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Tumour-to-tumour metastasis: colonic adenocarcinoma to papillary thyroid carcinoma
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PATHOLOGY 2013 ABSTRACT SUPPLEMENT
were reviewed and regraded according to the 2000 WHO criteria. Cox-2, PR and Ki-67 immunohistochemistry were performed. Immunohistochemical score (Cox-2, PR) and proliferative index (Ki-67) were analysed. Results: The majority of our patients were female (68%) and of Chinese ethnicity (44.3%). Most tumours were WHO grade 1 (92.5%), meningothelial subtype (57.4%), intracranial (88.5%) and located along the brain convexity (extra-axial) and skull base (42.6% each). The Ki-67 value was significantly higher with increasing WHO grade (p value <0.001). Most of the meningiomas in our series were positive for Cox-2 (77.9%) and PR (83.6%). Cox-2 was expressed in all extracranial tumours (p = 0.038). Discussion: High positivity of Cox-2 and PR expression in our population, especially Cox-2 in extracranial tumours, suggests future biological studies to explore these markers as potential therapeutic targets.
DIGITAL PAPILLARY ADENOCARCINOMA: A CASE REPORT G. Imhagwe, D. Kamra, T. Saw Dorevitch Pathology/Gippsland Pathology Service, Vic, Australia Introduction: Digital papillary adenocarcinomas are rare tumours of eccrine sweat gland origin usually occurring on the fingers and toes and adjacent parts of the palms and soles. Men are more commonly affected than women with a mean age of incidence of 52 years. They can have an indolent course and patients usually present with a painless solitary mass. Reports show they have a high recurrence rate and a tendency for deep infiltration into soft tissue and bone with about 15% of patients developing metastatic disease. These tumours were thought to have a benign counterpart, i.e., digital papillary adenoma, but none of the histological or clinical parameters examined in a study of 67 cases was predictive of recurrence or metastatic potential, thus all lesions are considered to be potentially malignant. Treatment is by wide local surgical excision which may result in amputation of the digit. Clinical history: The case of digital papillary adenocarcinoma is reported in a 53-year-old gentleman who was referred by his GP to the surgeons for excision of a right fingertip lesion that was thought to be an intraepidermal cyst. A wide excision was performed. Pathological features: Macroscopically the lesion was cystic and measured 10 mm in diameter containing tan mucoid material. Sections showed an encapsulated cystic tumour lined by a multilayered epithelium with pseudopapillary and solid glandular growth patterns. The solid glandular areas had a cribriform architecture. Squamous metaplasia, focal necrosis and numerous mitotic figures were present. No soft tissue or bone involvement was seen in this case. Conclusion: The indolent clinical course of these tumours and occasional benign morphology increases the chances of a mistaken diagnosis of a benign lesion, making it quite important to recognise this entity, thus ensuring patients receive appropriate therapy and follow-up. In this case, despite the degree of atypia, the lesion was well clear of the surgical margins and there was no invasion into blood vessels, surrounding soft tissue or bone. References 1. Weedon D. Skin Pathology. 2nd ed. New York: Churchill Livingstone, 2002; 897–8. 2. Fletcher CDM. Diagnostic Histopathology of Tumours. 3rd ed. New York: Churchill Livingstone, 2007; 1464–5.
Pathology (2013), 45(S1) 3. Duke W, Sherrod T, Lupton G. Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). Am J Surg Pathol 2000; 24: 775–84.
TUMOUR-TO-TUMOUR METASTASIS: COLONIC ADENOCARCINOMA TO PAPILLARY THYROID CARCINOMA Louise Jackett, Sarah Saxon, Catriona McLean, Sarah Swain, Janet Gomeze, Michelle Zammit Department of Anatomical Pathology, Alfred Health, Melbourne, Vic, Australia Tumour-to-tumour metastasis, defined as metastasis of one tumour type to a second primary tumour, is a rare and fascinating phenomenon. Approximately 150 cases have been documented in the medical literature. The most common donor neoplasms appear to be from the lung, breast, gastrointestinal tract and kidney,1 while renal cell carcinomas and meningiomas are among the more frequent recipients. There are, however, only around 30 case reports in the literature to date that describe tumour-to-tumour metastasis into thyroid neoplasms.2 We present a case from our institution of colonic adenocarcinoma metastasis to a papillary thyroid carcinoma, a unique combination which, to the best of our knowledge, has not yet been documented in the literature.3 We present the clinicopathological features including aspiration cytology, histology and immunohistochemical profile. We provide an overview of the literature regarding tumour-to-tumour metastases within the thyroid and highlight potential diagnostic pitfalls. References 1. Chung AY, Tran TB, Brumund KT, et al. Metastases to the thyroid: a review of the literature from the last decade. Thyroid 2012; 22: 258–68. 2. Stevens TM, Richards AT, Bewtra C, et al. Tumors metastatic to thyroid neoplasms: a case report and review of the literature. Patholog Res Int 2011; 2011: 238693. 3. Fadare O, Parkash V, Fiedler PN, et al. Tumor-to-tumor metastasis to a thyroid follicular adenoma as the initial presentation of a colonic adenocarcinoma. Pathol Int 2005; 55: 574–9.
INTRADUCTAL CARCINOMA OF PROSTATE (IDC-P) AND HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (HGPIN) IN PROSTATE BIOPSY: WHY WE SHOULD DISTINGUISH ONE FROM THE OTHER Sureshni I. Jayasinghe1,2, David Clouston3 Pathology (Pty) Ltd, 2Healthscope Pathology, The Northern Hospital, Epping, and 3Focus Pathology, South Yarra, Vic, Australia
1Border
Aims: To explore the distinction between Intraductal carcinoma of prostate (IDC-P) and high-grade prostatic intraepithelial neoplasia (HGPIN). Methods: A case of IDC-P is presented with review of literature. Results: Transurethral resection of prostate showed extensive IDC-P associated with a smaller component of Gleason pattern 5 + 5 adenocarcinoma. HGPIN was not identified. Prostate biopsies performed immediately prior were reported as HGPIN associated with Gleason pattern 5+5 adenocarcinoma. Discussion: IDC-P is an uncommon entity characterised by malignant cells that fill and expand pre-existing prostatic ducts and glands, with an intact basal cell layer, featuring cribriform or solid pattern with or without comedonecrosis.1 Morphological criteria have been proposed to distinguish IDC-P from several other
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
PATHOLOGY 2013 ABSTRACT SUPPLEMENT
were reviewed and regraded according to the 2000 WHO criteria. Cox-2, PR and Ki-67 immunohistochemistry were performed. Immunohistochemical score (Cox-2, PR) and proliferative index (Ki-67) were analysed. Results: The majority of our patients were female (68%) and of Chinese ethnicity (44.3%). Most tumours were WHO grade 1 (92.5%), meningothelial subtype (57.4%), intracranial (88.5%) and located along the brain convexity (extra-axial) and skull base (42.6% each). The Ki-67 value was significantly higher with increasing WHO grade (p value <0.001). Most of the meningiomas in our series were positive for Cox-2 (77.9%) and PR (83.6%). Cox-2 was expressed in all extracranial tumours (p = 0.038). Discussion: High positivity of Cox-2 and PR expression in our population, especially Cox-2 in extracranial tumours, suggests future biological studies to explore these markers as potential therapeutic targets.
DIGITAL PAPILLARY ADENOCARCINOMA: A CASE REPORT G. Imhagwe, D. Kamra, T. Saw Dorevitch Pathology/Gippsland Pathology Service, Vic, Australia Introduction: Digital papillary adenocarcinomas are rare tumours of eccrine sweat gland origin usually occurring on the fingers and toes and adjacent parts of the palms and soles. Men are more commonly affected than women with a mean age of incidence of 52 years. They can have an indolent course and patients usually present with a painless solitary mass. Reports show they have a high recurrence rate and a tendency for deep infiltration into soft tissue and bone with about 15% of patients developing metastatic disease. These tumours were thought to have a benign counterpart, i.e., digital papillary adenoma, but none of the histological or clinical parameters examined in a study of 67 cases was predictive of recurrence or metastatic potential, thus all lesions are considered to be potentially malignant. Treatment is by wide local surgical excision which may result in amputation of the digit. Clinical history: The case of digital papillary adenocarcinoma is reported in a 53-year-old gentleman who was referred by his GP to the surgeons for excision of a right fingertip lesion that was thought to be an intraepidermal cyst. A wide excision was performed. Pathological features: Macroscopically the lesion was cystic and measured 10 mm in diameter containing tan mucoid material. Sections showed an encapsulated cystic tumour lined by a multilayered epithelium with pseudopapillary and solid glandular growth patterns. The solid glandular areas had a cribriform architecture. Squamous metaplasia, focal necrosis and numerous mitotic figures were present. No soft tissue or bone involvement was seen in this case. Conclusion: The indolent clinical course of these tumours and occasional benign morphology increases the chances of a mistaken diagnosis of a benign lesion, making it quite important to recognise this entity, thus ensuring patients receive appropriate therapy and follow-up. In this case, despite the degree of atypia, the lesion was well clear of the surgical margins and there was no invasion into blood vessels, surrounding soft tissue or bone. References 1. Weedon D. Skin Pathology. 2nd ed. New York: Churchill Livingstone, 2002; 897–8. 2. Fletcher CDM. Diagnostic Histopathology of Tumours. 3rd ed. New York: Churchill Livingstone, 2007; 1464–5.
Pathology (2013), 45(S1) 3. Duke W, Sherrod T, Lupton G. Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). Am J Surg Pathol 2000; 24: 775–84.
TUMOUR-TO-TUMOUR METASTASIS: COLONIC ADENOCARCINOMA TO PAPILLARY THYROID CARCINOMA Louise Jackett, Sarah Saxon, Catriona McLean, Sarah Swain, Janet Gomeze, Michelle Zammit Department of Anatomical Pathology, Alfred Health, Melbourne, Vic, Australia Tumour-to-tumour metastasis, defined as metastasis of one tumour type to a second primary tumour, is a rare and fascinating phenomenon. Approximately 150 cases have been documented in the medical literature. The most common donor neoplasms appear to be from the lung, breast, gastrointestinal tract and kidney,1 while renal cell carcinomas and meningiomas are among the more frequent recipients. There are, however, only around 30 case reports in the literature to date that describe tumour-to-tumour metastasis into thyroid neoplasms.2 We present a case from our institution of colonic adenocarcinoma metastasis to a papillary thyroid carcinoma, a unique combination which, to the best of our knowledge, has not yet been documented in the literature.3 We present the clinicopathological features including aspiration cytology, histology and immunohistochemical profile. We provide an overview of the literature regarding tumour-to-tumour metastases within the thyroid and highlight potential diagnostic pitfalls. References 1. Chung AY, Tran TB, Brumund KT, et al. Metastases to the thyroid: a review of the literature from the last decade. Thyroid 2012; 22: 258–68. 2. Stevens TM, Richards AT, Bewtra C, et al. Tumors metastatic to thyroid neoplasms: a case report and review of the literature. Patholog Res Int 2011; 2011: 238693. 3. Fadare O, Parkash V, Fiedler PN, et al. Tumor-to-tumor metastasis to a thyroid follicular adenoma as the initial presentation of a colonic adenocarcinoma. Pathol Int 2005; 55: 574–9.
INTRADUCTAL CARCINOMA OF PROSTATE (IDC-P) AND HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (HGPIN) IN PROSTATE BIOPSY: WHY WE SHOULD DISTINGUISH ONE FROM THE OTHER Sureshni I. Jayasinghe1,2, David Clouston3 Pathology (Pty) Ltd, 2Healthscope Pathology, The Northern Hospital, Epping, and 3Focus Pathology, South Yarra, Vic, Australia
1Border
Aims: To explore the distinction between Intraductal carcinoma of prostate (IDC-P) and high-grade prostatic intraepithelial neoplasia (HGPIN). Methods: A case of IDC-P is presented with review of literature. Results: Transurethral resection of prostate showed extensive IDC-P associated with a smaller component of Gleason pattern 5 + 5 adenocarcinoma. HGPIN was not identified. Prostate biopsies performed immediately prior were reported as HGPIN associated with Gleason pattern 5+5 adenocarcinoma. Discussion: IDC-P is an uncommon entity characterised by malignant cells that fill and expand pre-existing prostatic ducts and glands, with an intact basal cell layer, featuring cribriform or solid pattern with or without comedonecrosis.1 Morphological criteria have been proposed to distinguish IDC-P from several other
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.