bromochloroacetic-acid and Hypercalcemia

Non-secretory multiple myeloma is a rare form of the disease that presents a diagnostic challenge. A 69-year-old woman presented to the emergency department with a pathological fracture of the right clavicle, along with a history of asthenia and middle back pain in the preceding three months. Workup revealed multiple focal lytic bone lesions in the clavicles, ribs, skull and thoracic- lumbar-sacral spine, without evidence of anemia, hypercalcemia or renal failure, with no abnormal immunofixation in the serum or urine and with normal serum free light chain ratios. The Iliac crest bone marrow aspiration and biopsy revealed a scarcely involved marrow, However, biopsy of one of the focal bone lesions revealed a hypercellular bone marrow with phenotypically abnormal plasmocytes, along with an intriguing, albeit aberrant, cytokeratin expression. Non-secretory multiple myeloma is in itself a rare diagnosis. However, the combination of a patchy marrow involvement and aberrant cytokeratin expression makes this a noteworthy presentation.. O mieloma múltiplo não-secretor é uma forma rara da doença e um desafio diagnóstico. Uma mulher de 69 anos recorreu ao serviço de urgência com uma fratura patológica da clavícula direita e uma história de astenia e dorsalgia com três meses de evolução. A investigação revelou múltiplas lesões ósseas focais osteolíticas nas clavículas, costelas, crânio e coluna dorso-lombo-sagrada, sem evidência de anemia, hipercalcemia ou insuficiência renal, sem imunofixação anormal no soro ou na urina e com rácios de cadeias leves livres normais. O aspirado e biópsia de medula óssea da crista ilíaca revelou um escasso envolvimento por plasmócitos. No entanto, a biópsia de uma das lesões focais revelou uma medula hipercelular com plasmócitos fenotipicamente anormais e com uma aberrante expressão de citoqueratinas. O mieloma múltiplo não-secretor é por si só um diagnóstico raro. Contudo, a combinação de envolvimento irregular da medula e a expressão aberrante de citoqueratinas são merecedoras de atenção.

Topics: Aged; Bone Marrow; Clavicle; Female; Humans; Hypercalcemia; Keratins; Multiple Myeloma

Topics: Calbindin 2; Carcinoma, Small Cell; Female; Humans; Hypercalcemia; Keratins; Ovarian Neoplasms; S100 Calcium Binding Protein G; Young Adult

Ovarian sex cord-stromal tumors are a morphologically diverse group of neoplasms that can mimic the appearance of other ovarian tumors. Because the treatment and prognosis of sex cord-stromal tumors differs substantially from those of other ovarian neoplasms, the development of an immunohistochemical panel to support the diagnosis of the former group of tumors would be useful. In this report, the utility of immunostaining for inhibin alpha, epithelial membrane antigen, MIC2 gene protein product, and keratin in the differential diagnosis of sex cord-stromal tumors was assessed in formalin-fixed, paraffin-embedded sections. In addition, the immunohistochemical staining pattern of ovarian small cell carcinomas (SCCs), hypercalcemic type, was analyzed in an attempt to clarify the histogenesis of these tumors. Thirty-two (97%) of 33 granulosa cell tumors (GCTs), 10 (91%) of 11 Sertoli-Leydig cell tumors (SLCTs), and 4 (8%) of 51 carcinomas showed inhibin alpha immunopositivity. None of the 3 lymphomas, 5 carcinoids, 6 dysgerminomas, or 12 SCCs showed inhibin alpha positivity. Eighteen (55%) GCTs, 6 (55%) SLCTs, 6 (12%) carcinomas, and 7 (58%) SCCs showed MIC2 gene expression. None of the GCTs and only one SLCT showed epithelial membrane antigen (EMA) positivity, although 92% of surface epithelial carcinomas and 75% of SCCs were immunoreactive. These data suggest that detection of inhibin immunoreactivity in an ovarian tumor that is EMA-negative provides both sensitive and specific support for the diagnosis of a sex cord-stromal tumor. Because SCCs generally stain for EMA but not for inhibin, it appears that SCCs probably represent a variant of surface epithelial tumor rather than a type of sex cord-stromal tumor.

Topics: 12E7 Antigen; Antigens, CD; Biomarkers, Tumor; Carcinoma, Small Cell; Cell Adhesion Molecules; Diagnosis, Differential; Female; Granulosa Cell Tumor; Humans; Hypercalcemia; Immunohistochemistry; Inhibins; Keratins; Mucin-1; Ovarian Neoplasms; Sertoli-Leydig Cell Tumor; Sex Cord-Gonadal Stromal Tumors

Primary squamous cell carcinoma of the liver is exceedingly rare and has previously been reported in association with hepatic teratoma, hepatic cyst or hepatolithiasis. This paper describes an autopsy case of squamous cell carcinoma which developed with hypercalcemia in a cirrhotic liver. This cancer was characterized histologically, immunohistologically and ultrastructurally, and was found to exhibit immunofluorescence positivity for anti-epidermal keratin monoclonal antibody, together with the presence of tonofilaments scattered sparsely in the cytoplasm of the cancer cells.

Topics: Antibodies, Monoclonal; Calcium; Carcinoma, Squamous Cell; Humans; Hypercalcemia; Immunohistochemistry; Keratins; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged

Topics: Animals; Calcification, Physiologic; Calcinosis; Calcium; Dihydrotachysterol; Hair; Hypercalcemia; Keratins; Male; Phosphorus; Rats; Skin; Time Factors; X-Ray Diffraction