PURPOSE: To report a case of poorly differentiated neuroendocrine carcinoma of the eyelid. CASE SUMMARY: A 70-year-old male presented with a 5-month history of a right upper eyelid mass. The mass appeared as 1.2 × 1.2 cm on the right upper eyelid. A mass excision was performed under frozen section control. The tumor was completely excised with a safety margin clearance and an upper eyelid reconstruction was performed. Histopathological examination revealed a tumor composed of small atypical cells which showed a high nuclear/cytoplasm ratio, nuclear molding, and increased mitotic activity. Immunohistochemical examination revealed positive reactivity for Ki-67, synaptophysin, CD56, and negative reactivity for chromogranin, cytokeratin 20, and thyroid transcription factor-1. CONCLUSIONS: Primary neuroendocrine carcinoma of the eyelid is extremely rare, but the tumor has high malignancy and readily metastasizes. Poorly differentiated neuroendocrine carcinoma should be considered in the differential diagnosis of a rapidly growing eyelid mass.
Aged ; Carcinoma, Merkel Cell ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell ; Diagnosis, Differential ; Eyelids ; Frozen Sections ; Fungi ; Humans ; Keratin-20 ; Male ; Synaptophysin ; Thyroid Gland

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor that is highly aggressive in nature and indolent in progression. The common risk factors for MCC are senility, prolonged exposure to sunlight, and immune deficient states. Moreover, Merkel cell polyomavirus has recently been characterized to be significantly associated with pathogenesis of MCC, including the expression of Cytokeratin 20 (CK20). Diagnosis is often difficult since histopathological results require a number of differential diagnoses through immunohistochemical (IHC) stains with other cutaneous malignancies. A 67-year-old man presented with a solitary domeshaped erythematous round mass on the left upper arm for 2 months. Biopsy and IHC studies revealed findings consistent with Merkel Cell Carcinoma of neuroendocrine origin. Common IHC stains usually confirm positive findings for CK20, which is also recognized as the key component in making the diagnosis. We present a CK20 negative MCC in light of expanding the knowledge of unusually stained IHC results in MCC.
Aged ; Arm ; Biopsy ; Carcinoma, Merkel Cell* ; Coloring Agents ; Diagnosis ; Diagnosis, Differential ; Humans ; Keratin-20* ; Keratins* ; Merkel cell polyomavirus* ; Neuroendocrine Tumors ; Risk Factors ; Sunlight

BACKGROUND/AIMS: Peritoneal micrometastasis is known to play an important role in the recurrence of gastric cancer. However, its effects remain equivocal. Herein, we examine the messenger RNA (mRNA) as tumor markers, carcinoembryonic antigen (CEA), and cytokeratin 20 (CK20), in peritoneal washing fluid. Moreover, we evaluate whether these results could predict the recurrence of gastric cancer following curative resection. METHODS: We prospectively enrolled 132 patients with gastric cancers, who had received an operation, between January 2010 and January 2013. The peritoneal lavage fluid was collected at the operation field and semi-quantitative PCR was performed using the primers for CEA and CK20. We excluded patients with stage IA (n=28) early gastric cancer, positive cytologic examination of peritoneal washings (n=7), and those who were lost during follow up (n=18). RESULTS: A total of 79 patients with gastric cancers were enrolled, and the mean follow-up period was 39.95±19.25 months (range, 5-72 months). According to the multivariate analysis, T4 stage at the initial diagnosis was significantly associated with recurrence. All cases of recurrence were CEA positive and 6 cases were CK20 positive. The positive and negative predictive values of CEA were 32.0% and 100%, respectively, whereas those of CK20 were 37.5% and 71.4%, respectively. Disease free survival of CK20-negative cases was 36.17±20.28 months and that of CK20-positive cases was 32.06±22.95 months (p=0.39). CONCLUSIONS: It is unlikely that the real time polymerase chain reaction results of mRNA for CEA and CK20 in peritoneal washing fluid can predict recurrence. However, negative results can convince surgeons to perform curative R0 resection.
Biomarkers, Tumor ; Carcinoembryonic Antigen* ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Keratin-20* ; Keratins* ; Multivariate Analysis ; Neoplasm Micrometastasis ; Peritoneal Lavage ; Polymerase Chain Reaction ; Prospective Studies ; Real-Time Polymerase Chain Reaction ; Recurrence ; RNA, Messenger* ; Stomach Neoplasms* ; Surgeons

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor that is highly aggressive in nature and indolent in progression. The common risk factors for MCC are senility, prolonged exposure to sunlight, and immune deficient states. Moreover, Merkel cell polyomavirus has recently been characterized to be significantly associated with pathogenesis of MCC, including the expression of Cytokeratin 20 (CK20). Diagnosis is often difficult since histopathological results require a number of differential diagnoses through immunohistochemical (IHC) stains with other cutaneous malignancies. A 67-year-old man presented with a solitary domeshaped erythematous round mass on the left upper arm for 2 months. Biopsy and IHC studies revealed findings consistent with Merkel Cell Carcinoma of neuroendocrine origin. Common IHC stains usually confirm positive findings for CK20, which is also recognized as the key component in making the diagnosis. We present a CK20 negative MCC in light of expanding the knowledge of unusually stained IHC results in MCC.
Aged ; Arm ; Biopsy ; Carcinoma, Merkel Cell ; Coloring Agents ; Diagnosis ; Diagnosis, Differential ; Humans ; Keratin-20 ; Keratins ; Merkel cell polyomavirus ; Neuroendocrine Tumors ; Risk Factors ; Sunlight

Breast cancer metastases to the gastrointestinal tract are very rare occurrences. Among the histological subtypes of breast cancer, invasive lobular carcinomas have a high capacity of metastasis to uncommon sites including the stomach. Conversely, there has not been sufficient evidence supporting the gastric metastasis of invasive ductal carcinoma. Herein, we report a unique case of metastatic ductal breast carcinoma mimicking primary linitis plastica in a male patient, particularly focusing on the clinical and pathological features of presentation. Moreover, we propose a immunohistochemical panel of selected antibodies including those for cytokeratin 20, cytokeratin 7, estrogen receptor, progesterone receptor, E-cadherin, gross cystic disease fluid protein 15, and GATA binding protein 3 for an accurate differential diagnosis.
Antibodies ; Biomarkers ; Breast Neoplasms* ; Breast* ; Cadherins ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carrier Proteins ; Diagnosis, Differential ; Estrogens ; Gastrointestinal Tract ; Humans ; Keratin-20 ; Keratin-7 ; Linitis Plastica* ; Male* ; Neoplasm Metastasis ; Receptors, Progesterone ; Stomach*

The objective of this study was to investigate the role of ErbB3-binding protein 1 (Ebp1) in the growth of esophageal squamous cell carcinoma (ESCC) cells and the underlying mechanism. Eca109 and KYSE150 cells were transfected with lentiviral vector carrying Ebp1 gene. The mRNA levels of Ebp1 in esophageal cancer tissues and paired adjacent normal tissues were examined by real-time PCR. The growth and viability of esophageal carcinoma cells were assessed using MTT and crystal violet assays, respectively. Clone-forming abilities of Eca109 and KYSE150 cells were analyzed by soft agar assay. Apoptotic rates of esophageal carcinoma cells were detected by flow cytometry, and expression levels of the proteins involved in apoptosis were assessed by Western blot. Tumorigenicity of Eca109 cells were detected by nude mouse transplantation tumor experiment. The results indicated that the mRNA levels of Ebp1 in esophageal cancer tissues was down-regulated compared with paired adjacent normal tissues. The growth and viability of Eca109 and KYSE150 cells were all suppressed by Ebp1 overexpression. Besides, Ebp1 overexpression induced apoptosis, increased Rb and P53 expressions, and decreased CyclinD1 expression in Eca109 and KYSE150 cells. In addition, Ebp1 overexpression inhibited the tumorigenesis of Eca109 cells in vivo. These results suggest that Ebp1 may suppress the growth of esophageal carcinoma cells in vitro and in vivo by inducing apoptosis.
Animals ; Apoptosis ; Carcinoma, Squamous Cell ; Cell Line, Tumor ; Cell Proliferation ; Down-Regulation ; Esophageal Neoplasms ; Humans ; Keratin-20 ; Mice ; Mice, Nude ; Real-Time Polymerase Chain Reaction ; Transfection ; Up-Regulation

OBJECTIVETo study the diagnostic value of SATB2, together with CK7 and CK20, in colorectal cancer.

METHODSImmunohistochemical study for SATB2, CK7 and CK20 was carried out in 210 cases of colorectal cancer tissue, 100 cases of non-colorectal cancer tissue, 90 cases of lymph node metastases and 50 cases of normal colorectal mucosa.

RESULTSThe sensitivity and specificity of CK20+/CK7- immunophenotype for diagnosis of colorectal adenocarcinoma were 78.1% and 92.0%, respectively. When triple markers were used, the immunophenotype CK20+/CK7-/SATB2+ had a sensitivity of 57.1% and a specificity of 98.0%. When combining the immunophenotype of SATB2+/CK7- or CK20+/CK7-, the sensitivity was 85.7% and specificity was 90.0%.

CONCLUSIONSA panel of immunohistochemical markers SATB2, CK7 and CK20 could increase the specificity for diagnosis of colorectal adenocarcinoma significantly. SATB2 is considered as a useful adjunct in this respect.

Adenocarcinoma ; diagnosis ; metabolism ; Biomarkers, Tumor ; metabolism ; Colorectal Neoplasms ; diagnosis ; metabolism ; Humans ; Immunophenotyping ; Keratin-20 ; metabolism ; Keratin-7 ; metabolism ; Lymphatic Metastasis ; Matrix Attachment Region Binding Proteins ; metabolism ; Sensitivity and Specificity ; Transcription Factors ; metabolism

Cutaneous metastasis from gastric adenocarcinoma is uncommon, and the eyelid is a rare metastatic site. Three patterns of clinical presentation of eyelid metastasis have been described: nodular, infiltrative, and ulcerated. The infiltrative pattern, also known as an inflammatory diffuse pattern or mask-like metastasis, can be easily misdiagnosed as cellulitis or contact dermatitis. Here, we report a case of gastric adenocarcinoma in a 75-year-old man who presented with a localized erythematous plaque on his eyelid that developed four months earlier. The patient had been treated with an antimicrobial agent owing to suspicion of preseptal cellulitis. Gastric adenocarcinoma metastasis was diagnosed on the basis of histopathological examination and immunophenotyping (i.e., cytoplasmic epithelial membrane antigen, cytokeratin- 7, cytokeratin-20, and carcinoembryonic antigen). For patients with malignant neoplasms, persistent skin lesions similar to cellulitis or contact dermatitis should be suspected of metastasis derived from an internal malignancy, even for very rare sites of metastasis.
Adenocarcinoma* ; Aged ; Cellulitis* ; Cytoplasm ; Dermatitis, Contact ; Eyelids ; Humans ; Immunophenotyping ; Keratin-20 ; Mucin-1 ; Neoplasm Metastasis ; Orbital Cellulitis ; Skin ; Ulcer

Thymic carcinomas are uncommon malignant tumors, and thymic adenocarcinomas are extremely rare. Here, we describe a case of primary thymic adenocarcinoma in a 59-year-old woman. Histological examination of the tumor revealed tubular morphology with expression of cytokeratin 20 and caudal-type homeobox 2 according to immunohistochemistry, suggesting enteric features. Extensive clinical and radiological studies excluded the possibility of an extrathymic primary tumor. A review of the literature revealed only two global cases of primary tubular adenocarcinomas of the thymus with enteric immunophenotype.
Adenocarcinoma* ; Female ; Genes, Homeobox ; Humans ; Immunohistochemistry ; Keratin-20 ; Middle Aged ; Thymoma ; Thymus Gland*

Upper tract urothelial carcinoma (UTUC), which comprises tumors of the ureter and renal pelvis, is a rare genitourinary malignancy. Among these tumors, transitional cell carcinoma (TCC) of the renal pelvis is highly uncommon, and cutaneous metastasis of this tumor is very rare. Herein, we report a case of cutaneous metastasis of TCC of the renal pelvis, clinically mimicking an abscess. A 79-year-old woman was diagnosed with TCC of the left renal pelvis, and underwent wide nephrectomy and chemotherapy in August 2012. She presented with painful, solitary 3 cm sized erythematous dome-shaped mass on the right lower abdomen that had been present for two weeks. We took biopsies of the center and periphery of the mass. Histopathological findings were consistent with cutaneous metastasis of TCC. Immunohistochemical examination showed strongly positive cytokeratin 7 staining, and negative cytokeratin 20 and thrombomodulin staining.
Abdomen ; Abscess* ; Aged ; Biopsy ; Carcinoma, Transitional Cell* ; Drug Therapy ; Female ; Humans ; Keratin-20 ; Keratin-7 ; Kidney Pelvis* ; Neoplasm Metastasis* ; Nephrectomy ; Thrombomodulin ; Ureter