bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unifocal Peritoneal Malignant Mesothelioma as Initial Presentation of Lynch Syndrome: A Case Report and Brief Review
Authors: Waters R , Taggart M , Malpica A , Mansfield P , Raghav K 
Published: November 2022

Abstract

Introduction/Objective
Peritoneal malignant mesothelioma (pMM) has scarcely been reported in the context of Lynch Syndrome (LS). No cases have directly led to a diagnosis of LS. We report an unusual case of pMM presenting as a localized mass, leading to the diagnosis of LS.

Methods/Case Report
A 55 year old female with no prior oncologic history presented with a solitary epigastric mass. Her mother and maternal relatives had colonic, gastric and ovarian cancers. Imaging studies revealed a perigastric mass abutting the left liver. The resected 9.8 cm mass showed a variegated histology with tubulopapillary formations and solid sheets. The neoplastic cells also showed variable cytologic features including anisocytosis, pleomorphic nuclei, multinucleation, prominent nucleoli, intranuclear pseudoinclusions, and rhabdoid features. A dense intratumoral and peritumoral lymphoplasmacytic infiltrate was present. Epithelioid pMM was confirmed with expression of cytokeratin 5/6, calretinin, WT-1, and thrombomodulin and loss of MOC31. Abnormal loss of MSH2 and MSH6 was seen (retained expression MLH1/PMS2 expression), suggesting high-level microsatellite instability. A germline pathogenic variant of MSH2 was identified.

Results (if a Case Study enter NA)
NA.

Conclusion
We report the first case of LS presenting as an atypical (unifocal) pMM showing variegated histology and lymphocytic infiltrate. Microsatellite instability in pMM is rare and has only been reported in known LS patients. Awareness of the pMM within LS is evolving and atypical features may prompt evaluation of DNA microsatellite repair system, with implications for the patient (treatment/screening) and their family.
Linear Identification of 8 or More Plasma Cells (PCs) in the Interfoveolar Areas (IFAs) of Sleeve Gastrectomies Is Highly Predictive ofHelicobacter pylori (H. pylori) Infection
Authors: Akrmah M , Ibrahim E , Ligato S 
Published: November 2022

Abstract

Introduction/Objective
Bariatric surgery for morbid obesity is dramatically increasing, and large number of sleeve gastrectomies is examined histopathologically. The GIPS guidelines recommend using a visual gestalt to identify substantial inflammation for prompting further ancillary testing for H. pylori microorganisms, and a recent study proposed an “Objective Visual Analog Scale” that justifies additional work-up for H. Pylori infection in gastric biopsies. Our study aims to establish a potential correlation between the number of plasma cells in the IFAs and the presence of H. pylori infection in sleeve gastrectomy specimens.

Methods/Case Report
We retrospectively reviewed 338 patients who underwent sleeve gastrectomy for morbid obesity at our institution from 2016-2021. Only 105 of 338 cases were included which demonstrated mild to marked lymphoplasmacytic infiltrate in the IFAs of the lamina propria on H&E stain. The number of plasma cells identified in the more expanded IFAs of the lamina propria was assessed by “drawing an imaginary horizontal line” and the number of plasma cells under the “line” were counted. H. pylori immunostain was performed in all cases. Statistical analyses were performed using IBM SPSS statistics Version 26.

Results (if a Case Study enter NA)
H. pylori like organisms were identified in 49 of 105 cases (20 cases on H&E stain and 29 cases on H. pylori immunostain). Receiver operator characteristic curve (ROC) showed that the identification of 8 or more plasma cells in expanded IFAs is both highly sensitive (93.9%; 46/49) and specific (83.9%; 47/56) for predicting H. Pylori infection with a positive predictive value of 83.6% (46/55) and area under the curve (AUC) of 0.94 (CI:0.89-0.99, p-value= 0.00).

Conclusion
In the light of above results, we propose that in sleeve gastrectomies specimens, in which H. pylori is not identified on H&E sections, the linear identification of 8 or more plasma in the more expanded IFAs is highly predictive of H. pylori infection and justify additional workup for H. pylori infection.
Diffuse Large B-cell Lymphoma of the Prostate: Case Study of an Uncommonly Encountered Entity
Authors: Harbert J , Chen J , Fakhri N , Bhalla R , Rinker E 
Published: November 2022

Abstract

Introduction/Objective
Hematologic neoplasms comprise less than 1% of prostate malignancies, with diffuse large b-cell lymphoma (DLBCL) accounting for 15% of those. Chronic lymphocytic leukemia/small lymphocytic lymphoma is most often seen, comprising 53% of lymphomas at this site, with the remainder consisting of marginal zone, mantle cell, and follicular lymphomas.

Methods/Case Report
Our case involves a 51-year-old African American male presenting to a medium-sized academic medical center with a chief complaint of hematuria with clot retention. Patient did endorse night sweats and chills at this time. Imaging revealed an 11 cm mass involving the prostate and bladder, a 10 cm right adrenal mass, and pelvic lymphadenopathy. A cystoscopy with transurethral resection was performed with tissue histology showing complete effacement of prostatic parenchyma by sheets of medium-sized, mildly irregular, non-cohesive cells with minimal cytoplasm. Tissue morphology appeared highly suspicious for lymphoma, but the rarity of this process along with the possibility of other lesions led to differential diagnoses including small cell carcinoma, poorly differentiated prostatic adenocarcinoma, high-grade urothelial carcinoma, and granulomatous prostatitis. Immunohistochemical staining of neoplastic cells showed CD20+ B cells with a non-germinal center immunophenotype (CD10-) and co-expression of Bcl-2 and c-myc. Subsequent FISH analysis demonstrated a Bcl-6 gene rearrangement without a Bcl-2 or MYC rearrangement. Ki67 was positive in 90% of tumor cells. Rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone was initiated for stage IV DLBCL with prophylactic intrathecal methotrexate. The patient has received 6 cycles of chemotherapy to date with resolution of the prostate and adrenal masses. Bladder involvement is still seen radiographically, but is suspected to be mainly necrotic tissue.

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

Conclusion
Less aggressive lymphomas are more common, which makes this presentation additionally unexpected. We employed a wide battery of immunohistochemical stains, including NKX3.1, s100, gata-3, pan-ck, CD68, and chromogranin and synaptophysin, when initially evaluating the neoplastic tissue.
Urinary Bladder Squamous Cell Carcinoma In-Situ in a Background of Condyloma Acuminatum – A Diagnostic Challenge
Authors: Pandiri M , Bharadwaj H , Cole L 
Published: November 2022

Abstract

Introduction/Objective
Condyloma acuminatum is a rare lesion of the urinary bladder and urethra, usually associated with extensive anogenital condyloma acuminatum and immunosuppression. It is considered a risk factor for developing urinary bladder squamous cell carcinoma.

Methods/Case Report
We report a case of an 80-year-old male with a history of invasive squamous cell carcinoma of the anus, status-post chemoradiation ten years prior, and renal transplantation for end-stage renal disease 15 years prior. He presented with a lesion adjacent to the neoureteral orifice at the bladder dome. Biopsy revealed nonkeratinizing, hyperplastic papillary fronds of squamous epithelium with koilocytic change and viral atypia. The tumor was positive for p16, GATA3, and p40 and negative for high-risk and low-risk Human Papilloma Virus by in-situ hybridization. However, the morphology was consistent with squamous cell carcinoma in-situ arising in a background of condyloma acuminatum, which was concurred by an outside expert. Bladder condyloma acuminata are often challenging to recognize, given their extreme rarity and the possibility of negative low-risk and high-risk Human Papilloma Virus tests. Lack of prior history of anogenital condylomas can further obscure this diagnosis.

Results (if a Case Study enter NA)
NA.

Conclusion
This case raises awareness of condyloma acuminatum as a rare entity that needs to be considered in the differential diagnosis of bladder tumors, especially in immunosuppressed patients. Given that the treatment strategies for squamous cell carcinoma arising from condyloma acuminatum differ from that for urothelial carcinoma with squamous differentiation, distinguishing these lesions from one another is imperative.
Primary S100 Negative Amelanotic Spindle Vaginal Melanoma
Authors: Halat S K , Bach K 
Published: November 2022

Abstract

Introduction/Objective
Vaginal melanoma is a rare malignancy composed of cells showing melanocytic differentiation and represents less than 3% of malignant vaginal tumors. It occurs in older women, typically in the distal third of the vagina. Outcomes are poor and median survival is less than 2 years. Macroscopically, 90% of these lesions are pigmented, polypoid and ulcerated. Microscopically they demonstrate diffuse, nested, trabecular, and/or fascicular patterns and are comprised of epithelioid cells with or without a spindle cell component. They are typically pigmented and S100 positive.

Methods/Case Report
Here we present a rare case of purely spindled amelanotic S100 negative vaginal melanoma. The patient is a 75 year old woman who presented with a 6 month history of vaginal discharge, and a one month history of new foul odor and vaginal bleeding, constipation, and unintentional weight loss. A large vaginal mass was palpated on physical exam. Subsequent computed tomography demonstrated a 8.2 x 8.2 x 9.4 cm mass occupying the vaginal vault with abutment of the urinary bladder anteriorly and the rectal and anal walls posteriorly. A biopsy was performed and a 3.8 x 2.2 x 1.2 cm aggregate of pink tan friable tissuse was obtained. Histopathologic examination showed a malignant neoplasm composed purely of spindled cells in a fasicular pattern. Tumor cells showed marked nuclear pleomorphism with inconspicuous nucleoli. Tumor necrosis was present. No pigment was seen. By immunohistochemistry, tumor was positive for SOX10, HMB45, and Melan A, and negative for S100, AE1/3, EMA, myogenin, desmin, smooth muscle actin, synaptophysin, chromogranin, Pax8, and GATA3. BRAF mutation analysis showed no mutations. Patient received radiation therapy with a good clinical reponse.

Results (if a Case Study enter NA)
NA.

Conclusion
Amelanotic S100 negative spindled vaginal melanoma is an unusual presenation of a rare tumor and should be considered in the workup of malignant vaginal tumors with a spindle cell morphology.
Analysis of p21expression in cervical carcinoma in a tertiary institution in Ghana: an immunohistochemical study
Authors: Duduyemi B M , Addae E , Bedu-Addo K 
Published: November 2022

Abstract

Introduction/Objective
Cervical cancer is one of the leading causes of female mortality worldwide. About 85% occur in low-income countries with 13.8% incidence and 14% death in Ghana. P21 overexpression in cervical cancer is linked to tumour growth and a bad prognosis. The expression profile of p21 in our setting is largely unknown, thus the necessity to evaluate p21 expression in cervical cancer

Methods/Case Report
A retrospective and descriptive study to investigate p21 expression in association with demographic and clinicopathological features of cervical cancer. The age, histologic type and tumour grade of patients were abstracted over 2 years. Tissue microarray (TMA) of suitable FFPE blocks was constructed and immunohistochemistry (IHC) was performed. Data was analysed using Statistical Package for Social Sciences (SPSS) Version 26.

Results (if a Case Study enter NA)
Of the 135 cases, age range was 31-115 years and mean age of 58.93 years (SD ± 17.88). Squamous cell carcinoma was the most common histological type (96.3%) with the non-keratinizing variant having the highest frequency (53.1%). Majority of the cases were high grade tumours (82.9%). About 66.7% of the cases stained positive for p21 antibody; most of which are high grade tumours and squamous cell carcinoma.

Conclusion
An overexpression of p21 (anti-apoptotic biomarker) was seen in high grade squamous cell carcinoma suggesting that it may contribute to tumour progression, aggressive behaviour and poor prognosis
Pelvic Cholelithiasis. A Report of 4 Cases
Authors: Policarpio-Nicolas M , Malenie R , Joehlin-Price A , Przybycin C 
Published: November 2022

Abstract

Introduction/Objective
Spillage of gallstones in the peritoneal cavity during laparoscopic cholecystectomy is a known intraoperative complication which could cause peritoneal irritation/abscess and occasionally present as ovarian cholelithiasis and pelvic mass. Our aim is to present the clinicopathologic findings of pelvic cholelithiasis in our institution.

Methods/Case Report
A one year computerized natural language search for “Halls, bile, pigment, crystals” in surgical final diagnosis and comment was performed. The patients’ demographic, clinical presentation & history of cholecystectomy were collected from the medical records. The pathologic findings were reviewed.

Results (if a Case Study enter NA)
We identified 4 women with an age range of 45-52 (mean=50). Three patients presented with abnormal uterine bleeding and one patient was admitted for sterilization. The time interval from cholecystectomy was 3-26 years (mean=18).Intra-operative findings were as follows: Case 1: blue-black 5 mm lesion located in the right ovary, Case 2: yellow-surface nodularity of left ovary and &lt;1 cm white lesion in posterior cul- de sac, Case 3 two left ovarian cysts (0.8 and 1.5 cm), and Case 4 for sterilization showed a 0.3 cm. brown peritoneal lesion and unremarkable fallopian tubes. The histologic findings revealed bile pigment/crystals overlying the surfaces of the ovaries (3) peritoneum (1), & pelvis (1) with fibrosis and foreign-body giant cell reaction. The pathologic diagnosis was made in conjunction with prior history of cholecystectomy. Halls bilirubin stain was positive in 2/2 cases.

Conclusion
Pelvic cholelithiasis is an incidental finding in pre and post-menopausal women often involving the ovaries, peritoneum and pelvis. Intra-operatively, it could mimic endometriosis and pelvic mass. Histologic findings show bile pigment/crystals on serosal surface with fibrosis and foreign-body giant cell reaction. Familiarity with the histologic findings in conjunction with history of cholecystectomy is helpful in arriving at the correct diagnosis.
Malaria Parasite Infection is associated with Inflammatory and Endothelial Dysregulation in Preeclampsia
Authors: Nwadike C N , Ikaraoha I , Anyagwa M , Mbionwu U , Ogbuokiri A C , Duru M 
Published: November 2022

Abstract

Introduction/Objective
Previous Studies have associated Preeclampsia with alterations in inflammation and endothelial dysfunction . However the relationship between the pathway of this alteration and the Malaria infection in pregnancy remains underexplored, especially in malaria endemic regions like Nigeria where there is high incidence of preeclampsia.

Methods/Case Report
A comparative cross-sectional study was carried out among 260 pregnant women at term (18-45 years); comprising 100 preeclamptic with Malaria (PEM), 80 preeclamptic without Malaria (PE2) and 80 Normotensive, Non Malaria (Control), at Federal Medical Center Owerri, Nigeria. The groups were matched for maternal age, gestational age, gravidity and body mass index. Fasting serum lipids were analyzed by Enzymatic colorimetric method. Some Inflammatory and anti-angiogenic markers; Vascular Endothelial growth factor (VEGF), Plasminogen Activator inhibitor 1, Intracellular adhesion molecule, CRP. IL 6 and IL 8 were tested by Magnetic multiplex ELISA.

Results (if a Case Study enter NA)
There were significantly higher levels of Total Cholesterol, LDL and triglyceride among the 2 pre-eclamptic groups (PEM,PE2) compared to the normotensive nonmalaria group; P&lt; 0.001, p=0.001, p=0.003 respectively, while HDL was decreased in the pre-eclamptic groups against the normotensive nonmalaria group (P = 0.024). PAI-1 and VEGF expressed significantly higher levels in the pre- eclamptic groups (PEM,PE2) compared to the normotensive nonmalaria group (P &lt; 0.0001, P=0.000). Based on Malaria exposure, PAI-1, and IL8 were significantly elevated in PEM group (P &lt; 0.0001) compared to the PE2 and normotensive nonmalaria group.
There was no significant difference in the CRP and ICAM-I between the 2 preeclamptic groups (PEM and PE2).

Conclusion
These findings demonstrated that Malaria is associated with dysregulated inflammation and endothelia function, which may enhance the pathogenesis of Preeclampsia. Further studies on the predictive role of PAI-I in the pathophysiology and diagnosis of Malaria and preeclampsia is hence suggested.
A Large High-Grade Endometrial Serous Carcinoma with Yolk Sac Tumor Differentiation in a Post- Menopausal Woman: Case Report
Authors: Nobee A , Taraif S , Arriola A , Mollaee M 
Published: November 2022

Abstract

Introduction/Objective
Yolk sac tumors are germ cell tumors mostly arising in the ovary or vagina, with cases reported throughout the gynecological tract. Only few cases were reported to arise in the endometrium and even fewer admixed with a conventional carcinoma especially in postmenopausal women. Yolk sac tumor-like areas are considered a form of retro-differentiation. Here we report a case of high-grade serous carcinoma of the endometrium with yolk sac differentiation in a postmenopausal woman.

Methods/Case Report
An 82-year-old Caucasian female presented with postmenopausal bleeding and a 17.6 cm endometrial mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. A large markedly necrotic friable mass occupied the entire endometrial cavity. Microscopic examination revealed a noninvasive carcinoma arising within a polyp. Tumor cells showed two different distinct morphologic patterns, including a predominantly high-grade serous carcinoma with scant foci of clear cell component, admixed with areas of squamous/eosinophilic-like morphological pattern. The latter was diffusely positive for p53, p16, AE1/AE3 and CK7, focally positive for CK5/6, GATA3, HepPar1 , AFP , PLAP , PAX8, CD30 and SALL4 , while negative for desmin, ER, PR, Napsin A, HCG, p40, p63, C-Kit, HMB45, S100, and Melan A. Mismatch repair proteins expression was intact throughout the entire tumor. Serum AFP level measured three weeks after surgery was within normal range.

Results (if a Case Study enter NA)
NA

Conclusion
Highlighting the yolk sac tumor differentiation in endometrial carcinoma is very challenging and requires a thorough immunohistochemical evaluation combined with morphologic assessment.
Review of Sclerosing stromal tumor: A relatively rare ovarian neoplasm
Authors: Fathima S , Mansheim K 
Published: November 2022

Abstract

Introduction/Objective
Sclerosing stromal tumor (SST) is sex cord stromal tumor which is rare primary ovarian neoplasm. Because its clinical presentation and imaging findings accurate preoperative clinical diagnosis can be difficult. We report three cases of a sclerosing stromal tumor of ovary and histopathological presentation.

Methods/Case Report
Our patients had an age ranged from 27-40 years with primary ovarian neoplasm and as incidental in 64-year-old patient. Radiologically lobulated and heterogeneously enhancing, partially calcified masses with nodular rind of avid enhancement about the periphery of the lesion with high risk malignancy were seen. Grossly the masses had firm tan-white, solid, lobulated cut surfaces with patchy calcifications

Results (if a Case Study enter NA)
Microscopically all the three tumors showed a hyalinized, well-circumscribed nodule with few scattered trabeculae of spindled to plump cells with pale grey cytoplasm within a sclerotic stroma with few staghorn- like blood vessels around the periphery. Scattered calcifications were identified. No mitoses are identified. The reticulin stain showed pericellular focal nested staining pattern. There was no necrosis, pleomorphism, or features of malignancy were identified. Findings were consistent with a sclerosing stromal tumor.

Conclusion
Ovarian sex cord-stromal tumors are relatively infrequent neoplasms of all primary ovarian tumors. Clinical and sonographic findings alone do not predict the presence of this tumor. SSTs should be considered in differentials in young females with unilateral masses with cystic and solid masses. These tumors carry a good prognosis. Histopathological features along with immunohistochemsitry establish the diagnosis.
Diagnostic Dilemma of a Widely Metastatic Gastric-type Cervical Adenocarcinoma
Authors: Jaramillo C , Adams T , Shah S , Miller C , Teschan N 
Published: November 2022

Abstract

Introduction/Objective
Gastric-type cervical adenocarcinoma is an HPV-independent neoplasm accounting for 0.5-0.6% of cervical carcinomas, typically in women aged 50-55 years presenting with bleeding or watery vaginal discharge. The immunophenotypic and molecular overlap with mucinous pancreatic carcinomas presents a diagnostic dilemma in metastatic cases.

Methods/Case Report
We report the case of a 50 year-old female with a remote history of cervical dysplasia who presented with abdominal pain in December 2020 with CT notable for an incidental prominent, heterogeneous appearing cervix. Follow-up in February-August 2021 showed two unsatisfactory pap smears and an ultrasound of the cervix revealed Nabothian cysts. A friable cervix and vaginal discharge were noted on physical exam, however, no malignancy was identified on endometrial and endocervical biopsies. The patient re-presented in March 2022 with a persistent cough and was found to have a metastatic process of unknown origin involving bilateral ovaries/lungs, abdominal mesentery, pancreas, and pelvis. Lung, cervical, endometrial, and pancreatic sampling demonstrated well- differentiated mucinous adenocarcinoma with an immunophenotype positive for CK7 and MUC6 and negative for PAX-8, CDX-2, ER, Vimentin, TTF1/Napsin, GATA-3, CK20, and p16 with wildtype p53 staining compatible with endocervical, upper gastrointestinal, or pancreaticobiliary origin. Labs were notable for elevations in CA125 (198 U/mL) and CA19-9 (4,939 U/mL), further supporting pancreatic or gynecologic primaries. A retrospective review of all gynecologic cytology and histology specimens collected from the uterus and cervix in 2021 revealed similar bland mucinous epithelium, without overt atypia or features of malignancy. Next generation sequencing demonstrated a nonspecific and complex mutational burden including STK11 D23fs*25, SMAD4 N107fs*3, CDKN2A/B loss, KRAS G12V, and MTAP loss.

Results (if a Case Study enter NA)
NA

Conclusion
The treatment regimens for metastatic mucinous carcinoma from the cervix and pancreas differ significantly. Ultimately, the diagnosis of widely metastatic gastric type endocervical carcinoma was made possible through extensive clinical/radiographic and retrospective pathologic correlation with the incorporation of molecular studies.