Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe the cytohistological, immunohistochemical and ultrastructural findings in a 55-yr-old-man with history of asbestos exposure and diffuse malignant mesothelioma (DMM) of the pleura, peritoneum, and tunica vaginalis presenting with chest pain and scrotal swelling. Pleural fine-needle aspiration (FNA) revealed mesenchymal elements and spindle-shaped epithelial-like cells, while biopsy showed pure sarcomatous tumor invading lung parenchymal. In both samples tumor cells coexpressed cytokeratin and vimentin. Peritoneal and hydrocele effusions contained aggregates of malignant mesothelial cells. Electron microscopy showed intermediate filaments, rare desmosomes and sparse microvilli. Morphological findings were consistent with a DMM, with a biphasic pattern in the pleura and an epithelial one in the peritoneum and tunica vaginalis. Although the possibility of a multicentric origin cannot be ruled out, clinical chronologic sequence suggests that the pleura was the primary involved site, followed by spread to peritoneum and tunica vaginalis.
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PMID:Concomitant malignant mesothelioma of the pleura, peritoneum, and tunica vaginalis testis. 873 55

We report 16 cases of a distinctive variant of primary thymic epithelial neoplasm characterized by prominent spindling of the tumor cells. The patients were seven women and nine men aged 23 to 82 years (mean, 54 years). The lesions presented as anterior mediastinal masses without clinical or radiographic evidence of tumor elsewhere. Most patients had chest pain, dyspnea, and cough; in five patients, the tumors were asymptomatic and were discovered on routine clinical examination. Grossly, the lesions were firm, well-circumscribed, and locally infiltrative, and had a firm cut surface with foci of hemorrhage, necrosis, and cystic changes. Most of the tumors were treated by complete surgical excision. Histologically, they were characterized by a spindle cell proliferation showing varying degrees of atypia and mitotic activity. In 12 cases, transitions could be seen with areas that showed the features of conventional spindle cell thymoma. In two cases, areas showing features of poorly differentiated (lymphoepitheliomalike) carcinoma and anaplastic carcinoma could also be observed. Immunohistochemical studies in 10 cases showed strong positivity of the spindle tumor cells for CAM5.2 cytokeratin, and negative staining for a panel of antibodies including epithelial membrane antigen, carcinoembryonic antigen, actin, desmin, vimentin, S-100 protein, HMB45, CD34, CD5, and CD99. Clinical follow-up of eight patients showed an aggressive biologic behavior with recurrence, metastasis, and death by tumor in five of them 2 to 5 years after diagnosis. Based on these findings, the present tumors are interpreted as an unusual spindle cell variant of thymic carcinoma. The close association of these cases with areas showing the features of spindle cell thymoma within the same tumor mass suggests that some of these lesions may arise as a result of malignant transformation in a preexisting spindle cell thymoma.
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PMID:Spindle cell thymic carcinoma: clinicopathologic and immunohistochemical study of a distinctive variant of primary thymic epithelial neoplasm. 1036 52

We reviewed 11 cases of primary thymic neuroendocrine carcinomas with combined features ranging from well-differentiated to poorly differentiated neuroendocrine carcinoma. For 3 asymptomatic patients, tumors were discovered during routine examination. Presentation in the other patients was as follows: Cushing syndrome, 2 patients; chest pain, 3 patients; superior vena cava syndrome, 1 patient; and hypercalcemia and hypophosphatemia, 1 patient. No clinical data were available for the 11th patient. All tumors were located in the anterior mediastinum and treated by surgical excision. The lesions were large and well-circumscribed with areas of hemorrhage and necrosis. They were characterized by areas showing a proliferation of monotonous, round tumor cells adopting a prominent organoid pattern admixed with areas showing sheets of atypical cells with hyperchromatic nuclei, frequent mitoses, and extensive areas of hemorrhage and necrosis. Immunohistochemical studies performed in 6 cases showed strong CAM 5.2 low-molecular-weight cytokeratin positivity in all cases, chromogranin and synaptophysin positivity in 4, Leu-7 in 3, and focal positivity for p53 in 2. Follow-up information for 9 cases showed that all patients died of their tumors between 1 and 4 years after diagnosis. The present cases highlight the heterogeneity of neuroendocrine neoplasms and reinforce the notion that these tumors form part of a continuous spectrum of differentiation.
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PMID:Thymic neuroendocrine carcinomas with combined features ranging from well-differentiated (carcinoid) to small cell carcinoma. A clinicopathologic and immunohistochemical study of 11 cases. 1070 13

Twenty-two cases of oncocytic thymic neuroendocrine carcinomas (carcinoid tumors) are presented. The patients were 17 men and 5 women between the ages of 26 and 84 years (median, 55 years). Nine were asymptomatic, and the tumor was found on routine examination; four patients presented with chest pain, two with weight loss, two with multiple endocrine neoplasia I syndrome, and one with Cushing's syndrome. Surgical resection of the mediastinal tumor was performed in all cases. The lesions were described as soft, light tan to brown, measuring from 3 to 20 cm in greatest diameter. On cut section, the tumors showed a homogeneous surface, soft consistency, and focal areas of hemorrhage. Microscopically, the lesions were characterized by nests or trabeculae of tumor cells that contained abundant granular to densely eosinophilic cytoplasm, with round to oval nuclei and in some areas prominent nucleoli. Mitotic figures ranged from 2 to 10 per 10 high-power fields; foci of comedonecrosis were seen in all cases. Immunohistochemical studies including broad spectrum keratin, CAM 5.2, chromogranin, synaptophysin, Leu-7, and p53 were performed in 12 cases. All of the tumors were strongly positive for CAM 5.2 low-molecular-weight cytokeratin, 11 showed strong positive reaction for Leu-7, 10 for broad-spectrum keratin, 8 for chromogranin, 7 for synaptophysin, and only 1 case showed focal positive staining of the tumor cells for p53. Clinical follow-up of 14 patients showed that 10 were alive between 2 and 11 years, and 4 patients had died of tumor from 4 to 11 years after diagnosis. Patients with good clinical outcome were those whose tumors showed low mitotic activity and minimal nuclear pleomorphism, whereas those who had died of their tumors were those whose tumors were characterized by marked nuclear atypia and higher mitotic rates. Oncocytic thymic carcinoids should be added to the differential diagnosis of anterior mediastinal neoplasms characterized by a monotonous population of tumor cells with prominent oncocytic features.
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PMID:Primary neuroendocrine carcinoma (thymic carcinoid) of the thymus with prominent oncocytic features: a clinicopathologic study of 22 cases. 1082 19

Synovial sarcoma commonly occurs in the para-articular regions of the extremities, and rarely in the pleura. We report a 46-year-old woman with primary synovial sarcoma of the pleura. She was admitted with a complaint of left-sided chest pain and exertional dyspnea. She had previously undergone two operations for pleural neoplasm, at the ages of 33 and 36 years. A computed tomography scan revealed an expanded mass in the left thoracic cavity, involving the surrounding tissue. Macroscopic findings demonstrated a 25 x 25 x 15-cm grayish-white mass with hemorrhage beneath the pleura. Both epithelial and spindle cells were observed microscopically. Ultrastructural microscopy of the epithelioid cells demonstrated short, blunt microvilli on the luminal surface, and desmosomes between the neoplastic cells. Immunohistochemically, the tumor cells of the epithelial component were positive for embryonal membrane antigen (EMA), carcinoembryonic antigen (CEA), human mesothelial cells (HBME)-1, and cytokeratin, and the spindle cells were positive for vimentin. These findings led us to a diagnosis of primary synovial sarcoma of the pleura. She had no evidence of recurrence or metastasis after the third operation.
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PMID:Synovial sarcoma arising from the pleura: a case report with ultrastructural and immunohistological studies. 1218 52

Pulmonary glomus tumours are rare lesions, with few cases reported previously. Herein, we present the clinical and pathological features of a case of pulmonary glomus tumour. A 29-year-old female patient presented to our clinic complaining of cough, dyspnoea and left-sided chest pain. Computed tomography (CT) of the thorax revealed a nodular lesion causing obstruction of the left main bronchus. Fibreoptic bronchoscopy demonstrated a polypoid mass occluding the left main bronchus 10 mm distal to the main carina. Bronchoscopic biopsy was interpreted histologically as carcinoid tumour. Bronchotomy plus mass extirpation was performed with left thoracotomy. Microscopically, a tumoral structure composed of uniform cells with a round centrally located nucleolus and narrow eosinophilic cytoplasm was seen. Thin-walled vessels lined with endothelium were interspersed between tumoral structures. The cells were stained chromogranin and cytokeratin negative and strongly vimentin positive. The pathological diagnosis for the thoracotomy specimen was pulmonary glomus tumour. Follow-up chest CT was negative for recurrent tumour and the patient remains free of disease 17 months after surgery.
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PMID:Pulmonary glomus tumour: a case initially diagnosed as carcinoid tumour. 1242 Dec 47

Pleural fibroma, or fibrous tumor of the pleura, is an uncommon entity which is characterized by slow proliferation of undifferentiated, intermediary or mature fibroblasts associated with collagen fibers forming a tumor stroma. We report a case in a 49-Year-old man who developed exercise-induced dyspnea and right chest pain. The thoracic CT scan revealed the presence of a mass in the right lung base composed of heterogeneous encapsulated tIssue. Tumor resection was performed leading to the histological diagnosis of pleural fibroma. Immunohistochemistry tests revealed positive vimetin and CD34, and negative cytokeratin uptake. These immunohistochemistry data contributed to the differential diagnosis with malignant pleural mesothelium. Pleural fibroma is a benign tumor in 80% of the cases. Prognosis is excellent. Local recurrence is exceptional and generally occurs after incomplete resection. Radial surgical treatment determines the prognosis and is required to prevent local recurrence. Other criteria of malignancy are not correlated with the clinical course of this type of tumor.
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PMID:[Fibrous tumor of the pleura]. 1529 27

Five cases of a distinctive type of undifferentiated large cell thymic carcinoma accompanied by an inflammatory reaction having morphologic features closely resembling those of Castleman disease (CD) of the hyaline vascular type (HVCD) are reported. The tumors occurred in 3 men and 2 women with a median age of 53 years. Three patients were asymptomatic and the tumors were found incidentally; 1 patient presented with fatigue, weight loss, dyspnea, and chest pain, and another with acanthosis nigricans. The tumors were characterized by the admixture of two components: a neoplasm of cytokeratin (+)/CD5(-) undifferentiated large tumor cells and an inflammatory reaction resembling the late stage of HVCD. Some of the cases were associated with a remarkably indolent clinical course, especially when considering their high-grade morphology. Three patients were alive without disease at 1, 10, and 22 years. One patient was alive with persistent disease at 1 year. One patient's clinical course was unique in that the primary thymic tumor was found 16 years after a metastasis had been detected in two distant lymph nodes. The two possible explanations for the coexistence here described are as follows: 1) a CD-like reaction to the tumor as the morphologic manifestation of a host immune response; and 2) a malignancy engrafted upon preexisting HVCD of the thymus, in a manner analogous to that operating in the reported cases of tumors of dendritic/reticulum cells complicating HVCD at other sites. The first hypothesis is favored, with the added suggestion that the CD-like reaction may bear a relationship to the peculiarly indolent behavior that these tumors exhibit.
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PMID:Undifferentiated large cell carcinoma of the thymus associated with Castleman disease-like reaction: a distinctive type of thymic neoplasm characterized by an indolent behavior. 1576 3

A series of 15 cases of primary mediastinal neoplasms displaying histopathologic, immunohistochemical, and ultrastructural features of synovial sarcoma is presented. The patients' ages ranged from 3 to 83 years, with a male-to-female ratio of 2:1. Nine cases presented as anterior mediastinal masses with chest pain, shortness of breath, and pleural effusion, and 6 cases were in paravertebral location in the posterior mediastinum and presented with neck or back pain and pleural effusion. The tumors measured from 5 to 20 cm in greatest diameter and showed a tan white, soft to rubbery cut surface with areas of hemorrhage and necrosis and foci of gelatinous material. Four cases showed areas of cystic degeneration. In 7 cases, the tumors were well circumscribed; in 6 cases, the tumors grossly invaded the pleura, pericardium, heart, great vessels, chest wall, rib, and vertebra. Histologically, 5 cases displayed a biphasic growth pattern, with well-formed glandular elements admixed with a monotonous spindle cell population. Ten cases were exclusively composed of a monotonous atypical spindle cell proliferation. Immunohistochemical studies showed focal positivity of the tumor cells for cytokeratin and/or epithelial membrane antigen, and strong positivity for vimentin and bcl-2 in the spindle cells in all cases studied (10 of 10). Eight cases also showed focal positivity for CD99. Electron microscopic examination in 5 cases showed oval to spindle tumor cells with closely apposed cell membranes, abundant cytoplasmic intermediate filaments and rough endoplasmic reticulum, and immature desmosome-type cell junctions. Ten patients were treated by complete surgical excision and two by partial excision followed by radiation therapy. In 4 patients, the tumors were inoperable and treated with radiation therapy only. Clinical follow-up was available in 5 patients and showed local recurrence with metastases to lung, lymph nodes, and epidural space from 1 to 3 years in 4 cases and liver metastases and death due to tumor after 6 month in 1 case. Synovial sarcoma should be considered in the differential diagnosis of biphasic and monophasic spindle cell neoplasms of the mediastinum.
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PMID:Primary synovial sarcomas of the mediastinum: a clinicopathologic, immunohistochemical, and ultrastructural study of 15 cases. 1583 79

We examined 14 spindle cell tumours of the pleura that were sent to a Mesothelioma Panel for re-evaluation after a primary suspicion of mesothelioma. The clinical, histological, immunohistochemical and CGH findings were investigated. Final diagnoses were eight sarcomatoid mesotheliomas (SM) and six non-mesotheliomas: two pulmonary sarcomatoid carcinomas, an epithelioid hemangioendothelioma, a malignant solitary fibrous tumour, a malignant pleural smooth muscle tumour and an extraskeletal osteosarcoma. Seven of the eight SM and two of the other six tumours presented with unilateral pleural effusion, dyspnoea, and chest pain, which are characteristic clinical findings in malignant mesothelioma. No single antibody used in the immunohistochemistry separated SM from other tumour types. The most frequently observed chromosomal losses in SM were 4q, 4p11-p13/p15, 6q and 13. Losses of 4p11-p13/p15 and 4q occurred in combination in four out of five SM with detectable chromosomal changes, but neither was found in any of the other tumours. Gain or high-level amplification of 5p was also common in SM. According to our results and literature, losses at 4p, 4q and 9p and gain at 5p are the chromosomal changes that best differentiate SM from pleural sarcomas and lung carcinomas. CGH analysis may help distinguish a cytokeratin-positive SM from a sarcomatoid carcinoma. Similarly, in the case of a cytokeratin-negative tumour, CGH analysis may disclose chromosomal changes characteristic of sarcomas or mesotheliomas.
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PMID:Spindle cell tumours of the pleura: a clinical, histological and comparative genomic hybridization analysis of 14 cases. 1617 May 37


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