The aim of our study was to investigate the correlation of the proliferative activity of pituitary neoplasms with clinical characteristics and recurrences. Tumor specimens were obtained from 44 consecutive patients with pituitary macroadenomas who underwent surgery between July 1998 and August 2003. Specimens were immediately fixed in 10% buffered formalin and then embedded in paraffin. The Ki-67 antigen was assessed by immumohistochemical analysis using the monoclonal antibody. We investigated the correlation of the Ki-67 labeling index with the following clinical and radiological characteristics: sex, age, presence or absence visual field defect, tumor classification, maximal tumor diameter, Hardy's classification, type of tumor, invasiveness, and recurrence. Our study suggests that the clinical characteristics such as visual field defect and recurrence are correlated with the high Ki-67 labeling index. No statistical differences were observed in the Ki-67 labeling index in relation to the following characteristics: sex, age, tumor classification, maximal tumor diameter, Hardy's classification, type of tumor, and invasiveness into the sphenoid sinus or cavernous sinus.
Adenoma/metabolism/*pathology/radiography ; Adult ; Aged ; Comparative Study ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen/*analysis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pituitary Neoplasms/metabolism/*pathology/radiography

PURPOSE: The risk of hepatocellular carcinoma (HCC) recurrence must be considered ahead of surgery. This study was undertaken to identify pre-operative risk factors for early intrahepatic recurrence of HCC after curative resection in a large-scale. MATERIALS AND METHODS: We retrospectively reviewed the preoperative three-phase multi-detector CT (MDCT) and laboratory data for 240 HCC patients who underwent curative resection; tumor size, number, gross shape, capsule integrity, distinctiveness of tumor margin, portal vein thrombosis (PVT), alpha-fetoprotein level (AFP), and protein induced by vitamin K absence-II (PIVKA-II) levels were assessed. Surgical pathology was reviewed; tumor differentiation, capsule, necrosis, and micro-vessel invasion were recorded. RESULTS: HCC recurred in 61 patients within six months (early recurrence group), but not in 179 patients (control group). In univariate analysis, large tumor size (p = 0.018), shape (p = 0.028), poor capsule integrity (p = 0.046), elevated AFP (p = 0.015), and PIVKA-II (p = 0.008) were significant preoperative risk factors. Among the pathologic features, PVT (p = 0.023), Glisson's capsule penetration (p = 0.033), microvascular invasion (p < 0.001), and poor differentiation (p = 0.001) showed statistical significance. In multivariate analysis, only the histopathologic parameters of microvascular invasion and poor differentiation achieved statistical significance. CONCLUSION: Preoperative CT and laboratory parameters showed limited value, while the presence of microscopic vascular tumor invasion and poorly differentiated HCC correlated with higher risk of early recurrence after curative resection.
Adult ; Aged ; Carcinoma, Hepatocellular/metabolism/pathology/*radiography/*surgery ; Female ; Humans ; Liver Neoplasms/metabolism/pathology/*radiography/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/metabolism/*pathology/*radiography ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; alpha-Fetoproteins/metabolism

OBJECTIVETo study the morphologic feature, immunohistochemistry phenotype of ESS and its metastases, with emphasis on the histogenesis, tumor differentiation and diagnostic criteria.

METHODSThe pathologic features of 15 cases and 4 metastases were studied. The immunohistochemical study was performed on selected sections by a panel of antibodies including CD10, smooth muscle actin, estrogen and progesterone receptors, keratin (AE1/3) and alpha-inhibin.

RESULTSPatients were 22 to 75 years of age (mean 45). The endometrial stromal component predomominated in 7 cases. Three cases showed a picture of smooth muscle differentiation. Endometrial stromal sarcoma with fibromyxoid features were present in 2 cases. There were 3 sarcomas of poorly differentiated. The morphology features of the metastatic foci in 3 of the 4 metastasis cases were not similar to that of the primary counterpart in uteri. Among 14 ESS and 4 metastases, 15 of 18, 5 of 18, 7 of 18, and 10 of 18 were positive for CD10, SMA, ER and PR, respectively. AE1/3 and alpha-inhibin were only positive in the adenomatous area of ESS. Strong expression of SMA was obtained in all 10 cellular leiomyomas, and CD10 was only weakly expressed in 1 case (P < 0.05).

CONCLUSIONSESS are morphologically heterogeneous with multipotential differentiation. The histologic features of the metastases may not be similar to those of the primary. CD10 and SMA are diagnostically useful markers for ESS.

Actins ; metabolism ; Adult ; Aged ; Cell Differentiation ; Endometrial Neoplasms ; metabolism ; pathology ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; metabolism ; secondary ; Middle Aged ; Muscle, Smooth ; pathology ; Neoplasm Recurrence, Local ; Neprilysin ; metabolism ; Radiography ; Sarcoma, Endometrial Stromal ; metabolism ; secondary ; Uterus ; metabolism ; pathology

OBJECTIVE: The maximum standardized uptake value (SUVmax) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate. MATERIALS AND METHODS: Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUVmax for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by chi2 test and overall survival was determined by Kaplan-Meier analysis. RESULTS: The mean SUVmax was 15.4 +/- 11.5 in the high SUV group and 3.9 +/- 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUVmax from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 +/- 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031). CONCLUSION: Pulmonary mucoepidermoid carcinoma patients with high SUVmax in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Mucoepidermoid/*pathology/radiography ; Female ; Fluorodeoxyglucose F18/metabolism ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms/*pathology/radiography ; Lymph Nodes/pathology/radiography ; Lymphatic Metastasis ; Male ; Mediastinum/radiography ; Middle Aged ; Neoplasm Grading ; Neoplasm Recurrence, Local/pathology/radiography ; Positron-Emission Tomography/*methods ; Prognosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Survival Rate ; Tomography, X-Ray Computed/*methods ; Young Adult

OBJECTIVETo study the histogenesis of giant cell tumor (GCT) and factors related to tumor recurrence, invasiveness and malignant transformation.

METHODSThe clinical features, radiologic classification, surgical approach, pathologic findings, immunophenotypes and follow-up data of 123 cases of GCT were analyzed.

RESULTSThere was a significant correlation between tumor recurrence and radiographic classification (P = 0.032), over-expression of CD147 (P = 0.034) and p53 (P = 0.005), and surgical approach (P = 0.0048) in GCT. The biologic behavior showed no correlation with intramedullary infiltration, cortical bone involvement, parosteal soft tissue extension, tumor thrombi, fusiform changes of mononuclear tumor cells, mitotic count, Ki-67 index, coagulative tumor necrosis, secondary aneurysmal bone cyst formation, and adjoining bony reaction. The positive rate of p63 in stromal cells of GCT (79.7%, 94/118) was significantly higher than that in chondroblastoma (44.7%, 21/47), osteosarcoma (22.2%, 10/45) and other giant cell-rich tumors.

CONCLUSIONSGCT is a bone tumor of low malignant potential. It is sometimes characterized by locally invasive growth, active proliferation, coagulative necrosis, secondary aneurysmal bone cyst and surrounding bony reaction. It is difficult to predict the biologic behavior of GCT. Over-expression of p53 in the tumor cells and CD147 in all components of GCT correlate with tumor invasiveness, recurrence and malignant transformation. Selection of suitable surgical approach with reference to radiologic classification is considered as an important factor in reducing the recurrence rate.

Adolescent ; Adult ; Aged ; Basigin ; metabolism ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; surgery ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; surgery ; Humans ; Male ; Membrane Proteins ; metabolism ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Phosphoglucomutase ; metabolism ; Radiography ; Tumor Suppressor Protein p53 ; metabolism ; Young Adult

OBJECTIVETo study the clinical, radiologic and pathologic features, as well as differential diagnosis of teratocarcinosarcoma in nasal cavity and paranasal sinuses.

METHODSLight microscopic examination and immunohistochemical study was performed in 5 cases of sinonasal teratocarcinosarcoma. The clinical, radiologic and pathologic features were analyzed and the literature was reviewed.

RESULTSAll 5 patients were males and their age ranged from 34 to 43 years (mean age = 39 years). The clinical presentation was nasal obstruction, epistaxis and headache. Physical examination often revealed a polypoid mass with contact bleeding. Computed tomography showed a homogeneous nasal mass with obturation of sinuses. Cystic changes, calcification or ossification was not observed. Histologically, the tumor showed a heterogeneous admixture of components from the 3 germ cell layers, exhibiting various degrees of maturation. Squamous epithelium, smooth muscle cells, chondro-osseous tissue, intestinal or respiratory type epithelium, "fetal-type" clear cells and immature neuroepithelium were commonly seen. Immunohistochemical study demonstrated that the epithelial component expressed cytokeratin and epithelial membrane antigen, while the mesenchymal component variably expressed vimentin, smooth muscle actin and S-100 protein. On the other hand, the neuroepithelial component expressed neuron-specific enolase, synaptophysin and chromogranin, and the primitive component expressed CD99. The initial biopsy diagnosis included capillary hemangioma, olfactory neuroblastoma, craniopharyngioma and malignant mixed tumor. Follow-up information was available in all patients. Two of which had local recurrence and 1 had cervical lymph node metastasis.

CONCLUSIONSSinonasal teratocarcinosarcoma is a rare and highly malignant tumor occurring in sinonasal tract. It manifests mainly in adult males and is characterized by a complex admixture of teratomatous and carcinosarcomatous components. "Fetal-type" clear cells, squamous epithelium and immature neuroepithelium represent important histologic characteristics useful in diagnosis.

Adult ; Carcinosarcoma ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Follow-Up Studies ; Humans ; Keratins ; metabolism ; Lymphatic Metastasis ; Male ; Mucin-1 ; metabolism ; Nasal Cavity ; Neck Dissection ; Neoplasm Recurrence, Local ; Nose Neoplasms ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Paranasal Sinus Neoplasms ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Radiography ; Teratocarcinoma ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery

OBJECTIVETo study the clinicopathologic and radiologic features of dedifferentiated chondrosarcoma, focusing on its diagnosis and differential diagnosis.

METHODClinical, radiological and pathologic findings of 14 cases of dedifferentiated chondrosarcoma (including biopsy and surgical specimens) were analyzed by hematoxylin and eosin stained sections and immunohistochemistry.

RESULTSThe mean age of patients was 52 years. The male-to-female ratio was 9:5. The most common sites of involvement were pelvis, femur and humerus, similar to the conventional chondrosarcoma. Radiologically, they were malignant tumors with dimorphic pattern. Grossly, central chondrosarcomas were more common than those of the peripheral. An essential histological feature of dedifferentiated chondrosarcoma was an abrupt interface between the low-grade cartilaginous tumor and high-grade anaplastic sarcoma. The most common dedifferentiated components were osteosarcoma, malignant fibrous histocytoma and fibrosarcoma. False negative diagnosis and erroneous diagnosis were frequent when only one-time biopsy was available.

CONCLUSIONSDedifferentiated chondrosarcoma is a rare subtype of chondrosarcoma with poor prognosis, which has different features of clinical manifestation, imaging features and pathological characteristics, compared to conventional chondrosarcoma and chondroblastic osteosarcoma.

Adult ; Aged ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Cell Differentiation ; Chondrosarcoma ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Chondrosarcoma, Mesenchymal ; pathology ; Diagnosis, Differential ; Female ; Femoral Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Follow-Up Studies ; Humans ; Humerus ; pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Pelvic Bones ; pathology ; Radiography ; Vimentin ; metabolism ; Young Adult

OBJECTIVETo study the clinicopathologic and immunohistochemical features of mesenchymal chondrosarcoma.

METHODSThe clinical and histologic features of 23 cases of mesenchymal chondrosarcoma were analyzed. Immunohistochemical study was also performed in 14 of the cases.

RESULTSThe age of patients ranged from 12 to 47 years. Fourteen of them occurred in males. Thirteen cases involved the bony skeleton and 5 cases affected the soft tissue. The patients presented with pain and/or swelling. Histologically, the tumor consisted of a mixture of undifferentiated small round cells and hyaline cartilage. Transition between the two components was demonstrated and growth plate-like cartilage was observed. Immunohistochemical study showed that the small round cells were positive for Sox9 (14/14), CD99 (12/14), vimentin (6/14), CD56 (4/14), CD57 (4/14), neuron-specific enolase (3/14) and desmin(1/14). They were negative for Coll-II, S-100 protein, epithelial membrane antigen, pan-cytokeratin, synaptophysin, chromogranin A, CD34 and c-erbB2.

CONCLUSIONSMesenchymal chondrosarcoma is a rare malignant tumor. Thorough histologic examination, when coupled with immunohistochemical findings, is helpful in arriving at a correct diagnosis.

12E7 Antigen ; Adolescent ; Adult ; Antigens, CD ; metabolism ; Bone Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Cell Adhesion Molecules ; metabolism ; Child ; Chondrosarcoma, Mesenchymal ; diagnostic imaging ; metabolism ; pathology ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lung Neoplasms ; secondary ; Male ; Mediastinal Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Orbital Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Radiography ; SOX9 Transcription Factor ; metabolism ; Vimentin ; metabolism ; Young Adult

OBJECTIVETo study the clinicopathologic features and differential diagnosis of myxoid dermafibrosarcoma protuberans (DFSP).

METHODSThe clinical and pathologic features of 16 cases of myxoid DFSP were reviewed.

RESULTSThere were altogether 15 males and 1 female. The age of the patients ranged from 11 to 73 years (mean = 47 years and median = 48 years). The commonest site of involvement was trunk (number = 11), followed by shoulder (number = 2), head and neck (number = 2), and extremity (number = 1). Similar to conventional DFSP, most patients presented with a slowly enlarging subcutaneous nodule which showed a rapid recent growth in some cases. Amongst the 16 cases studied, 12 occurred de novo and 4 represented local recurrence. The tumors ranged from 2 to 10 cm in greatest dimension (mean = 5 cm and median = 4 cm). Histologically, they were poorly circumscribed and located in the dermis, with focal infiltration into the underlying subcutaneous tissue. Seven cases were purely myxoid and composed of spindly and stellate cells with delicate arborizing vascular meshwork. The remaining 9 cases were predominantly myxoid (> 50%), with 5 cases containing cellular areas resembling conventional DFSP and 4 cases showing fibrosarcomatous transformation. In addition, foci of giant cell fibroblastoma-like areas were noted in 1 case. Immunohistochemical study showed that the tumors cells were positive for CD34. The staining was weak in the myxoid areas, as compared with conventional DFSP. Of the 4 recurrent cases, one patient developed lung metastases.

CONCLUSIONSMyxoid DFSP represents a rare variant of DFSP and may pose important diagnostic pitfalls. It is especially so if the tumor purely consists of myxoid element. Familiarity with the histologic features helps to avoid misdiagnosis.

Abdominal Wall ; Adolescent ; Adult ; Aged ; Antigens, CD34 ; metabolism ; Child ; Dermatofibrosarcoma ; diagnostic imaging ; immunology ; pathology ; surgery ; Diagnosis, Differential ; Female ; Head and Neck Neoplasms ; diagnostic imaging ; immunology ; pathology ; surgery ; Humans ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Radiography ; Shoulder ; Skin Neoplasms ; diagnostic imaging ; immunology ; pathology ; surgery ; Young Adult