Human Pathology Reports最新文献

Calcifying fibrous tumours of the pleura (CFTPs) are extremely rare benign tumours with uncertain aetiology, with only 34 cases, including this one, reported worldwide to date. CFTPs commonly originate from subcutaneous and deep soft tissues of the gastrointestinal tract and pleura. It is essential to differentiate CFTP from other pleural intrathoracic masses that present similarly but are challenging with radiological imaging alone. As a result, excision via surgical intervention alongside immunohistological and histological assessment is the current best method for definitive diagnosis. Due to the significantly low incidence of CFTP, extensive sample studies for further research are currently not possible. As a result, all cases of CFTP should be reported to help improve future research in diagnostic accuracy and understanding of pathogenicity and aetiology. We are reporting a case of an incidentally detected CFTP on CT in a 30-year-old female.

We report a case of a poorly differentiated somatic carcinoma with trophoblastic differentiation of the cervix in a 29-year-old woman. Her recent antecedent pregnancy, rising serum Beta-Human Chorionic Gonadotropin titres and cervical based site raised the possibility of a non-choriocarcinomatous gestational trophoblastic neoplasm. The available tumor morphology, although not classic, was suggestive of epithelioid trophoblastic tumor (ETT). Immunohistochemistry was equivocal in separating the two differential diagnoses of a carcinoma with trophoblastic differentiation versus an ETT. Genotypic analysis revealed that the tumor harboured an identical genetic profile to that of the normal tissue, excluding the possibility of an ETT. High-risk human papilloma virus (HPV) testing using a highly sensitive real-time PCR method confirmed the presence of an HPV16 subtype. We concluded that the tumor represents a poorly differentiated HPV associated squamous cell carcinoma.

A 60-year-old woman with marginal zone lymphoma was treated with obinutuzumab and bendamustine after failing rituximab. She later developed intractable nausea and diarrhea which resulted in a dramatic weight loss and multiple hospitalizations. During her hospital stay the patient had a colonoscopy and biopsy which identified apoptotic colopathy- a pathologic condition characterized histologically by apoptosis. Her apoptotic colopathy was ultimately attributed to bendamustine, a previously unidentified trigger of apoptotic colopathy. The patient was eventually discharged on total parenteral nutrition (TPN) and has regained weight with adequate control of her diarrhea.

Cerebral vein thrombosis (CVT) is a potentially fatal neurovascular disease that most commonly affects young women of child-bearing age. The risk of CVT has been reported to be increased by combined oral contraceptive (COC) use. Inherited thrombophilic conditions including factor V Leiden (FVL) and prothrombin G20210A mutation also increase the risk of CVT. Several studies have shown that a combination of risk factors including COC use plus an inherited thrombophilic disorder increases the risk of CVT in a multiplicative fashion. World Health Organization guidelines advise against the use of COC in women with hereditary thrombophilic defects due to the unacceptably elevated risk of thrombotic events. We report the case of a 16-year-old female with a six-week history of COC use who experienced 48 h of vomiting and ataxia and was found in cardiac arrest. Following cardiopulmonary resuscitation and hospitalization, brain imaging identified subarachnoid and intracranial hemorrhage. After a neurologic examination confirmed brain death, the patient expired. Genetic testing detected heterozygous mutations for both FVL and prothrombin G20210A. A brain only autopsy identified superior sagittal sinus thrombosis, subarachnoid hemorrhage, and foci of ischemic necrosis of the cerebral cortex. This case highlights the increased risk of CVT in patients with hereditary thrombophilia and oral contraceptive use. It is vital for physicians to identify risk factors for venous thrombosis and/or CVT prior to administration of COC.

Porocarcinoma (PC) is a rare malignant skin adnexal tumor, accounting for approximately 0.005% to 0.02% of all malignant cutaneous neoplasms. It occurs most commonly in the sun-exposed extremities. To our knowledge, only one case of a primary nipple eccrine poroma (benign counterpart of PC) has been reported in the literature. Herein we report a patient with a primary PC of the left nipple with metastasis to the left axilla.

A 52-year-old Japanese woman was admitted to our hospital for uterine cervical cancer treatment. She had noticed irregular genital bleeding, and uterine cervical biopsy confirmed the presence of a squamous cell carcinoma (SqCC). Radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed, and pathology confirmed adenosquamous carcinoma (ASC) at stage pT1b1pN1cM0 and stage IIIB. Interestingly, the adenocarcinoma components, which were approximately 5% of the ASC, were purely invasive micropapillary carcinoma (IMC) or IMC-like nests. The IMC and IMC-like components were seen at the invasive front connected to the squamous component. The patient underwent cisplatin-based concurrent chemoradiotherapy and has been disease-free for 1 year following the surgery. IMC is a histopathological type of adenocarcinoma of various organs, and uterine cervical IMCs have recently attracted attention as aggressive tumors. However, uterine cervical IMCs are rare and are not an independent entity in the latest 2020 World Health Organization’s classification of uterine cervical cancers. This case report describes the clinicopathological features of a patient with rare uterine cervical ASC and the curative potential of human epidermal growth factor receptor 2-targeting therapy.

Here, we report the development and relapse of nephrotic syndrome, complicated by thrombotic microangiopathy (TMA), after repeated injections of the mRNA-1273 (Moderna) coronavirus disease 2019 (COVID-19) vaccine. A 50-year-old male patient was admitted for further examination and treatment 28 days after receiving the second dose of the vaccine. Laboratory tests revealed nephrotic-range proteinuria, microscopic hematuria, low platelet count, and mild anemia with decreased haptoglobin levels. Renal biopsy revealed subendothelial swelling, double contours of the glomerular basement membrane, and mesangiolysis, which suggested glomerular endothelial injury. Further immunohistochemical analysis revealed the presence of platelet thrombi by CD42b staining and glomerular endothelial injury with proliferation by CD34 staining with periodic acid-Schiff counterstaining or Ki67 staining. The patient was, therefore, clinically diagnosed with TMA. Angiotensin receptor blocker treatment gradually resulted in the resolution of the patient’s clinical symptoms. However, the patient relapsed with full nephrotic syndrome. His clinical manifestations even worsened 20 days after the third vaccine injection. The close association between repeated vaccinations and development and relapse of nephrotic syndrome with TMA strongly suggests a causal relationship between these conditions. Clinicians and pathologists should be aware that this vaccine could induce not only simple minimal change disease but also nephrotic syndrome with TMA.

Immunoglobulin G4 related pseudotumour (IgG4-PT) of the gallbladder is a very rare condition formed by the infiltration of IgG4-positive lymphocytes and plasma cells, resulting in a mass effect that can mimic malignancy. We present a case of a patient who underwent an unremarkable laparoscopic cholecystectomy for symptoms of early cholecystitis that was incidentally found to have an inflammatory tumour adjacent to the cystic duct. Identification remains difficult and histopathology remains a cornerstone in correct diagnosis. Histopathological confirmation is based on meeting two of three histological criteria in the correct clinical context. IgG4-PT is a rare cause of cholecystitis and requires ongoing surveillance for IgG4 cholangiopathy.

Background

Chorangioma is a benign vascular tumour of the placenta. Majority of tumours are small and incidental. Large chorangiomas (colloquially “giant chorangiomas”) are relatively uncommon. Case report: A primiparous woman, booked at an external institution, presented at 32 + 2 weeks of gestation with abdominal pain. Ultrasound scan showed a thick placenta and features worrisome for fetal anemia. The patient underwent emergency caesarean section in view of non-reassuring fetal status. At delivery, there was a large mass adherent to the placenta, raising the clinical possibility of an acardiac twin. Histopathological examination showed a singleton placenta and a multinodular proliferation of capillaries with nucleated erythrocytes, which established the diagnosis of a giant chorangioma with evidence of fetal anemia. Baseline investigations of the neonate showed anemia and thrombocytopenia, complicated by cardiomegaly and hepatomegaly. Conclusion: Although histologically benign, large chorangiomas may be associated with adverse clinical outcomes for the fetus. Given their large size, they may clinically masquerade as acardius amorphous, especially if antenatal history or follow up is limited or absent.

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma are common subtypes of thyroid cancer, while hyalinizing trabecular tumor (HHT) of the thyroid is a rare peculiar type of follicular cell neoplasm. Although all three tumor types originate from thyroid follicular cells, the frequency of their co-presence in the same thyroid gland is unknown. Herein, we describe an extremely rare case with three types of concurrent thyroid neoplasms in one patient. This patient was a 60-year-old female who presented with large symptomatic multinodular goiter clinically. Fine needle aspiration of the right thyroid nodule showed atypia of undetermined significance. She then received total thyroidectomy. Microscopically, there were 3 types of tumors identified: multifocal (x4) PTC (largest focus 1.5 cm) with focal tall cell features, encapsulated angioinvasive oncocytic carcinoma (8.2 cm), and a small HHT (0.6 cm). The HHT was encapsulated, containing spindled to polygonal cells with oval to elongated nuclei arranged in a trabecular growth pattern. The PTC and oncocytic carcinoma were diagnosed by morphology only. The diagnosis of HHT was confirmed by immunohistochemistry showing the tumor cells to be positive for pan-cytokeratin, thyroglobulin, TTF-1, and PAX8, while negative for synaptophysin, chromogranin, and calcitonin. Next generation sequencing demonstrated different molecular alterations: BRAF V600E mutation in PTC; NRAS mutation in oncocytic carcinoma, and HRAS mutation in HHT. This is the first case report of triple thyroid neoplasms occurring synchronously in one patient. The unique genetic alteration of each individual tumor suggests different pathogenetic mechanisms.