It may also be used to detect the presence of malignant cells in the CSF, as in carcinomatous meningitis or medulloblastoma. CSF containing less than 10 red blood cells (RBCs)/mm³ constitutes a "negative" tap in the context of a workup for subarachnoid hemorrhage, for example. Taps that are "positive" have an RBC count of 100/mm³ or more.
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Causes of increased pre-sacral space are: ulcerative colitis, granulomatous colitis, lymphogranuloma venereum, and in postirradiation changes, thrombosis of the inferior vena cava and tuberculous proctitis, tumor of the sacrum or posterior wall of the rectum. Carcinomatous deposits in the pelvis can also cause presacral space widening. Presacral edema is common in patients with heart failure who are confined to bed.
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They also more frequently express "non-carcinomatous" markers typically associated with "dedifferentiated" neoplasms. Expression of thyroid transcription factor-1 (TTF-1), a commonly used marker for primary lung cancers, appears to be less frequent in rhabdoid carcinomas than in most other histotypes of pulmonary cancers. Vimentin, an intermediate filament protein usually found in sarcoma, is ubiquitously (nearly 100%) expressed diffusely throughout the cytoplasm of the rhabdoid cells, and is often intermingled with CK's in their whorled inclusions. Some studied have reported that neuroendocrine-related markers (i.e.
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Vimentin, an intermediate filament protein usually associated with non-carcinomatous tumors (i.e. sarcoma), is ubiquitous in rhabdoid cells. Co-expression of cytokeratins and vimentin are associated with cells undergoing epithelial-mesenchymal transition (EMT). While undifferentiated large-cell lung carcinoma is the most common parent lung tumor from which a rhabdoid phenotype evolves, malignant cells with a rhabdoid phenotype are known to occur in many different histological variants of lung cancer, including adenocarcinoma, sarcomatoid carcinoma, squamous cell carcinoma, combined large cell neuroencrine carcinoma, and mucinous bronchioloalveolar carcinoma and combined small cell lung carcinoma.
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Prior to Stevens's trip to the hospital, "A local physician suspected Albert had a malignant ulcer that had spread to the liver and advised him to consult specialists at the University of California Hospital." Stevens's surgeons found a "huge, ulcerating, carcinomatous mass that had grown into his spleen and liver... Half of the left lobe of the liver, the entire spleen, most of the ninth rib, lymph nodes, part of the pancreas, and a portion of the omentum... were taken out" to help prevent the spread of the cancer that Stevens did not have.
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Leptomeningeal cancer (also called leptomeningeal carcinomatosis, leptomeningeal disease (LMD), leptomeningeal metastasis, neoplastic meningitis, meningeal metastasis and meningeal carcinomatosis) is a rare complication of cancer in which the disease spreads from the original tumor site to the meninges surrounding the brain and spinal cord. This leads to an inflammatory response, hence the alternative names neoplastic meningitis (NM), malignant meningitis, or carcinomatous meningitis. The term leptomeningeal (from the Greek lepto, meaning 'fine' or 'slight') describes the thin meninges, the arachnoid and the pia mater, between which the cerebrospinal fluid is located. The disorder was originally reported by Eberth in 1870.
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People may present with pure lower motor neuron syndrome, a symptom of amyotrophic lateral sclerosis (ALS). RILP may also be misdiagnosed as leptomeningeal metastasis often showing nodular MRI enhancement of the cauda equina nerve roots or having increased CSF protein content. Other differential diagnoses to consider are Chronic Inflammatory Demyelinating Polyradiculoneuropathy, neoplastic lumbosacral plexopathy, paraneoplastic neuronopathy, diabetic lumbosacral plexopathy, degenerative disk disease (osteoporosis of the spine), Osteoarthritis of the spine, Lumbar Spinal Stenosis, post-infectious plexopathy, carcinomatous meningitis (CM), mononeuritis multiplex, and chemotherapy-induced plexopathy. The testing to resolve a RILP diagnosis involves blood serum analysis, X-rays, EMG, MRI and Cerebrospinal Fluid analysis.
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Several different malignancies, particularly small-cell lung cancer and Hodgkin lymphoma, are associated with a paraneoplastic neuritis. This carcinomatous polyneuropathy is associated with the presence of antibodies against onconeural antigen, Hu, Yo, amphiphysin, or CV2/CRMP5, which recognize and bind to both tumor cells and peripheral nervous system neurons. This paraneoplastic syndrome may present as either a sensory neuropathy, affecting primarily the dorsal root ganglion, resulting in a progressive sensory loss associated with painful paresthesias of the upper limbs, or a mixed sensorimotor neuropathy which is also characterized by progressive weakness. Treatment of paraneoplastic syndromes aim for both elimination of tumor tissue via conventional oncologic approach as well as immunotherapy options such as steroids, plasmapheresis or IVIG.
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A malignant mixed Müllerian tumor, also known as malignant mixed mesodermal tumor (MMMT) is a cancer found in the uterus, the ovaries, the fallopian tubes and other parts of the body that contains both carcinomatous (epithelial tissue) and sarcomatous (connective tissue) components. It is divided into two types, homologous (in which the sarcomatous component is made of tissues found in the uterus such as endometrial, fibrous and/or smooth muscle tissues) and a heterologous type (made up of tissues not found in the uterus, such as cartilage, skeletal muscle and/or bone). MMMT account for between two and five percent of all tumors derived from the body of the uterus, and are found predominantly in postmenopausal women with an average age of 66 years. Risk factors are similar to those of adenocarcinomas and include obesity, exogenous estrogen therapies, and nulliparity.
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