bluuebunny/crossref_metadata_2025 huggingface dataset:
Accurate Determination of Colorectal Polyp Counts Is Not Mission Impossible for Pathologists and Is Essential for Surveillance Interval Decision-Making: A Review of 1294 Specimens
Authors: Gamble D , Ziebell J , Chen W , Frankel W , Stanich P
Published: November 2022

Introduction/Objective

The US Multi-Society Task Force on colorectal cancer updated recommendations in 2020 for follow-up after colonoscopy. This emphasized differential surveillance intervals based on the number of polyps removed. We determined how often we accurately counted the number of polyps and what submission practices allowed accurate quantification.

Methods/Case Report

We reviewed consecutive colorectal polyp cases from 10/1 to 12/31, 2019, excluding inflammatory polyps in inflammatory bowel disease. Pathology reports were reviewed to determine if the polyp number could be determined from history, gross description, and histologic findings. When numbers did not match or were unclear, endoscopy reports and glass slides were reviewed.

Results (if a Case Study enter NA)

601 cases with 1294 specimens were identified. We accurately determined polyp number in 1235 (95.4%) specimens. 1072 (82.8%) specimens were submitted as single polyp per container (SP), while 222 (17.2%) were submitted with > 1 polyp per container (MP). Polyp number was not quantifiable in 58 (26.1%) MP due to 11 labeled as “multiple polyps” in requisition/endoscopy reports and 47 submitted with polyp number different from number of tissue portions seen grossly and microscopically. In 1 (0.1%) SP, polyp number was unclear because separate portions of tissue contained two different diagnoses. Rate of accurate polyp count is significantly different between SP and MP (p<0.01) by Fisher exact test.

Conclusion

We accurately determined number of polyps in most specimens (95.4%) because our gastroenterologists usually submit SP. In MP, polyp count in 26.1% of specimens was unquantifiable. This could lead to uncertainty in surveillance follow-up intervals. Therefore, we recommend submitting one polyp per container.
Gastrointestinal Stromal Tumors – Our Institutional 10-Year Experience
Authors: Proca D , Lazim A , Zenezan D , jhala N C
Published: November 2022

Introduction/Objective

Gastrointestinal stromal tumors (GIST), albeit very rare overall, with approximately 5,000 new diagnoses yearly in the US, represent the most common mesenchymal tumor involving the GI tract. particularly the stomach and small bowel. Pogress has been made in the past two decades in terms of describing pathogenesis, classification, and targeted therapy of GIST, however, their behavior is still quite challenging and unpredictable, and their prognosis remains guarded.

Methods/Case Report

We reviewed our institutional experience with GIST between 2010-2020; the review included surgical pathology reports, charts, and slides and we extracted data relevant for better characterization of these rare tumors.

Results (if a Case Study enter NA)

We identified a total of 53 GIST, with a preponderance of females (37 cases) versus males (16), and age ranging from 33yo (female) to 90yo (female). The majority of tumors were located in the stomach (39), with the remaining distributed between different locations: colon, small bowel, duodenum (3 each), esophagus and liver (2 each) and retroperitoneum (1). The GISTs ranged in size from 0.2 to 30 cm. 14 GISTs were smaller than 1 cm, with 8 of these being incidental findings: 4 associated with another tumor, 3 in sleeve gastrectomies, and 1 in a colon resected for perforated diverticulitis. Six GISTS were multiple, with 2-3 different tumors in the stomach, corresponding to a pT1m or pT2m stage. Majority of GISTs were spindled, while only 3 GISTwere mixed and 2 were epithelioid. All GIST in our review were c-kit positive.

Conclusion

In summary, we report data obtained from 53 resected GIST’s over a 10 year period. GIST ia a rare tumor overall, with an annual incidence of 10-20 new cases/ million, and therefore it is relatively difficult to study. Our findings confirm those reported in the literature as far as localization (preponderence of stomach), gender prevalence (female) and predominant proto-oncogen kit mutation, but shows a wider age range and interesting co-morbid associations in small, no risk GIST. These findings support the hypothesis that tumor microenvironment and host immune response are important factors in pathogenesis and provides empirical evidence that immunotherapy and immunomodulation should be studied as therapeutic additions in GIST.
Acute Hemorrhage Related Colonic Injury Misdiagnosed as Signet-Ring Cell Carcinoma
Authors: Pereira MD D , Jayaratne N , Crowley MD M , Jiang K
Published: November 2022

Introduction/Objective

Hypovolemic shock/hypoperfusion-related gastrointestinal injury is an unusual event in the practice of oncological pathology. The histologic findings can be ambiguous, potentially masquerading other entities, especially epithelial neoplasms. One needs to pay close attention to the subtle microscopic features and the associated sudden clinical event(s). Concordant hypovolemic history will help decision-making but can be overlooked or unaware of.

Methods/Case Report

A 72-year-old gentleman with prostate hypertrophy, rheumatoid arthritis, and hypertension presented to the emergency room with palpitation, dizziness, and dyspnea. He was diagnosed with atrial fibrillation and started on anticoagulation. Unexpectedly, the patient returned 3 days later with sudden gastrointestinal hemorrhage and severe anemia (hemoglobin 2.7). Emergency colonoscopy identified mucosal hemorrhage, erosion, and a friable, mass-like area in the sigmoid colon; the corresponding biopsy was called signet-ring cell carcinoma. Subsequently, the patient was referred to our institution for consultation.

Results (if a Case Study enter NA)

The provided biopsy showed multiple clusters of signet-ring-like cells with extravasated mucin, detached or distributed within edematous colonic fragments, resembling signet-ring cell carcinoma. However, no overt cytologic or architecture atypia or mitosis was appreciated; instead, microscopic hemorrhage, capillary thrombi, withering and distorted crypts, and mucosal necrotic sloughing were present, worse on the luminal surface. Furthermore, no background dysplasia or adenoma was identified. These findings uncovered an originally misdiagnosed acute colitis due to hypoperfusion. Subsequent imaging studies detected no gastrointestinal mass/lesion. 22-months later, the patient’s clinical follow-up was unremarkable.

Conclusion

Severe hemorrhage/hypoperfusion-induced colitis may pose a dilemma clinically and histopathologically when the contributing event is underrecognized. Detailed history and laboratory review and astute microscopic inspection are warranted.
Squamous Morules in a Fundic Gland Polyp: A Rare Benign Mimic of Well-Differentiated Neuroendocrine Tumor
Authors: Mitra A , Matsukuma K
Published: November 2022

Introduction/Objective

Fundic gland polyp is a benign polypoid lesion consisting of cystically dilated oxyntic glands; it can be either sporadic or associated with familial adenomatous polyposis or MUTYH-associated polyposis. Squamous morules are well-described in association with numerous epithelial lesions including tubular adenomas, cribriform- morular variant of papillary thyroid carcinoma, and endometrial neoplasia. However, to date only 2 cases have been reported in the stomach.

Methods/Case Report

We describe a third case, in a 53-year-old female who presented to endoscopy for hematemesis. Thirty-five sessile polyps ranging from 10-18 mm were identified and resected. On histologic sections, all were fundic gland polyps. Of these, one showed scattered small nests of epithelial cells with monomorphic round nuclei, inconspicuous nucleoli, and moderate eosinophilic cytoplasm, situated just below the luminal surface in continuity with adjacent glands. The nests showed focal expression of synaptophysin and cytokeratin 5/6, striking nuclear expression of β-catenin, and no expression of p63. Ki67 proliferative index was <1%. Interestingly, all 3 cases of gastric squamous morules have arisen in adults with symptoms of reflux, including our patient who was on a proton pump inhibitor. All were identified in a gastric polyp (either hyperplastic or fundic gland) within a background of numerous large fundic gland polyps (up to 2 cm), and none were associated with lower gastrointestinal polyposis. Nuclear accumulation of β-catenin, a common feature of squamous morules, was demonstrated in the one prior case that was tested.

Results (if a Case Study enter NA)

NA.

Conclusion

Gastric squamous morules are a rare finding. Given the nested arrangement of cells and bland cytology, well-differentiated neuroendocrine tumor may enter the differential diagnosis. Features that can help distinguish squamous morules from neuroendocrine tumor are: (1) focal expression of synaptophysin, (2) superficial location and continuity with adjacent glandular epithelium, and (3) nuclear accumulation of β-catenin.
Hepar-1 Positive Prostatic Adenocarcinoma: A Case Report and Review of Literature
Authors: Lazim A , Balshan E
Published: November 2022

Introduction/Objective

Poorly differentiated metastatic malignancy in patients with a history of more than one known primary tumor, such as a history of both hepatocellular and prostatic carcinoma as seen in our case, can be challenging. Both tumors are CK7/CK20 positive, and both can be reactive for hepar-1, as has been demonstrated in the current case, and rarely described in the literature.

Methods/Case Report

Herein we present a sixty-three-year-old male who presented for follow-up of his lower back pain in the setting of hepatocellular carcinoma. MRI of the spine was suggestive of an expansile metastatic lesion in the C2 vertebral body with extraosseous soft tissue extension resulting in moderate to severe central canal and left foraminal narrowing at C2-3. Multiple additional metastatic lesions were visualized throughout the cervical upper thoracic spine as detailed above. Vertebral body biopsy showed metastatic adenocarcinoma with sheets of neoplastic cells infiltrating the medullary spaces. The patient’s history of hepatocellular carcinoma was noted, and immunohistochemical staining for HepPar1 with appropriate control was performed and found to be diffusely reactive in the tumor cells. However, tumor cells were also positive for PSA, PSAP, and NKX3.1 (Fig-1-A-D, H&E, Hepar-1, PSAP, PAP). This immunoprofile is consistent with a prostatic origin of the tumor cells, and a diagnosis of metastatic prostatic adenocarcinoma was given.

Results (if a Case Study enter NA)

NA.

Conclusion

Hepar-1 and even arginase-1 have been observed in rare subsets of prostatic acinar adenocarcinoma. Even in the setting of PSA and PSAP negative metastatic disease in patients with a history of hepatocellular carcinoma, we suggest utilizing additional stains suggestive of a prostatic origin, such as NKX3.1, and even molecular studies. This could be useful diagnostic approach to help differentiate between the two neoplasms in such patients.
Potential Therapeutic Effects of Morin Hydrate in Folic Acid-Induced Acute Kidney Injury
Authors: Ahmed A , Elgamal D , Mohammad Farrag A , Ali F , Abd El-Aziz M , Abd El-Maksoud M , Ibrahim I
Published: November 2022

Introduction/Objective

Acute kidney injury (AKI) causes significant morbidity and mortality and, if left unmanaged, can progress to chronic kidney disease. Despite the advances in our understanding of the pathogenesis of AKI, there are no available therapeutics to combat it effectively. Folic acid (FA)-induced AKI is a well established rat model characterized by acute renal injury due to the disturbance of the antioxidant system with subsequent renal fibrosis. Morin hydrate, a well-known bioactive flavonoid, has been proven to alleviate oxidative stress and exhibits anti- inflammatory, anti-apoptotic and neuroprotective activity.

Methods/Case Report

We investigated the potential protective and therapeutic effects of morin hydrate on FA-induced AKI. Thirty-five rats were divided randomly into 5 groups (6 rats/ group) as follows: control group received a vehicle for 10 days, FA group received a vehicle for 10 days with an intraperitoneal (IP) injection of a single dose (SD) of FA (250 mg/kg) on the 7thday, FA-Withdrawal group injected with a SD of FA (250 mg/kg IP) on the 1st day with a vehicle for 10 days, morin-pretreated group received morin hydrate (40 mg/kg orally) for 7 days, followed by a SD of FA (250 mg/kg, i.p), and morin-treated group injected with a SD of FA (250 mg/kg IP), then treated with morin hydrate (40 mg/kg orally) for 7 consecutive days. All animals were sacrificed after 10 days and then, blood samples and kidneys were collected for biochemical and histopathological examination.

Results (if a Case Study enter NA)

FA group showed extensive structural damage in renal tubules and glomeruli with no significant improvement in withdrawal and morin-pretreated groups. Morin treatment significantly attenuated histopathological changes and reduced FA-induced increase in serum creatinine, albumin and urea levels. This therapeutic role of morin was associated with suppression of inflammation, oxidative stress, and apoptosis.

Conclusion

These findings suggest that morin hydrate constitutes a potential natural therapeutic product for treating AKI.
Rare Urinary Bladder Tumor with Unusual Morphology: A Potential Diagnostic Pitfall
Authors: Abdo M E , Walkenhorst M , AL-Kharouf I , Hamza A
Published: November 2022

Introduction/Objective

Transurethral resection of bladder tumor (TURBT) is a common surgical pathology specimen. The purpose of this report is to describe an unusual case encountered on a TURBT specimen with discussion of the differential diagnoses to avoid potential diagnostic pitfall.

Methods/Case Report

A 68-year-old male presented with history of urinary frequency, urgency and nocturia. Cystoscopy showed nodular, pedunculated lesion at the bladder trigone. Transurethral resection was performed. Histologic section showed a 4 mm polypoid lesion with classical appearance of cystitis glandularis and an adjacent area of relatively more atypical yet bland cells in tubular growth pattern. This elicited a differential diagnosis of nephrogenic adenoma / metaplasia, prostate type polyp / ectopic prostatic tissue and urothelial carcinoma with tubule formation. Immunohistochemical stains showed the lesional cells to be positive for high molecular weight cytokeratin and racemase (AMACR) and negative for GATA3, NKX 3.1, PAX-8, CK 7, CK 20, p63, PSA and PSAP. Literature review suggested that racemase is frequently positive in neuroendocrine tumors. Additional immunohistochemical stains performed showed the lesional cells to be positive for synaptophysin and chromogranin and negative for TTF-1 and CDX-2. Ki-67 proliferation index was less than 1%. Therefore, final diagnosis of well-differentiated neuroendocrine tumor, grade 1 involving urothelial mucosa was rendered. Patient did not have any history of prior malignancies. A subsequent PET / CT did not demonstrate any evidence of metastatic disease. Additional work up was also negative for carcinoid tumor of lung and well differentiated neuroendocrine tumor of gastrointestinal and pancreaticobiliary tracts. Multidisciplinary discussion recommended cystoscopy every 3 months for a year, then every 6 months for 2 more years and annually thereafter.

Results (if a Case Study enter NA)

n/a.

Conclusion

This case reminds pathologists that although rare, well differentiated neuroendocrine tumors can occur in the urinary bladder, they can show unusual histology with tubular growth, and can be racemase positive.
Eosinophilic Solid and Cystic Renal Cell Carcinoma with Non-typical Immunophenotype: A Series of Two Cases
Authors: Chen J , Harbert J , Bhalla R , Dewenter T
Published: November 2022

Introduction/Objective

Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is an emerging entity receiving increasing attention. Initially characterized in a large series by Trpkov et al, the distinct features of this tumor are voluminous eosinophilic cytoplasm with granular cytoplasmic stippling, mixed solid and cystic architecture, and CK20 positivity/CK7 negativity.

Methods/Case Report

We present two cases of ESC RCC diagnosed at our institution which exhibit a non-typical immunophenotype. The patients were a 58-year-old female and a 59-year-old male, with a 5.5 cm and 3.5 cm incidental renal mass, respectively. Both underwent uncomplicated partial nephrectomies. The tumors exhibited solid, alveolar, tubular and focally cystic growth patterns and were composed of cells with voluminous granular eosinophilic cytoplasm. Tubules and cysts were lined by single hobnail layer of neoplastic cells. Characteristic cytoplasmic stippling and compact leishmaniasis-like globules were present. The tumor nuclei were enlarged, with irregular nuclear contours and scattered multinucleation. The second case was significant for a diffuse neutrophil infiltration along with foamy macrophages. Immunohistochemically, the tumor cells were positive for PAX8, AMACR, CD10 and vimentin, while being negative for pan-cytokeratin, CD117, CAIX, Melan A, and HMB45. Interestingly, CK20 was only positive in very rare single cells and CK7 was focally positive in both cases. In our differentials, we considered SDH-deficient, low-grade FH-deficient, and MiT family translocation-associated RCC. FISH studies showed that the tumor cells have retained the expression of FH and SDHB, without TFE3 and TFEB alterations. Although our cases demonstrated non- typical CK20/CK7 expressions, based on the morphology with other molecular manifestations, the diagnosis of ESC RCC was rendered.

Results (if a Case Study enter NA)

NA.

Conclusion

ESC RCC poses diagnostic difficulties as many eosinophilic/oncocytic entities are included in the differentials, and the immunoprofile of this entity is variable. It is important to appreciate the characteristic histomorphologic features to increase its recognition as inclusion into the WHO classification system is likely.
Concurrent Prostatic Adenocarcinoma and Lymphoma: Clinicopathologic Study of 10 Cases
Authors: Cain S , Hamza A
Published: November 2022

Introduction/Objective

Synchronous and meta-synchronous hematolymphoid neoplasms and prostatic adenocarcinomas are known to occur, albeit rarely. The purpose of this study is to identify the clinicopathologic features of patients with coexisting prostatic adenocarcinoma and a lymphoma diagnosis.

Methods/Case Report

The institutional pathology archive was searched from 2016 to 2021. Data such as patient age, Gleason score, pathologic tumor stage, type of lymphoma and follow up data were collected.

Results (if a Case Study enter NA)

Ten patients were identified. Mean patient age was 65.4 ± 5.7 years. Nine specimens were prostatectomies and 1 was a needle core biopsy. Four patients had previous lymphoma diagnoses while 6 were diagnosed with lymphoma on lymph node dissection for prostatectomies. Seven patients had Gleason grade 3 + 4=7 disease, two had Gleason grade 4 + 3=7 and one had Gleason grade 4 + 5=9. Seven patients had small lymphocytic lymphoma/chronic lymphocytic leukemia, one had follicular lymphoma, one had mantle cell lymphoma and one had peripheral T-cell lymphoma. The patient with peripheral T-cell lymphoma died 18 months after lymphoma diagnosis and 11 months after prostate cancer diagnosis. The remaining 9 patients were alive for a mean of 27.7 ± 22.6 months after prostate cancer diagnosis.

Conclusion

There is minimal literature on patients with synchronous/meta-synchronous hematolymphoid neoplasms and prostatic adenocarcinoma. Our data provides one of the largest institutional series in this regard. Additional data and follow up is needed to evaluate if the concurrent low grade hematolymphoid malignancy, specifically small lymphocytic lymphoma/chronic lymphocytic leukemia, affects the survival outcome in these patients.
Sarcomatoid Chromophobe Renal Cell Carcinoma with Heterologous Elements: A Rare Form of an Aggressive Tumor
Authors: Hosseini H , Sham S , Unger P , Brodherson M S
Published: November 2022

Introduction/Objective

Chromophore renal cell carcinoma (ChRCC) accounts for approximately 4-10% of renal cell carcinomas. Compared with other subtypes of renal cell carcinoma, ChRCC generally has a more favorable outcome; however, sarcomatoid transformation is greatest in ChRCC. We report a case of ChRCC with extensive sarcomatoid transformation, which included the heterologous elements of osteosarcoma and chondrosarcoma. The presence of heterologous elements is distinctively rare, with only twelve previous cases in the English literature.

Methods/Case Report

A 64-year-old man presented with left flank pain and night sweats. The abdominal MRI showed a large exophytic hypervascular mass in the left kidney with metastasis to the left para-aortic lymph nodes. The patient underwent radical nephrectomy. Two months after the surgery, the patient was found to have extensive bony metastases. On gross examination, the nephrectomy specimen showed an 18 cm tumor replacing almost the entire kidney. The cut surface was white to tan with areas of hemorrhage and necrosis. Microscopic examination revealed a predominantly sarcomatoid ChRCC (nearly 80% of the tumor) with heterologous chondrosarcoma and osteosarcoma. The tumor extended into the perinephric adipose tissue and the adrenal gland. Multiple para-aortic lymph nodes contained sarcomatoid tumor with heterologous elements.

Results (if a Case Study enter NA)

NA.

Conclusion

ChRCC is frequently considered a more indolent renal cell carcinoma. It is important to recognize its higher propensity for sarcomatoid transformation. The presence of heterologous elements is exceptionally uncommon. Whether this correlates with a more aggressive tumor is not known because of the paucity of such cases.
Pitfalls in Pathology-Fibroepithelial Stromal Polyp of the Bladder
Authors: Li L
Published: November 2022

Introduction/Objective

The fibroepithelial stromal polyp is a benign polypoid proliferation of the stroma with overlying, usually squamous epithelium. It was originally reported in 1966 and is a generally recognized lesion of the female genital tract. Because the lesion contains atypical stromal cells, it can be mistaken for a sarcoma, particularly if it shows hypercellularity, pleomorphism, and atypical mitoses. It is often found in the female lower genital tract, urethra, and rarely extragenital sites, such as the breast. Other unusual locations such as the anus and nasal cavity have also been reported. The lesion is hormonally related and affects mostly reproductive-age women. Rare cases were reported in the male urinary tract and genital area. Because it is not well known in the bladder, overinterpretation as a sarcoma is possible.

Methods/Case Report

We report a ~60-year-old patient with a history of lower urinary tract symptoms due to prostatic hypertrophy on maximal medical therapy. He had been experiencing hematuria. On office cystoscopy, he was found to have a 3 cm prostate mildly obstructing the urethra, and 2 small velvety, erythematous patches on the posterior bladder wall. At cystoscopy, he was seen to have a small posterior bladder lesion, which was resected without difficulty. The pathology laboratory received two fragments of pink/tan soft tissue measuring 0.1 and 0.2 cm in the greatest dimension. On histology, the overlying urothelium was benign. The stroma was collagenous and hypocellular, containing scattered atypical and multinucleated cells, similar to the fibroepithelial stromal polyp well recognized in the female lower genital tract.

Results (if a Case Study enter NA)

N/A.

Conclusion

Benign fibroepithelial stromal polyp is an uncommon lesion usually seen in the lower genital tract of reproductive aged women. The presence in the bladder of a male is exceptionally rare. Recognition of the lesion will prevent overdiagnosis as a malignancy.
Endometrial Serous Adenocarcinoma with Septate Uterus: A Rare Case Report
Authors: Zedan M A , Wei E
Published: November 2022

Introduction/Objective

Congenital structural malformations of the uterus rarely coincide with uterine malignancies and can cause significant challenges to the detection of tumors originating from the uterine cavity. We report a case of delayed diagnosis of endometrial high-grade serous adenocarcinoma following an initial false-negative endometrial biopsy result. A septate uterus was discovered incidentally upon gross dissection, and it was recognized as the cause of the initial false-negative biopsy result. Exceptionally rare cases of uterine malformation combined with carcinoma have been reported in the literature and we are sharing this case to provide further awareness of such clinical scenario.

Methods/Case Report

A 67- year-old multigravida (G3P2103) female presented with postmenopausal bleeding. Initially, the patient underwent an endometrial biopsy revealing strips of benign glandular epithelium. Three months later endometrial biopsy showed high-grade serous carcinoma. A computed tomography scan (CT) of the abdomen and pelvis showed expanded and heterogeneously hypodense endometrium. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Gross examination of the specimen revealed a septate uterus with two cavities. Within the right cavity, there was an infiltrating polypoid mass and a superficial benign-appearing endometrial polyp was identified in the left cavity. After histologic examination of the right cavity mass, a diagnosis of endometrial high-grade serous adenocarcinoma was rendered.

Results (if a Case Study enter NA)

N/A

Conclusion

Congenital structural malformations of the uterus carry a higher risk of delayed or missed uterine cancer diagnosis. Septate uterus is associated with a higher chance of failed endometrial biopsy and can result in a false- negative outcome. The use of hysteroscopy, hysterosonography, and three-dimensional ultrasound could improve the diagnostic modality of malignant uterine tumors associated with structural malformations.
Uterine Leiomyosarcoma with a Novel RAB2A-PLAG1 Gene Fusion
Authors: Hosseini H , Vele O , Unger P , O'Leary X , DiNapoli S E , Mullaney K , Zaidinski M , Sukhadia P , Benhamida J K , Soslow R A , Villella J A
Published: November 2022

Introduction/Objective

Uterine leiomyosarcoma is a malignant neoplasm with three distinct histologic subtypes: spindle, epithelioid, and myxoid. Distinguishing leiomyosarcoma from mesenchymal uterine neoplasms such as endometrial stromal sarcoma can be challenging as they may exhibit a similar histology and immunohistochemical profile. In such cases, molecular studies can help achieve the definitive diagnosis. It has been shown that ~25% of the uterine myxoid leiomyosarcomas harbor TRPS1-PLAG1 and RAD51B-PLAG1 gene fusions. To our knowledge, no uterine leiomyosarcoma with RAB2A-PLAG1 gene fusion has been previously reported in the English literature.

Methods/Case Report

An 80-year-old woman presented with abnormal uterine bleeding. A large necrotic uterine mass with no evident lymphadenopathy was detected on imaging. Endometrial curettage demonstrated a malignant mesenchymal neoplasm that was positive for CD10, desmin, and vimentin and lacked expression of SMA, SMMH, synaptophysin, and chromogranin. AE1/AE3 highlighted rare foci. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy. The hysterectomy specimen was notable for a 10.8 cm rubbery focally calcified tan- white mass histologically composed of high-grade spindle and epithelioid cells with hypocellular and hyalinized areas. The mitotic activity was >25/10HPF. Immunohistochemically, the neoplastic cells expressed CD10, caldesmon, desmin (patchy), SMA (weak focal), and CAM5.2 (patchy) while they were negative for ER, PR, HMB45, AE1/AE3, WT1, cyclin D1, BCOR, myogenin, pan-NTRK, and ALK. P53 staining showed a wild type expression pattern.

Histology and immunohistochemistry could not definitively differentiate between leiomyosarcoma and high grade endometrial stromal sarcoma. RNA sequencing identified a RAB2A-PLAG1 gene fusion. In light of the histology and ancillary studies, a diagnosis of leiomyosarcoma was rendered.

Results (if a Case Study enter NA)

NA

Conclusion

This is the first case of a uterine leiomyosarcoma with RAB2A-PLAG1 gene fusion. Pathologists should be cognizant of the extensive morphologic and immunophenotypic overlap between various uterine mesenchymal neoplasms. In challenging cases, molecular analysis is crucial in allowing the pathologist to arrive at the final diagnosis.
Two Giant Placental Chorangiomas Discovered at 34 week’s Gestation: A Case Report
Authors: Amer S , Yin J , Hennawy H
Published: November 2022

Introduction/Objective

Chorangioma is a benign vascular tumor of the placenta, likely hamartoma, occurring in 1% of all examined placentas and arising from the primitive chorionic mesenchyme. The clinical significance is related to the size of the tumor. Most chorangiomas are small and asymptomatic; however, those larger than 4 cm are associated with intrauterine growth restriction (IUGR), polyhydramnios, preterm delivery, arteriovenous shunting, hydrops, and fetal thrombocytopenia.

Methods/Case Report

Herein, we present a case report of a placenta with two chorangiomas that are prenatally detected in a 25-year-old G2P1 female patient by ultrasound which showed a placental mass and mild polyhydramnios. The patient also developed hypertension and preeclampsia so she was referred for early induction of labor. The patient was elected for caesarian section and the placenta was delivered at 35 weeks of gestation. Grossly, two tan soft well-circumscribed lobulated placental masses were identified and measured 9.5 x 9.1 x 3.3 cm and 5.5 x 4.5 x 1.9 cm, respectively. The two masses were joined together by a thick blood vessel. The larger 9.5 cm mass was connected to the placental disc at the umbilical cord insertion site and is associated with blood vessel thrombosis. Microscopically the mass showed proliferation of capillary-sized vessels with surrounding stroma consistent with chorangioma. Clinical, radiological, and microscopic profiles support the diagnosis of placental chorangioma.

Results (if a Case Study enter NA)

N/A

Conclusion

To our knowledge, this is the first case report of two giant placental chorangiomas connected together by a thick blood vessel. Although both are giant (more than 4 cm), early diagnosis and timely intervention led to good maternal and neonatal outcomes aided with neonatal intensive care unit management.
S-100 Negative Granular Cell Tumor of Oral Cavity with Aggressive Clinical Behavior
Authors: Mohamed R , Givi J P , Bacaj P
Published: November 2022

Introduction/Objective

Granular cell tumors (GCTs) are neoplasms with neuroectodermal (Schwann cell) differentiation that is typically benign and cured by surgical excision. These tumors characteristically display strong expression of S-100 protein. Similar tumors without expression of S-100 protein are called “S-100 negative granular cell tumors.” The few reported cases of S-100 negative GCT in the oral cavity describe indolent clinical behavior. We report a case of a 49-year-old male with recurrent S-100 negative GCT in the oral cavity.

Methods/Case Report

The patient presented initially with a mass in the hard palate, which was resected and diagnosed as an S-100 negative GCT. One year later, the patient developed severe epistaxis and anemia (hemoglobin 7.2 g/dL). A large tumor of the hard palate was the source of bleeding. It was resected and diagnosed as recurrent S-100 negative GCT. Histologically, this tumor consists of small nests of epithelioid to spindled cells with moderately abundant granular eosinophilic cytoplasm, round central nuclei with vesicular chromatin and distinct eosinophilic nucleoli, and significant mitotic activity. The cells are immunoreactive for SOX10 and negative for S-100, melan-A, keratin AE1/AE3, p40, synaptophysin, smooth muscle actin, desmin, and myogenin.

Results (if a Case Study enter NA)

N/A

Conclusion

S-100 negative GCTs are rare, and only a few case reports describe their involvement in the oral cavity. We report this case because of its rarity and aggressive clinical behavior. Recognition of this entity and its potential for locally aggressive growth is important. Management of this tumor by complete excision seems advisable.
Adenoid cystic carcinoma of the orbit: a single institute experience
Authors: Deb P Q , Mirani N
Published: November 2022

Introduction/Objective

Adenoid cystic carcinoma (ADCC) is a malignant neoplasm usually arising from the major and minor salivary glands. Orbital ADCC arising from the lacrimal gland is rare. They present with morphology and immunohistochemical properties identical to their salivary gland counterparts. Due to their rarity, orbital ADCCs are poorly studied. Here, we describe our institutional experience of diagnosing ADCC in orbit.

Methods/Case Report

We queried the electronic laboratory information system for primary tumors arising in the orbit that resulted in the diagnosis of ADCC in the last twenty years. Clinical history, radiology, and immunohistochemical profile were obtained and summarized for all cases.

Results (if a Case Study enter NA)

Eight cases were with the diagnosis of orbital ADCC. The age at diagnosis ranged between 38 to 79 years, with most patients diagnosed between 41 to 50 years. The male to female ratio was 1:1. The tumor size varied between 1.5 to 8.7 cm. Most tumors were graded as grade III and showed perineural invasion. Five out of eight tumors showed predominantly solid architecture. The immunohistochemical pattern was similar to salivary gland ADCC, with one case showing MYB rearrangement.

Conclusion

Our data suggest that orbital ADCC closely resembles their salivary gland counterparts. Although small, our study broadens the general understanding of this rare group of malignancies.
Mandibular Solitary Intraosseous Myofibroma: A Case Report and Review of Literature
Authors: Lazim A , Kuklani R , Laski R
Published: November 2022

Introduction/Objective

Myofibroma (MF) is a benign soft tissue neoplasm of myofibroblastic origin, which frequently occurs in children and rarely presents as an intraosseous neoplasm. Other benign mesenchymal lesions and other low-grade malignant soft tissue neoplasms mimic morphologically to MF, thus making the diagnosis of MF challenging and crucial.

Methods/Case Report

Herein, we describe a 9-year-old female who was referred to an oral surgeon by her dentist, for evaluation of a radiolucent lesion on her left mandible associated with impacted tooth #21 and 22, which had slightly increased in size over 2 weeks. Her medical history was non-contributory other than asthma. Clinical examination revealed a large 5x4 cm firm mass slightly tender and causing expansion along the buccal as well as lingual aspects of the mandible in the canine and first premolar region. A radiograph CBCT of the mandible revealed malposed tooth #21 and 22 and unilocular radiolucency associated with the crowns #21 and 22. No evidence of calcifications within the lucency was noted. The patient underwent an incisional biopsy of the mandibular lesion, which showed a benign tumor composed of bland spindled cells arranged in fascicles with scattered thin walled blood vessels. Mitotic figures were inconspicuous and there was no discernible necrosis. Immunohistochemical stains show that the lesional cells are positive for SMA and Vimentin (Fig. 1 A-D, H&E, SMA, Ki-67, Vimentin) and negative for S100, desmin and CD34. Ki-67 (proliferative index) is interpreted to be low (<5%).

Results (if a Case Study enter NA)

NA

Conclusion

Mandibular intraosseous MF is extremely rare. Clinico-pathologic correlation, immunohistochemical features and sometimes molecular studies are essential for correct diagnosis and to rule out other benign and low-grade soft tissue neoplasms that mimic MF morphologically and radiographically. Thus MF, though rare neoplasm should be considered in the differential diagnosis of unilocular or multilocular radiolucent lesions of the jaws.
Continuing Professional Development (CPD) Training Need Assessment for Medical Laboratory Professionals in Ethiopia
Authors: Gebregzabher E H , Tesfaye F , Cheneke W , Edao A , Kedida G
Published: November 2022

Introduction/Objective

Continuing professional development (CPD) is required for health workers in practice to update knowledge and skills regularly to match the changing complexity of healthcare needs. The objective of this study was to identify the training needs of Medical Laboratory professionals in Ethiopia.

Methods/Case Report

A total of 457 Medical Laboratory professionals from five region and two city administrations were involved in the study. Data was collected from August 02 to 21, 2021 with structured self-administered online tool with five-point Likert scale. The tool had consent, demography, cross-cutting issues, and main activity area specific to medical laboratory.

Results (if a Case Study enter NA)

Majority of the participants were male (80.1%). Participants from Amhara region 110 (24.1%) were the largest groups in the survey followed by Oromia 105(23%) and Addis Ababa 101(22.1%). The study participants comprised of 54.7% with a Bachelor degree, 31.3% with a diploma (Associate degree), and 14% with a Master’s degree. The participants had varying years of service, ranging from less than one year to over 10 years of experience. Most of the participants work as generalists (24.1%) followed by working in microbiology (17.5%) and Parasitology (16%). The majority (96.9%) was working in a public sector or training institutions and the rest were employed in the private sector. Our study showed that the three most important topics selected for training in the cross cutting health issues were health and emerging technology, computer skills and medico-legal issues. Topics under microbiology, clinical chemistry and molecular diagnostics were selected as the most preferred technical areas for training. Participants have also selected topics under research skill and pathophysiology. When the laboratory specific issues were regrouped based on areas of application as technical competence, research skill and pathophysiology, thirteen topics under technical competence, four topics under research skill and three topics under pathophysiology were picked as priority areas.

Conclusion

In conclusion, our study identified that CPD programs should focus on topics that address technical competence in microbiology, clinical chemistry and molecular diagnostics. Additionally competencies in research skill and updating knowledge in pathophysiology should also receive due attention in designing trainings.
Triaging of Bone Marrow for Esoteric Testing – Cost-effective and Patient-centric Approach Utilizing WHO Nomenclature for Hematolymphoid Malignancies
Authors: Kumari D , Sanchez-Salazar A , Villa C , Herschap B , Ehsan A
Published: November 2022

Introduction/Objective

Esoteric testing (ES) plays a major role in bone marrow (BM) evaluation. Providers usually order tests considering differential diagnoses based on clinical history. Hematopathologists (HP) while reviewing the BM consider modifying the standing orders. Knowledge and simple guidelines for triaging BM for ES are limited in the literature.

Methods/Case Report

Between 2015-2021, a total of 2560 BMs were selected. Initial tests that were ordered by providers were reviewed by HP considering clinical history, medical necessity, and preliminary BM morphology. Average Medicare fee schedule for 2022 was used for cost analysis. Types of ES were evaluated for Flow Cytometry (FC); Cytogenetics (CG); Fluorescence In-Situ Hybridization (FISH) and Molecular Genetics (MG). Immunostains were excluded in this study.

Results (if a Case Study enter NA)

Cases were evaluated and categorized as cytopenias, cytosis, staging, MPN, MDS, myelomas, treatment follow-up and miscellaneous indications. ES were modified based on medical necessity and blinded with insurance plans or payment status. Initial clinical orders were modified by HP as follows: FC-reduced 15%; CG-reduced 38%; FISH-modified 25%; MG-modified 40% (single assays or NGS). Overall healthcare savings by modifying tests were close to $1.2M.

Conclusion

Effective triaging of BM is a complex decision and can result in significant cost savings. Factors positively impacting these savings are: 1) expertise training in hematopathology, 2) personalized order of ES considering clinical indication, 3) peer-to- peer interaction with providers, and 4) the types of samples obtained. Collaborative efforts among pathologists and clinicians may lead to appropriate ordering of tests, cost- saving effective patient care with relevant diagnostic, therapeutic and prognostic information obtained as recommended by WHO nomenclature for hematolymphoid malignancies. In addition, established practice guidelines with personalized medicine will reduce the burden for pre-authorization when challenged with time sensitive samples obtained from cancer patients obtained thru invasive procedures.
Primary Chronic Myelogenous Leukemia Blast Crisis with Precursor B Lymphoblastic Leukemia, a Case Report
Authors: Wei E , Bellamkonda V , Polski J
Published: November 2022

Introduction/Objective

Primary chronic myelogenous leukemia (CML) blast crisis at the initial disease presentation is rare. Most CML blast crisis cases present with increased myeloblasts with a minority of patients showing lymphoblastic leukemia. Differentiating primary CML lymphoblast crisis from de novo acute lymphoblastic leukemia may represent a diagnostic challenge to both pathologists and treating clinicians. This distinction is important as it has significant implications on patient management.

Methods/Case Report

A 15-year-old male patient was admitted to our University Hospital for hyperleukocytosis. Patient reportedly had weight loss with occasional sweats and cervical lymphadenopathy. She was found to have massive splenomegaly. Peripheral blood showed hyperleukocytosis with predominance of granulocytes at all maturation stages ranging from blast to segmented neutrophils with increased blasts. Subsequent bone marrow findings were consistent with extensive involvement by B-lymphoblastic leukemia. Ten-color Flow cytometry showed approximately 30% blasts with rare lymphocytes and monocytes. The blasts revealed precursor B-lymphoblastic immunophenotypic expression of CD45, CD10, CD19, CD20, CD22, CD34, CD38, CD200, HLA-DR and TdT expression. The results were similar to that of peripheral blood. Granulocytes showed abnormal maturation pattern with increased immature precursors and partial expression of CD4 and CD56 with no abnormalities detected in lymphocytes. In this case, while the bone marrow findings are consistent with B-lymphoblastic leukemia, the peripheral blood findings are consistent with blast phase of chronic myeloid leukemia. Further evaluation by cytogenetic and molecular studies confirmed the presence of Philadelphia chromosome, p210 transcripts, and rearrangement of BCR-ABL1, which supported the impression of precursor B-lymphoblastic leukemia in primary blast phase of CML. The patient was treated with tyrosine kinase inhibitor combined chemotherapy and went into remission. She has been followed up without significant complications for a year.

Results (if a Case Study enter NA)

NA.

Conclusion

The diagnosis of CML in primary lymphoblastic crisis is rare and needs to be systemically excluded before giving the diagnosis of de novo BCR-ABL1-positive acute lymphoblastic leukemia. If the patient does not have splenomegaly or previous leukocytosis, it needs cytological examination and extensive molecular analyses.
Focal Myositis with CD8+T-Cell predominance: an Inflammatory Myositis Mimicking a Soft Tissue Neoplasm
Authors: Shaheen M , Warmke L , Nassiri M
Published: November 2022

Introduction/Objective

FM is a rare self-limiting T-cell rich lesion arising within muscles of young adults as a solitary lesion and can be confused with a variety of neoplastic/inflammatory conditions or lymphoma. Here we describe a rare T-cell rich variant of FM with CD8 predominance.

Methods/Case Report

A 51-year-old female presented with two-month history of left trapezius swelling. MRI showed an enhancing tumor within the muscle, suspicious of sarcoma, less likely myeloma.

Results (if a Case Study enter NA)

Biopsy showed diffuse infiltration of small lymphocytes in a fibrotic background and atrophic skeletal muscle. These lymphocytes stained positive for CD2, CD3, CD7, CD8, CD5 (partial), TIA1 (partial), CD43, CD57 and negative for CD4, CD30, CD56, CD57, granzyme B, perforin, BCL-6, BCL-2, Pax5, TCL1, and CD56. Ki-67 was (<10%) with few background CD20+ B cells. By flow cytometry, the CD8+ T-cells co-express CD2, CD3, CD7, with dim CD5 expression. TCR gene rearrangement study by PCR showed no clonal TCR Gamma gene rearrangement.

Conclusion

FM is extremely rare with only 22 cases well-described in the literature, all predominantly composed of CD4+ T-cells, clinically concerning for low-grade sarcomas, as inflammatory myofibroblastic tumor, inflammatory leiomyosarcoma, or liposarcoma. Careful analysis is essential for correct diagnosis. Mimics include other causes of myositis, such as polymyositis and inclusion body myositis. Depending on the extent of lymphocytic infiltrate, gene rearrangement studies might be necessary to rule out clonality. Recognition of this rare entity with excellent prognosis is crucial to provide appropriate management and avoid unnecessary, aggressive procedures.
EBV+/HHV-8+/HIV+ high grade T Cell Lymphoma in the stomach
Authors: Li L , Cheng H
Published: November 2022

Introduction/Objective

T-cell Lymphoma is overly aggressive. T cells overgrow triggered by aberrant T-cell signaling and transform into a lymphoma. Virus infection contributes to the transformation, for example, EBV (Epstein Barr Virus) virus is associated with Extranodal NK/T-cell lymphoma, Angioimmunoblastic T-cell lymphoma, and peripheral T-cell lymphoma, HHV-8 is associated with Primary Effusion Lymphoma, Kaposi sarcoma, and very rarely associated with T cell lymphoma. The HIV (Human Immunodeficiency Virus) virus is associated with Burkitt lymphoma, Plasmablastic lymphoma et al. Among these lymphomas, only Primary Effusion lymphoma is associated with all three virus infections and is a B cell lymphoma. T cell lymphoma with all three infections has not been reported. Since most patients are diagnosed with advanced disease. So early diagnosis of this disease is especially important.

Methods/Case Report

An HIV+ 38-year-old male with no significant medical history complained of weakness, dizziness, and presenting with lower extremities swelling, and anemia for the last 2 weeks. The patient had a history of an unsafe sexual encounter with male sex workers but denies iv. drug use and blood transfusion. The screen before endoscopy reveals active, acute Hepatitis B Virus infection. Endoscopy findings show gastritis. The biopsy specimen shows mucosa is diffusely infiltrated by atypical plasmablastic cells. Immunostaining reveals they are positive for CD3, CD7, CD30, MUM1, CD43, and HHV8, but negative for Cd2, Cd4, Cd5, Cd8, Cd10, Cd21, Cd23, Cd25, Cd34, Cd56, Cd138, CD19, CD20, CD79a, PAX5, CD45, CD57, P53, CyclinD1, BCL6, BCL2, ALK, c-MYC, TdT, Granzyme B, TIA, S-100, Pancytokeratin. In situ hybridization for EBER is positive, but negative for Kappa and Lambda. The proliferative index (Ki-67) is high (99%). The morphologic and immunophenotypic features are consistent with an EBV CD30+ high-grade lymphoma. The sequencing from OnkoSightTM Advanced Chronic Lymphoid NGS Report shows a BCL-6 and EP300 mutation that has not been reported in a publicly available database (COSMIC; gnomAD).

Results (if a Case Study enter NA)

N/A.

Conclusion

To our knowledge, this is the first reported case of EBV+/HHV-8+/HIV+ high grade T Cell Lymphoma in the stomach. This type of lymphoma is extremely aggressive, and the early diagnosis is particularly important for prognosis.