Prognostic significance of the presence of epithelial cell clusters in the ascites of patients with pseudomyxoma peritonei.

BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare condition characterized by intraperitoneal accumulation of mucus due to mucinous neoplasia. The characteristic cytological feature of PMP in the ascites is abundant mucus with or without epithelial cell clusters. However, the prognostic significance of the presence of epithelial cell clusters has not been determined. This study aimed to determine the prognostic significance of epithelial cell clusters in the ascites of patients with PMP. METHODS: Patients who were clinically and histopathologically diagnosed with PMP and who underwent intraoperative cytological examination of their ascites were included in this study. Cytological characteristics including mucus and epithelial cell clusters, nuclear atypia, and the presence of signet ring cells were investigated. Overall survival was compared based on the presence of epithelial cell clusters or nuclear atypia. RESULTS: A total of 283 patients (199 women and 84 men) were investigated. The most common original site was the appendix (244 patients). Ninety patients (31.8%) had mucus without epithelial cell clusters (acellular mucin) while 193 (68.2%) had mucus with such clusters; 134 (69.4%) and 44 (22.8%) of these patients showed low-grade and high-grade nuclear features, respectively. Signet ring cells were detected in 15 patients (7.8%). The presence of epithelial cell clusters did not influence overall survival (P = .28); however, high-grade nuclear features and signet ring cell presence were significant negative prognostic factors (P < .001). CONCLUSION: The presence of high-grade nuclear features or of signet ring cells should be carefully investigated in the cytological specimens of patients with PMP.

Adenocarcinoma in situ admixed with small cell neuroendocrine carcinoma of the cervix: A case report with cytological features.

Primary cervical small cell neuroendocrine carcinoma (SCNEC) is a rare and aggressive tumor. Herein, we describe the first cytological case of adenocarcinoma in situ (AIS) admixed with SCNEC. A 65-year-old postmenopausal Japanese female presented with abnormal genital bleeding. The Papanicolaou smear of the cervix demonstrated the presence of 2 distinct neoplastic components in an inflammatory background. One component consisted of aggregates of small round cells with a high nuclear/cytoplasmic ratio and round to oval nuclei with powdery chromatin, and inconspicuous nucleoli. Nuclear molding was characteristic. The other component consisted of irregular overlapping clusters of tall columnar cells with large round to oval nuclei containing coarse chromatin, and relatively rich cytoplasm. Accordingly, AIS admixed with SCNEC was suspected. Although the cytological features of cervical SCNEC are characteristic, the cytodiagnosis of this type of tumor may be difficult because of the rarity of the tumor. The presence of non-neuroendocrine tumor components in cervical SCNEC is not unusual, therefore careful observation is needed not to miss SCNEC components in the diagnosis of squamous cell carcinoma and/or adenocarcinoma in cervical cytological specimens.

Thyrolipomatosis: A case report with review of the literature.

Fatty tissue is not usually present within the thyroid gland. Only a few fat-containing thyroid lesions have been reported to date, and thyrolipoma is the most common fat-containing lesion of the thyroid gland. Thyrolipomatosis is a condition characterized by diffuse mature adipose cell infiltration of the normal thyroid gland. In this report, we describe what is, to the best of our knowledge, the 12th documented case of thyrolipomatosis, and review the fat-containing lesions of the thyroid gland. A 68-year-old Japanese woman presented with a neck mass that had first been noticed ~7 years earlier. A computed tomography scan revealed diffuse thyroid gland enlargement and total thyroidectomy was performed. The histopathological examination revealed that mature fatty tissue was diffusely distributed throughout the thyroid gland, as well as among the hyperplastic follicles. Capsular formation or amyloid deposition were not observed. Nuclear grooves or intranuclear cytoplasmic inclusions were not observed. Accordingly, thyrolipomatosis was diagnosed. Albeit rare, various neoplastic and non-neoplastic thyroid lesions may contain mature fatty tissue. Therefore, thyrolipomatosis must be included in the differential diagnostic consideration of fat-containing lesions of the thyroid gland.

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei Arising from Urachus.

BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare locoregional disease characterized by disseminated intraperitoneal mucinous tumors. However, little is known about PMP from urachal neoplasm as a result of its rarity. METHODS: A total of 9 patients with PMP of urachal origin were treated by cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in our institution. All specimens of surgeries were submitted for pathologic examination. Representative slides of tumors and normal urachus were submitted for immunohistochemical staining. RESULTS: Four patients were men; the median age was 48 years (range 27-65 years). Initial radiologic examination of all patients showed a cystic tumor located between posterior aspect of umbilicus and the dome of urinary bladder, with or without leaking mucin. Complete CRS and HIPEC were performed in all patients. Until the latest follow-up, local recurrence occurred in 1 patient. Other 8 patients had a median disease-free survival of 27.5 months. Primary urachal tumors of 9 cases were all mucinous adenocarcinoma. Six patients had low-grade mucinous carcinoma peritonei, and 3 patients had high-grade mucinous carcinoma peritonei. Signet ring cells were noted in 4 patients. All tumor specimens of 9 patients were diffuse positive for CK-20, CDX-2, MUC-2, and MUC-5AC, and were variant positive for CK-7. CONCLUSIONS: PMP arising from urachus comes from neoplastic cells with development of intestinal-type mucinous neoplasm. It shares a similar pathophysiology as PMP from appendix. CRS including total urethrectomy, partial cystectomy, and peritonectomy plus HIPEC can be considered as a new option of treatment for PMP originating from urachus.

Pure gastric yolk sac tumor that was diagnosed after curative resection: case report and review of literature.

We recently experienced an 87-yr-old man with gastric yolk sac tumor. Preoperative diagnosis was poorly differentiated adenocarcinoma in the cardia of stomach without apparent metastasis. A total gastrectomy was performed. The precise histological examination after surgery revealed the tumor was composed of pure gastric yolk sac tumor without adenocarcinomatous components. The surgical margin and the resected lymph nodes were histologically negative for the tumor and a curative resection was performed. Five months after the operation, enlargement of the intraabdominal lymph nodes occurred with elevation of serum alpha fetoprotein (AFP), and the patient died 2 mo later. Gastric yolk sac tumors are very rare, and only six cases of gastric yolk sac tumors have been previously reported in the literature. Five out of six cases are accompanied by components of adenocarcinoma, and our present case is the second report of pure gastric yolk sac tumor to the best of our knowledge.