- Email: [email protected]
12. Primary mediastinal synovial sarcoma
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PATHOLOGY 2015 ABSTRACT SUPPLEMENT
extranodal B-cell lymphoma which is commonly diagnosed in the stomach where there is a well-documented association with Helicobacter pylori infection. In reported cases of primary liver MALT, it is often an incidental finding during imaging or surgery for other disease and patients usually do not have symptoms specifically related to the lymphoma. The information available from reported cases of primary liver MALT lymphoma have included associated inflammatory diseases of the liver including hepatitis B or hepatitis C (either with or without cirrhosis) or primary biliary cirrhosis. This supports the role of chronic inflammation in the pathogenesis of the condition regardless of primary site. As primary hepatic MALT lymphoma is usually asymptomatic it is likely to be an under-reported diagnosis. Only one case of concurrent hepatocellular carcinoma with hepatic MALT lymphoma on a background of hepatitis B infection is reported in the literature. We present a case of a 62 year old patient who presented with non-cirrhotic hepatocellular carcinoma on a background of cleared chronic hepatitis B infection. The patient has positive hepatitis B core antibody with negative hepatitis B surface antigen. The right hepatectomy specimen showed moderately differentiated hepatocellular carcinoma as well as an incidental diagnosis of extranodal marginal zone lymphoma of MALT type and the gallbladder specimen also showed involvement. We present this additional case of concurrent hepatocellular carcinoma and hepatic MALT lymphoma to bring to attention this extremely rare entity.
12. PRIMARY MEDIASTINAL SYNOVIAL SARCOMA R. Ferdous and S. Samra Anatomical Pathology Department, ICPMR, Westmead Hospital Synovial sarcoma predominantly occurs in the soft tissues of the extremities. Primary synovial sarcoma in the mediastinum is exceedingly rare and only a few cases have been reported, most of which were in the posterior mediastinum. This is a case of a 68 year old lady with a previous history of left sided mediastinal tumour (MPNST) who presented with increasing shortness of breath. CT scan revealed a posterior mediastinal mass. Microscopically, the tumour was composed of hypercellular spindle cells arranged predominantly in sheets, short fascicles with focal herring bone and hemangiopericytomatous pattern. The cells were oval to spindle with overlapping nuclei, inconspicuous nucleoli with scant indistinct cytoplasm. The stroma shows patchy areas of thick intercellular collagen and plentiful scattered thick and thin walled staghorn vessels. No definite epithelial elements were seen. The tumour cells showed strong diffuse staining for vimentin and CD99. Weak, patchy positivity for EMA and BCL-2 were noted. This is further confirmed by FISH which showed rearrangement of SS18 (18q11.2) in a significant proportion of tumour nuclei.
13. MUCINOUS MICROPAPILLARY CARCINOMA OF THE BREAST A. Forsyth1 and M. Egerton2 1Sullivan Nicolaides Pathology,Toowoomba, and 2St Vincents Hospital Toowoomba Introduction: Mucinous micropapillary carcinoma of the breast (MUMPC), also described as ‘pure mucinous carcinoma with
Pathology (2015), 47(S1)
micropapillary pattern’, is a newly recognised entity with histological features of both mucinous carcinoma and invasive micropapillary carcinoma. It has been observed to behave in a way intermediate between these subtypes. Case summary: A 38-year-old woman was found to have a rightsided 8 cm breast lump and axillary lymphadenopathy. Mammography showed a large area of abnormality and microcalcifications. Core biopsies of the breast and axilla showed an infiltrating carcinoma with mucinous and micropapillary differentiation. It had a Ki67 proliferation index in the order of 50% and p53 labelling. It was positive for ER and negative for PR and HER2. High grade comedo-type DCIS was present. The patient underwent neoadjuvant chemotherapy. A mastectomy showed a 12 cm MUMPC with 3 of 6 nodes positive. Histological findings of reduced cellularity and a reduction in the Ki67 index indicated a good response to chemotherapy. Post-operatively, she had further chemotherapy followed by radiotherapy and tamoxifen. Discussion: MUMPC is associated with higher rates of lymph node metastasis and lymphovascular invasion than pure mucinous carcinoma and (in some case series) a younger age. The diagnosis is based on a number of features, the most defining being micropapillary formations in the presence of extensive extracellular mucin. In addition, the pathologist should look for: psammomatous calcifications; nuclear pleomorphism; ‘hobnail’ cells; high Ki-67 labelling and p53 expression. High-grade micropapillary DCIS and HER2 positivity are suggestive. MUC1/EMA staining is not reliable in distinguishing MUMPCs from pure mucinous carcinoma. Conclusion: MUMPCs behave more aggressively than pure mucinous carcinomas. It is therefore important to distinguish them histologically. Further studies will be important in further delineating their characteristics and behaviour.
14. UPREGULATED PLK1 EXPRESSION CONFERS RADIATION RESISTANCE AND POOR PATIENT SURVIVAL OUTCOMES IN RECTAL CANCER Thein Ga Tut1, Stephanie Lim4, Irani Dissanayake1,3, Joseph Descallar5, Wei Chua4, Weng Ng4, Paul De Souza1,4, Les Bokey1,6, Joo-Shik Shin1,2,3 and C. Soon Lee1,2,3 1School of Medicine, University of Western Sydney, 2Discipline of Pathology and Molecular Medicine Research Group, and Cancer Biology Laboratory, Ingham Institute for Applied Medical Research, 3Department of Anatomical Pathology, Liverpool Hospital, 4Department of Medical Oncology, Liverpool Hospital, 5South Western Sydney Clinical School, University of New South Wales, and 6Department of Colorectal Surgery, Liverpool Hospital Background and aim: Colorectal cancers (CRC) are common in Western countries. Death due to colorectal malignancy is the second commonest cause of cancer related death in Australia. Preoperative radiotherapy is commonly used to downstage rectal cancers in order to improve clinical outcome. However, the effectiveness of radiotherapy is highly variable between individual patients. Currently there are no reliable predictive biomarkers of radiation sensitivity. Hypothesis: PLK1 (polo-like kinase 1), the serine/threonine protein kinase, has crucial roles in cell cycle regulation, such as centrosome maturation, mitotic spindle formation and cytokinesis. PLK1 expression in colorectal cancer cell lines and in rectal tumour tissues may be related to radiation sensitivity of these
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
PATHOLOGY 2015 ABSTRACT SUPPLEMENT
extranodal B-cell lymphoma which is commonly diagnosed in the stomach where there is a well-documented association with Helicobacter pylori infection. In reported cases of primary liver MALT, it is often an incidental finding during imaging or surgery for other disease and patients usually do not have symptoms specifically related to the lymphoma. The information available from reported cases of primary liver MALT lymphoma have included associated inflammatory diseases of the liver including hepatitis B or hepatitis C (either with or without cirrhosis) or primary biliary cirrhosis. This supports the role of chronic inflammation in the pathogenesis of the condition regardless of primary site. As primary hepatic MALT lymphoma is usually asymptomatic it is likely to be an under-reported diagnosis. Only one case of concurrent hepatocellular carcinoma with hepatic MALT lymphoma on a background of hepatitis B infection is reported in the literature. We present a case of a 62 year old patient who presented with non-cirrhotic hepatocellular carcinoma on a background of cleared chronic hepatitis B infection. The patient has positive hepatitis B core antibody with negative hepatitis B surface antigen. The right hepatectomy specimen showed moderately differentiated hepatocellular carcinoma as well as an incidental diagnosis of extranodal marginal zone lymphoma of MALT type and the gallbladder specimen also showed involvement. We present this additional case of concurrent hepatocellular carcinoma and hepatic MALT lymphoma to bring to attention this extremely rare entity.
12. PRIMARY MEDIASTINAL SYNOVIAL SARCOMA R. Ferdous and S. Samra Anatomical Pathology Department, ICPMR, Westmead Hospital Synovial sarcoma predominantly occurs in the soft tissues of the extremities. Primary synovial sarcoma in the mediastinum is exceedingly rare and only a few cases have been reported, most of which were in the posterior mediastinum. This is a case of a 68 year old lady with a previous history of left sided mediastinal tumour (MPNST) who presented with increasing shortness of breath. CT scan revealed a posterior mediastinal mass. Microscopically, the tumour was composed of hypercellular spindle cells arranged predominantly in sheets, short fascicles with focal herring bone and hemangiopericytomatous pattern. The cells were oval to spindle with overlapping nuclei, inconspicuous nucleoli with scant indistinct cytoplasm. The stroma shows patchy areas of thick intercellular collagen and plentiful scattered thick and thin walled staghorn vessels. No definite epithelial elements were seen. The tumour cells showed strong diffuse staining for vimentin and CD99. Weak, patchy positivity for EMA and BCL-2 were noted. This is further confirmed by FISH which showed rearrangement of SS18 (18q11.2) in a significant proportion of tumour nuclei.
13. MUCINOUS MICROPAPILLARY CARCINOMA OF THE BREAST A. Forsyth1 and M. Egerton2 1Sullivan Nicolaides Pathology,Toowoomba, and 2St Vincents Hospital Toowoomba Introduction: Mucinous micropapillary carcinoma of the breast (MUMPC), also described as ‘pure mucinous carcinoma with
Pathology (2015), 47(S1)
micropapillary pattern’, is a newly recognised entity with histological features of both mucinous carcinoma and invasive micropapillary carcinoma. It has been observed to behave in a way intermediate between these subtypes. Case summary: A 38-year-old woman was found to have a rightsided 8 cm breast lump and axillary lymphadenopathy. Mammography showed a large area of abnormality and microcalcifications. Core biopsies of the breast and axilla showed an infiltrating carcinoma with mucinous and micropapillary differentiation. It had a Ki67 proliferation index in the order of 50% and p53 labelling. It was positive for ER and negative for PR and HER2. High grade comedo-type DCIS was present. The patient underwent neoadjuvant chemotherapy. A mastectomy showed a 12 cm MUMPC with 3 of 6 nodes positive. Histological findings of reduced cellularity and a reduction in the Ki67 index indicated a good response to chemotherapy. Post-operatively, she had further chemotherapy followed by radiotherapy and tamoxifen. Discussion: MUMPC is associated with higher rates of lymph node metastasis and lymphovascular invasion than pure mucinous carcinoma and (in some case series) a younger age. The diagnosis is based on a number of features, the most defining being micropapillary formations in the presence of extensive extracellular mucin. In addition, the pathologist should look for: psammomatous calcifications; nuclear pleomorphism; ‘hobnail’ cells; high Ki-67 labelling and p53 expression. High-grade micropapillary DCIS and HER2 positivity are suggestive. MUC1/EMA staining is not reliable in distinguishing MUMPCs from pure mucinous carcinoma. Conclusion: MUMPCs behave more aggressively than pure mucinous carcinomas. It is therefore important to distinguish them histologically. Further studies will be important in further delineating their characteristics and behaviour.
14. UPREGULATED PLK1 EXPRESSION CONFERS RADIATION RESISTANCE AND POOR PATIENT SURVIVAL OUTCOMES IN RECTAL CANCER Thein Ga Tut1, Stephanie Lim4, Irani Dissanayake1,3, Joseph Descallar5, Wei Chua4, Weng Ng4, Paul De Souza1,4, Les Bokey1,6, Joo-Shik Shin1,2,3 and C. Soon Lee1,2,3 1School of Medicine, University of Western Sydney, 2Discipline of Pathology and Molecular Medicine Research Group, and Cancer Biology Laboratory, Ingham Institute for Applied Medical Research, 3Department of Anatomical Pathology, Liverpool Hospital, 4Department of Medical Oncology, Liverpool Hospital, 5South Western Sydney Clinical School, University of New South Wales, and 6Department of Colorectal Surgery, Liverpool Hospital Background and aim: Colorectal cancers (CRC) are common in Western countries. Death due to colorectal malignancy is the second commonest cause of cancer related death in Australia. Preoperative radiotherapy is commonly used to downstage rectal cancers in order to improve clinical outcome. However, the effectiveness of radiotherapy is highly variable between individual patients. Currently there are no reliable predictive biomarkers of radiation sensitivity. Hypothesis: PLK1 (polo-like kinase 1), the serine/threonine protein kinase, has crucial roles in cell cycle regulation, such as centrosome maturation, mitotic spindle formation and cytokinesis. PLK1 expression in colorectal cancer cell lines and in rectal tumour tissues may be related to radiation sensitivity of these
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.