bromochloroacetic-acid and Fistula

Spindle cell carcinoma (SpCC) is a rare tumor consisting of spindle cells which express cytokeratin. Despite recent advances in immunohistochemical and genetic studies, precise histogenesis of SpCC is still controversial and this tumor had been referred to with a wide range of names (in the past): carcinosarcoma, pseudosarcoma, sarcomatoid carcinoma, pseudosarcomatous carcinoma, and collision tumor. Recently, the authors experienced an extremely rare case of SpCC arising from the stomach. A 64-year-old male presented with unintended weight loss and hematochezia. Endoscopic examination revealed a fistulous tract between the stomach and the transverse colon which was made by direct invasion of SpCC of the stomach to the colon. Histologically, the tumor was positive for both vimentin and cytokeratin but negative for CD117, CD34, actin, and desmin. Herein, we report a case of SpCC arising from the stomach that formed a fistulous tract with the colon which was diagnosed during evaluation of hematochezia and weight loss.

Topics: Antineoplastic Agents; Brain Neoplasms; Carcinoma; Colon, Transverse; Endoscopy, Digestive System; Fistula; Gastrointestinal Hemorrhage; Humans; Keratins; Magnetic Resonance Imaging; Male; Middle Aged; Stomach Neoplasms; Tomography, X-Ray Computed; Weight Loss

Topics: Abscess; Adenoma; Adenoma, Sweat Gland; Biomarkers; Breast Diseases; Breast Neoplasms; Female; Fistula; Humans; Keratin-7; Keratins; Mucin-1; Nipples; Paget's Disease, Mammary; Receptor, ErbB-2; Sweat Gland Neoplasms

We describe a highly unusual lesion characterized grossly by the formation of a cavity within the lower uterine segment and upper endocervix that communicated with bilateral fistulae to both parametria. Histologically, the cavity and fistulous tracts were entirely coated by fibrinous material with underlying intermediate trophoblastic cells with atypical degenerate nuclei, absent mitotic activity, and a low MIB1 proliferation index. The overall cellular morphology of the lesion was similar to that of the well-circumscribed placental site nodule or plaque. Apart from the lining of the fistulae, there was no invasion of the myometrium by the trophoblastic cells. The patient had undergone previous cesarean deliveries; the lesion was related to the surgical site and was probably secondary to the previous surgery. In a review of the literature, we identified only a single previous report of a somewhat similar case. We propose the term uterine diffuse intermediate trophoblastic lesion resembling placental site plaque for this rare condition.

Topics: Adult; Female; Fistula; Humans; Keratin-1; Keratin-3; Keratins; Placenta; Pregnancy; Trophoblasts; Uterine Neoplasms; Uterus

Topics: Aged; Fistula; Hearing Loss, Sensorineural; Humans; Immunohistochemistry; Keratins; Labyrinth Diseases; Male; Ossicular Replacement; Otosclerosis; Oval Window, Ear; Rupture, Spontaneous; Saccule and Utricle

The surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. Forty cases (41 ears) of labyrinthine fistulas were reviewed. This represented 10% of our total series of cholesteatomas in adults and children (426 ears). Clinical presentation, extent of disease, results of fistula testing and audiometric studies, and radiographic findings were analyzed. A canal wall-down procedure was performed in all but one patient. Generally an attempt was made to completely remove the cholesteatoma, to graft the fistulous area, and to reconstruct the middle ear mechanism in one stage. The matrix was preserved in patients with large fistulas where the involved ear was the only hearing one, when the matrix was adherent to the underlying optic duct, and in selected elderly persons. Long-term followup did not reveal a significant difference in hearing, degree of vertigo, or incidence of recidivism when those patients in whom the matrix was removed were compared with those in whom the matrix was preserved. The importance of recognizing the presence of a labyrinthine fistula preoperatively is stressed, along with the need to be prepared for an unexpected fistula. Operative management is described.

Topics: Adolescent; Adult; Aged; Child; Cholesteatoma; Fistula; Hearing Loss, Conductive; Hearing Loss, Sensorineural; Humans; Keratins; Labyrinth Diseases; Mastoid; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Vertigo