High-grade colonic neuroendocrine carcinomas (NECs) are uncommon but extremely aggressive. Their co-existence with tubular adenoma (TA) has rarely been reported. We present a 68-year-old man who was found on routine c...High-grade colonic neuroendocrine carcinomas (NECs) are uncommon but extremely aggressive. Their co-existence with tubular adenoma (TA) has rarely been reported. We present a 68-year-old man who was found on routine colonoscopy to have multiple colorectal TAs and an ulcerated lesion in the ascending colon. Microscopically, a poorly-differentiated invasive carcinoma juxtaposed with a TA was identified. Differential diagnosis included a poorly-differentiated adenocarcinoma, medullary carcinoma, high-grade NEC and lymphoma. The immunohistochemical profile showed positive staining for keratins, synaptophysin and chromogranin but negative for LCA, CDX2, CK7, CK20, TTF-1 and PSA, supporting the NEC diagnosis. Upon subsequent laparoscopic right hemicolectomy, the tumor was identified as a 3.0 cm umbilicated and ulcerated mass with an adjacent TA. Both TA and NEC showed positive staining for β-catenin indicating a shared colonic origin. The mitotic counts (77/10 high power fields) and a high proliferation rate (75% by Ki-67) corroborated a high-grade stratification. Mutational analysis indicated a wild-type BRAF and KRAS with mismatch repair proficiency. The AJCC (7<sup>th</sup> edition) pathologic stage is pT3, pN0, pMx. The patient received adjuvant chemotherapy with cisplatin/etoposides for three cycles and will be followed up for a year to detect recurrence. In conclusion, the co-existence of TA with high grade-NEC in our case allowed early identification and intervention of the otherwise asymptomatic but aggressive tumor. In addition, the finding of a high-grade NEC within a large TA in this case suggests a link between the two lesions and could represent a shared stem cell origin.展开更多
Introduction:Tubular adenomas are rare benign epithelial neoplasms of the breast resembling fibroadenomas on both imaging and pathology.We aimed at characterizing and differentiating these lesions on contrast enhanced...Introduction:Tubular adenomas are rare benign epithelial neoplasms of the breast resembling fibroadenomas on both imaging and pathology.We aimed at characterizing and differentiating these lesions on contrast enhanced mammography and MRI.Material and methods:Out of all percutaneous breast biopsies performed at the Rabin medical center between the years 2010-2019,five cases which also had contrast-based imaging including contrast enhanced mammography and MRI were retrieved.Morphology and enhancement patterns of the lesions were analyzed by two dedicated breast radiologists.Results:The contrast imaging characteristics of all lesions were enhancing masses measuring 4-17 mm.The shape of the lesions was oval,borders well circumscribed,on both CEM and MRI.CEM revealed marked homogenous enhancement.MRI enhancement patterns of the small tumors showed homogenous enhancement,whereas the larger mass showed a more heterogeneous enhancement.Kinetic curves on MRI were of rapid marked enhancement.Conclusion:Tubular adenomas diverge pathologically from known enhancement patterns of fibroadenomas.展开更多
Turner syndrome (TS) is a female chromosomal disorder caused by the lack of an X chromosome. The loss of this chromosome may result in the deficiency of tumorsuppressive or DNA repair genes, leading to tumorigenesis. ...Turner syndrome (TS) is a female chromosomal disorder caused by the lack of an X chromosome. The loss of this chromosome may result in the deficiency of tumorsuppressive or DNA repair genes, leading to tumorigenesis. Recombinant human growth hormone (GH) has been popularly used for treatment in TS patients for growth promotion. Although treatment with GH has been correlated with precancerous and cancerous lesions in TS children, its associations with gastric or colonic tumors, especially ileal tubular adenomas, have not been reported frequently. We here report a case of a 16-year-old patient with TS and tubular adenoma of the small intestine. Whether the ileal adenoma was caused by TS itself or GH therapy was discussed.展开更多
Tubular adenomas, also called “pure adenomas”, are uncommon benign lesions of the breast which is characterized histologically by a circumscribed mass consisting of prominent lobular proliferation and closely packed...Tubular adenomas, also called “pure adenomas”, are uncommon benign lesions of the breast which is characterized histologically by a circumscribed mass consisting of prominent lobular proliferation and closely packed small ducts with minimal supporting stroma [1] [2]. These uniformly sized ducts are lined by single layers of epithelium and myoepithelium. They mainly appear in young women, rarely occurring in the elderly?[1]?[3]-[5]. Tubular adenoma must be differentiated from other benign lesions (fibroadenoma) and from malignant breast cancer (tubular carcinoma). Preoperative diagnosis is often difficult, but the histologic diagnosis of tubular adenoma would be an acceptable diagnosis after needle core biopsy. Both radiologic and cytohistologic examinations performed before surgery may be not diagnostic and surgical excision is necessary in order to reach a precise diagnosis and a definitive treatment. We report a case of tubular adenoma of the breast in a 62-year-old woman preoperatively diagnosed as a breast tubular adenoma by Ultrasuond-guided core biopsy.展开更多
Precisely distinguishing between hyperplastic and adenomatous polyps and normal human colonic mucosa at the cellular level is of great medical significance.In this work,multiphoton laserscarming microscopy(MPLSM)was u...Precisely distinguishing between hyperplastic and adenomatous polyps and normal human colonic mucosa at the cellular level is of great medical significance.In this work,multiphoton laserscarming microscopy(MPLSM)was used to obtain the high.-contrast images and the morpho-logical characteristics from normal colonic mucosa,hyperplastic polyps and tubular adenoma.Byintegrating the length and area measurement tools and computing tool,we quantified thedifference of crypt morphology and the alteration of nuclei in normal and diseased human colonicmucosa.Our results demonstrated that the morphology of crypts had an obvious tendency tocystic dilatation or elongated in hyperplastic polyps and tubular adenoma.The cont ent andnumber of mucin droplets of the scattered goblet cells had a piecemeal reduction in hyperplastic polyps and a large decrease in tubular adenoma The nuclei of epithelial cells might be elongated and pseudostratified,but overt dysplasia was absent in hyperplastic polyps.Nevertheless,thenuclei showed enlarged,crowded,stratified and a rod-like structure,with loss of polarity intubular adenoma.These results suggest that MPLSM has the capacity to distinguish betweenhyperplastic and adenomat ous polyps and normal human colonic mucosa at the celular level.展开更多
AIM: To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm.METHODS: Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas...AIM: To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm.METHODS: Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas > 20 mm in 179 patients(40.3% female; median age 68 years; range 35-91 years). All patients had at least 1 follow-up endoscopy with a minimum control interval of 2 mo(mean follow-up 6 mo/2.0-43.4 mo). Possible factors associated with local recurrence were analyzed by univariate and multivariate analysis. RESULTS: Median size of the lesions was 30 mm(20-70 mm),69.0% were localized in the right-sided(cecum,ascending and transverse) colon. Most of the lesions(85.6%) showed a non-pedunculated morphology and the majority of resections was in piecemeal technique(78.7%). Histology showed carcinoma or high-grade intraepithelial neoplasia in 51/216(23.6%) lesions including 4 low risk carcinomas(pT1 a,L0,V0,R0- G1/G2). Histologically proven recurrence was observed in 33/216 patients(15.3%). Patient age>65 years,polyp size>30 mm,non-pedunculated morphology,localization in the right-sided colon,piecemeal resection and tubular-villous histology were found as associated factors in univariate analysis. On multivariate analysis,only localization in the rightsided colon(HR = 6.842/95%CI:1.540-30.394; P=0.011),tubular-villous histology(HR = 3.713/95%CI: 1.617-8.528;P=0.002) and polyp size>30 mm(HR=2.563/95%CI:1.179-5.570; P=0.017) were significantly associated risk factors for adenoma recurrence. CONCLUSION: Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas localized in the right-sided colon larger than > 30 mm,with tubular-villous histology.展开更多
文摘High-grade colonic neuroendocrine carcinomas (NECs) are uncommon but extremely aggressive. Their co-existence with tubular adenoma (TA) has rarely been reported. We present a 68-year-old man who was found on routine colonoscopy to have multiple colorectal TAs and an ulcerated lesion in the ascending colon. Microscopically, a poorly-differentiated invasive carcinoma juxtaposed with a TA was identified. Differential diagnosis included a poorly-differentiated adenocarcinoma, medullary carcinoma, high-grade NEC and lymphoma. The immunohistochemical profile showed positive staining for keratins, synaptophysin and chromogranin but negative for LCA, CDX2, CK7, CK20, TTF-1 and PSA, supporting the NEC diagnosis. Upon subsequent laparoscopic right hemicolectomy, the tumor was identified as a 3.0 cm umbilicated and ulcerated mass with an adjacent TA. Both TA and NEC showed positive staining for β-catenin indicating a shared colonic origin. The mitotic counts (77/10 high power fields) and a high proliferation rate (75% by Ki-67) corroborated a high-grade stratification. Mutational analysis indicated a wild-type BRAF and KRAS with mismatch repair proficiency. The AJCC (7<sup>th</sup> edition) pathologic stage is pT3, pN0, pMx. The patient received adjuvant chemotherapy with cisplatin/etoposides for three cycles and will be followed up for a year to detect recurrence. In conclusion, the co-existence of TA with high grade-NEC in our case allowed early identification and intervention of the otherwise asymptomatic but aggressive tumor. In addition, the finding of a high-grade NEC within a large TA in this case suggests a link between the two lesions and could represent a shared stem cell origin.
文摘Introduction:Tubular adenomas are rare benign epithelial neoplasms of the breast resembling fibroadenomas on both imaging and pathology.We aimed at characterizing and differentiating these lesions on contrast enhanced mammography and MRI.Material and methods:Out of all percutaneous breast biopsies performed at the Rabin medical center between the years 2010-2019,five cases which also had contrast-based imaging including contrast enhanced mammography and MRI were retrieved.Morphology and enhancement patterns of the lesions were analyzed by two dedicated breast radiologists.Results:The contrast imaging characteristics of all lesions were enhancing masses measuring 4-17 mm.The shape of the lesions was oval,borders well circumscribed,on both CEM and MRI.CEM revealed marked homogenous enhancement.MRI enhancement patterns of the small tumors showed homogenous enhancement,whereas the larger mass showed a more heterogeneous enhancement.Kinetic curves on MRI were of rapid marked enhancement.Conclusion:Tubular adenomas diverge pathologically from known enhancement patterns of fibroadenomas.
基金Supported by The 2011 Ministry of Health Key Clinical Speciality Center Project
文摘Turner syndrome (TS) is a female chromosomal disorder caused by the lack of an X chromosome. The loss of this chromosome may result in the deficiency of tumorsuppressive or DNA repair genes, leading to tumorigenesis. Recombinant human growth hormone (GH) has been popularly used for treatment in TS patients for growth promotion. Although treatment with GH has been correlated with precancerous and cancerous lesions in TS children, its associations with gastric or colonic tumors, especially ileal tubular adenomas, have not been reported frequently. We here report a case of a 16-year-old patient with TS and tubular adenoma of the small intestine. Whether the ileal adenoma was caused by TS itself or GH therapy was discussed.
文摘Tubular adenomas, also called “pure adenomas”, are uncommon benign lesions of the breast which is characterized histologically by a circumscribed mass consisting of prominent lobular proliferation and closely packed small ducts with minimal supporting stroma [1] [2]. These uniformly sized ducts are lined by single layers of epithelium and myoepithelium. They mainly appear in young women, rarely occurring in the elderly?[1]?[3]-[5]. Tubular adenoma must be differentiated from other benign lesions (fibroadenoma) and from malignant breast cancer (tubular carcinoma). Preoperative diagnosis is often difficult, but the histologic diagnosis of tubular adenoma would be an acceptable diagnosis after needle core biopsy. Both radiologic and cytohistologic examinations performed before surgery may be not diagnostic and surgical excision is necessary in order to reach a precise diagnosis and a definitive treatment. We report a case of tubular adenoma of the breast in a 62-year-old woman preoperatively diagnosed as a breast tubular adenoma by Ultrasuond-guided core biopsy.
基金National Natural Science Foundation of ChinaContract grant numbers:81271620,61275006,81101209+1 种基金Program for Changjiang Scholars and Innovative Research Teamin UniversityContract grant number:IRT1115.
文摘Precisely distinguishing between hyperplastic and adenomatous polyps and normal human colonic mucosa at the cellular level is of great medical significance.In this work,multiphoton laserscarming microscopy(MPLSM)was used to obtain the high.-contrast images and the morpho-logical characteristics from normal colonic mucosa,hyperplastic polyps and tubular adenoma.Byintegrating the length and area measurement tools and computing tool,we quantified thedifference of crypt morphology and the alteration of nuclei in normal and diseased human colonicmucosa.Our results demonstrated that the morphology of crypts had an obvious tendency tocystic dilatation or elongated in hyperplastic polyps and tubular adenoma.The cont ent andnumber of mucin droplets of the scattered goblet cells had a piecemeal reduction in hyperplastic polyps and a large decrease in tubular adenoma The nuclei of epithelial cells might be elongated and pseudostratified,but overt dysplasia was absent in hyperplastic polyps.Nevertheless,thenuclei showed enlarged,crowded,stratified and a rod-like structure,with loss of polarity intubular adenoma.These results suggest that MPLSM has the capacity to distinguish betweenhyperplastic and adenomat ous polyps and normal human colonic mucosa at the celular level.
文摘AIM: To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm.METHODS: Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas > 20 mm in 179 patients(40.3% female; median age 68 years; range 35-91 years). All patients had at least 1 follow-up endoscopy with a minimum control interval of 2 mo(mean follow-up 6 mo/2.0-43.4 mo). Possible factors associated with local recurrence were analyzed by univariate and multivariate analysis. RESULTS: Median size of the lesions was 30 mm(20-70 mm),69.0% were localized in the right-sided(cecum,ascending and transverse) colon. Most of the lesions(85.6%) showed a non-pedunculated morphology and the majority of resections was in piecemeal technique(78.7%). Histology showed carcinoma or high-grade intraepithelial neoplasia in 51/216(23.6%) lesions including 4 low risk carcinomas(pT1 a,L0,V0,R0- G1/G2). Histologically proven recurrence was observed in 33/216 patients(15.3%). Patient age>65 years,polyp size>30 mm,non-pedunculated morphology,localization in the right-sided colon,piecemeal resection and tubular-villous histology were found as associated factors in univariate analysis. On multivariate analysis,only localization in the rightsided colon(HR = 6.842/95%CI:1.540-30.394; P=0.011),tubular-villous histology(HR = 3.713/95%CI: 1.617-8.528;P=0.002) and polyp size>30 mm(HR=2.563/95%CI:1.179-5.570; P=0.017) were significantly associated risk factors for adenoma recurrence. CONCLUSION: Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas localized in the right-sided colon larger than > 30 mm,with tubular-villous histology.
