D-dimer levels in the differential diagnosis between lipoma and well-differentiated liposarcoma.

BACKGROUND: Lipoma and well-differentiated liposarcoma (WDLS) are two representative lipogenic soft tissue tumors that have similar clinical, radiological, and pathological characteristics. Accordingly, it is difficult to distinguish these tumors preoperatively. Plasma D-dimer levels are associated with the status of tumor progression, and we hypothesized that D-dimer levels could contribute to differential diagnosis. The D-dimer levels of these two entities have not yet been reported. PATIENTS AND METHODS: We investigated 43 cases of lipoma and 14 cases of WDLS. We evaluated the utility of D-dimer levels and other clinicopathological factors for preoperative differential diagnosis between the two entities. RESULTS: Receiver operating characteristic analysis revealed that the D-dimer level may contribute to differential diagnosis (area under the curve=0.73). Univariate and multivariate models demonstrated that plasma D-dimer levels (p=0.001 (univariate), and p=0.006 (multivariate)) and lower extremity location (p=0.006 (univariate), and p=0.03 (multivariate)) were independent risk factors for WDLS. CONCLUSION: The D-dimer level may be a helpful marker for preoperative differential diagnosis between lipoma and WDLS.

Importance of intraoperative parathyroid hormone measurement in the diagnosis of parathyroid lipoadenoma.

BACKGROUND: Parathyroid lipoadenoma is an uncommon tumor that may be difficult to diagnose on intraoperative frozen section. Intraoperative parathyroid hormone (PTH) measurement is useful in assessing the adequacy of parathyroidectomy. This case demonstrates the value of intraoperative PTH measurement in recognizing a parathyroid lipoadenoma. METHODS AND RESULTS: A case of a 62-year-old woman with primary hyperparathyroidism in which intraoperative PTH measurement helped confirm the diagnosis of parathyroid lipoadenoma is presented. CONCLUSIONS: In patients with primary hyperparathyroidism, a significant decrease in intraoperative PTH confirms that an enlarged parathyroid with normal to low cellularity containing abundant fat is a lipoadenoma and that further exploration is not necessary.

The diagnostic importance of prolactin subgroups in patients with stalk mass.

In some situations, the identification of subgroups of patients with elevated serum prolactin (PRL) levels on the basis of different forms of PRL present in the blood, may be complementary to generally accepted and performed biochemical and radiological examinations in addition to a thorough clinical evaluation. Further analysis of elevated PRL subgroups is advisable especially for cases lacking the signs of amenorrhea and galactorea harboring a space occupying lesion in the sellar region. We present the case report of a patient with a high ratio of macroprolactin with regard to total serum PRL harboring a radiologically confirmed stalk mass lesion. An appropriate treatment plan for this patient is discussed.

A case of myxoid adrenocortical carcinoma with extensive lipomatous metaplasia.

We report a combination of unusual myxoid change and extensive lipomatous metaplasia of an adrenocortical carcinoma. The patient was a 38-year-old man with hypertension and heart failure. Radiographic examination revealed the presence of a left adrenal tumor, and adrenalectomy was performed. The tumor weighed 380 g and appeared encapsulated. The cut surface was predominantly gelatinous. Histologically, the tumor was composed of atypical round cells with eosinophilic to vacuolated cytoplasm. The tumor was diagnosed as adrenocortical carcinoma. The stroma accumulated copious mucinous material. In addition, individual to nodular mature adipocytes were admixed throughout the tumor. The transition from carcinoma cells to mature adipocytes was recognized. Myxoid change is a very rare phenomenon in adrenocortical carcinoma, and only 10 similar cases have been reported to date. Lipomatous metaplasia is another peculiar feature of adrenocortical lesions that has been reported only in benign conditions. To our knowledge, this is the first reported case of adrenocortical carcinoma with lipomatous metaplasia.

Fibrin stabilizing factor activity of the skin carcinoma.

Activity of fibrin stabilizing factor and contents of sulphydryl group in the homogenate of malignant skin carcinomas (melanoma, spinocellular carcinoma, basal cell carcinoma, fibromyoma, liposarcoma) is higher than in the homogenate of benign neoplasm (lipoma, papilloma) and in the homogenate of the normal skin. Fibrin stabilizing factor activity and contents of sulphydryl group in the blood serum of subjects with malignant skin carcinomas is slightly lower than in the blood serum of subjects benign neoplasm and in healthy subjects.

Natural killer cell activity in patients with neuroendocrine tumours of the gastrointestinal tract; relation with circulating gastrointestinal hormones.

We have evaluated the peripheral blood natural killer (NK) cell activity and the in vitro effect of recombinant gamma-interferon (r gamma-IFN) on NK cell activity in 23 patients with a neuroendocrine tumour of the pancreas, small intestine or liver, and 23 healthy controls. Patients with a gastrinoma showed a NK cell activity which was not different from that of the control group, whereas patients with another type of neuroendocrine tumour had a decreased NK cell activity compared to the controls (p less than 0.05) and the gastrinoma patients (p less than 0.02). The impaired NK cell activity in these patients was as such not related to the presence of liver metastasis or performance status of the patients. r gamma-IFN significantly stimulated the NK cell activity in patients and controls. However, the cytotoxic response of the patients with a hormone production other than gastrin remained lower than in the two other groups. Follow-up studies in 8 patients showed NK cell activities not to vary with stable disease, to decrease with progressive disease, and to increase with regression of disease. In conclusion, NK cell activity is suppressed in patients with neuroendocrine tumours that produce hormones other than gastrin. This impairment is not related to the presence of metastasis but seems to be related to the course of the disease.

Gastrointestinal lipoma and malignancies.

Twenty gastrointestinal lipomata in 18 patients are reviewed: 15 located in the colon, 3 in the distal ileum, one in the duodenum, and one in the stomach. They were found most frequently in European-born, elderly women and presented with variable abdominal symptomatology. Four lipomata were removed during endoscopy, the remainder at laparotomy, partial colectomy being performed in 10 cases. All, except 2 subserosal types, were located in the submucosa, and their average size was 2.7 cm diameter. Microscopically, none showed true encapsulation, and all were composed of mature fat cells without cellular atypia. In spite of nonspecific changes at endoscopy, one-half of the cases showed, on microscopic examination, atrophy of the overlying glands and a prominent eosinophilic and/or lymphoplasmocytic infiltration of the lamina propria. Two large subserosal lipomata were associated with Crohn's disease. In addition, in 39% of cases, malignant tumours, either single or double, were present in the gastrointestinal tract or elsewhere. Gastrointestinal "lipomata" are located in the sites of normal fatty infiltration in the elderly; these growths could be a local aging or reactive process of the intestinal wall rather than true neoplasms without any potential malignancy. However, coexistent malignancies should be carefully searched for in elderly patients with colonic lipoma.

Exposure of T-cryptantigen on red blood cells in a patient with angiomyolipoma.

A case of angiomyolipoma with cryptantigen exposure on the red blood cells is described. The exposed cryptanigen was classified with lectins as T-polyagglutination. This is the first case described of T-cryptantigen exposure associated with angiomyolipoma.

Treatment of metastatic lipid cell tumor of the ovary with BV-CAP and VAC chemotherapy, using serum testosterone and dihydrotestosterone as tumor markers.

A metastatic ovarian lipid cell tumor was treated with BV-CAP chemotherapy following cytoreductive surgery and VAC chemotherapy for persistent disease found at second-look laparotomy before disease progression was noted. Serum Dihydrotestosterone (DHT) levels correlated with disease status during all phases of treatment, as did serum testosterone (T) to a lesser degree. Measurement of these two hormones may provide additional useful information on the response of patients with subclinical metastatic disease to post-operative therapy.

[Cytological changes in the tumor, bone marrow and leukoconcentrate of peripheral blood in thymus neoplasms]. / Tsitologicheskie izmeneniia v opukholi, kostnom mozge i leikokontsentrate perifericheskoi krovi pri opukholiakh timusa.

Cytological studies of the bone marrow, peripheral blood leucoconcentrate and impressions of the removed tumor were made in 20 patients with benign and malignant thymoma. A number of differential-diagnostic signs was obtained.