DOCSLIB.ORG

The Diagnosis and Pathological Value of Combined Detection of HE4 and CA125 for Patients with Ovarian Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Diagnosis and Pathological Value of Combined Detection of HE4 and CA125 for Patients with Ovarian Cancer Open Med. 2016; 11:125-132 Research Article Open Access Li-e Zheng*, Jun-ying Qu, Fei He The diagnosis and pathological value of combined detection of HE4 and CA125 for patients with ovarian cancer DOI 10.1515/med-2016-0024 other. Conclusion HE4 can be used as a novel clinical bio- received January 28, 2016; accepted March 9, 2016 marker for predicting malignant ovarian tumors and its expression was closely related with the clinical pathologi- Abstract: Objective To evaluate the value of individual and cal features of malignant ovarian tumors. combined measurement of human epididymis protein 4 (HE4) and cancer antigen 125 (CA-125) in the diagnosis Keywords: HE4; CA125; diagnosis; ovarian tumor of ovarian cancer. Methods A clinical case-control study was performed in which the levels of serum HE4 and CA-125 of subjects with malignant, borderline, benign ovarian tumors and healthy women were measured before 1 Introduction surgery. An immunohistochemistry method was used In the female reproductive system, ovarian cancer ranks to measure the expression of HE4 in different tissues. third in incidence and 1st in mortality in gynecological Statistical analysis was performed to determine the rela- malignancies [1]. Nearly 70% of patients with ovarian tionship between the level of HE4 and the pathologic cancer are diagnosed at an advanced stage, and the 5 year type as well as the stage of the ovarian tumors. Results survival rate for patients with ovarian cancer rises up to The level of HE4 in the serum was significantly elevated in 90% through early effective treatment [2]. Hence, diag- the malignant ovarian cancer group compared with other nosing at early stage is crucial to improve the prognosis of groups. Women with benign ovarian tumors and non-neo- ovarian cancer. Currently, the most commonly used serum plastic lesions, and healthy women were designated as biomarkers for early diagnosis of ovarian cancer is CA125. references. When the level of HE4 in the serum was 58.66 But it could be also elevated in serum for patients with pmol/L, the sensitivity and specificity of HE4 in diagnos- pelvic inflammatory disease, such as endometriosis peri- ing malignant ovarian tumors was 82.35% and 96.03%, toneal disease and injury [3]. So the application of CA125 in respectively. The level of HE4 was negatively correlated ovarian cancer diagnosis showed high false positive rate, with the differentiation extent of the tumors whereas pos- and sometimes this would lead to unnecessary surgery. itively correlated to the clinical staging. In the groups of Human epididymis protein 4 (Human epididymis gene malignant and borderline tumors, the levels of HE4 were product 4, HE4) is considered a new biomarker for early higher than the other groups. The expression of HE4 was diagnosis of ovarian cancer. In this study, we included a significant higher in the serous types of ovarian tumors case-control study to determine the serum level as well as than that of the mucous types (P<0.05). The level of HE4 in the expression of HE4 and CA125 in clinical ovarian cancer the serum and tissues were positively correlated with each tissues. We also intended to evaluate the value of individ- ual and/or combined measurement of HE4 and CA-125 in the diagnosis of ovarian cancer and prognosis prediction. *Corresponding author: Li-e Zheng, The First Affliliated Hospital Of Fujian Medical University, Chazhong Road 22, Fuzhou, Fujian 350001, People’s Republic of China, Tel:0591-87982062, E-mail: [email protected] Fujian Medical University 350004, China Jun-ying Qu, Fei He, Department of obstetrics and gynecology, the First Affliliated Hospital Of Fujian Medical University, Fujian Fuzhou 350005, China; Fujian Medical University 350004 ,China © 2016 Li-e Zheng et al published by De Gruyter Open This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License. 126 Li-e Zheng et al 2 Material and method age of malignant ovarian cancer group was from 11 to 74, with an average age of 49.43±14.69 years old. Non-ovarian cancer group was aged from 15 to 76, with an average age 2.1 Patients of 40.66±12.56. The patients were not receiving any other treatment in our hospital. Over the same period, we also Select the patients with a pelvic mass, who were first tested the serum level of HE4 and CA125 in healthy women inpatient for gynecological surgery in the First Affiliated (59 cases). All the subjects of our study were in non-men- Hospital of Fujian Medical University, from December 2010 strual period, with no breast/thyroid disease, and a to October 2012. All patients had no significant syndrome history of other cancers. that effecting tumor biomarkers, and received no preop- erative chemotherapy and other treatments. According Ethical approval: The research related to human use to the postoperative pathology judging results, the sub- has been complied with all the relevant national regula- jects were divided into malignant ovarian tumor group (58 tions, institutional policies and in accordance the tenets cases), borderline ovarian tumor group (10 cases), benign of the Helsinki Declaration, and has been approved by ovarian tumors (40 cases), ovarian non-neoplastic lesions the authors’ institutional review board or equivalent (27 cases) and other gynecologic malignancies (26 cases). committee. Among the 58 cases of malignant ovarian tumors, there were 42 cases of epithelial ovarian tumors and 16 cases of Informed consent: Informed consent has been obtained non-epithelial ovarian tumors. In addition, the malignant from all individuals included in this study. ovarian tumor group included 30 cases of serous carcino- mas, 12 cases of mucous carcinomas, 6 cases of ovarian endometrioid adenocarcinomas, 3 cases of clear-cell car- 2.2 Method cinomas , 4 cases of yolk sac tumors, and 3 cases of dys- germinoma. Clinical staging was classified according to The electrochemical luminescence method was used the International Federation of Gynecology and Obstetrics to detect the level of HE4 and CA125 in the serum. We (FIGO) criteria: 18 cases of I, 6 cases of II, 30 cases of III, applied the human epididymis protein 4 assay kit (Roche, and 4 cases of IV stage. There were 8 cases of highly dif- Shanghai, China, 05950929190),Roche cobas e 601 and ferentiated, 18 cases of moderately differentiated and 32 electrochemiluminescence assay. cases of poorly differentiated. There were 22 patients with Monoclonal mouse anti-human HE4 (ZM- viscera metastasis. The borderline ovarian tumor group 0413) and CA125 (ZM-0019) antibodies were ordered included 6 cases of borderline serous papillary tumors, from Beijing Zhongshan Golden Bridge Company. 4 cases of borderline mucous cystadenomas. The benign Immunohistochemical detection reagents (PV-9000) were ovarian tumor group included 17 cases of serous cysta- also purchased from Beijing Zhongshan Golden Bridge denomas, 12 cases of mucous cystadenomas, 5 cases of Company. Take the above paraffin blocks of ovarian mature teratomas, 4 cases of simple cysts, and 2 cases cancer tissues, and perform routine HE staining, and then of fibromas. Ovarian non-neoplastic lesions included observe the morphology of tumor cells through the micro- 27 cases of ovarian endometriosis cysts. Gynecological scope. Phosphate buffer was used as a negative control cancer group included 2 cases of uterine sarcomas, 6 cases instead of primary antibody. of endometrial cancer and 18 cases of cervical cancer. All The reference value of serum HE4 is 0-140pmol/L, blood samples were taken from the elbow in the day before regarding HE4>140pmol/L as positive. The reference value surgery, fasting venous whole blood 3 ml, placed in a test of serum CAl25 is 0~35U/ml, regarding CAl25>35U/ml as tube without anticoagulant, Specimen collection was positive. Serum HE4 diagnostic cutoff points was obtained stand at room temperature for 1 hour, centrifuged (3000 through the ROC curve. Ovarian tumors were used as r/min) to take the clear phase, and stored in -80 degrees positive controls, with PBS instead of primary antibody C freezer for testing. After reading the pathological sec- as blank control. Comprehensive observing each slice, tions of these patients, select respective paraffin blocks regard the brown particles appearing in cytoplasm as pos- for section at the thickness of 4 micrometers. Meanwhile, itive. Two pathologists read the piece randomly. The deter- we selected 10 cases of partial ovarian normal tissues mine criteria was shown as follows: staining were divided from the surgically hysteromyoma resections followed into four levels: almost not colored for 0 point, yellow for by 4% paraformaldehyde-fixed, paraffin-embedded, and 1 point, brown for 2 point, tan for 3 point; coloring cells in histologically confirmed by conventional HE staining. The percentage: ≤ 5% as 0, 6% -25% as 1, 26-50% as 2, ≥ 51% as HE4 and CA125 for patients with ovarian cancer 127 3. The degree of ovarian tissue coloring, coloring percent- 4.2 Serum HE4 and CA125 joint evaluation age score: 0-1 as negative, 2-3 as +, 4-6 as ++, 6 points or more as +++. In the group of malignant ovarian cancer, including serous ovarian cancer, mucous ovarian cancer and ovarian endometrium adenoendometriocarcinoma, there was about 66.67% of those CA125 negative cases emerged 3 Statistical analysis as HE4 positive. In the group of non-neoplastic lesions of ovarian, there was about 88.00% of those CA125 positive Statistical analysis were performed using SPSS 13.0. The cases emerged as HE4 negative. level of HE4 and CA125 were expressed as median number The relationship between the serum HE4 level and (M). The pathologic diagnosis was considered as the stan- the patient age, pathological type, grading and clini- dard, the ROC curve was traced, and the sensitivity and cal staging in the malignant ovarian tumor group before specificity were calculated.
Load more

Recommended publications
  • Pediatric Suprasellar Germ Cell Tumors: a Clinical and Radiographic Review of Solitary Vs
    cancers Article Pediatric Suprasellar Germ Cell Tumors: A Clinical and Radiographic Review of Solitary vs. Bifocal Tumors and Its Therapeutic Implications Darian R. Esfahani 1 , Tord Alden 1,2, Arthur DiPatri 1,2, Guifa Xi 1,2, Stewart Goldman 3 and Tadanori Tomita 1,2,* 1 Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL 60611, USA; [email protected] (D.R.E.); [email protected] (T.A.); [email protected] (A.D.); [email protected] (G.X.) 2 Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA 3 Division of Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL 60611, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-312-2274220 Received: 7 August 2020; Accepted: 10 September 2020; Published: 14 September 2020 Simple Summary: Bifocal suprasellar germ cell tumors are a unique type of an uncommon brain tumor in children. Compared to other germ cell tumors in the brain, bifocal tumors are poorly understood and have a bad prognosis. In this paper we explore features that predict which children will have good outcomes and which will not. This is important for the research community because it can help physicians decide what type of radiation treatment is best to treat these children. Our study shows that bifocal tumors have a unique appearance on magnetic resonance imaging (MRI) compared to other germ cell tumors. Children with bifocal tumors are more likely to be male, have tumors that come back sooner, and cause death sooner.
    [Show full text]
  • Clinical Radiation Oncology Review
    Clinical Radiation Oncology Review Daniel M. Trifiletti University of Virginia Disclaimer: The following is meant to serve as a brief review of information in preparation for board examinations in Radiation Oncology and allow for an open-access, printable, updatable resource for trainees. Recommendations are briefly summarized, vary by institution, and there may be errors. NCCN guidelines are taken from 2014 and may be out-dated. This should be taken into consideration when reading. 1 Table of Contents 1) Pediatrics 6) Gastrointestinal a) Rhabdomyosarcoma a) Esophageal Cancer b) Ewings Sarcoma b) Gastric Cancer c) Wilms Tumor c) Pancreatic Cancer d) Neuroblastoma d) Hepatocellular Carcinoma e) Retinoblastoma e) Colorectal cancer f) Medulloblastoma f) Anal Cancer g) Epndymoma h) Germ cell, Non-Germ cell tumors, Pineal tumors 7) Genitourinary i) Craniopharyngioma a) Prostate Cancer j) Brainstem Glioma i) Low Risk Prostate Cancer & Brachytherapy ii) Intermediate/High Risk Prostate Cancer 2) Central Nervous System iii) Adjuvant/Salvage & Metastatic Prostate Cancer a) Low Grade Glioma b) Bladder Cancer b) High Grade Glioma c) Renal Cell Cancer c) Primary CNS lymphoma d) Urethral Cancer d) Meningioma e) Testicular Cancer e) Pituitary Tumor f) Penile Cancer 3) Head and Neck 8) Gynecologic a) Ocular Melanoma a) Cervical Cancer b) Nasopharyngeal Cancer b) Endometrial Cancer c) Paranasal Sinus Cancer c) Uterine Sarcoma d) Oral Cavity Cancer d) Vulvar Cancer e) Oropharyngeal Cancer e) Vaginal Cancer f) Salivary Gland Cancer f) Ovarian Cancer & Fallopian
    [Show full text]
  • Genitourinary Advanced Pca and Its Efficacy As a Therapeutic Agent Is Presently Being Studied in Clinical Trials
    ANNUAL MEETING ABSTRACTS 133A because they were over age 80 and as such, the IHC results were likely due to acquired 599 Anterior Predominant Prostate Tumors: A Contemporary methylation of the MLH1 promoter. The remaining 4 patients with absent staining have Look at Zone of Origin been referred to Cancer Genetics for possible further work-up. The reimbursement rate HA Al-Ahmadie, SK Tickoo, A Gopalan, S Olgac, VE Reuter, SW Fine. Memorial Sloan and turn-around time for the IHC stains were similar to that for other IHC stains used Kettering Cancer Center, NY, NY. in clinical practice. Background: Aggressive PSA screening and prostate needle biopsy protocols have Conclusions: IHC stains for the MMR proteins are fast and relatively easy to institute in successfully detected low-volume posterior tumors, with a concurrent increase in routine evaluation of CRC, and we have not had difficulty interpreting the stains leading anterior-predominant prostate cancer (AT). Zone of origin, patterns of spread, and to additional testing. Furthermore, reimbursement was obtained at a level similar to extraprostatic extension of these tumors have not been well studied. other IHC stains used in clinical practice. The surgeons and oncologists welcomed the Design: We greatly expanded and refined our previous studies to include pathologic prognostic information. Further study is warranted to confirm these initial findings. features of 197 patients with largest tumors anterior to the urethra in whole-mounted radical prostatectomy specimens. 597 High Fidelity Image Cytometry in Neoplastic Lesions in Barrett’s Results: Of 197 AT, 97 (49.2%) were predominantly located in the peripheral zone Esophagus, Including Basal Crypt Dysplasia-Like Atypia with Surface (PZ-D), 70 (35.5%) in the transition zone (TZ-D), 16 (8.1%) were of indeterminate Maturation zone (IND), and 14 (7.1%) in both PZ and TZ (PZ+TZ).
    [Show full text]
  • Pathogenesis of Intracranial Germ Cell Tumors Reconsidered
    Neurosurg Focus 5 (1):Article 1, 1998 Pathogenesis of intracranial germ cell tumors reconsidered Keiji Sano, M.D., D.M.Sc. Department of Neurosurgery, Fuji Brain Institute, University of Tokyo, and Department of Neurosurgery, Teikyo University, Tokyo, Japan The author studied 153 cases of intracranial germ cell tumors (GCTs) through 1994, 62.7% of which showed monotypic histological patterns and 37.3% of which were shown to be mixed tumors. All of these cases, except for six patients who died soon after admission and underwent autopsy, underwent surgery followed by radio- and/or chemotherapy. All patients with choriocarcinoma died within 2 years. Patients with yolk sac tumor (endodermal sinus tumor) and embryonal carcinoma also had poor outcomes. Patients with mature teratoma had 5- and 10-year survival rates of 92.9% each. Patients with immature teratoma and malignant teratoma had a 5- and 10-year survival rate of 70.7% each. Patients with germinoma had a 5-year survival rate of 95.4% and a 10-year survival rate of 92.7%. These results may bring into question the validity of the germ cell theory, because germinoma, which should be the most undifferentiated according to the theory, was the most benign and choriocarcinoma and yolk sac tumor (endodermal sinus tumor), which should be the most differentiated, were the most malignant according to results obtained during follow-up study. Therefore, GCTs other than germinoma may not originate from one single type of cell (primordial germ cells). The embryonic cells of various stages of embryogenesis may perhaps be misplaced in the bilaminar embryonic disc at the time of the primitive streak formation, becoming involved in the stream of lateral mesoderm and carried to the future cranial area to become incorrectly enfolded into the brain at the time of the neural tube formation.
    [Show full text]
  • Prostate and Testicular Cancer V1.Indd
    IHC PANEL MARKERS Prostate & Testicular Cancer BioGenex offers wide-ranging antibodies for several IHC panel for initial differentiation, tumor origin, treatment methods, and prognosis. All BioGenex antibodies are validated on human tissues to ensure sensitivity and specificity. BioGenex comprehensive IHC panels include a range of mouse monoclonal, rabbit monoclonal, and polyclonal antibodies to choose from. BioGenex offers a vast spectrum of high-quality antibodies for both diagnostic and reference laboratories. BioGenex strives to support efforts in clinical diagnostics and drug discovery development as we continue to expand our antibody product line offering in both ready-to-use and concentrated formats for both manual and automation systems. Antibodies for Prostate & Testicular Cancer ERG, AMACR, PSA, PSAP, AR, p63, CK Pan, Oct4, CK7, CK20, AFP, CD30, PSMA, EMA, CD117, CD30 IHC PANEL MARKERS - Prostate & Testicular Cancer ERG ERG is directed against the C-terminus of the ETS transcription regulator, ERG, and is capable of detecting both wildtype ERG, and truncated ERG resulting from ERG gene rearrangement. This antibody exhibits a nuclear staining pattern and may be used to aid in the identification of prostate adenocar- cinomas through the detection of truncated ERG. This ERG antibody also recognizes Fli-1 by western blot analysis. Antibody Clone Localization Catalog Family ERG EP111 Nucleus AN782, AX782, MU782 P504S (AMACR) AMACR (Alpha-Methylacyl-CoA Racemase) has been recently described as a prostate cancer-specific gene that encodes a protein involved in the beta-oxidation of branched-chain fatty acids. High expression of AMACR (P504S) protein is usually found in prostatic adenocarcinoma but not in benign prostatic tissue by immunohistochemical staining in paraffin-embed- ded tissues.
    [Show full text]
  • Primary Intracranial Germ Cell Tumor (GCT)
    Primary Intracranial Germ Cell Tumor (GCT) Bryce Beard MD, Margaret Soper, MD, and Ricardo Wang, MD Kaiser Permanente Los Angeles Medical Center Los Angeles, California April 19, 2019 Case • 10 year-old boy presents with headache x 2 weeks. • Associated symptoms include nausea, vomiting, and fatigue • PMH/PSH: none • Soc: Lives with mom and dad. 4th grader. Does well in school. • PE: WN/WD. Lethargic. No CN deficits. Normal strength. Dysmetria with finger-to-nose testing on left. April 19, 2019 Presentation of Intracranial GCTs • Symptoms depend on location of tumor. – Pineal location • Acute onset of symptoms • Symptoms of increased ICP due to obstructive hydrocephalus (nausea, vomiting, headache, lethargy) • Parinaud’s syndrome: Upward gaze and convergence palsy – Suprasellar location: • Indolent onset of symptoms • Endocrinopathies • Visual field deficits (i.e. bitemporal hemianopsia) – Diabetes insipidus can present due to tumor involvement of either location. – 2:1 pineal:suprasellar involvement. 5-10% will present with both (“bifocal germinoma”). April 19, 2019 Suprasellar cistern Anatomy 3rd ventricle Pineal gland Optic chiasm Quadrigeminal Cistern Cerebral (Sylvian) aquaduct Interpeduncular Cistern 4th ventricle Prepontine Cistern April 19, 2019 Anatomy Frontal horn of rd lateral ventricle 3 ventricle Interpeduncular cistern Suprasellar cistern Occipital horn of lateral Quadrigeminal Ambient ventricle cistern cistern April 19, 2019 Case CT head: Hydrocephalus with enlargement of lateral and 3rd ventricles. 4.4 x 3.3 x 3.3 cm midline mass isodense to grey matter with calcifications. April 19, 2019 Case MRI brain: Intermediate- to hyper- intense 3rd ventricle/aqueduct mass with heterogenous enhancement. April 19, 2019 Imaging Characteristics • Imaging cannot reliably distinguish different types of GCTs, however non-germinomatous germ cell tumors (NGGCTs) tend to have more heterogenous imaging characteristics compared to germinomas.
    [Show full text]
  • Neuroendocrine TUMORS
    NeuroendocrinE This book provides you with five informative chapters These chapters guide the clinician through: • Diagnosing and Treating Gastroenteropancreatic Tumors, Including ICD-9 Codes TumorS • Clinical Presentations and Their Syndromes, Including ICD-9 Codes Diagnosis and Management Diagnosis A Comprehensive Guide to to Guide A Comprehensive NeuroendocrinE The remaining three chapters guide the clinician through the selection of appropriate assays, profiles, and dynamic challenge protocols for diagnosing and monitoring neuroendocrine symptoms. TumorS • Assays, Including CPT Codes A Comprehensive Guide to • Profiles, Including CPT Codes • Dynamic Challenge Protocols, Including CPT Codes Diagnosis and Management Inter Science Institute Inter Science Institute 944 West Hyde Park Boulevard Inglewood, California 90302 (800) 255-2873 (800) 421-7133 (310) 677-3322 Vinik Aaron I. Vinik, MD, PhD Eugene A. Woltering, MD Fax (310) 677-2846 www.interscienceinstitute.com Woltering Thomas M. O’Dorisio, MD Vay Liang W. Go, MD O’Dorisio Go Inter Science Institute GI Council Chairman Eugene A. Woltering, MD, FACS The James D. Rives Professor of Surgery and Neurosciences Chief of the Sections of Surgical Endocrinology and Oncology Director of Surgery Research The Louisiana State University Health Sciences Center New Orleans, Louisiana Executive Members Aaron I. Vinik, MD, PhD, FCP, MACP Professor of Medicine, Pathology and Neurobiology Director of Strelitz Diabetes Research Institute Eastern Virginia Medical School Norfolk, Virginia Vay Liang W.
    [Show full text]
  • Lessons Learned
    Prevention and Reversal of Chronic Disease Copyright © 2019 RN Kostoff PREVENTION AND REVERSAL OF CHRONIC DISEASE: LESSONS LEARNED By Ronald N. Kostoff, Ph.D., School of Public Policy, Georgia Institute of Technology 13500 Tallyrand Way, Gainesville, VA, 20155 [email protected] KEYWORDS Chronic disease prevention; chronic disease reversal; chronic kidney disease; Alzheimer’s Disease; peripheral neuropathy; peripheral arterial disease; contributing factors; treatments; biomarkers; literature-based discovery; text mining ABSTRACT For a decade, our research group has been developing protocols to prevent and reverse chronic diseases. The present monograph outlines the lessons we have learned from both conducting the studies and identifying common patterns in the results. The main product of our studies is a five-step treatment protocol to reverse any chronic disease, based on the following systemic medical principle: at the present time, removal of cause is a necessary, but not necessarily sufficient, condition for restorative treatment to be effective. Implementation of the five-step treatment protocol is as follows: FIVE-STEP TREATMENT PROTOCOL TO REVERSE ANY CHRONIC DISEASE Step 1: Obtain a detailed medical and habit/exposure history from the patient. Step 2: Administer written and clinical performance and behavioral tests to assess the severity of symptoms and performance measures. Step 3: Administer laboratory tests (blood, urine, imaging, etc) Step 4: Eliminate ongoing contributing factors to the chronic disease Step 5: Implement treatments for the chronic disease This individually-tailored chronic disease treatment protocol can be implemented with the data available in the biomedical literature now. It is general and applicable to any chronic disease that has an associated substantial research literature (with the possible exceptions of individuals with strong genetic predispositions to the disease in question or who have suffered irreversible damage from the disease).
    [Show full text]
  • Successful Treatment of Pituitary Germinoma with Etoposide
    ANTICANCER RESEARCH 37 : 3111-3115 (2017) doi:10.21873/anticanres.11668 Successful Treatment of Pituitary Germinoma with Etoposide, Cisplatin, Vincristine, Methotrexate and Bleomycin Chemotherapy Without Radiotherapy AMINA SCHERZ 1* , KATRIN FELLER 2* , SABINA BEREZOWSKA 3, VERA GENITSCH 3 and MARTIN ZWEIFEL 1 Departments of 1Medical Oncology, and 2Diabetology, Endocrinology, Clinical Nutrition and Metabolism, University Hospital Bern, Bern, Switzerland; 3Institute of Pathology, University of Bern, Bern, Switzerland Abstract. We report on the case of a 25-year-old man with Intracranial germ cell tumours (GCTs) are a rare entity with pituitary germinoma. The patient had noticed polydipsia, excellent prognosis if treated with combined chemoradiation. reduced sexual function, and loss of body hair. Laboratory However, long-term toxicity of radiotherapy is of concern investigations confirmed panhypopituitarism including and it is still debated whether a chemotherapy-only approach diabetes insipidus. Magnetic resonance imaging of the brain with salvage radiotherapy, if needed, is feasible. showed a 14 ×8.4 mm enhancing lesion of the pituitary stalk We report on the case of a 25-year-old man with pituitary and histopathology of the neurosurgical biopsy confirmed germinoma. pituitary germinoma. The patient was treated with 3 cycles of chemotherapy, consisting of 150 mg/m 2 etoposide and Case Report 75 mg/m 2 cisplatin, with the administration of intrathecal 12.5 mg methotrexate, on day one, alternating every 10 to The patient was referred to the endocrinology unit for 11 days with 1 mg/m 2 vincristine, 1,000 mg/m 2 hypogonadotropic hypogonadism. For over a year, the patient methotrexate on day 1 and 30 mg/m 2 bleomycin on day 2.
    [Show full text]
  • Application of Immunohistochemistry in Undifferentiated Neoplasms
    Application of Immunohistochemistry in Undifferentiated Neoplasms A Practical Approach Shivani R. Kandukuri, MD; Fan Lin, MD, PhD; Lizhen Gui, MD, PhD; Yun Gong, MD; Fang Fan, MD, PhD; Longwen Chen, MD, PhD; Guoping Cai, MD, PhD; Haiyan Liu, MD Context.—Advances in interventional technology have may arise while using immunohistochemical staining on enhanced the ability to safely sample deep-seated suspi- small quantities of tissue. cious lesions by fine-needle aspiration procedures. These Data Sources.—The sources include literature procedures often yield scant amounts of diagnostic (PubMed), the first Chinese American Pathologists Associ- material, yet there is an increasing demand for the ation Diagnostic Pathology Course material, and the performance of more ancillary tests, especially immuno- review authors’ research data as well as practice experi- histochemistry and, not infrequently, molecular assays, to ence. Seven examples selected from the CoPath database at Geisinger Medical Center (Danville, Pennsylvania) are increase diagnostic sensitivity and specificity. A systematic illustrated. approach to conserving diagnostic material is the key, and Conclusions.—A stepwise approach to the evaluation of our previously proposed algorithm can be applied aptly in fine-needle aspiration and small biopsy tissue specimens in this context. conjunction with a small panel of select immunohisto- Objective.—To elaborate a simple stepwise approach to chemical stains has been successful in accurately assessing the evaluation of cytology fine-needle aspiration speci- the lineage/origin of the metastatic tumors of unknown mens and small biopsy tissue specimens, illustrating the primaries. The awareness of the common pitfalls of these algorithmic application of small panels of immunohisto- biomarkers is essential in many instances.
    [Show full text]
  • Pulmonary Metastasectomy in Germ Cell Tumors and Prostate Cancer
    2668 Review Article on Pulmonary Metastases Pulmonary metastasectomy in germ cell tumors and prostate cancer Federico Raveglia1, Lorenzo Rosso2, Mario Nosotti2, Giuseppe Cardillo3, Gabrielle Maffeis4, Marco Scarci4 1Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milano, Italy; 2Department of Thoracic Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy; 3Department of Thoracic Surgery, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy; 4Department of Thoracic Surgery, ASST Monza e Brianza, Ospedale San Gerardo, Monza, Italy Contributions: (I) Conception and design: F Raveglia, M Scarci; (II) Administrative support: M Scarci; (III) Provision of study materials or patients: L Rosso; (IV) Collection and assembly of data: M Nosotti; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All author; (VII) Final approval of manuscript: All authors. Correspondence to: Federico Raveglia. ASST Santi Paolo e Carlo, Via di Rudinì 8, 20142 Milano, Italy. Email: [email protected]. Abstract: Pulmonary oligo-metastases and oligo-recurrences are terms used to define a set of clinical conditions consisting of limited metastatic malignant disease characterized by an intermediate aggressive behavior compared to diffuse metastatic conditions. If the primary tumor has been controlled and extra- thoracic lesions are excluded, there is a suggestion in the medical literature that removal of such lesions could potentially prolong survival. The lungs are a common metastatic spreading site, especially from epithelial malignancies and sarcomas; pulmonary surgical or interventional metastasectomy have been proposed with curative intent in case of limited tumor load (usually less than 5 lesions). There are many series reporting data about colorectal, renal or breast lung metastasectomy, but the absence of multi centric prospective trials determines a lack of definitive evidence, especially for less common tumors such as metastatic germ cell and prostate cancer.
    [Show full text]
  • Diagnostic Utility of SALL4 in Primary Germ Cell Tumors of the Central Nervous System: a Study of 77 Cases
    Modern Pathology (2009) 22, 1628–1636 1628 & 2009 USCAP, Inc. All rights reserved 0893-3952/09 $32.00 Diagnostic utility of SALL4 in primary germ cell tumors of the central nervous system: a study of 77 cases Kaiyong Mei1,*, Aijun Liu2,*, Robert W Allan3, Peng Wang4, Zhaoli Lane5, Ty W Abel6, Lixin Wei2, Hong Cheng7, Shuangping Guo7, Yan Peng8, Dinesh Rakheja9, Min Wang10, Joe Ma11, Maria M Rodriguez12, Jianping Li13 and Dengfeng Cao13 1Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou, China; 2Department of Pathology, The Chinese PLA General Hospital, Beijing, China; 3Department of Pathology, University of Florida, Gainesville, FL, USA; 4Department of Pathology, Beijing Ditan Hospital, Beijing, China; 5Department of Pathology, Henry Ford Hospital, Detroit, MI, USA; 6Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA; 7Department of Pathology, Xijing Hospital, Xian, China; 8Department of Pathology, The University of Texas-Southwestern Medical Center, Dallas, TX, USA; 9Children’s Medical Center, The University of Texas-Southwestern Medical Center, Dallas, TX, USA; 10Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA; 11Department of Pathology, Florida Hospital, Orlando, FL, USA; 12Department of Pathology, University of Miami, Miami, FL, USA and 13Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA Primary germ cell tumors of the central nervous system (CNS) sometimes pose diagnostic difficulty. In this study we analyzed the diagnostic utility of a novel marker, SALL4, in 77 such tumors (59 pure and 18 mixed) consisting of the following tumors/tumor components: 49 germinomas, 7 embryonal carcinomas, 27 yolk sac tumors, 3 choriocarcinomas, and 14 teratomas.
    [Show full text]