| Japanese Journal of Clinical Oncology | Pages |
Introduction
Case Report
Pathological Findings
Gross Findings
Microscopic Findings
Discussion
Acknowledgements
References
Papillary Adenocarcinoma of the Sigmoid Colon Associated with Psammoma Bodies and Hyaline Globules: Report of a Case
We report a case of papillary adenocarcinoma of the sigmoid colon with psammoma bodies and intracytoplasmic hyaline globules. The patient was a 59-year-old woman. The tumor showed central ulceration with smooth elevated ridges. Histologically, the tumor was composed of numerous large irregular tubular structures accompanying infolded papillary growth. The tumor cells showed cytoplasmic basophilia and prominent nuclear atypia. Psammomatous-type calcification was scattered in the tumor stroma as well as in the glandular lumina. In addition, intracytoplasmic hyaline globules of various sizes were seen in the neoplastic cells. We propose the name papillary adenocarcinoma associated with psammoma bodies and hyaline globules for this tumor. Accumulation of further cases is needed to clarify the clinical significance of this type of tumor.
INTRODUCTION
Psammoma bodies are round calcific concretions exhibiting concentric lamination that occur in about 50 % of papillary carcinomas of the thyroid gland (1). Other than in thyroid papillary carcinoma, psammoma bodies are frequently observed in serous papillary adenocarcinomas of the ovary (2), adenocarcinomas of the endometrium (3) and meningiomas (4). Adenocarcinomas of the lung infrequently contain psammoma bodies (5).
On the other hand, intracytoplasmic hyaline globules (HGs), spherical intracytoplasmic eosinophilic droplets, have been associated with a variety of malignancies, including hepatocellular carcinoma (6,7), undifferentiated liver sarcoma (8), pulmonary adenocarcinoma (7,9) , yolk sac tumor (10), breast carcinoma (7), cartilaginous neoplasm (11) and Kaposi's sarcoma (12).
The present report describes one case of papillary adenocarcinoma of the sigmoid colon associated with psammoma bodies and HGs, and discusses these characteristic features.
CASE REPORT
A 59-year-old woman was admitted to Yoshijima Hospital, Hiroshima, for treatment of a sigmoid colon tumor, on July 10, 1995. Her family practitioner had found occult blood in her feces. A barium enema of the colorectum revealed a tumor in the sigmoid colon. Endoscopic examination of the colorectum demonstrated a sigmoid colon tumor showing ulceration with elevated ridges. A biopsy specimen showed the features of moderately differentiated adenocarcinoma. Serum levels of CEA and CA19-9 were within normal limits. Sigmoidectomy and regional lymph node dissection were performed on July 19, 1995. At the time of surgery, three of four regional lymph nodes dissected showed metastasis, as confirmed by frozen sections. Distant metastasis was not seen and the gynecological organs were normal. No recurrence was detected clinically during the following 17 months.
Pathological Findings
Gross Findings
This tumor, measuring 3 × 2.5 × 0.5 cm, was categorized as a type 2 or well circumscribed fungated tumor with central ulceration (Fig. 1). The cut surface had a well defined margin and showed subserosal invasion.
Microscopic Findings
We sectioned the tumor serially at intervals of 3 mm, took all the tumor tissue for histological examination and prepared HE-stained sections from all paraffin-embedded blocks. This sigmoid colon cancer was composed of numerous large irregular tubular structures showing infolded papillary growth, mostly without a fibrovascular core (Fig. 2a). The tumor cells possessed large, pleomorphic, hyperchromatic or pale-stained nuclei, small nucleoli and basophilic cytoplasm (Fig. 2b). Not only ordinary calcium deposits at the growing edge, but also psammoma bodies were scattered adjacent to viable neoplastic cells (Fig. 3a) as well as in the glandular lumen (Fig. 3b). Intracytoplasmic hyaline globules (HGs) of various sizes (3-30 [mu]m in diameter) were seen in the tumor cells at the tip of the papillary structure and in the superficial area of the tumor (Fig. 4). The HGs were stained by the periodic acid-Schiff method, which was resistant to diastase digestion, and with phosphotungstic acid-hematoxylin but were not stained by mucicarmine or alcian blue. To elucidate the nature of the HGs in the present tumor, we used four kinds of rabbit polyclonal antibodies against alpha-1-antitrypsin, alpha-1-antichymotrypsin, lysozyme and human chorionic gonadotropin and one mouse monoclonal antibody against AFP. The first four were from DAKO Japan, Kyoto, and the last was from Nichirei, Tokyo, Japan. The HGs were not reactive with any of these antibodies.
References
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Copyright© Japanese Journal of Clinical Oncology, 1997.
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