Epithelioid angiosarcoma at chest wall which needs to be carefully distinguished from malignant mesothelioma: report of a rare case.

Angiosarcoma is a malignant soft tissue tumor the cells of which variably recapitulate the morphologic and functional features of normal endothelium. Most lesions are located in the deep muscles of the lower extremities followed by the arm, trunk and head and neck. Herein we present a case of epithelioid angiosarcoma which is a variant of angiosarcoma at chest wall in a 73-year-old female. Morphologically, the tumor cells are arranged predominantly in luminal structures which can be seen in both angiosarcoma and malignant mesothelioma. Most of the tumor cells are large rounded "epithelioid" cells with abundant eosinophilic cytoplasm which can be also seen in both tumors. The epithelioid of cytomorphology and the localization at chest wall of this case may remind of a diagnosis of malignant mesothelioma which should be carefully distinguished from epithelioid angiosarcoma from imaging and morphology. CT scanning of the patient shows a mass at her chest wall, the majority of which is around the rib but not inside the lung which indicates a tumor originates more likely from soft tissues of chest wall but not pleura. Immunohistochemical staining shows that the tumor cells are positive for cytokeratin, CD31, Vimentin and WT1, and negative for CEA, TTF-1, Calretinin, Mesothelial Cell (MC), CD56, CK19, and Hepatocyte. Thus this case is diagnosed as epithelioid angiosarcoma but not malignant mesothelioma. From this case we suggest that carefully reading and understanding of the imaging are a very important clue for appropriate diagnosis. A misdiagnosis may occur on the basis of misunderstanding of tumor localization and a consequent inappropriate immunohistochemical staining programme.

High expression of a disintegrin and metalloproteinase-9 predicts a shortened survival time in completely resected stage I non-small cell lung cancer.

The aim of this study was to investigate the abnormal expression of a disintegrin and metalloproteinase-9 (ADAM9) in human resected non-small cell lung cancer (NSCLC) tissue, in order to evaluate the significance of ADAM9 expression in surgically resected NSCLC. Sixty-four cases of completely resected stage I NSCLC with mediastinal N2 lymph node dissection were immunohistochemically analyzed for ADAM9 protein expression. Survival, univariate and multivariate analyses were conducted to assess the significance of ADAM9 expression and its correlation with other clinicopathological characteristics. ADAM9 was observed to be significantly more highly expressed in NSCLC tissue compared with normal control lung tissue (P=0.001). The 5-year survival rate for patients with NSCLC tissues highly expressing ADAM9 was significantly lower when compared with NSCLC tissues of patients exhibiting low expression of ADAM9 (56.9 vs. 88.9%, P= 0.012). Multivariate analysis identified that high expression of ADAM9 is an independent factor of shortened survival time in resected stage I NSCLC (HR, 3.385; 95% CI, 1.224-9.360; P=0.019). These results clearly demonstrate that ADAM9 is highly expressed in NSCLC and highly expressed ADAM9 correlates with shortened survival time, suggesting that ADAM9 is a novel biomarker for predicting prognosis in resected stage I NSCLC. ADAM9 may also become a useful predictive biomarker for the selection of adjuvant chemotherapy treatment of NSCLC.

Dysgerminoma in a case of 46, XY pure gonadal dysgenesis (Swyer syndrome): a case report.

Simple 46, XY gonadal dysgenesis syndrome, also called Swyer syndrome, is known as pure gonadal dysgenesis. Individuals with the syndrome are characterized by 46, XY karyotype and phenotypically female with female genital appearance, normal Müllerian structures and absent testicular tissue. The condition usually first becomes apparent in adolescence with delayed puberty and primary amenorrhea due to the gonads have no hormonal or reproductive potential. Herein, we report a case of dysgerminoma diagnosed in a dysgenetic gonad of a 21-year-old patient with Swyer syndrome.

[Aberrant expression of HDGF and its prognostic values in surgically resected non-small cell lung cancer].

BACKGROUND AND OBJECTIVE: Our previous studies revealed that hepatoma-derived growth factor (HDGF) is highly expressed in non-small cell lung cancer (NSCLC) cells, playing important roles in promoting NSCLC cells growth and invasion. The aim of this study is to detect the expression of HDGF in 158 cases of surgically resected NSCLC and evaluate its clinical significance. METHODS: Immunohistochemical SP method was used to detect the expression of HDGF in 158 NSCLC tissues and 12 normal control lung tissues. Survival analysis was further conducted. RESULTS: HDGF was found significantly highly expressed in 158 NSCLC tissues compared with normal control lung tissues (P < 0.001). The 5-year survival rate was 38.2% in HDGF high expression cases, compared with 63.1% in HDGF low expression cases, the difference was statistically significant (P=0.009). Linear correlation analysis discovered a significantly negative correlation between HDGF expression and the survival time (r=-0.183, P=0.022). COX proportion hazard model analysis revealed that pathological stages and HDGF expression were independent prognostic factors for this group of 158 resected NSCLC cases. CONCLUSIONS: HDGF is highly expressed in human NSCLC tissues, predicting worse prognosis in resected NSCLCs. It might be useful molecular biomarker for predicting the prognosis of resected NSCLCs.

[Nasal and pharyngeal non-Hodgkin lymphomas and their relationship with Epstein-Barr virus: a report of 158 cases].

OBJECTIVE: To study the clinical features, immunophenotypes and the significance of Epstein-Barr virus infection in primary nasal and pharyngeal non-Hodgkin's lymphomas in Shenyang. METHODS: One hundred and fifty eight cases of primary nasal and pharyngeal non-Hodgkin's lymphomas were included in this study. The samples were stained with haematoxylin and eosin for histological examination. Immunohistochemistry studies were performed using monoclonal antibodies, including CD3 for T-lymphocytes, CD20 for B-lymphocytes, and CD56 and CD57 for NK cells. All cases were reclassified according to the new WHO classification of lymphomas (2001). In situ hybridization detection of EBV-encoded small nuclear RNA (EBER-1) was performed in 99 cases. RESULTS: Overall, 101 (63.9%) of the 158 NHL were extranodal NK/T cell lymphomas (nasal type), 23 (14.6%) were nonspecific peripheral T cell lymphomas and the remaining 34 cases (21.5%) were B cell lymphomas. The primary sites of involvement were the nasal cavity (53.2%, 84/158), the tonsil (24.7%, 39/158) and the pharynx (22.1%, 35/158). Among 99 cases studied by EBER-1 in situ hybridization, a positive detection was seen in 70/71 cases (98.6%) of extranodal NK/T cell lymphoma (nasal type), 8/12 cases (66.7%) of T cell lymphoma, and 7/16 cases (43.8%) of B cell lymphoma. CONCLUSIONS: Among primary nasal and pharyngeal NK lymphomas, extranodal NK/T cell lymphoma (nasal type) is the most common type and is strongly associated with EBV infection. The pathological diagnosis of nasal and pharyngeal lymphomas should take considerations of the anatomic sites and immunophenotypical features.

[Proliferative activity of intratumoral fibroblasts in lung cancer and its implications].

BACKGROUND: The interaction between tumor cells and stroma cells plays an important role in the invasion and metastasis of tumor. The purpose of this study is to evaluate the proliferative activity of fibroblasts in lung cancer, and to explore its correlation with tumor biologic behavior. METHODS: Ninety-four cases of surgically resected specimens of lung cancer were collected. The proliferative activity of fibroblasts was immunohistochemically evaluated with the mouse monoclonal antibody against proliferating cell nuclear antigen (PCNA). RESULTS: The tumor cells in the outer area had significantly higher PCNA label index (LI) than those in the inner area, however, the PCNA LI of fibroblasts in the inner area was significantly higher than those in the outer area regardless of tumor size. The PCNA LI of fibroblasts in the paracancerous tissues was significantly lower than that of fibroblasts in the inner or outer area of tumor. There was a significant correlation between the PCNA LI of fibroblasts and that of tumor cells in the inner or outer area of tumor. The PCNA LI of fibroblasts in either inner or outer area showed a significant correlation with lymph node metastasis of lung cancer. CONCLUSIONS: The results demonstrate that there is a discrepancy in the distribution of highly proliferative tumor cells and highly proliferative fibroblasts in lung cancer. The proliferative activity of tumor cells should be assessed in tumor cells in the outer area, and proliferative activity of fibroblasts should be assessed in fibroblasts in the inner area.