Common extrathoracic sites of metastasis include bone blood pressure medication popular order 5mg bisoprolol with amex, bone marrow arrhythmia dysrhythmia cheap 5mg bisoprolol with mastercard, liver hypertension patient teaching buy 10mg bisoprolol with amex, and brain heart attack vol 1 pt 3 order bisoprolol 5mg fast delivery. Paraneoplastic syndromes such as Cushing syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and the EatonLambert syndrome are characteristically associated with small cell lung cancer. Small Cell Carcinoma Small cell carcinoma is characterized by a proliferation of primitive-appearing, round to oval-shaped tumor cells that average two to three times the size of normal small lymphocytes. In the classical oat-cell variety, the tumor cells form haphazardly arranged sheets of monotonous tumor cells that may be separated by thin fibrous septa and display extensive areas of necrosis. Nucleoli are usually inconspicuous or absent, and the tumor cells are characterized by brisk mitotic activity. In small endoscopic biopsies, the tumor cells will show a tendency to become markedly distorted and crushed, a finding that traditionally has been associated with small cell carcinoma but that may also be observed in lymphoid neoplasms. A trabecular or ribbon-like arrangement of tumor cells, peripheral palisading of nuclei, and formation of rosette-like microacinar structures are rarely seen in small cell carcinoma and are features indicative of a higher degree of differentiation. A continuum of cell types is usually appreciated, ranging from typical small cells (oat cells) to the large cells. A large cell component admixed with the small cells is also frequently observed at metastatic sites of otherwise conventional small cell carcinomas. B between areas of high-grade and intermediate-grade differentiation within the same tumor. In the "intermediate" subtype of small cell carcinoma, the cells appear larger, oval to polygonal, with more marked nuclear pleomorphism, less stippling of chromatin, more prominent nucleoli, and more abundant cytoplasm. Large cell neuroendocrine carcinoma has represented a controversial category for which the clinical implications, as well as histopathologic criteria for diagnosis, were only more recently defined. However, the cellular proliferation may be focally arranged in ribbons or cords admixed with rosettelike structures, giving the lesion a vaguely neuroendocrine appearance. In addition, the tumor cells may show positive staining with neuroendocrine markers such as synaptophysin or chromogranin. This latter feature is similar to that described in basaloid carcinoma of the lung, a variant of squamous cell carcinoma (see p 213). Because the histologic features of these tumors are indistinguishable from those of their salivary gland counterparts, it is imperative, before rendering a diagnosis of this type of tumor in the lung, that a thorough history be obtained to rule out the possibility of a metastasis from a head and neck primary. These tumors most likely originate from submucosal glands of the bronchi; nevertheless, not all of them occur in relationship with a bronchus. In unusual circumstances, they may arise within the pulmonary parenchyma, in the periphery of the lung, without direct connection to a bronchial structure. However, in recent years, several reports addressing their biologic behavior and spectrum of histopathologic features have been presented. For instance, mixed tumors, which represent the most common tumor in salivary gland, are rarely seen in the lung. Other subtle differences in the pathologic features and behavior of these lesions have also been noted. Clinically, they most often present as endobronchial lesions that cause symptoms related to bronchial obstruction, including cough, dyspnea, and hemoptysis. Peripheral lesions are more likely to be asymptomatic and hence discovered incidentally on routine chest radiograph. However, some exceptions exist; for example, adenoid cystic carcinomas may follow an aggressive course with distant spread and high mortality, depending on the stage of the disease at the time of initial diagnosis. Tumors found to be at an advanced stage at the time of diagnosis will usually prove fatal, independent of the histologic features. Adenoid Cystic Carcinoma Adenoid cystic carcinoma of the bronchus may demonstrate a variety of histologic growth patterns: (1) cribriform (cylindromatous), (2) tubular, and (3) solid. The islands of tumor cells are separated by fibrous bands and contain cells with round nuclei showing clear nuclear outlines and scant eosinophilic cytoplasm. The cystic areas are composed of two rows of cells, and mitotic figures are usually absent. The solid growth pattern is perhaps the most uncommon and is characterized by similar cells that form diffuse sheets. Mitotic figures are found more frequently in association with the latter growth pattern. Perineurial invasion is another common feature of adenoid cystic carcinoma; this feature, however, is not associated with a more ominous prognosis, although it may play a role in local recurrence. The only parameter that has been found to predict the prognosis for these tumors reliably is staging at the time of initial diagnosis. Immunohistochemical stains will identify both a glandular secretory and a myoepithelial component. Several morphologic growth patterns have been identified in these tumors, including acinar, cystic or papillocystic, nesting, and oncocytic. Some tumors may be composed predominantly of oncocytic cells showing a strikingly nested growth pattern, thus closely resembling a neuroendocrine neoplasm. The most important feature for diagnosis, however, is the finding of 600- to 800-nm membrane-bound intracellular zymogen granules by electron microscopy.
Syndromes
Anemia (various types)
Mammography
Neurological losses are treated according to the type and severity of function loss.
Lymph node biopsy
Severe hypoxia (low oxygen)
Nosebleeds
Vitamin K deficiency
Liver failure
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Binkley G W, Johnson H H Jr 1951 Epithelioma adenoides cysticum: basal cell nevi, agenesis of the corpus callosum and dental cysts. Brownstein M H, Starink T M 1987 Desmoplastic trichoepithelioma and intradermal nevus: a combined malformation. Burrows N P, Russell Jones R, Smith N P 1992 the clinicopathological features of familial cylindromas and trichoepitheliomas (Brooke-Spiegler syndrome): a report of two families. Cramers M 1981 Trichoepithelioma multiplex and dystrophia unguis congenita: a new syndrome Gross P P 1953 Epithelioma adenoides cysticum with follicular cysts of maxilla and mandible. Lloyd K M, Lloyd J R, Fatteh S 1990 Palmar pits and multiple trichoepitheliomas: an association. Hunt S J, Abell E 1991 Malignant hair matrix tumor ("malignant trichoepithelioma") arising in the setting of multiple hereditary trichoepithelioma. Walsh N, Ackerman A B 1990 Infundibulocystic basal cell carcinoma: a newly described variant. 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Silver S A heart attack american cheap bisoprolol 10mg amex, Tavassoli F A 2000 Pleomorphic carcinoma of the breast: clinicopathological analysis of 26 cases of an unusual highgrade phenotype of ductal carcinoma blood pressure of 130/80 order bisoprolol 5 mg mastercard. Moore O S arrhythmia event monitor discount bisoprolol 5 mg with mastercard, Foote F W Jr 1949 the relatively favourable prognosis of medullary carcinoma of the breast prehypertension early pregnancy purchase on line bisoprolol. Foote F W Jr, Stewart F W 1946 A histologic classification of carcinoma in the breast. Wheeler J E, Enterline H T 1976 Lobular carcinoma of the breast in situ and infiltrating. Fechner R E 1975 Histological variants of infiltrating lobular carcinoma of the breast. Martinez V, Azzopardi J 1979 Invasive carcinoma of the breast: incidence and variants. Eusebi V, Magalhaes F, Azzopardi J G 1992 Pleomorphic lobular carcinoma of the breast: an aggressive tumour showing apocrine differentiation. Weidner N, Semple J P 1992 Pleomorphic variant of invasive lobular carcinoma of the breast. Yoder B J, Wilkinson E J, Massoll N A 2007 Molecular and mor phologic distinctions between infiltrating ductal and lobular car cinoma of the breast. CletonJansen A M 2002 Ecadherin and loss of heterozygosity at chromosome 16 in breast carcinogenesis: different genetic path ways in ductal and lobular breast cancer Page D L, Anderson T J, Sakamoto G 1987 Infiltrating carci noma: major histological types. Pinder S E, Elston C W, Ellis I O 1998 Invasive carcinoma- usual histological types. Welling S R, Jensen H M, Marcum R G 1975 An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. A syllabus derived from findings of the National Surgical Adjuvant Breast Cancer Project (protocol no. Rosen P P 1979 the pathological classification of human mammary carcinoma: past, present and future. Com parative pathological study of breast carcinoma among American and Japanese women. Li C I, Uribe D J, Daling J R 2005 Clinical characteristics of different histologic types of breast cancer. Shin S J, Kanomata N, Rosen P P 2000 Mammary carcinoma with prominent cytoplasmic lipofuscin granules mimicking melano cytic differentiation. Histopathology 37: 456459 16 Tumors of the Breast postmenopausal hormone replacement therapy. Obstet Gynecol 85: 1117 Henson D, Tarone R 1979 A study of lobular carcinoma of the breast based on the Third National Cancer Survey in the United States of America. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and meta static patterns. J Gynecol Obstet Biol Reprod (Paris) 32: 529534 Cocquyt V, Van Belle S 2005 Lobular carcinoma in situ and inva sive lobular cancer of the breast. Curr Opin Obstet Gynecol 17: 5560 Cornford E J, Wilson A R M, Athanassiou E 1995 Mammo graphic features of invasive lobular and invasive ductal carcinoma of the breast: a comparative analysis. Am J Surg Pathol 21: 653657 Page D L, Anderson T J (eds) 1987 Uncommon types of invasive carcinoma. Churchill Livingstone, Edinburgh Wahed A, Connelly J, Reese T 2002 Ecadherin expression in pleomorphic lobular carcinoma: an aid to differentiation from ductal carcinoma. Ann Diagn Pathol 6: 349351 Palacios J, Sarrio D, GarciaMacias M C 2003 Frequent Ecadherin gene inactivation by loss of heterozygosity in pleo morphic lobular carcinoma of the breast. Mod Pathol 16: 674678 Richter G O, Dockerty M B, Clagett O T 1967 Diffuse infiltrat ing scirrhous carcinoma of the breast. McBoyle M F, Razek H A, Carter J L, Helmer S D 1997 Tubular carcinoma of the breast: an institutional review. Rajakariar R, Walker R A 1995 Pathological and biological fea tures of mammographically detected invasive breast carcinomas. Peters G N, Wolff M, Haagenson C D 1981 Tubular carcinoma of the breast-clinical pathologic correlations on 100 cases. Venable J G, Schwartz A M, Silverberg S G 1990 Infiltrating cribriform carcinoma of the breast: a distinctive clinicopathologic entity. Holland R, Van Haelst U J G M 1984 Mammary carcinoma with osteoclastlike giant cells. Clayton F 1986 Pure mucinous carcinomas of the breast: morpho logic features and prognostic correlates. Rasmussen B B, Rose C, Christensen J B 1987 Prognostic factors in primary mucinous breast carcinoma. Di Saverio S, Gutierrez J, Avisar E 2008 A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma. Maluf H M, Koerner F C 1994 Carcinomas of the breast with endocrine differentiation: a review. Siriaunkgul S, Tavassoli F A 1993 Invasive micropapillary carci noma of the breast.
This grading system had the following advantages: use of familiar terminology and histologic features and relative ease of assessment because the degree of differentiation did not need to be determined blood pressure chart different ages purchase bisoprolol now. An increased number of ferritin-positive cells and loss of S-100 protein positivity have been correlated with a poor prognosis hypertension treatment guidelines discount bisoprolol 5 mg visa. Neurofilaments and dense-core neurosecretory granules were also present in other fields heart attack kid bisoprolol 5 mg sale. B blood pressure medication toprol buy generic bisoprolol 5 mg online, A few dense-core neurosecretory-type granules are present along with free polyribosomes. Granules are often round, regular, and uniformly dense and surrounded by a limiting membrane. The cut surface has a bulging, pale, coarsely trabecular appearance resembling a "fibroid" or leiomyoma. An abundant spindle cell matrix is seen that can resemble a schwannoma or neurofibroma. Mature ganglion cells are present, but the number, density, and distribution of these cells may be quite variable. In some cases conspicuous finely granular brown pigment resembling lipofuscin or neuromelanin may be seen within ganglion cells. Occasionally some ganglion cells may be associated with a layer of smaller cells suggesting satellite cells. Note interlacing fascicles of spindle cells resembling Schwann cells along with cytodifferentiated ganglion cells. Arias-Stella J, Valcarcel J 1976 Chief cell hyperplasia in the human carotid body at high altitudes: physiologic and pathologic significance. Heath D, Edwards C, Harris P 1970 Post-mortem size and structure of the human carotid body. Lack E E, Perez-Atayde A R, Young J B 1985 Carotid body hyperplasia in cystic fibrosis and cyanotic heart disease. Lack E E, Cubilla A L, Woodruff J M 1979 Paragangliomas of the head and neck region. Papaspyrou K, Mann W J, Amedee R G 2009 Management of head and neck paragangliomas: review of 120 patients. Bradshaw J W, Jansen J C 2005 Management of vagal paraganglioma: is operative resection really the best option Boedeker C C, Ridder G J, Schnipper J 2005 Paragangliomas of the head and neck: diagnosis and treatment. Fishbein L, Nathanson K L 2012 Pheochromocytoma and paraganglioma: understanding the complexities of the genetic background. Baysal B E 2003 On the association of succinate dehydrogenase mutations with hereditary paraganglioma. Wasserman P G, Savargaonkar P 2001 Paragangliomas: classification, pathology and differential diagnosis. Feldman S A, Eiden L E 2003 the chromogranins: their role in secretion from neuroendocrine cells and as markers for neuroendocrine neoplasia. Chetty R, Pillay P, Jaichand V 1998 Cytokeratin expression in adrenal phaeochromocytomas and extra-adrenal paragangliomas J Clin Pathol 51: 477-478 54. Grimley P M, Glenner G G 1967 Histology and ultrastructure of carotid body paragangliomas: comparison with the normal gland. Tischler A S, Kimura N, McNicol A M 2006 Pathology of pheochromocytoma and extra-adrenal paraganglioma. Zuckerkandl E 1901 Ueber nebenorgane des sympathicus im retroperitonaealraum des Menschen. Fries J G, Chamberlin J A 1968 Extra-adrenal pheochromocytoma: literature review and report of a cervical pheochromocytoma. Moran C A, Rush W, Mena H 1997 Primary spinal paragangliomas: a clinicopathological and immunohistochemical study of 30 cases. Clinicopathologic study of 31 cases with special reference to immunocytology and ultrastructure. Gupta R, Howell R S, Amin M B 2009 Paratesticular paraganglioma: a rare cause of an intrascrotal mass. A lesion that may be misdiagnosed as urothelial carcinoma in transurethral resection specimens. Carney J A 1999 Gastric stromal sarcoma, pulmonary chondroma and extra-adrenal paraganglioma (Carney triad): natural history, adrenocortical component and possible familial occurrence. Stratakis C A, Carney J A 2009 the triad of paragangliomas, gastric stromal tumours and pulmonary chondromas (Carney triad), and the dyad of paragangliomas and gastric stromal sarcomas (Carney-Stratakis syndrome): molecular genetics and clinical implications. McWhinney S R, Pasini B, Stratakis C A 2007 Familial gastrointestinal stromal tumors and germ-line mutations. Cancer 60: 1776-1781 2084 28 Tumors of the Autonomic Nervous System, Including Paraganglia 104. Hachitanda Y, Tsuneyoshi M 1994 Neuroblastoma with a distinct organoid pattern: a clinicopathologic, immunohistochemical and ultrastructural study. An assessment of the significance of histologic maturation in neuroblastoma diagnosed beyond infancy. Dehner L P 1988 Classic neuroblastoma: histopathologic grading as a prognostic indicator.
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