Background: Urothelial carcinoma (UC) accounts for roughly 90% of bladder cancer, and has a high propensity for diverse differentiation. Recently, certain histologic variants of UC have been recognized to be associated with unfavorable clinical outcomes. Several UC studies have also suggested that tumor budding is a poor prognostic marker. Distant metastasis of UC after radical cystectomy is not uncommon. However, these metastatic lesions are not routinely confirmed with histology. Methods: We investigated the histopathologic features of 13 cases of UC with biopsy-proven distant metastases, with a special emphasis on histologic variants and tumor budding. Results: Lymph nodes (6/13, 46%) were the most common metastatic sites, followed by the lung (4/13, 31%), liver (4/13, 31%), and the adrenal gland (2/13, 15%). The histologic variants including squamous (n=1), micropapillary (n=4), and plasmacytoid (n=1) variants in five cases of UC. Most histologic variants (4/5, 80%) of primary UCs appeared in the metastatic lesions. In contrast, high-grade tumor budding was detected in six cases (46%), including one case of non-muscle invasive UC. Our study demonstrates that histologic variants are not uncommonly detected in distant metastatic UCs. Most histologic variants seen in primary UCs persist in the distant metastatic lesions. In addition, high-grade tumor budding, which occurs frequently in primary tumors, may contribute to the development of distant metastasis. Conclusions Therefore, assessing the presence or absence of histologic variants and tumor budding in UCs of the urinary bladder, even in non-muscle invasive UCs, may be useful to predict distant metastasis.

BACKGROUND: Chromophobe renal cell carcinoma is a category of renal cell carcinoma composed of histologically characteristic tumor cells. E-cadherin is an intercellular adhesion protein that has been correlated with tumor aggressiveness in many carcinomas, including clear cell renal cell carcinoma. However, the significance of an E-cadherin expression in chromophobe renal cell carcinoma is not known. METHODS: We evaluated the E-cadherin expression status of 65 chromophobe renal cell carcinomas by performing immunohistochemical staining with the tissue microarray method. The percentage of positively stained tumor cells was evaluated and this was then classified into two categories: a low expression where 0 to 25% of the cells are positive, and a high expression where more than 25% of the cells are positive. RESULTS: Among 65 cases, 11 cases (17%) showed a low expression, and 54 cases (83.0%) showed a high expression. The tumors with low expression were more likely to have a higher stage but this was not significant (p=0.056). On the survival analysis, a low E-cadherin expression was significantly associated with poor cancer-specific survival (p=0.005) and progression-free survival (p=0.003). CONCLUSIONS: The E-cadherin expression is a good prognostic marker for survival in patients with chromophobe renal cell carcinoma.
Cadherins ; Carcinoma, Renal Cell ; Disease-Free Survival ; Humans ; Immunohistochemistry

Metastatic carcinoma that causes appendicitis is extremely rare. To our knowledge, metastatic cholangiocarcinoma in the appendix has been reported in only 1 case in the English literature. We report herein the case of an 87-year-old woman who presented with abdominal pain and jaundice. Advanced cholangiocellular carcinoma and a proximal appendiceal mass with appendicitis were detected on contrast-enhanced computed tomography and positron emission tomography/computed tomography. After elective laparoscopic appendectomy and wedge resection of the cecum, pathologic results revealed metastatic adenocarcinoma from extrahepatic cholangiocellular carcinoma in the appendix.
Abdominal Pain ; Adenocarcinoma ; Aged, 80 and over ; Appendectomy ; Appendicitis* ; Appendix ; Cecum ; Cholangiocarcinoma* ; Electrons ; Female ; Humans ; Jaundice ; Neoplasm Metastasis

BACKGROUND: CD44 is a cell surface receptor that has been implicated in tumor cell invasion and metastasis in a range of tumors of various organs, including breast, ovary, colon, lung, and brain. CD44 stimulates the invasive ability by interacting with matrix metalloproteinase 14 (MMP14). The expression of MMP14 on the cell surface is thought to trigger multiple proteinase cascades and to stimulate cell migration. METHODS: A total 54 astrocytoma patients were eligible for this study. We performed a retrospective clinicopathological review and CD44 and MMP14 immunohistochemistry. RESULTS: The expressions of CD44 and MMP14 were significantly correlated with the World Health Organization (WHO) grade. On univariate analysis, the WHO grade and the expression of CD44 were the significant prognostic factors affecting overall survival (OS) and disease progression free survival (DPFS). On the multivariate analysis by the Cox regression model, the only WHO grade was shown to be a significant independent prognostic factor for predicting the DPFS and OS. CONCLUSIONS: In this study, the CD44 and MMP14 expressions were related to the WHO grade of astrocytoma. The CD44 expression status was a prognostic factor for DPFS and OS on univariate analysis, but it was not an independent prognostic factor on the multivariate analysis.
Antigens, CD44 ; Astrocytoma ; Brain ; Breast ; Colon ; Disease Progression ; Female ; Humans ; Lung ; Matrix Metalloproteinase 14 ; Multivariate Analysis ; Neoplasm Metastasis ; Ovary ; Prognosis ; Retrospective Studies ; World Health Organization

Wegener's granulomatosis is a very rare systemic vasculitis characterized by necrotizing granulomatosis. The detection of antineutrophil cytoplasm antibody (ANCA) is a valuable finding in diagnosing Wegener's granulomatosis because ANCA is positive in approximately 90 percent of patients with active, generalized Wegener's granulomatosis. But ANCA is not necessarily positive to make a diagnosis. A 59-year-old man was transferred to our hospital. He was diagnosed with lung abscess and treated with antibiotics at previous hospital. Initially, the ANCA was negative in immunofluorescence assay but we suspected Wegener's granulomatosis because of systemic inflammatory symptoms. Clinical symptoms deteriorated rapidly so we did bronchoscopic biopsy early. Wegener's granulomatosis was diagnosed according to pathologic finding that reported necrotizing granulomatous inflammation associated with vasculitis. Thus we treated with steroid then clinical symptoms and laboratory findings were improved.
Anti-Bacterial Agents ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Cytoplasm ; Fluorescent Antibody Technique ; Humans ; Inflammation ; Lung Abscess ; Systemic Vasculitis ; Vasculitis ; Wegener Granulomatosis

No abstract available.
Cytodiagnosis* ; Immunohistochemistry* ; Nuclear Proteins* ; Nuts* ; Testis*

Tufting enteropathy is a rare autosomal recessive disorder presenting with early-onset severe intractable diarrhea. The epithelial cell adhesion molecule gene (EpCAM) has recently been identified as the gene responsible for tufting enteropathy. Based on histology, a diagnosis of tufting enteropathy was made in two Korean siblings. They developed chronic diarrhea and failure to thrive. They had a broad nasal bridge and micrognathia. Duodenal and colonic biopsies showed villous atrophy, disorganization of surface enterocytes, and focal crowding resembling tufts. Protracted diarrhea continued and so cyclic parenteral nutrition was supplied. The sister had juvenile rheumatoid arthritis. Mutation analysis of EpCAM identified two compound heterozygous mutations in these siblings: 1) a donor splicing site mutation in intron 5 (c.491+1G>A) and 2) a novel nonsense mutation in exon 3 (c.316A>T, Lys106X). Analysis of EpCAM will be useful for genetic counseling and prenatal diagnosis of tufting enteropathy.
Antigens, Neoplasm ; Arthritis, Juvenile Rheumatoid ; Atrophy ; Biopsy ; Cell Adhesion Molecules ; Codon, Nonsense ; Colon ; Crowding ; Diarrhea ; Enterocytes ; Epithelial Cells ; Exons ; Failure to Thrive ; Genetic Counseling ; Humans ; Introns ; Parenteral Nutrition ; Prenatal Diagnosis ; Siblings ; Tissue Donors

The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse.
Adult ; Aged ; Antibodies, Antinuclear/blood ; Female ; Follow-Up Studies ; Humans ; Idiopathic Interstitial Pneumonias/drug therapy/pathology ; Lung Diseases, Interstitial/*drug therapy/mortality/pathology ; Male ; Middle Aged ; Prognosis ; Recurrence ; Retrospective Studies ; Steroids/*therapeutic use