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Background Rhabdomyosarcoma (RMS) of the breast, a mesenchymal neoplasm with skeletal muscle differentiation, is an extremely rare tumour in males, with less than 30 cases published in English-language literature. We report on the first case of a male breast RMS, with an unusual ectomesenchymal/neuroectodermal component. Case summary A 55-year-old, previously healthy male, underwent a radical left mastectomy for an ulcerated tumour mass, occupying the breast and left anterior thoracic wall. The biopsy specimen indicated the presence of a tumour with neural origins, namely a peripheral neuroectodermal tumour (PNET). The surgical specimens identified two components. The rhabdomyosarcomatous component (over 70%) was represented by large pleomorphic cells with positivity for desmin, sarcomeric actin and myogenin. The PNET-like ectomesenchymal component, which was admixed with the RMS cells, and was also revealed during the preoperative biopsy, consisted of small cells which expressed neurofilament, neuron specific enolase and CD99. The microscopic examination, along with the immunohistochemical profile, allowed the diagnosis of an RMS, with unusual ectomesenchymal differentiation. The patient refused the postoperative oncologic therapy and died three months after surgery. Conclusion In patients with RMS of the breast, the PNET-like ectomesenchymal component increases the diagnosis difficulty, especially in biopsy specimens. This differentiation can be immunohistochemically proven and might highlight the possible development of high-grade sarcoma of the breast from remnants of the embryological ectodermal layer.

BACKGROUND A collecting duct carcinoma is a very rare, malignant renal epithelial tumor. Distant metastases are present in one third of cases at the time of diagnosis. It is known to have a poor prognosis. CASE SUMMARY A 42-year-old male was sent to our surgery clinic for removal of a 119.2 mm × 108.3 mm encapsulated cystic mass, which was localized in the 8th segment of the right liver lobe. The lesion was first identified on ultrasonography. A computed tomography scan confirmed the presence of a Bosniak type III cystic lesion, which affected the liver and convexity of the right kidney. Surgical intervention involved a right nephrectomy, with removal of the cystic mass. The patient was mobilized on the first postoperative day and was discharged after 7 d. The histological and immunohistochemical examination revealed a low-grade collecting duct renal carcinoma, which is a rare variant of papillary carcinoma, with low malignant potential. The patient did not receive chemotherapy and after 21 mo of follow-up, a radiological examination and laboratory analyses showed normal aspects. No relapse or other complications were reported. CONCLUSION To manage renal tumors properly, a correct histopathological diagnosis is crucial, as is early diagnosis and correct surgical treatment.

Absztrakt: Bevezetés: Az óriás hasfali defektusok kezelése kihívást jelent a sebészek számára. CT-vizsgálattal meghatározható a sérvzsák és a hasüreg térfogata közötti arány, megállapítva a téraránytalanság mértékét, amely a műtét utáni hasűri nyomás mértékének kifejezője lehet. Célkitűzés: A posztoperatív óriás hasfali defektusok kivizsgálásában alkalmazott CT-vizsgálat jelentőségének alátámasztása, a rekonstrukciós módszer hatékonyságának elemzése a hasűrinyomás-méréssel. Módszer: Prospektív kutatást végzünk klinikánkon, vizsgálva az óriás hegsérvvel kezelt betegeinket, akiknél műtét előtt hasi CT-vizsgálat készül. A hasfal rekonstrukciója feszülésmentesen, retromuscularisan elhelyezett Prolene hálóval és sérvzsákból készített peritoneumlebenyekkel történik. Műtét alatt és műtét után hasűri nyomást mérünk, posztoperatívan 2, 4, 6 hónap után telefonon keresztül követjük betegeinket. Eredmények: Elért eredményeinket három eset kapcsán mutatjuk be. 1. eset: A 48 éves nőbetegnél óriás kiújult hegsérv, több társbetegség állt fenn. Testtömegindexe 43,6, a hasfali defektus átmérője 155 mm, a hegsérv térfogata 1536,63 cm3 volt. A műtét utáni 7. napon hazabocsátottuk. 2. eset: Az 51 éves férfi betegnél multilocularis óriás hegsérv keletkezett, testtömegindexe 26,85 volt. A két hasfali defektus átmérője 123 mm és 105 mm, térfogatuk együttes értéke 406,41 cm3 volt. A műtét utáni 5. napon a beteget elbocsátottuk. 3. eset: A 67 éves férfi beteg testtömegindexe 23,7, a hasfali defektus mérete 100 mm, térfogata 258,10 cm3 volt. A beteget a műtét utáni 4. napon elbocsátottuk. Következtetés: A preoperatív CT-vizsgálat adatai fontosak az alkalmazott műtéti technika megválasztásában. A sérvzsák és a háló együttes alkalmazása az óriás hegsérvek rekonstrukciójában olcsó és feszülésmentes műtéti technikát biztosít a fokozott rizikóval rendelkező betegek esetében. A technika rövid távú hatékonyságának elemzésére a húgyhólyagon keresztül mért hasűri nyomás a választandó módszer. Orv Hetil. 2020; 161(9): 347–353.

Background: In patients with synchronous colorectal cancer (SCRC), understanding the underlying molecular behavior of such cases is mandatory for designing individualized therapy. The aim of this paper is to highlight the importance of transdisciplinary evaluation of the pre- and post-operative assessment of patients with SCRCs, from imaging to molecular investigations. Methods: Six patients with SCRCs presented with two carcinomas each. In addition to the microsatellite status (MSS), the epithelial mesenchymal transition was checked in each tumor using the biomarkers β-catenin and E-cadherin, same as KRAS and BRAF mutations. Results: In two of the patients, the second tumor was missed at endoscopy, but diagnosed by a subsequent computed-tomography-scan (CT-scan). From the six patients, a total of 11 adenocarcinomas (ADKs) and one squamous cell carcinoma (SCC) were analyzed. All the examined carcinomas were BRAF-wildtype microsatellite stable tumors with an epithelial histological subtype. In two of the six cases, KRAS gene status showed discordance between the two synchronous tumors, with mutations in the index tumors and wildtype status in the companion ones. Conclusions: Preoperative CT-scans can be useful for detection of synchronous tumors which may be missed by colonoscopy. Where synchronous tumors are identified, therapy should be based on the molecular profile of the indexed tumors.

Introduction: Colorectal cancer is one of the most common types of malignant tumors worldwide. In patients with situs abnormalities such as situs inversus totalis or situs ambiguus, the presence of this tumor could be a challenge for the surgeon, especially in cases in which the laparoscopic approach is considered. Case presentation: We report the case of a 69-year-old male patient with situs inversus totalis. This particular case of situs inversus totalis was not a classical type because the patient had bilateral bilobed lungs, polysplenia, preduodenal portal vein in association with midgut malrotation. The pathology report after surgery revealed moderately differentiated adenocarcinoma of the sigmoid colon, stage pT3 N1c M1a, liver metastases but without metastases in the eight resected lymph nodes. We compared this rare association of diseases of particular anatomic aspects with other reports in the specialty literature. Conclusion: The identification of situs abnormalities or other malformations in patients with resectable colorectal cancer is essential, thus preoperative imaging studies are imperative for a proper surgical management. Colorectal cancer metastasizing patterns in patients with intestinal malrotation need to be further investigated.

Background The most recent histopathological guideliness recommend evaluation of tumor buds, as an independent prognostic factor of colorectal carcinoma (CRC). In the present paper, we examined the immunoprofile of tumor buds, using three markers of epithelial mesenchymal transition (EMT): E-cadherin, β-catenin and vimentin, which were evaluated in both tumor core and buds. Methods In 157 CRCs specimens, consecutive cases with curative resection, without preoperative therapy, three molecular subtypes were defined: epithelial (positive for E-cadherin, membrane expression for β-catenin and negative for vimentin, in core and buds), mesenchymal (loss of E-cadherin staining and vimentin positivity and/or nuclear β-catenin, in core and buds) and hybrid cases (epithelial tumor core and mesenchymal tumor buds). Based on the number of buds, which were evaluated at high power field (HPF), cases were divided in two groups: group A or low grade (≤5 buds/HPF) and and group B or high-grade CRCs (>5 buds/HPF). Results It was a similar distribution between the two groups: 74 cases (47.13%) in group A and 83 cases in group B (52.87%). Most of the cases (n = 76; 48.41%) were classified as epithelial-type, followed by hybrid- (n = 63; 40.13%) and mesenchymal-type CRCs (n = 18; 11.46%). On both groups, a similar distribution was seen between epithelial- and hybrid-type cases but 14 out of the 18 mesenchymal-type CRCs belonged to group B (p = 0.01). All of the mesenchymal-type CRCs from group B showed lymph node metastases. Both lymph node status and budding degree proved to be independent prognostic factors. Conclusions In daily practice, the immunoprofile of CRC buds might have a prognostic impact. Further studies are necessary to check the prognostic role of mesenchymal-immunoprofile of tumor buds. Legal entity responsible for the study University of Medicine, Pharmacy, Sciences and Technology, Tirgu-Mures, Romania. Funding University of Medicine, Pharmacy, Sciences and Technology, Tirgu-Mures, Romania. Disclosure All authors have declared no conflicts of interest.