Pub Date : 2023-09-05DOI: 10.5348/100075z11ao2023cr
Aimé Sosthène Ouédraogo, F. Ido, Souleymane Ouattara, Savadogo Ibrahim, R. A. Ouédraogo, Assita Sanou Lamien
Introduction: Central neurocytoma is a typically rare intraventricular glioneuronal tumor in young adults. Clinically, it is revealed by symptomatology of intracranial hypertension. Intra-parenchymal, extraventricular, and intramedullary localizations are exceptional. Central neurocytoma is considered a benign tumor that can recur locally, but craniospinal dissemination remains as an exception. Case Report: We report a case in a 35-year-old male subject who consulted for quadriparesis and genito-sphincter dysfunctions. The clinical examination noted a syndrome of intracranial hypertension, a kinetic and static cerebellar syndrome, spastic tetraplegia with crural predominance, and anesthesia going up to the sixth thoracic vertebra (T6). A magnetic resonance imaging (MRI) showed a heterogeneous left cerebellar lesion. This lesion was excised, and the sample was freshly sent to the pathological anatomy laboratory. Extemporaneous cytology using the Smear technique was performed and was consistent with a hemangioblastoma. The standard histological examination also revealed the diagnosis of hemangioblastoma, and an additional immunohistochemical (IHC) study was performed for better diagnostic accuracy. The study was conducted in a North African laboratory and was conclusive of a neurocytoma. The evolution was marked by cerebellar tumor regrowth at five months, then the death of the patient at eight (08) months after surgery. Conclusion: Central neurocytoma is a rare tumor that can be confused with several other tumors of the central nervous system. Immunohistochemistry is essential for diagnostic confirmation.
{"title":"Unusual location of a central neurocytoma: Particularities of a rare brain tumor","authors":"Aimé Sosthène Ouédraogo, F. Ido, Souleymane Ouattara, Savadogo Ibrahim, R. A. Ouédraogo, Assita Sanou Lamien","doi":"10.5348/100075z11ao2023cr","DOIUrl":"https://doi.org/10.5348/100075z11ao2023cr","url":null,"abstract":"\u0000 Introduction: Central neurocytoma is a typically rare intraventricular glioneuronal tumor in young adults. Clinically, it is revealed by symptomatology of intracranial hypertension. Intra-parenchymal, extraventricular, and intramedullary localizations are exceptional. Central neurocytoma is considered a benign tumor that can recur locally, but craniospinal dissemination remains as an exception.\u0000\u0000 Case Report: We report a case in a 35-year-old male subject who consulted for quadriparesis and genito-sphincter dysfunctions. The clinical examination noted a syndrome of intracranial hypertension, a kinetic and static cerebellar syndrome, spastic tetraplegia with crural predominance, and anesthesia going up to the sixth thoracic vertebra (T6). A magnetic resonance imaging (MRI) showed a heterogeneous left cerebellar lesion. This lesion was excised, and the sample was freshly sent to the pathological anatomy laboratory. Extemporaneous cytology using the Smear technique was performed and was consistent with a hemangioblastoma. The standard histological examination also revealed the diagnosis of hemangioblastoma, and an additional immunohistochemical (IHC) study was performed for better diagnostic accuracy. The study was conducted in a North African laboratory and was conclusive of a neurocytoma. The evolution was marked by cerebellar tumor regrowth at five months, then the death of the patient at eight (08) months after surgery.\u0000\u0000 Conclusion: Central neurocytoma is a rare tumor that can be confused with several other tumors of the central nervous system. Immunohistochemistry is essential for diagnostic confirmation.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"348 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133844778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-28DOI: 10.5348/100074z11rp2023cr
Rebecca Phillips, Sumit Das
Introduction: Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive mesenchymal neoplasm characterized by a chromosomal translocation involving the EWSR1 and WT1 genes. It typically arises in intra-abdominal tissues (i.e., mesentery, omentum, pelvic organs), and commonly spreads to regional lymph nodes, lungs, or liver, while central nervous system (CNS) metastasis is rare. Case Report: We present a unique case of DSRCT originating from the pleura in a young female, which was metastatic to intrathoracic and mediastinal tissue at diagnosis and later spread to the brain. The initial tumor samples exhibited characteristic histopathological features, including small round cells with minimal cytoplasm and indistinct borders embedded in a fibroblastic stroma. Notably, the brain metastasis demonstrated distinct histological characteristics, lacking the desmoplastic stroma observed in previous biopsies. Conclusion: This case underscores the diagnostic challenges associated with DSRCT, emphasizes the significance of early recognition and appropriate histological evaluation, and contributes to the limited literature on the histological features and metastatic behavior of this rare tumor.
{"title":"Desmoplastic small round cell tumor of the pleura with brain metastasis: A case report and literature review","authors":"Rebecca Phillips, Sumit Das","doi":"10.5348/100074z11rp2023cr","DOIUrl":"https://doi.org/10.5348/100074z11rp2023cr","url":null,"abstract":"\u0000 Introduction: Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive mesenchymal neoplasm characterized by a chromosomal translocation involving the EWSR1 and WT1 genes. It typically arises in intra-abdominal tissues (i.e., mesentery, omentum, pelvic organs), and commonly spreads to regional lymph nodes, lungs, or liver, while central nervous system (CNS) metastasis is rare.\u0000\u0000 Case Report: We present a unique case of DSRCT originating from the pleura in a young female, which was metastatic to intrathoracic and mediastinal tissue at diagnosis and later spread to the brain. The initial tumor samples exhibited characteristic histopathological features, including small round cells with minimal cytoplasm and indistinct borders embedded in a fibroblastic stroma. Notably, the brain metastasis demonstrated distinct histological characteristics, lacking the desmoplastic stroma observed in previous biopsies.\u0000\u0000 Conclusion: This case underscores the diagnostic challenges associated with DSRCT, emphasizes the significance of early recognition and appropriate histological evaluation, and contributes to the limited literature on the histological features and metastatic behavior of this rare tumor.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128043870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21DOI: 10.5348/100073z11ke2023cr
Kylie Rose Everard, O. Ikpatt, Amrah Pirzada
We present a previously healthy 63-year-old female with incidental polyps in the colon that were detected during a surveillance endoscopy. Clinical examination and imaging studies did not detect any lymphadenopathy or organomegaly. Histopathologic evaluation of polyps revealed a low-grade follicular lymphoma. We suggest that follicular lymphoma should be considered as a differential diagnosis of polypoid lesions of the colon.
{"title":"Primary follicular lymphoma of the colon presenting as an incidental finding on endoscopy","authors":"Kylie Rose Everard, O. Ikpatt, Amrah Pirzada","doi":"10.5348/100073z11ke2023cr","DOIUrl":"https://doi.org/10.5348/100073z11ke2023cr","url":null,"abstract":"\u0000 We present a previously healthy 63-year-old female with incidental polyps in the colon that were detected during a surveillance endoscopy. Clinical examination and imaging studies did not detect any lymphadenopathy or organomegaly. Histopathologic evaluation of polyps revealed a low-grade follicular lymphoma. We suggest that follicular lymphoma should be considered as a differential diagnosis of polypoid lesions of the colon.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123996138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-26DOI: 10.5348/100072z11fi2023cr
Franck Auguste Hermann Adémayali Ido, A. Ouédraogo, I. Savadogo, Rakiswendé Alexis Ouedraogo, S. Ouattara
Introduction: Pneumatosis cystoides intestinalis is a rare condition characterized by the presence of gas cysts in the intestinal wall. It can affect different segments of the digestive tract. Male patients over 50 years old seem to be more affected. Classically, one opposes the primary or idiopathic forms and the secondary forms. Case Report: We report the case of a 62-year-old female patient with a history of treated peptic ulcers, who presented with episodes of intermittent atypical abdominal pain that worsened abruptly. The physical examination revealed a surgical abdomen with tenderness to palpation. The patient underwent a jejunal resection. The pathological examination showed macroscopically an intestinal fragment with confluent subserosal and intestinal intraparietal bullae. On opening, the portion containing the bullae was thickened, infarcted, congestive, hemorrhagic, and brittle with narrowing of the intestinal lumen. The bullae are tense and leave serosities. On histological examination, the intestinal wall was very congestive with hemorrhagic patches of suffusion. There were optically empty cystic formations that does not communicate with the digestive lumen. The adjacent mucosa is the site of a moderate subacute inflammatory reaction. Conclusion: Pneumatosis cystoides intestinalis is a rare and usually benign pathology. The symptoms, when they exist, are not specific. Its physiopathology is still very much debated. The prognosis is generally good. The knowledge of this pathology is necessary to avoid invasive explorations and heavy treatment without interest for the patient.
{"title":"Pneumatosis cystoides intestinalis revealed by an occlusive syndrome: A case report","authors":"Franck Auguste Hermann Adémayali Ido, A. Ouédraogo, I. Savadogo, Rakiswendé Alexis Ouedraogo, S. Ouattara","doi":"10.5348/100072z11fi2023cr","DOIUrl":"https://doi.org/10.5348/100072z11fi2023cr","url":null,"abstract":"\u0000 Introduction: Pneumatosis cystoides intestinalis is a rare condition characterized by the presence of gas cysts in the intestinal wall. It can affect different segments of the digestive tract. Male patients over 50 years old seem to be more affected. Classically, one opposes the primary or idiopathic forms and the secondary forms.\u0000\u0000 Case Report: We report the case of a 62-year-old female patient with a history of treated peptic ulcers, who presented with episodes of intermittent atypical abdominal pain that worsened abruptly. The physical examination revealed a surgical abdomen with tenderness to palpation. The patient underwent a jejunal resection. The pathological examination showed macroscopically an intestinal fragment with confluent subserosal and intestinal intraparietal bullae. On opening, the portion containing the bullae was thickened, infarcted, congestive, hemorrhagic, and brittle with narrowing of the intestinal lumen. The bullae are tense and leave serosities. On histological examination, the intestinal wall was very congestive with hemorrhagic patches of suffusion. There were optically empty cystic formations that does not communicate with the digestive lumen. The adjacent mucosa is the site of a moderate subacute inflammatory reaction.\u0000\u0000 Conclusion: Pneumatosis cystoides intestinalis is a rare and usually benign pathology. The symptoms, when they exist, are not specific. Its physiopathology is still very much debated. The prognosis is generally good. The knowledge of this pathology is necessary to avoid invasive explorations and heavy treatment without interest for the patient.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125768141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-13DOI: 10.5348/100071z11jy2023cr
J. Yablonski, Christian D Tvetenstarnd, J. Sidhu
Introduction: Appendiceal goblet cell adenocarcinoma is a rare cancer that usually has histological features of both well-differentiated carcinoid tumors and adenocarcinomas (neuroendocrine cells are not required for the diagnosis). Appendiceal goblet cell adenocarcinoma can present as acute appendicitis, abdominal pain, a mass, or be discovered incidentally following appendectomy. Case Report: A 67-year-old female presented with signs of acute appendicitis and underwent laparoscopic appendectomy. Pathological evaluation showed evidence of both acute appendicitis/periappendicitis and an incidental appendiceal intramucosal well-differentiated adenocarcinoma in the lamina propria of a 12 mm long segment in the middle of the proximal half of the appendix. Conclusion: Appendiceal goblet cell adenocarcinoma can sometimes be an incidental finding. It can be difficult to identify it, especially when it is in the form of only a few cells and clusters of cells limited to lamina propria. This case is the first reported incidence of an intramucosal goblet cell adenocarcinoma that was present in a 12 mm long segment in the middle of the proximal half of the appendix. The location of this tumor provides justification for making submission of an appendix in its entirety for histologic examination as a standard-of-care.
{"title":"Intramucosal goblet cell adenocarcinoma: The evil got nipped in the bud","authors":"J. Yablonski, Christian D Tvetenstarnd, J. Sidhu","doi":"10.5348/100071z11jy2023cr","DOIUrl":"https://doi.org/10.5348/100071z11jy2023cr","url":null,"abstract":"\u0000 Introduction: Appendiceal goblet cell adenocarcinoma is a rare cancer that usually has histological features of both well-differentiated carcinoid tumors and adenocarcinomas (neuroendocrine cells are not required for the diagnosis). Appendiceal goblet cell adenocarcinoma can present as acute appendicitis, abdominal pain, a mass, or be discovered incidentally following appendectomy.\u0000\u0000 Case Report: A 67-year-old female presented with signs of acute appendicitis and underwent laparoscopic appendectomy. Pathological evaluation showed evidence of both acute appendicitis/periappendicitis and an incidental appendiceal intramucosal well-differentiated adenocarcinoma in the lamina propria of a 12 mm long segment in the middle of the proximal half of the appendix.\u0000\u0000 Conclusion: Appendiceal goblet cell adenocarcinoma can sometimes be an incidental finding. It can be difficult to identify it, especially when it is in the form of only a few cells and clusters of cells limited to lamina propria. This case is the first reported incidence of an intramucosal goblet cell adenocarcinoma that was present in a 12 mm long segment in the middle of the proximal half of the appendix. The location of this tumor provides justification for making submission of an appendix in its entirety for histologic examination as a standard-of-care.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116999318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-05DOI: 10.5348/100069z11lo2023cr
Dalia Y Ibrahim, Lojayne Osman
Introduction: Breast cancer is the second most common cancer among women in the United States. Metaplastic breast cancer is characterized by two or more poorly differentiated cellular types, with epithelial or mesenchymal components. Metaplastic breast carcinoma is a rare and aggressive entity, accounting for less than 1% of invasive breast cancers. Hence, there is insignificant literature and research. Few cases are described in the literature. We report a rare case of metaplastic breast carcinoma with squamous and spindle cell differentiation. Case Report: An 82-year-old female was diagnosed with metaplastic breast cancer with squamous and spindled differentiation based on histological appearance. She underwent mastectomy, and we track her radiation follow-up. Conclusion: The report reviews and corroborates existing literature regarding clinical features, histologic characteristics, and treatment methods, and explores genetic components and clinical trials underway.
{"title":"Metaplastic breast cancer: A case report and literature review","authors":"Dalia Y Ibrahim, Lojayne Osman","doi":"10.5348/100069z11lo2023cr","DOIUrl":"https://doi.org/10.5348/100069z11lo2023cr","url":null,"abstract":"\u0000 Introduction: Breast cancer is the second most common cancer among women in the United States. Metaplastic breast cancer is characterized by two or more poorly differentiated cellular types, with epithelial or mesenchymal components. Metaplastic breast carcinoma is a rare and aggressive entity, accounting for less than 1% of invasive breast cancers. Hence, there is insignificant literature and research. Few cases are described in the literature. We report a rare case of metaplastic breast carcinoma with squamous and spindle cell differentiation.\u0000\u0000 Case Report: An 82-year-old female was diagnosed with metaplastic breast cancer with squamous and spindled differentiation based on histological appearance. She underwent mastectomy, and we track her radiation follow-up.\u0000\u0000 Conclusion: The report reviews and corroborates existing literature regarding clinical features, histologic characteristics, and treatment methods, and explores genetic components and clinical trials underway.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134318619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-07DOI: 10.5348/100068z11lv2023cr
L. Akhila Vemulakonda, Yaritzy M. Astudillo, Elayna Maxx Shanker
Introduction: Pleuropulmonary blastoma (PPB) is a rare primary neoplasm of the thorax frequently diagnosed in early childhood. Pleuropulmonary blastoma arises from primitive intrathoracic mesenchyme—either pulmonary and pleural, or both. Patients with pleuropulmonary blastoma usually present with respiratory symptoms and are often misdiagnosed as pneumonia in the early clinical course. Pleuropulmonary blastoma can be further classified into types I, II, and III based on histological components. Such histological distinctions have significant implications for the treatment of these lesions as well as prognosis. Currently, the treatment of pleuropulmonary blastoma is surgical resection with or without chemotherapy, based on the histological type. Case Report: We highlight the histopathological presentation of pleuropulmonary blastoma in a 3-year-old male who presented with nonspecific symptoms. After identifying an intrathoracic mass on imaging, frozen section demonstrated primarily mature cartilaginous tissue without rhabdomyosarcomatous differentiation or anaplasia. Surgical resection specimens, however, contained small areas of proliferating spindle cells with skeletal muscle features as well as primitive blastema-like cells. Following ancillary testing, the patient was diagnosed with a type II PPB. Conclusion: This case illustrates the challenges of using frozen sections to diagnose heterogenous neoplasms such as PPB. The histologic features of this patient’s tumor identified on frozen section were largely mature and benign-appearing. Only when considering the histology of the surgical specimens in combination with immunohistochemistry and gross morphology, we were able to make an accurate assessment about the type of PPB and corresponding prognosis and treatment plan. Therefore, we urge pathologists to consider PPB for large thoracic masses in pediatric patients.
{"title":"Case report of pleuropulmonary blastoma: The heterogenous features of a rare primitive neoplasm of the thorax","authors":"L. Akhila Vemulakonda, Yaritzy M. Astudillo, Elayna Maxx Shanker","doi":"10.5348/100068z11lv2023cr","DOIUrl":"https://doi.org/10.5348/100068z11lv2023cr","url":null,"abstract":"\u0000 Introduction: Pleuropulmonary blastoma (PPB) is a rare primary neoplasm of the thorax frequently diagnosed in early childhood. Pleuropulmonary blastoma arises from primitive intrathoracic mesenchyme—either pulmonary and pleural, or both. Patients with pleuropulmonary blastoma usually present with respiratory symptoms and are often misdiagnosed as pneumonia in the early clinical course. Pleuropulmonary blastoma can be further classified into types I, II, and III based on histological components. Such histological distinctions have significant implications for the treatment of these lesions as well as prognosis. Currently, the treatment of pleuropulmonary blastoma is surgical resection with or without chemotherapy, based on the histological type.\u0000\u0000 Case Report: We highlight the histopathological presentation of pleuropulmonary blastoma in a 3-year-old male who presented with nonspecific symptoms. After identifying an intrathoracic mass on imaging, frozen section demonstrated primarily mature cartilaginous tissue without rhabdomyosarcomatous differentiation or anaplasia. Surgical resection specimens, however, contained small areas of proliferating spindle cells with skeletal muscle features as well as primitive blastema-like cells. Following ancillary testing, the patient was diagnosed with a type II PPB.\u0000\u0000 Conclusion: This case illustrates the challenges of using frozen sections to diagnose heterogenous neoplasms such as PPB. The histologic features of this patient’s tumor identified on frozen section were largely mature and benign-appearing. Only when considering the histology of the surgical specimens in combination with immunohistochemistry and gross morphology, we were able to make an accurate assessment about the type of PPB and corresponding prognosis and treatment plan. Therefore, we urge pathologists to consider PPB for large thoracic masses in pediatric patients.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123628802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-23DOI: 10.5348/100067z11ti2023cr
Trent Irwin, Mugahed Hamza, E. George, Ata S Moshiri
Introduction: Calcinosis cutis is characterized by basophilic crystalline or amorphous calcium within the dermis/subcutis. Calcinosis cutis has many different clinical subtypes and associated etiologies that may lead clinicians to consider this diagnosis. Von Kossa and/or Alizarin red special stains may be used by pathologists to highlight deposition of insoluble calcium salts, especially in histologically ambiguous or subtle cases. Case Report: We report the case of a 27-year-old male who presented with an inferior right buttock mass clinically diagnosed as epidermal inclusion cyst(s). Gross pathology revealed a gray-white pasty substance within a cyst-like structure. Histopathologic examination demonstrated pools of amorphous blue-gray material with rare deposits of admixed coarse calcifications surrounded by foreign-body giant cells. No cyst wall was seen in the specimen. Special stains, including von Kossa, were initially negative. Following additional review, it was discovered that surface decalcifying solution had been applied to the paraffin block in the histology lab prior to microtome sectioning. Hypothesizing that this could be the cause of the unusual morphology, the paraffin block was reprocessed and subsequent H and E stained sections displayed characteristic basophilic calcium deposits, which were correspondingly positive by von Kossa stain. Conclusion: The histopathologic diagnosis of calcinosis cutis is apparent by HandE in most cases, though von Kossa and/or Alizarin red special stains can be used to aid the pathologist. Given the unusual histomorphology following surface decalcification and initial lack of von Kossa stain prior to reprocessing, this report serves to make pathologists aware of this potential diagnostic pitfall.
{"title":"Idiopathic calcinosis cutis with unusual histomorphology and negative von Kossa stain: A diagnostic pitfall","authors":"Trent Irwin, Mugahed Hamza, E. George, Ata S Moshiri","doi":"10.5348/100067z11ti2023cr","DOIUrl":"https://doi.org/10.5348/100067z11ti2023cr","url":null,"abstract":"\u0000 Introduction: Calcinosis cutis is characterized by basophilic crystalline or amorphous calcium within the dermis/subcutis. Calcinosis cutis has many different clinical subtypes and associated etiologies that may lead clinicians to consider this diagnosis. Von Kossa and/or Alizarin red special stains may be used by pathologists to highlight deposition of insoluble calcium salts, especially in histologically ambiguous or subtle cases.\u0000\u0000 Case Report: We report the case of a 27-year-old male who presented with an inferior right buttock mass clinically diagnosed as epidermal inclusion cyst(s). Gross pathology revealed a gray-white pasty substance within a cyst-like structure. Histopathologic examination demonstrated pools of amorphous blue-gray material with rare deposits of admixed coarse calcifications surrounded by foreign-body giant cells. No cyst wall was seen in the specimen. Special stains, including von Kossa, were initially negative. Following additional review, it was discovered that surface decalcifying solution had been applied to the paraffin block in the histology lab prior to microtome sectioning. Hypothesizing that this could be the cause of the unusual morphology, the paraffin block was reprocessed and subsequent H and E stained sections displayed characteristic basophilic calcium deposits, which were correspondingly positive by von Kossa stain.\u0000\u0000 Conclusion: The histopathologic diagnosis of calcinosis cutis is apparent by HandE in most cases, though von Kossa and/or Alizarin red special stains can be used to aid the pathologist. Given the unusual histomorphology following surface decalcification and initial lack of von Kossa stain prior to reprocessing, this report serves to make pathologists aware of this potential diagnostic pitfall.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126385994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-31DOI: 10.5348/100066z11jf2022cr
Jeffrey E Fournier, Tiffany Shao, S. Popovic, S. Alowami
Introduction: Solitary cutaneous reticulohistiocytosis represents a rare form of benign monocyte/macrophage proliferation. On routine histology, these lesions are typically described as large cells with cytoplasm showing ground glass appearance and giant cells. They grow up to 1 cm in size with rare cases exceeding this size. Case Report: This case report of a 28-year-old male demonstrated a nodule of reticulohistiocytosis measuring 2.2 cm in size. Microscopic features showed a well-demarcated nodule in the dermis with large histiocytes with ground-glass eosinophilic cytoplasm, giant cells, and foamy macrophages in a background of mixed inflammatory cells. Immunohistochemical staining showed positive staining for vimentin, CD68, CD31, with focal and patchy positivity for S100, CD43, and CD45 and negative staining for CD1a, langerin, CD21, CD23, CD30, CD34, ERG, D2-40, AE1/AE3, epithelial membrane antigen (EMA), smooth muscle actin (SMA), myogenin, desmin, SOX10, HMB-45, tyrosinase, and MelanA. Conclusion: The microscopic and immunohistochemical findings are characteristic of this entity but it is important to recognize for proper management and differentiation from other malignant lesions.
{"title":"Solitary nodule of cutaneous reticulohistiocytosis: A case report","authors":"Jeffrey E Fournier, Tiffany Shao, S. Popovic, S. Alowami","doi":"10.5348/100066z11jf2022cr","DOIUrl":"https://doi.org/10.5348/100066z11jf2022cr","url":null,"abstract":"\u0000 Introduction: Solitary cutaneous reticulohistiocytosis represents a rare form of benign monocyte/macrophage proliferation. On routine histology, these lesions are typically described as large cells with cytoplasm showing ground glass appearance and giant cells. They grow up to 1 cm in size with rare cases exceeding this size.\u0000\u0000 Case Report: This case report of a 28-year-old male demonstrated a nodule of reticulohistiocytosis measuring 2.2 cm in size. Microscopic features showed a well-demarcated nodule in the dermis with large histiocytes with ground-glass eosinophilic cytoplasm, giant cells, and foamy macrophages in a background of mixed inflammatory cells. Immunohistochemical staining showed positive staining for vimentin, CD68, CD31, with focal and patchy positivity for S100, CD43, and CD45 and negative staining for CD1a, langerin, CD21, CD23, CD30, CD34, ERG, D2-40, AE1/AE3, epithelial membrane antigen (EMA), smooth muscle actin (SMA), myogenin, desmin, SOX10, HMB-45, tyrosinase, and MelanA.\u0000\u0000 Conclusion: The microscopic and immunohistochemical findings are characteristic of this entity but it is important to recognize for proper management and differentiation from other malignant lesions.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129861272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-22DOI: 10.5348/100064z11el2022cr
Tian Li, John Diks, Snow Trinh Nguyen, Jianying Zeng, Neil Chen, S. Vignesh
Introduction: Two tumors having different histopathologies at anatomically distinct sites giving the picture of dual primary malignancies. Here we presented a case of two possible primary tumors and one secondary mass. Case Report: A 74-year-old female, active smoker, without personal or family cancer history presented with early satiety and weakness for two months. Systems review was positive for a “raw” feeling in stomach, alleviated with antacids. Vital signs were stable with a negative abdominal exam. Lab showed leukocytosis 24.8 K/uL (3.5–10.8 K/uL) with left shift, microcytic anemia with hemoglobin 6.1 g/dL (12.0–16.0 g/dL), and reactive thrombocytosis 477 K/uL (130–400 K/uL). Contrast-enhanced computed tomography (CT) showed right upper lobe necrotizing cavitating lesion with reactive mediastinal and right hilar lymphadenopathy, two irregular hypodense lesions in pancreatic head and tail without ductal dilation with two irregular hypodense liver lesions. Immunohistochemistry of lung and pancreatic lesions were biopsied through endoscopic ultrasound (EUS), consistent with poorly differentiated squamous cell carcinoma (SCC) with extensive necrosis, which indicates pancreatic masses are likely metastases from the lung. Liver lesion biopsy exhibited high-grade neuroendocrine tumor (NET) with focal necrosis. Next gene sequencing was pursued. Given poor functional status, palliative immunotherapy was offered; however, the patient succumbed to respiratory failure. Conclusion: Given the morphology and immunoprofile, differential diagnosis includes dual primary cancers with one metastasis, or primary SCC with metastasis with neuroendocrine differentiation. Despite having different histopathology and immunophenotype, both lung and liver tumors harbor the same molecular profile even at the variants of unknown significance that show identical mutations. As a result, they are directly related. TP53, RB1, MYCL1, and MEK1 mutations are more prevalent in SCC than NET. Tumor mutation burden values may vary as the tumor clonal structure varies between primary and metastatic sites, with higher rates of monoclonal structure recorded in metastases due to clonal selection, leading to a reduction in overall genetic diversity (“bottlenecking”). This raises the suspicion that the liver tumor is a SCC with neuroendocrine differentiation. The paucity of the specimen and rapid clinical course limited further investigation. Germline testing would have been useful to determine whether these findings are somatic or germline.
{"title":"Next-generation sequencing proves clonal relationship between two distinguished lung and liver carcinomas by standard histopathology approach","authors":"Tian Li, John Diks, Snow Trinh Nguyen, Jianying Zeng, Neil Chen, S. Vignesh","doi":"10.5348/100064z11el2022cr","DOIUrl":"https://doi.org/10.5348/100064z11el2022cr","url":null,"abstract":"\u0000 Introduction: Two tumors having different histopathologies at anatomically distinct sites giving the picture of dual primary malignancies. Here we presented a case of two possible primary tumors and one secondary mass.\u0000\u0000 Case Report: A 74-year-old female, active smoker, without personal or family cancer history presented with early satiety and weakness for two months. Systems review was positive for a “raw” feeling in stomach, alleviated with antacids. Vital signs were stable with a negative abdominal exam. Lab showed leukocytosis 24.8 K/uL (3.5–10.8 K/uL) with left shift, microcytic anemia with hemoglobin 6.1 g/dL (12.0–16.0 g/dL), and reactive thrombocytosis 477 K/uL (130–400 K/uL). Contrast-enhanced computed tomography (CT) showed right upper lobe necrotizing cavitating lesion with reactive mediastinal and right hilar lymphadenopathy, two irregular hypodense lesions in pancreatic head and tail without ductal dilation with two irregular hypodense liver lesions. Immunohistochemistry of lung and pancreatic lesions were biopsied through endoscopic ultrasound (EUS), consistent with poorly differentiated squamous cell carcinoma (SCC) with extensive necrosis, which indicates pancreatic masses are likely metastases from the lung. Liver lesion biopsy exhibited high-grade neuroendocrine tumor (NET) with focal necrosis. Next gene sequencing was pursued. Given poor functional status, palliative immunotherapy was offered; however, the patient succumbed to respiratory failure.\u0000\u0000 Conclusion: Given the morphology and immunoprofile, differential diagnosis includes dual primary cancers with one metastasis, or primary SCC with metastasis with neuroendocrine differentiation. Despite having different histopathology and immunophenotype, both lung and liver tumors harbor the same molecular profile even at the variants of unknown significance that show identical mutations. As a result, they are directly related. TP53, RB1, MYCL1, and MEK1 mutations are more prevalent in SCC than NET. Tumor mutation burden values may vary as the tumor clonal structure varies between primary and metastatic sites, with higher rates of monoclonal structure recorded in metastases due to clonal selection, leading to a reduction in overall genetic diversity (“bottlenecking”). This raises the suspicion that the liver tumor is a SCC with neuroendocrine differentiation. The paucity of the specimen and rapid clinical course limited further investigation. Germline testing would have been useful to determine whether these findings are somatic or germline.\u0000","PeriodicalId":142535,"journal":{"name":"Journal of Case Reports and Images in Pathology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130721283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：