The pathology of urinary bladder lesions with an inverted growth pattern

Inverted lesions in the urinary bladder have been the source of some difficulty in urological pathology. The two common ones are von Brunn＇s nests and cystitis cystic/cystitis glandularis, which are considered normal variants of urothelium. Apart from them, a number of other rare urothelial lesions with inverted growth pattern occur in the urinary bladder. Some of them are only reactive conditions, just as pseudocarcinomatous hyperplasia. Some are benign tumors, namely inverted papilloma. Whereas others are malignant neoplasms, including inverted papillary urothelial neoplasm of low malignant potential （PUNLMP）, non-invasive inverted papillary urothelial carcinoma （low-grade and high-grade）, and invasive urothelial carcinoma （inverted, nested and big nested variants）. Because of the overlapping morphological features of all the inverted lesions mentioned above, even between high-grade invasive carcinoma and psendoearcinomatous hyperplasia which are only a kind of reactive conditions, it is very important for the surgical pathologist to recognize and be familiar with these inverted lesions in urinary bladder. In this article, we review these spectrums of inverted lesions of the urinary bladder. Emphasis is placed on histogenesis, morphology, differential diagnosis of these lesions, and the pathologic grading of the non-invasive inverted neoplasms, such as inverted papilloma, inverted PUNLMP, non-invasive inverted papillary urothelial carcinoma with low-grade, and non-invasive inverted papillary urothelial carcinoma with high-grade.

Detection of superficial esophageal squamous cell neoplasia by chromoendoscopy-guided confocal laser endomicroscopy

AIM: To evaluate the diagnostic potential of Lugol'schromoendoscopy-guided confocal laser endomicroscopy(CLE) in detecting superficial esophageal squamous cell neoplasia(ESCN).METHODS: Between December 2008 and September2010, a total of 52 patients were enrolled at the Chinese PLA General Hospital in Beijing, China. First,Lugol's chromoendoscopy-guided CLE was performed in these patients and the CLE in vivo histological diagnosis was recorded. Then, chromoendoscopyguided biopsy was performed in the same patients by another endoscopist who was blinded to the CLE findings. Based on the biopsy and CLE diagnosis, en bloc endoscopic resection was performed. The CLE in vivo diagnosis and the histological diagnosis of biopsy of ESCN were compared, using a histological examination of the endoscopic resection specimens as the standard reference.RESULTS: A total of 152 chromoendoscopy-guided biopsies were obtained from 56 lesions. In the 56 lesions of 52 patients, a total of 679 CLE images were obtained vs 152 corresponding biopsies. The sensitivity, specificity, negative predictive value and positive predictive value of chromoendoscopy-guided CLE compared with biopsy were 95.7% vs 82%(P <0.05), 90% vs 70%(P < 0.05), 81.8% vs 46.7%(P <0.05), and 97.8% vs 92.7%(P > 0.05), respectively.There was a significant improvement in sensitivity,specificity, negative predictive value, and accuracy when comparing chromoendoscopy-guided CLE with biopsy.CONCLUSION: Lugol's chromoendoscopy-guided CLE is a real-time, non-invasive endoscopic diagnostic technology; the accuracy of the detection of superficial ESCN is equivalent to or may be superior to biopsy histology.

Primary hepatic neuroendocrine tumor case with a preoperative course of 26 years: A case report and literature review

Primary hepatic neuroendocrine tumor(PHNET) is an extremely rare liver tumor. Patients often have no clinical symptoms or have only non-specific symptoms, such as abdominal pain and abdominal mass. The clinical manifestations, disease development, treatment methods, and treatment outcomes of PHNET vary greatly among cases. Here we report a case of PHNET with a confirmed 26-year survival before surgery. The patient was a 56-year-old female. A large right hepatic mass was detected when the patient was 30 years old. The tumor could not be removed during exploratory laparotomy, and constriction of the right hepatic artery and biopsy were conducted. Pathological results indicated a diagnosis of benign tumor, but a confirmed diagnosis was not reached. Twenty-six years after the patient had been living with the tumor, she sought treatment again because of tumor progression. After systematic evaluation of the resectability, the tumor was resected. Based on the examination results of the gastrointestinal tract and lungs, intraoperative examination results, pathological findings, and long-term follow-up results, the diagnosis of PHNET was confirmed. This case represents the longest reported survival time for a PHNET patient before removal of the tumor.

Prognostic significance of PTEN,Ki-67 and CD44s expression patterns in gastrointestinal stromal tumors

AIM:To develop a prognostic approach for gastrointestinal stromal tumors(GISTs) using a cluster of indicators and follow-up information.METHODS:One hundred and four GISTs that had not been subjected to targeted therapies were collected and classified by NIH risk assessment and anatomic location.By immunohistochemistry,the expressions of PTEN,Ki-67,CD44s matrix metalloproteinase(MMP)-9 and TIMP-1 were detected on tissue microarray.Univariate and multimarker survival analyses were performed and then a COX hazard proportion model was constructed to evaluate a cluster of predictors of GIST.RESULTS:Our data showed small intestinal GIST are more aggressive than gastric GIST.The NIH risk assessment correlated with disease-free survival foreither gastric GIST or small intestinal GIST.Immunohistochemical analysis revealed that Ki-67 labeling indexes(LIs) < 5% predicted higher disease-specific survival(DSS) in gastric and small intestinal GIST.CD44s positivity and PTEN LIs ≥ 50% correlated with higher DSS in gastric GIST.MMP-9 and TIMP-1 had no correlation with survival.Multimarker analysis revealed that the expression pattern of PTEN LIs ≥ 50% combined with Ki-67 LIs < 5% and CD44s positivity reliably predicted favorable outcomes for gastric GIST(P = 0.009),as did the combination of PTEN LIs ≥ 50% and Ki-67 LIs < 5% for small intestinal GIST(P = 0.011).Authors also found that high NIH risk grade was correlated with DSS in patients with gastric GIST and disease-free survival in patients with small intestinal GIST.CONCLUSION:PTEN LIs ≥ 50%,Ki-67 LIs < 5% and CD44s positivity provides an accurate,favorable prognosis for gastric GIST.PTEN LIs ≥ 50% and Ki-67 LIs < 5% does the same for small intestinal GIST.Ki-67 LIs enhances the NIH assessment.

Prognostic and clinicopathological significance of glypican-3 overexpression in hepatocellular carcinoma: A meta-analysis

AIM: To investigate the prognostic and clinicopathological significance of glypican-3 (GPC3) overexpression in hepatocellular carcinoma (HCC). METHODS: Publications were searched using PubMed, EMBASE, the Cochrane Library and the Chinese Biomedical Literature Database up to March 2013. Inclusion and exclusion criteria were established to screen eligible studies for meta-analysis. The hazard ratios (HRs) of the eligible studies were pooled using RevMan 5.2 software to evaluate the impact of GPC3 overexpression on overall survival (OS) and disease-free survival (DFS) in HCC patients. The correlation between GPC3 expression and clinicopathological parameters of HCC was also analyzed. RESULTS: A total of five studies with 493 patients were included in the meta-analysis. The combined HRs indicated that GPC3 overexpression can predict poor OS (n = 362 in 3 studies, HR = 2.18, 95%CI: 1.47-3.24, Z = 3.86, P = 0.0001) and DFS (n = 325 in 3 studies, HR = 2.05, 95%CI: 1.43-2.93, Z = 3.94, P < 0.0001) in HCC patients without heterogeneity. Egger's and Begg's tests were applied to detect publication bias, and the results showed that there was no evidence of publication bias detected in the OS studies (the P value for Egger's test was 0.216) or DFS studies (the P value for Egger's test was 0.488). The combined odds ratios (ORs) suggested that GPC3 expression tends to be associated with tumor vascular invasion (OR = 2.74, 95%CI: 1.15-6.52, P = 0.02), hepatic cirrhosis (OR = 2.10, 95%CI: 1.31-3.36, P = 0.002), poor tumor differentiation (OR = 0.22, 95%CI: 0.13-0.40, P < 0.00001) and advanced TNM stage (OR = 0.31, 95%CI: 0.18-0.51, P < 0.00001). CONCLUSION: From this study, we conclude that GPC3 overexpression tends to be associated with a poor prognosis (poor OS or DFS) in HCC. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Aberrant cytological localization of p16 and CDK4 in colorectal epithelia in the normal adenoma carcinoma sequence

AIM： To study the correlation between the patterns of subcellular expression of p16 and CDK4 in colorectal epithelia in the normal-adenoma-carcinoma sequence.METHODS： Paraffin sections of 43 cases of normal colorectal epithelia and corresponding adenomas as well as carcinomas were analysed immunocytochemically for subcellular expression of p16 and CDK4 proteins.RESULTS： Most carcinomas showed more cytoplasmic overexpression for p16 and CDK4 than the adenomas from which they arised or the adjacent normal mucosa. Most normal or non-neoplastic epithelia showed more p16 and CDK4 expression in the nucleus than their adjacent adenomas and carcinomas. There was a significant difference between the subcellular expression pattern of p16 and CDK4 in normal-adenoma-carcinoma sequence epithelia （P 〈 0.001）. Neither p16 nor CDK4 subcellular patterns correlated with histological grade or Dukes＇ stage.CONCLUSION： Interaction of expression of p16 and CDK4 plays an important role in the Rb/p16 pathway.Overexpression of p16 and CDK4 in the cytoplasm, as well as loss expression of p16 in the nucleusmighlc be important in the evolution of colorectal carcinoma from adenoma and, of adenoma from normal epitheiia.

Rare case of Helicobacter pylori -related gastric ulcer: Malignancy or pseudomorphism?

Helicobacter pylori (H. pylori ) is a pathogen and the most frequent cause of gastric ulcers. There is also a close correlation between the prevalence of H. pylori infection and the incidence of gastric cancer. We present the case of a 38-year-old woman referred by her primary care physician for screening positron emission tomography-computed tomography (PET-CT), which showed a nodular strong accumulation point with standardized uptake value 5.6 in the gastric fundus. Gastroscopy was then performed, and a single arched ulcer, 12 mm in size, was found in the gastric fundus. Histopathological examination of the lesion revealed chronic mucosal inflammation with acute inflammation and H. pylori infection. There was an obvious mitotic phase with widespread lymphoma. Formal anti-H. pylori treatment was carried out. One month later, a gastroscopy showed a single arched ulcer, measuring 10 mm in size in the gastric fundus. Histopathological examination revealed chronic mucosal inflammation with acute inflammation and a very small amount of H. pylori infection. The mitotic phase was 4/10 high power field, with some heterotypes and an obvious nucleolus. Follow-up gastroscopy 2 mo later showed the gastric ulcer in stage S2. The mucosal swelling had markedly improved. The patient remained asymptomatic, and a follow-up PET-CT was performed 6 mo later. The nodular strong accumulation point had disappeared. Follow-up gastroscopy showed no evidence of malignant cancer. H. pylori-associated severe inflammation can lead to neoplastic changes in histiocytes. This underscores the importance of eradicating H. pylori , especially in those with mucosal lesions, and ensuring proper follow-up to prevent or even reverse early gastric cancer.

Growth inhibitory effect of wild-type Kras2 gene on a colonic adenocarcinoma cell line

AIM： To observe the growth inhibitory effect of wild-type Kras2 gene on a colonic adenocarcinoma cell line Caco-2. METHODS： Recombinant plasmid pCI-neo-Kras2 with wild type Kras2 open reading frame was constructed. The Caco-2 cells were transfected with either pCI-neo or pCI-neo-Kras2 using Upofectamine 2000. The expression of wild type Kras2 was examined by Northern blot analysis. And the expression of wild type Kras2 protein was examined by Western blot analysis. The effects of wild-type Kras2 on cell proliferation were analyzed by monotetrazolium （MTT） assay, meanwhile analyses of cell cycle and spontaneous apoptosis rate were carried out by flow cytometry （FCM）. RESULTS： The plasmid of pCI-neo-Kras2 was successfully established. The growth rate of cells transfected with pCI-neo-Kras2 was significantly lower than the control cells transfected with the empty pCI- neo vector （P 〈 0.05）. Cell cycle analysis revealed arrest of the pCI-neo-Kras2 transfected cells in G0/G1 phases, decreased DNA synthesis and decreased fractions of cells in S phase. The proliferative index of cells transfected with pCI-neo-Kras2 was decreased compared with the control cells （49.78% vs 64.21%）, while the apoptotic rate of Caco-2 cells with stable Kras2 expression increased （0.30% vs 0.02%）. CONCLUSION： The wild-type Kras2 gene effectively inhibits the growth of the colonic adenocarcinoma cell line Caco-2.

Quantitative analysis of a panel of gene expression in prostate cancer——with emphasis on NPY expression analysis

Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdissected （LCM） specimens from 300 prostate cancer （PCa） patients undergoing radical prostatectomy （RP） were defined. Ten patients representing ＂aggressive＂ PCa, and 10 representing ＂non-aggressive＂ PCa were selected based on prostate-specific antigen （PSA） recurrence, Gleason score, pathological stage and tumor cell differentiation, with matched patient age and race between the two groups. Normal and neoplastic prostate epithelial cells were collected with LCM from frozen tissue slides obtained from the RP specimens. The expressions of a panel of genes, including NPY, PTEN, AR, AMACR, DD3, and GSTP1, were measured by quantitative real-time RT-PCR （TaqMan）, and correlation was analyzed with clinicopathological features. Results： The expressions of AMACR and DD3 were consistently up-regulated in cancer cells compared to benign prostate epithelial cells in all PCa patients, whereas GSTP1 expression was down regulated in each patient. NPY, PTEN and AR exhibited a striking difference in their expression patterns between aggressive and non-aggressive PCas （P=0.0203, 0.0284, and 0.0378, respectively, Wilcoxon rank sum test）. The lower expression of NPY showed association with ＂aggressive＂ PCas based on a larger PCa patient cohort analysis （P=0.0037, univariate generalized linear model （GLM） analysis）. Conclusion： Despite widely noted heterogeneous nature of PCa, gene expression alterations ofAM,4CR, DD3, and GSTP1 in LCM-derived PCa epithelial cells suggest for common underlying mechanisms in the initiation of PCa. Lower NPY expression level is significantly associated with more aggressive clinical behavior of PCa; PTEN and AR may have potential in defining PCa with aggressive clinical behavior. Studies along these lines have potential to define PCa-associated gene expression alterations and likely co-regulation of genes/pathways critical in the biology of PCa onset/progression.

增龄脑中毛细血管形态及与神经元密度相关改变

目的 观察增龄脑中毛细血管形态变化及神经元和毛细血管密度的相对改变,探讨血管因素在脑老化中的作用。方法 以 28例正常增龄病例及 6例阿尔茨海默病 Alzheim er's disease AD 患者尸检脑标本为研究对象。应用荆豆凝集素 ulex europaeus agglutinin UEA 免疫组织化学及甲苯胺蓝等染色观察正常增龄病例额叶、枕叶、壳核、海马及 AD 患者海马的神经元、毛细血管形态改变,应用图像分析技术测算各部位神经元与毛细血管密度比值,并分析其与年龄之间的相关性。结果 老年及 AD 患者脑内毛细血管可见 诸多病理形态改变。正常增龄病例额叶、枕叶、壳核神经元和毛细血管数目及面积之比与年龄呈正相关。结论 脑老化中毛细血管可出现病理形态改变且数目相对减少,故血管因素可能是脑老化发生机制中的重要因素之一。

SUBJECTIVE TINNITUS AS FIRST PRESENTATION IN A PATIENT WITH METASTATIC LUNG CANCER IN TEMPORAL BONE-A CASE REPORT

Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indi-cated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scan-ning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chron-ic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preopera-tive chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the tempo-ral bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The pa-tient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.

OPRT Is a Potential Predictive Factor for the Response to S-1 in Gastric Cancer

Objective: To analyze the impact of mRNA expression of oral fluoropyrimidine (S-1) metabolism (thymidylate synthase, dihydropyrimidine dehydrogenase, thymidine phosphorylase, and orotate phosphoribosyltransferase [OPRT]), on treatment outcomes in locally advanced gastric cancer patients receiving preoperative S-1 combined with oxaliplatin chemotherapy. Methods: Preoperative stage III gastric cancer patients received S-1 (80 mg/m2/day;days 1-14) and oxaliplatin (130 mg/m2;day 1) every 3 weeks and subsequently received gastrectomy with D1/D2 lymphadenectomy. Paired tumor and normal fresh frozen tissues were collected to evaluate mRNA levels of thymidylate synthase, thymidine phosphorylase, dihydropyrimidine dehydrogenase, and orotate phosphoribosyltransferase using quantitative reverse-transcriptase polymerase chain reaction. Results: Between December 2009 and October 2010, thirty-five patients were enrolled in this study. 24 (68.5%) patients had clinical tumor response and 10 (28.6%) patients achieved histological response. Quantitative reverse-transcriptase polymerase chain reaction results showed that orotate phosphoribo-syltransferase (OPRT) mRNA expression was significantly higher in histological responders than non-responders (3.75 vs. 1.81, P = 0.005). Diffuse-type gastric cancer patients demonstrated higher orotate phosphoribosyltransferase (OPRT) expression levels than intestinal-type ones (2.79 vs. 1.60, P = 0.014). Similar results were not found when comparing thymidylate synthase, thymidine phosphorylase and dihydropyrimidine dehydrogenase expression levels. Conclusion: Orotate phosphoribosyltransferase (OPRT) expression level may be a potential predictive biomarker in advanced gastric cancer patients treated with oral fluoropyrimidine (S-1) based chemotherapy. Mini Abstract: Orotate phosphoribosyltransferase (OPRT) expression level may be a potential predictive biomarker in advanced gastric cancer patients treated with oral fluoropyrimidine (S-1) based chemotherapy.

Evaluation of pathological diagnosis using ultrasonographyguided lymph node core-needle biopsy

Background Image-guided core-needle biopsy as a minimally invasive procedure has partially replaced excisional biopsy of the lymph node. However, it is still a great challenge to pathologists. The aim of this study was to survey and evaluate the accuracy of pathological diagnosis using the ultrasonography （US）-guided core-needle biopsy （CNB） of the lymph node.Methods Lymph node CNBs of 1119 consecutive patients from the Chinese People＇s Liberation Army （PLA） General Hospital were reviewed retrospectively. Biopsies were performed following outpatient procedures with direct US guiding by using 18-gauge cutting needle. The tissues of CNB were prepared according to the routine paraffin embedding and hematoxylin-eosin staining. Ancillary studies, including acid-fast staining and immunohistochemical staining, were performed when necessary.Results The age range was 1 year old to 85 years old. Locations of the lymph node were as follows： cervical area （n=482）, clavicular region （n=-227）, retroperitoneum （n=-150）, axilla （n=93）, groin （n=79）, abdomen/mesentery （n=44）,submaxillary region （n=-33）, postauricular region （n=4）, iliac rosa （n=3）, parotid （n=2）, hepatic hilar region （n=1）, and elbow （n=1）. The histological diagnoses were conclusive in 815 cases （73%） and inconclusive in 304 cases （27%）. The conclusive cases mainly included metastatic carcinoma （n=-449）, tuberculosis （n=111）, lymphoma/leukemia （n=124）, reactive hyperplasia （n=-87）, and other rare diseases （n=44）. The reasons for inconclusive cases were insufficient material for diagnosis, noncompliance of outpatients, or crushing artifacts of tissues caused by operation.Conclusions US-guided CNB can obtain lymphoid tissues from nearly all parts of the body for diagnostic purposes.Conclusive pathological diagnosis can be made in most of cases when adequate material was provided. Besides metastatic carcinoma,lymphomas with special immunophenotype can be accurately diagnosed and subclassified by US-guided CNB.

Clinical and pathological features of miR-10b and RHOC gene expression in hepatocellular carcinoma

Aberrant expression of microRNAs(miRNAs)was reported frequently in different human cancers.The major role of miRNA is targeting 30-UTR of coding gene and causing translational repression or mRNA degradation.miR-10b overexpression was reported to promote breast cancer metastasis by up-regulating RHOC expression.But its expression in hepatocellular carcinoma(HCC)remains unclear.Our study indicated that the expression of miR-10b was different in HCC and adjacent tissue samples,and reduced expression of miR-10b in HCC was related tovein invasion.High-level expression of RHOC was also related to vein invasion in HCC.But no correlation was found between miR-10b and RHOC expression.These results suggest that miR-10b and RHOC are independent predictors of HCC invasion and metastasis.

Chordoid meningioma:a report of two cases

Although meningiomas are common rumors in adults, the chordoid variant is very rare. According to the World Health Organization Classification of Tumors of the Nervous System （Lyon, 2000）,chordoid meningioma together with another rare variant, lymphoplasmacyterich meningioma, usually contain abundant lymphoplasmacytic infiltration, and are associated even with hematological abnormalities, especially in young adults. Few cases of chordoid meningioma have been reported in detail until Couce and his colleagues reported a sizable series of forty-two cases. Even then, the clinical and pathological features of these tumors were not well characterized, because of variations in different papers. In the present article, we report two adult patients with chordoid meningioma.

Secondary pulmonary alveolar proteinosis associated with myelodysplastic syndrome

Pulmonary alveolar proteinosis （PAP） IS an uncommon disease first reported by Rosen et al^1 in 1958, and characterized by the accumulation of surtactant proteins and phospholipids within the alveolar spaces. Acquired PAP is divided into two forms based on clinical features： idiopathic PAP and secondary PAE Secondary PAP is reported to be associated with haematological malignancies, Pneumocystis carinii pneumonia and inhalation of silica or titanium, and the most frequent underlying disease of secondary PAP is haematological malignancy. The exact incidence of PAP in haematological malignancies is still obscure, since there have been only sporadic reports of secondary PAP.^ 2, 3

Prognostic significance of clinicopathologic parameters in gastrointestinal stromal tumors:a study of 156 cases

The biological behavior of gastrointestinal stromal tumors(GISTs)are highly variable.To invest-igate the biological behavior of GIST,we collected 83 cases of gastric and 62 cases of small intestinal GIST from the Department of Pathology of the Chinese PLA General Hospital.The parameters include age,primary tumor location,tumor diameter,mitotic index,tumor necrosis,risk assessment,clinical stage and the c-kit exon 11 muta-tion.All these were analyzed in 105 cases along with the follow-up data and tested by log rank and COX hazard proportional model.We find that the average age of gast-ric GIST was 55.4 years.Of the 62 cases that were fol-lowed up,17 cases had metastasis or recurrence and the 5-year survival rate was(66.51±17.06)%.For the small intestinal GIST,the average age was 50.6 years and 43 cases were followed up.Of these,22 cases had meta-stasis or recurrence and the 5-year survival rate was(61.76±18.30)%.Small intestinal GIST was more fre-quently associated with metastasis and tumor relapse than gastric GIST(x^(2)=56.131,P=0.013).For gastric GIST,patients younger than 50 years(P=0.046),the advanced clinical stage(P=0.0001),the large tumor diameter(P=0.0001),a high mitotic index(P=0.0001),necrosis(P=0.0001)and a high risk grade(P=0.004)were all correlated with a lower survival rate.The COX hazard proportional model revealed that advanced clinical stage(P=0.001),large tumor size(P=0.001),a high mitotic index(P=0.002)and the high risk grade(P=0.018)indi-cated a poorer prognosis in gastric GIST.For small intest-inal GIST,necrosis(P=0.036)and advanced clinical stage(P=0.010)were associated with lower survival rates and the clinical stage was shown to be an independent prognostic indicator.A total of 25 cases harbored muta-tions in c-kit exon 11.The frequency of c-kit mutation was 32%and 22.5%for gastric and small intestinal GIST,respectively.In gastric GIST,the mutated c-kit was pre-dominant in patients older than 50 years of age.But in the small intestinal GIST,the mutated c-kit was predominant in the age group of 40-49 years.In conclusion,for gastric GIST,clinical stage,tumor size,mitotic index,and risk grade are the prognostic indicators.For small intestinal GIST,necrosis and clinical stage are the prognostic indi-cators.Small intestinal GIST are more aggressive than gastric GIST.The occurrence of c-kit mutation may cor-relate with the age of patients.

Clinicopathological features of atypical lipomatous tumors of the laryngopharynx

Atypical lipomatous tumor (ALT) of the laryngopharynx is rare.Here we report five cases to demonstrate their clinicopathological features.The patients were four males and one female,aged 41 to 69 years (median 53.6 years).All tumors (two in the hypopharynx and three in the larynx) presented as a slowly growing,painless mass.Symptoms included dysphagia (2/5),dysphonia (3/5),and the feeling of a foreign body in the throat (5/5).Tumors were well circumscribed or focally infiltrative,ranging from 2.0 to 5.0 cm (median,3.4 cm) in size,and microscopically showed the typical features of lipoma-like ALT.Immunohistochemically,tumor cells were stained with S-100,vimentin,murine double minute 2 (MDM-2),and cyclin-dependent kinase 4 (CDK4).Two patients had local tumor recurrences at 6 and 14 months after initial surgery during follow-up.ALT of laryngopharynx is an indolent tumor.Immunohistochemical staining for MDM-2 and CDK4 is helpful in pathological diagnosis.

Granulation Tissue-type Hemangioma in the Internal Jugular Vein

Granulation tissue-type hemangiomas are rare benign vascular lesions that mainly affect the head,neck,and hands.In 75% of the cases,the lesion shows a striking predilection for the mucosa,while skin is the second common site for the lesions.Granulation tissue-type hemangiomas occur upon various stimuli such as chronic low-grade irritation,traumatic injury,and hormonal factors.The lesions occur predominantly in young females,possibly triggered by a vascular effect due to hormonal changes.They range in size from a few millimeters to several centimeters and can grow rapidly with frequently bleeding.The purpose of this article is to present a case of granulation tissue-type hemangioma and to briefly review the current literature for this condition.