49m. male with partial mesorectal rectum resection with lymphadenectomy, bladder and ureteral resection.  
CLIN. DGN.: Ca partis superioris ampullae recti cT4N2M0 penetrans ad vesicae urinariae et ureteris dex.  
DGN.:  
1. Poorly differentiated (G3) adenocarcinoma (<5%) with undifferentiated rhabdoid carcinoma (G4) (>95%): pT4b (bladdder) N2b (mts 28/52 (max 1,5cm makro) with extranodal spread) M1 (mts 2/4 right iliacal nodes). The resection not complete (ureter margin). V1/L1. Exulceration in the rectal and bladder mucosa.  
IH: A) Rhabdoid ca: PANCK+; Vimentin+; EMA+; pCEA(+/-); CK7/CK20/TTF1/CDX2(-); Desmin/MyoD1(-);  
B) Adenoca rest (small nidus close to mucosa): PanCK+; CK7/CK20(-); Vimentin+; cdx2+. Small glands in nodal mts dissapear in IH slides (only rhabdoid ca).  
MOLECS: KRAS(-); BRAF V600+.  
TREATMENT: FOLFIRI.  
Status: DOD several months after diagnosis (tumoral spread).  
SPECIAL QUEST: the link between adenoca and rhabdoid components? Molecular verification need? Other comments?  
Thank you for collaboration.  
 
The case will be stained IH by INI1 (kindly agreed by dr.S.Frank (Basel) and prepared for report.  
 
LITERATURE: 1) Pancione M, Di Blasi A, Sabatino L et al. A novel case of rhabdoid colon carcinoma associated with a positive CpG island methylator phenotype and BRAF mutation. Hum Pathol. 2011 Feb 10. 2) Amrikachi M, Ro JY, Ordonez NG, Ayala AG. Adenocarcinomas of the gastrointestinal tract with prominent rhabdoid features. Ann Diagn Pathol. 2002 Dec;6(6):357-63.  
3) Kono T, Imai Y, Imura J, Ono Y et al. Cecal adenocarcinoma with prominent rhabdoid feature: report of a case with immunohistochemical, ultrastructural, and molecular analyses. Int J Surg Pathol. 2007 Oct;15(4):414-20.  
 
imported on 2012-09-24 12:03:53 originally owned by ugnius