Perianal skin and anal cancer
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Also rare, this is a bizarre lesion: the nature, pathogenesis, and natural history remain unclear. First described as a disease of the nipple, the anus is the most common site for so-called ‘extra-mammary Paget’s disease’. The typical appearance is a slightly raised area of variegated red/gray discoloration of the skin around the anus. It is four times more common in women. The diagnosis is confirmed by the typical Paget’s cells, with their abundant foamy cytoplasm, infiltrating the epidermis of the perianal skin. In at least 25 percent of cases, an occult adenocarcinoma will be found, usually in the rectum, but sometimes more proximally. Occasionally, Paget’s disease itself can metastasize to the inguinal lymph nodes. In the absence of an associated primary adenocarcinoma, surgical treatment is usually by wide local excision and appropriate skin advancement or grafting.
Post-esophagectomy Colon Diaphragmatic Herniation
Wickii T. Vigneswaran in Thoracic Surgery, 2019
Her physical exam at her initial preoperative consultation was normal; she was a well-nourished woman with a soft abdomen with no gross neurological deficits. An esophagogastroduodenoscopy revealed semi-circumferential thickening with central ulceration at the esophagogastric junction, a hiatal hernia, and antral erosions. A biopsy of the suspicious lesion was positive for adenocarcinoma. Other testing included an endoscopic ultrasound, which showed a T1N0 lesion, and a PET scan, which demonstrated only local disease. It was felt that she was a surgical candidate, but she was referred to Neurosurgery for evaluation of her untreated brain aneurysms. The neurosurgeon noted that her two brain aneurysms were small and asymptomatic and therefore recommended she follow-up in one year with imaging.
Radiologic Diagnosis of Pulmonary Neoplasms
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
The incidence of adenocarcinoma has risen dramatically since the 1980s to become currently the most common of all lung cancers, making up nearly half of all cases (21). Since adenocarcinoma more commonly occurs peripherally in the distal airways, many initially attributed its increased incidence to advances in chest CT, the use of flexible bronchoscopy, and improved histologic stains for mucin. Epidemiologic data from the American Cancer Society, however, revealed two more likely reasons for the rise in adenocarcinoma stemming from changes in cigarette design. The first is the change from unfiltered cigarettes to medium-yield filtertip cigarettes in the 1950s, allowing smoke to be inhaled more deeply and carcinogens to reach the bronchioloalveolar junction where adenocarcinomas are frequently found. The second design change to cigarettes, which also occurred in the 1950s, was the use of blended reconstituted tobacco with higher concentrations of nitrosamines derived from tobacco stems in place of purely tobacco leaves alone. Nitrosamines in the rodent model were shown to induce adenocarcinoma (22,23). In Connecticut, from 1959 through 1991, there was found to be a 17-fold increased incidence of adenocarcinoma in women and a 10-fold increase in men, both strongly associated with cigarette smoking (22). One other finding that remains unresolved is the increased incidence of adenocarcinoma among nonsmokers as well.
Immunohistochemistry features and molecular pathology of appendiceal neoplasms
Published in Critical Reviews in Clinical Laboratory Sciences, 2021
Reger R. Mikaeel, Joanne P. Young, Gonzalo Tapia Rico, Peter J. Hewett, Jennifer E. Hardingham, Wendy Uylaki, Mehgan Horsnell, Timothy J. Price
The PSOGI expert panel recommended that the term, adenocarcinoma, be reserved for tumors with infiltrative invasion, which refers to destructive stromal invasion into the appendiceal wall. In addition, in contrast to “pushing” invasion of LAMNs and HAMNs that is associated with poorly cellular, dense and often hyalinized fibrosis, features of infiltrative invasion include desmoplastic reaction, small angulated irregular glans or tumor budding [14] (Figure 2). Accordingly, the PSOGI system classifies AMNs with infiltrative invasion into three types: mucinous adenocarcinomas (MACs), poorly differentiated adenocarcinoma with signet ring cells, and signet ring cell carcinoma [14]. The AJCC system classifies MACs as either moderately differentiated (G2) neoplasms that exhibit high-grade cytology with infiltrative invasion but without signet ring cells, or poorly differentiated (G3) neoplasms that exhibit high-grade cytology with signet ring cells and typically infiltrative invasion [12]. However, the WHO classification system (2019) uses a three-tiered grading system for grading LAMNs, HAMNs and mucinous adenocarcinoma, and a two-tiered grading system for grading non-mucinous adenocarcinoma that is similar to the system for grading CRC [9].
Advances in technologies for cervical cancer detection in low-resource settings
Published in Expert Review of Molecular Diagnostics, 2019
Kathryn A. Kundrod, Chelsey A. Smith, Brady Hunt, Richard A. Schwarz, Kathleen Schmeler, Rebecca Richards-Kortum
The gold standard for the diagnosis of both cervical dysplasia and invasive cancer is histopathologic examination of biopsied specimens to identify premalignant and malignant conditions of the cervix. In this process, a pathologist examines the biopsied epithelium of the cervix and classifies it according to the fraction of the epithelial layer that displays abnormal cellular morphology. For squamous epithelium, cervical intraepithelial neoplasia (CIN) 1 or low-grade squamous intraepithelial neoplasia (LSIL) is when a third or less of the epithelium has undergone cellular changes; CIN2 and 3 or high-grade squamous intraepithelial neoplasia (HSIL) is when greater than one-third of the squamous epithelium displays abnormal cellular morphology. Adenocarcinoma-in-situ (AIS) is when the glandular cells show abnormal morphology. Cancer is diagnosed when invasion is noted in the squamous epithelium (squamous cell carcinoma) or glandular epithelium (adenocarcinoma). If left untreated, CIN2 or more severe diagnoses (referred to as CIN2+ diagnoses) can progress to invasive cancer and therefore are commonly treated by ablation or excision to prevent progression [5]. More detailed definitions of tumors and their precursors are outlined in the World Health Organization (WHO) Blue Book [8]. Screening and diagnostic tests are generally evaluated in terms of clinical sensitivity and specificity relative to the gold-standard of biopsy-proven CIN2+; the sensitivities and specificities reported throughout this article follow this convention.
Lacrimal gland pleomorphic adenoma with extensive necrosis
Published in Orbit, 2022
Micheal A. O’Rourke, Penelope A. McKelvie, Christopher M. Angel, Alan A. McNab
Two days prior to surgical exploration of the lacrimal gland, the patient developed painful acute S-shaped swelling and pain of the left upper lid (Figure 1b). She was prescribed Diclofenac and Amoxicillin/Clavulanic acid. Bacterial and viral conjunctival swabs were non-contributory. The swelling abated quickly and an incisional biopsy via the upper lid skin crease was carried out as scheduled which identified firm, necrotic tissue. Histology showed an inflamed lacrimal gland with focal necrosis and atypia of adjacent cytology and gland architecture (Figure 2a). There were interconnected and infiltrating cords of atypical low columnar and cuboidal epithelial cells bearing moderately atypical, mostly ovoid hyperchromatic nuclei with mildly coarse chromatin and occasionally small and sometimes multiple nucleoli. The cells had eosinophilic or clear cytoplasm forming glandular structures with pale blue mucin within lumina and the background stroma was fibrosclerotic and densely hyalinotic in appearance (Figure 2a). There was no perineural or lympho-vascular invasion and no adenoid cystic architectural patterns. These features suggested a diagnosis of adenocarcinoma.
Related Knowledge Centers
- Carcinoma
- Epithelium
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- Exocrine Gland
- Endocrine System
- Neoplasm
- Breast Cancer
- Cancer
- Gland
- Invasive Carcinoma of No Special Type