Abstract
Background
Cardiac tumours are of rare incidence and usually occur in the form of secondary tumours. Most metastatic tumours are melanomas, sarcomas, lung, and haematological malignancies. ...Neuroendocrine carcinomas (NECs) of the heart are extremely unusual. This case report demonstrates a solitary high-grade NEC of the heart with an individual therapy strategy and follow-up.
Case summary
A 50-year-old gentleman presented with a 2 days history of recurrent episodes of chest pain. Echocardiography, computed tomography, and magnetic resonance imaging revealed tumorous lesions of the ventricles and aortic valve with large circular pericardial effusion. Histopathology results of the biopsy revealed a poorly differentiated small cell tumour of the neuroendocrine type. Despite further investigations with multiple imaging modalities and laboratory, no primary was found. Chemotherapy was initiated but size progression of the tumour was detected. As no other tumorous lesions were detected and resection was not possible because of the tumour complexity, decision on heart transplantation was made. However, due to the necessary immunosuppression after the heart transplantation, multiple metastasis where discovered in the course of treatment.
Discussion
The presence of a NEC in the heart without evidence of any other metastasis or evidence of primary tumour in other organs is clinically unique. For this individual case, heart transplantation was the therapy of choice due to tumour progression under chemotherapy and lacking possibility of resection, as no other suspect lesion was found other than the ones found in the heart. However, the risk of exacerbation of undiscovered micrometastases under necessary immunosuppression following the heart transplantation should be considered.
Background. Enhanced sialylation has been considered important for the metastatic growth of colorectal carcinomas. Using sequence‐ and sialic acid‐specific lectins and a monoclonal antibody, the ...tumor‐associated expression of alpha(2,3)‐ and alpha(2,6)‐sialylated oligosaccharides was investigated. The study was designed to examine whether a random increase of sialylation or the expression of oligosaccharides carrying distinct sialic acid residues affect the biology of colorectal carcinomas.
Methods. Using computerized image analysis, formalin fixed and paraffin wax embedded specimens from 152 primary colorectal carcinomas were subjected to a quantitative analysis of the occurrence of sialoglycoconjugates detected by the maackia amurensis agglutinin (MAA: specific for alpha(2,3)‐linked sialic acid residues), sambucus nigra agglutinin (SNA: specific for alpha(2,6)‐linked sialic acid residues), and the monoclonal antibody B72.3 (MAB B72.3: specific for alpha(2,6)‐N‐acetyl‐galactosamine‐1‐O‐Ser/Thre). The data obtained by quantitating lectin/immunohistochemistry were related to morphologic and clinical parameters.
Results. Alpha(2,3)‐linked sialic acid residues increased from Stage I to Stage II tumors but decreased in advanced carcinomas. Alpha(2,6)‐sialylated glycoconjugates did not show any association with local tumor growth (depth of invasion). However, metastatic tumor growth was accompanied by a significant increase of alpha(2,6)‐sialylated carbohydrate sequences. Univariate survival analysis revealed that the expression of SNA‐and MAB B72.3‐defined reactivity displayed an inverse relation to 5‐year survival. Although more advanced tumor stage was associated with poor 5‐year survival, tumors below the cutoff points for SNA‐ and MAB B72.3‐defined reactivity indicated a better prognosis than the neoplasms above the cutoff points. In contrast, the expression of alpha(2,3)‐linked sialic acid residues as detected by MAA had no significant effect on survival. Multivariate regression analysis revealed that SNA‐reactivity, followed by tumor stage and the MAB B72.3‐defined antigen reactivity were independent prognostic variables predicting overall survival, whereas MAA‐reactivity, sex, age, histologic differentiation, and tumor grade had no independent prognostic value. The simultaneous expression of both sialyl‐Tn‐ and SNA‐reactivity determined tumors of high risk patients within the different tumor stages.
Conclusions. Sequence‐specific sialylation is associated with altered biologic behavior of colorectal carcinomas.
Study Design
Case report and review of the literature.
Objective
To report a unique case of an intraspinal chondrosarcoma that was diagnosed 18 years after radiotherapy for a cervical carcinoma and ...its remarkably unusual clinical presentation.
Methods
A retrospective case description of an intraspinal mass lesion that occurred 6 weeks after previous spinal surgery.
Results
Within ∼9 weeks, the tumor had infiltrated the peritoneal cavity and reached the lumbar subcutaneous tissue.
Conclusion
Radiation-induced sarcomas are rare, are highly aggressive, and may be difficult to diagnose. Furthermore, the only means of achieving long-term survival is through early and extensive surgery.
This study was undertaken to analyze the differentiation profiles assessed by immunophenotyping in AIDS-related B-cell lymphoma (ARL) and their relation to the clinical course. Paraffin-embedded ...sections of 89 ARL cases during 1989 to 2004 were stained immunohistochemically with antibodies to CD3, CD10, CD20, CD38, CD138/Syndecan-1 (Syn-1), multiple myeloma-1/interferon regulatory factor-4 (MUM1/IRF4), B-cell lymphoma protein-2 (BCL-2), BCL-6, latent membrane protein-1 (LMP-1), and Ki-67. Expression of CD10 and CD20 were associated with better overall survival (OS; P = .009 and P = .04, respectively). Expression of CD20 was associated with longer disease-free survival (DFS; P = .03), whereas expression of CD138/Syn-1 was associated with shorter DFS (P = .03). OS and DFS were worse in patients with immunophenotypic profiles related to post-germinal center (GC) differentiation (BCL-6 and CD10 negative, MUM1/IRF4 and/or CD138/Syn-1 positive) when compared with GC differentiation (P = .01). When controlled for age-adjusted International Prognostic Index (IPI), prior AIDS-defining illness (ADI), and year of ARL diagnosis, a post-GC differentiation remained significantly associated with poor OS and DFS. Expression of CD10 was associated with a preserved immunocompetence, whereas CD20 was less frequent in patients developing ARL while on highly active antiretroviral therapy (P = .04). In summary, lack of CD20 or CD10 expression and a post-germinal center signature are associated with a worse prognosis in ARL. (Blood. 2005;106:1762-1769)
BACKGROUNDCardiac tumours are of rare incidence and usually occur in the form of secondary tumours. Most metastatic tumours are melanomas, sarcomas, lung, and haematological malignancies. ...Neuroendocrine carcinomas (NECs) of the heart are extremely unusual. This case report demonstrates a solitary high-grade NEC of the heart with an individual therapy strategy and follow-up. CASE SUMMARYA 50-year-old gentleman presented with a 2 days history of recurrent episodes of chest pain. Echocardiography, computed tomography, and magnetic resonance imaging revealed tumorous lesions of the ventricles and aortic valve with large circular pericardial effusion. Histopathology results of the biopsy revealed a poorly differentiated small cell tumour of the neuroendocrine type. Despite further investigations with multiple imaging modalities and laboratory, no primary was found. Chemotherapy was initiated but size progression of the tumour was detected. As no other tumorous lesions were detected and resection was not possible because of the tumour complexity, decision on heart transplantation was made. However, due to the necessary immunosuppression after the heart transplantation, multiple metastasis where discovered in the course of treatment. DISCUSSIONThe presence of a NEC in the heart without evidence of any other metastasis or evidence of primary tumour in other organs is clinically unique. For this individual case, heart transplantation was the therapy of choice due to tumour progression under chemotherapy and lacking possibility of resection, as no other suspect lesion was found other than the ones found in the heart. However, the risk of exacerbation of undiscovered micrometastases under necessary immunosuppression following the heart transplantation should be considered.
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