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Additional file 1. Table S1. Comparison of diagnostic accuracy between two needles.

Additional file 1: Table S1. Correlation between H3K27me3 and ATRX immunoreactivity among gliomas; Figure S1. Decision tree of recursive partitioning model starting with IDH1-R132H staining followed by ATRX and H3K27me3 staining. Blue bars correspond to IDH Mut 1p/19q codeleted oligodendrogliomas, and orange bars correspond to not IDH Mut 1p/19q codeleted gliomas. We considered IDH Mut 1p/19q codeleted oligodendroglioma as a dependent variable and immunostaining (H3K27me3, ATRX, and IDH1-R132H) as predictors. NR nuclear retention, NL nuclear loss, Mut mutated.

Additional file 2. Table S2. Comparison of diagnostic accuracy in each pancreatic location between two needles.

Metastatic uterine tumors originating from extragenital cancers are a rare clinical occurrence. We report a case of metastatic uterine cancer derived from small-cell lung cancer (SCLC) that necessitated surgical treatment. The patient was a 59 y/o female who had undergone chemotherapy for stage IIIB SCLC. A 15 cm uterine tumor lesion was initially detected on CT scans. The patient had previously been diagnosed with uterine fibroids, but compared to the most recent CT scans taken one and a half months earlier, imaging diagnosis revealed a sudden increase in the size of the tumor when compared to the 8 cm myoma fibroid noted previously. Additional work-up with MRI scans revealed T2-enhanced images of a tumor that had almost completely invaded the myometrium; the tumor presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. A differential diagnosis of uterine sarcoma was considered, but due to the lack of focal hemorrhage or necrosis findings on MRI imaging, the possibility of differential diagnosis of metastatic SCLC was also noted. As the patient was experiencing abdominal symptoms including abdominal distension and tenderness due the tumor, a simple hysterectomy and bilateral salpingo-oophorectomy were performed to palliate the symptoms. During the surgical procedures, intra-abdominal findings noted peritoneal dissemination while intraoperative cell cytology diagnosis of ascites revealed small-cell cancer. The final histopathological diagnosis likewise revealed metastatic small-cell cancer from the primary lung cancer. The clinical status of the lung cancer was evaluated as progressive disease (PD), and a change in chemotherapy regimen was necessitated. Further disease progression was noted on CT scans at 2 and a half months after surgery, and with gradual systemic disease progression, the patient died of disease at 3 months postsurgery. Initial evaluation of rapidly enlarging uterine tumors should include a differential diagnosis of uterine sarcoma; additionally, it is necessary to also consider the rare possibility of metastatic disease as in the present case with a clinical history of extragenital malignancy.

Histopathological features of primary and recurrent tumors in a 34 year-old female (patient 6). The primary tumor was diagnosed as anaplastic oligodendroglioma (WHO grade III) (A). Postoperatively, the patient was treated with 8 courses of PAV chemotherapy. Eight years after the initial surgery, an MRI FLAIR-high lesion was noticeably enlarged and this region showed high uptake in Methionine PET. Tumor recurrence was therefore suspected and surgical resection was performed. In the recurrent tumor, atypia of the nucleus was improved and numbers of mitotic cells were decreased compared to the primary tumor, and the tumor was diagnosed as oligodendroglioma (WHO grade II) (B). Formalin-fixed paraffin-embedded tissues were sectioned and stained with Hematoxylin and Eosin (bar = 100 μm). Figure S2. Histopathological features of different tumor portions from the same patient as listed in Additional file 1: Table S1. Formalin-fixed paraffin-embedded tissues were sectioned and stained with Hematoxylin and Eosin (bar = 100 μm). A. Patient 13, Methionine PET low uptake, grade II; B. Patient 13, Methionine PET high uptake, grade III; C. Patient 14, Gadolinium enhanced -, grade II; D. Patient 14, Gadolinium enhanced +, grade III; E. Patient 15, Methionine PET low uptake, grade II; F. Patient 15, Methionine PET high uptake, grade II; G. Patient 16, Methionine PET low uptake, grade III; H. Patient 16, Methionine PET high uptake, grade III. (PPTX 1597 kb)