with anaplastic carcinoma at the time of presentation, and this is unlike the usual cases of pancreatic carcinoma. So most cases of anaplastic carcinoma are confirmed by autopsy. We report here on our experiences of two cases of the anaplastic pancreatic carcinoma that were confirmed by the postoperative pathology. From January 2006 to December 2006, two patients at Chung-Nam National University Hospital were postoperatively diagnosed as having anaplastic carcinoma of the pancreas. The clinicopathologic data of these patients was reviewed. Case 1) A seventy-years-old male was admitted to our hospital due to his left abdominal pain. On physical examination, there was ill-defined palpable mass on the left upper abdomen. The CA 19-9 level was 4.8 (U/ml). On the abdominal CT scans, a 14.8 cm sized cystic mass with a mild enhancing internal solid portion was detected. He underwent distal pancreatectomy, total gastrectomy and segmental resection of the transverse colon due to direct invasion. The mass was pathologically confirmed as anaplastic pancreatic carcinoma. Postoperatively 3 months later, multiple liver and lymph node metastases were detected on the follow-up CT scan. Case 2) A sixty-five years-old female was referred to our department for a splenic hilar mass that involved the distal pancreas. The CA19-9 level was 3.18 (U/ml). On the preoperative CT scan, an 8.0 cm sized irregular mass with heterogenous contrast enhancement was detected on the tail of the pancreas. She underwent distal pancreatectomy with splenectomy and segmental resection of the transverse colon due to direct invasion. On the pathology report, the pancreatic mass was revealed to be anaplastic carcinoma of the pancreas. One month later, a recurred pancreatic mass and multiple liver and peritoneal metastases were detected on the follow-up CT scan. Anaplastic pancreatic carcinomas show distinctive aggressive behavior and a dismal prognosis.

A Case of Anaplastic Carcinoma Arising from Mature Cystic Teratoma of Ovary / 대한산부인과학회잡지

Benign cystic teratoma is the common ovarian tumor, and the incidence reported about 20%. Malignant transformation of mature cystic teratoma of the ovary is rare, which can develop with an incidence of less than 2%. The most common malignant tumor arising in mature cystic teratoma is squamous cell carcinoma which account for 75-85%, but vary rare cases of anaplastic carcinoma arising from mature cystic teratoma has been reported all over the world and prognosis of this malignant tumor was poor. No case of anaplastic carcinoma has been reported before in Korea. We experienced a case of anaplastic carcinoma arising from mature cystic teratoma of the ovary and report our case with a brief review of literature.

Fine Needle Aspiration Cytology of Anaplastic Carcinoma of the Thyroid with Osteoclast-like Giant Cells : A Case Report / 대한세포병리학회지

Multinucleated giant cells of osteoclast-like appearance can be seen in a type of anaplastic carcinoma of thyroid and only a few case reports for fine needle aspiration cytologic findings are found in the literatures. Recently, we experienced a case of anaplastic carcinoma of thyroid with many osteoclast-like giant cells in a 72-year-old woman. The cytologic features and immunohistochemical results are described with special emphasis on differential diagnosis.

The Study for Prognostic Factors in Anaplastic Carcinoma of the Thyroid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anaplastic carcinoma of thyroid gland is a lethal entity: few patients live more than 12 months following the diagnosis. We retrospectively reviewed the experience with this entity at our institute with respect to prognostic factors influencing survival. MATERIALS AND METHODS: Thirteen cases of anaplastic carcinoma of thyroid gland diagonsed from 1995 to 2000 were analyzed retrospectively. The median age at presentation was 66.2 years; the male/female ratio was 1.17:1: and the most common symptom was a rapidly enlarging neck mass. RESULTS: All but one patient died within one year of diagnosis. Tumor size of less than 7 cm and complete resection of tumor were significant prognostic factors. Patients who had operation with or without radiotherapy and/or chemotherapy survived significantly longer than other patients. Median survival duration was 74 days. CONCLUSION: This study showed that complete resection and multimodal treatment for tumor of size less than 7 cm resulted in prolonged survival for a subgroup of patients with anaplastic thyroid carcinoma.

A pancreas anaplastic carcinoma after operation of the distal common bile duct cancer / 한국간담췌외과학회지

Anaplastic carcinomas of the pancreas, also known as pleomorphic, sarcomatoid, or undifferentiated carcinomas, are in most cases variants of duct-derived carcinomas. However, their appearance is so distinctive and their behavior so aggressive that a distinction from the ordinary ductal adenocarcinoma is warranted. They comprise about 7% of all non-endocrine pancreatic malignancies. Most tumors are large and apparently more likely to involve the body or tail of the pancreas rather than the head. Most patients are above the age of 50 at the time of diagnosis, and there is a distinct male predilection. Here we report on a 50-year woman who diagnosed pathologically as a anaplastic carcinoma of the pancreas. The patient underwent Whipple's operation because of a distal common bile duct cancer 6 years ago. Distal pancreatectomy and splenectomy were performed. The patient was discharged with a good general condition.

Ovarian Mucinous Cystadenocarcinoma with Mural Nodules of Anaplastic Carcinoma: A case report

A case of an ovarian mucinous cystadenocarcinoma with mural nodules of anaplastic carcinoma is reported. The patient was a 46-year-old female with a right ovarian cystic mass and underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient died of the disease in five months. Macroscopically, the right ovarian cyst wall contained numerous well-demarcated mural nodules. Histologically, the cysts were mucinous cystadenocarcinoma, and the nodules were composed of sarcoma-like spindle and polygonal cells with atypia and numerous mitoses. Spindle cells in the mural nodule showed epithelial characteristics by electron microscopy and immunohistochemistry. This case supports an epithelial origin of the mural nodule of anaplastic carcinoma in ovarian mucinous tumors.

A Case of Ovarian Mucinous Cystadenocarcinoma with Mural Nodule of Anaplastic Carcinoma / 대한부인종양콜포스코피학회잡지

Mural nodules in ovarian mucinous tumors, whether benign, borderline, or malignant, have been described by several authors since Prat and Scully first described sarcoma or sarcoma-like mural nodules occurring in association with mucinous epithelial neoplasia in 1979. Three distinct types of the mural nodule have been identified; i. e., 1) sarcoma-like lesion, 2) true mesenchymal sarcome, and 3) anaplastic carcinoma simulating a sarcoma. Mural nodules of sarcomatous and carcinomatous foci associated with mucinous ovarian tumors should be separated from sarcoma-like nodules because of the poor prognosis of the former compared to the favorable prognosis of the latter. We experienced a case of ovarian mucinous cystadenocarcinoma with sarcoma-appearing mural nodule of anaplastic carcinoma occurred in a 59-year-old woman and reported with brief review of the literatures.

Cytology of Anaplastic Thyroid Carcinoma with Varied Histologic Patterns Arising in Preexisting Goiter: Report of A Cese / 대한세포병리학회지

Anaplastic carcinoma of the thyroid(ACT0 is a rare subtype of thyroid neoplasm. This tumor represents approximately 5-10% of all thyroid malignancies and has poor prognosis. ACT often arises in a long-standing thyroid nodule and has been documented to be associated with a variety of more with a variety of more well-differentiated thyroid carcinomas. We experienced a case of anaplastic thyroid carcinoma who had had about a year history of thyroid goiter. The patients had been injected with sclerosing agents in treatment of preexisting goiter. The ACT in this case had varied cytologic and histologic appearances pleomorphic, giant cells, spindle and squamoid. Immunohistochemically, strong cytoplasmic positivity for cytokeratin was seen in all kinds of tumor cells. Ultrastructurally. the evidences of epithelial differentiation were seen such as intercellular junctions and tonofibrils.

DNA Ploidy in Anaplastic Carcinoma of the Thyroid Gland by Image Analysis / 대한세포병리학회지

Anaplastic carcinoma of the thyroid gland is one of the most malignant tumors. Recently, DNA ploidy measured by flow cytometry and image analysis has been suggested as an additional useful indicator of tumor behavior. Studies on the occurrence and clinical significance of DNA aneuploidy in anaplastic carcinoma of the thyroid are rare. In this study, the pattern of DNA ploidy was measured by image analysis on Papanicolaou stained slides in four cases of anaplastic carcinoma and also measured by flow cytometry using paraffin blocks in two cases. In all cases of anaplastic carcinoma. DNA aneuploidy was found by image analaysis. By flow cytometry, one case had a diploid peak and the other case had an arieuploid peak. According to the above results, we conclude that anaplastic carcinoma of the thyroid glands have a high incidence of DNA aneuploidy and image analysis using Papanicolaou stained slides is a useful method in detecting DNA aneuploidy.

Fine Needle Aspiration Cytology of Anaplastic Carcinoma with Osteoclastlike Giant Cells of the Thyroid / 대한세포병리학회지

Anaplastic carcinoma of the thyroid is one of the most malignant tumors and survival for longer than three years after diagnosis is exceptional. Multinucleated giant cells of osteoclastlike appearances are seen in some of the anaplastic carcinoma, but only three cases in which the diagnosis was made by fine needle aspiration(FNA) cytology are reported in the international literature. We experienced a case of anaplastic carcinoma with osteoclastlike giant cells in a 66-yr-old female, diagnosed by FNA cytology. The smears revealed two cell populations; multinucleated giant cells and large polygonal or spindle shaped malignant cells. The FNA cytodiagnosis of anaplastic thyroid carcinoma containing osteoclastilke giant cells was substantiated by subsequent biopsy.