Solitary Fibrous Tumor of the Pancreas: A Case Report and Review of the Literature.

Pancreas is an extremely rare abdominal localization of the solitary fibrous tumor (SFT). It usually grows asymptomatically for a long time before a diagnosis can be made on the basis of symptoms and/or mechanical complications. Due to the rarity and nonspecific clinical presentation, this entity is diagnostically challenging. We present a 47-year-old man with a history of progressive epigastric pain for the last two weeks, and jaundice, who was admitted to hospital for further investigation. Cystadenocarcinoma was suspected based on the radiologic findings, and a pancreatoduodenectomy was performed. The removed portion of the pancreas contained a 3.5 × 2 × 1.8 cm well-circumscribed, but not encapsulated white tumor mass with smooth cut surface, cystic component and duct dilatation within the tumor and within the adjacent pancreatic tissue. Based on the histology and immunostaining profile, a diagnosis of the solitary fibrous tumor was made. One week post-operatively, the patient died due to surgical complications. Microscopic and immunohistochemical examinations are necessary for accurate diagnosis of cystic SFT of the pancreas. Because there is limited data regarding the biological behavior of SFT with extra-pleural localization the authors recommend clinical follow-up for SFT treatment if the criteria of malignancy are not met.

FROM ANEURYSMAL BONE CYST TO TELANGIECTATIC OSTEOSARCOMA WITH METASTASIS IN INGUINAL LYMPH NODES - CASE REPORT.

INTRODUCTION: Aneurysmal bone cyst is a benign bone lesion composed of blood filled cystic cavities lined by fibrous septa. Its malignant transformation of is a rare event. CASE REPORT: We report a case of a lesion in the second metatarsal bone in a 29-year-old male, presented as a slight swelling of the right foot. After the curettage had been done, the diagnosis of aneurysmal bone cyst was made but the recurrence occurred 4 years later. The biopsy of the recurrent tumor showed compact neoplastic tissue consistent with diagnosis of giant cell tumor with malignancy. The malignant component was recognized as a high grade sarcoma with osteoid production. A tumor mass with the whole II metatarsal bone was extirpated and a resected part of fibula was transplanted. A year later, another recurrence occurred, an amputation was performed and a teleangiectatic osteosarcoma with ingvinal lymph nodes metastases was diagnosed. No other tumor mass was confirmed, either clinically or by imaging techniques at the time of his third operation. He died 4 months later with multiple pulmonary metastases. CONCLUSION: We emphasize the importance of team work in order to achieve the accurate diagnosis, highlighting careful radiological examinations, good sampling and awareness of unusual cases in bone tumor pathology.

LEIOMYOSARCOMA OF THE COLON.

INTRODUCTION: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the digestive tract. Leiomyosarcomas of the gastrointestinal tract are rare mesenchymal neoplasms which grossly and histologically resemble gastrointestinal stromal tumors. They may be differentiated from gastrointestinal stromal tumors by using immunohistochemistry and they are typically positive for a smooth muscle actin and desmin and negative for c-kit, CD34 and DOG1.1. They often express calponin and h-caldesmon. CASE REPORT: We present a case of a 59-year-old male with anemia, weight loss, intermittent abdominal pain and right abdominal mass. Colonoscopy revealed an exophytic ulcerated neoplastic mass in the ascending colon and abdominal computed tomography scan showed an ill-defined heterogeneous tumor mass which surrounded almost the whole ascending colon. The patient underwent right hemicolectomy and partial resection of ileum. Histopathological examination revealed a leiomyosarcoma composed of atypical spindle cells positive for a smooth muscle actin, desmin and vimentin, and negative for c-kit, CD34, S100 and neuron specific enolase. The patient is alive 8 months after the operation, undergoing chemotherapy. CONCLUSION: We have concluded that the multimodal approach comprising chemotherapy and complete surgical resection controls the leiomyosarcomas.

Superficial leiomyomas of the gastrointestinal tract with interstitial cells of Cajal.

OBJECTIVE: Some authors suggest common origin of gastrointestinal stromal tumors from stem cells, which may show diverse differentiation. There are reports in which cells morphologically identical to the interstitial cells of Cajal are found in deep leiomyomas. The aim of this study was to demonstrate CD117 positive cells in superficial gastrointestinal (GI) leiomyomas and to find other cells that would suggest diverse differentiation in histologically typical leiomyoma. MATERIALS AND METHODS: We analyzed 8 cases of superficial leiomyomas and one deep leiomyoma, received in our institutions as endoscopically or surgically obtained material. The tumor sections were immunohistochemicaly stained with CD117, CD34, NF, S100, αSMA, desmin, caldesmon and mast cell antigen. RESULTS: All leiomyomas showed diffuse positivity for αSMA, caldesmon and desmin. All of them had CD117 and CD34 positive cells morphologically identical to the interstitial cells of Cajal between smooth muscle fibers, 5 had S-100 and NF positive cells and 2 showed positivity for GFAP. The cells were found in different quantity; they were usually diffusely scattered through the tumors without predilection site, forming small groups in some areas. CONCLUSION: CD177, CD34, S-100 and NF positive cells are present in superficial leiomyomas and they may suggest common origin of GI stromal tumors.

Non-Tumor Cystic Lesions of the Adrenal Gland.

UNLABELLED: Adrenal cystic lesions are uncommon but due to the improved radiologic imaging techniques their appearance seems to increase. MATERIAL AND METHODS: We analyzed the clinical and radiological findings of 10 patients with adrenal cysts and the pathological features of the operative material. Standard dissection procedure and paraffin embedded tissue sections were made, stained by HE and immunohistochemically with CD34, CD 31, Factor 8, Podoplanin, CKWS and AE1/AE3 RESULTS: The mean age of the patients was 40.6 years; female to male ratio was 2.3:1. All the cysts were diagnosed as cystic lesions radiologically except one. The most present clinical symptom was abdominal pain. The diameter of the cysts measured from 2 to 7 cm. Four of the cysts were diagnosed as pseudocysts and six as endothelial. Six cysts were lined by CD34(+) and CD31(+) cells, four were lined by Factor 8(+) and podoplanin(+) cells and four had no lining. CONCLUSION: Endothelial cysts were more common cysts in our study and the immunohistochemical results suggested common vascular origin to all endothelial cysts and supported additional separation of angiomatous and lymphangiomathous adrenal vascular cysts.

Tissue expansion in limbs vs other body regions.

INTRODUCTION: The development of tissue expansion technique as an important routine procedure in plastic and reconstructive surgery in the past two decades reflects the tendency of getting quality skin that would replace the defect. The aim of this study was to present our experience in the application of tissue expanders in the limbs, and to compare the complications of this procedure in limb and non-limb sites. MATERIAL AND METHODS: This retrospective study included 16 expanders in 14 patients. Indications for tissue expansion were post burn scarring and contractures, post mastectomy reconstruction and before excision of giant nevus. The expanders were placed in the following sites: scalp, breast, abdomen, leg and arm. RESULTS: Despite the fact that there were complications in 3 out of the 16 expanders used, failure occurred in 1 expander, which was removed. The remaining complications were managed either by immediate delivery whenever expansion approached full size or by salvage of the expander by exteriorizing the buried part in cases of infection.

Prognostic factors of primary cutaneus melanoma.

INTRODUCTION: The purpose of this study was to identify tumor characteristics of primary malignant melanoma predictive of sentinel lymph node positive status, and then to determine whether sentinel lymph node status has an impact on recurrence and survival. MATERIAL AND METHODS: A total of 100 patients with primary malignant skin melanoma were analyzed. The prospective melanoma database identified patients with histologically confirmed cutaneus melanoma, clinically negative and clinically positive regional lymph nodes with no evidence of distant disease, who had undergone surgery between April 2001 and May 2012. Univariate and multivariate analyses were performed to assess factors that predict sentinel lymph node positive status, recurrence and survival. RESULTS: We identified Breslow's thickness and lymphocytic response as independent predictors of sentinel lymph node status in cutaneous melanoma patients. Sentinel lymph node status was a significant predictor of disease free survival. CONCLUSION: Despite the limitation, this study confirms Breslow's thickness and tumor lymphocytic infiltration as two factors predictive of sentinel lymph node metastasis in cutaneous melanoma patients. We also found sentinel lymph node status to be the most significant independent predictor of disease free survival and identified sentinel lymph node status as an important variable to consider when estimating the risk of regional recurrence.

Dermatoglyphics in patients with schizophrenia--findings in the Macedonian population.

UNLABELLED: The human palms and soles are textured with skin different to that of the other body surface. Instead of sebaceous glands or hairs, there are sweat glands opening into epidermal ridges. They are variously oriented, thus forming different patterns. The aim of the study was to assess some dermatoglyphic patterns, the TRC and the a-b ridge count in a sample of patients and a control group of healthy examinees. MATERIAL AND METHOD: 59 male and 50 female patients with schizophrenia and 60 healthy male and 50 female individuals as a control group were included in the study. Hand prints were taken using the method of Cummins and Midlo; pattern types were determined and classified using the Henry classification. An analysis of pattern frequency in schizophrenia compared to the normal controls was conducted. RESULTS: The patterns most frequently present are loops (ulnar) with greater incidence and whorls with smaller incidence in patients with schizophrenia compared to the healthy individuals. The number of arches is higher in male patients and lower in female patients. Complex patterns are rare. TRC in females has lower values found in patients. The a-b ridge count has significant difference in male and female patients; higher values in male and lower in female patients. CONCLUSION: There is some association between the frequency of certain dermatoglyphic characteristicss and schizophrenia. Our findings form a useful database for the dermatoglyphic marks present in patients with schizophrenia and healthy subjects of Macedonian nationality.

Morphometric analysis of the cervical spinal canal on MRI.

Two useful numerical values, called the Torg ratio and the spinal canal diameter (SC diameter) are widely accepted as reliable morphometric determinants of spinal stenosis. The aims of the study were to examine morphometric determinants of the cervical spinal canal on MRI in both sexes and analyse them as reliable indicators of spinal stenosis. Measurements were made on 50 MR images (sagittal T2 weighted images from C3 to C7) of the cervical spine of patients from the Emergency Centre who had undertaken MRI of the cervical spine in addition to CT for various diagnostic indications. Torg ratio, used in evaluation of the spinal canal stenosis on plain x-ray radiographs, cannot be used as a spinal canal stenosis indicator due to the gender differences in the vertebral bodies' width. Sagittal canal diameters were more spread out in males than in females. MRI enables the value of the space available for the spinal cord, (SAC) to be determined, by subtracting the sagittal diameter of the spinal cord from the sagittal diameter of the spinal canal. Not gender, but individual and level differences in the SAC values were evident (cervical cord enlargement). SAC values relied more on the spinal canal than on the spinal cord, so that the differences in the dimensions of the spinal cord accounted for less variability in the SAC values. MR imaging of the cervical spine provides more accurate cervical canal and spinal cord measurements that could serve as morphometric determinants of the cervical canal stenosis.