Osteoclast-like Giant Cell-type Pancreatic Anaplastic Carcinoma Presenting with a Duodenal Polypoid Lesion.

Osteoclast-like giant cell-type (OCGC) anaplastic carcinoma is a rare variant of pancreatic ductal adenocarcinoma, and its imaging characteristics and progression pattern have not been fully clarified. The patient was a 73-year-old man who had been incidentally found to have a pancreatic head tumor. Computed tomography demonstrated a 3-cm marginally enhanced mass at the pancreatic head, continuing toward the duodenum. Diffusion-weighted magnetic resonance imaging showed a retained diffusion capacity. Duodenoscopy revealed a 1.5-cm polypoid lesion, covered by a dirty coat, near the major papilla. Surgical material revealed OCGC pancreatic anaplastic carcinoma protruding to the duodenum, accompanied by multiple hemorrhagic foci and hemosiderin precipitations.

An Invasive Lepidic Predominant Adenocarcinoma Extensively Involving the Lung with Areas of Sarcomatoid Carcinoma Containing Osteoclast-like Giant Cells.

Primary lung tumor tissue exhibiting numerous multinucleated osteoclast-like giant cells (OGCs) is an extremely rare histological type. In this study, we describe the case of an 82-year-old woman. Chest CT demonstrated an extensive crazy-paving appearance in both of the lung fields and a solid round mass in the right lower lobe. A pathological examination of the tumor revealed sarcomatoid carcinoma containing OGCs combined with diffused, invasive lepidic predominant adenocarcinoma. We herein present an extremely rare lung cancer, invasive lepidic predominant adenocarcinoma extensively involving the lung with areas of sarcomatoid carcinoma containing OGCs.

Locally advanced undifferentiated carcinoma with osteoclast-like giant cells of the pancreas.

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas (UCOGCP) is an unusual pancreatic neoplasm that represents < 1% of all pancreatic malignancies. Moreover, the giant cells of UCOGCP morphologically resemble the benign giant cells of bone tumors. Due to the rarity of this tumor type, the histogenesis and biologic behavior of UCOGCP remain controversial. Here, we report a case of UCOGCP that exhibited an invasive growth pattern involving infiltration of the adjacent bowel loop and portal vein, as well as superior mesenteric vein thrombosis. The patient underwent a distal pancreatectomy with splenectomy and partial colectomy, followed by four cycles of gemcitabine chemotherapy. No evidence of recurrence was detected after ten years. In addition to this case, clinical information on other UCOGCP cases reported in the English literature is summarized.

Differential diagnosis between secondary and tertiary hyperparathyroidism in a case of a giant-cell and brown tumor containing mass. Findings by (99m)Tc-MDP, (18)F-FDG PET/CT and (99m)Tc-MIBI scans.

Brown tumor is one of the skeletal manifestations of hyperparathyroidism. It is a benign but locally aggressive bone lesion and its differential diagnosis with giant cell containing skeletal tumors or metastases may be complicated. We present a male patient with chronic renal failure who was initially misdiagnosed as having a giant-cell rich neoplasm of bone in his right thumb. Diffusely increased fluorine-18 fluorodeoxyglucose ((18)F-FDG) uptake in the axial and appendicular skeleton and multiple (18)F-FDG avid lytic lesions suggesting multiple metastases were observed on the (18)F-FDG positron emission tomography/computed tomography (PET/CT) scan. On the usual technetium-99m methylene diphosphonate ((99m)Tc-MDP) bone scan we noticed diffusely increased uptake in the skeleton and two focuses with very much increased uptake, which suggested a metabolic bone disease rather than a multiple metastatic giant cell tumor or bone metastases. Additional investigation documentated increased levels of parathyroid hormone. Parathyroid hyperplasia was finally diagnosed with (99m)Tc-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. Fluorine-18-FDG avid lytic lesions were attributed to hyerparathyroidism associated brown tumors instead of multiple metastases. In conclusion, we present a patient with chronic renal insufficiency, who suffered from secondary and later from tertiary HPT with polyostotic brown tumors, which were best shown by the (18)F-FDG PET/CT than by the (99m)Tc-MDP or the (99m)Tc-MIBI scans.

Diagnóstico y tratamiento de los tumores pulmonares neuroendocrinos / Diagnosis and Treatment of Neuroendocrine Lung Tumors

Los tumores neuroendocrinos pulmonares (TNP) abarcan un amplio espectro de tumores que incluyen los carcinoides típicos (CT) y atípicos (CA), el carcinoma neuroendocrino de células grandes (CNCG) y el carcinoma microcítico de pulmón (CMP). Aunque ninguna variedad puede considerarse benigna, los CA y CT tienen un potencial metastásico mucho menor, habitualmente se diagnostican en estadios tempranos y la mayoría son subsidiarios de tratamiento quirúrgico. Se dispone de varias pautas de quimioterapia (QT) en caso de recidiva o en estadios avanzados, aunque la evidencia científica es insuficiente. Los CNCG, encuadrados en la clasificación actual junto a los carcinomas de células grandes, tienen rasgos moleculares, conducta biológica y perfil de sensibilidad a la QT que los asemejan más a los CMP. Con frecuencia su diagnóstico anatomopatológico es difícil, pese al uso de técnicas de inmunohistoquímica, y pueden ser necesarias muestras quirúrgicas. Las pruebas diagnósticas a utilizar son similares a las empleadas en otros tumores de pulmón, con algunas diferencias en cuanto al trazador óptimo que se usa en la tomografía de emisión de positrones. La nueva clasificación TNM es de utilidad en la estadificación de estos tumores. El síndrome carcinoide, muy infrecuente en los TNP, puede dar síntomas de difícil control que requieren medicación especial con análogos de la somatostatina y otros fármacos. En general, y con la excepción del CMP, se necesitan nuevos ensayos que den respuesta a numerosos interrogantes sobre el mejor tratamiento a aplicar en cada estirpe y cada estadio

Pulmonary neuroendocrine tumors (PNT) encompass a broad spectrum of tumors including typical carcinoid (TC) and atypical (AC) tumors, large-cell neuroendocrine carcinoma (LCNEC) and small-cell lung cancer (SCLC). Although no variety can be considered benign, AC and TC have a much lower metastatic potential, are usually diagnosed in early stages, and most are candidates for surgical treatment. Several chemotherapy (CT) regimens are available in the case of recurrence or in advanced stages, although scientific evidence is insufficient. LCNEC, which is currently classified alongside large-cell carcinomas, have molecular features, biological behavior and CT sensitivity profile closely resembling SCLC. Pathological diagnosis is often difficult, despite the availability of immunohistochemical techniques, and surgical specimens may be necessary. The diagnostic tests used are similar to those used in other lung tumors, with some differences in the optimal tracer in positron emission tomography. The new TNM classification is useful for staging these tumors. Carcinoid syndrome, very rare in PNT, may cause symptoms that are difficult to control and requires special therapy with somatostatin analogs and other drugs. Overall, with the exception of SCLC, new trials are needed to provide a response to the many questions arising with regard to the best treatment in each lineage and each stage

Combined large cell neuroendocrine carcinoma with giant cell carcinoma of the lungs: a case report.

Combined large cell neuroendocrine carcinoma of the lungs (combined LCNEC) with giant cell carcinoma is extremely rare. A 65-year-old man was found to have an abnormal shadow in his left lung field. Computed tomography revealed a solid, round mass measuring 2.8 × 2.2 cm that was located in the left S9. The patient underwent left lower lobectomy and mediastinal lymph node dissection. Histopathological examination revealed an LCNEC, combined with giant cell carcinoma. The patient received by S-1 (TS-1, an oral fluoropyrimidine) chemotherapy, and he has been disease-free for over 8 months. Combined LCNEC with giant cell carcinoma is an extremely rare tumor with high malignant potential, and thus, multidisciplinary therapy and close follow-up are advised.

Tumor compuesto de intestino grueso: adenocarcinoma mucinoso y carcinoma neuroendocrino de célula grande. A propósito de un caso / A case report of a composite tumour of the large intestine: Mucinous adenocarcinoma with large cell neuroendocrine carcinoma

IntroducciónLos tumores compuestos primarios del tracto intestinal son infrecuentes y representan entre 2,5–20% de estas neoplasias. Se caracterizan por la presencia de un componente glandular y otro neuroendocrino, entremezclados en proporción similar. La mayoría de los casos descritos incluyen un componente de estirpe glandular de adenoma o adenocarcinoma convencional y un componente de carcinoide o carcinoma neuroendocrino de célula pequeña.Caso clínicoPresentamos un tumor compuesto de intestino grueso con componentes que no han sido descritos hasta ahora: un adenocarcinoma mucinoso con presencia de células en anillo de sello y un carcinoma neuroendocrino de célula grande.ConclusiónEl tratamiento de este tipo de tumores es el mismo que el que se emplea para los adenocarcinomas convencionales pero el componente endocrino les confiere un peor pronóstico(AU)

IntroductionPrimary composite tumours of the intestine are rare and are characterised by the presence of glandular and neuroendocrine components occurring in almost equal proportions. The majority of reported cases include conventional type adenoma or adenocarcinoma and carcinoid or small cell neuroendocrine carcinoma.Case reportA composite tumour of the large intestine with as yet unreported components is described. Mucinous adenocarcinoma with signet-ring cells and large cell neuroendocrine carcinoma were found.ConclusionsAlthough the treatment of these tumours is similar to that of conventional adenocarcinomas, the presence of a neuroendocrine component worsens the prognosis(AU)

Hemotórax espontáneo como forma de presentación de carcinoma de pulmón / Spontaneous haemothoraz as a form of pesentation of lung cancer

El hemotórax espontáneo como forma de presentación de uncarcinoma de pulmón es extremadamente raro, siendo muy pocoslos casos reflejados en la literatura. Hemos tenido la oportunidadde tratar a una paciente de 64 años, no fumadora, cuyo ingresohospitalario fue debido a un hemotórax masivo izquierdo queestaba originado por un carcinoma de células gigantes en lóbuloinferior, como se comprobó en la intervención, y a la que se le pudorealizar una lobectomía inferior izquierda y linfadenectomía (AU)

Haemothorax as a form of presentation of lung cancer isextremely rare, and very few cases have been reported in the literature.We have had the opportunity to treat a 64 year old, nonsmokerpatient, whose hospital admission was due to a massive lefthaemothorax that was originated by a giant cell carcinoma in thelower lobe and confirmed in the intervention. A left lower lobectomyand lymphadenectomy was completed (AU)

Giant cell tumor complicating Paget disease of long bone.

Giant cell tumor (GCT) is a rare complication of Paget disease of bone. It usually occurs in the skull or pelvic bones of patients with long-standing polyostotic disease. This report describes a 62-year-old patient who presented with monostotic Paget disease of the distal femur complicated by GCT. He had a 2-year history of discomfort and pain in his left knee. Conventional plain films and MRI demonstrated the characteristic bone changes of Paget disease and an associated lytic lesion involving the epiphyseal and metaphyseal regions of the distal femur. A diagnostic curettage showed the characteristic histopathologic features of Paget disease and GCT. There was no evidence of malignancy. The clinicopathologic features of this rare lesion are described and correlated with a review of the literature.

Dermatofibroma gigante: descripción de un caso y revisión de la literatura / Giant dermatofibroma: case report and review of the literature

El dermatofibroma es una lesión muy frecuente que suele aparecer como un nódulo en dermis de lento crecimiento que afecta de forma predominante a las mujeres en los miembros inferiores. Se han descrito diferentes variedades clínicas. El dermatofibroma gigante se ha definido como una variante poco común de dermatofibroma de más de 5 cm que presenta las características histológicas típicas y un comportamiento biológico benigno. Presentamos el caso de un varón de 52 años que presentó un dermatofibroma gigante de 6 cm de diámetro en el hombro derecho y hacemos una revisión de los pocos casos de esta variedad descritos en la literatura

Dermatofibroma is a very frequent lesion that usually appears as a slowly growing nodule in the dermis, and preferentially involves the lower extremities of women. Several clinical variants have been described. Giant dermatofibroma has been defined as a rare variant of dermatofibroma measuring more than 5 cm that presents typical histological features and a benign biological behavior. We report the case of a 52-year-old man that presented a giant dermatofibroma with a diameter of 6 cm in the right shoulder and we review the few cases of this variant that have been described in the literature

Microvesicle-associated tissue factor and Trousseau's syndrome.

BACKGROUND: Trousseau's syndrome is a prothrombotic state associated with malignancy that is poorly understood pathophysiologically. METHODS AND RESULTS: Here we report studies on the blood of a 55-year-old man with giant-cell lung carcinoma who developed a severe form of Trousseau's syndrome. His clinical course was dominated by an extremely hypercoagulable state. Despite receiving potent antithrombotic therapy, he suffered eleven major arterial and venous thrombotic events over a 5 month period. We examined the patient's blood for tissue factor (TF), the major initiator of coagulation, and found its concentration in his plasma to be forty-one-fold higher than the mean concentration derived from testing of 16 normal individuals. CONCLUSION: Almost all of the TF in the patient's plasma was associated with cell-derived microvesicles, likely shed by the cancer cells.

[Pituitary apoplexy in giant cell adenoma].

Hemorrhage in giant cell adenomas of the pituitary gland was detected in 20.8%. It occurred mostly in supracellular mixed multi-nodular tumors. The course of the disease was symptom-free, acute, subacute or mild. There was a relationship between pituitary apoplexy course, on the one hand, and age and tumor growth, on the other. Since postoperative complication and lethality rates were relatively higher in younger patients, it is suggested that differentiated approach be taken to the diagnosis and management of the disease.

[Bladder carcinoma with osteoclast-type giant cells. A case with a rare presentation. Review of the literature]. / Carcinoma con células gigantes tipo osteoclasto de vejiga. Un caso de rara presentación. Revisión de la literatura.

We report a case of neoplasm of the urinary bladder with pseudosarcomatous stromal differentiation. Heterologous carcinosarcomas are extremely rare malignant neoplasms (seventy-eight cases have been previously described). This is a case of carcinoma containing numerous osteoclast type giant cells that stained for vinmentin and acid phosphatase and were negative for cytokeratin and lysozyme.

Pleomorphic carcinoma: report of a case with massive pleural effusion and asbestos particles.

Pleomorphic (spindle/giant cell) carcinoma (PC) is one subset of large cell carcinoma. It is well known that PC patients have a poor survival rate. This report describes a 68-year-old man with PC. The patient's tumor had a massive pleural effusion. A left lower lobectomy and partial resection of the left diaphragm, peritoneum, and parietal pleura were performed to remove the tumor. Numerous asbestos particles were found in the left lower lobe. This is the first reported case of PC which may have been caused by asbestos particles. Further investigation is needed into whether asbestos exposure causes PC.

Postbronchoscopy expectoration of tumour tissue in lung cancer.

A case of undifferentiated giant cell type bronchogenic carcinoma in an old man is reported. Following bronchoscopy, the patient expectorated tumour mass tissue in his sputum and was relieved of breathlessness to a great extent.