Primary myofibrosarcoma of the lung. A rare case with challenging diagnosis.

Primary myofibrosarcoma (MFS), or myofibroblastic sarcoma of the lung, is a rare tumor. A 47-year-old man with a history of melanoma presented with a central tumor of the left lung. The initial diagnosis was inflammatory myofibroblastic tumor but after extensive pathologic analysis MFS of the lung was confirmed. He underwent left pneumonectomy and died on the 6th postoperative month. This is the second case of primary pulmonary MFS to be reported.

Prognostic significance of CA 125, CD44, and epithelial membrane antigen in renal cell carcinoma.

OBJECTIVES: To study retrospectively CA 125, CD44, and epithelial membrane antigen (EMA) expression in renal cell carcinoma and their role as prognostic factors. CD44 is a cell adhesion molecule, and CA 125 and EMA are tumor-associated antigens used in the diagnosis and monitoring of the outcome and response to treatment of various human malignancies. Their expression and prognostic significance after resection of renal cell carcinoma have not been adequately studied. METHODS: The expression of CA 125, CD44, and EMA were studied immunohistochemically and correlated with the outcome of 92 patients who underwent nephrectomy for renal cell carcinoma. RESULTS: Positive staining was found for CA 125 in 28 patients (30.43%), CD44 in 48 patients (52.17%), and EMA in 74 patients (80.43%). CA 125 expression was increased in those with higher T stage (P <0.001) and histologic grade (P = 0.007). An inverse relationship was found between EMA expression and grade (P <0.001). The median follow-up was 41.5 months (range 30 to 65). The median survival for positive and negative patients was 34.6 versus 54.3 months for CA 125 (P = 0.0044), 48.3 versus 51.5 months for CD44 (P = 0.4677), and 53.2 versus 34 months for EMA (P = 0.0046). Multivariate analysis showed that CA 125 and EMA expression were independent prognostic factors (P = 0.021 and P = 0.018, respectively). Subgroup analysis showed that CA 125 expression predicted a significantly higher probability of death (28.6% versus 8%, P =0.0413) in patients with T1 or T2 tumors. CONCLUSIONS: CA 125 and EMA appear to be useful prognostic markers in renal cell carcinoma. Additional studies are needed to determine the value of these markers as a means of selection for postoperative management.

Multiple cervical and intrathoracic plexoid neurofibromas. Case report.

A 29-year-old male with known von Recklinghausen's disease is presented. The main symptom of the patient was paroxysmal episodes of pain and numbness in the right upper hand for the last 10 years. Cervical and mediastial magnetic resonance imaging (MRI) revealed 3 large tumors originating from the right vagus nerve and another of the same origin contralaterally. Surgical resection of the masses in the right hemithorax was performed via right posterolateral thoracotomy. The postoperative course was uneventful and symptoms recessed. Plexoid neurofibromas were diagnosed at histological examination. The mass in the left hemithorax is under surveillance according to the patient's preference. The clinical, radiological, surgical, and histopathological features of this rare case are discussed.

Deoxyribonucleic acid measurements in transitional cell carcinomas: comparison of flow and image cytometry techniques.

PURPOSE: We compared the results of deoxyribonucleic acid (DNA) ploidy determinations performed by flow cytometry and image cytometry in transitional cell carcinomas of the bladder. MATERIALS AND METHODS: In 81 cases of transitional cell carcinoma of the bladder DNA indexes were measured by flow cytometry of bladder washings and tumor tissue samples, and by image cytometry of imprints from tumor tissue samples. RESULTS: There was good correlation between bladder washings and tissue samples analyzed by flow cytometry in 68 cases but aneuploidy was missed with bladder washings in 13 (16%). There was also good correlation between flow and image cytometry in 75 cases (92.59%) regarding the detection of aneuploidy. There was agreement between detection of aneuploidy and DNA index in 45 cases (55.5%), while both methods detected an aneuploid population in 30 (37%) but there was disagreement regarding DNA index. Aneuploid populations were missed by flow cytometry in 6 cases (7.4%). Furthermore, in 10 cases peridiploid peaks were found on the image cytometry histograms, which were not visible on flow cytometry. However, it was not possible to assess accurately if these were true peridiploid populations. CONCLUSIONS: There is good overall correlation between DNA content measured by flow and image cytometry but image cytometry has the advantage of visual discrimination, permitting preferential selection and analysis of tumor cells. However, certain problems remain with image cytometry, particularly in the case of peridiploid peaks, which cannot be classified accurately as showing true peridiploid or right shifted diploid populations.

The value of neuroendocrine markers in non-small cell lung cancer: a comparative immunohistopathologic study.

In order to estimate the value of immunohistochemical identification of neuroendocrine (NE) differentiation markers in non-small cell lung carcinomas (NSCLCs), we investigated the expression of five neuroendocrine and neural differentiation-related antigens in 51 NSCLCs. Additionally, 20 epithelial lung tumors with NE differentiation [15 carcinoids and five small cell lung carcinomas (SCLCs)] and 61 epithelial tumors of various other origin (breast, prostate, colon and head-neck carcinomas) were studied. An indirect two-stage immunoperoxidase method was performed in formalin-fixed and paraffin-embedded tissue specimens, by using commercially available monoclonal antibodies. These antibodies are directed against neuron-specific enolase (NSE), chromogranin-A and Leu-7 which are general markers of NE differentiation, bombesin, which is a specific NE secretory product and neurofilament triplet protein (NFTP), an intermediate filament protein of neuronal differentiation. All five markers demonstrated a positive immunoreactivity in NSCLCs, equally distributed to all three histologic subtypes, ranging from 16 to 47% of the cases (NSE 47%, bombesin 21.5%, Leu-7 21.5%, chromogranin-A 18% and NFTP 16%). Most of the carcinoids and SCLCs expressed multiple or all NE markers. The other four epithelial tumors showed a positive immunoreactivity for bombesin, Leu-7 and NFTP, ranging from 11 to 40% of the cases. Chromogranin-A was not expressed in any of these tumors, whereas NSE was demonstrated only in 17% of breast carcinomas. The following remarks can be drawn from this study: (1) some NSCLCs showed immunophenotypic NE differentiation; (2) among all the markers used, NSE was the most sensitive (sensitivity, 100%) and chromogranin-A the most specific (specificity, 100%); and (3) NSE and chromogranin-A appear to be the most valuable and useful indicators of probable neuroendocrine differentiation in lung epithelial tumors.

Inverted papilloma of the renal pelvis.

The authors describe a case of inverted papilloma. It is relatively rare and generally appears as a benign tumour.

Immunohistochemical and immunocytochemical study of bladder carcinomas using the epithelium-specific, tumour-associated monoclonal antibodies HMFG1 and AUA1.

The antigenic expression of normal bladder epithelium and transitional carcinomas has been studied using the epithelium-specific, tumour-associated monoclonal antibodies HMFG1 and AUA1. Tissues from 79 cases of bladder carcinoma and 11 cases of non-neoplastic bladder tissues were stained with both the haematoxylin-eosin (H/E) and the indirect two-stage immunoperoxidase methods using the monoclonal antibodies (MAbs) HMFG1 and AUA1 at a concentration of 25 micrograms ml-1. Positive and negative controls were also used. Moreover, 46 urine smears prepared after cytocentrifugation were stained with both the Papanicolaou and the indirect two-stage immunoperoxidase methods. The results showed that HMFG1 reacted with the majority of cases of grade III carcinomas and carcinomas in situ and with a subset only of low-grade (I and II) carcinomas. The pattern of staining showed the following characteristics: (1) the epithelial surface membrane stained both in normal bladder and bladder carcinomas (surface of the papillae), (2) a variant number of cancer cells, increasing with the degree of malignancy, showed membrane and/or cytoplasmic staining, (3) tumours of the same histological grade showed antigenic heterogeneity. The MAb AUA1 was not widely expressed. The immunocytochemical study confirmed the reaction of HMFG1 with a variant number of malignant urothelial cells exfoliated in urine. Their reaction with AUA1 was much more limited. The immunocytochemical staining seemed to be more sensitive in the detection of malignant cells in some cases which had been characterized as negative or suspicious for malignancy by the Papanicolaou examination. The intravesical treatment with chemotherapeutic agents did not seem to influence the antigenic expression of malignant urothelial cells.