bluuebunny/crossref_metadata_2025 huggingface dataset:
Fine Needle Aspiration Biopsies of the Head and Neck: The Surgical Pathologist's Perspective
Authors: Cerilli Lisa A. , Wick Mark R.
Published: June 2007

Masses of the head and neck comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgical pathologist and surgeon. Fine needle aspiration cytology is an increasingly popular technique in the initial evaluation of such lesions. The high diagnostic accuracy of this technique makes it generally preferable to traditional surgical biopsy. It is particularly useful in the sampling of histologically uniform neoplasms of the salivary glands, identification of classical papillary carcinoma and medullary carcinoma of the thyroid, separation of colloid goiter from follicular neoplasms, and confirmation of clinically suspicious lymph node metastases in cases with already documented malignant diseases. Despite its usefulness, aspiration cytology of head and neck lesions has certain inherent pitfalls, and these are briefly examined in this review.
Angiomyofibroblastoma of the Male Perineum
Authors: Hlaing Thazin , Tse Gary
Published: June 2007

We report a case of angiomyofibroblastoma (AMF)-like tumor of the perineum in a 54-year-old man. The asymptomatic lesion measured 3 cm and appeared as a tan homogeneous mass. Histologically, it appeared as a circumscribed nodular spindle cell proliferation with alternating cellular and hypocellular areas. The spindle cells exhibited minimal nuclear pleomorphism and scanty mitotic activity. Focally, some cells were epithelioid. Large blood vessels were present, with perivascular fibrosis. The spindle cells expressed vimentin, but not desmin, actin, S10, or CD34. These features were similar to those of AMF as initially reported in the vulva. A perineal location of this lesion in a male has not been reported in the literature, to the best of our knowledge.
Hu Immunolabeling as a Marker of Neural and Neuroendocrine Differentiation in Normal and Neoplastic Human Tissues: Assessment Using a Recombinant Anti-Hu Fab Fragment
Authors: Gultekin S. Humayun , Rosai Juan , Demopoulos Alexis , Graus Yvo F. , Posner Jerome B. , Dalmau Josep , Rosenblum Marc K.
Published: June 2007

The recombinant antibody fragment Fab GLN 495 recognizes an epitope shared by members of the neuron-associated Hu protein family (including HuC, HuD, and HelNI). This novel reagent labels the nuclei of neurons throughout the peripheral and central neuraxes and has been shown to recognize pulmonary small cell carcinomas and central nervous system (CNS) tumors of mature neuronal phenotype or neuronogenic differentiating capacity. Using this Fab fragment, we have undertaken a systematic survey of normal human tissues and an assessment of 554 non-CNS tumor samples for immunohistochemical evidence of Hu expression. Adrenomedullary cells, pancreatic islet cells, paraganglial chief cells, isolated adenohypophyseal cells, and spermatogonia were the only nonneuronal normal tissue elements to bind Fab GLN 495. In addition to labeling all 10 small cell carcinomas studied (six of which were extrapulmonary in origin), this recombinant anti-Hu Fab proved immunoreactive with neuroblastomas (four/four), esthesioneuroblastomas (one/one), typical (three/four) and atypical (one/four) pulmonary carcinoids, pancreatic islet cell tumors (two/six), large-cell neuroendocrine carcinoma of lung (one/four), Merkel cell tumors (two/three), medullary carcinomas of the thyroid (four/six), pheochromocytomas (two/four) and paragangliomas (four/four). Nonneural/neuroendocrine tumor labeling was restricted to the neuronal and immature neuroepithelial components of teratomas, to extraskeletal myxoid chondrosarcomas (three/four) and to small subsets of cells within examples of renal rhabdoid tumor (one/four), desmoplastic small cell tumor (one/four), alveolar rhabdomyosarcoma (two/four), Ewing sarcoma/PNET (two/nine), and Wilms tumor (one/four). Immunoreactivity was principally nuclear, with variable cytoplasmic labeling. Our findings support the largely restricted expression of Hu by neural/neuroendocrine neoplasms, suggest a potential role for Fab GLN 495 in the identification of small cell carcinomas irrespective of primary site, and support a recent proposal that at least some extraskeletal myxoid “chondrosarcomas” actually represent neuroendocrine tumors of soft parts.
Extraskeletal Myxoid Chondrosarcoma with Rhabdoid Features, with Special Reference to Its Aggressive Behavior
Authors: Oshiro Yumi , Shiratsuchi Hideki , Tamiya Sadafumi , Oda Yoshinao , Toyoshima Satoshi , Tsuneyoshi Masazumi
Published: June 2007

The presence of rhabdoid cells has been reported in various types of malignant neoplasms. Thirty-six cases of extraskeletal myxoid chondrosarcoma (EMC) were reviewed, and three of them revealed rhabdoid features. These cases contained cells having prominent eosinophilic globular cytoplasm, but were otherwise typical of EMC. Immunohistochemically, cytokeratin (CAM 5.2) was positive in three of 20 cases (15%), including two of the three with rhabdoid features. The rhabdoid cells were also immunostained with vimentin. The 5-year survival rate in the 26 cases with follow-up information was 73%, and the 10-year survival rate was 63%. The cases with rhabdoid features had a significantly poorer prognosis (p=0.0271). This study suggests that presence of rhabdoid features is a predictor of aggressive behavior in EMC, as it was shown to be in other mesenchymal neoplasms.
Meigs' Syndrome: Dr. Richard Cabot's Hidden First American Case
Authors: Young Robert H.
Published: June 2007

The syndrome known most widely as “Meigs' syndrome” is so named as a result of the description of it by Dr. Joe V. Meigs (a gynecologist with a strong interest in pathology) and Dr. John W. Cass (an internist with a major interest in pulmonary disease) in 1937. In his final writings on the topic 17 years later, Dr. Meigs reviewed the literature prior to his first report in more detail than he had initially and credited appropriately those who had noted the association of ovarian fibromatous tumors, ascites and pleural effusion in earlier times. He did not, however, record the description of the association by the great physician, Dr. Richard C. Cabot in 1912 even though they worked in the same hospital and the case in question was one of those that formed the basis of the report of Meigs and Cass.
Application of CARD-ISH for Assessment of Numerical Chromosome Aberrations in Interphase Nuclei of Human Tumor Cells
Authors: Buonamici Laura , Serra Massimo , Losi Luisa , Eusebi Vincenzo
Published: June 2007

In this study based on the study of a centromeric DNA probe specific for chromosome 8 the authors standardized a method for the enzymatic detection of specific chromosome copy numbers on interphase nuclei from tumor tissue samples. Since the in situ hybridization (ISH) of chromosome 8 specific probe was revealed with a catalyzed reporter deposition (CARD), which allows a high amplification of the hybridization signal, the method was designated as CARD-ISH. This method has been standardized on interphase nuclei isolated from clinical samples of pituitary adenomas, as well as on human normal lymphocytes. On the same samples, they also evaluated chromosome 8 copy number distribution by FISH. Comparison between CARD-ISH and FISH results showed no significant differences between the two methods, proposing CARDISH as a reliable alternative to FISH for chromosome numerical aberration assessment in laboratories that do not have specific facilities for epifluorescence microscopy or cytogenetics and that need a long-term storage of slides that had been used for diagnostic purposes.
Two Previously Unemphasized Features of Endometriosis: Micronodular Stromal Endometriosis and Endometriosis with Stromal Elastosis
Authors: Clement Philip B. , Young Robert H.
Published: June 2007

This report draws attention to two unusual features of the stromal component of endometriosis that can create problems in diagnosis. One of these is the exclusive presence of endometriotic stroma, so-called stromal endometriosis, that can occasionally take the form of microscopic nodules of endometriotic stroma on the pelvic peritoneum and other locations. This finding, which we refer to as a micronodular stromal endometriosis, can be overlooked entirely or lead to confusion with peritoneal involvement by low-grade endometrial stromal sarcoma. The other finding we describe is the presence of a prominent elastotic stromal response to endometriosis that can occasionally obscure or even focally obliterate the typical endometriotic stroma. This finding, although nonspecific, can be a diagnostic clue to the presence of endometriosis, especially when accompanied by the presence of the typical endometriod glands of that lesion.
Diagnostic Pitfalls in Surgical Pathologyuncovered by a Review of Malpractice Claims
Authors: Troxel David B.
Published: June 2007

Breast fine needle aspiration (FNA) biopsy accounted for 6% of surgical pathology and FNA claims reviewed from 1995-97. The majority of these claims were for false negative breast FNA resulting from sampling error in a woman with a palpable breast mass. Controversies concerning the definition of specimen adequacy for breast FNA are discussed and a strategy for minimizing the management and liability consequences of the problem is proposed. Claims for false positive breast FNA usually result from interpretive error.
Warty Carcinoma Arising in Condyloma Acuminatum of Urinary Bladder
Authors: Botella E. , Burgués O. , Navarro S. , Ramos D. , Ferrer J. , Gimeno C. , Llombart-Bosch A.
Published: June 2007

We describe the case of a 62-year-old man with chronic irritation of the urinary bladder resulting in dysuria and hypogastric pain. Three neoplasms measuring 0.5, 1, and 1.5 cm, respectively, were observed by cystoscopy and removed by transurethral resection (TUR). Histologic examination showed a complex folding of squamous hyperplastic epithelium around a connective tissue core. The superficial epithelium contained numerous koilocytes. The double polymerase chain reaction (PCR) detected DNA of type 11 human papillomavirus (HPV). The diagnosis was condyloma acuminatum of bladder. Three months later the patient presented with fever, and a new cytoscopy demonstrated an ulcerated, exophytic 4.5 cm mass. Histopathology showed a squamous carcinoma with papillomatous structure, pronounced viral koilocytosis, and irregular invasive deep margin. HPV type 11 was found with double PCR. The diagnosis was warty carcinoma arising in condyloma acuminatum. To the best of our knowledge, this is the first case of warty carcinoma of the urinary bladder described in the literature. We discuss the relationship between the infection by HPV and the development of condyloma acuminatum, its evolution toward a well-differentiated squamous carcinoma, and its distinction from verrucous carcinoma.
K-ras Gene Mutations in Liver Carcinomas from a Mediterranean Area of Spain
Authors: Boix-Ferrero Javier , Pellin Antonio , Blesa Jose Rafael , Adrados Manuel , Llombart-Bosch Antonio
Published: June 2007

The prevalence of human liver cancer shows a broad spectrum of variation in distinct geographical regions, depending on different risk factors, and their pathogenesis is poorly understood. We study the significance of molecular alterations of K-ras gene in human liver carcinomas in a low-incidence region such as a Mediterranean area of Spain (Valencia and Gerona). Our results reveal a low incidence of K-ras codon 12 mutations in hepatocellular carcinomas (HCC) and a higher incidence in cholangiocarcinomas (CCC). Similar results have been obtained in high-risk areas. We conclude that K-ras gene mutations are not a major event in the malignant transformation of hepatic cells in this region of the Mediterranean but that molecular implications of hepatocellular and cholangiocarcinomas appear to be different.
Differential Diagnosis Between Intraductal Papillary-Mucinous Tumors and Mucinous Cystic Tumors of the Pancreas
Authors: Fukushima Noriyoshi , Mukai Kiyoshi
Published: June 2007

Mucinous cystic tumors (MCTs) and intraductal papillary-mucinous tumors (IPMTs) are often confused with each other. However, clinicopathological studies have shown that these are two distinct entities. In this review, clinicopathological differences and important features for differential diagnosis are presented. MCTs are cyst-forming tumors in the body or tail of the pancreas seen almost exclusively in females. IPMTs show distinct duct ectasia in the pancreatic head with male predominance. Histologically both tumors consist of mucin secreting tall columnar epithelium. MCTs are often accompanied by characteristic “ovarian-type stroma.” Recent immunohistochemical and gene analysis have not demonstrated significant differences between two tumor types. These tumors should be clearly separated from ordinary ductal adenocarcinomas of the pancreas as they follow indolent course.
Uterine Endometrioid Carcinoma with Small Nonvillous Papillae: An Analysis of 26 Cases of a Favorable-Prognosis Tumor To Be Distinguished from Serous Carcinoma
Authors: Murray Shawn K. , Young Robert H. , Scully Robert E.
Published: June 2007

We have encountered a number of endometrioid carcinomas with small papillary buds lacking fibrovascular cores that could be confused with the small cellular papillae of serous papillary carcinoma (SPC). We have designated these tumors “endometrioid carcinoma with small nonvillous papillae” (ECSP). Because they have not been investigated previously we analyzed 26 examples and compared their features with those of 21 SPCs of the uterus. Three hundred and ninety consecutive cases of endometrial carcinoma diagnosed between January, 1989, and January, 1994, were retrieved from our hospital files; 26 (6.7%) of them, (8% of the endometrioid carcinomas) were identified as ECSP, and 21 (5.4%) as SPC. Tumors were classified as ECSP when the small papillae were present within the glands of otherwise typical endometrioid carcinoma or on the villous projections of villoglandular endometrioid carcinoma. Most of the papillae were in the form of buds of cells with ample eosinophilic cytoplasm and a low nuclear-to-cytoplasmic ratio, but some papillae had a more complex pattern. The papillae arose on a background of International Federation of Gynecology and Obstetrics (FIGO) grade 1 or 2 endometrioid carcinomas, which showed squamous differentiation in half the cases. SPCs were identified according to generally accepted criteria. The mean age of the patients with ECSP was 67 years, intermediate between that of the patients with endometrioid carcinoma lacking small nonvillous papillae (62 years) and that of the patients with SPC (71 years). Patients with ECSP more frequently presented at an earlier stage (73% stage I/LI) than those with SPC (29% stage I/II). The overall 5-year survival of patients with ECSP was 84% (95%CI: 0.68-1), more than double that of patients with SPC, 33% (95%CI: 0.10-0.56). ECSP may be confused with SPC on microscopic examination but has clinical and pathological features similar to those of endometrioid carcinoma lacking small nonvillous papillae, and unlike SPC, should be treated in the same manner as the former.
Vaginal Leiomyoma with Heterologous Paragangliomatous Elements
Authors: Naidoo Prabha
Published: June 2007

A vaginal leiomyoma with heterologous paragangliomatous elements is reported. The patient was a 62-year-old woman who presented with uterovaginal prolapse and an asymptomatic vaginal mass that had been present for many years. Histology of the excised mass showed a leiomyoma in a submucosal location, with irregularly shaped islands of chief cells scattered throughout the lesion. These cells were arranged in nests and were surrounded by S 100 protein-positive sustentacular cells. The chief cells showed immunoreactivity with chromogranin, synaptophysin, and neuron-specific enolase. Although various heterologous elements are commonly encountered within uterine leiomyomata, such elements have not been described within vaginal leiomyomata. Furthermore, the occurrence of paragangliomatous tissue within leiomyomata has not been reported to date.
Cytokeratin Subunits of Inclusion Bodies in Rhabdoid Cells: Immunohistochemical and Clinicopathological Study of Malignant Rhabdoid Tumor and Epithelioid Sarcoma
Authors: Shiratsuchi Hideki , Oshiro Yumi , Saito Tsuyoshi , Itakura Eijun , Kinoshita Yoshiaki , Tamiya Sadafumi , Oda Yoshinao , Komiyama Sohtaro , Tsuneyoshi Masazumi
Published: June 2007

Extrarenal malignant rhabdoid tumor (MRT), which is recognized as being histologically similar to renal MRT, is characterized by the presence of “rhabdoid cell” (RC) and a highly aggressive biological behavior. Recently it has been proposed that “proximal variant” of epithelioid sarcoma (ES), whose morphology is similar to that of MRT, actually has a more aggressive clinical course than classical type ES. Detailed immunohistochemical analysis of cytokeratin (CK) subunits was performed in 3 cases of extrarenal MRT, 3 cases of renal MRT, and 11 cases of ES comprising 2 “proximal variants” and 9 classical types. Renal and extrarenal MRTs showed positive immunoreactivity for both CK8 and CK18. Classical type ESs were diffusely positive, not only for CK8 and CK18, but also for other cytokeratin subunits including CK4, 6, 10, 13, 16, 17, and “high-molecular-weight” CKs (CK1, 5, 10, and 14). On the other hand, proximal ES revealed limited immunohistochemical reactivity for cytokeratins, compared with classical ES. In conclusion, the inclusion bodies of RCs show immunoreactivity confined to CK8, CK18, and vimentin. Furthermore, ES has additional CK expressions, while proximal ES possesses characteristics intermediate between those of classical ES and those of external MRT.
Renal Cell Carcinoma Metastatic to the Testis and Its Adnexa: A Report of Five Cases Including Three That Accounted for the Initial Clinical Presentation
Authors: Datta Milton W. , Ulbright Thomas M. , Young Robert H.
Published: June 2007

Five cases of renal cell carcinoma metastatic to the testis or its adnexa are described, including 3 that represented the initial presentation and mimicked primary testicular neoplasms. The patients ranged from 46 to 85 years of age. Three presented with self-identified testicular masses. One patient was investigated because of fever of unknown origin and was found to have a left rib metastasis. Further work-up led to the discovery of a testicular mass. The final patient had a tumor of the spermatic cord that was examined without knowledge that he had a prior renal neoplasm. All the tumors were unilateral. They ranged from 1.8 to 5.0 cm; multiple tumor nodules were present in one of them but the others were discrete solitary masses. Four tumors were yellow/yellow-tan, and one was gray. On microscopic examination all the tumors were of the clear cell type. Patterns included solid sheets, acini, cysts, alveoli, and trabeculae. Two had prominent vascular invasion. Diagnoses initially entertained in these cases included Sertoli cell tumor, Sertoli-Leydig cell tumor, and clear cell cystadenoma of the epididymis. In 3 cases a kidney tumor was discovered 2 to 4 weeks after the diagnosis of renal cell carcinoma metastatic to the testis was rendered. On follow-up two patients died of tumor, and two were alive (5 months and 1 year) after orchiectomy. The diagnosis of renal cell carcinoma metastatic to the testis should be considered in evaluating a clear cell tumor of the testis, particularly in an older male or if the appearance suggests a Sertoli cell tumor. The differences in survival between metastatic renal cell carcinoma and sex cord-stromal tumors indicate the importance of considering the former in the differential.
Erdheim-Chester Disease with Extensive Marrow Necrosis
Authors: Kim Na-Rae , Ko Young-Hyeh , Choe Yeon Hyeon , Lee Hong-Gi , Huh Bang , Ahn Geung-Hwan
Published: June 2007

Erdheim-Chester disease is a rare systemic disorder characterized by a fibrosing xanthogranulomatous infiltration of multiple organs. We report a case of Erdheim-Chester disease with diffuse necrosis leading to difficulty in making a prompt diagnosis. Radiologically, osteosclerotic lesions with osteolytic element involved metadiaphyses of both proximal tibia, and retroperitoneal infiltrations encasing both kidneys, both adrenals, and aorta were found. A biopsy of the tibia showed diffuse infiltration of foamy histiocytes, Touton-type giant cells, and fibroblastic cells associated with extensive coagulative necrosis. Immunohistochemically, foamy histiocytes were positive for CD68 and peanut agglutinin and negative for S-100 protein. A few Langerhans' cells, which were difficult to identify in hematoxylin-eosin stain, were highlighted by immunostain for S-I 00 protein. The patient received supportive therapy and was alive 1½ years after diagnosis, with newly developed bilateral retrobulbar lesions and worsened heart failure.
Phyllodes Tumor in Ectopic Breast Tissue of the Vulva
Authors: Chulia M. T. , Paya A. , Niveiro M. , Ceballos S. , Aranda F. I.
Published: June 2007

Phyllodes tumor arising from ectopic breast tissue of the vulva is an extremely rare occurrence. A case is reported in a 34-year-old nulligravida woman, presenting as a nodule on the left labium majus. A simple excision was carried out, and no recurrence has been detected after 18 months of follow-up.
Combined Carcinoid Tumor and Ganglioneuroblastoma of the Lung: A Case Report
Authors: Freeman Jonathan K. , Otis Christopher N.
Published: June 2007

Carcinoid tumor is a well-differentiated epithelial neuroendocrine neoplasm which is common in the lung. Ganglioneuroblastoma is a moderately differentiated nonepithelial neuroendocrine neoplasm which is very rare in the lung. Neuroendocrine tumors with epithelial and nonepithelial elements are rare in any site and have not been reported in the lung. This case is an example of a primary neuroendocrine lung tumor combining epithelial and non-epithelial components: carcinoid tumor and ganglioneuroblastoma.
Orbital Hemangiopericytoma and Solitary Fibrous Tumor: A Morphologic Continuum
Authors: Goldsmith Jeffrey D. , van de Rijn Matt , Syed Nasreen
Published: June 2007

Solitary fibrous tumors (SFT) and hemangiopericytomas (HPC) are soft tissue tumors with known histologic and immunohistochemical overlap. A series of these tumors located in the orbit were analyzed in order to determine whether they could be reclassified based on currently recognized histologic criteria. Ten orbital spindle cell lesions, all of which were positive for CD34 antigen, were examined. Diagnostic criteria for SFT included a cytologically bland spindle cell lesion with variable cellularity and focal dense collagenization with diffuse, strong CD34 reactivity, while the criteria for HPC required a more monotonous cellular proliferation without significant variability in cellularity, a “staghorn” vascular pattern, minimal collagenization, and focal or absent CD34 staining. Tumors with typical histologic and immunohistochemical features of HPC or SFT were diagnosed as HPC and SFT, respectively. Those tumors with histologic or antigenic profiles not classic for HPC or SFT were defined as ‘indeterminate.’ Three lesions were classified as SFT and 1 tumor was diagnosed as HPC through use of the above-cited histologic criteria. All lesions showed positive staining of tumor cells with CD34 antigen in varying amounts and were negative for cytokeratin AE 1-3, epithelial membrane antigen, CD68, and Factor XIlla. One solitary fibrous tumor focally stained for S-100 protein and 1 hemangiopericytoma was focally positive for HHF-3 5. Of the 10 analyzed tumors, 6 were classified as ‘indeterminate.’ Furthermore, 1 lesion whose primary histology was that of an SFT recurred 9 years later with an appearance consistent with an ‘indeterminate’ lesion. Our results call into question the present histologic separation of HPC and SFT in the orbit. As in other sites, including deep soft tissue, these data suggest that SFT and HPC are 2 lesions whose morphologic features are best interpreted to exist along a continuum, rather than 2 lesions with distinctly defined histopathology.
Mammary Epithelioid Myofibroblastoma Arising in Bilateral Gynecomastia
Authors: Reis-Filho Jorge Sergio , Faoro Leonardo Nercolini , Gasparetto Emerson Leandro , Totsugui Joel Takashi , Schmitt Fernando Carlos
Published: June 2007

Myofibroblastoma of the breast is a rare benign neoplasm, which has rarely been reported in association with gynecomastia. We report a case of a 25-year-old male patient with an epithelioid myofibroblastoma arising in a context of bilateral gynecomastia. The lesion was composed of nests and cords of epithelioid cells, with round to oval nuclei, granular chrornatin, and distinct nucleoli dispersed in a myxoid to collagenous stroma with marked vascular proliferation. Immunohistocrhemical profile showed diffuse positivity for vimentin and focal immunoreactivity for desmin, whereas cytokeratins (CAM5.2 and AE1/AE3), EMA, alph-a smooth muscle actin, actin HHF35, CEA, S1OO, factor VIII, neuron-specific enolase, CD31, and CD34 were all negative. We emphasize that this diagnosis is difficult to establish, owing to the rarity of this variant and clinical presentation.
Thymidine Phosphorylase Expression in Gallbladder Adenocarcinomas
Authors: Giatromanolaki Alexandra , Sivridis Efthimios , Simopoulos Constantinos , Polychronidis Alexandros , Gatter Kevin C. , Harris Adrian L. , Koukourakis Michael I.
Published: June 2007

The expression of thymidine phosphorylase (TP), a potent chemotactic factor for enothelial cells, was studied in 60 adenocarcinomas of the gallbladder, by use of imunohistochemical techniques. Results on patterns of TP expression were correlated with angiogenesis (anti-CD31), histopathological variables, and patient survival. TP was frequently expressed in tumor cells, stromal cells, tumor-associated macrophages, and lymphocytes of gallbladder adenocarcinomas. The expression was mixed nuclear/cytoplasmic. However, only nuclear TP (TPnuc) expression by tumor cells was correlated with increased angiogenic activity. High angiogenesis, assessed as microvessel density (MVD), was the most significant prognostic factor. The subgroup of patients with TPnuc and medium/high MVD had the worst prognosis as evaluated by the survival curves. Furthermore, CD31+ lymphocytes, frequently seen in carciomas with high-fibroblastic TP reactivity, were connected with an improved surival. It is concluded that angiogenesis, as verified by multivariate analysis, is the most important prognostic factor in gallbladder carcinomas. In these tumors, high histologic grade and low CD31+ lymphocytic infiltration are also independent preictors of poor prognosis. TP is associated with an aggressive phenotype apparently because of its anglogenic activity. Therapeutic strategies targeting TP may be of value in patients overexpressing this enzyme.
Brain-Invasive Solitary Fibrous Tumor of the Meninges: Report of a Case
Authors: Castilla Elias A. , Prayson Richard A. , Stevens Glen H. J. , Barnett Gene H.
Published: June 2007

Solitary fibrous tumor is a mesenchymal neoplasm that most commonly arises in the pleura, but also in multiple extrapleural sites including, rarely, the meninges. Imunohistochemical findings facilitate its differentiation from other spindle cell lesions such as fibrous meningioma. Although the great majority of extrapleural solitary firous tumors behave in a benign fashion, only rare examples of brain-invasive tumors have been documented. We present a case of a brain-invasive solitary fibrous tumor arising in the meninges of a 40-year-old woman. The tumor was marked by focally prominent hypercellularity, moderate nuclear pleomorphism, and increased mitotic activity. Focal infiltration into the underlying brain parenchyma was observed. The tuor was CD34 positive and EMA negative.
Loss of Heterozygosity of p53, BRCA1, VHL, and Estrogen Receptor Genes in Breast Carcinoma: Correlation with Related Protein Products and Morphologic Features
Authors: Otis Christopher N. , Krebs Patricia A. , Albuquerque Ana , Quezado Martha M. , Juan Xavier San , Sobel Mark E. , Merino Maria J.
Published: June 2007

Correlation of loss of heterozygosity (LOH) of p53, BRCA1, VHL, and estrogen receptor (ER) genes with the expression of related protein products and morphologic features predictive of aggressive biologic behavior was investigated to determine the significance of LOH in these genes. DNA from 35 formalin-fixed, paraffin-embedded breast carcinomas was obtained by microdissection of histologic sections. LOH was determined by polymerase chain reaction (PCR) using primers TP53, D3S1038, D17S855, and ESR for p53, VHL, BRCA1, and ER genes, respectively. p53, ER, and progesterone receptor (PR) protein expression was evaluated by immunohistochemistry. Morphologic evaluation included histologic type, and histologic and nuclear grades. TP53 LOH was identified in 13 (52%), BRCA1 LOH in 3 (17%), VHL LOH in 1 (4%), and ER LOH in 4 (21%) of 25, 17, 24, and 19 informative cases, respectively. p53 and ER protein expression was identified in 20 (57%) and 25 (71%) cases, respectively. TP53 LOH directly correlated with both high histologic and nuclear grade (P<O.0 1). BRCA1, VHL, and ER LOH was not frequent enough for correlation to morphologic features. Although 4 of 4 ER and 7 of 13 p53 LOH cases expressed related proteins, LOH did not correlate with protein expression. TP53 LOH may be an event contributing to aggressive biologic behavior since it is strongly associated with high histologic and nuclear grade. Missense or nonsense mutations may explain the absence of detectable p53 protein in 6 of 13 cases with p53 LOH. All 4 ER LOH cases expressed ER protein. BRCAI and VHL LOH is infrequent in sporadic breast carcinoma.
Lymphomas of the Bone: A Pathological and Clinical Study of 54 Cases
Authors: Gianelli Umberto , Patriarca Carlo , Moro Alessia , Ponzoni Maurilio , Giardini Roberto , Massimino Maura , Alfano Rosa Maria , Armiraglio Elisabetta , Nuciforo Paolo , Bosari Silvano , Coggi Guido , Parafioriti Antonina
Published: June 2007

We examined 28 cases of primary bone lymphomas (PBL; stage IE) and 26 cases of systemic lymphomas involving the bone (SBL; stage IIE to IV). Two histologic types were prevalent: Diffuse large B-cell lymphomas (DLBCL; 26 PBL and 21 SBL) and CD30+ anaplastic large cell lymphomas (ALCL; 1 PBL and 4 SBL). A mature B phenotype (CD45+, CD20+, CD79a+, CDw75+/-, CD10-/+) was established in the DLBCL group. Bcl-2 immunoreactivity was demonstrated in 13/37 cases (35%), and bcl-6 immunostaining was observed in 22/32 cases (69%). ALCL showed null/T phenotype (CD3-/+; CD43+/-; CD30+), with ALKI-1 expression in 3/3 cases. With use of a FR3A primer, a monoclonal pattern was demonstrated by PCR analysis in 22/41 lymphomas (54%). Bcl-2 translocation was identified in 2/41 cases (5%). This study details the clinical and pathological characteristics of bone lymphomas. Our immunohistochemical and molecular data suggest that most of them are “de novo” DLBCL and support their follicle center origin.
Can We Rely on Pathologic Parameters to Define Conservative Treatment of Papillary Thyroid Carcinoma?
Authors: Paessler Michele , Kreisel Friederike H. C. , LiVolsi Virginia A. , Akslen Lars A. , Baloch Zubair W.
Published: June 2007

Papillary thyroid carcinoma is the most common malignant tumor of the thyroid and usually behaves in an indolent fashion. At most institutions these tumors are treated by near-total or total thyroidectomy followed by radioactive iodine ablation. The 2 main reasons for this extensive treatment include high rate of multicentricity in papillary carcinoma and difficulty in ablating large thyroid remnants with radioactive iodine after partial thyroidectomy. Some authors believe, however, that this treatment protocol may not be justified in all cases of papillary carcinoma. We analyzed 253 total thyroidectomies performed for papillary thyroid carcinoma for the following pathologic variables: tumor size, presence of tumor capsular and/or vascular invasion, intrathyroidal spread, tumor in the contralateral lobe, and lymph node metastases. Tumors measuring less than 1 cm and those with extrathyroidal soft tissue extension were excluded from this study. Among 253 cases (197 females, 56 males, age range 14-88 years), the primary tumor size ranged from 1-9.5 cm; 162 cases were completely encapsulated. Tumor capsule invasion was seen in 139 (86%) and vascular invasion was present in 32 (13%) cases; of these 27 (11% of the total) patients showed both tumor capsule and vascular invasion. Seventy-four (29%) patients showed tumor in the contralateral lobe; in 35 (47%) of these cases the contralateral tumor measured less than 1.0 cm. Lymph nodes were sampled in 106 cases, metastases were present in 67 (67/106 = 63%) and only 16 cases with lymph node metastases showed contralateral tumors. No significant correlation was noted between tumor size, occurrence of contralateral tumors, and lymph node metastases. Seventy-one percent of cases included in this study failed to show contralateral tumors. Hence, pathologic parameters such as lack of vascular invasion and lack of multifocality may be used to identify patients who can benefit from conservative therapy alone.
Mesectodermal Leiomyoma of Ciliary Body
Authors: Alenda C. , Aranda F. I. , Paya A. , Cordoba C.
Published: June 2007

A 37-year-old woman had a mass in her left ocular globe. Uveal melanoma was suspected and enucleation was performed. Microscopically, the lesion proved to be a typical case of mesectodermal leiomyoma of the ciliary body. Acording to some authors, the peculiar neural appearance of this tumor could be the reflection of its probable origin from mesectodermal smooth muscle. Immunohistochemical analysis showed reactivity for muscle-specific actin and negativity for desmin, S-o00 protein, HMB-45, EMA, and GFAP. Our results do not support the proposed neuroectodermical origin of this tumor, since coexpression of muscular and neural markers was not observed.
Patterns of β-Catenin Expression in Gastric Carcinoma: Clinicopathological Relevance and Mutation Analysis
Authors: Nabais Sérgio , Machado José Carlos , Lopes Carlos , Seruca Raquel , Carneiro Fáitima , Sobrinho-Simões Manuel
Published: June 2007

Studies on the expression of β-catenin (β-ct) in gastric carcinoma have provided conflicting results, and the role played by β-ct mutations in gastric carcinogenesis remains unclear. In an attempt to clarify the aforementioned issues we undertook the retrospective study of 157 gastric carcinomas by using immunohistochemistry and molecular genetics. Reduced/absent membranous β-ct expression was significantly associated with isolated-cell/diffuse histotype both in “pure” diffuse gastric carcinomas and in the isolated-cell/diffuse component of mixed carcinomas. Cytoplasmic and/or nuclear β-ct expression was particularly prevalent in mixed carcinomas and was significantly associated with lymphatic vessel invasion and lymph node metastases. β-ct mutations were not detected in any case. We conclude that the pattern of β-ct expression is closely related to gastric carcinoma histotype. The activation of Wnt/β-ct pathway is associated with mixed gastric carcinoma and with features of clinical aggressiveness; the mechanism(s) underlying this pathway in gastric carcinoma are not due to β-ct mutations and remain to be elucidated.
Lymphoid Progenitor Cells in Human Tonsils
Authors: Strauchen James A. , Miller Lorraine K.
Published: June 2007

To investigate the occurrence of lymphoid progenitor cells in human tonsils, we studied tonsils from children and adults by immunohistochemistry by using a panel of antibodies to antigens associated with lymphoid progenitor cells, including terminal deoxynucleotidyl transferase (TdT), CDl0 (CALLA), CD34, CD99 (p30/32mic2), and CD 117 (c-kit), and compared them to reactive lymph nodes. Lymphoid progenitor cells, positive for TdT, CD 10, and CD99, but not CD34 or CD1 17, were readily identified in tonsils from children and adults (TdT, 14 of 15; CD10, 15 of 15; CD99, 11 of 15), but were rarely present in lymph nodes (TdT, 1 of 8; CD 10, 1 of 8; CD99, 0 of 8). Lymphoid progenitor cells in tonsils were localized to discrete foci at the periphery of lymphoid lobules adjacent to fibrous septae. Lymphoid progenitor cells are present in human tonsils, and the tonsils are a potential site of postnatal lymphopoiesis. The presence of lymphoid progenitor cells in human tonsils should not be confused with lymphoblastic lymphoma or leukemia.
Pulmonary Hyalinizing Granuloma Associated with Aspergillus Infection
Authors: Pinckard J. Keith , Rosenbluth Daniel B. , Patel Kishor , Dehner Louis P. , Pfeifer John D.
Published: June 2007

A 38-year-old immunocompetent man with occupational exposure to Aspergillus presented with dyspnea, pleuritic chest pain, and hemoptysis. Chest roentgenograms and computed tomography scans demonstrated multiple pulmonary nodules bilaterally. An initial set of bronchial washing cultures grew Aspergillus fumigatus, serologic testing showed an elevated anti-Aspergillus titer, and immunodiffusion testing was positive for antibody against A. fumigatus and A. niger. There was no microbiologic or serologic evidence of infection by other pathogens, and no clinical or laboratory evidence of autoimmune disease. An open lung biopsy was diagnostic of pulmonary hyalinizing granuloma. This novel association with Aspergillus infection not only expands the spectrum of pathogens linked to pulmonary hyalinizing granuloma but also documents a new pattern of lung disease that can be caused by Aspergillus.
The Concept of Bronchioloalveolar Cell Adenocarcinoma: Redefinition, A Critique of the 1999 WHO Classification, and an Ultrastructural Analysis of 155 Cases
Authors: Sidhu Gurdip S. , Wieczorek Rosemary , Cassai Nicholas D. , Zhu Chang-Cheng
Published: June 2007

Bronchioloalveolar cell adenocarcinoma (BACA) is bronchioloalveolar because (1) it arises in bronchioles and alveoli and (2) differentiates into bronchiolar and alveolar cells. Every entity possesses unique characteristics that separate it from other entities. The unique characteristic of BACA is its cell type. Lepidic growth is a clue to the cell type and, even though present in the vast majority, is not unique or absolutely essential. Because of the algebraic nature of concepts, the degree of differentiation, the extent of lepidic growth, and the degree of stromal desmoplasia cannot be used as definitional requirements. Likewise, in malignant tumors, absence of stromal invasion cannot be required. An epistemologically valid definition of BACA is proposed and a study of 155 cases defined this way and examined ultrastructurally is presented.
Progressive Transformation of Germinal Centers: A Clinicopathological Study of 42 Japanese Patients
Authors: Kojima Masaru , Nakamura Shigeo , Motoori Tadashi , Itoh Hideaki , Shimizu Kazuhiko , Yamane Nobuo , Ohno Yoshihiro , Ban Satoshi , Yoshida Katsue , Hoshi Kazue , Oyama Tetsunari , Shimano Shunichi , Sugihara Shiro , Sakata Noriyuki , Masawa Nobuhide
Published: June 2007

To clarify the clinicopathological features of progressive transformation of germinal center (PTGC) unrelated to nodular lymphocyte predominant Hodgkin's lymphoma in Japanese patients, we reviewed 42 cases and compared the results with those of the United States and Germany. Our results were similar to theirs, with male predominance (M/F ratio, 3:1) and the presentation of a solitary asymptomatic enlarged lymph node in the head and neck area as the common features. However, in Japan, PTGC occurs more frequently in elderly patients. In this study, 12 (29%) of the patients with PTGC were aged 60 years or more. Thirteen patients (31%) with lymphadenopathy in the neck and head area had developed localized chronic inflammation (chronic sialoadenitis=4, chronic tonsillitis=3, infectious epidermal cyst=2) or an autoimmune disorder (hyperthyroidism=2 and bronchial asthma=2). None of the patients developed a malignant lymphoma during the follow-up period of 5 to 238 months (median 27 months). Histologically, in a single longitudinal section of the lymph node, the PTGC occupied up to 5% of the total follicles in 22 patients, 5-10% in 10, 10-20% in 7, and more than 20% in 3. In 5 (12%) patients, an association with prominent marginal zone hyperplasia was also noted. This study also indicates that nodal involvement by various low-grade B-cell lymphomas exhibiting marginal zone distribution patterns should be considered as a differential diagnosis of PTGC. Moreover, in Japan, PTGC is thought to be involved in the etiology of florid reactive follicular hyperplasia in elderly patients.
Overexpression of NSAID-Activated Gene Product in Prostate Cancer
Authors: Iczkowski Kenneth A. , Pantazis Cooley G.
Published: June 2007

NSAID-activated gene (NAG-1) protein was previously identified by microarray analysis as overexpressed in prostate cancer. We performed immunohistochemistry and Western blotting with rabbit polyclonal antibody to NAG 1. Fifty malignant tissues obtained by prostatectomy and 17 from benign cases were compiled. Cancer tissues included Gleason scores 3-6, 3+4=7, 4+3=7, and 8-10. Cancer and high-grade prostatic intraepithelial neoplasia (PIN) consistently showed moderate to intense cytoplasmic reactivity in 95-100% of epithelium. Staining intensity inversely correlated with preoperative serum prostate-specific antigen (PSA) (p=0.005) and with grade, averaging (on a 0 to 3+ scale) 2.3 ± 0.6 in the lowest grade group, and 2.0 ± 0.7, 1.8 ± 0.5, and 1.5 ± 0.6 as grade increased (p < 0.008). Benign epithelium was nonreactive in 17/17 specimens without concurrent cancer (1 transurethral resection, 2 enucleation, 4 biopsy, p=0.002). Decreased NAG I expression in higher grade cancer is consistent with its known antitumorigenic, proapoptotic activities
Issues in the Interpretation of Breast Core Biopsies
Authors: Shousha Sami
Published: June 2007

Core biopsies are now widely used for the nonoperative diagnosis of breast masses and microcalcifications and have replaced fine-needle aspiration (FNA) cytology for most lesions in many centers. In the United Kingdom, a scoring system of 5 reporting categories, B 1-B 5, has been adopted, which is to some extent similar to that used in the interpretation of breast FNA. This article is based on the practice at Charing Cross Hospital, London, which is a major regional breast screening and treatment center covering the West of London area; as well as on a thorough review of the contemporary literature. It begins by discussing issues related to the adoption of the technique and to handling core biopsies, followed by a brief presentation of the reporting categories. The article then deals with some commonly encountered diagnostic problems
Upper Gastrointestinal Bacillary Angiomatosis Causing Hematemesis: A Case Report
Authors: Chetty R. , Sabaratnam R. M.
Published: June 2007

A 38-year-old HIV-positive woman presented with massive hematemesis on initial admission to hospital. Endoscopy revealed ulcerated nodular lesions in the esophagus, stomach, and duodenum. The clinical impression was of Kaposi's sarcoma. The stomach was biopsied when the patient re-presented, and another endoscopy was performed. The biopsy showed mucosal ulceration with a proliferation of vascular channels associated with neutrophils and clumps of purplish, granular bacterial colonies, which were highlighted by a Warthin-Starry stain. The histopathological features were typical of bacillary angiomatosis. This case highlights bacillary angiomatosis involving the gastrointestinal tract at multiple sites, the cause of massive upper gastrointestinal hemorrhage that was the initial presentation of an HIV-positive patient, and the occurrence of visceral bacillary angiomatosis in the absence of cutaneous lesions
Histologic Features of Mycophenolate Mofetil-Related Colitis: A Graft-Versus-Host Disease-Like Pattern
Authors: Papadimitriou John C. , Cangro Charles B. , Lustberg Alexander , Khaled Amr , Nogueira Joseph , Wiland Ann , Ramos Emilio , Klassen David K. , Drachenberg Cinthia B.
Published: June 2007

Mycophenolate mofetil (MMF) is widely used for maintenance immunosuppression in solid organ transplantation. Gastrointestinal toxicity, usually manifested as diarrhea, is the most common side effect of MMF. We evaluated colonic biopsies from 20 renal transplant patients with MMF-related diarrhea. The latter was defined by the absence of any other demonstrable etiology and improvement or resolution of symptoms by the discontinuation or reduction of the dose of MMF alone. These biopsies were compared with colon biopsies from patients with the following: acute graftversus-host disease (GVHD, n=10), inflammatory bowel disease (IBD) or infectious colitis (n=10), and colon biopsies from renal transplant patients not receiving MMF (n=8). Normal colonic segments from surgical specimens served as normal controls (n=5). Colonic biopsies from patients with MMF-related diarrhea showed prominent crypt cell apoptosis and reactive/reparative changes including enterocyte cytologic atypia, increased neuroendocrine cells, and glandular architectural distortion. The changes were similar, although of milder degree to the ones seen in patients with acute intestinal GVHD. This pattern of injury was not seen in controls or in biopsies from transplant patients not receiving MMF, and it was markedly different from the one seen in idiopathic inflammatory or infectious colitis. The severity of histologic changes correlated significantly with the endoscopic degree of "colitis." There was no statistically significant correlation between histologic damage and the dose of MMF (corrected for body weight and renal function). MMF-related colitis is a distinct entity that displays histologic features remarkably similar to the ones associated with intestinal GVHD. This form of injury could be related to either direct toxicity or an "innocent bystander" phenomenon secondary to the alteration of the immunologic microenvironment of the colon caused by the MMF.
Sclerosing Variant of Follicular Lymphoma Arising from Submandibular Glands and Resembling “Küttner Tumor”: A Report of 3 Patients
Authors: Kojima Masaru , Nakamura Shigeo , Itoh Hideaki , Yamane Yuko , Tanaka Hiroshi , Sugihara Shiro , Sakata Noriyuki , Masawa Nobuhide
Published: June 2007

We present 3 patients with a sclerosing variant of follicular lymphoma that arose from the submandibular gland and resembled "Kiittner tumor." All 3 patients developed a painless unilateral tumor in the submandibular region. Histologically, all 3 lesions were categorized as follicular lymphoma grade 2. The neoplastic follicles were found to be separated by thick connective tissue, and periductal chronic inflammation with periductal fibrosis and duct ectasia was found in the residual atrophic gland. Immunohistochemistry revealed that all of the lesions contained a monoclonal tumor cell population. The immunophenotyopes of the lymphoma cells were CD 10+, CD 20+, CD 79a+, BCL-6+, CD 3-, CD 5-, CD 21-, CD 23-, CD 43-, CD 45RO-, BCL-2-, and Cyclin DI -. Two of the 3 patients exhibited clonal bands for the IgH gene by polymerase chain reaction assay. "Kiittner tumor," which is a common fibrosing, chronic inflammatory lesion of the submandibular gland, is sometimes diagnosed as a malignant tumor. This study indicates that this sclerosing variant of follicular lymphoma should be added to the list of different diagnoses for “Kuittner tumor.”
Ovarian Metastasis from Renal Cell Carcinoma: A Report of Three Cases
Authors: Insabato Luigi , De Rosa Gaetano , Franco Renato , D'Onofrio Vittoria , Di Vizio Dolores
Published: June 2007

Ovarian metastases from renal cell carcinoma (RCC) are very rare. Over the past 16 years we have encountered 3 examples. The first 2 cases occurred in adults 49 and 50 years old, respectively, who had huge ovarian metastases, clinically detected 12 and 14 months, respectively, after diagnosis of RCC. The third case was a 17-year-old girl in whom a metastatic renal cell carcinoma was detected in an otherwise benign-appearing cystic ovarian mass. To the best of our knowledge only 11 cases of clinically detected ovarian metastases of RCC have been reported. We report 3 new cases and review the literature on the subject.