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Cancer
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Breast cancers most commonly develop from epithelial tumors. Carcinoma in situ is diagnosed when there is cancer cell proliferation in the ducts or lobules. The majority of breast cancers are ductal carcinomas. A small or wide breast area may be affected. If the area is wide, microscopic invasive foci may eventually develop. Metastatic carcinoma is usually adenocarcinoma. The mucinous subtype usually develops in older women, and grows slowly with a much better prognosis. Inflammatory breast cancer grows quickly and is often fatal. Breast cancer may spread via the regional lymph nodes, bloodstream, or both. Metastatic breast cancer may spread to the lungs, bones, brain, liver, or skin. The pathophysiological link between diabetes and breast cancer is a bit complicated. When there is increased abdominal fat, there is decreased production of adiponectin and increased production of estrogen – all of which lead to increased insulin levels. Increased insulin also increases estrogen and increases the blood supply to cancer cells. Increased estrogen decreases sex hormone binding globulin, further increasing estrogen, and the increased estrogen contributes to breast cancer cell growth.
Miscellaneous
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
Metastatic carcinoma represents the most common malignant tumor in the liver. The primary neoplasm is most likely in the stomach, pancreas, colon, kidney, lung, and breast (Figures 154 to 156). The rare multiple bile-duct hamartomas should be considered in the differential diagnosis.306
Brain
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
Joseph Kovi, M.D. Hung Dinh Duong
Meningioma must be differentiated from an intracerebral tumor (astrocytoma or glioblastoma), and also from metastatic neoplasm to the meninges. Skull X-ray, EEG, brain scan, and computed axial tomography is of great assistance in determining whether the lesion is intracerebral or extracerebral. Metastatic carcinoma to the brain coverings can be suspected from the history and from the rapid onset of clinical symptoms and signs. Meningioma is a slowly growing tumor and the duration of symptoms may be years. Cytological study of the cerebrospinal fluid often reveals malignant cells in a patient with metastatic meningeal neoplasia.
Intraparenchymal Schwannoma: A Rare Entity
Published in Neuro-Ophthalmology, 2021
Michael S. Vaphiades, James Hackney
There were several alternative histological diagnostic possibilities including cystic meningioma, pilocytic astrocytoma or other astrocytic neoplasm (potentially seeded into the meninges), metastatic carcinoma, metastatic melanoma, a primary meningeal sarcoma and neurofibroma. All of these alternatives were eliminated based on the immunohistochemical profile, the histological appearance of the lesion or both. Although astrocytic neoplasms are S100 positive, they should be GFAP immunoreactive. Further, the extensive collagen type IV staining evident in this tumour is not characteristic of astrocytic neoplasms. The morphological features of this tumour, together with the absence of cytokeratin and/or EMA immunoreactivity, mitigates against metastatic carcinoma. Likewise, the morphology and immunophenotype of this tumour are inconsistent with metastatic melanoma. Meningiomas, the main differential diagnosis, should be EMA positive and S100 negative. Our patient was EMA negative and S-100 positive. Finally, this tumour does not show the characteristic mixture of cell types and the presence of axons scattered throughout the tumour; features that are typically present in neurofibromas.
A perianal subcutaneous metastasis as the presenting sign for lung cancer
Published in Baylor University Medical Center Proceedings, 2021
Aaminah Azhar, Elizabeth Wilder
A 77-year-old white man presented with a 9-day history of a rapidly growing and painful mass on his left buttock. He reported a 60 pack-year smoking history, previously worked in the US Navy, and had exposure to asbestos. Present in his left medial buttock, in the gluteal cleft, was a 2.2 cm subcutaneous mass (Figure 1a) with an overlying punch biopsy wound. Initial pathology reports from the punch biopsy showed a dermal carcinoma compatible with poorly differentiated SCC. Given the deep dermal location of the neoplasm and the complete lack of epidermal involvement, a metastatic carcinoma could not be excluded. The lesional cells were positive for cytokeratin AE1/AE3 and negative for Mart-1. This immunohistochemical profile along with the histomorphology confirmed the diagnosis of a poorly differentiated SCC. Wide local excision of the mass (Figure 1b) and full-body positron emission tomography (PET)–computed tomography imaging were carried out.
Renal cell carcinoma with metastases to the rectum and gastric body
Published in Baylor University Medical Center Proceedings, 2020
Michelle Bernshteyn, Umair Masood, Alexandria Smith-Hannah, Divey Manocha
A 68-year-old man with stage IV renal cell carcinoma (RCC) to the skin and lung, treated by right total nephrectomy and right upper lobe wedge resection, presented to the hospital with a 1-month history of dyspnea and 10 to 15 episodes of melena per day. His heart rate was 121 beats per minute and his blood pressure quickly dropped from 130/80 mm Hg to 110/60 mm Hg. His abdomen was tender. He was cachectic. His hemoglobin was 6.7 g/dL and his serum sodium level was 128 mmol/L. The hepatic panel and coagulation parameters were within normal limits. Hemoccult testing was positive. He was subsequently started on intravenous fluids, a pantoprazole infusion, and blood transfusions (2 units). A computed tomography scan of the abdomen demonstrated a metastatic lesion in the distal sigmoid colon. Endoscopy revealed a nodule in the duodenum, and a mass was visualized on the greater curvature of the gastric body (Figure 1a). Colonoscopy revealed a single 10-mm polyp in the rectum, which was treated with bipolar cauterization. Pathological reports demonstrated metastatic carcinoma consistent with a renal primary source (Figure 1b).