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Skin and soft tissue
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The commonest presenting symptom is pruritis; the lesion is typically erythematous, eczematous and scaly. It is often mistaken for inflammatory or infective conditions such as lichen sclerosus, Bowens, psoriasis, eczema, tinea cruris, etc. A high index of suspicion is needed in persistent lesions and definitive diagnosis requires biopsy. Cell markers such as carcinoembryonic antigen, CAM 5.2, epithelial membrane antigen and cytokeratin 7 can enhance diagnostic accuracy. Differential metalloproteinase distribution and mucin gene expression have also been noted in those with or without underlying carcinoma.
Liver, Gallbladder, and Exocrine Pancreas
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Russell C. Cattley, James A. Popp, Steven L. Vonderfecht
A variety of immunohistochemical markers can be used to differentiate the epithelial components of the exocrine pancreas, although some species differences are noted. In the rat, cytokeratins 19 and 20 were detected only in cells of the ductal system, from centroacinar cells to the main ducts. Antibodies to cytokeratin 7 labeled epithelial cells of the main, interlobular, and intralobular ducts, but not the centroacinar or terminal duct cells and weakly stained cells in the islets. All three of these cytokeratins were expressed in proliferating ducts during tissue regeneration following partial pancreatectomy (Bouwens et al. 1995). Additionally, antibodies to Sox9 and Hnf1b have been used to label centroacinar and duct epithelium (Solar et al. 2009; Furuyama et al. 2011; Kopp et al. 2011).
Pathophysiology of Accreta
Published in Robert M. Silver, Placenta Accreta Syndrome, 2017
Eric Jauniaux, Amar Bhide, Graham J. Burton
Ki-67, a nuclear protein that is associated with, and may be necessary for, cellular proliferation is rarely observed in EVT, except in the trophoblast columns of first-trimester PA cases.90 Increased VEGF and phosphotyrosine immunostaining has been observed in EVT cells from PA.91 These cells also co-expressed vimentin and cytokeratin-7, an epithelial-to-mesenchymal transition feature and tumor-like cell phenotype (Table 2.1). Lower MS levels of free VEGF and a switch of the interstitial EVT to a metastable cell phenotype have been reported in placenta previa with excessive myometrial invasion.91 One of the proposed mechanisms through which the EVTs lose their invasive phenotype is through syncytial-type fusion into MNGCs.90 The secretion of VEGF by MNGCs is likely to be one of the signals initiating and coordinating vascularization in the decidua and placenta during implantation.92 More recently, soluble fms-like tyrosine kinase (sFLT-1), which is a potent antiangiogenic growth factor that has been found to be markedly elevated in preeclampsia, has been found in lower concentration in the MS and in lower immunostaining in the EVTs cells of women presenting with PA.93 These findings suggest that VEGF and sFLT-1 play a pivotal role in the process of pathological programming of EVTs toward increased motility and invasiveness in PA.
Metastatic pulmonary pleomorphic carcinoma replaced by a granulomatous lesion after spontaneous regression and PD-1 blockade-induced regression: can epithelioid granuloma be a histological hallmark of cancer immunity?
Published in Immunological Medicine, 2023
Naoki Shijubou, Yuichiro Asai, Michiko Hosaka, Keiko Segawa, Terufumi Kubo, Masahiro Miyajima, Tomohide Tsukahara, Yoshihiko Hirohashi, Takayuki Kanaseki, Kenji Murata, Atsushi Watanabe, Tadashi Hasegawa, Hirofumi Chiba, Toshihiko Torigoe
At 8 months after the first visit, abdominal CT showed thickening of the duodenal wall (Figure 2(A)). Gastrointestinal endoscopy revealed a type 2 tumor in the third portion of the duodenum. The duodenal biopsy specimen consisted predominantly of polygonal cells with an abundant amount of pale eosinophilic cytoplasm, irregular nuclear contour, and increased chromatin, suggesting a malignant tumor (Figure 2(B)). The tumor cells did not express caudal type homeobox 2, a marker for intestinal differentiation (data not shown). Although the tumor cells were positive for cytokeratin 7, no other typical diagnostic markers for pulmonary adenocarcinoma or squamous cell carcinoma were detected (data not shown). A SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4)-deficient tumor was also excluded, indicating pleiotropic carcinoma probably originating from the lung. Since more than 50% of the tumor cells highly expressed programmed death ligand 1 (PD-L1), pembrolizumab monotherapy was started as first-line treatment for metastatic pulmonary pleomorphic carcinoma (Figure 2(B)).
Acute inflammatory presentation of orbital metastasis from urothelial carcinoma: a case report
Published in Orbit, 2022
Abdullah Ghali, Tyler Bahr, Anusha Sherwani, Mouhamed Nashawi, David Wilde, Scott Woolf
Tissue pathology at high power noted cellular irregularities such as a linear pattern suspicious of metastatic growth, irregular cell morphology with variable nuclear:cytoplasmic ratio and some inclusion bodies, and urothelial-like cells. Immunohistologic stains specific for urothelial markers cytokeratin 7 (CK7) and GATA3 were performed, and the positive staining provided definitive evidence of metastatic urothelial carcinoma (shown in Figures 4 and 5). No additional tumor markers were assessed. The tumor was staged IV-B due to distant metastasis to a distant organ. The patient was referred to hematology/oncology for outpatient follow-up, but he elected not to meet with the team or initiate treatment. He was seen by palliative care and elected to go home on hospice with comfort care and expired at home about 3.5 months after the start of his ocular symptoms.
Diagnosis of epithelioid hemangioendothelioma eight days postpartum: Is there a link with pregnancy? A case report and review of the literature
Published in Acta Clinica Belgica, 2022
Nicky Somers, David Creytens, Simon Van Belle, Gwen Sys, Lore Lapeire
Echo-guided biopsy of the largest liver lesion (largest diameter of 3 cm) showed features suggestive of EHE. Based on the light microscopic evaluation, cords of endothelial cells were found, associated with cytoplasmic vacuoles (Figure 2). No atypical histological features (including nuclear pleomorphism, increased mitotic activity, solid sheet-like growth or necrosis) were observed. The tumor cells were immunoreactive for cytokeratin 7, CD31, CD34, ERG and Factor VIII. Moreover, strong and diffuse CAMTA1 expression was seen in the tumor cells. Estrogen and progesterone receptor expression was negative. Based on the morphology and the immunohistochemical profile, a diagnosis of HEHE was made. Meanwhile, a PET-CT with 18 F-fluorodeoxyglucose was used to evaluate lesions at other sites. Multiple focal spots in the liver could be visualised. There was no uptake in the pulmonary nodules, as these lesions were too small to be detected.