Pleomorphic adenoma(mixed tumor)of the upper lip:A case report

BACKGROUND Salivary gland tumors are relatively rare.Most minor salivary gland tumors are malignant with benign tumors accounting for 18%of the tumors.Pleomorphic adenoma(PA)is the most common salivary gland tumor.Lip PA is uncommon with 9.8%occurring in the upper lip.We are adding on the knowledge of the rare upper lip PA(benign mixed tumor).CASE SUMMARY We report an upper lip PA(benign mixed tumor)in a 28-year-old man.His complaint was a painless swelling on the upper lip.A painless,non-tender,well-circumscribed,slightly mobile,sessile,nodular,and rubbery(in consistency)tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip.The overlying skin was not fixed and of normal color.There was no ulceration,and palpation did not elicit pain or bleeding.There was no history of trauma.Blunt dissection was used to completely excise the nodular,whitish,and encapsulated tumor.Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion,with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells,well-formed tubules containing eosinic secretion,and nests of myoepithelial cells.A diagnosis of PA(benign mixed tumor)was confirmed.CONCLUSION Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.

Mixed Epithelial and Stromal Tumor of the Kidney: A Case Report

Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently described rare neoplasm. Malignant transformation, recurrence and metastasis are rare, therefore histopathological distinction from other renal neoplasms, especially from renal cell carcinoma is important. Histologically the tumor is composed of biphasic components including cysts and tubules embedded in the spindle cell stroma. We report a case of a MESTK in 60-year-old postmenopousal woman who presented with an incidental solid renal mass but no urinary complaint.

Solitary concomitant endocrine tumor and ductal adenocarcinoma of pancreas

Pancreatic tumors with combined exocrine and endocrine features are rare.Most reported cases are classified as mixed exocrine and endocrine carcinoma of the pancreas.We report the first case of solitary concomitant endocrine tumor and ductal adenocarcinoma of the pancreas.A 58-year-old patient was admitted for uncontrolled diabetes mellitus and body weight loss.The tumor was fortuitously discovered in the pancreatic tail after a tumor survey panel.Grossly,the solitary tumor had a central fibrous band that clearly divided it into two parts.On microscopic examination,the tumor contained both endocrine and exocrine components distinctly separated by the central fibrous band.The exocrine part showed a poorly-differentiated adenocarcinoma.The endocrine part was strongly immunoreactive to chromogranin,synaptophysin and glucagon.We reviewed the literature on pancreatic tumors with combined exocrine and endocrine features.A simple classification for this group of neoplasms is suggested,including five types:amphicrine,mixed,collision,solitary concomitant and multiple concomitant.

Mixed neuroendocrine non-neuroendocrine tumors:The quest for evidence

Mixed neuroendocrine non-neuroendocrine neoplasms(MiNENs)are rare mixed tumors containing both neuroendocrine and non-neuroendocrine components that occupy at least 30%of the whole tumor.Biologically,both components appear to derive from an identical cellular precursor undergoing early dual differentiation or late transdifferentiation.While our understanding of MiNENs has improved in recent years,many areas of uncertainty remain.In this context,setting diagnostic criteria capable of capturing the continuum of disease biology while providing clinically meaningful information in terms of prognosis and response to treatments appears vital to advance the field and improve patients’outcomes.Evidence is needed to generate robust classification schemes,and multi-institutional cooperation will likely play a crucial role in building adequately powered cohorts to address some of the most pressing questions discussed in this Editorial.What is the minimum representation for each component needed to define MiNENs?How can the epidemiology of MiNENs change according to different diagnostic definitions?How can we generate the clinical evidence nee-ded to optimize the management of MiNENs?

Successful management of a mixed epithelial and stromal renal tumor masquerading as lower pole renal cyst:A laparoscopic deroofing approach

Background:Renal cysts are common in clinical practice,but some may harbor rare pathological entities such as mixed epithelial and stromal tumors(MEST).Imaging studies are crucial for accurate diagnosis.While laparoscopic deroofing is an established approach for symptomatic renal cysts,encountering MEST within a cyst is uncommon.Case Presentation:We present the case of a 37-year-old female who presented with persistent left flank pain.Imaging revealed a large renal cyst in the lower pole of the left kidney,classified as Bosniak 2.Despite analgesia,the patient's symptoms persisted,leading to a laparoscopic deroofing procedure.Histopathological examination postprocedure revealed a MEST.The patient reported complete resolution of symptoms at the 3-month follow-up.Conclusion:This unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing.It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.

Mixed epithelial endocrine neoplasms of the colon and rectum–An evolution over time:A systematic review

BACKGROUND Mixed tumors of the colon and rectum,composed of a combination of epithelial and endocrine elements of benign and malignant potential are rare neoplasms.These can occur anywhere in the gastrointestinal tract and are often diagnosed incidentally.Though they have been a well-documented entity in the pancreas,where the exocrine-endocrine mixed tumors have been known for a while,recognition and accurate diagnosis of these tumors in the colon and rectum,to date,remains a challenge.This is further compounded by the different terminologies that have been attributed to these lesions over the years adding to increased confusion and misclassification.Therefore,dedicated literature reviews of these lesions in the colon and rectum are inconsistent and are predominantly limited to case reports and case series of limited case numbers.Though,most of these tumors are high grade and of advanced stage,intermediate and low grade lesions of these mixed tumors are also increasingly been reported.There are no established independent consensus based guidelines for the therapeutic patient management of these unique lesions.AIM To provide a comprehensive targeted literature review of these complex mixed tumors in the colon and rectum that chronicles the evolution over time with summarization of historical perspectives of terminology and to further our understanding regarding their pathogenesis including genomic landscape,clinicoradiological features,pathology,treatment,prognosis,the current status of the management of the primary lesions,their recurrences and metastases.METHODS A comprehensive review of the published English literature was conducted using the search engines PubMed,MEDLINE and GOOGLE scholar.The following search terms[“mixed tumors colon”OR mixed endocrine/neuroendocrine tumor/neoplasm/lesion colon OR adenocarcinoma and endocrine/neuroendocrine tumor colon OR mixed adenocarcinoma and endocrine/neuroendocrine carcinoma colon OR Amphicrine tumors OR Collision tumors]were used.Eligibility criteria were defined and all potential relevant items,including full articles and/or abstracts were independently reviewed,assessed and agreed upon items were selected for in-depth analysis.RESULTS In total 237 full articles/abstracts documents were considered for eligibility of which 45 articles were illegible resulting in a total of 192 articles that were assessed for eligibility of which 139 have been selected for reference in this current review.This seminal manuscript is a one stop article that provides a detailed outlook on the evolution over time with summarization of historical perspectives,nomenclature,clinicoradiological features,pathology,treatment,prognosis and the current status of the management of both the primary lesions,their recurrences and metastases.Gaps in knowledge have also been identified and discussed.An important outcome of this manuscript is the justified proposal for a new,simple,clinically relevant,non-ambiguous terminology for these lesions to be referred to as mixed epithelial endocrine neoplasms(MEENs).CONCLUSION MEEN of the colon and rectum are poorly understood rare entities that encompass an extensive range of heterogeneous tumors with a wide variety of combinations leading to tumors of high,intermediate or low grade malignant potential.This proposed new revised terminology of MEEN will solve the biggest hurdle of confusion and misclassification that plagues these rare unique colorectal neoplasms thus facilitating the future design of multi institutional prospective randomized controlled clinical trials to develop and evaluate newer therapeutic strategies that are recommended for continued improved understanding and personal optimization of clinical management of these unique colorectal neoplasms.

Cutaneous ciliated cyst on the anterior neck in young women: A case report

BACKGROUND A cutaneous ciliated cyst(CCC)is a rare,benign tumor in young female adults,which is usually found on the lower extremities.CASE SUMMARY We found an uncommon location of CCC in the anterolateral cervical area and reviewed the literature.A 20-year-old female complained of a well-defined,painless,palpable mass that started several years ago.The mass was tense and movable and located at the anterolateral aspect of the neck.Imaging showed a non-enhancing round mass.Surgical excision biopsy was performed,and the cystic mass was revealed to be a CCC.CONCLUSION The rare location of CCC can be found in anterior neck area,which should be another diagnostic option for mass on anterior neck.

Chondroid syringoma of the lower back simulating lipoma:A case report

BACKGROUND Chondroid syringoma(CS)is a rare tumor of the apocrine or eccrine glands.CS of the lower back is rare,and its clinical manifestations are similar to those of lipoma,which is a common misdiagnosis for this disease.CASE SUMMARY A 39-year-old woman presented with a 2-year history of an asymptomatic subcutaneous mass on the lower back.The lesions increased progressively over time.The patient denied any history.Dermatological examination showed that there was a subcutaneous mass,ranging from 3-4 cm in diameter,with a clear boundary on the lower back.The surface of the skin was smooth without ulceration or scaling.Histopathologic examination was consistent with the diagnosis of CS.CONCLUSION CS is a rare tumor of the apocrine or eccrine glands.It usually presents as a wellcircumscribed and single subcutaneous masses.Histopathology showed the tumor was located in the dermis,with nests,sheets,and cords of basal-like cells,mucin deposition,and chondroid structures.We herein report a case of CS located in the lower back.CS of the lower back is rare,and its clinical manifestations are similar to those of lipoma,for which it is commonly misdiagnosed.

Study on the protein expression and amplification of HER2 gene in gastric cancer

Objective: The aim of the study was to investigate the human epidermal growth factor receptor 2(HER2) gene amplification and protein expression and interpretation points in the stomach mixed carcinomas. Methods: Immunohistochemistry(IHC) and fluorescence in situ hybridization(FISH) technique were used to detect HER2 gene amplification and expression of HER2 protein in 442 cases of gastric mixed carcinoma. Results: The expression rate of HER2 protein was 41.2%(182/442): the HER2 protein expression IHC 3+ extensive type in 18 cases, partial type in 21 cases, focal type in 8 cases, accounting for 10.6%(47/442); the HER2 protein expression IHC 2+ extensive type in 23 cases, partial type in 28 cases, focal type in 11 cases, accounting for 14.0%(62/442); the HER2 protein expression IHC 1+ extensive type in 27 cases, partial type in 31 cases, focal type in 15 cases, accounting for 16.5%(73/442). HER2 gene amplification rate of 442 cases was 16.1%(71/442). In 182 cases of HER2 protein positive expression, the HER2 gene cluster amplification rate was 14.8%(27/182), large granular amplification rate 11.0%(20/182), punctate amplification rate 6.0%(11/182) and high polysomy 7.1%(13/182). In 71 cases of HER2 gene amplification, there was 42 cases of HER2 protein expression IHC 3+, 22 cases of HER2 protein expression IHC 2+, and 7 cases of IHC 1+. Conclusion: HER2 detection of gastric mixed carcinoma has great heterogeneity, HER2 protein positive expression is divided into extensive type, partial type and focal type, and HER2 gene positive amplification is divided into cluster amplification, large granular amplification, punctate amplification and high polysomy. These typing of HER2 protein expression and HER2 gene amplification provide reference index to quantify for targeted therapeutic effect of anticancer drugs.

Primary omental malignant mixed Müllerian tumor in a 67-year-old woman

背景 大网膜原发苗勒氏管混合瘤很少见 ,迄今为止仅报道了 2例 ,具有其特殊临床特征。病例 女性 ,6 7岁 ,G6P5 ,主因腹痛、腹胀 15天就诊于北京大学人民医院妇科。体格检查发现一直径 12厘米腹部包块 ,活动度差。行肿瘤及大网膜大部分切除 ,全子宫加双附件切除术。术后病理示大网膜原发恶性苗勒氏管混合瘤。术后顺铂、吡喃阿霉素、足叶已甙化疗一疗程 ,因严重骨髓抑制 ,未继续化疗 ,术后 8个月发现肿瘤肝转移。结论 原发性恶性苗勒氏管混合瘤预后差 ,现今手术仍是最有效的治疗手段 ,化疗及放疗效果不确切。

Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report

BACKGROUND Liver tumors with dual differentiations[combined hepatocellular carcinoma(HCC)and cholangiocarcinoma]are common.However,liver tumors that exhibit hepatocellular,biliary,and neuroendocrine differentiation are exceedingly rare,with only three previous case reports in the literature.CASE SUMMARY A 65-year-old female with a previous history of hepatitis C and a distant history of low grade,well-differentiated rectal neuroendocrine tumor was found to have two liver lesions in segment 4 and segment 7 on imaging.Serum alpha-fetoprotein and chromogranin A were elevated.Biopsy of the larger lesion in segment 4 revealed a high-grade tumor,with morphologic and immunohistochemical features of a neuroendocrine tumor.Given the previous history of rectal neuroendocrine tumor,imaging investigation,serologic markers,and biopsy findings,metastatic neuroendocrine tumor was considered.Subsequent regional resection of these hepatic lesions revealed the segment 4 lesion to be a HCC with additional biliary and neuroendocrine differentiation and the segment 7 lesion to be a cholangiocarcinoma with neuroendocrine differentiation.Follow-up of the patient revealed disease recurrence in the dome of the liver and metastasis in retro-pancreatic lymph nodes.The patient eventually expired due to complications of chemotherapy.CONCLUSION HCC cases with additional biliary and neuroendocrine differentiation are exceedingly rare,posing a diagnostic challenge for clinicians and pathologists.