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Introduction. primary mucinous carcinoma of the eyelid skin is a rare adenocarcinoma of skin glands. This tumor rarely metastasizes but frequently recurs.The study objective is to describe a rare clinical case of primary mucinous carcinoma of the eyelid skin, present macroscopic, histological and immunohistological descriptions of this pathology.Clinical case. male, 66 years old, sought medical care due to a neoplasm of the lower eyelid. macroscopically a subcutaneous node 1.2 × 1.0 cm was observed, of yellow-brown color, gelatinous in section. microscopic examination showed that the tumor consists of islands of epithelial cells surrounded by mucinous “lakes”. Immunohistochemical examination showed Ck7, estrogen, p53 expression in the tumor cells, as well as absence of Ck20 expression. Based on the data of macro-, microscopic and immunohistochemical examinations, primary mucinous carcinoma of the eyelid skin was diagnosed. Observed morphological signs of this tumor allow to differentiate it from cancer metastasis.Conclusion. primary mucinous carcinoma of the skin should be differentiated from metastasis of mucinous carcinoma of the breast, lung, colon, et al. macro- and microscopic signs of this tumor are subjective. Immunohistochemical examination is a more reliable diagnostic tool.

Background: Cancer of unknown primary (CUP) is a malignant and aggressive tumor whose primary origin is still unknown despite thorough evaluation. CUP can be life-threatening with a median overall survival of less than 1 year based on empirical chemotherapy. Gene detection technology advances the driver gene detection of malignant tumors and the appropriate precise therapy. Immunotherapy has ushered in a new era in cancer therapy, changing the way advanced tumors, including CUP, are treated. Combined with comprehensive clinical and pathological investigations, molecular analysis of the original tissue and detection of potential driver mutations may provide therapeutic recommendations for CUP. Case presentation: A 52-year-old female was admitted to hospital for dull abdominal pain, with peripancreatic lesions below the caudate lobe of the liver and posterior peritoneal lymph nodes enlargement. Conventional biopsy under endoscopic ultrasonography and laparoscopic biopsy both revealed poorly differentiated adenocarcinoma based on immunohistochemical series. To help identify tumor origin and molecular characteristics, 90-gene expression assay, tumor gene expression profiling with Next-generation sequencing (NGS) method and Immunohistochemical expression of PD-L1 were employed. Although no gastroesophageal lesions discovered by gastroenteroscopy, the 90-gene expression assay yielded a similarity score and prompted the most likely primary site was gastric/esophagus cancer. NGS revealed high TMB (19.3mutations/Mb) but no druggable driver genes identified. The Dako PD-L1 22C3 assay IHC assay for PD-L1 expression revealed a tumor proportion score (TPS) of 35%. Given the presence of negative predictive biomarkers for immunotherapy, including adenomatous polyposis coli (APC) c.646C>T mutation at exon 7 and Janus kinase 1(JAK1), the patient received immunochemotherapy instead of immunotherapy alone. She was successfully treated with nivolumab plus carboplatin and albumin-bound nanoparticle paclitaxel for six cycles and nivolumab maintenance, which achieved a complete response (CR) maintained for 2 years without severe adverse events. Conclusions: This case highlights the value of multidisciplinary diagnosis and individual precision treatment in CUP. Further investigation is needed as an individualized treatment approach combining immunotherapy and chemotherapy based on tumor molecular characteristics and immunotherapy predictors is expected to improve the outcome of CUP therapy. [ABSTRACT FROM AUTHOR]

Primary bladder adenocarcinoma is rare and metastatic or locally invasive adenocarcinomas from other organs are more frequently seen within the bladder. Here we present a 61-year-old patient with an adenocarcinoma within the bladder neck. It was a diagnostic challenge to differentiate between primary bladder adenocarcinoma, metastatic colorectal adenocarcinoma, and prostatic adenocarcinoma. After extensive immunohistochemistry the diagnosis of primary bladder adenocarcinoma was made. We discuss how to come to this diagnosis and what immunohistochemistry approaches can be taken to differentiate it from other adenocarcinomas. [ABSTRACT FROM AUTHOR]

It is very rare for colorectal neoplasms to metastasize to the heart in the worldwide medical literature; only a single case of well-documented colorectal cancer metastasis to the left atrium was found. The case of a 66-year-old man is explained in this paper, who was suffering from metastatic adenocarcinoma of the colon that included the left atrium. In transthoracic and transesophageal echocardiography, a large multilobulated mass was present in the left atrium. An accidental pulmonary mass was also seen in a lung spiral CT scan. The cardiac mass was taken out, and a biopsy was obtained from the pulmonary mass. Adenocarcinoma was seen in histological assessment. Immunohistochemical staining was carried out to examine the expression of cytokeratin 7, cytokeratin 20, and caudal-related homeobox transcription factor 2 (CDX2) to determine the origin of the adenocarcinoma. In addition, the expression of these proteins was linked to the attributes of the patient and tumor. Post-surgical transesophageal echocardiography showed normal left ventricle and right ventricle function with no evidence of left atrium mass. Therefore, we suggest that asymptomatic cancer patients with a history of colorectal cancer and who have developed cardiac symptoms should be immediately examined for potential cardiac metastasis. [ABSTRACT FROM AUTHOR]

Abstract Background Metastatic adenocarcinoma of unknown primary site (MACUP) is the most common cancer of unknown primary site, and shows worse prognosis. Prediction of its tumor site origin attracts a growing attention. However, the site determined by gene expression profiling does not have a significant impact on the survival. Some other special method might need to be found out. Methods We reviewed 1011 MACUP patients diagnosed by pathological examination and immunohistochemistry based on the Surveillance, Epidemiology, and End Results (SEER) database during 2010–2016. Kaplan–Meier curves and Cox proportional hazard model were analyzed to compare the survival. Logistic regression models and relevant nomograms were performed to predicting the probability of the primary site which including digestive system, respiratory system, and female breast. The validation and clinical utility of models were measured with relevant statistical approaches. Results About 324 (32.1%), 299 (29.6%), and 203 (20.1%) of MACUP patients were identified as the primary sites of digestive system, respiratory system, and female breast, respectively. Patients derived from digestive system and respiratory system showed poorer survival than these with other sites. Digestive system was significantly associated with liver (Odds ratio =13.21 [95% confidence interval =8.48–21.02]) or lung (2.36 [1.40–3.97]) metastasis, while respiratory system was linked to brain (11.68 [6.68–21.26]) or lymph node (3.39 [2.26–5.13]) metastasis. Patients identified as female breast were prone to occur bone metastasis (5.85 [3.68–9.45]). Logistic regression nomograms were developed to help clinicians intuitively predict the probabilities of tumor site origin with 0.867, 0.824, and 0.753 of the C‐index, respectively. Decision curve analysis and clinical impact curves both revealed the clinical effectiveness. Conclusions We profiled different tumor site origin of MACUP patients and established prediction models. These features might be significant for clinicians to improve the probabilities of predicting the primary sites, and to decide subsequent treatment strategy.

Abstract Background Intestinal-type adenocarcinoma is widely detected in the gastrointestinal tract, head and neck, lower respiratory and urinary systems. Determining the nature (monoclonal or multicentric) of the intestinal adenocarcinoma is sometimes a diagnostic challenge owing to its occurrence at various locations of the body, especially in the lower gastrointestinal tract. Herein, we successfully diagnosed metastatic colon cancer in the small intestine using tumor protein 53 gene (TP53) mutation analysis. Case presentation An 83-year-old woman presented with severe abdominal pain and nausea at the emergency department of the hospital. Her history included surgery and adjuvant chemotherapy for colon and breast cancers. Abdominal computed tomography revealed small intestinal dilation, which was associated with the mural nodule detected on fluorodeoxyglucose positron emission tomography. Laparoscopy-assisted small bowel resection was performed based on the diagnosis of small bowel obstruction, probably due to recurrence of the colon or breast cancer. Macroscopically, an ulcerated tumor was present in the resected small intestine. Histologically, the cancer cells showed infiltrative growth of colonic dysplastic glands, whose non-specific finding made it difficult to determine the relationship with past colon cancers. Retrospective pathological examination confirmed that the previous breast and colon carcinomas were primary cancers. Immunohistochemical analysis revealed that the small intestinal and colon cancer cells showed diffuse positive tumor protein 53 (p53) expression. However, the breast cancer cells showed only weakly positive p53 expression. In addition, TP53 mutational analysis detected an identical missense mutation (p.T211I) between the two intestinal cancers. Moreover, further molecular genetic work-up revealed that both small intestinal and colon adenocarcinomas harbored an identical missense mutation (p.G12D) of KRAS gene. In conclusion, the small intestinal cancer in this case was identified as a metastatic adenocarcinoma arising from a past colon cancer. Conclusions Genetic analyses help in clarifying the identity of the cells in multiple cancer cases. In morphologically indeterminate cases, molecular analysis of common cancer-related genes can be useful for a precise and reproducible diagnosis.

Background: Fine-needle aspiration cytology (FNAC) is an increasingly common procedure in the diagnosis of neoplastic lesions of the liver, particularly in differentiating primary hepatocellular carcinoma (HCC) from metastatic adenocarcinoma (MA). However, there are certain limitations of FNAC. Sometimes, FNAC does not yield sufficient material for the precise diagnosis and the risk of the wrong diagnosis by FNAC cannot be excluded from the study. The aim of the study was to overcome such problems using a cell block (CB) technique along with immunohistochemistry (IHC) to diagnose and differentiate HCC from MA. Materials and Methods: This was a prospective study, conducted in a tertiary care hospital in Darjeeling district of West Bengal, over a period of 1 year. A total of 52 adult cases presenting with liver mass suspicious of malignancy were studied; CB with a histopathological examination and IHC for Hep par1 and CD10 were done in all cases. Results: In our study of 52 cases, CB with IHC was found superior in differentiating primary HCC from MA than only CB with a diagnostic accuracy of 96.15% and 92.31%, respectively. Among the IHC markers, Hep par1 was found more useful than CD10 with a diagnostic accuracy of 94.23% and 82.6%. However, CD10 was found to have greater diagnostic utility than Hep par1 in the context of poorly differentiated HCC. Conclusions: IHC study with Hep par1 and CD10 may be useful in differentiating HCC from the MA of the liver. Therefore, CB along with IHC improves the diagnostic accuracy of FNAC diagnosis.

Background: The liver is the digestive organ where metastatic adenocarcinoma of unknown primary site is most often observed. Case Report: A 74-year-old man was diagnosed with a growing gallbladder tumor and multiple liver tumors limited to the left lateral sector. Liver tumors were suggested to be primary or secondary adenocarcinoma with no relation to the gallbladder tumor. Also for diagnostic purposes, laparoscopic full-thickness resection of the gallbladder, laparoscopic lateral sectionectomy and lymph node sampling were performed. The final histopathological diagnosis was hyperplastic polyp of the gallbladder and metastatic poorly differentiated adenocarcinoma of the liver. Liver tumors were suspected to originate from the stomach, duodenum, or small intestine; however, the primary sites could not be identified. The patient has been closely followed up without any chemotherapy 3 months after surgery. Conclusion: Laparoscopic surgery can be strongly recommended for patients with multiple liver tumors of unknown origin concomitant with a gallbladder tumor. [ABSTRACT FROM AUTHOR]

Abstract Colonic metastasis due to pancreatic adenocarcinoma is extremely rare. Although it is rare, colonic metastasis should be included in the differential diagnosis of colonic mass.

Discrimination between primary ovarian neoplasia and ovarian metastases is important as their management and prognosis are markedly different. We hereby describe the case of a 39 year female who presented with bilateral ovarian masses. Histology of the ovaries predominantly showed a hypercellular and markedly oedematous ovarian stroma with features mimicking a sex-cord stromal tumour. Only with extensive tumour sampling were scant signet ring cells identified, allowing for the diagnosis of bilateral metastatic signet ring adenocarcinoma (Krukenberg tumour) to be made. Our case is used to illustrate and highlight the importance of good morphological assessment, adequate tumour sampling alongside the judicious use of immunohistochemistry and tinctorial staining in the evaluation of an ovarian mass in order to avoid misdiagnosis.

Metastatic prostatic adenocarcinoma (PAC) has mostly involved the pelvic lymph nodes; metastases to the cervical lymph nodes are exceedingly rare. A retrospective review of cytopathology files (January 1990 to March 2019) identified 13 cases of metastatic PAC to cervical lymph nodes diagnosed using fine-needle aspiration biopsy (FNAB). The clinical and demographic information were collected from the electronic medical records, and the slides were reviewed. A total of 13 male patients with a mean age at FNAB 69 years (range, 61-86 years); 12 patients had a known history of PAC. In the patient without a history of PAC, the FNAB finding had been misinterpreted as papillary thyroid carcinoma. The interval between the original diagnosis and cervical lymph node metastasis was 98.5 months (range, 1-288 months). Most involved the left side (85%). Most smears had a clean background with few lymphocytes (46%) and numerous cellular clusters in flat sheets and acini (62%) and were composed of polygonal cells (46%) with round-oval shaped nuclei and indistinct cell borders (92%). The cytoplasm was granular (61%) or scanty (46%). The nuclei were uniform, size ≥2 times that of a neutrophil (69%). Prominent nucleoli and anisonucleosis were seen in 54% of cases; cellular pleomorphism was infrequent (30%). Immunostains confirmed the prostate origin in 7 tissue cores. Metastatic PAC to the cervical lymph nodes occurs infrequently. If the history is unknown, cases can be misdiagnosed as metastases from cervical neoplasms. The findings indicating metastatic PAC to the cervical lymph nodes on FNAB include involvement of left-sided cervical lymph nodes in elderly male patients and cellular smears composed of uniform polygonal cells, arranged in flat sheets and acini, with granular cytoplasm, indistinct cell borders, and round-oval nuclei with prominent nucleoli. • Prostate adenocarcinoma (PAC) rarely metastasizes to cervical lymph nodes. • Cytopathologists need to consider this possibility if the patient is an older male (>50 years) with left-sided involvement of cervical lymph nodes. • The cytomorphology of most of our cases shows cellular clusters arranged in flat sheets and acini with uniform round-oval nuclei with prominent nucleoli and indistinct cell borders. • Establishing this diagnosis in a head and neck lymph node implies a poor prognostic outcome. [ABSTRACT FROM AUTHOR]

Background: Metastatic adenocarcinoma of unknown primary site (MACUP) is the most common cancer of unknown primary site, and shows worse prognosis. Prediction of its tumor site origin attracts a growing attention. However, the site determined by gene expression profiling does not have a significant impact on the survival. Some other special method might need to be found out. Methods: We reviewed 1011 MACUP patients diagnosed by pathological examination and immunohistochemistry based on the Surveillance, Epidemiology, and End Results (SEER) database during 2010–2016. Kaplan–Meier curves and Cox proportional hazard model were analyzed to compare the survival. Logistic regression models and relevant nomograms were performed to predicting the probability of the primary site which including digestive system, respiratory system, and female breast. The validation and clinical utility of models were measured with relevant statistical approaches. Results: About 324 (32.1%), 299 (29.6%), and 203 (20.1%) of MACUP patients were identified as the primary sites of digestive system, respiratory system, and female breast, respectively. Patients derived from digestive system and respiratory system showed poorer survival than these with other sites. Digestive system was significantly associated with liver (Odds ratio =13.21 [95% confidence interval =8.48–21.02]) or lung (2.36 [1.40–3.97]) metastasis, while respiratory system was linked to brain (11.68 [6.68–21.26]) or lymph node (3.39 [2.26–5.13]) metastasis. Patients identified as female breast were prone to occur bone metastasis (5.85 [3.68–9.45]). Logistic regression nomograms were developed to help clinicians intuitively predict the probabilities of tumor site origin with 0.867, 0.824, and 0.753 of the C‐index, respectively. Decision curve analysis and clinical impact curves both revealed the clinical effectiveness. Conclusions: We profiled different tumor site origin of MACUP patients and established prediction models. These features might be significant for clinicians to improve the probabilities of predicting the primary sites, and to decide subsequent treatment strategy. [ABSTRACT FROM AUTHOR]

Zosteriform cutaneous metastases are an unusual and rare morphological variant. We discuss the case of a 78‐year‐old gentleman with a background of end‐stage renal disease with metastatic adenocarcinoma of the lung which was diagnosed due to the development of zosteriform cutaneous metastases around his vascular catheter (vascath) site. The vascath may have acted as a traumatic nidus for lymphatic spread.

Histopathology, despite being the gold standard as a diagnostic tool, does not always provide a correct diagnosis for different pleural lesions. Although great progress was made in this field, the problem to differentiate between reactive and malignant pleural lesions still stimulates the search for additional diagnostic tools. Our research using vibrational spectroscopy and principal component analysis (PCA) statistical modeling represents a potentially useful tool to approach the problem. The objective method this paper explores is based on the correlation between different types of pleural lesions and their vibrational spectra. Obtained tissue spectra recorded by infrared spectroscopy allowed us to categorize spectra in different groups using a created PCA statistical model. The PCA model was built using tissues of known pathology as the model group. The validation samples were then used to confirm the functionality of our PCA model. Student's t -test was also used for comparing samples in paired groups. The PCA model was able to clearly differentiate the spectra of mesothelioma, metastasis and reactive changes (inflammation), and place them in discrete groups. Thus, we showed that Fourier transform infrared spectroscopy combined with PCA can differentiate pleural lesions with high sensitivity and specificity. This new approach could contribute in objectively differentiating specific pleural lesions, thus helping pathologists to better diagnose difficult pleural samples but also could shed additional light into the biology of malignant pleural mesothelioma. [ABSTRACT FROM AUTHOR]

Background: Early detection of small HCC and differentiation between HCC from AC metastatic to the liver is very essential for surgical pathologists, due to different treatment modalities. Immunohistochemistry plays a very important role in such conditions. In our study, we aimed to identify the diagnostic benefits of Arginase-1, FTCD& MOC-31 in the early detection of HCC in normal or cirrhotic liver, differentiation between HCC and metastatic ACs to the liver, and for early detection of small micro-metastases from ACs to liver. Materials and Methods: We included 20 samples from liver cirrhosis, 10 samples from normal liver tissue, 30 samples from primary HCCs in the liver, and 30 samples from metastatic ACs to the liver. We have evaluated Arginase-1, FTCD, and MOC-31 expression using immunohistochemistry. Results: The sensitivity of Arginase-1 expression in differentiation between HCC and metastatic carcinoma was 93.3% and the specificity was 93.3%. The sensitivity of FTCD expression in differentiation between HCC and normal or cirrhotic liver and early detection of well-differentiated HCC was 90% and the specificity was 86.7%. The sensitivity of MOC-31 expression in differentiation between HCC and metastatic carcinoma was 90% and the specificity was 90%. The sensitivity of combination of panel of Arginase 1 + FTCD + MOC 31 expression in differentiation between HCC, metastatic carcinoma, and normal and cirrhotic liver was 93.3% and the specificity was 93.3%. Conclusions: The combination of Arginase 1 + FTCD + MOC 31 expression was helpful in diagnosing most cases of HCC and metastatic carcinoma with high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Colonic metastasis due to pancreatic adenocarcinoma is extremely rare. Although it is rare, colonic metastasis should be included in the differential diagnosis of colonic mass. [ABSTRACT FROM AUTHOR]

• Meckel's diverticulum is an outpouching of the distal small bowel. • This diverticulum may contain ectopic gastric epithelium which can become malignant. • A patient with gastric cancer with peritoneal metastases had the cancer origin in a Meckel's diverticulum. • Systemic cancer chemotherapy followed by cytoreductive surgery provided 4 years of disease-free survival. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete obliteration of the omphalomesenteric duct in early fetal development. The diverticulum frequently contains ectopic gastrointestinal epithelial tissue, most commonly gastric or pancreatic. Adenocarcinoma can arise from either of these epithelia but is extremely rare, with less than 50 cases reported in the world literature. In a patient with peritoneal metastases from ectopic gastric mucosae in a Meckel's diverticulum a multidisciplinary treatment plan was initiated. Diagnosis was evident from study of the resected specimen of small bowel in a patient with acute abdominal pain. A multiagent chemotherapy regimen using oxaliplatin, mitomycin C, doxorubicin, and capecitabine (O-Max) resulted in a clinical and radiologic response. A second surgery with extensive sampling of tissues from the abdomen and pelvis confirmed a complete response to systemic chemotherapy. At four years from onset of disease the patient has no evidence of recurrence. Peritoneal metastases from malignant degeneration of ectopic gastric epithelium in a Meckel's diverticulum was reported. Multidisciplinary treatments were beneficial. [ABSTRACT FROM AUTHOR]

Introduction Calcification in brain metastasis occurs rarely so it is reported in approximately 1% of surgical and 6.6% of autopsy specimens. Here we report a new case of brain metastasis with calcification. Case presentation A 44-year-old woman presented with a generalized tonic–clonic seizure with no neurological deficit on physical examination. Brain imaging demonstrated a hyperdense lesion on computed tomography scan and hyposignal and rim enhancement on T1, T2 and T1 with gadolinium injection sequence images in the right parieto-occipital lobe. Intraoperatively, there was a well-defined solid homogenous calcified mass within brain parenchyma. The lesion that resembled a meningioma was totally resected. The histopathological examination revealed metastatic adenocarcinoma. Conclusion Metastatic brain lesions should be in the differential diagnosis of a solitary calcified brain mass, although it occurs rarely. It is important to differentiate it radiologically from intralesional haemorrhage. [ABSTRACT FROM AUTHOR]

Primary fallopian tube cancer is a rare gynecological malignancy. We report a case of fallopian tube cancer that was incidentally diagnosed during laparoscopy for metastatic adenocarcinoma of unknown primary lesion. A 60-year-old woman had two intraperitoneal calcific masses, which a biopsy revealed to be a metastatic malignancy with an unknown primary site. She was asymptomatic, and the primary site was not identified in imaging evaluations such as transvaginal ultrasonography. A diagnostic laparoscopy was performed and revealed papillary tumor-like lesions in the right fallopian tube. The laparoscopy was immediately converted to laparotomy. Total hysterectomy, bilateral salpingo-oophorectomy, and an omentectomy were also performed. The histopathologic diagnosis was primary serous adenocarcinoma of the fallopian tube. The patient received adjuvant chemotherapy. At 8 months postoperatively, there were no signs of recurrence. In this patient, the diagnostic laparoscopy was more useful for detecting the primary small-volume fallopian tube cancer, compared with ultrasonography, computed tomography (CT), magnetic resonance imaging, and positron emission tomography–computed tomography (PET-CT). Laparoscopy may be a tool for revealing an obscure primary lesion in the abdominal cavity.

Filariasis is a global social health problem of tropical and sub tropical countries like India. W.bancrofti accounts for 95% of cases of lymphatic filariasis. Microfilaria in cytosmears are a rare finding. We report a case of 55 year old female presented with right axillary swelling with ipsilateral breast lump. Cytosmears from the lymph node aspirate showed metastatic adenocarcinomatous deposits and a bunch of microfilariae surrounding the tumor cells and the aspirate from the breast shows ductal carcinoma. We report an additional case of a rare association of microfilaria co-existing with carcinomatous deposit in the lymph node.

Zosteriform cutaneous metastases are an unusual and rare morphological variant. We discuss the case of a 78-year-old gentleman with a background of end-stage renal disease with metastatic adenocarcinoma of the lung which was diagnosed due to the development of zosteriform cutaneous metastases around his vascular catheter (vascath) site. The vascath may have acted as a traumatic nidus for lymphatic spread. [ABSTRACT FROM AUTHOR]

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Small bowel adenocarcinoma is a rare entity in both adult and paediatric populations. Diagnosis is usually delayed due to vague symptoms. We report a case of ileal adenocarcinoma presented with multiple metastases. A 10-year-old Chinese girl presented with recurrent right lower quadrant pain developed intestinal obstruction. Computerized tomography showed terminal ileum wall thickening, a pelvic mass and suspicious pulmonary metastases. Laparotomy showed a terminal ileal tumour causing mechanical obstruction with metastases to the left ovarian and mesenteric lymph nodes. Palliative right hemi-colectomy with double-barrel ileostomy was performed. The pathology was reported to be ileocaecal adenocarcinoma with extensive lymphovascular permeation. She was the started on palliative chemotherapy with static disease. Diagnosis of small bowel adenocarcinoma remains a challenge to surgeons as the clinical presentation is subtle in spite of the advanced clinical course. Surgery plays a role in symptomatic treatment for patients with intestinal obstruction in advanced stage.