ABSTRACT
BACKGROUND: Primary solid tumor metastasis to the spleen is a rare event, and often presents as an incidental finding without clinical symptoms of the patient. The most common primary tumors that metastasize to the spleen are colorectal, ovarian, and lung carcinomas. Parotid tumor metastasis to the spleen is extremely rare. We report an unusual case of metastatic parotid adenocarcinoma NOS (not otherwise specified) to the spleen. CASE REPORT: The patient presented with primary parotid carcinoma and underwent left parotidectomy. On pathological examination of the primary parotid tumor, no vascular or perineural invasion was found; all surgical resection margins and neck lymph nodes were also uninvolved by the tumor. No other therapy was given after the surgery. Four years later, the patient developed a solitary splenic lesion detected by a routine follow-up computed tomography (CT) scan. The subsequent fine needle aspiration (FNA) and splenectomy showed a metastatic adenocarcinoma consistent with the parotid primary. Immunohistochemical (IHC) staining of the metastatic tumor also showed a similar pattern as that of the primary tumor, including positivity for pancytokeratin, S-100 and SOX10, supporting the diagnosis. Furthermore, A PIK3CA (phosphatidylinositol 3-kinase catalytic subunit) mutation was also detected in the splenic metastasis. CONCLUSION: Based on our review of the literature, we believe that this is the first report of such a case. Accurate diagnosis and molecular characterization of the splenic metastasis have a critical impact on the clinical management of the patient.
Subject(s)
Adenocarcinoma/secondary , Class I Phosphatidylinositol 3-Kinases/genetics , Parotid Neoplasms/pathology , Splenic Neoplasms/secondary , Adenocarcinoma/genetics , Humans , Male , Middle Aged , Mutation , Parotid Neoplasms/genetics , Splenic Neoplasms/geneticsABSTRACT
Melanoma is the second most common non-hematopoietic malignancy after carcinomas to metastasize to the breast and often appears as a well-circumscribed, dense nodule on imaging. Although metastatic lesions presenting as bilateral cysts have been reported, this presentation is not common and may mimic benign breast cysts. We present a challenging case of metastatic melanoma presenting as bilateral breast cysts with spindled cytomorphology in a patient with a history of mammary carcinoma. Discordance between the spindled cytomorphology and the morphology of the core biopsy, which was similar to the patient's primary breast cancer, allowed for entertainment of other tumors and disease processes. Confirmatory immunostaining of the cytology material with HMB-45 was important to establish the diagnosis of metastatic melanoma. Diagn. Cytopathol. 2017;45:446-451. © 2017 Wiley Periodicals, Inc.
Subject(s)
Biomarkers, Tumor/genetics , Breast Cyst/diagnosis , Breast Neoplasms/diagnosis , Melanoma/diagnosis , Skin Neoplasms/diagnosis , Biopsy, Large-Core Needle , Breast Cyst/genetics , Breast Cyst/pathology , Breast Neoplasms/genetics , Breast Neoplasms/secondary , Diagnosis, Differential , Female , Humans , Immunohistochemistry , MART-1 Antigen/genetics , Melanoma/genetics , Melanoma/secondary , Melanoma-Specific Antigens/genetics , Middle Aged , S100 Proteins/genetics , Skin Neoplasms/genetics , Skin Neoplasms/pathology , gp100 Melanoma AntigenABSTRACT
OBJECTIVES: To examine interactions among clinical factors and pathologic biomarkers in predicting the outcome of patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab-based immunochemotherapy. METHODS: In 85 patients treated at a single institution, clinicopathologic variables were analyzed, including the International Prognostic Index (IPI); germinal/nongerminal center phenotype; MYC, p53, BCL2, Ki-67, and Epstein-Barr virus (EBV) expression; and MYC translocation status. RESULTS: In univariate analysis, overall survival (OS) was worse for patients with high IPI scores, nongerminal center phenotype, high MYC and p53 expression by immunohistochemistry, and EBV positivity. In multivariable analysis, p53 expression was the strongest prognostic factor (P < .05) independent of IPI and cell of origin. A significant positive association between p53 and MYC expression was found. Moreover, coexpression of p53/MYC had an enhanced negative effect on OS independent of BCL2 expression. CONCLUSIONS: Immunohistochemical assessment of p53, particularly in combination with MYC, could be useful in identifying a high-risk subgroup of DLBCL.
