bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastrointestinal Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma with Synchronous Precancerous/Malignant Epithelial Mucosal Lesions: A Clinico-Pathologic Review
Authors: Sivanandham S , Gattuso P , Al-Sabti R 
Published: November 2022

Abstract

Introduction/Objective
Mucosa-associated lymphoid tissue (MALT) lymphoma of the gastrointestinal(GI) tract and synchronous precancerous/malignant epithelial lesions have been sporadically reported in literature. We sought to assess the incidence of GI MALT lymphoma and synchronous epithelial lesions.

Methods/Case Report
We performed a retrospective study by searching the pathology files at our institution from 1992 to December 2021, for GI lymphomas including extranodal marginal zone lymphoma(E-MZL).

Results (if a Case Study enter NA)
There were a total of 178 cases of lymphoma involving the GI tract. The basis of this report was formed by the 40/178(22.5%) cases, which were E-MZL. Twenty-four were males and 16 females(age range:37-80 years; mean:62 years). Sites of tumors were stomach(21), colon(6), ileum(4), duodenum(4), rectum(3), and cecum(2). Four cases were multifocal. Lymph nodes were assessed in 8/40, of which 4 were positive. One patient had malignant pleural effusion and another had retroperitoneal soft-tissue involvement. Overall, 11/40(27.5%) cases had a synchronous precancerous/malignant epithelial lesion. Gastric E-MZL were the most common (21), out of which 8(38%) were associated with synchronous epithelial lesion (3 gastric adenocarcinomas and 5 tubular adenomas(TA) at different colorectal locations). Out of 6 colonic E-MZL, 2 were associated with synchronous TAs at different colorectal sites and one rectal E-MZL was associated with cecal TA.

Conclusion
In our cohort, precancerous/malignant epithelial lesions were seen in 11/40(26.8%) of GI E-MZL cases. Gastric adenocarcinomas comprised 3/8 (37.5%) of gastric synchronous precancerous/malignant epithelial lesions; the association of E-MZL and gastric adenocarcinoma is well-known, arising in the background of chronic atrophic gastritis and intestinal metaplasia secondary to chronic inflammatory disorders. The remaining 8 cases of synchronous mucosal epithelial lesions were TAs at different colorectal sites. Based on our observations, unlike gastric adenocarcinoma, the association of colorectal pre-cancerous lesions with E-MZL is less likely, since, in all cases, the TAs were seen in sites other than E-ZML sites and also, sporadic colorectal TAs are a common pathology. However, possible association between E-MZL and precancerous mucosal epithelial lesions needs more work and further investigation.
An Interesting Case of Acute Colitis Possibly Associated with Deposition of Pharmaceutical Fillers
Authors: Rahmanov N , Varshney N , Chakraborty J 
Published: November 2022

Abstract

Introduction/Objective
Crospovidone and microcrystalline cellulose, known as pharmaceutical fillers, are nonabsorbable and insoluble white powders. They are widely used in the pharmaceutical and food industries to facilitate the delivery of consumed substances and can be identified in pathological specimens from the gastrointestinal tract. Here, we report a case of diarrhea and colonic inflammation associated with extensive deposition of crospovidone and microcrystalline cellulose within the colonic mucosa.

Methods/Case Report
A 49-year-old male with no significant past medical history presented with abdominal pain and diarrhea for 3 weeks. CT abdomen showed wall thickening and inflammatory stranding throughout the colon, and area with possible pneumatosis coli versus pseudo-pneumatosis. Colonoscopy revealed segmental involvement with congested, erythematous and friable mucosa confined to hepatic flexure, transverse colon and splenic flexure. The biopsies of these areas showed colonic mucosa with chronic and acute inflammation, architectural distortion of the glands, melanosis coli, and extensive deposition of foreign body material within the mucosa. Closer microscopic examination of the foreign body material revealed an aggregate of coral-shaped particles with a pink center and purple periphery, which were non-birefringent under polarized light, consistent with crospovidone. Also, there was an extensive deposition of aggregates of polygonal, transparent fragments which appeared brightly birefringent under polarized light, consistent with microcrystalline cellulose. The patient denied the usage of laxatives.

Results (if a Case Study enter NA)
NA.

Conclusion
Although the data does not suggest an association between the presence of pharmaceutical fillers within the gastrointestinal tract and mucosal injury, our case suggests the possibility of associated colitis. Here, extensive mucosal deposition of crospovidone and microcrystalline cellulose shows possible association with endoscopic findings of congested and inflamed colonic mucosa, supported by microscopic examination of the sampled tissue. Hence, more investigation of iatrogenic foreign body materials, such as pharmaceutical fillers is required for optimal patient care.
Synchronous Bilateral Testicular Tumors with Different Histology: Case Report and Review of Literature
Authors: Khalaf Z , Irfan A , Mateescu V 
Published: November 2022

Abstract

Introduction/Objective
Germ cell tumor (GCT) is the most common cancer among males in the 20–39 year-old age range, representing 21% of invasive cancer diagnoses. Majority of bilateral testicular tumors are metachronous. The synchronous tumors comprise approximately 0.5%-1% of all cases. Most of the synchronous tumors share the same histologic pattern, predominantly seminoma. The synchronous bilateral testicular GCTs (SBTGCTs) with discordant subtypes are extremely rare.

Methods/Case Report
A 26-year-old male presented with left testicular pain, the ultrasound revealed bilateral testicular masses with calcifications and microlithiasis in the right side. His serum markers showed elevated alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG). Lactate dehydrogenase (LDH) was normal. He underwent bilateral orchiectomy. The pathology report showed a non-seminomatous mixed germ cell tumor, 2.0 cm in greatest dimension, predominantly embryonal carcinoma (90%), with a minor yolk sac tumor component (10%), lymphovascular invasion, Germ-cell neoplasia in situ (GCNIS) and calcifications in the left testicle, and a seminoma, 0.3 cm in greatest dimension with GCNIS and calcifications in the right testicle. The pathologic staging was pT2pNX for the left testicle and pT1pNX for the right testicle. Computed tomography (CT) revealed two mildly enlarged left sided para-aortic retroperitoneal lymph nodes. Radical pelvic lymph node dissection was performed. The pathology report showed four para-aortic lymph nodes positive for metastatic carcinoma. Tumor was positive for CD30 in the embryonal component, positive for Glypican-3 in the yolk sac tumor component, and seminoma was positive for PLAP. The final staging was IIB for the left testicle and IA for the right testicle. He underwent 4 cycles of Etoposide and Cisplatin chemotherapy (EP). He is in complete remission after 10 months of his diagnosis.

Results (if a Case Study enter NA)
NA.

Conclusion
The SBTGCTs with discordant subtypes represent a rare entity with no standard therapy. Our patient was treated with 4 cycles of chemotherapy and achieved complete remission.
A Rare Case of Paratesticular Cystadenoma with Ovarian Stroma Found by Scrotal Ultrasound on a Cirrhotic Patient with Elevated Alpha-fetoprotein
Authors: Fujita Y , Ittmann M M , Rosen D G 
Published: November 2022

Abstract

Introduction/Objective
Paratesticular cystadenoma with ovarian stroma is a rare benign cyst-forming neoplasm with less than 10 cases reported in the literature. Typically, it presents in men aged 11 to 68 years (average 30) and is asymptomatic. The tumor is hypothesized to represent the efferent ductulus undergoing metaplastic change, the vestigial remnants of Mullerian duct, or mesothelium of the tunica vaginalis. Most tumors are considered benign, but a few cases of malignant transformation have been reported.

Methods/Case Report
We present a case of a 54-year-old male with a history of cirrhosis and elevated alpha-fetoprotein (17.85 ng/ML) who was found to have a paratesticular mass by scrotal ultrasound. Clinical history was obtained from review of electronic medical record. CD10 (Novocastra Clone 56C6) and progesterone receptor (PR) (Leica Clone 16) Immunoperoxidase stains were performed following the vendor recommendations. Surgical excision revealed a 0.6-cm polypoid nodule on tunica albuginea that was entirely submitted. Microscopically, the tumor was comprised of cystic spaces lined by cuboidal epithelium identical to that of the Fallopian tubes. There was a sparse spindle-shaped stroma underlying the epithelium similar to ovarian stroma. No nuclear atypia or mitosis was found. Immunoperoxidase stains showed the epithelium was positive for PR, and the stroma was positive for CD10. No evidence of germ cell tumor was identified.

Results (if a Case Study enter NA)
NA.

Conclusion
Characteristic histologic and immunophenotypic findings can aid in the diagnosis of paratesticular cystadenoma with ovarian stroma. Surgical resection for histological confirmation and long-term monitoring for the potential recurrence and metastatic spread are required.
Primary Carcinoid Tumor of the Prostatic Urethra: Case Report and Review of the Literature
Authors: Potterveld S K , Olson D 
Published: November 2022

Abstract

Introduction/Objective
We report a case of a 72-year-old male with a past medical history of previously treated urothelial cell carcinoma without recurrence in over ten years.

Methods/Case Report
Surveillance cystoscopy revealed a small lesion involving the prostatic urethra. Microscopic examination of the prostatic urethra lesion revealed a proliferation of pseudoglandular structures within the lamina propria adjacent to an area of urothelial cystitis cystica et glandularis. The pseudoglandular structures contained primarily small bland nuclei with fine chromatin and featured frequent intracytoplasmic neuroendocrine granules. Scattered foci of enlarged hyperchromatic nuclei were present, but no necrosis or increased mitotic activity was identified. Immunohistochemistry revealed the lesional cells were diffusely positive for chromogranin and synaptophysin; while negative for GATA3 and NKX3.1. The histologic features and immunoprofile are characteristic of primary carcinoid tumor of the prostatic urethra, which uniquely shows a predominantly pseudoglandular architecture compared to carcinoid tumors of other sites and are often associated with reactive urothelial proliferations.

Results (if a Case Study enter NA)
NA.

Conclusion
Acknowledgement of this rare entity as a diagnostic mimicker is critical to ensure proper treatment and management of the patient.
An Extremely Rare Case of Renal Collision Tumor Comprised of Hyperpigmented Microcystic Chromophobe Renal Cell Carcinoma and Papillary Renal Cell Carcinoma
Authors: Sun Y , Takeda K , Sutton A , Geradts J 
Published: November 2022

Abstract

Introduction/Objective
Renal collision tumors are rare lesions defined as the coexistence of two adjacent but histologically distinct tumors with sharp borders forming a single lesion. A combination of chromophobe renal cell carcinoma (ChRCC) and papillary renal cell carcinoma (RCC) is extremely rare. Here we report a collision tumor of hyperpigmented microcystic ChRCC, an uncommon variant of ChRCC, and papillary RCC. To our knowledge, it is the first reported case of this particular combination.

Methods/Case Report
A 70-year-old male with aortic stenosis presented with dyspnea and renal insufficiency. A renal mass was discovered incidentally. MRI characterized the left renal mass as 7.2 cm and bilobed. Radical nephrectomy was performed. Grossly, the tumor was located in the upper pole and consisted of two distinct components separated by fibrous tissue: a 5.4 cm black/orange mottled tumor and an adjacent 5.0 cm yellow lobulated tumor. Histologically, the larger tumor displayed a microcystic and solid pattern comprised of large cells with pale cytoplasm, hyperchromatic wrinkled nuclei, perinuclear halos, prominent cell membranes, and extensive intracellular and extracellular brown-black pigment, consistent with hyperpigmented microcystic ChRCC. The adjacent tumor showed diagnostic features of papillary RCC including papillae with fibrovascular cores lined by columnar cells with low nuclear grade, abundant macrophages, and foci of psammomatous calcifications. The hyperpigmented microcystic ChRCC was positive for CD117 and negative for Melan-A. Papillary RCC was strongly positive for Cytokeratin7 and Vimentin.

Results (if a Case Study enter NA)
N/A

Conclusion
Meticulous examination of the histologic features, aided by immunohistochemistry, can generate an accurate diagnosis of collision tumor and direct to the appropriate treatment choice.
P63-expressing Prostate Adenocarcinoma: A Case Study of a Rare Subtype
Authors: Harbert J , Chen J , Dewenter T , Bhalla R , Halat S K 
Published: November 2022

Abstract

Introduction/Objective
Prostate acinar adenocarcinoma (PCa) is a well-researched,and often diagnosed entity. A combination of architectural and cytologic characteristics are used in accurately identifying these carcinomas. However, the diagnosis can be challenging when the foci are minute or the cancer presents with unusual features. Ancillary studies aid in these scenarios. The loss of basal cells in adenocarcinoma makes markers targeting these cells desirable. PIN4 cocktail immunohistochemical stain, which combines alpha-methylacyl-coA racemase (AMACR), that is overexpressed in prostate carcinoma, with basal markers high molecular weight cytokeratin and p63, is a popular ancillary study to assist diagnosing demanding cases. Herein, we present a rare, challenging subtype of prostate carcinoma expressing p63.

Methods/Case Report
A 66-year-old male, with a past medical history of treated HIV and hyperlipidemia, underwent screening biopsies for a PSA of 7.5 ng/mL. Out of 22 parts, three cores showed modest amounts of atypical infiltrating cells. The architecture comprised of ill-defined glands, individual cells and single files of cells. They possessed high nucleocytoplasmic ratio giving a hint of atrophy, with occasional spindling and prominent nucleoli. To add to the challenge, PIN4 immunostaining showed strong nuclear expression of a basal marker with negative AMACR. Due to unusual morphology and basal marker expression, a consideration of basal cell lesion was entertained. However, subsequent staining revealed negative expression of HMWCK, and positive expressions of NKX3.1 and p40. Overall, with this morphology and immunoprofile we diagnosed our case as prostate carcinoma with aberrant expression of p63.

Results (if a Case Study enter NA)
N/A

Conclusion
Grading these lesions is controversial as they are considered to carry a better prognosis over conventional acinar adenocarcinoma of similar grade. A distinct etiopathology is suspected as molecular tests for ERG and PTEN are without alterations. Further discussion and characterization of these lesions is warranted as they are infrequently encountered and prone to being overlooked due to their similarities to benign basal cells.
Incidental Succinate Dehydrogenase (SDH) Deficient Renal Cell Carcinoma and Paraganglioma in a 24-Year-Old
Authors: Freeman J , MONIKA F , Didde R D , Siref L , Alouch N 
Published: November 2022

Abstract

Introduction/Objective
Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) is rare neoplasm (&lt;0.2% of all RCCs) caused by SDH-subunit gene mutation, usually SDHB. Patients carrying such mutations are also predisposed to other SDH-deficient neoplasms such as paraganglioma, gastrointestinal stromal tumor, and pituitary adenoma. Here, we report a case of incidental SDH-deficient RCC and paraganglioma.

Methods/Case Report
A 24-year-old male without past medical or family history presented to ED for perianal abscess. Imaging showed 8-cm heterogeneous left renal mass (figure-A) and 3.3-cm mass below aortic bifurcation, highly concerning for RCC with metastasis. Biopsy of kidney mass showed nested and trabecular epithelial neoplasm with weakly eosinophilic and occasionally vacuolated cytoplasm (figure-B). Nuclei were round with smooth contour and inconspicuous nucleoli. Tumor was immunopositive for PAX8, e-cadherin, P504S, and CD10, while negative for CK7, CD117, and Melan-A. SDHB immunostain was negative in tumor with intact staining in intervening endothelium. Findings were consistent with SDH-deficient RCC. Biopsy of pelvic mass showed low-grade neoplasm that was immunopositive for synaptophysin, chromogranin, and GATA3, with S100-positive sustentacular cells, consistent with paraganglioma. Patient underwent radical nephrectomy which revealed 7.5-cm, well-circumscribed, tan-red, predominantly solid mass with few cysts. Histologically, tumor had thin fibrous capsule and morphologically similar to biopsy. Tumor was limited to kidney without necrosis, sarcomatoid/rhabdoid differentiation, or vascular invasion.

Results (if a Case Study enter NA)
NA.

Conclusion
SDH-deficient RCC is rare low-grade entity with risk of metastasis and development of other neoplasms, which requires continued follow-up and potential genetic testing for patient and family members. Therefore, including SDH-deficient RCC in differential diagnosis of eosinophilic renal neoplasms is essential.
Cadherin-16 (CDH16) Immunohistochemistry: A Novel Diagnostic Tool for Renal Cell Carcinoma and Papillary Carcinomas of the Thyroid
Authors: Lennartz M , Minner S , Gorbokon N , Menz A , Krech T , Höflmayer D , Simon R , Blessin N C , Sauter G , Clauditz T S , Hinsch A 
Published: November 2022

Abstract

Introduction/Objective
Introduction: Cadherin-16 (CDH16), also termed kidney specific cadherin (ksp-cadherin), is a membrane-associated glycoprotein with a role in the embryonal development of tubules in kidney and thyroid. Downregulation of CDH16 RNA was found in papillary carcinomas of the thyroid.

Methods/Case Report
Methods: A set of tissue microarrays containing 14,978 samples from 149 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry to determine the expression of CDH16 in cancer and to assess the diagnostic utility of immunohistochemical CDH16 analysis.

Results (if a Case Study enter NA)
Results: Among normal tissues, a membranous CDH16 immunostaining predominated in thyroid, kidney, cauda epididymis, and in mesonephric remnants. In the thyroid, CDH16 staining was seen in 100% of normal samples, 83% of follicular adenomas, 58% of follicular carcinomas, but in only 9% of papillary carcinomas (p&lt;0.0001). Among non-thyroidal tumors, CDH16 positivity was particularly frequent in nephrogenic adenomas (100%), oncocytomas (98%), chromophobe (97%), clear cell (85%), and papillary (76%) renal cell carcinomas (RCCs), clear cell (56%), mucinous (36%), and endometroid (16%) carcinomas as well as carcinosarcomas (18%) of the ovary, adenocarcinomas of the cervix uteri (40%), serous (33%), clear cell (33%), and endometroid carcinomas (18%) of the endometrium and in various subtypes of neuroendocrine neoplasms (4-26%).

Conclusion
Given the massive loss of CDH16 expression in &gt;90% of papillary carcinomas of the thyroid, CDH16 is a highly useful diagnostic marker for these tumors. CDH16 immunohistochemistry is also useful for the identification of nephrogenic adenomas and the distinction of renal cell carcinomas from other neoplasms.
Multifocal Malignant Epithelioid Mesothelioma of the Testis
Authors: Karimi S S , Alagiozian-Angelova V 
Published: November 2022

Abstract

Introduction/Objective
Testicular mesothelioma is an extremely uncommon entity, and presents with non-specific clinical symptomatology, including painless scrotal enlargement and hydrocele formation. Testicular mesothelioma arising from the mesothelial cells of the tunica vaginalis accounts for 0.3%-5% of all mesothelioma cases and is often associated with poor prognosis. While the pathophysiology of this entity remains unclear, exposure to asbestos and long-standing hydrocele are associated risk factors.

Methods/Case Report
Herein, we present a case of a 65-year-old male with history of hypertension, 4-year history of left scrotal hydrocele, and a 7-month history of painless, progressively enlarging left scrotum. Scrotal ultrasound revealed a left, septated hydrocele with multiple heterogenous intratesticular masses. A left radical orchiectomy was performed and the specimen was sent to pathology for histopathological evaluation. Gross examination revealed a tan-brown fluid-filled cystic and solid mass measuring 7.5 x 4.0 x 3.5 cm involving the entire epididymis with multiple pink-tan, friable, papillary excrescences and nodules in the intratesticular parenchyma. Microscopic examination revealed a cystic and solid lesion with tubular and papillary architecture comprised of cuboidal cells with cellular pleomorphism, irregular nuclear contour, and dense chromatin involving the epididymis, rete testis, tunica albuginea, the testicular parenchyma including the hilar fat and the spermatic cord stroma. Immunohistochemical staining of the lesion demonstrated positive staining with AE1/AE3, CK7, WT1, PAX8, Calretinin, Vimentin, Podoplanin D2-40, and lack of staining with Chromogranin, Inhibin, MART-1, SMA, AFP, CD99, S100, c-kit, PLAP, HCG, MOC31, BerEP4. Based on the histomorphology and the immunophenotype of the lesion, a diagnosis of an epithelioid-type malignant mesothelioma was favored.

Results (if a Case Study enter NA)
N/A.

Conclusion
Malignant epithelioid mesothelioma of the testis is a rare and important clinical consideration for patients presenting with scrotal lesion, non-specific clinical presentation, and a history of asbestos exposure and/or long- standing hydrocele.
Automated Prostate Cancer Identification Facilitates Prognosis Marker Assessment in 11,845 Prostate Cancers Using Artificial Intelligence and BLEACH&STAIN Multiplex Fluorescence Immunohistochemistry
Authors: Blessin N C , Müller J , Mandelkow T , Bady E , Lurati M C , Lennartz M , Graefen M , Sauter G , Steurer S 
Published: November 2022

Abstract

Introduction/Objective
Although most prostate cancers behave in an indolent manner, a small proportion is highly aggressive. To evaluate the patient’s risk, several prognosis parameters, that can be accompanied by a high interobserver variability has been established. A reproducible prognostic evaluation is lacking.

Methods/Case Report
To enable automated prognosis marker quantification, we have developed and validated a framework for automated prostate cancer detection that comprises three different artificial intelligence analysis steps and an algorithm for cell-distance analysis of BLEACH&STAIN multiplex fluorescence immunohistochemistry (mfIHC). We have used the analysis framework to measure PSA, PSMA, INSM1, AR, Ki-67, CD56, Chromogranin A, Synaptophysin, CD8 in a cohort of 11,845 prostate cancers.

Results (if a Case Study enter NA)
The Ki-67 labeling index provided the strongest prognostic information among all analyzed prognosis marker in 11,845 successfully analyzed prostate cancers (p&lt;0.001 each). The combined analysis of the Ki67-LI and Gleason grades obtained on identical tissue spots showed that the Ki67-LI added significant additional prognostic information in case of classical ISUP grades (AUC:0.82 [p=0.002]) and quantitative Gleason grades (AUC:0.83 [p=0.018]). Several combinations of these 8 prognosis markers were combined to prognosis scores and used for unsupervised clustering to identify a proportion of prostate cancers with a particularly poor prognosis (p&lt;0.001 each).

Conclusion
Automated prostate cancer identification enables fully automated prognosis marker assessment in routine clinical practice using deep learning and BLEACH&STAIN mfIHC.