bluuebunny/crossref_metadata_2025 huggingface dataset:
Sclerosing Epithelioid Fibrosarcoma Primary of the Bone
Authors: Abdulkader Ihab , Cameselle-Teijeiro José , Fraga Máiximo , Caparrini Ana , Forteza Jerónimo
Published: June 2007

Sclerosing epithelioid fibrosarcoma (SEF) is an uncommon tumor originally decribed in soft tissues. We repor a case of SEF primary of the left iliac bone in a 42ear-old woman. The tumor was grossly well circumscribed. The histologic examinaion disclosed a hypocellular neoplasm with densely hyalinized stroma. It was composed predominantly of small-to-moderate-sized round-to-ovoid cells, relatively uniform, often with clear cytoplasm, and arranged in nest, cord, and strand patterns. Because the distinctive morphologic patterns and the immunohistochemical profile of this entity may be mistaken for many different tumors, we here emphasize the diferential diagnostic problems of this variant of fibrosarcoma. To our knowledge, this is the first tumor of this kind described in the bone.
Mediastinal Rhabdomyoma
Authors: Sidhu Jagmohan S. , Nicolas Marlo M. , Taylor William
Published: June 2007

An incidental anterior-superior mediastinal rhabdomyoma is reported in a 68-year-old man who died of hypovolemic shock as a result of massive blood loss due to transection of aorta after being hit by a moving motor vehicle. This is the third reported case of mediastinal rhabdomyoma in the literature. The immunohistochemical evidence of expression of muscle-specific markers supports the rhabdomyomatous nature of this neoplasm, and electron microscopic demonstration of haphazardly arranged myofilaments with prominent Z bands, “jack-straws” in the mitochondria, and the absence of desmosomes is supportive of extracardiac origin of this rhabdomyoma. The possible histogenesis of extracardiac adult rhabdomyoma (EAR) in the anterior-superior mediastinum from the thymic myoid cells is also discussed.
Eccrine Syringofibroadenoma Arising in Peristomal Skin
Authors: Clarke Loren E. , Joffreda Michael , Abt Arthur B.
Published: June 2007

Eccrine syringofibroadenoma (ESFA) is a benign neoplasm arising from the intraepidermal portion of eccrine ducts. It is characterized by a distinctive histologic pattern of epithelial cells arranged in anastomosing cords surrounded by a fibrovascular stroma. Approximately 50 cases of ESFA have been reported, and in recent years the lesion has been described occurring in association with other skin conditions. We report 2 cases of ESFA arising in abdominal skin adjacent to enterostomy sites.
The Prognostic Impact of Hormone Receptors and c-erbB-2 in Pregnancy-Associated Breast Cancer and Their Correlation with BRCAI and Cell Cycle Modulators
Authors: Reed Wenche , Sandstad Berit , Holm Ruth , Nesland Jahn M.
Published: June 2007

A population-based series of 122 patients with pregnancy-associated breast carcinomas was histologically revised and the relationship between hormone receptors, cerbB-2, BRCA1, p27, cyclin E, and cyclin D1 was studied. The 5-year overall survival was 41%; 70% had tumor size >20 mm; 72% had metastasized to regional lymph nodes; 95% were histologic grade II or III; 66% and 75% were negative for estrogen and progesterone receptor, respectively; and c-erbB-2 expression was high (44%). BRCA1 expression was reduced in 33% of the cases. The expression of p27, cyclin D 1, and cyclin E was low, 11%, 9%, and 16%, respectively. Cyclin D I was positively associated with the hormone receptors (p<0.01). In multivariate analysis, lymph node status, progesterone receptor, and c-erbB-2 were significant prognostic factors. In subdividing the group according to lymph node status, c-erbB-2 and progesterone receptor retained a prognostic significance in the node positive group only. In conclusion, pregnancy-associated breast carcinomas are aggressive tumors, with low expression of hormone receptors, BRCA1, p27, and cyclin E and DI, and high expression of c-erbB-2.
An Osteoclast-Rich Tumor of the Gastrointestinal Tract with Features Resembling Clear Cell Sarcoma of Soft Parts: Reports of 6 Casesof aGIST Simulator
Authors: Zambrano Eduardo , Reyes-Mugica Miguel , Franchi Alessandro , Rosai Juan
Published: June 2007

Six cases are reported of an osteoclast-rich tumor of the gastrointestinal tract that should be segregated from GIST. Five of the cases were located in the small bowel and one in the stomach. The age of the patients ranged from 13 to 37 years. The tumors behaved aggressively, with metastases to regional lymph nodes, liver, and other intraabdominal sites. Microscopically, the tumor cells were medium-sized, predominantly oval, relatively monomorphic, diffusely immunoreactive for S-100-protein, and negative for CD1 17, CD34, HMB-45, and Mart-i. They were admixed with scattered osteoclast-like, multinucleated giant cells which were S-100-protein negative and KPIpositive. One case studied cytogenetically had the karyotype 46XX t(I2;22)(qI3;q12). The cases here reported are interpreted as examples ofa distinctive type of gastrointestinal neoplasm which shares somefeatures with clear cell sarcoma of soft parts (melanoma of soft parts), including in one case the chromosomal translocation that is characteristically associated with that entity.
Distinct Genetic and Epigenetic Changes in Medullary Breast Cancer
Authors: Osin P. , Lu Y-J. , Stone J. , Crook T. , Houlston R. S. , Gasco M. , Gusterson B. A. , Shipley J.
Published: June 2007

Genetic instability resulting in chromosome aneuploidy or mismatch repair defi ciency characterizes cancer. Medullary carcinoma (MC) of the breast is a specific form of breast cancer with unique clinical, epidemiologic, and prognostic features, sug gesting distinctive tumorigenic pathways. To investigate the nature of the genetic changes associated with MC we analyzed a series of 22 tumors. Chromosomal im balances were assessed by comparative genomic hybridization (CGH) and mismatch repair (MMR) deficiency tested for through assessment of microsatellite instability (MSI) and expression of MLH1 and MSH2 genes. MMR deficiency was detected in only a small proportion of cases. The chromosomal copy number changes showed some similarities to BRCAl-associated tumors. A high level of BRCA1 promoter hy permethylation was detected, suggesting a possible role of this gene in MC develop ment
Myositis Ossificans and Fibroosseous Pseudotumor of Digits: A Clinicopathological Review of 64 Cases with Emphasis on Diagnostic Pitfalls
Authors: de Silva M. V. C. , Reid R.
Published: June 2007

Myositis ossificans (MO) and fibroosseous pseudotumor of digits (FP) are pseudotumoral mimics of malignancy. A review of 50 cases of MO and 14 cases of FP showed that a malignant diagnosis was suggested by referring pathologists in 23% of MO and 9% of FP. The most common misdiagnosis was osteosarcoma. Awareness of the spectrum of clinicopathological features of MO and FP will help pathologists avoid misdiagnoses. A comparison of the clinicopathological features of MO and FP showed that most features were similar, but FP involved an older age group (p<0.001). MO showed a statistically significant higher tendency to contain fibrinous material (p=0.007), edematous lymphangioma-like areas (p=0.01 3), and cartilage (p=0.017) and FP to contain excessive immature osteoid (p=0.029). These differences may be related to the site of occurrence
Malignant Monotypic Epithelioid Angiomyolipoma of the Retroperitoneum
Authors: Lau Sean K. , Marchevsky Alberto M. , McKenna Robert J. , Luthringer Daniel J.
Published: June 2007

Monotypic epithelioid angiomyolipoma (EAML) is an uncommon variant of angiomyolipoma, occurring primarily in the kidney and characterized by a predominance of HMB-45-positive epithelioid cells. EAML is generally considered a benign neoplasm, though rare cases exhibiting malignant behavior have been reported. We describe a patient with a primary retroperitoneal monotypic EAML, composed exclusively of atypical epithelioid cells, which metastasized to the liver and the mediastinum. This case represents, to our knowledge, the first description of metastatic disease occurring in an EAML of this particular site
Proliferative Mucinous Lesions of the Endometrium: Analysis of Existing Criteria for Diagnosing Carcinoma in Biopsies and Curettings
Authors: Vang Russell , Tavassoli Fattaneh A.
Published: June 2007

It is often difficult to make a diagnosis of carcinoma in endometrial biopsies and curettings that show proliferative mucinous lesions because of the deceptively bland appearance of invasive mucinous adenocarcinoma at this site. Only limited information is available regarding criteria for distinguishing mucinous carcinoma from atypical mucinous proliferations and mucinous metaplasia of the endometrium. The threshold for diagnosing mucinous carcinoma in endometrial biopsies/ curettings may possibly be lower than that for endometrioid carcinoma. We evaluated different sets of existing criteria in order to determine which best facilitate a diagnosis of carcinoma in endometrial biopsies/curettings containing mucinous lesions. The biopsy/ curetting samples with the corresponding uterus (hysterectomy performed within 6.5 months) from each of 31 patients were studied. The biopsies/curettings were assessed with previously published criteria that more typically are used for endometrioid proliferations, as well as recently proposed criteria for mucinous lesions (Mod Pathol 12:1137-1142, 1999; Nucci et al. criteria [Type A, B, or C]). The presence of myoinvasion in the uterus was used as the gold standard for testing the biopsies/ curettings. The sensitivity and specificity of diagnosing carcinoma with use of endometrioid criteria were 20.0% and 71.4%, respectively, while the corresponding figures for diagnosing carcinoma with use of the criteria of Nucci et al. were 0% and 81.0% (Type A), 70.0% and 52.4% (Type B), and 30.0% and 66.7% (Type C), respectively. Combining the Types B and C criteria of Nucci et al. into a single category (Combined Type B or C) yielded a sensitivity and specificity of 100% and 19.0%, respectively, for diagnosing carcinoma. With use of a diagnosis of carcinoma by endometrioid criteria and application of the criteria of Nucci et al. for mucinous lesions, myoinvasive carcinoma was present in the uterus in 25.0% (endometrioid criteria) and 0%, 41.2%, 30.0%, and 37.0% (Types A, B, C, and Combined Tlype B or C, respectively) of cases, respectively. Because of the high sensitivity/low specificity of the criteria of Nucci et al. and low sensitivity/high specificity of endometrioid criteria in this small study, neither of the sets tested is perfect for handling mucinous proliferations. However, the criteria of Nucci et al. do have utility. Application of the criteria available for endometrioid proliferations in biopsies/curettings that show mucinous lesions may be misleading.
Metanephric Adenoma of the Kidney with Massive Hemorrhage and Necrosis: Immunohistochemical, Ultrastructural, and Flow Cytometric Studies
Authors: Kato Hiroyuki , Suzuki Masafumi , Aizawa Shigeo , Hano Hiroshi
Published: June 2007

Metanephric adenoma of the kidney is rare. We report 2 cases of metanephric adenoma with massive hemorrhage and necrosis. Case 1, a 42-year-old Japanese woman, complained of abdominal pain. Case 2, a 41-year-old Japanese woman, complained of fever and lumbago. They underwent nephrectomy. The cut surface was solid and yellow with massive hemorrhage and necrosis. These tumors showed packed tubular and glomeruloid patterns. The tumor cells were uniform and small, with uniform, oval, and hyperchromatic nuclei and scant cytoplasm, and showed reactivity for cytokeratin, vimentin, and CD 57. The MIB-1 indexes were up to 0.63%. The DNA ploidy pattern was diploid. The tumor cells formed small tubular structures with lumina and microvilli. These features suggested that metanephric adenoma is a benign tumor of an immature epithelial nature.
Clinical Implication of Idiopathic Plasmacytic Lymphadenopathy with Polyclonal Hypergammaglobulinemia: A Report of 16 Cases
Authors: Kojima Masaru , Nakamura Shigeo , Shimizu Kazuhiko , Itoh Hideaki , Yamane Yuko , Murayama Kayoko , Tanaka Hiroshi , Sugihara Shiro , Shimano Shunichi , Sakata Noriyuki , Masawa Nobuhide
Published: June 2007

Idiopathic plasmacytic lymphadenopathy (IPL) with polyclonal hyperimmunoglobulinemia is considered identical to multicentric Castleman's disease (MCD) reported in western countries. Clinically, both IPL and MCD are characterized by multicentric lymphadenopathy, prominent polyclonal hypergammaglobulinemia, elevated erythrocyte sedimentation rate, elevated serum interleukin-6 concentration, bone marrow plasmacytosis, and various abnormal laboratory data such as anemia and positive autoantibodies. However, IPL has a significantly better 5-year survival rate than that of MCD. Moreover, none of the present 16 cases developed Kaposi's sarcoma or B-cell lymphoma. Histologically, the interfollicular area contains a sheet of polytypic mature plasma cells in both IPL and MCD. In MCD, the majority of lymphoid follicles had hyaline-vascular germinal centers. However, lymphoid follicles of IPL usually exhibit a hyperplastic germinal center. Immunostaining also demonstrated a normal/ reactive follicular dendritic cell network pattern in the germinal center of IPL. Moreover, there were no human herpes virus-8-positive cells detected by immunohistochemistry. The overall clinicopathologic and immunohistochemical findings of our 16 cases suggest that IPL is distinct from MCD reported in Western countries.
Loss of Heterozygosity on Chromosome 1 and 9 and Hormone Receptor Analysis of Metastatic Malignant Melanoma Presenting in Breast
Authors: Beaty Michael W. , Quezado Martha , Sobel Mark E. , Duray Paul , Merino Maria J.
Published: June 2007

Malignant melanoma (MM), the most common metastatic solid tumor to involve the breast, may present as a diagnostic problem, frequently requiring the use of ancillary studies for accurate diagnosis. The implication of hormonal interplay is strong since metastatic MM to the breast is seen nearly always in women. However, the role of hormonal status as a predisposing factor in the development of this entity is largely unresolved. A number of chromosomal loci, including ip36 and 9p2l-22, appear to harbor critical genes important to melanoma tumorigenesis, and additionally chromosome 9q22.3-31. We wanted to know if metastatic MM in breast showed chromosome lp and 9p genetic alterations (loss of heterozygosity) similar to those that occur in primary cutaneous MM, and whether additional 9q LOH changes are present. Hormonal receptor status of the metastatic MM was also determined. We identified 20 patients with known MM metastatic to the breast, which we analyzed with the following genetic markers: D9S12 (9q22.3), D9S171 (9p21), IFNA (9p22), and DlS450 (ip). Visually directed microdissection was performed on archival histologic slides containing both tumor and adjacent normal breast epithelium, followed by single-step DNA extraction and polymerase chain reaction (PCR) amplification for evaluation of loss of heterozygosity (LOH) for the above-listed markers. Immunohistochemical (IHC) stains for estrogen receptor (ER) and progesterone receptor (PR) was performed on 10 of the cases. Twelve of the 20 cases contained DNA suitable for PCR amplification following direct visualization microdissection. Four of 8 (50%) informative cases showed LOH at 9p21 with D9S171. Ten cases were heterozygous for IFNA, with 2 cases (20%) showing LOH at this locus. These particular cases also showed LOH at 9p21. One of 9 (11%) informative cases showed LOH for DlS450 (Ip36). Five cases were heterozygous for D9S12, and 2 1-22 (50%) and lp36 (11%), as previously described in primary cutaneous MM. Additional LOH was observed at the 9q22.3-31 locus (40%). We suggest this locus to be investigated for harboring potential genes important in the tumorigenesis of cutaneous MM.
Invasive Micropapillary Carcinoma of the Breast: An Immunohistochemical Study of Neoplastic and Stromal Cells
Authors: Kuroda Naoto , Sugimoto Takeki , Takahashi Tamotsu , Moriki Toshiaki , Toi Makoto , Miyazaki Eriko , Hiroi Makoto , Enzan Hideaki
Published: June 2007

A 59-year-old woman complained of a palpable mass in the right breast, and a needle biopsy disclosed small clusters of neoplastic cells in the fibrous stroma. The small clusters did not contain fibrovascular cores but exhibited micropapillary configuration. Epithelial membrane antigen (EMA) immunohistochemistry confirmed the reverse polarity of the neoplastic cells. Additionally, the plasma membrane of many neoplastic cells stained with E-cadherin and f-catenin. Myofibroblasts, which were positive for alpha smooth muscle actin (ASMA) and negative for cytokeratin 14, were abundant in the neoplastic stroma, but no CD34-positive stromal cells were observed in the neoplastic stroma. For comparison, 3 additional cases of invasive micropapillary carcinoma (IMC) and 4 cases of invasive ductal carcinoma (IDC) were studied. Similar results for stromal cells were obtained in all cases. Our results from this preliminary investigation suggest that CD34-positive stromal cells may disappear from the stroma of IMC as well as IDC.
Correlation of Periacinar Retraction Clefting in Needle Core Biopsies and Corresponding Prostatectomy Specimens of Patients with Prostatic Adenocarcinoma
Authors: Krušlin Božo , Tomas Davor , Rogatsch Hermann , Reljić Ante , Vučić Majda , Baličević Drinko , Belicza Mladen , Mikuz Gregor
Published: June 2007

One of the underemphasized supportive criteria for the diagnosis of prostatic cancer is the presence of retraction clefting around neoplastic glands. We analyzed a series of 152 prostatic cancer cases to determine the frequency, extent, and correlation of periacinar retraction clefting between needle core biopsies (NCB) and corresponding matched radical prostatectomy (RP) specimens. Clefting was significantly more frequent in neoplastic compared to nonneoplastic acini in NBC and RP (p<0.05). There was no significant difference in the frequency of retraction clefting in neoplastic acini between NCB and corresponding RP (p>O.05). We have also found a concordance in matched RP and NCB (Kappa=0.582). We conclude that periacinar retraction clefting appears more frequently in neoplastic acini and could serve as a reliable criterion in the diagnosis of prostatic adenocarcinoma.
Comprehensive Examination of Sentinel Lymph Node in Breast Cancer: A Solution Without a Problem?
Authors: Falconieri Giovanni , Pizzolitto Stefano , Gentile Giuliana
Published: June 2007

Although several methods have been devised to examine sentinel lymph node (SLN) specimens in breast cancer, the extent of examination and whether it should routinely include multilevel sectioning to detect micrometastases (MM) (<2.0 mm) is still debated. In this study all "positive" SLN biopsies from 67 consecutive patients with breast carcinoma and evaluated by means of an extended protocol were reviewed. Abnormal findings included micrometastases (MM) between 0.2 and 1.0 mm (14 cases), (MM) between 1.0 and 2.0 mm (8 cases), metastases > 2.0 mm (22 cases), and isolated tumor cells (ITCs) (23 cases). The likelihood of finding metastatic deposits was comparable if sections were carried out at 100-, 150-, 200-, 250-, and 500-pm intervals. No metastatic foci > 2.0 mm would have been missed. 1 MM (1.1 mm focus) was missed within the 250-and 500-pm levels on hematoxylineosin, but not complementary cytokeratin staining. Our data show that SLN step sectioning does not add significant yield if compared to standard examination carried on initial levels, if the minimal target of 1.0 mm micrometastatic deposit is sought.
Epithelioid Hemangioma of Bone: A Potentially Metastasizing Tumor?
Authors: Floris Giuseppe , Deraedt Karen , Samson Ignace , Brys Peter , Sciot Raf
Published: June 2007

The case of a 15-year-old boy with a severe swelling of the 2nd toe in the left foot and a large swelling of the left inguinofemoral region is described. Histologic examination of the foot lesion showed a typical epithelioid hemangioma of bone that extended into the soft tissues, with a secondary location in the groin, suggestive of lymph node involvement. Subsequently, imaging also revealed swelling of iliac and para-aortic lymph nodes, which probably indicates further lymph node spread.. Besides the fact that epithelioid hemangioma of the toe has not been reported yet, our case showed a noncontinuous localization, most likely in draining lymph nodes. This finding suggests metastatic disease, an event that is extremely rare for epithelioid hemangioma. As such, epithelioid hemangioma might be comparable to another benign vascular tumor, the retiform hemangioendothelioma, which occasionally metastasizes to the lymph nodes without systemic spread.
Intraabdominal Myositis Ossificans: A Report of 9 New Cases
Authors: Zamolyi Renata Q. , Souza Paola , Nascimento Antonio G. , Unni K. Krishnan
Published: June 2007

Intraabdominal myositis ossificans (IMO) is a rare benign disorder characterized by reactive bone formation in intraabdominal soft tissue that should be distinguished from a malignant condition. We retrospectively searched our patient records and report 9 new cases of IMO. The lesions occurred in 7 men and 2 women with a mean age of 50 years (range, 24-76 years), 5 of whom had previous abdominal surgery. Histologically, all the cases were similar, consisting of a reactive mesenchymal process in adipose tissue. Mitosis was observed, but with no atypical forms, and the lesions lacked malignant cytologic features. IMO is an uncommon benign lesion that develops relatively rapidly. The pathogenesis is related to intraabdominal surgical procedures, but the exact mechanism remains to be determined.
Breast Tumor Resembling the Tall Cell Variant of Papillary Thyroid Carcinoma: A Case Report
Authors: Cameselle-Teijeiro J. , Abdulkader I. , Barreiro-Morandeira F. , Ruiz-Ponte C. , Reyes-Santias R. , Chavez E. , Sobrinho-Simoes M.
Published: June 2007

The breast tumor resembling the tall cell variant of papillary thyroid carcinoma is a very unusual mammary carcinoma whose histologic and predominant nuclear features mimic a papillary thyroid carcinoma. We report the case of a 64-year-old woman who presented with a palpable nodule in the right breast. Fine needle aspiration disclosed abundant cellularity with isolated cells, sheets, and papillary formations of epithelial cells with nuclear grooves. Histologically, the neoplastic cells were arranged in a solid to papillary architecture, with follicular-like and cribriform areas. The cells were columnar to cuboidal with eosinophilic cytoplasm, clear chromatin, nuclear grooves, and occasional nuclear pseudoinclusions. Tumor cells were positive for cytokeratins, alpha and beta-estrogen receptors, progesterone receptor, androgen receptor, CEA, and bcl-2. We searched for BRAF mutations with negative results. Recognizing the cytologic and histologic characteristics of these peculiar mammary tumors that mimic thyroid carcinomas can avoid unnecessary clinical investigations.
Tubular Adenocarcinoma of the Thymus: Case Report and Review of the Literature
Authors: Sawai Toyomitsu , Inoue Yuichi , Doi Seiji , Ikuta Yasushi , Kimino Koji , Nakashima Masahiro , Soda Hiroshi , Kohno Shigeru
Published: June 2007

Primary carcinomas of the thymus are rare. A variety of histologic patterns have been reported, and the most common are squamous cell carcinoma, lymphoepithelioma like carcinoma, and basaloid carcinoma. Adenocarcinomas of the thymus are extremely rare. As determined from a literature search, a pure tubular adenocarcinoma has never been previously described, and thus, this is first case report of tubular adenocarcinoma of the thymus. A combined resection of the superior vena cava and pericardium was performed. Immunohistochemically, the tumor cells were positive for CD5.
Primary Peritoneal Epithelioid Hemangioendothelioma
Authors: Posligua Lorena , Anatelli Florencia , Dehner Louis P. , Pfeifer John D.
Published: June 2007

Epithelioid hemangioendothelioma is an uncommon malignant vascular tumor of intermediate grade that occurs in a variety of organs and soft tissues. Diagnosis of epithelioid hemangioendothelioma is often complicated by the rarity of the tumor, and because the tumor shares many morphologic features with other peritoneal neoplasms. This report presents 3 cases of epithelioid hemangioendotheliomas arising as primary tumors of the peritoneum and reviews 7 previously reported cases to establish the demographic, clinical, morphologic, immunohistochemical, and ultrastructural features of this neoplasm. These cases demonstrate that the light microscopic features are very similar to epithelioid hemangioendothelioma arising at more conventional sites, such as the liver, that immunohistochemical analysis provides a reliable approach for confirming or establishing the diagnosis, and that at least one endothelial marker (either CD31, CD34, or factor VIII) should be positive for a definitive diagnosis. This series identifies the characteristics of peritoneal epithelioid hemangioendothelioma that can be reliably used for diagnosis.
The Potential of Comparative Genomic Hybridization as a Tool in the Differential Diagnosis of Matrix-Producing Bone Lesions
Authors: Gebert Carsten , Brinkschmidt Christian , Bielack Stefan , Bernhardt Thomas , Jürgens Heribert , Böcker Werner , Winkelmann Winfried , Bürger Horst , Gosheger Georg
Published: June 2007

Matrix-producing bone lesions consist of a wide variety of benign and malignant conditions. With respect to morphology, an overlap exists between benign and malignant bone tumors that causes difficulties in the final determination of the tumor. This study was conducted to show the potential of comparative genomic hybridization as a tool in the differential diagnosis of matrix-producing bone lesions. Thirty benign bone tumors were evaluated by conventional comparative genomic hybridization. To test its diagnostic reliability, 5 additional cases were analyzed, all with differential diagnostic difficulties related to morphology and radiology. All were ultimately diagnosed as malignant sarcomas, and unbalanced alterations were detected. In contrast benign tumors or tumor-like lesions did not reveal any chromosomal alterations. Comparative genomic hybridization is a useful adjunct in the complicated differential diagnostic algorithms of matrix-producing bone tumors.
Epithelioid Hemangioendothelioma of the Spinal Cord
Authors: Marucci Gianluca , Barbanera Andrea , Tosi Anna Lisa , Andreoli Alvaro , Simonetti Luigi , Magrini Elisabetta , Farnedi Anna , Foschini Maria Pia
Published: June 2007

A case of epithelioid hemangioendothelioma of the cauda equina is reported. The patient presented with rapidly worsening low back pain. Magnetic resonance imaging revealed a sharply demarcated intradural lumbar lesion. A bluish-red lesion, attached to the filum terminale, was removed. The patient is alive without evidence of recurrence 18 months after surgery. The tumor was composed of variously sized vessels lined by epithelioid endothelial cells with clear cytoplasm and centrally located, moderately atypical nuclei. These cells were immunoreactive for CD31 and factor VIII antibodies. Cytogenetic analysis disclosed two clones: 44-45X, - Y [cp3]/46XY[11]. Epithelioid hemangioendothelioma may arise in several sites, the most common being soft tissues. It is a borderline tumor that may recur, may metastasize, and rarely causes death. The present case appears to be the first example of epithelioid hemangioendothelioma of the spinal cord.
Benign Schwannoma With Perineurioma-Like Areas: A Clinicopathologic Study of 11 Cases
Authors: Kazakov Dmitry V. , Magro Gaetano , Yu Orlov Andrey , Shelekhova Ksenya V. , Matsko Dmitry E. , Spagnolo Dominic V. , Michal Michal
Published: June 2007

Eleven schwannomas are described. All tumors were well demarcated and surrounded by a true capsule or pseudocapsule and manifested Antoni A and Antoni B areas, Verocay bodies, and hyalinized vessels. In addition to typical schwannoma, there were clear cell areas composed of spindled cells arranged either in parallel sheets or in loops within the myxoid matrix, morphologically identical to retiform (reticular) perineurioma. The Schwann cells in the conventional schwannomatous areas displayed typical ultrastructural features. Those comprising the perineurioma-like areas revealed a primitive morphology. They were slender or polygonal and were devoid of an external lamina, pinocytic vesicles, or junctions. These findings suggest that the perineurioma-like areas consist of primitive or modified Schwann cells, or, alternatively, these perineurioma-like areas represent true, but incomplete perineurial differentiation within otherwise ordinary benign schwannomas. These neoplasms represent a morphologic variant of schwannoma having distinctive perineurial-like areas, a pattern which may elicit diagnostic difficulties.
Breast Tumor Resembling the Tall Cell Variant of Papillary Thyroid Carcinoma: Report of 4 Cases With Evidence of Malignant Potential
Authors: Tosi Anna L. , Ragazzi Moira , Asioli Sofia , Del Vecchio Marina , Cavalieri Monica , Eusebi Leonardo H.U. , Foschini Maria P.
Published: June 2007

A new type of breast carcinoma resembling the tall cell variant of papillary thyroid carcinoma has recently been described. To date, rare cases are on record. Here, 4 new cases of the tall cell variant of papillary thyroid carcinoma of the breast are described in women aged from 45 to 80 years old. All patients presented with palpable breast nodules and were treated with quadrantectomy. One patient presented with a long clinical history and a metastatic intramammary lymph node. The patient is alive and well 3 months after surgery. The remaining 3 patients are disease free at mean 7.5 months (range, 5 to 10 months) after surgery. These data suggest that papillary thyroid-like carcinomas of the breast show malignant potential.
Artefact as the Pathologist’s Friend: Peritumoral Retraction in In Situ and Infiltrating Duct Carcinoma of the Breast
Authors: Irie Junji , Manucha Varsha , Ioffe Olga B. , Silverberg Steven G.
Published: June 2007

Peritumoral retraction artefact appears in tissue sections as an empty space partially or completely encircling a nest of tumor cells, usually in conformity with the rounded or angular outline of that particular nest. The present study was designed to test this finding in a large series of cases and to quantify the appearance of peritumoral retraction artefact in, in situ and infiltrating duct carcinoma of the breast. We examined 199 cases of infiltrating duct carcinoma (IDC) and 188 cases of ductal carcinoma in situ (DCIS). Of the total of 387 cases, 111 were core needle biopsies, whereas the others were larger resections. In each specimen, retraction was evaluated on hematoxylin and eosin-stained slides as negative, 1+ (1% to 25% of tumor showing retraction), 2+ (26% to 50%), 3+ (51% to 75%), or 4+ (76% to 100%). Overall, peritumoral retraction was noted in 168 of 199 cases (84.4%) of IDC, versus 30 of 188 cases (16%) of DCIS ( P < 0.0001). Peritumoral retraction scored as 2+ or greater (26% to 50%) was seen in only 1 of 188 DCIS specimens, compared with 77 of 199 IDC. Thus, peritumoral retraction artefact appears to be a significant finding seen during the evaluation of hematoxylin and eosin specimens for the diagnosis of carcinoma. We discuss the possibility that this phenomenon might represent true prelymphatic space involvement rather than a fixation artefact.
A Unique Simultaneous Occurrence of Paratracheal Granular Cell Tumor and Papillary Thyroid Carcinoma
Authors: Colella Renato , Sidoni Angelo , Bellezza Guido , Cavaliere Antonio
Published: June 2007

We report an unusual case of granular cell tumor in the paratracheal region detected during total thyroidectomy for papillary carcinoma and clinically misdiagnosed as tracheal infiltration of thyroid neoplasia. Histologically, the granular cell tumor had infiltrated the thyroid gland close behind the papillary carcinoma. At immunohistochemical investigation, the cells showed diffuse positivity for S-100, neuron-specific enolase, and CD68, and surprisingly, positivity also for galectin-3 and HBME-1. A granular cell tumor should also be considered in the cytologic differential diagnosis of the thyroid and paratracheal nodules.
Regression of Gastric Large B-Cell Lymphoma Accompanied by a Florid Lymphoma-like T-Cell Reaction: Immunomodulatory Effect of Ganoderma lucidum (Lingzhi)?
Authors: Cheuk Wah , Chan John K. C. , Nuovo Gerard , Chan May K. M. , Fok Manson
Published: June 2007

Complete regression of high-grade lymphoma is extremely rare. We report 1 such case that might have been conceivably mediated by Ganoderma lucidum (Lingzhi), an immunomodulatory herbal medicine. A 47-year-old man presented with epigastric pain. Endoscopy revealed a large gastric ulcer, which on biopsy was diagnostic of large B-cell lymphoma. At gastrectomy 11 days later, no evidence was found of large B-cell lymphoma despite thorough sampling. Instead, there was a dense and permeative infiltrate of CD3+ CD8+ cytotoxic small T lymphocytes spanning the whole thickness of the gastric wall. In situ reverse transcription polymerase chain reaction for T-cell receptor β-chain family did not detect a monoclonal T-cell population. We postulate that the cytotoxic T cells may represent an active host−immune response against the large B-cell lymphoma that resulted in a complete regression. On questioning, the patient had taken megadoses of Ganoderma lucidum, which might have triggered the successful immune reaction.
Expression of p21WAF in Salivary Gland Mucoepidermoid Carcinoma and Its Relation to Histologic Grade
Authors: Etemad-Moghadam Shahroo , Baghaee Fereshteh , Tirgary Farrokh , Motahhary Pouria , Khalili Maryam , Eshghyar Nosratollah , Alaedini Mojgan , Eslami Mohammad
Published: June 2007

The biologic behavior and factors influencing the development of salivary gland mucoepidermoid carcinoma are not fully understood. Alteration of the cyclin-dependant kinase inhibitor p21WAF could cause uncontrolled proliferation leading to cancer. Thirty-five mucoepidermoid carcinomas were graded and immunohistochemically stained for p21WAF. The percentage of positive tumor cells was determined using an eyepiece graticule and a computer-assisted image analyzer, which revealed 8.6% and 22.9% of the cases to be positive for p21WAF, respectively. A statistically significant correlation was not observed between p21WAF and grading. Considering the absence of p21WAF expression in most mucoepidermoid carcinomas, it appears that the inhibitory effect of p21WAF on cell growth is removed in most cases. Given the lack of correlation with tumor grade, it is possible that the impact of p21WAF is in the earlier stages of tumorigenesis. A p53-independent pathway of p21WAF induction may exist for the small proportion of tumors that showed positivity.
Renal Tuberculosis in Adult Polycystic Kidney Disease: Report of 2 Cases and Review of the Literature
Authors: Simões do Espírito Santo Kleber , Teixeira Vicente de Paulo Castro , Costa Henrique de Oliveira , Franco Marcello
Published: June 2007

Adult polycystic kidney disease (APKD) is a common and potentially fatal disease, leading to end-stage renal failure in 50% of cases. The disease is frequently complicated by arterial hypertension, bacterial pyelonephritis, and hematuria. The association between APKD and tuberculosis has rarely been reported and is related to a more unfavorable course since the infection becomes refractory to specific treatment. The authors report 2 cases of renal tuberculosis diagnosed in the native nephrectomy specimens of 2 patients with APKD after renal transplantation. Tuberculosis, although not common, must be recognized as a potential source of infection of native polycystic kidneys in immunocompromised transplant recipients.
The Histopathologic Spectrum of Carcinomas Involving the Gastroesophageal Junction in the Chinese
Authors: Huang Qin , Zhang Li Hua
Published: June 2007

Carcinomas involving the gastroesophageal junction are common in China. The histopathologic characteristics of these cancers have not been systematically investigated. Reported are 41 such resected cancers from Chinese patients (30 men, 11 women). Their mean age was 62 years. The mean tumor size was 4.4 cm (range, 2 to 9 cm), and 58% were poorly differentiated. An unusual spectrum of tumor differentiation was observed, including adenocarcinomas (83%), adenosquamous (32%), colloid (2%), signet-ring (10%), squamous (5%), oncocytic (7%), pancreatic acinar (12%), and neuroendocrine (5%) carcinomas. Cancers with multiple types of differentiation in the same tumor were identified in 37 cases (90%). The adjacent gastric cardiac mucosa showed hyperplasia, oncocytic, and pancreatic acinar metaplasia, and mild chronic inflammation. Dysplasia was uncommon (n = 6). Barrett esophagus was not identified. Carcinomas involving the gastroesophageal junction in the Chinese are morphologically distinct, heterogeneous, and may be of esophageal origin.
Nodular Fasciitis of the Male Breast: A Case Report
Authors: Squillaci Salvatore , Tallarigo Federico , Patarino Rosanna , Bisceglia Michele
Published: June 2007

A case of nodular fasciitis is reported that involved the breast parenchyma of a 40-year-old man. The differential diagnosis of nodular fasciitis in the male breast mainly includes fibromatosis and myofibroblastoma. However, other benign and malignant spindle cell lesions of the breast, such as pseudoangiomatous stromal hyperplasia and especially spindle cell metaplastic carcinoma and fibrosarcoma, may enter the differential. The classic histomorphologic features and immunohistochemical findings are helpful in arriving at the correct diagnosis. The patient underwent a total excision of the lesion and is free of disease after 14 months. To our knowledge, this is the first reported case of a lesion of this type in the male breast.
Classical Hodgkin's Lymphoma Presenting as a Testicular Mass: Report of a Case
Authors: Seliem Rania M. , Chikwava Kudakwashe , Swerdlow Steven H. , Young Robert H. , Ferry Judith A.
Published: June 2007

Hodgkin's lymphoma almost always presents with lymphadenopathy. Presentation with extranodal disease is quite unusual, although Hodgkin's lymphoma is known to occasionally involve extranodal sites. However, no well-documented cases of testicular Hodgkin's lymphoma have been described. We report the case of a 52-year-old man who presented with a left testicular mass; orchiectomy revealed morphologic and immunophenotypic features typical of classical Hodgkin's lymphoma, nodular sclerosis type.
Morphologic Changes in the Endometrium Associated With the Use of the Mirena Coil: A Retrospective Study of 106 Cases
Authors: Hejmadi Rahul K. , Chaudhri Shalini , Ganesan Raji , Rollason Terence P.
Published: June 2007

This study outlines the histologic changes seen in 106 endometrial specimens after use of the Mirena coil (levonorgestrel) and compares these changes with previous studies. The variables assessed include nature of the endometrial glands, metaplastic glandular changes, nuclear atypia, hobnail change, and endometrial hyperplasia. Stromal changes include pseudodecidualization, mucinous change, ulceration, and infiltration by granulocytes, neutrophils, and plasma cells, and stromal hyaline nodules, a feature not described previously. Additional changes include superficial micropapillary change, infarcted decidua, dystrophic calcification, hemosiderophages, polypoid indentations, cervical microglandular hyperplasia and endocervical pseudodecidualization. These variables are compared with a similar previous study. Significant differences in the incidence of glandular metaplasia, dystrophic calcification, plasma cell infiltrates, hemosiderophages, and presence of nuclear atypia are noted. With increased use of the Mirena coil, histopathologists need to be aware of the characteristic and constant endometrial changes due to progestogenic and mechanical effects, despite a wide variation in the duration of usage.
Evaluation of NF2 Gene Deletion in Pediatric Meningiomas Using Chromogenic In Situ Hybridization
Authors: Begnami Maria D. , Rushing Elisabeth J. , Santi Mariarita , Quezado Martha
Published: June 2007

Meningiomas are uncommon childhood tumors. They could be of significant size at presentation, which has been associated with difficult surgical excision, high recurrence rate, and possibly aggressive clinical behavior. Monosomy 22 is a common molecular event in this neoplasm. Additionally, losses on chromosomes 1,7,10, and 14 have been identified in clinically aggressive meningiomas. Using chromogenic in situ hybridization, we studied a group of pediatric meningiomas, including neurofibromatosis type II—associated, sporadic, and radiation-induced cases. We found NF2 gene deletion in about 72% of the cases, with corresponding absent or minimal merlin protein expression by immunohistochemistry. Our findings confirm that the NF2 gene plays a role in the tumorigenesis of pediatric meningiomas and that chromogenic in situ hybridization is an efficient, economic, and reliable method for routinely assessing NF2 gene deletion in formalin-fixed, paraffin-embedded tissues.
BRAF T1799A Mutation Occurring in a Case of Malignant Struma Ovarii
Authors: Flavin Richard , Smyth Paul , Crotty Paul , Finn Stephen , Cahill Susanne , Denning Karen , Jinghuan Li  , O'Regan Esther , O'Leary John , Sheils Orla
Published: June 2007

Struma ovarii is an extremely rare tumor that occasionally undergoes malignant transformation. Because struma ovarii is composed of thyroid tissue, it is conceivable that the pathogenetic events involved in thyroid follicular transformation may take place also in struma ovarii. The authors describe a case of a classical variant of papillary thyroid carcinoma arising in a struma ovarii of a 22-year-old female. The tumor was heterozygous for BRAF T1799A mutation. No ret/ PTC-1 or ret/PTC-3 rearrangements were detected. This finding would suggest that malignant struma ovarii is similar histologically and genetically to primary papillary thyroid carcinoma.
Transthyretin (Prealbumin) Immunoreactivity in Renal Cell Carcinoma and Other Neoplasms
Authors: Giordano Thomas J. , Medeiros L. Jeffrey , Monterroso Victoria , Linehan W. Marston , Merino Maria J.
Published: June 2007

Transthyretin (prealbumin) previously was identified immunohistochemically in a majority of primary and metastatic renal cell carcinomas, whereas its presence was not detected in other adenocarcinomas. These findings suggested that transthyretin may be useful in differentiating renal cell carcinoma from other morphologically similar neoplasms. To further explore the use of transthyretin as immunohistochemical tumor marker, 24 primary and metastatic renal cell carcinomas of varying architectural patterns, cytoplasmic types, and nuclear grades, as well as tumors of other types that may resemble renal cell carcinoma, were examined with an antitransthyretin antibody using an avidin-biotin-peroxidase complex technique. A variety of normal tissues also was examined to define further the normal spectrum of transthyretin immunoreactivity. Transthyretin was detected in the neoplastic cells of 9 of 13 (69.2%) primary and 10 of 15 (66.7%) metastatic renal cell carcinomas. Transthyretin immunoreactivity correlated with the tumor architectural pattern but not with the type of cytoplasm or nuclear grade. In particular, tumors with an alveolar growth pattern showed consistent staining, whereas tumors with papillary or sarcomatoid growth patterns were more likely to lack transthyretin. In addition, one collecting duct carcinoma lacked prealbumin immunoreactivity. Diffuse transthyretin immunoreactivity was also detected in three of four (75%) hepatocellular carcinomas, and focal staining was present in seven of eight (87.5%) adrenocortical neoplasms, two of two spinal cord hemangioblastomas, one of two papillary carcinomas of the thyroid, one large-cell carcinoma of the lung, and one of four neuroendocrine tumors of the duodenum and pancreas. Other neoplasms studied were negative. Among normal tissues, transthyretin was found in proximal renal tubules, hepatocytes, and pancreatic islets of Langerhans but not in adrenal cortex or medulla, thyroid gland, exocrine pancreas, lung, skin, breast, duodenum, and brain. In summary, these results indicate that immunoreactive transthyretin is widely distributed in normal and neoplastic tissues. Thus, the immunohistochemical detection of transthyretin is of limited use in differentiating renal cell carcinoma from other morphologically similar neoplasms. A recent study by Jacobssen et al. (Histopathology 26:559-564, 1995) suggests that transthyretin immunoreactivity in renal cell carcinomas is due to reabsorption from serum and is not the result of synthesis by renal tubules.
Primary Jej unal Well-differentiated Liposarcoma (Atypical Lipomatous Tumor) With Leiomyosarcomatous Dedifferentiation
Authors: Vartanian Robert K. , O'Connell John X. , Holden Janet K. , MacFarlane John , Owen David A.
Published: June 2007

Primary small intestinal malignant mesenchymal tumors are uncommon, and liposarcomas originating in the small bowel are extraordinarily rare. To the authors' best knowledge, no well-documented case of a primary small intestinal dedifferentiated well-differentiated liposarcoma (atypical lipomatous tumor) has been reported in the English language literature. A 72-year-old demented man presented with fatigue, weight loss, and anemia. He was discovered on gastrointestinal series with follow-through to have a 7-cm pedunculated, polypoid jejunal tumor with an adjacent 2.5-cm submucosal fatty mass. Microscopically, the smaller tumor was a well-differentiated liposarcoma (atypical lipomatous tumor) containing microscopic foci of benign smooth muscle. Based on classic light microscopic and immunohistochemical findings, the adjacent larger mass proved to be a moderately differentiated (Coindre grade II) leiomyosarcoma. We report the clinical, radiologic, and pathologic findings of this primary jejunal dedifferentiated liposarcoma. The possibly relevant association of myogenous elements in tumors showing adipocytic differentiation with leiomyosarcomatous dedifferentiation in the present case is also discussed.
Superficial Hemosiderotic Angiomyxoma
Authors: Trotter Martin J. , O'Connell John X. , Tron Victor A.
Published: June 2007

A case of superficial angiomyxoma presenting as a pigmented nevus on the shoulder of a 77-year-old man is described. Histologically, the lesion was unencapsulated and demonstrated numerous small, bland, bipolar spindle cells embedded in a vascular, mucinous stroma. The lesion was also characterized by extensive, perivascular collections of large macrophages with foamy cytoplasm and extensive intracellular deposition of granular, golden-brown pigment consistent with hemosiderin. The iron stain was strongly positive. These phagocytic cells stained positively for vimentin and Ham 56, supporting a macrophage lineage. Hemosiderin was also noted within the cytoplasm of the spindle cells in the angiomyxomatous component; these spindle cells expressed factor XIIIa, CD34, or both, and thus likely represented dermal dendritic cells with phagocytic properties. Numerous hemosiderinladen macrophages in cutaneous angiomyxoma, possibly a result of occult trauma, result in a distinctive histologic appearance and may result in clinical resemblance to a melanocytic nevus.
Pathologic Features of Recurrent Intestinal Behçet's Disease
Authors: Kim Hee Jung , Piao Zhe , Kim Hoguen
Published: June 2007

We studied the pathologic findings of 10 resected specimens from the 9 patients who underwent repeated intestinal resections owing to recurrent intestinal Behçet's disease and compared the pathologic features with the findings of the primary lesions and another 13 resected specimens with the disease without recurrence. The repeated resection of intestinal Behçet's disease was a frequent event (9/22, 41%), and the mean period between operations was 2.6 years. None of the clinical features were significantly related to recurrence. All the lesions included the anastomosis area. The pathologic characteristics of recurrent intestinal Behçet's disease are deep ulcer (100%), transmural fibroinflammatory reaction (100%), and vasculitis (60%). There were no pathologic differences between the primary and recurrent lesions.