Krukenberg's tumour unilateral giant metachronous of colonic origin - Case report.

INTRODUCTION: Krukenberg tumour (KT) is defined by the World Health Organization as a metastatic ovary carcinoma, usually of gastric origin. The term has also been applied to metastatic tumors originating from adenocarcinomas of other sites, such as the colon. After radical resection of colorectal carcinoma, metachronous ovarian metastases can occur in 1.1% of cases. Due to their rarity and rapid progression, KTs needs a high level of suspicion. Here we present an atypical case of KT and highlight the importance of the timely recognition of this disease. CASE PRESENTATION: A 57-year-old patient presented a 30-cm metastatic ovarian tumor on the major axis, whose primary tumor was a resected sigmoid adenocarcinoma 6 years ago. She was submitted to complete resection of the tumor, whose anatomopathological and immunohistochemical analysis proved the colonic metastatic origin. DISCUSSION: Besides being unusual, this disease is most commonly bilateral, premenopausal, and synchronous with the primary tumor. Unlike the common behavior, the case described is unilateral, postmenopausal, and metachronous, with a 6-year interval between the primary colonic tumor and the dissemination of ovarian metastasis. CONCLUSION: KT is an uncommon and poor prognosis disease, whose chance of better therapeutic results depends on accurate diagnosis and proper management.

H4K12 and H3K18 Acetylation Associates With Poor Prognosis in Pancreatic Cancer.

BACKGROUND/OBJECTIVES: Epigenetic deregulation may be involved in tumor cell biology, including differentiation, tumor progression, and cell death, and histone acetylation is a major regulatory mechanism of gene transcription. Patterns of global histone modifications have been recently suggested as outcome predictors in cancer patients, but few studies have been conducted on pancreatic ductal adenocarcinomas (PDACs). This study was designed to investigate the predictive value of histone acetylation modifications on PDAC. MATERIALS AND METHODS: A retrospective clinicopathologic analysis was undertaken in 119 patients diagnosed with PDAC between 2005 and 2011, and immunohistochemistry performed with polyclonal antibodies against H4K12ac, H3K9ac, and H3K18ac. Positive nuclear staining for each histone was measured as the intensity and expression, being classified into low-staining or high-staining groups. Results were analyzed in relation to patients' clinicopathologic parameters. RESULTS: There was a positive relationship between tumor differentiation and H4K12ac high scores (P<0.05) and staining with the 3 markers correlated positively with tumor stage (P<0.01). Univariate analysis showed worse survival in patients with high detection levels of H4K12ac (P=0.038) and H3K18Ac (P=0.033). A backwards Cox proportional hazards model analysis revealed the independent prognostic effect of high H4K12ac and H3K18ac levels (hazard ratios of 1.6 and 1.7, respectively, P<0.05), especially for patients at early stages of disease. CONCLUSIONS: We propose that acetylation of H4K12 and H3K18 may be considered valuable prognostic factors for pancreatic cancer, although the mechanism involved needs further investigation. Increasing insights into histone acetylation modifications can ultimately generate new ideas for rational and molecularly based diagnostic and therapeutic approaches.

Atypical fibroxanthoma†.

Atypical fibroxanthoma (AFX) is a rare skin neoplasm of low-grade malignancy and fibroblastic origin. AFX is a curable cutaneous disease and the diagnosis depends on knowledge of its clinical and histological features and combined immunohistochemistry markers. This study presents a case of a male patient, aged 90 years, presented with painless skin lesion in his ear. The lesion had been growing progressively for 2 months, measured ∼1.5 cm, ulcerated, fixed and firm. After a biopsy, the patient underwent a complete resection with adequate surgical margins and showed favorable evolution without complications or recurrence. The histopathological evaluation showed a poorly circumscribed ulcerated dermal nodule, mesenchymal proliferation, with pleomorphic spindle cells. There was infiltration of the deep dermis and subcutis, showing malignant features, but there was no invasion of cartilage. The immunohistochemical analysis confirmed the diagnosis of AFX.