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Pancreatic carcinoma with multilineage (acinar, neuroendocrine, and ductal) differentiation

Newman, Kia; Stahl-Herz, Jay; Kabiawu, Oluyomi; Newman, Elliot; Wieczorek, Rosemary; Wang, Beverly; Pei, Zhiheng; Bannan, Michael; Lee, Peng; Xu, Ruliang
The preponderance of pancreatic tumors is adenocarcinoma of the ductal type; carcinomas with multiple lineage differentiation are extremely rare. We report an unusual case of pancreatic carcinoma with combined acinar and neuroendocrine differentiation and minor ductal component with concurrent acinar-ductal metaplasia (ADM), an early lesion implicated in ductal carcinogenesis. The patient is a 56-year-old man with vague complaints of dull left upper quadrant pain with radiation across the mid-portion of his abdomen. A computer tomography scan revealed an irregular enlargement of the distal 3.2 cm of the pancreatic body. A distal pancreatectomy was then performed. Histologic examination revealed a pancreatic carcinoma with cellular features of eosinophilic granular cytoplasm and salt-pepper nuclei. The acinar differentiation of the carcinoma was confirmed by positivity on periodic acid-Schiff stain resistant to diastase digestion (dPAS), positivity for antitrypsin on immunohistochemistry (IHC), and presence of zymogen granules on electron microscopy (EM). The neuroendocrine differentiation was evident by positive synaptophysin and chromogranin stain on IHC and neuroendocrine granules on EM. The ductal component was only visible by PAS stain and immunostains for CEA and CK19A and accompanied by a number of the acinar-ductal metaplasia lesions adjacent to the main tumor. Thus, the histological, histochemical, immunohistochemical and electron-microscopic evidence all suggested that the pancreatic carcinoma underwent trilineage differentiation
PMCID:2713457
PMID: 19636408
ISSN: 1936-2625
CID: 101289

Encapsulated anaplastic thyroid carcinoma transformed from follicular carcinoma: a case report [Case Report]

Rapkiewicz, Amy; Roses, Daniel; Goldenberg, Alec; Levine, Pascale; Bannan, Michael; Simsir, Aylin
BACKGROUND: Anaplastic thyroid carcinoma (ATC) is rare but is one of the most aggressive and lethal human malignancies. Cytologically, ATC has a variable morphologic appearance, including squamoid, giant, spindled and pleomorphic cells. The coexistence of ATC and differentiated or poorly differentiated thyroid carcinoma has been described and usually is diagnosed when the disease is locally advanced. CASE: We describe a case of surgically resectable, encapsulated, well-circumscribed ATC occurring in association with a better differentiated follicular carcinoma diagnosed by fine needle aspiration in a patient exposed to external ionizing radiation. CONCLUSION: Encapsulated variants of anaplastic carcinoma can be seen in association with lower grade thyroid carcinoma such as follicular carcinoma. Accurate diagnosis is dependent on adequate sampling
PMID: 19534279
ISSN: 0001-5547
CID: 100202

Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging--initial experience

Hagiwara, Mari; Rusinek, Henry; Lee, Vivian S; Losada, Mariela; Bannan, Michael A; Krinsky, Glenn A; Taouli, Bachir
Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. The purpose of this study was to prospectively evaluate sensitivity and specificity of various estimated perfusion parameters at three-dimensional (3D) perfusion magnetic resonance (MR) imaging of the liver in the diagnosis of advanced liver fibrosis (stage >or= 3), with histologic analysis, liver function tests, or MR imaging as the reference standard. Whole-liver 3D perfusion MR imaging was performed in 27 patients (17 men, 10 women; mean age, 55 years) after dynamic injection of 8-10 mL of gadopentetate dimeglumine. The following estimated perfusion parameters were measured with a dual-input single-compartment model: absolute arterial blood flow (F(a)), absolute portal venous blood flow (F(p)), absolute total liver blood flow (F(t)) (F(t) = F(a) + F(p)), arterial fraction (ART), portal venous fraction (PV), distribution volume (DV), and mean transit time (MTT) of gadopentetate dimeglumine. Patients were assigned to two groups (those with fibrosis stage <or= 2 and those with fibrosis stage >or= 3), and the nonparametric Mann-Whitney test was used to compare F(a), F(p), F(t), ART, PV, DV, and MTT between groups. Receiver operating characteristic curve analysis was used to assess the utility of perfusion estimates as predictors of advanced liver fibrosis. There were significant differences for all perfusion MR imaging-estimated parameters except F(p) and F(t). There was an increase in F(a), ART, DV, and MTT and a decrease in PV in patients with advanced fibrosis compared with those without advanced fibrosis. DV had the best performance, with an area under the receiver operating characteristic curve of 0.824, a sensitivity of 76.9% (95% confidence interval: 46.2%, 94.7%), and a specificity of 78.5% (95% confidence interval: 49.2%, 95.1%) in the prediction of advanced fibrosis
PMID: 18195377
ISSN: 1527-1315
CID: 76458

Interobserver variability in differentiation of nodal nevus from melanoma micrometastasis in sentinel lymph adenectomy specimens [Meeting Abstract]

Celin, N; Bannan, M; Darvishian, F; Hajdu, C; Nonaka, D; Ye, W; Pei, Z; Melamed, J
ISI:000252180200409
ISSN: 0893-3952
CID: 100682

Prospective evaluation of an extended histologic protocol for detection of melanoma micrometastasis [Meeting Abstract]

Cetin, N; Bannan, M; Wang, B; Melamed, J
ISI:000252180200410
ISSN: 0893-3952
CID: 75908

Prospective evaluation of an extended histologic protocol for detection of melanoma micrometastasis [Meeting Abstract]

Cetin, N; Bannan, M; Wang, B; Melamed, J
ISI:000252181100410
ISSN: 0023-6837
CID: 75930

Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience

Taouli, Bachir; Tolia, Anuj J; Losada, Mariela; Babb, James S; Chan, Edwin S; Bannan, Michael A; Tobias, Hillel
OBJECTIVE: The purpose of this study was to evaluate our preliminary experience using diffusion-weighted MRI for quantification of liver fibrosis. SUBJECTS AND METHODS: Diffusion-weighted MRI with single-shot echo-planar technique at b values of 50, 300, 500, 700, and 1,000 s/mm2 was prospectively performed on 23 patients with chronic hepatitis and on seven healthy volunteers. The apparent diffusion coefficient (ADC) was measured in four locations in the liver. Liver biopsy results (n = 19) were retrospectively reviewed by two hepatopathologists in consensus to determine stage of fibrosis and grade of inflammation. A Mann-Whitney test was used to compare the ADCs between patients classified with respect to having stage 2 or greater versus stage 1 or less fibrosis and stage 3 or greater versus stage or less 2 fibrosis. Receiver operating characteristics analysis was used to assess the performance of ADC in prediction of the presence of stage 2 or greater and stage 3 or greater fibrosis. RESULTS: Using a b value of 500 s/mm2 and all combined b values, we found significantly lower hepatic ADCs in stage 2 or greater versus stage 1 or less fibrosis and stage 3 or greater versus stage 2 or less fibrosis. The mean ADCs (x 10(-3) mm2/s) with all b values were 1.47 +/- 0.11 (SD) versus 1.65 +/- 0.10 for stage 2 or greater versus stage 1 or less fibrosis (p < 0.001) and 1.44 +/- 0.07 versus 1.66 +/- 0.10 for stage 3 or greater versus stage 2 or less fibrosis (p <0.001). Hepatic ADC was a significant predictor of stage 2 or greater and stage 3 or greater fibrosis, with areas under the curve of 0.896 and 0.896, sensitivity of 83.3% and 88.9%, and specificity of 83.3% and 80.0% (ADC with all b values, 1.54-1.53 x 10(-3) mm2/s or less). CONCLUSION: Diffusion-weighted MRI can be used for prediction of the presence of moderate and advanced liver fibrosis
PMID: 17885048
ISSN: 1546-3141
CID: 74407

Two cases of hepatoid adenocarcinoma of the intestine in association with inflammatory bowel disease [Case Report]

Liu, Q; Bannan, M; Melamed, J; Witkin, G B; Nonaka, D
PMID: 17532770
ISSN: 0309-0167
CID: 73000

Immunohistochemical differential expression in lung and breast cancers [Meeting Abstract]

Yang, MC; Bannan, M; Chiriboga, L; Yee, H; Nonaka, D
ISI:000244922402374
ISSN: 0893-3952
CID: 74794

Immunohistochemical differential expression in lung and breast cancers [Meeting Abstract]

Yang, MC; Bannan, M; Chiriboga, L; Yee, H; Nonaka, D
ISI:000244935302375
ISSN: 0023-6837
CID: 100697