bromochloroacetic-acid and Peritoneal-Neoplasms

To present the clinicopathologic features of two cases of luteinized thecomas with sclerosing peritonitis (LTSP), characterize the cellular proliferation in the sclerosing peritonitis (SP), and review the literature.. The clinical, laboratory, and imaging data, operative findings, and pathology materials were reviewed and summarized. Samples of the SP were stained with keratin AE1/AE3, vimentin, CD34, calretinin, smooth muscle actin, ER/PR, CD10 and desmin. A literature search was performed to identify cases of LTSP for comparison.. A total of 43 cases of LTSP syndrome were identified. Frequent clinical features included ascites (74%), abdominal pain (35%), bowel obstruction (42%), and bilateral masses (84%). We isolated a distinct form of ovarian luteinized thecoma (thecomatosis) and peculiar sclerosing peritonitis (SP). IHC analysis shows a proliferation of specialized (vimentin+/keratin+/CD34+) submesothelial fibroblasts (SMF) with patchy expression of calretinin and hormone receptors.. LTSP syndrome is a rare entity presenting with abdominal pain, bowel obstruction, ascites, ovarian masses, and SP containing specialized (vimentin+/keratin+/CD34+) SMF. LTSP must be distinguished from abdominal cocoon, isolated SP, Meigs' syndrome, and peritoneal carcinomatosis. The importance of recognizing the diagnosis is stressed, as failure to manage this disease conservatively leads to significant morbidity and mortality. The SP and bowel obstruction may persist for months, even after resection of the tumours, resulting in extended medical therapy. Based on the immunophenotype of the peritoneal lesions, strategies to elucidate 'targeted' pharmacologic agents that could inhibit the proliferation of specialized (vimentin+/keratin+/CD34+) SMF may be of benefit.

Topics: Adult; Antigens, CD34; Antineoplastic Agents; Carcinoma; Disease Management; Female; Fibroblasts; Humans; Intestinal Obstruction; Keratins; Meigs Syndrome; Middle Aged; Ovarian Neoplasms; Ovariectomy; Peritoneal Fibrosis; Peritoneal Neoplasms; Thecoma; Treatment Outcome; Vimentin

Extraovarian yolk sac tumors (YSTs) arising in the omentum represent an exceedingly rare malignancy.. A 37-year-old Korean woman was admitted with a history of lower abdominal pain of 3 weeks duration. Pelvic computerized tomography (CT) scanning reported a bilateral ovarian malignancy with peritoneal seeding. Exploration findings revealed a greater omental mass and the result of frozen biopsy was adenocarcinoma or mesothelioma. She was treated with supracolic omentectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymph node dissection, multiple peritoneal biopsies and appendectomy. Histological evaluation of the specimen after operation exhibited typical patterns of YST and stained for alpha-fetoprotein (AFP) and cytokeratin. Four courses of bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy repeated every 3 weeks were added to therapy and she has remained free of disease for 1 year after completion of the therapy.. To our knowledge this is the fourth case of primary omental YST. A review of the literature indicates that the diagnosis of YST requires proper evaluations of tumor makers and a skilled pathologist for analysis of frozen sections.

Topics: Adult; alpha-Fetoproteins; Antineoplastic Combined Chemotherapy Protocols; Appendectomy; Bleomycin; Cisplatin; Endodermal Sinus Tumor; Etoposide; Fallopian Tubes; Female; Histocytochemistry; Humans; Keratins; Lymph Node Excision; Omentum; Ovariectomy; Peritoneal Neoplasms; Peritoneum; Tomography, X-Ray Computed

Topics: Adenocarcinoma; Biomarkers, Tumor; Brain Neoplasms; Breast Neoplasms; Carcinoma, Hepatocellular; Carcinoma, Neuroendocrine; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cell Differentiation; Cytogenetic Analysis; Head and Neck Neoplasms; Humans; Immunohistochemistry; Keratins; Liver Neoplasms; Lymphatic Metastasis; Magnetic Resonance Imaging; Mesothelioma; Neoplasm Metastasis; Neoplasms, Unknown Primary; Peritoneal Neoplasms; Positron-Emission Tomography; Prognosis; Rhabdomyosarcoma; Tomography, X-Ray Computed; Urinary Bladder Neoplasms

We report two rare cases of neoplastic pseudomyxoma peritonei associated with splenic mucinous epithelial cysts and review previously reported cases of splenic mucinous lesions in order to investigate the extent and implications of such an association.. The majority of mucinous lesions of the spleen appear to be associated with pseudomyxoma peritonei. The clinicopathological profile of these cases conforms to that of neoplastic pseudomyxoma peritonei, showing a similar age of onset, outcome and histological features. Most of the cases were associated with a confirmed or suspected appendiceal primary. The immunophenotype (cytokeratin 7 negative; cytokeratin 20 and CEA positive) of the lesions of both our cases, including those in the ovary, was suggestive of a gastrointestinal origin.. Splenomegaly due to cystic intrasplenic mucinous epithelial lesions may occasionally be the presenting feature of pseudomyxoma peritonei or herald tumour recurrence. Mucinous epithelial cysts of the spleen may also precede the development of pseudomyxoma peritonei. All cases of pseudomyxoma peritonei should be investigated for splenic involvement and, conversely, a primary mucinous neoplasm sought elsewhere in the abdomen in all cases of splenic mucinous cysts.

Topics: Cysts; Epithelial Cells; Fatal Outcome; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Middle Aged; Mucins; Peritoneal Neoplasms; Pseudomyxoma Peritonei; Splenic Diseases

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition that primarily affects women of reproductive age. Immunohistochemical studies were performed in four cases: LPD from a premenopausal woman on oral contraceptives (one case); LPD associated with postpartum massive ectopic decidual reaction (one case); and LPD from a perimenopausal and a postmenopausal woman. Progesterone receptor activity was present in nine of nine cases, and eight of eight cases were strongly positive for vimentin; reactivity for cytokeratin was uniformly negative. Most cases had a pattern of staining typical of smooth muscle tumors with expression of desmin, smooth muscle actin, and muscle-specific actin. Although estrogen receptor was detected in most cases, reactivity was notably absent (one case) or weak (one case) in nodules with a prominent decidual reaction. Expression of CD 34, a marker for which LPD staining characteristics have not been previously reported, varied from absent to weak. Peritoneal nodules from the postmenopausal woman lacked staining for both estrogen receptor and desmin, smooth muscle actin and muscle-specific actin were only focally expressed, whereas staining for CD 34 was focally intense. Uterine myometrium and leiomyomata were positive for progesterone and estrogen receptor, vimentin, desmin, smooth muscle actin, and muscle-specific actin. Cytokeratin expression was absent. CD 34 exhibited weak staining in leiomyomata, but was absent from myometrium. Progesterone receptor appears to be uniformly expressed in LPD nodules from premenopausal and postmenopausal women, a finding supporting the contention that hormones influence the development of LPD in all cases, regardless of menopausal status.

Topics: Actins; Adult; Antigens, CD34; Desmin; Female; Humans; Immunohistochemistry; Keratins; Leiomyomatosis; Menopause; Middle Aged; Peritoneal Neoplasms; Postmenopause; Premenopause; Receptors, Estrogen; Receptors, Progesterone; Vimentin

Malignant mixed mesodermal tumors (malignant mixed Müllerian tumors [MMMT]) occur rarely in extragenital sites.. The authors analyzed the clinical, pathologic, and immunohistochemical features of three cases of primary MMMT of the female peritoneum.. The neoplasms occurred in 60-, 64- and 84-year-old women and arose from pelvic peritoneum. Two patients died with disseminated disease 8 and 24 months postoperatively. The third died of cardiac failure 12 months postoperatively with questionable metastatic disease. Microscopically, two tumors were of the heterologous type, containing foci of rhabdomyosarcomatous (case 1) and chondrosarcomatous (case 3) differentiation. Immunohistochemically, coexpression of keratin and vimentin was observed focally in both carcinomatous and sarcomatous components in all three neoplasms, whereas coexpression of low molecular weight cytokeratin, vimentin and actin was observed focally in case 2. Rhabdomyosarcomatous areas were positive with desmin and actin, and chondrosarcomatous areas for S-100 protein. Both epithelial and mesenchymal components were positive for alpha-1 antichymotrypsin in all cases.. On the basis of the present cases and a review of 15 reports from the literature, primary MMMT of the female peritoneum proved to be a rare but highly malignant neoplasm occurring in elderly postmenopausal women. Of 15 patients with available follow-up, 12 died with disease, mostly within 1 year, regardless of the initial tumor stage, histology (homologous versus heterologous MMMT) or treatments attempted. The tumor developed within pelvic peritoneum in half the cases. Histogenetically, peritoneal MMMT are thought to represent "metaplastic" carcinomas originating from the secondary Müllerian system.

Topics: Actins; Aged; Aged, 80 and over; alpha 1-Antichymotrypsin; Chondrosarcoma; Desmin; Female; Humans; Immunohistochemistry; Keratins; Middle Aged; Mixed Tumor, Mullerian; Peritoneal Neoplasms; Prognosis; Rhabdomyosarcoma; S100 Proteins; Vimentin

Diffuse malignant mesothelioma is a rare tumor in the general population, yet is unique in that it is caused almost exclusively by exposure to asbestos with long-term latency (15 years and over). Pathologists are required to provide a reliable diagnosis of the tumor for clinicians who are responsible for the treatment of affected patients. Pathological diagnosis of diffuse malignant mesothelioma is not always easy; however, it has improved over the last few decades. Currently, comprehensive analysis, including gross appearance, histology, histochemistry, immunocytochemistry and electron microscopy is recommended as the best approach to an accurate diagnosis of diffuse malignant mesothelioma.

Topics: Carcinoembryonic Antigen; Humans; Hyaluronic Acid; Immunohistochemistry; Keratins; Membrane Glycoproteins; Mesothelioma; Microscopy, Electron; Mucin-1; Mucins; Peritoneal Neoplasms; Pleural Neoplasms

A diffuse, well-differentiated, malignant peritoneal mesothelioma (MPM) developed in a nine-year-old girl. She received limited chemotherapy and radiation therapy and is alive and well without clinical evidence of disease 109 months after diagnosis. The neoplastic cells stained immunohistochemically for cytokeratin and epithelial membrane antigen but were unreactive with B72.3, anti-carcinoembryonic antigen, and anti-Leu-M1. Ultrastructurally, the tumor cells had abundant desmosomes, numerous tonofilament bundles, and variable-length microvilli. These findings confirm the mesothelial nature of the cells. Features consistent with malignancy included DNA aneuploidy by flow cytometric analysis and diffuse peritoneal involvement. The three previously described survivors with MPM were also premenarchal girls. Some MPMs in premenarchal girls have an indolent biologic behavior similar to that of low-grade peritoneal serous neoplasia or well-differentiated papillary mesothelioma in adult women.

Topics: Adolescent; Child; Child, Preschool; DNA, Neoplasm; Female; Flow Cytometry; Humans; Immunohistochemistry; Infant; Keratins; Male; Membrane Glycoproteins; Mesothelioma; Microscopy, Electron; Mucin-1; Peritoneal Neoplasms

We report a case of benign multicystic mesothelial proliferation (the so-called multicystic peritoneal mesothelioma) arising multifocally in the abdomen of a 46-year-old white man. His anamnesis showed an 8-year history of intermittent pain in the right lower abdominal quadrant. Mucin stains, immunohistochemistry, and electron microscopy confirmed the mesothelial origin of the lesion. Review of the available literature allowed us to find another 85 reported cases of benign multicystic mesothelial proliferations of the peritoneum. Out of these cases, eighteen only occurred in men, the majority being reported in middle-aged women mostly with complaints of abdominal pain. Electron microscopy or immunohistochemistry are needed to make a differential diagnosis towards other multicystic lesions, such as peritoneal cystic lymphangioma. Although multicystic mesothelial proliferations of the peritoneum have often been regarded as benign neoplasms, the true nature--neoplastic or hyperplastic--of these lesions still remains greatly elusive. Therefore, we believe that the unbinding term benign multicystic mesothelial proliferation (first used with regard to the unique hitherto reported case arisen in the pleural cavity) should be considered at present more appropriate to indicate even these peritoneal lesions.

Topics: Abdominal Pain; Actins; Cysts; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma; Middle Aged; Peritoneal Neoplasms

Extraskeletal Ewing sarcoma presenting as intra-abdominal or pelvic disease in adult female patients is very rare and may lead to diagnostic difficulty due to clinical and histologic overlap with Mullerian adenocarcinomas, which are far more common. We report a case of an intra-abdominal Ewing sarcoma in a postmenopausal female patient whose clinical and radiological presentation closely resembled that of peritoneal carcinomatosis. Biopsy of an omental nodule revealed numerous histologic features suggestive of a Mullerian carcinoma, including gland-like rosettes, strong, diffuse PAX8 immunoreactivity and cytokeratin expression. After excluding other differential diagnostic considerations, the possibility that this might represent an intra-abdominal Ewing sarcoma was entertained. Reverse transcriptase polymerase chain reaction testing demonstrated the presence of an EWSR1-ERG fusion transcript, confirming the diagnosis. The differential diagnostic considerations when dealing with this unusual clinical scenario and the uncommon yet important pitfall of PAX8 immunoreactivity in Ewing sarcoma are discussed.

Topics: Abdomen; Adenosarcoma; Carcinoma; Diagnosis, Differential; Female; Gene Fusion; Humans; Keratins; Middle Aged; Mullerian Ducts; PAX8 Transcription Factor; Peritoneal Neoplasms; Postmenopause; RNA-Binding Protein EWS; Sarcoma, Ewing; Transcriptional Regulator ERG

Anal duct carcinoma is an uncommon malignancy of the glands of the anal duct. This entity poses a diagnostic challenge, both clinically and histologically. This article describes histopathologic findings in a case of anal duct carcinoma, including the initial diagnosis on biopsy and subsequent cytology specimens. Additionally, differential diagnoses of this neoplasm are discussed. With a high index of suspicion, and attention to histological and immunohistochemical features, anal duct carcinoma can be accurately diagnosed both on biopsy and on cytology.

Topics: Abdominal Pain; Anus Neoplasms; Ascites; Biopsy; Carcinoma, Ductal; Constipation; Cytodiagnosis; Diagnosis, Differential; Female; Hospice Care; Humans; Keratins; Middle Aged; Paracentesis; Peritoneal Neoplasms

The aim of this study was to verify if positive results yielded with conventional cytology and immunocytochemical analysis of peritoneal washes correlate with established prognostic factors and overall survival (OS) in gastric cancer patients.. The study included the data of 271 gastrectomized patients. Peritoneal washes of 131 (48.3%) patients were examined by means of conventional cytology, and material from 140 (51.7%) subjects treated surgically after this date was subjected to immunocytochemical analysis.. Free cancer cells (FCCs) were detected significantly less often in patients from conventional cytology group than in those from immunocytochemistry group (4.6% vs. 12.1%). Positive result of immunocytochemical analysis was significantly more often associated with presence of pT3/4 tumor (94.1% vs. 60.2%), lymph node ratio ≥0.2 (82.4% vs. 43.1%) and involvement of blood vessels (64.7% vs. 28.5%). Median OS in patients with immunocytochemical evidence of FCCs in peritoneal washes was significantly shorter than in those without (11 vs. 45 months). Moreover, the two groups differed significantly in terms of 5- (0% vs. 43.1%) and 10-year OS rates (0.0% vs. 29.3%).. In contrast to conventional cytology, immunocytochemically documented presence of FCCs in peritoneal washes correlates with established prognostic factors and OS in gastric cancer patients.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Cytological Techniques; Female; Gastrectomy; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Keratins; Lymph Node Excision; Male; Middle Aged; Neoplasm Proteins; Neoplasm Staging; Peritoneal Lavage; Peritoneal Neoplasms; Proportional Hazards Models; Stomach Neoplasms

Topics: Aged; Biomarkers, Tumor; Biopsy; Carcinosarcoma; Fatal Outcome; Humans; Immunohistochemistry; Keratins; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Peritoneal Neoplasms; Renal Dialysis

Tumor invasion of the peritoneal membrane may have an adverse prognostic significance, but its histopathologic features can be diagnostically difficult to recognize. We observed that local peritoneal injury associated with tumor invasion is characterized by activation and proliferation of serosal stromal cells that express cytokeratin, a characteristic property of injured serosal membranes that may have diagnostic utility. To explore this, we examined 120 primary tumors of the gastrointestinal tract and pancreaticobiliary system using cytokeratin and elastic stains to assess for tumor invasion of peritoneal membranes. Peritoneal invasion by tumor was associated with retraction, splaying, and destruction of the elastic lamina and proliferation of keratin-expressing stromal cells of serosal membranes. All 82 peritoneal invasive tumors were characterized by neoplastic cells that invaded the elastic lamina and the serosal connective tissue with neoplastic cells that abutted or were surrounded by keratin-positive stromal cells, whereas all 38 tumors limited to the subserosa showed none of these features. The diagnosis of tumor invasion of peritoneal membranes is enhanced by the combined use of cytokeratin and elastic stains, which in turn would enable better histopathologic correlation with patient treatment and outcome.

Topics: Gallbladder Neoplasms; Gastrointestinal Neoplasms; Humans; Immunohistochemistry; Keratins; Pancreatic Neoplasms; Peritoneal Neoplasms; Peritoneum

Peritoneal mesothelioma is rare, and the sarcomatoid variant is more infrequent, with <30 cases reported to date in the literature. Several case series have described the morphologic features of sarcomatoid peritoneal mesothelioma (SPe); however, the clinicopathologic features are not well characterized. To our knowledge, this is the first large series reporting the clinicopathologic features of SPe. We reviewed our database of 3106 malignant mesothelioma cases. Of 248 peritoneal mesotheliomas, 15 (4%) were sarcomatoid variant (0.5% of all mesotheliomas). Only cases with 100% sarcomatoid morphology diagnosed by open surgical biopsy and/or autopsy were included. Thus, 4 cases were excluded leaving 11 cases of SPe. Two additional cases of SPe previously published by 1 of the authors (V.L.R.), not included in the database, are added yielding 13 cases total. The median age at diagnosis was 66 years (range=48 to 85 y), and there was a male predominance (M:F=3.25:1). Survival from date of diagnosis to date of death was 5 months (range=0 to 12 mo). The most common presenting symptom was abdominal pain, and 3 of 4 women were suspected to have cholecystitis/cholelithiasis. All cases stained positive for cytokeratins, and 2 contained heterologous elements. Seven cases had objective markers of asbestos exposure, and 2 additional cases had occupations strongly associated with mesothelioma. Two cases with alleged household contact exposures could not be confirmed to be asbestos related by lung fiber analysis. SPe is a rare variant of mesothelioma attributed to asbestos exposure in 69% of our cases.

Topics: Aged; Aged, 80 and over; Asbestos; Autopsy; Biomarkers, Tumor; Biopsy; Databases, Factual; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Incidence; Inhalation Exposure; Keratins; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Occupational Exposure; Peritoneal Neoplasms; Predictive Value of Tests; Prognosis; Risk Factors; Sarcoma; Survival Analysis

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Calbindin 2; Cholecystitis; Cisplatin; Cystitis; Diagnosis, Differential; Female; Glutamates; Guanine; Humans; Inflammation; Keratins; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Pemetrexed; Peritoneal Neoplasms; Survival Rate; Vimentin

A premature dead equine fetus with excessive fluctuating distension of the abdomen was delivered by extraction. Post-mortem examination revealed ascites and a solitary, irregular, bulging, multinodular, firm, yellow mass of 25 cm in diameter in the right liver lobe. Extensive peritoneal implantation metastases were present. The masses were composed of polygonal embryonal cells arranged in sheets and nests. Based on the immunohistochemical expression of Ki67, low molecular weight cytokeratin and alpha-1 fetoprotein, a diagnosis of hepatoblastoma with peritoneal implantation metastases was made.

Topics: alpha-Fetoproteins; Animals; Ascites; Autopsy; Biomarkers, Tumor; Female; Fetus; Hepatoblastoma; Horse Diseases; Horses; Keratins; Liver Neoplasms; Peritoneal Neoplasms; Pregnancy; Premature Birth

Malignant peritoneal mesothelioma (MPM) is a rare tumor that develops in the peritoneum. In this paper, we describe an extremely rare case of MPM metastasizing to the appendix in a 48-year-old female who initially presented with a persistent high fever. The woman reported a slight lower abdominal discomfort which had been relieved by urination for four months. She had lost 5 kg of weight. There was no nausea, vomiting, diarrhea, abdominal pain, or abdominal distension. Many broad spectrum antibiotics were given without relief of fever. Computed tomography (CT) scans revealed a thickened omentum majus and diffused multiple omental nodules. An omentectomy, appendectomy, and adnexectomy were carried out. A gross pathologic specimen of omentum tissue revealed a firm gray-white mass. Microscopic and immunohistochemical examinations confirmed the diagnosis of appendiceal and bilateral adnexal metastases of an MPM. These results suggest that MPM should be considered in the differential diagnosis of unexplained persistent high fever. Awareness of such atypical presentations of mesothelioma may help to make a correct diagnosis.

Topics: Appendiceal Neoplasms; Biomarkers, Tumor; Calbindin 2; Diagnosis, Differential; Female; Fever of Unknown Origin; Humans; Immunohistochemistry; Keratins; Mesothelioma; Middle Aged; Peritoneal Neoplasms; S100 Calcium Binding Protein G; Tomography, X-Ray Computed; WT1 Proteins

Primary peritoneal serous papillary carcinoma (PPSPC) is a rare primary tumor of the peritoneum that found predominantly in elderly and post-menopausal women. The aim of our study is to review the clinical and pathologic information of 22 patients, and then try to summarize clinical behavior and pathological characteristics of PPSPC, in order to be better recognized of this entity in future. We retrospectively reviewed the data from 22 patients with PPSPC treated at our hospital from 1992 to 2008. All paraffin blocks were recut for periodic acid-Schiff diastase and immunohistochemical staining for CD15, cytokeratin7(CK7), cytokeratin20(CK20), S-100 protein, carcinoembryonic antigen (CEA), CA125, estrogen receptor(ER) and progesterone receptor(PR). The median age of the patients at the time of surgical staging was 56 years (range, 32-77 years). The most common presenting symptoms were abdominal distension (59.1%) and ascites (63.6%). Pretreatment CA125 levels were significant elevated in 90.5% patients. Optimal debulking was performed in 18 patients. All patients were consequently treated with platinum-based chemotherapy. Response to treatment is promising, and the median overall survival of all patients was 21.0 months (95% CI 16.9, 25.1 months). The positive rate of immunohistochemical staining was CD15 95.5%, CK7 90.9%, S-100 protein 68.2%, CA125 59.1%, CK20 31.8%, ER 31.8%, CEA 27.3% and PR 9.1%, respectively. Gynecologist should be aware of PPSPC when abdominal distension, gross ascites and a raised level of CA125 in women without ovarian enlargement. Immunohistochemical staining might be helpful as accessory criteria for the differential diagnosis among the PPSPC, peritoneal malignant mesothelioma (PMM), primary epithelial ovarian carcinoma (PEOC) and peritoneal carcinomatosis from the gastrointestinal tumors (SPCGT). Cytoreductive surgery combined with pre/postoperative platinum-based chemotherapy may be effective for PPSPC patients.

Topics: Adult; Aged; Biomarkers, Tumor; CA-125 Antigen; Carcinoma, Ovarian Epithelial; Carcinoma, Papillary; Cystadenocarcinoma, Serous; Female; Follow-Up Studies; Humans; Immunoenzyme Techniques; Keratins; Mesothelioma; Middle Aged; Neoplasms, Glandular and Epithelial; Ovarian Neoplasms; Peritoneal Neoplasms; Prognosis; Receptors, Estrogen; Receptors, Progesterone; Retrospective Studies; S100 Proteins; Survival Rate

A 53-year-old woman had a tumor in the ascending colon. CT revealed tumor invasion to the surrounding tissue and also showed multiple swollen lymph nodes, liver metastases and ascites. Colonic tumor with severe stenosis was diagnosed by colonoscopy and the obtained biopsy specimen revealed poorly differentiated adenocarcinoma. Immunohistochemically, the tumor was positive for CEA, CK7, MUC2, MUC5AC·MUC6 (spotty) and negative for CK20, CDX2, TTF-1, GCDFP-15. Cytology of ascites also showed malignant cells. Although these protein expressions were specific for not primary colonic cancer but metastasis from ovarian cancer, the case was clinically and pathologically diagnosed as poorly differentiated adenocarcinoma of the colon with peritoneal metastases composed of micropapillary carcinoma. MLH1 and MSH2 protein expressions were normal. Even though modified FOLFOX6 chemotherapy was administered, the patient rapidly worsened due to pulmonary carcinomatous lymphangiosis and died a month after diagnosis. To determine the high-risk group of metastases, it seems necessary to require the accumulation of further cases evaluated by a precise immunohistochemistrical approach.

Topics: Adenocarcinoma; Colonic Neoplasms; Female; Humans; Immunohistochemistry; Keratins; Middle Aged; Peritoneal Neoplasms

Primary mucoepidermoid carcinoma (MEC) of the skin is an unusual neoplasm with few cases reported in the English medical literature. It has to be differentiated from adenosquamous carcinoma, usually a high-grade neoplasm with poorer outcome, and metastasis from a primary MEC arising elsewhere in the body. We report a 78-year-old woman with an abdominal skin lesion of recent onset. Histopathological examination revealed a dermal located carcinoma with variable proportions of squamous differentiation and goblet cells. The patient died in a very short time for an unrelated disease. Immunohistochemical study showed staining for cytokeratins (AE1AE3, 7, and 34betaE12), epithelial membrane antigen (EMA), and p63, whereas cytokeratins 18 and 20 and gross cystic disease fluid protein (GCDFP15) were negative. We conclude that primary MEC of the skin is usually a slow-growing neoplasm that should be differentiated from adenosquamous carcinoma. The immunohistochemical staining for p63 is helpful to differentiate primary and metastatic MEC in the skin.

Topics: Aged; Biomarkers, Tumor; Carcinoma, Adenosquamous; Carcinoma, Mucoepidermoid; Diagnosis, Differential; Fatal Outcome; Female; Humans; Immunohistochemistry; Keratins; Leiomyosarcoma; Liver Neoplasms; Neoplasms, Multiple Primary; Peritoneal Neoplasms; Skin Neoplasms; Trans-Activators; Transcription Factors; Tumor Suppressor Proteins

We describe the clinical, pathologic and molecular characteristics of a xenograft model of metastatic mucinous appendiceal adenocarcinoma. Tumours from patients with mucinous appendiceal neoplasms were implanted in nude mice and observed for evidence of intraperitoneal tumour growth. Morphologic and immunohistochemical features, temporal growth characteristics relative to controls, and loss of heterozygosity (LOH) at multiple chromosomal alleles were assessed in a successfully engrafted tumour. Two of seventeen implanted tumours successfully engrafted and only one mucinous adenocarcinoma propagated throughout the course of the study. The successful xenograft is morphologically similar to the original tumour, produces abundant extracellular mucin and exhibits non-invasive growth on peritoneal surfaces. The temporal growth characteristics of the xenograft tumour relative to controls reveal that tumour burden can be followed indirectly by measuring the weight or abdominal girth of engrafted animals. The cytokeratin, mucin core protein, CDX2, Ki-67 and p53 expression patterns are identical in the xenograft and resected tumour and are consistent with the expected pattern of protein expression for mucinous adenocarcinoma of the appendix. LOH was found in 1 of 10 informative chromosomal loci (chromosome 10p23) in xenograft tumour cells. Although we were unable to engraft a low-grade appendiceal mucinous neoplasm, the engrafted adenocarcinoma will be useful for future evaluation of novel therapeutic strategies directed at mucinous appendiceal adenocarcinoma and evaluation of strategies for treating widespread, bulky, mucinous peritoneal surface neoplasms. Xenograft tumour enrichment can facilitate molecular studies of appendiceal epithelial neoplasia.

Topics: Adenocarcinoma, Mucinous; Animals; Appendiceal Neoplasms; CDX2 Transcription Factor; Cell Proliferation; Chromosomes, Human, Pair 10; Gene Expression Regulation, Neoplastic; Homeodomain Proteins; Humans; Keratins; Ki-67 Antigen; Loss of Heterozygosity; Mice; Mice, Nude; Mucins; Mutation; Peritoneal Neoplasms; Proto-Oncogene Proteins; Proto-Oncogene Proteins p21(ras); ras Proteins; Time Factors; Tumor Burden; Tumor Suppressor Protein p53; Xenograft Model Antitumor Assays

This report describes the macroscopic, histologic, immunohistologic and ultrastructural characteristics ofa biphasic malignant mesothelioma in the peritoneal and pleural cavity of a 13-year-old Icelandic pony mare, which exhibited recurrent ascites clinically. Immunohistology was performed employing multiple monoclonal antibodies against cytokeratins (CK) and vimentin. The ultrastructural examination included the quantitative evaluation of the length to diameter ratio of the microvilli. Post mortem examination revealed a severe ascites and hydrothorax. The serosal surfaces of the peritoneum and pleura displayed poorly-demarcated, multifocal to coalescing laminar masses and small nodules. Histology revealed a bimorphic mass consisting of spindle-shaped cells and microcystic epithelioid areas. A transcoelomic and local invasive growth pattern as well as lymph node metastases were noticed. Immunohistology revealed a strong expression of CK. Though a low and moderate expression of CK5/6 and CK20 was present, respectively, CK7 and CK10-antigens were lacking. Ultrastructurally, the epithelioid mesothelioma cells displayed long microvilli, cytoplasmic tonofilaments, and desmosomes. Quantitative evaluation of the length to diameter ratio of the 10 longest microvilli revealed a mean value of approximately 16.2. Summarized, this report described the case of a malignant biphasic mesothelioma with an atypical CK20 expression but a characteristic ultrastructural morphology including long microvilli.

Topics: Animals; Antibodies, Monoclonal; Fatal Outcome; Horse Diseases; Horses; Immunohistochemistry; Keratins; Male; Mesothelioma; Microvilli; Peritoneal Neoplasms; Pleural Neoplasms; Vimentin

Only a small number of malignant mesotheliomas with heterologous elements have been described. There are currently no criteria for diagnosis and little data regarding prognosis. We suggest that the term heterologous mesothelioma should be reserved for tumours that show malignant heterologous elements, notably osteosarcomatous, chondrosarcomatous, or rhabdomyoblastic elements but have immunohistochemical and clinical characteristics of mesothelioma. We identified 27 such cases and characterized the clinical and pathological characteristics of these tumours. In our series, 89% originated in the pleura, and 11% from the peritoneal cavity. The median age at diagnosis was 68 years, ranging from 27 to 85 years. Of these cases, 93% occurred in males and 7% in women. Of the 27 mesothelioma cases 16 (59%) were sarcomatoid, 10 (37%) were biphasic, and one was reported as epithelioid; 40% (11 cases) showed osteosarcomatous elements only, 19% showed areas of rhabdomyosarcoma only, 19% contained areas of chondrosarcoma only, and 22% exhibited osteochondromatous elements. Immunohistochemical labelling for cytokeratins was present in the majority of cases. Exposure to asbestos was identified in all the 17 cases for which an exposure history was available (63%). Median survival was 6 months after diagnosis, similar to the survival seen in sarcomatoid mesotheliomas. The differential diagnosis includes primary and secondary pleural sarcomas, including osteosarcomas and chondrosarcomas. Immunohistochemical labelling for cytokeratins is helpful in the distinction, but lack of labelling for cytokeratins in a spindle cell/sarcomatoid tumour does not exclude the diagnosis of mesothelioma, irrespective of the presence of heterologous elements. We suggest that if the anatomical distribution conforms to that of mesothelioma, a diagnosis of heterologous mesothelioma should be made in preference to a diagnosis of primary pleural osteosarcoma or chondrosarcoma, regardless of cytokeratin positivity, as for conventional non-heterologous sarcomatoid mesothelioma.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Chondrosarcoma; Diagnosis, Differential; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Mesothelioma; Middle Aged; Osteosarcoma; Peritoneal Neoplasms; Pleural Neoplasms; Rhabdomyosarcoma; Sarcoma; Survival Rate

Adenomatoid tumors are benign mesothelial neoplasms most commonly found in the male and female genital tracts. Extragenital adenomatoid tumors are rare, most of them being solitary tumors. To our knowledge, only one case of multiple extragenital adenomatoid tumors, involving the liver and peritoneum, has been reported to date. Here we report another case of multiple extragenital adenomatoid tumors involving the mesocolon and omentum. A 47-year-old woman presented with a delayed menstrual period. Ultrasonography revealed a left adnexal mass, and surgical resection was attempted at a local hospital. The patient was transferred to our hospital without resection due to the intraoperative finding of multiple peritoneal tumors. At our hospital, an 8.0x7.5x6.0 cm tumor at the mesocolon of the sigmoid colon and three omental nodules measuring up to 2.5x2.0x1.7 cm were resected. Grossly, they were well circumscribed, gray-tan and elastic with small cystic spaces. Microscopically, they were composed of tubules and anastomosing channels lined by flattened or cuboidal cells with bland nuclei. Immunohistochemically, the tumor cells were positive for pan-cytokeratin AE1/AE3, vimentin, cytokeratin 5/6 and calretinin. The postoperative course was uneventful, and the patient was well 10 months after the operation. Despite their rarity, adenomatoid tumors should be included in the differential diagnosis of multiple intra-abdominal tumors.

Topics: Adenomatoid Tumor; Calbindin 2; Female; Humans; Keratins; Mesocolon; Middle Aged; Neoplasms, Multiple Primary; Omentum; Peritoneal Neoplasms; S100 Calcium Binding Protein G; Vimentin

Soluble mesothelin-related protein (SMRP) in serum is potentially a sensitive marker of malignant mesothelioma (MM) diagnosis and progression, and may be useful as screening marker. Mesothelin expression in tumors is regarded as a sensitive marker for diagnosis and disease progression, and is a candidate prognostic marker. Levels of SMRP, CA125 and CYFRA 21-1 in pre-diagnostic (1-30 years) serum samples from 47 mesothelioma cases and 141 matched controls were analysed. Mesothelin expression in tumors was assessed. The association between biomarker level and mesothelioma risk and survival was analysed, adjusting for asbestos exposure. Survival related to tumor mesothelin expression, age, sex, histological type, location, asbestos exposure and pre-clinical SMRP was analysed. There was no significant association between biomarker levels and mesothelioma risk when analysed as continuous variables or as tertiles. Biomarker levels <10, 10-19 and >or=20 years before diagnosis were not significantly associated to mesothelioma risk. Mesothelin expressed in >50% of tumor cells was seen in 36 of 47 (77%) tumors. Mesothelin expression in <50% of tumor cells was a significant negative prognostic marker in all cases of malignant mesothelioma (median survival=6 months vs. 12 months, hazard ratio (HR)=2.49, 95%CI 1.17-5.27), and also when only epithelial mesothelioma was analysed (median=6 months vs. 14 months, HR=2.36, 95%CI 1.07-5.22). When adjusted for age and gender, the prognosis was still dismal, but non-significant (HR=1.85, 95%CI 0.85-4.05). High age (>65 years) was an independent negative prognostic factor that was related to both mesothelin expression and asbestos exposure. Mesothelioma of the epithelial type of the peritoneum had a significantly longer survival than epithelial type in pleura and was also related to mesothelin expression.

Topics: Adolescent; Adult; Age Factors; Antigens, Neoplasm; Asbestos; Biomarkers, Tumor; Case-Control Studies; Child; Child, Preschool; Female; GPI-Linked Proteins; Humans; Infant; Intracellular Signaling Peptides and Proteins; Keratin-19; Keratins; Male; Membrane Glycoproteins; Mesothelin; Mesothelioma; Occupational Exposure; Peritoneal Neoplasms; Pleural Neoplasms; Prognosis; Proteins; Survival Analysis

To present eight cases of primary diffuse peritoneal malignant mesothelioma in children <15 years old, with a discussion of the pitfalls of this diagnosis in the paediatric age group.. The cases were selected based on the following criteria: (i) primary peritoneal neoplasms confined grossly or radiographically to the abdominal cavity; (ii) negative history of previous or another associated malignancy; (iii) histopathological confirmation. All patients (five female, three male) presented clinically with symptoms of abdominal pain, distention and ascites. Grossly, the tumours showed multiple, diffuse peritoneal nodules. Histologically, seven cases corresponded to epithelioid mesotheliomas and one case displayed biphasic (epithelioid and spindle) cellular proliferation. Immunohistochemical studies for cytokeratin (CK) 5/6, calretinin and low-molecular-weight CK (CAM5.2) showed strong cytoplasmic positivity in the neoplastic cells. Three patients were treated by chemotherapy. On clinical follow-up, four patients with epithelioid mesotheliomas were alive and well from 12 to 18 months after initial diagnosis; one patient with a mixed (biphasic epithelioid/sarcomatoid) mesothelioma died of tumour 24 months after diagnosis.. Peritoneal malignant mesothelioma in children is a rare condition that can introduce difficulties in histopathological diagnosis.

Topics: Adolescent; Biomarkers; Biomarkers, Tumor; Calbindin 2; Child; Fatal Outcome; Female; Humans; Keratin-5; Keratin-6; Keratins; Male; Mesothelioma; Peritoneal Neoplasms; S100 Calcium Binding Protein G

There are cases of recurrence even after curative resection in early gastric cancer.. Seven hundred and sixty-five patients with early gastric cancer who underwent curative gastrectomy were analyzed to identify the prognostic factor. Micrometastases within lymph nodes were determined by immunohistochemistry using anti-cytokeratin antibody in node-negative early gastric cancer patients with recurrence.. The recurrence was observed in 17 patients. Hematogenous recurrence was observed most frequently (47.1%), followed by peritoneal recurrence (23.5%). Of 17 patients with recurrence, 6 (35.3%) patients died more than 5 years after operation. The prognosis was poorer when the patients were older, and the depth of invasion was greater, lymph node metastasis, lymphatic involvement, and vascular involvement were present, and lymph node dissection was limited. The independent prognostic factors were lymph node metastasis, lymph node dissection, and age by multivariate analysis using Cox proportional hazards. Micrometastases within lymph nodes were confirmed in 3 of 6 node-negative patients with recurrence.. When patients have lymph node metastases or are older, close and long-term follow-up and careful planning of postoperative adjuvant therapy might be necessary to avoid recurrence. The detection of micrometastases by anti-cytokeratin antibody might be useful for predicting the possibility of recurrence in early gastric cancer.

Topics: Adenocarcinoma; Age Factors; Aged; Aged, 80 and over; Female; Follow-Up Studies; Gastrectomy; Humans; Immunoenzyme Techniques; Keratins; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplastic Cells, Circulating; Peritoneal Neoplasms; Prognosis; Proportional Hazards Models; Stomach Neoplasms

The histologic distinction between peritoneal epithelioid mesotheliomas and serous carcinomas diffusely involving the peritoneum may be difficult, but it can be facilitated by the use of immunohistochemistry and electron microscopy. D2-40 and podoplanin are two recently recognized lymphatic endothelial markers that can be expressed in normal mesothelial cells and mesotheliomas. The purpose of this study is to compare the value of these new mesothelial markers with those that are commonly used for discriminating between mesotheliomas and serous carcinomas, and also to determine the current role of electron microscopy in distinguishing between these malignancies. A total of 40 peritoneal epithelioid mesotheliomas and 45 serous carcinomas of the ovary (15 primary, 30 metastatic to the peritoneum) were investigated for the expression of the following markers: D2-40, podoplanin, calretinin, keratin 5/6, thrombomodulin, MOC-31, Ber-EP4, B72.3 (TAG-72), BG-8 (Lewis(Y)), CA19-9, and leu-M1 (CD15). All 40 (100%) of the mesotheliomas reacted for calretinin, 93% for D2-40, 93% for podoplanin, 93% for keratin 5/6, 73% for thrombomodulin, 13% for Ber-EP4, 5% for MOC-31, 3% for BG-8, and none for B72.3, CA19-9, or leu-M1. All 45 (100%) serous carcinomas were positive for Ber-EP4, 98% for MOC-31, 73% for B72.3, 73% for BG-8, 67% for CA19-9, 58% for leu-M1, 31% for keratin 5/6, 31% for calretinin, 13% for D2-40, 13% for podoplanin, and 4% for thrombomodulin. After analyzing the results, it is concluded that Ber-EP4 and MOC-31 are the best negative mesothelioma markers for differentiating between epithelioid mesotheliomas and serous carcinomas. The best discriminators among the positive markers for mesotheliomas are D2-40, podoplanin, and calretinin. From a practical point of view, Ber-EP4 and MOC-31, in combination with calretinin, and/or D2-40 or podoplanin allow the differential diagnosis to be established between mesothelioma and serous carcinoma in nearly all instances. As a clear distinction could be made between these two malignancies in all of the cases in which electron microscopy was performed, this technique can be very useful in establishing the correct diagnosis when the immunohistochemical results are equivocal or further support of a diagnosis of either mesothelioma or serous carcinoma is needed.

Topics: Antigens, Neoplasm; Biomarkers, Tumor; CA-19-9 Antigen; Calbindin 2; Cystadenocarcinoma, Serous; Diagnosis, Differential; Female; Glycoproteins; Humans; Immunohistochemistry; Keratins; Lewis X Antigen; Male; Membrane Glycoproteins; Mesothelioma; Microscopy, Electron; Ovarian Neoplasms; Peritoneal Neoplasms; S100 Calcium Binding Protein G; Thrombomodulin

This study was performed to characterize the gene expression profile and to identify the major carcinogenic pathways involved in rat peritoneal mesothelioma (RPM) formation following treatment of Fischer 344 rats with o-nitrotoluene (o-NT) or bromochloracetic acid (BCA). Oligo arrays, with over 20,000 target genes, were used to evaluate o-NT- and BCA-induced RPMs, when compared to a non-transformed mesothelial cell line (Fred-PE). Analysis using Ingenuity Pathway Analysis software revealed 169 cancer-related genes that were categorized into binding activity, growth and proliferation, cell cycle progression, apoptosis, and invasion and metastasis. The microarray data were validated by positive correlation with quantitative real-time RT-PCR on 16 selected genes including igf1, tgfb3 and nov. Important carcinogenic pathways involved in RPM formation included insulin-like growth factor 1 (IGF-1), p38 MAPkinase, Wnt/beta-catenin and integrin signaling pathways. This study demonstrated that mesotheliomas in rats exposed to o-NT- and BCA were similar to mesotheliomas in humans, at least at the cellular and molecular level.

Topics: Acetates; Animals; Cell Line; Gene Expression Regulation, Neoplastic; Insulin-Like Growth Factor I; Integrins; Male; Mesothelioma; Oligonucleotide Array Sequence Analysis; p38 Mitogen-Activated Protein Kinases; Peritoneal Neoplasms; Rats; Rats, Inbred F344; Reverse Transcriptase Polymerase Chain Reaction; Signal Transduction; Toluene; Wnt Proteins

The role of immunohistochemical markers in distinguishing peritoneal mesothelioma from primary or metastatic serous papillary carcinoma of the peritoneum was evaluated. We immunostained 20 peritoneal mesotheliomas (from 14 men and 6 women), 14 primary peritoneal carcinomas, and 14 metastatic serous ovarian carcinomas with a panel of 16 antibodies. Positive staining for calretinin was identified in 17 (85%) of 20 mesotheliomas, but all carcinomas were negative. Positive staining for Ber-EP4 was identified in 27 (96%) of 28 carcinomas and in 2 (10%) of 20 mesotheliomas. Estrogen receptors were positive in 26 (93%) of 28 carcinomas, and progesterone receptors were positive in 8 (29%) of 28 carcinomas. All mesotheliomas were negative for estrogen and progesterone receptors. The other antibodies evaluated were insufficiently sensitive and/or specific to be diagnostically useful. In conjunction with calretinin and Ber-EP4, estrogen and progesterone receptors are useful discriminatory markers for distinguishing peritoneal mesothelioma from primary or metastatic serous carcinoma.

Topics: Antibodies, Neoplasm; Biomarkers, Tumor; CA-125 Antigen; Carcinoembryonic Antigen; Cystadenocarcinoma, Serous; Female; Glycoproteins; Humans; Immunohistochemistry; Keratin-7; Keratins; Male; Mesothelioma; Peritoneal Neoplasms; Receptors, Estrogen; Receptors, Progesterone; Retrospective Studies

CDX-2 is a highly sensitive and specific marker of intestinal epithelial cells and their neoplastic counterparts. CDX-2 status in pseudomyxoma peritonei (PMP) has been barely reported. The aim of this study was to investigate the clinicopathological features of 42 cases of PMP with a special emphasis on CDX-2.. All patients were treated by cytoreduction. Immunohistochemistry was performed for CDX-2, MUC-2, MUC-5AC, cytokeratin (CK) 7 and CK20. Statistical correlation was evaluated for age, sex, completeness of cytoreduction and histological subtype with overall and progression-free survival (OS and PFS). PMP consisted of 32 cases of disseminated peritoneal adenomucinosis and 10 cases of peritoneal mucinous carcinomatosis. The appendix evaluated in 25 cases showed two mucinous adenocarcinomas and 21 low-grade appendiceal mucinous neoplasms. CDX-2 was diffusely positive in 40 cases, with the remaining two cases being focally positive. All cases demonstrated diffuse reactions to CK20 and MUC-2, and variable reactions to MUC-5AC, while CK7 was variably positive in 38 cases. Five-year OS was 97%. Histological type was significantly correlated with PFS (P=0.02).. CDX-2 is diffusely and strongly positive in PMP. This is a useful marker to confirm an appendiceal origin of PMP, particularly when used in conjunction with CK7, CK20, MUC-2 and MUC-5AC.

Topics: Adult; Aged; Appendiceal Neoplasms; Biomarkers, Tumor; Carcinoid Tumor; CDX2 Transcription Factor; Disease-Free Survival; Female; Homeodomain Proteins; Humans; Immunohistochemistry; Keratin-20; Keratin-7; Keratins; Male; Middle Aged; Mucin 5AC; Mucin-2; Mucins; Neoplasms, Multiple Primary; Peritoneal Neoplasms; Prognosis; Pseudomyxoma Peritonei; Retrospective Studies; Survival Analysis; Trans-Activators

A 10-year-old German shepherd dog was presented with a severe abdominal distension. At necropsy, whitish and firm mass was observed in the mesentery with metastases in the pericardium and pleura. The intestinal serosa was thickened and stiff. Histologically, the tumours were composed of a biphasic population of cells, which reacted with cytokeratin, vimentin and Wilms' tumour 1 protein antibody. Ultrastructural examination revealed numerous microvilli, abundant rough endoplasmic reticulum, numerous desmosomes and bundles of microfilament. The tumour was classified as biphasic mesothelioma of peritoneal origin.

Topics: Animals; Dog Diseases; Dogs; Fatal Outcome; Immunohistochemistry; Keratins; Male; Mesothelioma; Neoplasm Metastasis; Peritoneal Neoplasms; Vimentin

Reported herein is a case of hepatocellular carcinoma (HCC) with unusual peritoneal dissemination masquerading as peritoneal mesothelioma. A 61-year-old man was clinically found to have multiple tumors in his abdominal cavity; peritonitis carcinomatosa was suspected. An autopsy revealed numerous tumors of various sizes in the abdominal serosa, omentum, and diaphragm. No signs of tumor, fibrosis, or cirrhosis were found in the liver, except for a small nodule in the hepatic triangular ligament. Histologically, the tumor cells proliferated in thick trabeculae or in sheets and formed a few canaliculi and tubules with homogenously brown contents in their lumina, which stained positively with Hall stain. Immunohistochemically, these tumors were positive for hepatocyte, alpha-fetoprotein (AFP) and low-molecular-weight cytokeratin; were focally positive for pan-cytokeratin and epithelial membrane antigen (EMA); and were negative for high-molecular-weight cytokeratin, vimentin, and calretinin. Carcinoembryonic antigen (CEA) produced a bile canalicular immunohistochemical staining pattern. Thus, the tumor was diagnosed as an HCC (Edmondson II type) of the triangular ligament with massive peritoneal dissemination. The origin of this tumor and its differential diagnosis (malignant mesothelioma, hepatoid adenocarcinoma, and hepatoid yolk sac tumor) are discussed.

Topics: Adenocarcinoma; alpha-Fetoproteins; Calbindin 2; Carcinoembryonic Antigen; Carcinoma, Hepatocellular; Diagnosis, Differential; Humans; Immunohistochemistry; Keratins; Liver Neoplasms; Male; Mesothelioma; Middle Aged; Mucin-1; Peritoneal Neoplasms; S100 Calcium Binding Protein G; Vimentin

Extraskeletal osteosarcoma is a rare malignant soft tissue tumor. Authors present the history of a 61-year-old woman who had bone like tissue in her gallbladder at cholecystectomy. Histology proved, it was extraskeletal osteosarcoma of the gallbladder. Such disease has not been previously reported in the literature. She developed metastatic disease five months after the operation: multiplex cystic-calcified metastases appeared in the abdominal wall and in the peritoneal cavity. We present pathology findings, including ultrastructural features.

Topics: Abdominal Wall; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Biomarkers, Tumor; Female; Gallbladder Neoplasms; Humans; Immunohistochemistry; Intestinal Neoplasms; Keratins; Middle Aged; Osteosarcoma; Peritoneal Neoplasms; Tomography, X-Ray Computed

A case of peritoneal sclerosing mesothelioma in a 3-year-old German shepherd dog is reported. The dog presented a severe abdominal distension. Cytological examination of the peritoneal fluid revealed anaplastic epithelioid cells. Necropsy findings revealed an irregular-shaped mass attached to the pancreas and stomach with numerous nodules covering the intestinal and urinary bladder serosa. The diagnosis was made by histology and immunohistochemistry, with cytokeratin, vimentin and calretinin antibodies. Differential diagnosis with chronic peritonitis and spreading of abdominal primary carcinoma is discussed.

Topics: Animals; Ascites; Diagnosis, Differential; Dog Diseases; Dogs; Immunohistochemistry; Keratins; Male; Mesothelioma; Peritoneal Neoplasms; Vimentin

We report a case of an adult-type granulosa cell tumor of the ovary which was diagnosed in a 20-yr-old woman. After a 21-yr disease-free interval, she developed a pelvic recurrence, followed by a splenic metastasis and, more recently, omental masses. This report is concerned with the fine-needle aspiration (FNA) diagnosis of the granulosa cell tumor in the latter site and corroboration of the interpretation by immunocytochemistry. Only one previous case is similar to the present one documenting the role of immunocytochemistry in the evaluation of suspected metastatic granulosa cell tumor. The cytopathologic features of metastatic granular cell tumor have been described in a limited number of previous reports.

Topics: Adult; Biopsy, Needle; Diagnosis, Differential; Female; Granulosa Cell Tumor; Humans; Immunohistochemistry; Inhibins; Keratins; Neoplasm Recurrence, Local; Omentum; Ovarian Neoplasms; Peritoneal Neoplasms; Splenic Neoplasms; Vimentin

To evaluate the role of mesothelial markers (calretinin, thrombomodulin, cytokeratin 5/6, and CD44H) and carcinoma markers (polyclonal and monoclonal carcinoembryonic antigen, Leu-M1, CA-125 and Ber-EP4) in distinguishing diffuse peritoneal malignant mesothelioma from primary serous papillary adenocarcinoma of the ovary and peritoneum.. Paraffin-embedded formalin-fixed blocks from 32 diffuse peritoneal mesotheliomas of epithelial subtype (all females), 20 serous papillary ovarian carcinomas and three primary peritoneal serous papillary carcinomas were studied. Calretinin and Ber-EP4 appeared to be the best positive mesothelial and carcinoma marker, respectively. Nuclear calretinin expression was identified in 28 of 32 malignant mesotheliomas with no nuclear immunoreactivity in the cohorts of serous papillary ovarian and peritoneal carcinomas, thus yielding 88% sensitivity and 100% specificity. Ber-EP4 showed 95% sensitivity and 91% specificity for serous papillary ovarian carcinoma. Thrombomodulin, cytokeratin 5/6 and CD44H immunoreactivities were seen in 18 (56%), 17 (53%) and 15 (47%) of peritoneal mesotheliomas, respectively, and in six (30%), five (25%) and five (25%) of the ovarian tumours, respectively. None of the three primary peritoneal serous papillary carcinomas expressed calretinin, thrombomodulin, cytokeratin 5/6 or CD44H. Polyclonal and monoclonal CEA, and Leu-M1 were expressed by two (10%), one (5%) and seven (35%) serous papillary ovarian carcinomas, respectively. None of the serous papillary peritoneal carcinomas expressed polyclonal CEA, monoclonal CEA or Leu-M1. CA-125 was positive in 19 (95%) and two (67%) ovarian and peritoneal carcinomas, respectively, and in eight (25%) peritoneal mesotheliomas.. Calretinin and Ber-EP4 are useful discriminant markers in distinguishing peritoneal mesothelioma in women from serous papillary ovarian and peritoneal carcinoma. The other mesothelial markers (thrombomodulin, cytokeratin 5/6, and CD44H) and carcinoma markers (polyclonal and monoclonal CEA, and Leu-M1) yielded a too low sensitivity for practical use.

Topics: Antigens, Neoplasm; Antigens, Surface; Biomarkers, Tumor; CA-125 Antigen; Calbindin 2; Carcinoembryonic Antigen; Cystadenocarcinoma, Papillary; Cystadenocarcinoma, Serous; Diagnosis, Differential; Epithelium; Female; Humans; Hyaluronan Receptors; Immunohistochemistry; Keratin-5; Keratins; Lewis X Antigen; Mesothelioma; Ovarian Neoplasms; Peritoneal Neoplasms; Predictive Value of Tests; S100 Calcium Binding Protein G; Thrombomodulin

Lymph node metastasis in colorectal carcinoma is an important prognostic factor, yet the prognostic relevance of occult tumor cells in lymph nodes has not elucidated. This study was performed to investigate the correlation between isolated tumor cells in lymph nodes and malignancy potential in patients with Dukes B colorectal carcinoma and, thus, to determine whether presence of isolated tumor cells in lymph nodes has a prognostic significance.. To evaluate the incidence of isolated tumor cells in lymph nodes in patients with Dukes B colorectal carcinoma, 1,808 lymph nodes taken from 93 patients (19.4 per case) were assessed by immunohistochemical technique using a monoclonal antihuman cytokeratin (MNF 116). Clinicopathologic parameters and prognosis were compared between patients with and without isolated tumor cells.. Isolated tumor cells were identified in 54 lymph nodes from 29 patients (31.2 percent) by the immunostaining. No correlations were observed between the incidence of positive isolated tumor cells and various clinicopathologic parameters, including preoperative carcinoembryonic level, tumor site and size, histologic differentiation, pT stage, vascular invasion and lymphatic invasion, and perineural invasion. There was no difference in five-year survival estimated by Kaplan-Meier life-table method between positive and negative groups for isolated tumor cells (82.8 and 85.9 percent, respectively). Multivariate analyses showed that sex (P = 0.0236), serum carcinoembryonic level (>or= 5 ng/ml, P = 0.0002), and lymphatic vessel invasion (P = 0.0002) were significant factors in the survival time.. Immunohistochemical staining with an anticytokeratin antibody is useful in identifying isolated tumor cells in lymph nodes missed in routine hematoxylin-eosin staining, but clinically it seems to be of little prognostic value in patients with Dukes B colorectal carcinoma. Thus, this immunostaining technique does not offer a significant benefit of different strategies for additional therapy or follow-up during conventional pathologic staging using hematoxylin-eosin staining.

Topics: Adult; Aged; Antibodies, Monoclonal; Carcinoma; Colorectal Neoplasms; Female; Humans; Immunohistochemistry; Incidence; Keratins; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Peritoneal Neoplasms; Prognosis; Retrospective Studies; Survival Analysis

Primary effusion lymphoma (PEL) has been recognized as a body-cavity-based lymphoma that was originally reported to be associated with human herpes virus 8 (HHV8) infection, and was frequently found in human immunodeficiency virus-positive (HIV) patients. Here we describe an autopsy case of PEL of the peritoneal cavity in an immunocompetent patient. Cytological analysis of tumor cells within ascites revealed immunocytochemical features of keratin positivity and CD45 negativity. At autopsy, the presence of a massive volume of ascites as well as diffuse tumor cell infiltrates within the serosa of the intestine and mesenterium were observed. Tumor cells were morphologically similar to anaplastic large-cell lymphoma, but were immunohistochemically positive for keratin and epithelial membrane antigen (EMA). They also showed no reactivity to representative lymphocyte surface markers including CD45, in addition to being negative for CD30 and p80NPM/ALK. Molecular analysis of the tumor cells revealed monoclonality of the immunoglobulin heavy-chain gene rearrangement which demonstrated a lymphoma of the B-cell lineage. Furthermore, HHV8 was not detected by immunohistochemical analysis, PCR or nested PCR technique. Based on these results, we consider the present case to be an HHV8-negative PEL with keratin and EMA positivity.

Topics: Adult; Ascites; Ascitic Fluid; Female; Herpesvirus 8, Human; Humans; Immunohistochemistry; Keratins; Lymphoma; Mucin-1; Peritoneal Neoplasms; Phenotype

Pseudomyxoma peritonei (PMP) is a rare condition characterized by gelatinous ascites. Although the histologic attributes of PMP have been well studied, the cytologic features remain ill defined.. We reviewed the peritoneal washings (PW) in 67 patients with PMP to identify cytomorphologic features useful in classifying cases as either disseminated peritoneal adenomucinosis (DPAM) or peritoneal mucinous carcinomatosis (PMCA). Histologic specimens were correlated with the cytologic diagnoses. Correlation between cytologic diagnosis and patient outcome was investigated.. Neoplastic epithelial cells were identified in 63 of 67 PW (94%). Concordance with the histologic diagnosis was obtained in 61 of 63 cases. Of these 36.5% were cytologically classified as DPAM with primary appendiceal neoplasms in 19 cases. Thirty-four of 63 cases (53.9%) were cytologically diagnosed as PMCA based on PW cytology. Most were of appendiceal or colonic origin. Four cases displayed cytologic features of both DPAM and PMCA. Two discordant cases each with a cytologic diagnosis of PMCA had an appendiceal adenoma. Acellular mucin alone was identified in the PW in four cases. Analysis of follow-up data revealed that cases diagnosed as DPAM had a better prognosis than those diagnosed as PMCA.. Cytomorphologic features of epithelial cells in PW material can accurately categorize cases of PMP as either DPAM or PMCA. Furthermore, this categorization appears to have important prognostic implications.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Ascites; Calbindin 2; Carcinoembryonic Antigen; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratins; Male; Middle Aged; Peritoneal Neoplasms; Pseudomyxoma Peritonei; S100 Calcium Binding Protein G

A 10-year-old male aardwolf (Proteles cristatus) was presented abdominal distention and emaciation for 3 months. Physical examination revealed firm abdominal masses with effusions. Cytologic assessment of the effusion showed uniform round tumor cells with a surface brush border. Necropsy showed white velvety masses covering the peritoneal surface of the liver, gall bladder, stomach, omentum, mesentery, spleen, intestine, abdominal wall and diaphragm. Histologic examination demonstrated papillary projections, lined with cuboidal tumor cells supported by fibrous connective tissue cores, arising from the serosa of visceral organs. Cytoplasmic vacuolation and a surface brush border were evident on some cells under light microscopy. Tumor cells stained positive for both cytokeratin (AE1/AE3) and vimentin. Electron microscopy showed prominent surface microvilli, rough endoplasmic reticulum, mitochondria and desmosomes in tumor cells. This may be the first reported case of peritoneal mesothelioma in a captive wild aardwolf.

Topics: Animals; Animals, Zoo; Ascites; Biomarkers, Tumor; Carnivora; Keratins; Male; Mesothelioma; Neoplasm Proteins; Neoplastic Stem Cells; Peritoneal Neoplasms; Vimentin

To identify the most accurate and useful panel to diagnose mesothelioma, we immunostained sections from 112 mesotheliomas, 18 adenocarcinomas, and 11 reactive pleural specimens with 13 antibodies. Positive results for mesotheliomas, adenocarcinomas, and reactive pleura, respectively, were CAM5.2, 111, 18, and 11; vimentin, 30, 3, and 3; HBME-1, 75, 10, and 8; thrombomodulin, 31, 2, and 2; calretinin, 43, 6, and 11; and CD44H, 68, 10, and 4. Positive results for adenocarcinoma markers in mesotheliomas and adenocarcinomas, respectively, were carcinoembryonic antigen, 1 and 15; LeuM1, 7 and 9; and Ber-EP4, 5 and 12. All reactive pleura were negative. Positive results for markers to help distinguish mesothelioma from reactive pleura in mesotheliomas, adenocarcinomas, and reactive pleura, respectively, were epithelial membrane antigen, 76, 17, and 6; p53, 78, 16, and 9; P-170 glycoprotein, 37, 4, and 2; and platelet-derived growth factor receptor beta, 31, 1, and 2. The differential diagnosis of mesothelioma from adenocarcinoma is based on negative markers. Individual mesothelial markers are of low sensitivity and specificity for mesothelioma. However, diagnostic accuracy is improved by the use of antibody panels. To date there are no antibodies that help distinguish mesothelioma from reactive pleura.

Topics: Adenocarcinoma; Antigens, Surface; ATP Binding Cassette Transporter, Subfamily B; Biomarkers; Biomarkers, Tumor; Calbindin 2; Carcinoembryonic Antigen; Diagnosis, Differential; Glycoproteins; Humans; Hyaluronan Receptors; Immunohistochemistry; Keratins; Lewis X Antigen; Mesothelioma; Mucin-1; Neoplasm Metastasis; Peritoneal Neoplasms; Pleural Neoplasms; Receptor, Platelet-Derived Growth Factor beta; S100 Calcium Binding Protein G; Thrombomodulin; Tumor Suppressor Protein p53; Vimentin

Micrometastases are considered to be a cause of recurrence after curative surgery for gastric cancer. It is important to clarify the clinicopathologic characteristics of micrometastases in the lymph nodes and peritoneal cavity to determine the treatment options in gastric cancer. Two consecutive sections of lymph nodes from patients with various cancers were examined by simultaneous staining with ordinary hematoxylin and eosin (H & E) and immunostaining with anti-cytokeratin antibody, respectively. Micrometastases in the lymph nodes were found in 18% of mucosal cancer, 25% of submucosal cancer, and 65% of T3 (serosal) cancers pecimens, with cancer-free nodes examined by H & E staining. A reduced 5-year survival rate was demonstrated in patients with nodal micrometastases among those with submucosal cancer and those with T3 cancer and cancer-free nodes examined by H & E staining. Molecular biological detection (MBD) of micrometastasis in lavage cytology specimens was performed by RT-PCR of carcinoembryonic antigen mRNA or telomerase activity assay. MBD protocols revealed micrometastases in cases with negative cytology results. Survival analysis demonstrated peritoneal recurrences in MBD-positive cases, whereas there was no recurrence in MBD-negative cases. Peritoneal micrometastases detected by MBD protocols appear to be a significant risk factor for recurrence. Therefore indications for lymph node dissection and postoperative chemotherapy should be determined based on the findings of micrometastases in gastric cancer.

Topics: Biomarkers, Tumor; Carcinoembryonic Antigen; Humans; Keratins; Lymph Nodes; Lymphatic Metastasis; Peritoneal Neoplasms; Prognosis; RNA, Messenger; Stomach Neoplasms; Survival Rate

Topics: Aged; Antigens, Neoplasm; Ascites; Biomarkers, Tumor; Humans; Keratin-19; Keratins; Male; Mesothelioma; Peritoneal Neoplasms

Pseudomyxoma peritonei syndrome is a rare disease that originates from an adenomatous lesion of the appendix that, from pressure, perforates to gain access to the free peritoneal cavity. The relative sparing of the small bowel surfaces allows for complete cytoreduction even though many kilograms of mucinous tumour exist at other sites within the abdomen and pelvis. The purpose of this study was to examine the mechanism whereby the small bowel remains free of gross tumour and peritoneal surface polyps form.. Peritoneal surface polyps were harvested and examined grossly and histologically. A hypothesis for their formation on small bowel and small bowel mesentery was proposed. Polyps are known to be associated with repeated motion of enteric contents moving past adenomatous tissue so that, over time, an elongated stalk is created. We have repeatedly observed pedunculated polyps on the peritoneal surface of the small bowel in patients with pseudomyxoma peritonei syndrome. No other site within the peritoneal cavity has had a pseudomyxoma polyp located upon its surface.. The peristaltic motion of the small bowel causes adherent adenomatous tissue to develop a stalk on the peritoneal surface. Motion not only creates polypoid lesions but also repeatedly clears mucinous tumour cells from the small bowel surface. With pseudomyxoma peritonei and with other types of cancerous dissemination, prevention of adherence by motion may interfere with the implantation of malignant cells.

Topics: Biomarkers; Humans; Immunohistochemistry; Keratins; Peritoneal Neoplasms; Peritoneum; Polyps; Pseudomyxoma Peritonei; Syndrome

We report a case of cystic mesothelioma of the peritoneum in a young male with local recurrences and whose diagnosis was confirmed by standard histological studies and immunohistochemistry. This rare tumor appears generally in young females through abdominal pain and mass. Local recurrences without distant metastases are a feature of this pathology. The adequate treatment requires complete resection.

Topics: Adult; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma, Cystic; Peritoneal Neoplasms

Topics: Adult; Carcinoma, Small Cell; Desmin; Humans; Immunohistochemistry; Keratins; Male; Mucin-1; Peritoneal Neoplasms; Phosphopyruvate Hydratase; Vimentin

Topics: Adult; Female; Humans; Immunohistochemistry; Keratins; Mesothelioma, Cystic; Peritoneal Neoplasms

To evaluate the origin of pseudomyxoma peritonei (PMP) in Chinese women.. The clinicopathologic features of 15 cases of PMP were reviewed. Immunostaining using antibodies for CK7 and CK20 was performed in the ovarian, appendiceal and peritoneal lesions of these cases.. Appendiceal pathology was documented in five cases, including four mucinous cystadenoma and one simple mucocele. Eight ovarian tumors were found, including seven mucinous cystadenocarcinomas of low malignant potential and one mucinous cystadenoma. Synchronous ovarian and appendiceal lesions were discovered in three cases. One patient had adenocarcinoma of the pancreas. The origin of mucin production was not known in four cases with metastatic adenocarcinoma found in two of them. Immunoreactivity for CK20 was demonstrated in the tissues derived from the peritoneum, ovary, appendix and pancreas while only 23% (3 out of 13 women) of the peritoneal lesions and 33% (2 out of 6 women) of the ovarian tumors were immunoreactive for CK7.. PMP is a heterogeneous lesion, which may develop from mucinous metaplasia of the peritoneum or from appendiceal, or ovarian lesions. Careful examination of the ovary and appendix with performance of appendectomy is advised in every case of PMP. Immunohistochemical examination of the peritoneal, ovarian or appendiceal lesions using antibodies, in particular that for CK7 would help in defining the origin of mucin production.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratins; Middle Aged; Peritoneal Neoplasms; Pseudomyxoma Peritonei; Retrospective Studies

Cytokeratin 7 (CK-7) has been shown to be uncommonly expressed in colonic epithelial tumors, as opposed to ovarian epithelial tumors, which are always CK-7 positive. The authors investigated the expression of CK-7 in 17 appendiceal cystadenomas and carcinomas, 20 mucinous borderline tumors of the ovary, 10 cases of simultaneous mucinous tumors of the appendix and ovary, three so-called high-stage mucinous borderline tumors of the ovary, and three cases of pseudomyxoma peritonei (PP) of unknown origin. Nine appendiceal cystadenomas were CK-7 negative; two of these were associated with PP, and the peritoneal lesions were negative as well. Three cystadenomas were CK-7 positive. Three appendiceal carcinomas were CK-7 negative, and in one case the metastases were also negative. Two carcinomas were CK-7 positive. All 20 ovarian borderline tumors were CK-7 positive. Six cases of simultaneous mucinous tumors of the ovary and appendix were CK-7 negative, as were their peritoneal mucinous deposits. Four cases showed a positive reaction in both appendiceal and ovarian sites. Two of three so-called high-stage ovarian borderline tumors were CK-7 negative. All three cases of PP of unknown origin were CK-7 negative. In conclusion, appendiceal cystadenomas are often CK-7 negative, whereas ovarian mucinous borderline tumors are always CK-7 positive. The concordant staining pattern for CK-7 of simultaneous mucinous tumors involving the appendix and ovary (60% of which were CK-7 negative) supports an appendiceal origin for these tumors. Our results also support an appendiceal (or colonic) source for any CK-7-negative mucinous tumor involving the ovary or the peritoneum. Furthermore, our findings are in agreement with the assumption that mucinous borderline-like tumors in the ovary associated with PP are not ovarian in origin but are often, if not always, metastatic from an appendiceal (or other) mucinous tumor.

Topics: Adult; Aged; Aged, 80 and over; Appendiceal Neoplasms; Carcinoma; Cystadenocarcinoma; Female; Humans; Keratins; Male; Middle Aged; Ovarian Neoplasms; Peritoneal Neoplasms; Pseudomyxoma Peritonei

The immunohistochemical diagnosis between epithelial mesothelioma and adenocarcinoma is currently based on the use of a panel of antibodies to adenocarcinoma-associated antigens and a few antibodies to mesothelial-associated antigens. Since the introduction of epitope retrieval methods, the sensitivity of many antibodies has been enhanced. Thus, a reevaluation of the mesothelioma/adenocarcinoma diagnostic panel becomes necessary. We studied 268 paraffin-embedded formalin-fixed tumor samples that included 57 epithelial mesotheliomas and 211 adenocarcinomas of various origins, comparing an extensive antibody panel with and without heat-induced epitope retrieval (HIER). Marked increase in the sensitivity of several antibodies, with no loss of specificity, was found when HIER was used. After statistical analysis, the antibodies to the epithelial glycoproteins carcinoembryonic antigen, BerEp4, and Bg8 emerged as the best discriminators between adenocarcinoma and epithelial mesothelioma within the entire panel. The mesothelium-associated antibodies, HBME-1, calretinin, and thrombomodulin were less sensitive and less specific than the former, although they were found to be useful on certain cases. Antibodies to cytokeratins and vimentin, although of minor diagnostic value in this context, may be helpful to evaluate the quality of antigen preservation. This study confirms the value of immunohistochemistry to accurately distinguish mesothelioma from adenocarcinoma when an antibody panel approach is used. The addition of heat-induced epitope retrieval methods increases the effectiveness of the procedure and is recommended for most of the antibody panel members.

Topics: Adenocarcinoma; Biomarkers, Tumor; Breast Neoplasms; Calbindin 2; Carcinoembryonic Antigen; Colorectal Neoplasms; Decision Trees; Diagnosis, Differential; Epitopes; Female; Hot Temperature; Humans; Immunohistochemistry; Keratins; Lung Neoplasms; Mesothelioma; Ovarian Neoplasms; Peritoneal Neoplasms; Pleural Neoplasms; Retrospective Studies; S100 Calcium Binding Protein G; Sensitivity and Specificity; Thrombomodulin; Vimentin

We describe the cytohistological, immunohistochemical and ultrastructural findings in a 55-yr-old-man with history of asbestos exposure and diffuse malignant mesothelioma (DMM) of the pleura, peritoneum, and tunica vaginalis presenting with chest pain and scrotal swelling. Pleural fine-needle aspiration (FNA) revealed mesenchymal elements and spindle-shaped epithelial-like cells, while biopsy showed pure sarcomatous tumor invading lung parenchymal. In both samples tumor cells coexpressed cytokeratin and vimentin. Peritoneal and hydrocele effusions contained aggregates of malignant mesothelial cells. Electron microscopy showed intermediate filaments, rare desmosomes and sparse microvilli. Morphological findings were consistent with a DMM, with a biphasic pattern in the pleura and an epithelial one in the peritoneum and tunica vaginalis. Although the possibility of a multicentric origin cannot be ruled out, clinical chronologic sequence suggests that the pleura was the primary involved site, followed by spread to peritoneum and tunica vaginalis.

Topics: Asbestos; Biopsy, Needle; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma; Microscopy, Electron; Middle Aged; Neoplasms, Multiple Primary; Occupational Diseases; Peritoneal Neoplasms; Pleural Neoplasms; Testicular Neoplasms; Tomography, X-Ray Computed; Vimentin

A case is reported of intra-abdominal desmoplastic small cell tumor (IDSCT) with biphasic histologic features in a patient with proximal spinal muscular atrophy. The tumor was composed of small epithelial cell nests with spindle cell sarcomatous areas. Both areas were surrounded by a desmoplastic stroma. Immunohistochemical studies revealed reactivity for low molecular weight cytokeratin, epithelial membrane antigen, vimentin, desmin and Leu-7 in both areas. Electron microscopic examination demonstrated paranuclear aggregates of intermediate filaments, zonula adherens and basement membrane-like material in the epithelial cells, while spindle cells in the tumor had fewer intracytoplasmic organelles. However, intermediate or transitional forms of both types of tumor cells were frequently observed. Although IDSCT are known to express multi-phenotypes immunohistochemically, attention should be paid to the broad spectrum of cell morphology in these tumors.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Combined Modality Therapy; Desmin; Fatal Outcome; Humans; Immunoenzyme Techniques; Keratins; Male; Muscular Atrophy, Spinal; Neoplasm Recurrence, Local; Omentum; Peritoneal Neoplasms; Sarcoma, Small Cell

A 46-year-old man presented with recurrent anemia and polyarthralgia. Investigations revealed a mass in the ileal mesentery, which was resected. Results of routine histologic examination suggested a diagnosis of synovial sarcoma, a rare malignancy usually not reported at this site.. Tissue was examined immunohistochemically, ultrastructurally, and by fluorescent in situ hybridization to confirm the diagnosis.. Immunohistochemical studies revealed widespread labeling for cytokeratins and focal labeling for desmin and vimentin in the epithelial component, with labeling for epithelial membrane antigen in the epithelial and spindle-cell components. Fluorescent in situ hybridization analysis showed the characteristic t(X;18) translocation of synovial sarcoma.. This is a unique case of synovial sarcoma in the small intestinal mesentery. Immunohistochemical labeling confirmed the diagnosis, although, to the authors' knowledge, the pattern of desmin labeling has not been described previously. The clinical association with polyarthralgia, which resolved after removal of the neoplasm, also has not been described previously.

Topics: Desmin; Humans; Ileum; Immunohistochemistry; In Situ Hybridization, Fluorescence; Keratins; Male; Mesentery; Middle Aged; Peritoneal Neoplasms; Sarcoma, Synovial; Vimentin

A 32-yr-old man was admitted to Anjo Kosei Hospital for the examination of a cystic peritoneal lesion. This patient had a past medical history significant for an appendectomy. Ultrasonography and computed tomography revealed multiple cysts in the abdominal and pelvic cavities. An exploratory laparotomy was performed on July 1, 1993, revealing numerous thin-walled and translucent cysts in the serosal tissues of the parietal and visceral abdominal peritoneum. These cysts were excised surgically because of clinical suspicion of pseudo-myxoma peritonei. Microscopic examination revealed cysts within the thin cyst wall that were composed of fibrous connective tissue and lined by a single layer of cuboidal or flattened epithelium. Immunohistochemical and ultrastructural studies demonstrated that the lining cells were of mesothelial origin, and the diagnosis was benign cystic mesothelioma. In this paper, we present appropriate diagnostic and treatment procedures for benign cystic mesothelioma and discuss the particular usefulness of using immunohistochemical methods to achieve a histological diagnosis.

Topics: Adult; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma, Cystic; Peritoneal Neoplasms

We established an in vitro peritoneal dissemination model using six ovarian cancer cell lines and cultured mesothelial cells. Ovarian cancer cells were classified into two types, invasive or adhesive, on the basis of their interaction with the mesothelial cell monolayer. The ovarian cancer cell lines derived from mucinous cystadenocarcinoma, poorly differentiated adenocarcinoma and undifferentiated carcinoma, which belonged to the invasive type, began to invade beneath the mesothelial monolayer from several hours after seeding in vitro, expelling the mesothelial cells at the periphery and forming colonies directly on the dish surface. On the other hand, cancer cell lines of clear cell carcinoma, which belonged to the adhesive type, showed colony formation with adhesion on the mesothelial monolayer even 18 h after seeding. Invasive-type cell lines invaded into the mesothelial monolayer at various rates in vitro, and the degree of invasiveness showed good correlation with the degree of peritoneal dissemination in vivo after intraperitoneal injection of cancer cells into nude mice. Adhesive-type cells showed rather higher dissemination rates in vivo. Microscopic observation of in vivo peritoneal dissemination at one day after inoculation also revealed two patterns of peritoneal involvement similar to those in vitro. In the in vitro model, anti-integrin alpha 2- and beta 1-antibodies inhibited the infiltration of invasive-type cells into the mesothelial monolayer, but did not affect colony formation by adhesive-type cells on the monolayer, indicating that invasion by both cell types was mediated by different molecules. This in vitro model is thought to be useful for analysis of the molecular mechanisms of peritoneal dissemination.

Topics: Animals; Cell Adhesion; Cells, Cultured; Epithelial Cells; Epithelium; Factor VIII; Female; Humans; Keratins; Mice; Mice, Inbred BALB C; Neoplasm Invasiveness; Omentum; Ovarian Neoplasms; Peritoneal Neoplasms; Tumor Cells, Cultured; Vimentin

Cytokeratin 7 (CK-7) is a simple epithelial keratin that may be used to investigate the site of origin of adenocarcinomas. In fact, CK-7 is present in ovarian epithelial neoplasms but is generally absent in colonic carcinomas. This pattern of CK-7 expression may aid in elucidating the genesis of mucinous tumors occurring simultaneously in the ovary and appendix, accompanied by psuedomyxoma peritonei. Five such cases were immunostained with anti-CK-7, and all showed a concordant staining pattern of the appendiceal, ovarian, and peritoneal lesions. Two cases showed a negative reaction for CK-7 and thus would appear to represent ovarian and peritoneal metastases from an appendiceal primary tumor. Three cases were CK-7 positive, and the nature of these mucinous lesions remains open to debate; they may either represent independent primary tumors or originate from the appendix. For comparison, five Stage I mucinous borderline tumors of the ovary and their normal appendices were also stained with anti-CK-7. These ovarian tumors were all CK-7 positive, whereas the appendices were negative. It is concluded that CK-7 is capable of distinguishing a group of tumors that can reliably be classified as primary appendiceal neoplasms metastatic to the ovaries and peritoneum.

Topics: Adult; Aged; Aged, 80 and over; Appendiceal Neoplasms; Cystadenocarcinoma, Mucinous; Female; Humans; Immunohistochemistry; Keratins; Middle Aged; Ovarian Neoplasms; Peritoneal Neoplasms; Pseudomyxoma Peritonei

Peritoneal mesotheliomas are rare in women, compared to serous epithelial neoplasms with which they are often confused. We evaluated the clinicopathologic features of 19 true mesothelial neoplasms affecting the genital tract or peritoneum of women (other than adenomatoid tumors, benign multicystic mesotheliomas, and localized fibrous tumors) to characterize their clinicopathologic features and to determine their clinical behavior. Six tumors were localized to one anatomic site at presentation, and 13 involved more than one anatomic site. The six localized tumors were solitary, small (0.8-2.0 cm), polypoid or nodular lesions, five of which were incidental findings. All had a predominantly tubulopapillary pattern, either pure or mixed with adenomatoid-like or small solid foci. Nuclear grade ranged from 0 to 2. Mitotic figures (MF) were absent in two tumors. The mitosis count in the other four tumors was < 1 MF/10 high-power microscopic fields (HPF) (average method) and ranged from 1 to 3 MF/10 HPF (highest count method). Five patients were alive without recurrence after postoperative intervals ranging from 19 months to 9 years (median, 5 years); one patient died of metastatic gastric carcinoma at 14 months. Thirteen tumors involved more than one anatomic site and were classified as diffuse mesothelioma. Typically, these tumors were symptomatic and accompanied by ascites. The tumors had either a plaque-like or endophytic configuration. Eleven were purely epithelial mesotheliomas, and two had a minor sarcomatoid component. Tubulopapillary patterns were present in 10 tumors, usually admixed with focal adenomatoid-like or solid patterns, and three had a purely solid pattern. All 13 tumors had grade 3 nuclei. The mitosis count ranged from < 1 to 2 MF/10 HPF (average count method) with a range of 1-4 MF/10 HPF by the highest count method. Immunohistochemically, 13/13 tumors stained for cytokeratin (AE1/AE3). None were immunoreactive for polyclonal carcinoembryonic antigen (CEA), Leu-M1, or B72.3. One diffuse mesothelioma stained focally for Ber-EP4, and electron microscopy confirmed the mesothelial nature of this tumor. Nine patients died of tumor after postoperative intervals ranging from 1 month to 6 years. Eleven patients had received postoperative adjuvant intraperitoneal or systemic chemotherapy. One patient died with increased abdominal girth 8 years after operation and one course of intraperitoneal chemotherapy, though the role of mesothelioma in her death

Topics: Adenomatoid Tumor; Adult; Aged; Aged, 80 and over; Female; Fibroma; Follow-Up Studies; Genital Neoplasms, Female; Humans; Immunohistochemistry; Keratins; Mesothelioma; Mesothelioma, Cystic; Microscopy, Electron; Middle Aged; Mitosis; Peritoneal Neoplasms; Prognosis

Desmoplastic small round cell tumors (DSRCT) have been only recently identified.. The authors report DSRCT in two pediatric patients (an 8-year-old boy and 12-year-old boy). In both patients, the initial diagnosis was rhabdomyosarcoma. The resistance to standard chemotherapy and radiation therapy prompted the authors to review the initial biopsy specimens and perform complementary immunophenotypic characterization.. These analyses revealed that the tumor cells were strongly positive for keratin epithelial marker antigen, desmin, vimentin, neurospecific enolase, and S100 protein, corresponding to pleomorphic differentiation, characteristic of DSRCT:. The authors suggest that extensive immunohistologic characterization be performed in all cases of small round cell tumors of the abdomen so that the diagnosis of DSRCT is not overlooked. These rare tumors are refractory to chemotherapy, and initial aggressive surgery is warranted.

Topics: Antigens, Neoplasm; Child; Desmin; Diagnosis, Differential; Humans; Keratins; Male; Membrane Glycoproteins; Mucin-1; Neoplasm Invasiveness; Pelvic Neoplasms; Peritoneal Neoplasms; Phosphopyruvate Hydratase; Rhabdomyosarcoma; Vimentin

Two cases of malignant peritoneal mesothelioma are reported. These tumors affected young women and displayed an unusual histopathologic pattern that closely simulated exuberant, ectopic decidual reaction or at least a malignant counterpart thereof. The importance of the differential diagnosis from decidual reaction is emphasized because decidua-like mesothelioma appears to be a highly malignant neoplasm. The cause of this lesion is unknown; and, considering the young age of the patients and the failure to demonstrate hormone receptors in the neoplastic cells, it is unlikely that asbestos exposure or hormonal imbalance played any role in the development of the disease.

Topics: Adult; Decidua; Diagnosis, Differential; Female; Humans; Keratins; Mesothelioma; Microscopy, Electron; Peritoneal Neoplasms; Phenotype

Topics: Alcian Blue; Animals; Cricetinae; Hyaluronoglucosaminidase; Immunohistochemistry; Keratins; Male; Mesocricetus; Mesothelioma; Periodic Acid-Schiff Reaction; Peritoneal Neoplasms; Rodent Diseases; Staining and Labeling; Vimentin

A 2-year-old girl presented with a 3-month history of progressive painless abdominal distension. Results of the clinical examination suggested massive ascites, but no other symptoms or signs could be elicited. There was no history of any other illness preceding the onset of distension. Ultrasonography and a computed tomography scan confirmed gross ascites, with multiple thin-walled loculi throughout the abdomen, from the diaphragm to the pelvis. The preoperative diagnosis was intraabdominal lymphangioma. During laparotomy, multiple transparent cysts were found throughout the peritoneum. There was no evidence of malignancy in any organ, and the cysts appeared almost completely avascular. Histological and ultrastructural appearances were those of benign cystic mesothelioma of the peritoneum, a condition that hitherto has been recognized only in adults. It is thought to represent a borderline variant between a truly benign adenomatoid lesion and the better-known malignant mesothelioma. The experience with adult cases suggests a high potential for recurrence but no progression to malignancy. It is possible that some cases of intraabdominal lymphangioma may have been misdiagnosed in the past; future cases should be fully evaluated, both immunohistochemically and ultrastructurally, to establish the true incidence of mesothelial proliferative disease in children.

Topics: Ascites; Biomarkers, Tumor; Child, Preschool; Diagnosis, Differential; Female; Humans; Keratins; Mesothelioma, Cystic; Peritoneal Neoplasms; Peritoneum; Radiography

A case report of epithelioid adrenal angiosarcoma is presented. Tumor cells showed expression of cytokeratin, Factor VIII-related antigen, Ulex europaeus agglutinin-I, and vimentin. The patient also was found to have mesenteric fibromatosis (abdominal desmoid tumor) and an elevated serum level of estradiol. The authors discuss the unique appearance of these rare tumors, their relationship to hyperestrinism, and review the recent data in the literature showing cytokeratin expression by malignant epithelioid vascular tumors.

Topics: Adrenal Gland Neoplasms; Adult; Estradiol; Fibroma; Hemangiosarcoma; Humans; Immunohistochemistry; Keratins; Male; Mesentery; Peritoneal Neoplasms

Primary tumors of the peritoneum are rare. Histological differentiation between papillary mesotheliomas, primary ovarian tumors, borderline tumors of the ovary with peritoneal deposits and primary peritoneal carcinoma may be difficult. The expression of vimentin, keratin, pankeratin, CEA, CA125, CA19-9, S100, B72.3 and BerEP4 was therefore investigated in twelve women with primary malignant peritoneal tumors, twelve women with pleural mesothelioma, eight women with serous ovarian carcinoma and four men with peritoneal mesothelioma. The marker pattern we used was no help in differentiating between metastatic ovarian carcinoma and primary peritoneal carcinomatosis. A combination of the markers S100, B72.3 and BerEP4 helped the distinction between mesotheliomas and the other malignancies. If two or all three markers are detectable, primary peritoneal carcinomatosis or metastatic ovarian carcinoma is the possible diagnosis. If none of the three markers are found, a diagnosis of mesothelioma is highly probable.

Topics: Biomarkers, Tumor; Carcinoma; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma; Ovarian Neoplasms; Peritoneal Neoplasms

An autopsy case of diffuse malignant peritoneal mesothelioma in a young woman who showed a high serum level of CA125 is reported. Autopsy revealed extensive tumor involvement of the visceral and parietal peritoneum. The liver, spleen and other abdominal viscera were encased by tumor nodules. Histologically, the polygonal tumor cells were arranged mostly in a sheet-like fashion with a few tubular or papillary forms. No PAS reaction-positive mucin was recognized, but there was a strongly positive colloidal iron reaction. The colloidal iron positivity was effaced after combined treatment with hyaluronidase and sialidase. Immunohistochemically the tumor cells showed strongly positive reactions for CA125, epithelial membrane antigen (EMA) and cytokeratin, weak positivity for carcinoembryonic antigen (CEA) and focal positivity for vimentin. Ultrastructurally, the most characteristic feature was the expression of numerous long microvilli projecting from the tumor cell surfaces and abundant long desmosomes between the tumor cells. We consider that pretreatment using a combination of hyaluronidase and sialidase might be useful for the diagnosis of malignant mesothelioma. CA125 staining should be performed routinely in cases where this tumor is suspected.

Topics: Adolescent; Antigens, Tumor-Associated, Carbohydrate; Desmosomes; Female; Humans; Immunohistochemistry; Keratins; Membrane Glycoproteins; Mesothelioma; Microvilli; Mucin-1; Peritoneal Neoplasms; Vimentin

A case of primary clear cell carcinoma of the pelvic and abdominal peritoneum which occurred in a 67-year-old woman and with histological characteristics of Mullerian derivation is presented. To our knowledge, this is the first report of such a case. Although clear cell carcinomas have been previously described in peritoneal or retroperitoneal locations, these have been mass lesions thought to arise from endometriosis. All other cases of diffuse primary peritoneal adenocarcinomas have been of the serous type.

Topics: Adenocarcinoma; Aged; Female; Humans; Immunohistochemistry; Keratins; Peritoneal Neoplasms

Desmoplastic small cell tumors arising diffusely within the abdomen and lacking an apparent organ of origin are rare. Most previously reported cases occurred in children, but young adult patients also have been described. Light microscopic examination shows the tumors to be composed of nests of small cells surrounded by an abundant desmoplastic stroma. Immunohistochemical findings reveal multidirectional differentiation with coexpression of cytokeratin, milk fat globule, neuron-specific enolase, Leu-7, desmin, and vimentin. Electron microscopic examination demonstrates paranuclear condensations of intermediate filaments. The authors describe two patients who died of their disease, despite aggressive chemotherapy and surgical intervention.

Topics: Adolescent; Adult; Biomarkers, Tumor; Desmin; Fibroma; Histocytochemistry; Humans; Immunoenzyme Techniques; Keratins; Male; Peritoneal Neoplasms; Vimentin

Two cases of peritoneal papillary carcinoma are reported. The patient in the first case was a 71-year-old woman with symptoms of obstructive ileus. Laparotomy revealed a tumor in the omentum involving the transverse colon, and several small tumors in the peritoneum and pelvic wall. However, no primary site of the tumor was seen in the ovary, pancreas, or gastrointestinal tract. The patient in the second case was a 44-year-old woman with carcinomatous peritonitis. Postmortem examination revealed multiple tumors in the peritoneum, omentum, and pelvic wall. Tumors were also found in the cortex with mild invasion of the underlying parenchyma of the bilateral ovaries, although these lesions were thought to be metastatic. The histologic features of the tumor in both cases were those of tubulopapillary adenocarcinoma containing scattered psammoma bodies. The cells were positive with the PAS-D technique, but negative with alcian blue staining. In both cases, the serum levels of CA-125 were considerably elevated, and the tumor cells showed positivity for CA-125, S-100 protein, cytokeratin and EMA by immunohistochemistry. The present cases were most likely peritoneal serous papillary adenocarcinoma derived from extraovarian peritoneal mesothelium with müllerian potential, being different from the usual type of diffuse malignant mesothelioma.

Topics: Adult; Aged; Antigens, Tumor-Associated, Carbohydrate; Autopsy; Cystadenocarcinoma; Female; Humans; Immunohistochemistry; Keratins; Membrane Glycoproteins; Mucin-1; Omentum; Pelvis; Peritoneal Cavity; Peritoneal Neoplasms; S100 Proteins

Serous surface carcinoma (SSC) of the peritoneum is defined as a primary tumor histologically indistinguishable from serous carcinoma of the ovary, diffusely involving the peritoneal surface but sparing or only superficially invading the ovaries. In this study of 22 cases of SSC, it was found that the main clinical manifestations of SSC were abdominal pain and enlargement. In most cases, SSC evenly involved the entire mesothelial surface but rarely was predominant in or even limited to the pelvis. It frequently invaded the submesothelium, but deep invasion into abdominal and pelvic organs or local metastasis was rare, and distant metastasis was not seen at presentation. Microscopically, SSC was a high-grade tumor frequently showing high mitotic rate, psammomas bodies, and necrosis. The tumor was usually contiguous with hyperplastic mesothelium on either ovarian surface or other locations. Tumor cells in all cases except one showed cytoplasmic or surface neutral or acidic mucin or both. Tumor cells stained positive for keratin (100% of cases), epithelial membrane antigen (100%), Leu-M1 (45%), B72.3 (85%), vimentin (35%), and carcinoembryonic antigen (25%). Electron microscopic studies of six cases showed epithelial differentiation in each. Seven patients (32%) were alive with no clinical disease at 3 to 31 months, one patient (4%) was alive with extensive local disease at 24 months, 11 patients (50%) died almost exclusively of local recurrence at 1 to 70 months, and three patients (14%) died of operative complications. It is concluded that SSC arises from peritoneal mesothelium but has epithelial phenotype. It can be morphologically differentiated from other conditions with similar laparotomy findings, such as malignant mesothelioma, benign papillary mesothelioma, cystic mesothelioma, and benign or borderline peritoneal serous tumors. The prognosis of SSC is poor, and most patients die of uncontrollable local disease.

Topics: Adult; Aged; Biomarkers, Tumor; Carcinoma; Female; Humans; Keratins; Lymphatic Metastasis; Membrane Glycoproteins; Middle Aged; Mucin-1; Ovarian Neoplasms; Peritoneal Neoplasms

Primary and metastatic tumor tissues of serous papillary adenocarcinoma of the endometrium were examined for the following: (1) amplification of int-2, c-erbB-2 and c-myc proto-oncogenes by Southern blot hybridization; (2) DNA ploidy by flow cytometric study; (3) and expression of specific proteins, such as estrogen and progesterone receptors, keratin, vimentin, and carcinoembryonic antigen (CEA) using immunohistochemical and biochemical techniques. Amplification of c-myc was observed in the specimens from the endometrium (ten-fold) and from omental metastasis (five-fold). Both int-2 and c-erbB-2 amplification were not observed. The tumor showed aneuploidy, with the specimens from the endometrium and omental metastasis exhibiting multiple populations of aneuploid tumor cells. Estrogen and progesterone receptors could not be detected biochemically; however, immunohistochemically, estrogen receptors were observed in tumor cells forming papillary structures but not in the tumor cells of the solid, more poorly differentiated areas. A similar distribution was observed for both low and high molecular weight keratin. The findings of c-myc amplification and aneuploidy in the serous papillary adenocarcinoma of the endometrium are consistent with its aggressive behavior observed clinically and emphasize the importance of distinguishing this lesion from other types of endometrial carcinoma.

Topics: Blotting, Southern; Cystadenocarcinoma; DNA, Neoplasm; Female; Flow Cytometry; Gene Amplification; Humans; Immunoenzyme Techniques; Keratins; Middle Aged; Molecular Weight; Peritoneal Neoplasms; Ploidies; Proto-Oncogene Mas; Proto-Oncogenes; Receptors, Estrogen; Receptors, Progesterone; Uterine Neoplasms

The distinction between serous neoplasms of the peritoneum in women and conventional mesothelioma can be difficult. In order to determine any significant immunohistochemical differences, formalin-fixed, paraffin-embedded sections of 10 peritoneal serous tumors (PST), 10 ovarian serous tumors (OST), and 10 epithelial mesotheliomas were evaluated with a panel of 10 antibodies directed against carcinoembryonic antigen (CEA: polyclonal, monoclonal), high molecular weight keratin (34 beta E12), low molecular weight keratin (35 beta H11), Leu-M1, TAG-72 (monoclonal antibody B72.3), human milk fat globulin (HMFG-2), vimentin, placental alkaline phosphatase (PLAP), and S-100 protein. The antibodies CEA, Leu-M1, and B72.3 had the most discriminatory value in differentiating serous tumors from mesothelioma. Eighty-five percent of PSTs and OSTs (17 of 20) were positive with CEA, Leu-M1, and/or B72.3. None of the mesotheliomas stained for CEA or Leu-M1; three mesotheliomas had very focal positivity with B72.3 (1% or less). Vimentin, PLAP, HMGF-2, keratin, and S-100 had no significant discriminatory value. Epithelial mucin was present in 80% of serous tumors, while the mesotheliomas lacked epithelial mucin. Leu-M1, CEA, and/or B72.3 positivity in a peritoneal tumor supports a diagnosis of serous tumor. However, since some PST do not stain for any of the three antibodies and the focal nature of positive reactions in some cases may be difficult to interpret, exclusion of mesotheliomas is enhanced by the use of mucin stains.

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Antibodies; Antigens, Differentiation, Myelomonocytic; Antigens, Neoplasm; Diagnosis, Differential; Female; Gene Expression; Glycoproteins; GPI-Linked Proteins; Humans; Isoenzymes; Keratins; Membrane Glycoproteins; Mesothelioma; Middle Aged; Mucin-1; Mucins; Ovarian Neoplasms; Peritoneal Neoplasms; Pleural Neoplasms; S100 Proteins; Vimentin

Three cases of peritoneal cystic mesothelioma are reported. All patients were women who had undergone previous abdominal surgery for unrelated conditions. Tumors consisted of solitary and multiple cystic masses involving the abdominal and pelvic peritoneum. The cysts focally infiltrated the muscularis externa of the small intestine in case 1, the outer muscular layer of the uterus in case 2, and the omental tissue in case 3. These findings give morphologic support to the borderline clinical behavior of this tumor that often recurs and support the hypothesis that previous surgery may play a role in its pathogenesis.

Topics: Abdomen; Adult; Carcinoembryonic Antigen; Factor VIII; Female; Humans; Immunohistochemistry; Keratins; Mesothelioma; Middle Aged; Peritoneal Neoplasms; Vimentin

In order to evaluate adjunctive histologic methods for separating mesothelioma (MM) and serous adenocarcinoma (SC), we studied 28 and 46 respective cases histochemically and immunohistochemically. Ten serous adenocarcinomas arose primarily in extraovarian sites within the abdomen. Diagnoses in each case were established retrospectively by a combination of electron microscopy and clinicopathologic correlation. A panel of antibodies to cytokeratin (CK), epithelial membrane antigen (EMA), B72.3, placental alkaline phosphatase (PLAP), S-100 protein, carcinoembryonic antigen (CEA), Leu M1, CA-125, and amylase (AM) was applied to paraffin sections of each case. Serous carcinoma was reactive for neutral mucins whereas mesothelioma was not; however, only 50% of adenocarcinoma cases stained in this manner. Peritoneal mesothelioma showed reactivity for CK (28 of 28 cases), EMA (24 of 28 cases), AM (five of 28 cases), CA-125 (four of 28 cases), and S-100 protein (three of 28 cases), but lacked B72.3, PLAP, and CEA. Three mesotheliomas expressed Leu M1, but in an extremely focal distribution. Serous carcinoma reacted for CK (46 of 46 cases), EMA (46 of 46 cases), CA-125 (42 of 46 cases), S-100 protein (40 of 46 cases), Leu M1 (34 of 46 cases; with diffuse staining), B72.3 (33 of 46 cases), PLAP (29 of 46 cases), AM (15 of 46 cases), and CEA (six of 46 cases). Two profiles (S-100 + B72.3; S-100 + PLAP) were seen in 41 of 46 serous adenocarcinoma cases but were absent in all mesotheliomas. Hence, these combinations of determinants are effective in separating such neoplasms diagnostically. Moreover, diffuse reactivity for Leu M1, B72.3, PLAP, or CEA in papillary peritoneal neoplasms appears to exclude the possibility of mesothelioma; however, focal Leu M1 reactivity may indeed be seen in mesothelioma. Although CA-125 is a sensitive marker for serous carcinoma, it is not effective in distinguishing it from mesothelioma.

Topics: Antigens, Differentiation, Myelomonocytic; Antigens, Neoplasm; Basement Membrane; Cell Nucleus; Cystadenocarcinoma; Cytoplasm; Female; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma; Peritoneal Neoplasms; S100 Proteins

Primary papillary serous carcinoma arising from the peritoneal surface (serous surface papillary carcinoma; SSPC) is a distinctive neoplasm with a histomorphologic resemblance to serous ovarian papillary carcinoma (SOPC). To determine if these tumors are similar antigenically, we studied 13 examples of SSPC and 31 of SOPC immunohistochemically. Antibodies to several determinants known to occur in the Müllerian epithelium were employed. Both neoplasms were uniformly positive for cytokeratin and epithelial membrane antigen (EMA); in addition, SSPC and SOPC were similar in quantitative and qualitative reactivity for B72.3 antigen, carcinoembryonic antigen, Leu M1, CA-125 antigen, LN1, LN2, MB2, S100 protein, placental alkaline phosphatase, and amylase. Residual nonneoplastic mesothelium failed to express any of these antigens except for cytokeratin, EMA, and CA-125. The clinical behavior of SSPC was similar to that of high-stage SOPC; all patients with adequate follow-up died of their tumors. These results suggest that SSPC and SOPC are analogous lesions, with respect to their cellular differentiation. Moreover, it would appear that both neoplasms display only a limited immunophenotypic homology to the mesothelium.

Topics: Adult; Aged; Aged, 80 and over; Amylases; Antigens, Neoplasm; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Keratins; Membrane Glycoproteins; Middle Aged; Mucin-1; Ovarian Neoplasms; Peritoneal Neoplasms; Proteins

Topics: Antigens; Cytoplasm; Humans; Immunoenzyme Techniques; Immunohistochemistry; Keratins; Peritoneal Neoplasms

Localized fibrous tumor of the serosal cavities (localized fibrous mesothelioma) is a generally benign spindle cell neoplasm of uncertain histogenesis. Fourteen histologically similar primary tumors from different mesothelium-lined sites (11 pleural and 1 each in the pericardium, peritoneal cavity, and pouch of Douglas) and 2 recurrences of those tumors (pericardium and pouch of Douglas) were examined histopathologically and by flow cytometry to relate histologic features and DNA ploidy to biologic behavior (follow-up, 48-255 months among 13 patients). All 16 tumors (14 primaries and 2 recurrences) displayed diploid DNA pattern, and none of 13 patients died of disease (1 patient was lost to follow-up). To elucidate the histogenesis, seven primary tumors were examined for vimentin and keratin immunostaining and six primary tumors were assessed by electron microscopy. All cases exhibited spindle-fibroblastic cell proliferation with a prominent hemangiopericytic pattern. All cases so examined had positive results for vimentin and negative results for keratin. Ultrastructurally, the tumor cells showed mesenchymal-fibroblastic features. These results support a mesenchymal origin, most likely from submesothelial fibroblasts. Further, this neoplasm may recur but retain its basic histologic features, diploidy, and benign outcome.

Topics: Adult; Aged; DNA; Female; Flow Cytometry; Heart Neoplasms; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma; Microscopy, Electron; Middle Aged; Pericardium; Peritoneal Neoplasms; Pleural Neoplasms; Ploidies; Vimentin

N-Propyl-N-nitrosourea is a strong leukemogen that induces myelogenic leukemia in Donryu rats and thymic lymphoma in F344 rats when administered in drinking water. In the present study, a single or multiple doses of PNU (total 500 mg/kg body weight) was given to young male and female F344 rats via a stomach tube. The results demonstrated that the percentage of tumor-bearing rats was 100% in all PNU-treated male groups, while that of the control group was 46%. Predominant tumors induced by PNU in male rats were lung adenoma/adenocarcinoma followed by peritoneal mesothelioma, and forestomach papilloma. In females, the tumor incidence of PNU-treated groups varied between 58% and 92% while that of the control group was 42%. Although pituitary tumor was the most frequent tumor in PNU-treated female rats, it was thought to be spontaneous since its incidence in each experimental group was not statistically different from that of the control group. Lung tumors and forestomach papillomas were also induced by PNU in female rats. No thymic lymphoma, however, was found in any of the PNU-treated groups of either sex. Lung tumors developed in almost all PNU-treated male rats and in about one-third of PNU-treated female rats. Mesothelioma was induced only in male rats, and its incidence depended on the treatment schedule. Induced mesotheliomas were extensively examined histologically, histochemically, immunohistochemically, and electron microscopically.

Topics: Animals; Female; Immunohistochemistry; Keratins; Lung Neoplasms; Male; Mesothelioma; Nitrosourea Compounds; Peritoneal Neoplasms; Rats; Rats, Inbred F344; Vimentin

We present a case of diffuse malignant peritoneal mesothelioma, initially misdiagnosed as benign. Electron microscopy and immunocytochemistry proved helpful diagnostically. Using monoclonal antibodies against cytokeratin and vimentin, we compared neoplastic with normal and reactive mesothelia and we found coexpression of these two intermediate filaments in the reactive and neoplastic mesothelial but not in the normal mesothelia, supporting the suggestion that surface mesothelial cells are derived from multipotential submesothelial cells.

Topics: Adolescent; Female; Humans; Keratins; Mesothelioma; Peritoneal Neoplasms; Vimentin

Eighteen examples of serous carcinoma arising in a background of a serous tumor of low malignant potential (SLMP with microinvasion) are reported. Nine of the 18 patients were less than 35 yr of age, and 5 were pregnant. In one patient, the microinvasive tumor was bilateral. The contralateral ovary had a serous tumor of low malignant potential (SLMP) in 9 additional women. Twelve patients presented with Stage I tumors, while 6 (33%) had tumors in Stages II and III. The tumors in all patients below the age of 30 were Stage I, and all three patients with Stage III tumors were older than 50. Two cell types were identified in all 18 tumors. The more dominant cell type was similar to those found in the typical SLMP tumors. The second cell type was larger with abundant eosinophilic cytoplasm, round nuclei, and prominent nucleoli; these were the cells that invaded the stroma of the papillary stalks in every case. Only one patient died of her disease, and she had Stage III tumor with massive ascites at presentation. All other patients are alive and well without evidence of disease from 2.5 to 5.5 yr after the diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Carcinoembryonic Antigen; Cystadenoma; Female; Follow-Up Studies; Humans; Hysterectomy; Keratins; Membrane Glycoproteins; Middle Aged; Mucin-1; Neoplasm Invasiveness; Ovarian Neoplasms; Ovariectomy; Pelvic Neoplasms; Peritoneal Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic

Topics: Carcinoembryonic Antigen; Histocytochemistry; Humans; Immunohistochemistry; Keratins; Mesothelioma; Peritoneal Neoplasms; Pleural Neoplasms; Vimentin

The diagnostic value of an immunoperoxidase panel composed of antisera to carcinoembryonic antigen (CEA), epithelial membrane antigens (EMA), and high- and low-molecular-weight cytokeratins was evaluated on 39 consecutive pleural and peritoneal fluid specimens and correlated with routine cytologic and histochemical studies. The cases were classified into two groups: malignant (epithelial and small-cell undifferentiated carcinomas) and benign effusions. We found that the CEA and EMA antisera identified 91% and 100% of the epithelial malignancies, respectively. Mucin stains were positive in only 41% (mucicarmine) and 59% (Alcian blue) of these cases. The battery of cytokeratin markers identified malignant cells from 45%-100% of the cases but showed considerable positive staining of mesothelial cells. A selective review of the literature is presented along with recommendations for technical improvement in immunoperoxidase studies. We believe that an immunoperoxidase panel can be of considerable value in the cytologic diagnosis of epithelial malignancies in effusions. The panel composed of CEA and EMA can prove helpful in a routine cytology practice. Although the cytokeratin marker identified malignant cells, the concomitant immunostaining of mesothelial cells limits its utility. The commercially available panel can be a potential aid in improving the accuracy of serous fluid cytologic examination by decreasing both false-positive and false-negative diagnoses and thereby helping to prevent delays in diagnosis and treatment.

Topics: Ascitic Fluid; Carcinoembryonic Antigen; Cytodiagnosis; Female; Humans; Immunoenzyme Techniques; Keratins; Membrane Proteins; Molecular Weight; Mucin-1; Peritoneal Neoplasms; Pleural Effusion; Pleural Neoplasms

Abdominal diffuse malignant mesotheliomas develop in rats administered asbestos by the intraperitoneal route. A latency period of 6 to 24 months precedes tumor development; the biological and morphological features of these tumors resemble mesotheliomas in humans. Using one- and two-dimensional gel electrophoresis and immunoblotting, rat mesotheliomas (n = 24) were shown to express two classes of intermediate filament (IF) proteins. The tumors contained both vimentin and at least one of six keratins (p40, Mr 40,000; Dm, Mr 50,000; p53, Mr 53,000; Bm, Mr 53,000; Cm, Mr 54,000; Am, Mr 54,000). Vimentin predominated in 15 of 16 tumors exhibiting either sarcomatous or mixed (epithelial and mesenchymal) appearance. One of eight mixed lesions and six of eight epithelial tumors had a complement of IF proteins in which cytokeratins predominated. A similar pattern has been reported in mesotheliomas in humans (Blobel et al., Am. J. Pathol. 121: 235, 1985). Epithelial tumors often contain comparable amounts of vimentin and low molecular weight cytokeratins, while vimentin is the most actively expressed IF protein in sarcomatous tumors. Thus, tumors induced by asbestos in the rat peritoneum express IF proteins in a manner that resembles human mesotheliomas, supporting the notion that these lesions are appropriate models of human mesothelioma.

Topics: Animals; Asbestos; Asbestos, Serpentine; Electrophoresis, Polyacrylamide Gel; Female; Immunosorbent Techniques; Intermediate Filament Proteins; Keratins; Mesothelioma; Molecular Weight; Peritoneal Neoplasms; Rats; Rats, Inbred F344; Vimentin

The clinical, pathological, and ultrastructural features of two cases of peritoneal cystic mesothelioma occurring in men were studied. The results of immunohistochemical staining for CAM 5.2, epithelial membrane antigen, carcinoembryonic antigen, and Factor VIII related antigen are reported for the first time and compared with the staining results of two peritoneal cystic lymphangiomas. Although resembling cystic lymphangioma by light microscopy, cystic mesothelioma may have a greater tendency for local recurrence. Staining for CAM 5.2 or epithelial membrane antigen may facilitate the differentiation of these two entities.

Topics: Adult; Antigens; Carcinoembryonic Antigen; Factor VIII; Humans; Keratins; Lymphangioma; Male; Membrane Proteins; Mesothelioma; Microscopy, Electron; Middle Aged; Mucin-1; Peritoneal Neoplasms; von Willebrand Factor

It is uncertain whether localized lesions of serosal membranes have a kinship to mesotheliomas or are truly fibromatous in nature. Ultrastructural and immunohistochemical investigations were carried out on 12 localized benign and malignant pleural and peritoneal tumours from 10 patients. Electron microscopic findings, including the consistent and non-fibroblastic cellular organization of localized neoplasms, the presence of some form of intercellular junctions in 7 of 10 cases, basal lamina deposition in 3 cases, and polarized microvilli in one case indicated a form of mesothelial differentiation. Using monoclonal and polyclonal antibodies, positive immunostaining of tumour cells for cytokeratin peptides was detected in one case, while antibody to vimentin stained four cases. Light microscopic, ultrastructural and immunohistochemical features of one benign localized serosal tumour, with a unique blend of epithelial and spindle cells, provided further evidence for a histogenic link between localized serosal tumours and diffuse epithelial mesotheliomas. On the basis of the current findings and reports in the literature, it would appear that the majority of localized tumours of serosal membranes are a subset of mesothelioma, while a minority are fibromas.

Topics: Adult; Aged; Antibodies, Monoclonal; Female; Fibroma; Histocytochemistry; Humans; Keratins; Male; Mesothelioma; Microscopy, Electron; Middle Aged; Peritoneal Neoplasms; Pleural Neoplasms; Serous Membrane

A so-called diffuse biphasic pleural and a monophasic malignant "fibrous" peritoneal mesothelioma were examined using monoclonal anticytoskeleton-antibodies and polyclonal antibodies against macrophage markers. Cytokeratin, vimentin and desmin were each expressed in both of the tumors. GFAP could not be detected. In addition the tumor cells differed in the quantity of macrophage markers. The immunologic findings corresponded to the histologic features of particular areas of the carcinosarcoma. This supports the view that malignant mesotheliomas derive from pluripotential mesothelial cells capable of both epithelial and mesenchymal differentiation. Contrary to some opinions expressed in the literature this histogenesis applies equally to the so-called monophasic diffuse "fibrous" mesotheliomas.

Topics: Aged; Antibodies, Monoclonal; Antigens, Surface; Desmin; Female; Histocytochemistry; Humans; Immunoenzyme Techniques; Keratins; Male; Mesothelioma; Peritoneal Neoplasms; Pleural Neoplasms; Vimentin

The occurrence and coexpression of the cytoskeletal proteins vimentin and cytokeratins were studied in malignant mesotheliomas and pulmonary carcinomas. For this purpose a double immunoenzyme staining with monoclonal antibodies was developed which made it possible to visualize vimentin and cytokeratins simultaneously within the same cell. A clear distinction between stromal cells (vimentin only) and tumour cells was also obtained. A total of 12 mesotheliomas (six mixed type and six epithelioid type) and 13 carcinomas (eight adenocarcinomas and five large cell undifferentiated carcinomas) were studied. The results revealed a clear difference between mesotheliomas and adenocarcinomas: 11 of 12 mesotheliomas showed coexpression of vimentin and cytokeratins in at least 50% of the tumour cells, while in seven of the eight adenocarcinomas none or only a few cells could be seen with this coexpression. In the undifferentiated large cell carcinomas three of five expressed both components, but in less than 25% of the cells. It is concluded that a reliable double immunoenzyme staining of vimentin and cytokeratins can be used as an additional means to distinguish malignant mesothelioma from pulmonary adenocarcinoma.

Topics: Adenocarcinoma; Antibodies, Monoclonal; Diagnosis, Differential; Humans; Immunoenzyme Techniques; Keratins; Lung Neoplasms; Mesothelioma; Peritoneal Neoplasms; Pleural Neoplasms; Staining and Labeling; Vimentin

A multicystic peritoneal mesothelioma in a 55-year-old man is reported. The large multicystic tumor was only partially removed. 36 months after the first presentation he is still working and his only complaint is abdominal swelling. The light microscopical, immunocytochemical and ultrastructural features are described and differential diagnoses discussed.

Topics: Histocytochemistry; Humans; Keratins; Male; Mesothelioma; Microscopy, Electron; Middle Aged; Peritoneal Neoplasms; Protein Precursors; Vimentin

In differentiating diffuse epithelial mesothelioma from metastatic adenocarcinoma in pleural and peritoneal biopsies, the number and form of microvilli and the amount and distribution of tonofilaments are thought to be the most useful criteria. This report details 5 cases of diffuse epithelial mesothelioma in which the characteristic fine structural features of neoplastic mesothelial cells were markedly modified. The majority or all tumor cells were poorly differentiated in electron micrographs, particularly with reduced prominence or absence of intermediate filaments, desmosomes, intracytoplasmic lumina, and microvilli. Immunohistochemistry revealed the absence of carcinoembryonic antigen and the presence of cytokeratin in all cases. Comparison with a better differentiated case suggests cytologic details that are useful in distinguishing the poorly differentiated type of epithelial mesotheliomas from adenocarcinoma. These include a mosaic pattern of closely associated tumor cells with a few long, narrow cytoplasmic processes lying parallel to adjacent plasma membranes, abundant cytoplasm with limited organelles usually having a polar arrangement, and nuclei with markedly disaggregated chromatin and prominent nucleolonemal-type nuclei.

Topics: Biopsy; Cell Differentiation; Cytoskeleton; Desmosomes; Female; Humans; Keratins; Male; Mesothelioma; Microscopy, Electron; Microvilli; Middle Aged; Peritoneal Neoplasms; Pleural Neoplasms

We have determined the intermediate filament proteins present in normal and malignant mesothelium in vivo. Pure sheets of normal lung mesothelium were obtained by transfer to agarcoated slides or by gentle scraping and cytocentrifugation. Cytoplasmic filament networks in the mesothelium were labeled via indirect immunofluorescence both by anti-Mr 40,000 keratin and anti-vimentin antisera. Two-dimensional gel electrophoresis of the Triton:high-salt-insoluble proteins of normal lung mesothelium disclosed the presence of vimentin and all but the largest (Mr 55,000) of the four simple epithelial keratins synthesized by mesothelial cells in culture. Samples of three peritoneal and three pleural mesotheliomas were found to contain either all four simple epithelial keratins or all but the Mr 55,000 keratin. Notably, none of the keratins characteristic of stratified and many glandular epithelia and their malignant forms was present in these mesotheliomas. Two mesothelioma samples from which the tumor cells could be obtained free of other cell types were found to contain vimentin as well as simple epithelial keratins and to synthesize these same proteins during short-term culture. None of the mesotheliomas placed in culture grew progressively in medium optimal for the growth of normal mesothelial cells. These data demonstrate that malignant mesothelial cells preserve the normal pattern of intermediate filament protein synthesis, including coexpression of simple epithelial keratins and vimentin, and suggest the use of this characteristic as an aid in the identification of cells of mesothelial origin.

Topics: Cells, Cultured; Epithelium; Female; Fetus; Fluorescent Antibody Technique; Humans; Intermediate Filament Proteins; Keratins; Lung; Mesothelioma; Molecular Weight; Peritoneal Neoplasms; Pleural Neoplasms; Pregnancy; Vimentin