bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Ewing's Sarcoma of the Duodenum: A Case Report
Authors: Kie Jeong-Hae , Lee Mi-Kyung , Kim Chong-Jai , Lee Kyibeom , Kwon Kuk-Whan , Yang Woo-Ick
Published: June 2007

We report a case of Ewing's sarcoma arising from the duodenum in a 20-year-old woman who presented with a rapidly progressive ulcerative lesion. The surgical specimen obtained via Whipple's operation revealed a small round-cell tumor (SRCT) in the first and second portion of the duodenum. The tumor cells revealed strong immunoreactivity for CD 99 and vimentin and focal paranuclear dot-like immunoreactivity for cytokeratin. Electron microscopy showed primitive tumor cells with few cytoplasmic organelles, but neither neurosecretory granules nor specific cell junctions were present. On Western blot study, 68-kDa EWS/FLIl fusion protein was detected. The occurrence of Ewing's sarcoma in the gastrointestinal hollow viscus has recently been recognized, and this case expands the known anatomic sites that can harbor Ewing's sarcoma by demonstrating primary duodenal involvement.
Malignant Fibrous Histiocytoma Arising Within a Bone Infarct in a Patient with Sickle Cell Trait
Authors: Duong Scott , Sallis Julian G. , Zee Sui Y.
Published: June 2007

Sarcoma associated with osteonecrosis or bone infarction is a rare but well-documented pathological event. In this report, a 69-year-old man with sickle cell trait presented with malignant fibrous histiocytoma (MFH) in his distal tibia. The resected tumor was found in association with a large medullary infarct that extended 10 cm proximal from the tumor site. Bone infarcts can be caused by a number of processes including corticosteroid overuse, alcoholism, dysbarism, and hemoglobinopathies such as sickle cell disease. Patients with sickle cell anemia often develop osteonecrosis, but osteonecrosis has also been reported in people with sickle cell trait, albeit much more rarely. Our patient is only the third reported case of infarct-related bone sarcoma in a patient with sickle cell trait. Bone infarction may be a rare though serious consequence of sickle cell trait.
Focal Divergent Chondrosarcomatous Differentiation in a Primary Pleomorphic Liposarcoma and Expression of Transforming Growth Factor 3
Authors: Panoussopoulos Dimitris , Theodoropoulos George , Lazaris Andreas Ch. , Papadimitriou Konstantina
Published: June 2007

A rare case of primary pleomorphic liposarcoma of the thigh with a myxoid component, in which divergent differentiation to a well-differentiated chondrosarcoma was focally present, is described. Presence of heterologous elements has mainly been recognized in the context of dedifferentiated liposarcomas. Few cases of benign mesenchymal tissue have also been reported in well-differentiated and myxoid liposarcomas, while divergent sarcomatous differentiation in liposarcomas appears to be also rare in the absence of dedifferentiation. Positive immunostaining of transforming growth factor-n, which seems to play a role in the formation of bone and cartilage, was demonstrated in our case. Review of the existing literature on the subject has been carried out.
ret/PTC and BRAF Act as Distinct Molecular, Time-Dependant Triggers in a Sporadic Irish Cohort of Papillary Thyroid Carcinoma
Authors: Smyth P. , Finn S. , Cahill S. , O'Regan E. , Flavin R. , O'Leary J. J. , Sheils O.
Published: June 2007

The purpose of this study was to assess BRAF mutation rates in various thyroid tissues and to investigate if concomitant mutations with ret/PTC activation occurred in inflammatory and neoplastic lesions. To this end, we developed a novel Taqman® based screening assay for the common T1799A BRAF mutation. Heterozygous T1799A mutations were detected in 13 of 34 (44%) papillary thyroid carcinomas (PTCs) tested. No such mutations were detected in the other tissue types tested. Concomitant presence of both oncogenes was reported in 5 of the 34 PTCs. A significant temporal trend was observed, with ret/PTC chimera detected for the most part before 1997 and BRAF mutations being more prevalent after 1997. The results suggest that some environmental/etiological agent(s) may have influenced the pathobiology of thyroid tumor development, among the population examined, over time.
Benign Hürthle Cell Adenoma with Papillary Architecture: A Benign Lesion Mimicking Oncocytic Papillary Carcinoma
Authors: Mai Kien T. , Elmontaser Ghazi , Perkins D. Garth , Thomas Jane , Stinson William A.
Published: June 2007

We studied the significance of encapsulated Hürthle cell thyroid nodules with papillary structures lacking the nuclear features of papillary thyroid carcinoma (PTC); 19 cases fulfilling these criteria were encountered The patients' ages ranged from 22 to 40 years (32±6), and the F:M ratio was 3:1 The tumors measured from 0.5-5 cm (2±1 .1). The diameter of the tumor cell nuclei ranged from 5.6 to 7.2 microns. Many nodules had nuclei displaying a fine chromatin pattern somewhat resembling those of PTC, but these were present in <20% of the tumor cells. Immunohistochemically, there was reactivity for MIB-I in the papillary structures, negativity to focally weak reactivity for HBME and galectin-3, and negativity to moderate diffuse reactivity for CK19. Clinical follow-up from 1 to 19 years revealed no evidence of metastases in any of the cases. It is unlikely that the papillary structures in the study cases represent degenerative changes in view of the proliferative activity we have demonstrated in them. In view of (1) the encapsulation and the uniformity of the constituent cells, (2) the negative or weak immunoreactivity for galectin-3 and HBME and negative to moderate immunoreactivity for CK19, and (3) the absence or paucity of nuclear criteria for the diagnosis of PTC and the absence of lymph node metastasis in all study cases, we believe that these lesions represent the papillary variant of oncocytic follicular adenoma (Hürthle cell adenoma). Recognition of this entity is important to avoid an overdiagnosis of oncocytic PTC.
Keratin-Positive Ewing's Sarcoma: An Ultrastructural Study of 12 Cases
Authors: Srivastava Amitabh , Rosenberg Andrew E. , Selig Martin , Rubin Brian P. , Nielsen G. Petur
Published: June 2007

Ewing's sarcoma/primitive neuroectodermal tumor (EWS/PNET) is an aggressive neoplasm of bone and soft tissue. Histologically, it is characterized by the presence of small round blue cells, which usually express MIC-2 and FLI-1 immunohistochemically. The most specific feature for diagnosis, however, is cytogenetic or molecular evidence of a consistent abnormality, the t(1;22) (q24;q12), or variants thereof. The immunohistochemical expression of keratins in a significant proportion of these cases has been highlighted in several recent studies. The ultrastructural features of these keratin-positive tumors have not, however, been characterized in detail. In this study we analyzed the ultrastructural features of 12 well-documented EWS/PNETs that stained strongly for pankeratin by immunohistochemistry. Ultrastructurally, the tumor cells contained a few organelles, which included a small number of mitochondria, poorly developed Golgi complexes, free ribosomes, and inconspicuous roughendoplasmic reticulum. Rudimentary cell junctions were seen in 2 tumors while prominent junctions were observed in the remaining 10. Five tumors contained intracytoplasmic filaments, and definite tonofibrils were identified in 2. Well-developed basal lamina around tumor cells were also demonstrated in 2 tumors. Follow-up information was available for all cases. Seven patients died of disease, 2 are alive with disease, and 3 have no current evidence of disease. The cohort includes 5 patients with a type-I translocation, which has been associated with a better prognosis in some studies; 4 of these patients have died of their disease, and 1 is alive with recurrent disease. This study shows that keratin-positive EWS/PNETs have evidence of epithelial differentiation ultrastructurally, and may possibly represent a more aggressive subset of the EWS/PNET group of tumors.
Myoepithelial Cell Markers in Salivary Gland Neoplasms
Authors: Furuse Cristiane , de Sousa Suzana O. Machado , Nunes Fabio Daumas , de Magalhaes Marina Helena Cury Gallottini , de Arauijo Vera Cavalcanti
Published: June 2007

We compared the immunoexpression of 5 myoepithelial cell (MEC) markers (asmooth-muscle actin, calponin, h-caldesmon, vimentin, and S-100-protein) using 16 pleomorphic adenomas (PA), 15 adenoid cystic carcinomas (ACC), and 3 epithelialmyoepithelial carcinomas (EMC) of salivary glands. The cx-smooth-muscle actin was useful for identification of MECs, especially in cribriform and tubular ACC, followed by EMC. Calponin was similar to ct-smooth-muscle actin, except for polygonal and plasmacytoid cells of PA and for solid ACC, which showed a-smooth-muscle actin negative and calponin positive. H-caldesmon was negative. Vimentin immunostained all MEC types, and was negative in luminal cells. S-100 protein was expressed both in the nuclei and cytoplasm of MECs and luminal cells, especially in PA. The best way to identify MEC is using a-smooth-muscle actin or calponin, plus vimentin, since in tumors MECs are hardly ever fully differentiated.
Primary Alveolar Soft Part Sarcoma (ASPS) of the Breast
Authors: Wu Julie , Brinker David A. , Haas Mark , Montgomery Elizabeth A. , Argani Pedram
Published: June 2007

Alveolar soft part sarcoma (ASPS) is a rare neoplasm that most commonly presents in the lower extremities. Although ASPS has distinctive histologic features, it may cause diagnostic problems when it arises in unusual locations. To our knowledge, only 1 case of ASPS arising within the breast has previously been reported. Here, we report a second case of primary mammary ASPS. The patient was a 44-year-old woman who presented with a breast mass. Needle biopsy was performed, yielding a polygonal cell lesion with abundant, predominantly xanthomatous cytoplasm. The cells labeled strongly for the histiocytic marker CD68, suggesting a benign macrophage-rich lesion. However, the unusual nature of the lesion as well as the prominence of nucleoli prompted suggestion for an excision. The excision more clearly revealed the lesion's alveolar architecture and demonstrated cells with more eosinophilic cytoplasm, along with the xanthomatous cells. The diagnosis of ASPS was confirmed by electron microscopy, which revealed characteristic membranebound rhomboidal crystals, as well as by nuclear labeling for TFE3 protein by immunohistochemistry. With this report, we confirm the utility of a novel immunohistochmical technique for the identification of an ASPS presenting in an unusual locale.
Malignant Lymphoma in Patients with Systemic Rheumatic Disease (Rheumatoid Arthritis, Systemic Lupus Erythematosus, Systemic Sclerosis, and Dermatomyositis): A Clinicopathologic Study of 24 Japanese Cases
Authors: Kojima Masaru , Itoh Hideaki , Shimizu Kazuhiko , Saruki Nobuhiro , Murayama Kayoko , Higuchi Keiko , Tamaki Yoshio , Matsumoto Morio , Hirabayashi Kaoru , Igarishi Seiji , Masawa Nobuhide , Nakamura Shigeo
Published: June 2007

We conducted clinicopathologic and immunohistochemical analyses of the prevalence of Epstein-Barr virus (EBV) among 24 patients with malignant lymphoma complicating systemic rheumatic diseases. (SRD) These 24 patients included 17 with rheumatoid arthritis (RA), 3 with systemic lupus erythematosus (SLE), 2 with systemic sclerosis (SS), and 2 with dermatomyositis (DM). There were 2 men and 22 women ranging in age from 30 to 86 years (mean: 64 years). The interval between the onset of rheumatic disease and that of malignant lymphomas ranged from 3 months to 35 years (mean: 142 months). The use of immunosuppressive drugs before the onset of malignant lymphoma was recorded in 15 patients. Among them, 5 patients received methotrexate (MTX) therapy. Malignant lymphomas were found at extranodal sites in 9 patients, and the disease was in the advanced stage in 17 patients. Histologic and immunohistochemical studies demonstrated that 18 cases (75%) were B-cell lymphoma (RA=12, SLE=2, SS=2, DM=2), 3 (12.5%) were peripheral T-cell lymphoma (RA=3), and 3 (12.5%) were classical Hodgkin lymphoma (RA=2, SLE=1). As in previous reports, there was an increased frequency of diffuse large B-cell lymphoma (50%) in the present series. Moreover, a majority of the diffuse large B-cell lymphomas exhibited activated B-cell phenotype. EBV-encoded small RNAs (Epstein-Barr early region [EBER]-) and/or LMP-1+tumor cells were identified in only 3 cases of classical Hodgkin lymphomas. Our findings suggested EBV-associated lymphoma comprised only a small fraction of all non-Hodgkin's lymphomas in the general SRD patient population.
Fibrous Histiocytoma-like Spindle-Cell Proliferation in the Nipple After Body-Piercing
Authors: Castillo M. , Sanjuan A. , Perez N. , Zanon G. , Bons N. , Vilanova M. , Vanrell J. A. , Merino M. J. , Fernandez P. L.
Published: June 2007

We report the case of a 19-year-old pregnant woman who presented with a nipple tumor. The lesion consisted in a spindle-cell proliferation with histologic features similar to those of fibrous histiocytoma, with a highly vascularized stroma. Although it showed low mitotic activity, scattered marked atypical cells with prominent nucleoli were identified, thus raising concern about the benign nature of the tumor. Immunohistochemical evaluation revealed that the spindle cells were diffusely positive for vimentin, focally positive for CD68, and negative for all the other tested antibodies. The patient had a total excision of the lesion and she is free of disease after 30 months. To our knowledge this is the first reported case of a lesion of this type in the nipple after body-piercing.
Evaluation of RB Gene and Cyclin-Dependent Kinase Inhibitors P21 and P27 in Pleomorphic Xantoastrocytoma
Authors: Begnami Maria D. , Rushing Elisabeth J. , Evangelista Regia , Santi Mariarita , Quezado Martha
Published: June 2007

Pleomorphic xantoastrocytoma (PXA) is a rare, circumscribed astrocytic tumor that usually occurs in the superficial cerebral hemispheres in children and young adults. Most patients have a favorable prognosis, but recurrence and malignant transformation have been reported. In diffuse gliomas, approximately one third demonstrate mutations of the RB gene. Low expression level and high activity of p27 are known to constitute an independent prognostic factor in patients with malignant gliomas, while p21 expressions have variable labeling ranges. The molecular and genetic basis for tumorigenesis and progression of PXA are still largely unknown. In this study, 13 PXAs were examined immunohistochemically for pRb, p21, and p27 expression. Nine PXAs expressed homogeneous pRb positivity in the most nuclei of the tumor cells. Four cases showed an abnormal pRb staining pattern. All PXAs were positive for nuclear expression of p21. Diffuse nuclear positivity of p27 was seen in 10 cases, focal in 2, and in 1 case was not present. The cases with focal and negative p27 nuclear expression had few pRb-positive nuclei. The majority of PXAs appear to have preserved pRb, p21, and p27 functions. Additional studies are necessary to investigate whether cases with altered pRb and p27 expressions are associated with increased risk of recurrence or malignant transformation.
Well-differentiated Chondrosarcoma of the Humerus with Prominent Granular Cell Component: A Hitherto Unreported Occurrence
Authors: Cremonini Anna , Kuhn Elisabetta , De Biase Pietro , Franchi Alessandro
Published: June 2007

We report the case of a well-differentiated chondrosarcoma of the proximal humerus in a 60-year-old man that featured a prominent component of granular cells, the granules being shown by electron microscopy to be lysosomal. Although secondary granular cell changes have been described in a large variety of tumor types, this is, to the best of our knowledge, the first documentation of this phenomenon in a skeletal chondrosarcoma.
Early Post-transplant Smooth Muscle Neoplasia of the Colon Presenting as Diminutive Polyps: A Case Complicating Post-transplant Lymphoproliferative Disorder
Authors: Medlicott S. A. C. , Devlin S. , Helmersen D. S. , Yilmaz A. , Mansoor A.
Published: June 2007

A 44-year-old woman, 3 years post-transplant for pulmonary sarcoidosis, developed abdominal pain and diarrhea 13 months subsequent to an eradicated diffuse large B-cell-type, post-transplant lymphoproliferative disorder (PTLD) of the cecal region. Endoscopic examination identified multiple pale tan 5-to-9 mm rubbery nodules of the transverse and right colon in an otherwise unremarkable mucosa. Histology was characterized by bland smooth muscle proliferations, focally pushing into the mucosa. Immunohistochemistry (IHC), in situ hybridization (ISH), and polymerase chain reaction (PCR) of the sampled nodules confirmed Epstein-Barr virus (EBV) infection of neoplastic cells. To our knowledge, this is the first reported case of EBV-related post-transplant lymphoproliferative and smooth muscle neoplasms (PTSN) having distinct tropism for the colon. Endoscopic features of early PTSN, which in this case presented as diminutive polypoid lesions, have not been described previously
Extranodal Marginal Zone B-Cell Lymphoma/Maltoma of the Lip in a Child
Authors: Zambrano Eduardo , Mejía-Mejía Olga , Bifulco Carlo , Shin Joseph , Reyes-Múgica Miguel
Published: June 2007

All forms of cutaneous lymphomas are rare in children. Extranodal marginal zone B-cell lymphomas (EMZBL)/mucosa-associated lymphoid tissue (MALT) lymphomas are unusual neoplasms in children and young adults. We report a case of an EMZBL/MALT lymphoma of the lip in a previously healthy 14-year-old boy without immunodeficiency, confirmed by immunohistochemistry and documentation of clonal rearrangement of the immunoglobulin heavy-chain gene. Additionally, we present a review of the differential diagnosis of skin and mucosal lymphoid proliferations in childhood.
Skin Adnexal Neoplasm Closely Resembling Adenomatoid Tumor: A Unique Occurrence
Authors: Crippa S. , Bella C. Di , Faravelli A.
Published: June 2007

We describe a primary skin neoplasm located in the left chest wall that closely resembled adenomatoid tumor of male and female genital tract. It occurred in a 52year-old woman who had undergone a left quadrantectomy with regional lymphadenectomy for invasive ductal carcinoma of the breast 7 years previously. The tumor involved the dermis and subcutaneous tissue and measured 0.7 cm in greatest diameter. Immunohistochemical evaluation showed strong positivity for cytokeratin pool and negativity for CD31, calretinin, WT-180, and for estrogen and progesterone receptors. We are unaware of a previous description of this morphologic pattern in a primary skin tumor, which we have interpreted as of skin adnexal and specifically of eccrine sweat gland origin.
Exclusive Intrapulmonary Lepidic Growth of a Malignant Pleural Mesothelioma Presenting With Pneumothorax and Involving the Peritoneum
Authors: Rossi Giulio , Cavazza Alberto , Turrini Ercole , Costantini Matteo , Casali Christian , Morandi Uliano , Dallari Rossano
Published: June 2007

We report a rare case of malignant pleural mesotheliomapresentingclinically with pneumotho ax and histologically with an exclusiveintrapulmonary lepidic growth. Neither intrathoracic nodules norpleural thickening were found. The patient subsequently experiencedacute abdominal painwith peritonitis and intestinal occlusion byperitoneal mesothelioma. The morphologic clues leading to the correct diagnosis of mesothelioma with prominent intrapulmonary growth are briefly discussed.
Malignant Mesothelioma Masquerading as a Multinodular Bronchioloalveolar Cell Adenocarcinoma With Widespread Pulmonary Nodules
Authors: Felner Kevin J. , Wieczorek Rosemary , Kline Marilyn , Smith Robert L. , Sidhu Gurdip S.
Published: June 2007

A 72-year-old man had a unilateral pleural effusion and multiple bilateral pulmonary nodules. Thoracoscopic biopsy revealed multiple discrete nodules in the pleura and lung. The latter consisted of tall columnar malignant cells arranged on alveolar surfaces in a lepidic growth pattern. Mucin filled the alveolar lumina, both in the nodules and surrounding lung. It stained with Alcian blue but not with periodic acid Schiff, suggesting that it was a glycosaminoglycan, which was confirmed as hyaluronic acid by complete digestion with hyaluronidase. Tumor cells were calretinin, Wilms tumor-1, and high-molecular-weight cytokeratin 5/6 positive, and were negative for thyroid transcription factor-1, cytokeratin 7, and cytokeratin 20. Ultrastructurally, they had very long and abundant, slender microvilli typical of a malignant mesothelioma. This is the first example of a mesothelioma masquerading as a bronchioloalveolar carcinoma.
Pediatric Sclerosing Rhabdomyosarcoma
Authors: Zambrano Eduardo , Pérez-Atayde Antonio R. , Ahrens William , Reyes-Múgica Miguel
Published: June 2007

Sclerosing rhabdomyosarcoma, a particular phenotypic variant of rhabdomyosarcoma initially described in the adult population, has emerged as a potential pitfall in the evaluation of pediatric sarcomas. Because of its densely hyalinized collagenous matrix and its occasional expression of a pseudovascular pattern of growth, sclerosing rhabdomyosarcoma has been at times misdiagnosed as chondrosarcoma, osteosarcoma, or angiosarcoma. We describe 3 pediatric patients with sclerosing rhabdomyosarcoma and provide a detailed description of its distinguishing pathologic features. Awareness about this rhabdomyosarcoma variant and careful immunophenotypical evaluation are necessary to establish the correct diagnosis. Although no specific genetic aberrations have been recognized, yet the cytogenetic findings in 2 tumors of this series suggest a link with embryonal rhabdomyosarcoma. It is likely that further genotyping will result in better nosologic delineation of sclerosing rhabdomyosarcoma and that it will uncover pathogenetically and prognostically relevant genes.
β-Catenin and E-Cadherin Expression in Salivary Gland Tumors
Authors: Furuse Cristiane , Cury Patricia Ramos , Altemani Albina , dos Santos Pinto Júnior Décio , de Araújo Ney Soares , de Araújo Vera Cavalcanti
Published: June 2007

This study evaluated the expression of E-cadherin and β-catenin in salivary gland tumors. Twelve biopsy specimens from cases diagnosed as pleomorphic adenoma, 17 adenoid cystic carcinomas, 10 epithelial-myoepithelial carcinomas, and 4 polymorphous low-grade adenocarcinomas were immunohistochemically labeled for E-cadherin and β-catenin antibodies. Healthy salivary glands were used as controls. Membrane-associated E-cadherin and β-catenin expression was present in all the tumor types studied. E-cadherin and β-catenin showed a similar distribution; however, β-catenin labeling was weaker than that for E-cadherin. In the epithelial-myoepithelial carcinomas, myoepithelial cells exhibited diffuse nuclear staining, although occasional cells presented only focal labeling. Epithelial-myoepithelial carcinomas present changes in [.beta]-catenin expression but the other salivary tumors studied do not, which may reflect divergence in tumorigenesis of this extensive subset of salivary gland tumors.
A Primary Pure Yolk Sac Tumor of the Lung Exhibiting CDX-2 Immunoreactivity and Increased Serum Levels of Alkaline Phosphatase Intestinal Isoenzyme
Authors: Pelosi Giuseppe , Petrella Francesco , Sandri Maria Teresa , Spaggiari Lorenzo , Galetta Domenico , Viale Giuseppe
Published: June 2007

Malignant extragonadal germ cell tumors primary to the lung are quite uncommon lesions, but pure yolk sac tumor is even more exceptional. This is believed to be the first reported case of yolk sac tumor of the lung in which an intense and diffuse immunoreactivity for CDX2, a marker of intestinal differentiation reportedly expressed also in gonadal yolk sac tumor, was associated with increased serum levels of the alkaline phosphatase intestinal isoform. Nine months after radical surgery and adjuvant chemotherapy, the patient is alive and well without evidence of recurrent or metastatic disease and with serum levels of the alkaline phosphatase intestinal isoform within normal limits. The pathologist should be aware of yolk sac tumor arising in the lung and that alkaline phosphatase intestinal isoform could become an additional serum marker for such a tumor.
Ectopic Modified Sebaceous Glands in Human Penis
Authors: Batistatou Anna , Panelos John , Zioga Aikaterini , Charalabopoulos Konstantinos A.
Published: June 2007

The balanopreputial sulcus is believed to be the most frequent site of the so-called Tyson’s glands. The intriguing feature of these anatomical structures is their mere existence, which has been doubted. Herein, the authors present a case of a 24-year-old man who underwent surgical treatment of his phimosis. On microscopic examination of the specimen, glands with morphological features similar to those described by Tyson were noted.
Isolated Hepatic Involvement of Cat Scratch Disease in Immunocompetent Adults
Authors: Marsilia Giuseppina Marino , La Mura Anna , Galdiero Roberta , Galdiero Emilia , Aloj Giovanni , Ragozzino Alfonso
Published: June 2007

Visceral involvement in absence of lymphadenopathy is a rare manifestation in cat scratch disease; hepatic granulomas are rare, representing 0.3% of systemic manifestations of cat scratch disease, and gallbladder extension is a singular case. The present article refers to 2 rare cases of visceral cat scratch disease in immunocompetent adults with hepatic granulomatous inflammation, caused by Bartonella henselae infection, with gallbladder involvement in 1 case and no lymphadenopathy. Histological features demonstrated the presence of inflammatory necrotizing granulomatous nonneoplastic process. Molecular studies (polymerase chain reaction) were performed to confirm the infectious etiology.
Intratumoral Heterogeneity of HER-2/neu in Invasive Mammary Carcinomas Using Fluorescence In-Situ Hybridization and Tissue Microarray
Authors: Shin Sandra J. , Hyjek Elizabeth , Early Erin , Knowles Daniel M.
Published: June 2007

Fluorescence in-situ hybridization is increasingly being used to determine HER-2/neu status in patients with breast carcinoma. The possibility that intratumoral heterogeneity of HER-2/neu gene amplification may potentially contribute to inaccurate assessment of HER-2/neu status was investigated in routine cases of invasive mammary carcinomas. From 169 representative formalin-fixed, paraffin-embedded blocks of invasive duct mammary carcinomas with grade 3 architecture, 48 cases were analyzed by fluorescence in-situ hybridization and 59 analyses were performed. Intratumoral heterogeneity for HER-2/neu gene amplification was demonstrated in only 5 (16%) of 31 cases where morphologically similar areas of a single tumor were analyzed. We conclude from this study that intratumoral heterogeneity of HER-2/neu gene amplification is a demonstrable but relatively uncommon occurrence. For invasive mammary carcinomas, the accurate assessment of HER-2/neu status by fluorescence in-situ hybridization analysis is not significantly confounded by intratumoral heterogeneity of HER-2/neu gene amplification in individual tumors.
The Correlation Between the Tumor Necrosis and Renal Artery Changes in Renal Cell Carcinoma
Authors: Krušlin Božo , Tomić Karla , Tomas Davor , Mladinov Domagoj , Trnski Davor , Belicza Mladen
Published: June 2007

Necrosis, cysts, hemorrhage, and calcification represent common findings in renal cell carcinoma. Different lesions, including arteriosclerosis or fibromuscular dysplasia, or both, may involve the main renal artery. This study analyzed the relationship between the presence and extent of necrosis in renal cell carcinoma with renal artery changes in a consecutive series of 112 patients (71 men, 41 women) with mean renal cell carcinoma of 7.7 cm (range, 2 to 20 cm). Necrosis was seen macroscopically and confirmed microscopically in 88 cases (78.6%), with 64 tumors having less than 50% and 24 more than 50% necrosis. Fibromuscular dysplasia was found in 41 patients (36.6%; 17 men, 24 women) and atherosclerotic changes in 21 patients (18.8%; 18 men, 3 women). The results suggest that necrosis of renal cell carcinoma was significantly more common in women with associated fibromuscular dysplasia (especially type I) and men with atherosclerotic changes of renal artery.
Xp11 Translocation Carcinoma of the Kidney Presenting With Multilocular Cystic Renal Cell Carcinoma-Like Features
Authors: Suzigan Sueli , Drut Ricardo , Faria Paulo , Argani Pedram , De Marzo Angelo M. , Barbosa Rui Nogueira , Mello Denadai Eliseu Roberto , Martins-Filho Júlio , Martucci Rubens Carlos , Bauab Tufik
Published: June 2007

Reported is the case of a 17-year-old girl with a multicystic tumor in the middle of the right kidney. Partial nephrectomy revealed an epithelial neoplasm with multilocular cystic renal cell carcinoma pattern. The cells exhibited strong nuclear reactivity for TFE3 protein and supported the diagnosis of Xp11 translocation carcinoma of the kidney. A similar case has not been found in the literature. The example emphasizes the high index of suspicion needed for an accurate diagnosis of renal carcinomas.
Malakoplakia of the Prostate on Needle Core Biopsy: A Case Report and Review of the Literature
Authors: Wagner David , Joseph Jean , Huang Jiaoti , Xu Haodong
Published: June 2007

Malakoplakia is a rare inflammatory disorder that results from an infectious process and that may be associated with immunosuppression. It most often occurs in the genitourinary tract; however, isolated cases have been reported in many other organs, including colon, stomach, lung, liver, bone, uterus, and skin. In the bladder, which is the most common site of involvement, it may be mistaken for malignancy on cystoscopic examination or computerized topography scan. Gram-negative bacteria such as Escherichia coli and Klebsiella pneumonia are often isolated from malakoplakia lesions, although other less common bacteria such as Rhodococcus equi may also be found. This is a case report of prostatic malakoplakia diagnosed on needle core biopsy from a patient suspected to harbor a malignancy.
Metastatic Potential of Encapsulated (Intracystic) Papillary Carcinoma of the Breast: A Report of 2 Cases With Axillary Lymph Node Micrometastases
Authors: Mulligan Anna Marie , O'Malley Frances P.
Published: June 2007

Intracystic papillary carcinoma of the breast has rarely been reported to be associated with metastases. Presented are 2 cases, both of which showed micrometastatic carcinoma in axillary lymph nodes; neither demonstrated stromal invasion. Nearly complete absence of a myoepithelial cell layer around the periphery of the lesions was noted. One case showed 3 separate foci of micrometastatic carcinoma in 1 of 3 sentinel lymph nodes; the second showed micrometastases in 2 of 11 axillary lymph nodes. The clinical significance of micrometastases in lymph nodes associated with intracystic papillary carcinoma is unknown. The term encapsulated papillary carcinoma has been proposed to name papillary carcinomas that are surrounded by a fibrous rim, but which show a scant or absent myoepithelial cell component. The current 2 cases offer evidence to support the use of this term for particularly large encysted lesions. Sentinel lymph node biopsy may be prudent in such cases.
Lymphoid Polyps of the Palatine Tonsil
Authors: Barreto Icleia , Juliano Priscila , Chagas Cristiano , Altemani Albina
Published: June 2007

Tonsillar lymphoid polyps are uncommon lesions that have rarely been studied. The authors describe the clinical, histopathologic, and immunohistochemical features of 6 tonsillar polyps in which lymphoid tissue represented more than 80% of the lesion. Presenting symptoms were tonsillar mass and/or dysphagia. No predisposing factor was detected. Microscopically, all polyps contained follicles with germinal centers, crypts lined by lymphoepithelium, and a small amount of fibrous tissue in the center of the lesion. B cells (CD20+), T cells (CD45RO+), plasma cells (κ+ and λ+) and vessels (lymphatic, D2-40+; blood, CD34+) presented distribution and architectural patterns as expected for lymphoid tissue of a palatine tonsil. Tonsillar lymphoid polyps are possibly hamartomas characterized by overgrowth of lymphoid elements, which maintain an architectural pattern and cellular composition similar to those of the palatine tonsil.
Defective Synthesis of Beta-Humran Chorionic Gonadotropin in Placenta Percreta
Authors: Coppola D. , Putong P. B. , Finkeistein S. , Cooper H. S. , Jones M. W.
Published: June 2007

The clinical and pathologic features of two cases of placenta percreta were reviewed. The findings were compared with three cases of normal implantation obtailned by matching the patients' age and the gestational age. Two abnormal implantations showed the absence of decidua and the interruption of Nitabuch's fibrinoid layer in the areas of deepest chorionic invasion., The surface of penetrating trophoblast was negative for beta-human chorionic gonadotropin immunostaining in both placenta percretas but positive in normal implantations; however, reverse transcriptase-polymerase chain reaction analysis of RNA extracted from the same sites demonstrated the presence of beta-human chorionic gonadotropin in RNA obtained from both normal and abnormal implantations. These findings suggest that trophoblastic invasion in placenta percreta may be related to a post-transcriptional defect in beta-human chorionic gonadotropin synthesis.
Cell Cycle Control of Ovarian Granulosa Cells in Tumors and Cysts
Authors: Costa Michael J. , Walls Judy , Dickerman Alexandra , Ames Peter F. , Roth Lawrence M. , Guinee Donald
Published: June 2007

Ovarian granulosa cell tumors (GCTs) behave unpredictably. Stage I patients suffer recurrences many years after treatment, and histopathologic evaluation of the primary GCT offers few clues. p21IPl/wafl (Waft), the principle downstream effector of the p53-dependent pathway of growth control, inhibits cyclin-dependent kinases responsible for conversion of GI to S in the cell cycle. This study hypothesizes that immunohistochemistry for these proliferation-related markers will help discern granulosa cell growth control and may predict the GCTs' clinical behavior. Paraffin sections from a surgical series of 43 GCTs (34 primary and 9 recurrent: 19 diffuse and 18 typical adult; 6 juvenile type) and 12 benign cysts (8 follicular and 4 corpora luteal) were immunostained for Waft and p53. Ki67 (MIB-1 clone) proliferation index is the percent of nuclei immunoreactive on a count of at least 400. The 43 GCTs stained as follows: 40% Waft + (11 St = < 10%, 4 S2 = 10-50%, and 2 S3 = > 50% of nuclei) and 28% p53 + (2 W = weak, 8 S 1, 2 S2). All p53 + GCTs stained with Waf 1; the number of immunoreactive nuclei correlated (P < .00001). Juvenile more often than adult type GCTs exhibited Waf 1 (6/6) and p53 staining (5/6) (P < .001). No difference in pS3 or Waft staining was present in primary compared with recurrent GCTs. Ki67 proliferation index for GCTs ranged from 1 to 50% (mean, 13.8%; median, 10.9%) and associated with both p53 and Waft (P < .000 1). The 12 benign cysts stained as follows: 100% Waft + (6 S1, 5 S2, 1 S3) and 75% p53+ (4 W, 4 S1, 1 S2). Of the 43 patients, 41 were available for follow-up study: 15 suffered recurrences after 16-133 (mean 59.3, median 55) months, and 26 were disease-free 21-369 (mean 78.2, median 57.5) months after diagnosis. Waft staining of the primary GCT does not help predict recurrence. All GCTs immunoreactive for p53 produce Waft, suggesting detection of an active wild type p53 rather than overproduction of mutant p53. Waft is produced by granulosa cells in all benign functional cysts, suggesting a physiologic role in the ovulation sequence. Waf t's association with proliferation in GCTs suggests possible physiologic feedback. Proliferation (correlated with histopathologic grading) in GCTs may signify appropriate feedback control; thus it is not a predictor of aggressive clinical behavior.
c-erbB-2 Oncoprotein Immunoreactivity in Gallbladder and Biliary Tract Cancers
Authors: Lee C. Soon , Pirdas Anne
Published: June 2007

Overexpression of c-erbB-2 protein, a 185-kD transmembrane tyrosine kinase protein, is found in a number of human cancers. c-erbB-2 expression was examined, using immunohistochemistry with the polyclonal antibody NCL-PC 11 in carcinoma of the gallbladder (n = 13), biliary tract (n = 6), and ampulla of Vater (n = 9). These were compared with nonmalignant conditions such as chronic cholecystitis (n = 1 1), gallbladder dysplasia (n = 3), and adenoma (n = 1), and ampullary carcinoma in situ (n = 3) and adenoma (n = 1). Most gallbladder carcinomas (85%) and dysplasias (100%), common bile duct (83%) and ampullary (67%) carcinoma, and ampullary carcinoma in situ (67%) showed moderate to strong c-erbB-2 protein immunoreactivity. In contrast, the majority of cases of chronic cholecystitis (64%) had absent or weak c-erbB-2 protein immunostaining. However, immunohistologic detection of c-erbB-2 overexpression in the form of distinct cell membrane immunostaining was found in a minority of gallbladder carcinomas (23%) and not in any of the other preneoplastic or neoplastic lesions of the biliary tract or chronic cholecystitis. The patients who had carcinoma with c-erbB-2 overexpression had a shorter median survival period (3.1 months). However, there was no correlation between tumor stage and c-erbB-2 expression. This may be related to the small number of cases of gallbladder tumors available for this study, and further work with a larger series with adequate clinical follow-up time may be required to confirm the prognostic trend. The differences in c-erbB-2 expression between gallbladder, common bile duct, and ampullary carcinomas suggest that mutation of the gene may be a late event in the sequential development of gallbladder and biliary tract cancers.
Adenoid Cystic Carcinoma of the Uterine Cervix
Authors: Domínguez-Malagón Hugo R. , Flores-Flores Guillermo , Garcia Abelardo Meneses , Ro Jae Y.
Published: June 2007

Adenoid cystic carcinoma of the cervix, an aggressive tumor, shows the same histologic features as adenoid cystic carcinoma of the salivary glands. It is characterized by small cells in a cribriform, pseudoglandular pattern with hyaline cylinders. The authors present the ultrastructural features of two cases of adenoid cystic carcinoma of the cervix. Both tumors were composed of epithelial cells, myoepithelial cells, and cylinders formed of reduplicated basement membrane. In addition, the second case had neuroendocrine differentiation.
Pseudosarcomatous Sclerosing Peritonitis
Authors: Finney A. L. , Spagnolo D. V. , Crawford G. P. , Shilkin K. B.
Published: June 2007

Chronic lupus peritonitis is uncommon, manifesting as ascites when other signs and symptoms of systemic lupus erythematosus are minimal, thus making diagnosis difficult. It is rarely the initial and only presenting symptom of systemic lupus erythematosus. We report such a case, which clinically and pathologically mimicked a malignant process. At laparotomy homogenous, thick, gray-white, firm tissue covered the bowel and other abdominal organs. Light microscopy showed a highly cellular, predominantly spindle-cell proliferation, raising the possible diagnosis of malignant peritoneal mesothelioma. A conservative approach was taken, and further investigation led to the definitive diagnosis of serositis associated with systemic lupus erythematosus. High-dose immunosuppressive therapy resulted in clinical and serologic improvement. The authors propose the term pseudosarcomatous sclerosing peritonitis to describe this unusually florid peritoneal reaction. The pathologic findings are discussed in the context of other reports of chronic lupus peritonitis, and the differential diagnosis of florid spindle-cell peritoneal reactions is considered.
Utility of Proliferation Markers Ki-67 and Proliferating Cell Nuclear Antigen (PCNA) in the Evaluation of Uterine Papillary Serous Carcinomas
Authors: Lynn Amy A. A. , King Stephanie A. , LiVolsi Virginia A.
Published: June 2007

We examined proliferation markers Ki-67 and proliferating cell nuclear antigen (PCNA) to determine whether immunohistochemical staining results could predict outcome in 22 uterine papillary serous carcinomas (UPSC). Eighteen tumors (82%) had increased proliferation as demonstrated by Ki-67 immunostaining with 50% of these patients dying of disease. Twenty tumors (91%) showed high PCNA immunoreactivity; 60% of these patients died of disease. Most UPSC exhibit high immunoreactivity to Ki-67 and/or PCNA, which showed no correlation with outcome or stage. These results may reflect the aggressive clinical behavior of UPSC. We conclude that Ki-67 and PCNA immunohistochemistry have limited use as prognostic indicators in UPSC.
Cardiac Tumors in Hong Kong
Authors: Chan K. W. , Lee W. T. , Lam K. Y. , Chan Alexander C. L. , Fu K. H.
Published: June 2007

A retrospective analysis of cardiac tumors surgically excised in a 14-year period in Hong Kong was performed. The study showed 65 primary tumors (64 cardiac myxomas, one unclassified sarcoma), and one metastatic leiomyosarcoma. All patients were Chinese except a Filipino woman who had a cardiac sarcoma. The incidence of primary cardiac tumors in Hong Kong Chinese was estimated to be 0.83 per million population per year. The mean age of patients at operation was 50. There were 37 females and 27 males with no difference in mean ages between the two groups. The average size of myxoma was 4.7 cm. The anatomic locations of the 64 myxomas were left atrium (60), right atrium (2), mitral valve (1), and atrial septum on both sides (1). The main presenting clinical features were dyspnea (46%), cerebral embolism (32%), and palpitation (27%). No familial or syndromatic case was noted. Well-differentiated glandular structures were found in one right atrial myxoma. The findings were compared with those of a local series of cardiac tumors found at autopsy.
Synovial Sarcoma of the Parotid Gland Region
Authors: Yu Gordon H. , Kobos Jozef W. , Brooks John S. J.
Published: June 2007

Primary sarcomas of the salivary gland region occur rarely and may be confused with other primary salivary gland neoplasms. This distinction is critical, as the treatment of salivary gland sarcomas differs significantly from the therapy of the more common tumors typically found in these glands. We report an unusual case of synovial sarcoma arising within the parotid gland of a 51-year-old female. Large areas were monophasic and resembled hemangiopericytoma, but a focal unequivocal biphasic area was noted. Previous cases reported in this region are reviewed.
Neurofibroma of the Common Bile Duct
Authors: Walsh Mary M. , Drew Michael , Bleiweiss Ira J.
Published: June 2007

A case of solitary neurofibroma of the common bile duct is presented. A review of the world literature reveals only one previously reported case of solitary neurofibroma in this location. Rare case reports of neurofibroma in association with von Recklinghausen's disease (neurofibromatosis 1) located in the hepatobiliary system are found. Discussion of traumatic neuroma, another clinically and histologically confusing entity occurring in the biliary system, is also included.
Subungual Osteogenic Malignant Melanoma
Authors: Golouh Rastko , Zidar Andreja
Published: June 2007

Osteogenic melanoma may mimic many other tumors, especially osteogenic sarcoma; only 12 cases have been reported so far. To characterize this unusual neoplasm further, we present the clinicopathologic findings of a new case. A 67-year-old woman was treated unsuccessfully for “fungal granuloma” of her great toe. After nail ablation and incisional biopsy, the toe was exarticulated. Histologically, we found a high-grade, spindle, focally epithelioid, amelanotic malignant tumor with a distinct osteoid and chondroid matrix. Spindle, epithelioid, osteoblastic, and chondroblastic tumor cells were immunoreactive for vimentin, S-100 protein, and NKI/C3. Ultrastructurally, diagnostic premelanosomes were not identified. Features that support a diagnosis of osteogenic melanoma are superficial subungual location, absence of bone involvement, and immunoreactivity for vimentin, S-100 protein, and NKI/C3. The unusual features of current tumor are absence of radial growth phase, negative reaction to HMB-45, and ultrastructural absence of melanosomes.
A Non-epithelial Pseudosarcomatous Mural Nodule in a Mucinous Cystic Neoplasm of the Pancreas
Authors: Hunt Jennifer L. , Gannon Francis H. , Rosato Ernest F. , Siegelman Evan S. , Tomaszewski John E. , LiVolsi Virginia A.
Published: June 2007

A mucinous cystic neoplasm of indeterminate malignant potential was found to have a well-circumscribed, 3.1 cm pseudosarcomatous mural nodule, similar to those previously described in the ovary. The nodule contained reactive giant cells and intermediate to large-sized tumor cells with bizarre mitotic figures and nuclear atypia. The tumor cells were found to be of non-epithelial origin, based on multiple negative stains for cytokeratins and ultrastructural demonstration of osteoclastic and osteoblastic differentiation and absent desmosomes. This case report is the only description of a pseudosarcomatous mural nodule in a mucinous cystic neoplasm with non-epithelial origins.
Oncocytic Pheochromocytoma with Cytokeratin Reactivity
Authors: Wang Beverly Y. , Gabrilove Lester , Pertsemlidis Demetrius , Gordon Ronald E. , Unger Pamela D.
Published: June 2007

A large hemorrhagic pheochromocytoma (275 g) is described in a 38-year-old obese woman who had no history of sustained or sporadic hypertension. The tumor was unusual histologically because of the striking presence of oncocytic cells. Immunohistochemical studies revealed the positivity for neuron-specific enolase, synaptophysin, and cytokeratin CAM 5.2. Electron microscopy demonstrated neurosecretory dense core granules characteristic of a pheochromocytoma. Oncocytic pheochromocytoma was briefly documented in previous case reports but has not been well recognized. The expression of cytokeratin by pheochromocytoma is also very rare and has been described in a single study in the literature. This case had both unusual clinical and pathologic manifestations and is the first report of a pheochromocytoma with coexistence of oncocytic changes and cytokeratin immunoreactivity.
Endometrial Stromal Sarcoma Presenting as Extrauterine Metastases
Authors: Kolda Timothy F. , Ro Jae Y. , Ordonez Nelson G. , Tornos Carmen , Park Yong W. , Hyman William J. , Ayala Alberto G.
Published: June 2007

A case of endometrial stromal sarcoma that initially presented as an umbilical mass 5 years before and as a lung lesion 8 months before the primary tumor was detected in the uterus is reported. The morphologic features and immunohistochemical profile of the two initial extrauterine lesions suggested metastases from a primary endomerial stromal sarcoma of the uterus, which was confirmed by subsequent endometrial curettage. The tumors in all three locations were characterized histologically by small to medium-sized uniform cells with fewer than 10 mitoses per 10 high-power fields and distinct arterial vasculature that resembled the spiral arteries of the normal enometrium. Both the endometrial and umbilical tumors were immunoreactive for estrogen and progesterone receptors but showed no immunoreactivity for cytokertin. Additionally, the tumor cells of the umbilical mass showed no immunoreactivty for S-100 protein, HMB-45, smooth-muscle actin, or desmin. Endometrial stromal sarcomas are usually confined to the uterus at the time of diagnosis. When they preent initially as an extrauterine metastasis, diagnostic difficulties may arise. A recogition of the morphologic features, together with the immunoreactivity pattern, is needed in evaluating endometrial stromal sarcomas that present as extrauterine metastases.