Sotir Stavridis, Aleksandar Mickovski, Vanja Filipovski, Sasho Banev, Sasho Dohcev and Ljupcho Lekovski
Epithelioid Angiosarcoma of the Adrenal Gland. Report of a Case and Review of the Literature
Background: Primary mesenchymal neoplasms of the adrenal gland are rare, and a malignant one is an extraordinary finding. Angiosarcomas are uncommon neoplasms and account for less than 1% of sarcomas. Due to their rarity, they can easily be misdiagnosed, both by the clinician and the pathologist.
Case report: We present a case of 55 year old man with primary epitheloid angiosarcoma of the right adrenal gland and a review of the literature in an attempt to better define the clinical and pathological features of these neoplasms and their biologic potential. Immunohistochemical analyses were performed using endothelial cell markers (CD31, CD34 and Factor VIII). The analyses showed focal positivity of tumor cells, especially CD31 and weak focal positivity for tumor cells of Cytokeratin 18. The review of the literature showed 32 cases described up-to-date.
Conclusion: The present case emphasizes problems in differential diagnosis that arise from its epithelioid differentiation. We show review of the relevant literature which underlines the poor clinical outcome of adrenal angiosarcoma despite the adequate surgical treatment.
Introduction: "Triple" negative breast cancer is a subgroup of so-called basal-like breast cancer. They are represented with 15% of all breast cancers, characterized with lack of hormone receptor as well as with negative expression of HER2 test. These tumors are more frequent in Afro-Americans and Latin-Americans, in patients with BRCA1 mutations and in patients with recent delivery. The aim of this study is to present the immunohistochemical and clinico-pathological characteristics of the triple negative breast cancer and their correlation with expression of the protein product of the tumor suppressor gene p53.
Methods: A retrospective analyses of 24 patients with triple negative breast cancer was performed. All of the patients were evaluated in the Histopathological Laboratory of the Clinical Hospital Sistina, during the period from June 2009, until June 2011. The standard immunohistochemical procedures, including the hormone receptor status, HER2 status, proliferative index - Ki67 and p53 gene protein product were performed, as well as additional immunohistochemical staining for socalled basal keratins (Cytokeratin 5/6 and high molecular weight cytokeratin 34BE12).
Results: The age of the patients ranged from 29-77 years. Positive lymph nodes were found in 14 (59%) patients. The tumor was poorly differentiated in 19 patients (79%). Overexpression of the p53 protein product was evaluated in 19 (79%) of the cases. All p53 negative patients (5/5) had poorly differentiated tumors (G3), associated with positive regional lymph nodes. The p53 positive group expressed quite opposite correlation, only 9/19 (47%) were with positive lymph nodes (p = 0.03). The expression of p53 protein product was also associated with the nuclear grade (p = 0.005), the mitotic index (p = 0.001), lymph-vascular invasion (p = 0.005) and with the proliferation index Ki67 (p = 0.003). There was a trend for association with the tumor size - pT (p = 0.05).
Conclusion: According to the results, the triple negative breast cancers are subgroup of the poorly differentiated neoplasms frequently associated in the younger age groups. The majority of these have overexpression of the p53 protein product, which in other hand, are inversely correlated with lymph nodes metastases. Hence, the necessity of enriching the immunohistochemical protocol of these patients with new antibodies, in order to evaluate their expression, which would be helpful for prediction the outcome of different therapeutical modalities.
We report a case of synovial sarcoma of liver in a 44 year old man, presented as a tumor mass in left hepatic lobe. The patient was admitted at the hospital with clinical symptoms of acute abdomen and severe pain in the right upper quadrant.
Imaging examinations showed a tumor mass in the left hepatic lobe and free liquid in the abdominal cavity, due to the rupture of the tumor. A resection of 2 segments of the left hepatic lobe, where the tumor was located, was performed. Morphological, immunohistochemical and FISH studies confirmed the diagnosis of monophasic synovial sarcoma. Additional clinical and imaging examinations, made after the surgery, did not confirm tumor mass in any other localization. The patient refused any therapy other than surgery, at that time.
A relapsing tumor mass was found 6 months later and another surgical intervention was done. The patient received five monotherapy cycles of Doxorubicin, 75 mg/m2, after the second surgical intervention. He is still alive 11 months after the first operation receiving the same therapy and having second relapsing inoperable tumor mass filling the retroperitoneal space and a great fraction of the abdominal cavity.