Case Reports in Pathology最新文献

In a case of pigmented purpuric dermatosis with hyperlipidemia reported earlier to be persistent for over 20 years, the primary disease was cured by oral rinsing with ozone water; however, the remaining prominent pigmentation was not remarkably improved even with oral administration of vitamin C and laser treatment. A histological examination of the lesion was performed to resolve the difficulty in removing this pigmentation. No granuloma reaction, including giant cells, was observed in the lesion tissue, even after such a long course and significant pigmentation. Granuloma formation in this disease may be a functional problem of the patient's histiocytes and/or phagocytes rather than its chronic course or excessive hemosiderin deposition. Similarly, hyperlipidemia did not affect granuloma formation.

Hidradenoma (HA) is a rare, benign adnexal tumor typically arising in the skin, with only a few reported cases in the breast. Histologically, HA displays solid and cystic patterns with diverse cellular components. Although MAML2 gene rearrangement is observed in some cutaneous HAs, its significance in breast HA remains unclear. We retrospectively analyzed four cases of breast HA at our institution, focusing on clinicopathologic and molecular characteristics. MAML2 rearrangement was detected in all cases by FISH, suggesting it may be a defining feature of breast HA. Because breast HA frequently mimics malignancy and is often diagnosed only after excision, heightened awareness and recognition of its distinctive clinicopathologic and molecular features are essential to prevent overtreatment.

Aortitis can be either infectious or noninfectious, and cases of noninfectious aortitis are not well understood. Our study presents a case of noninfectious ascending aortitis in a relatively young, previously healthy man, characterized by a predominantly neutrophilic infiltrate on histopathological examination without an inciting microorganism. This case report highlights that a neutrophilic infiltrate does not necessarily indicate an infectious etiology in ascending aortic aneurysms.

Background: Within 1 month of diagnosis, 40% of patients with positive blood cultures will develop CNS complications. Rare pathogens, that is, Paeniclostridium sordellii, pose diagnostic challenges due to atypical presentations and detection difficulties.

Case presentation: A 67-year-old man presented with metabolic encephalopathy and diabetes insipidus. Imaging showed bilateral basal ganglia abnormalities and an enhancing lesion near the anterior commissure, suspicious for neoplasm. Postmortem findings included reactive gliosis, atypical lymphocytic inflammation, and polyclonal plasma cells. NGS performed at the University of Washington confirmed P. sordellii infection.

Neuropathologic findings: The gross and histologic examination showed mild hydrocephalus, right hippocampal atrophy, and anterior commissure-centric inflammation. Vascular congestion, arteriosclerosis with microthrombi, and oligodendrocyte loss were present without hemorrhage.

Differential diagnosis: Hemophagocytic lymphohistiocytosis and CNS lymphoma were considered but ruled out microscopically.

Conclusion: This case highlights the importance of considering P. sordellii in CNS inflammatory lesions and demonstrates the utility of molecular diagnostics in negative cultures.

We conducted an autopsy on a patient who succumbed to thyroid storm complicated by liver failure. As autopsies of thyroid storm are rare, we present the findings of the autopsy. A 70-year-old female patient who developed rapid onset acute liver failure passed away on the 15th day of hospitalization due to a thyroid storm. As in previously reported cases, lobular central necrosis of the liver was a predominant feature, and fibrosis was also seen. In this case, acute cardiac failure seemed to play a significant role as a cause of the liver failure. It may be crucial to prevent heart failure (HF), leading to hepatic ischemia before liver fibrosis develops.

This case details a 78-year-old male with a history of old myocardial infarction and chronic myeloid leukemia treated with tyrosine kinase inhibitors (TKIs). The patient presented with exertional dyspnea and was hospitalized for congestive heart failure. Following the development of a urinary tract infection, the patient exhibited signs of sepsis-induced cardiomyopathy (SIC), including myocardial injury and rapid hemodynamic deterioration, leading to death. Autopsy findings indicated SIC, characterized by neutrophil-dominant inflammatory cell infiltration and endothelial damage, which might have been exacerbated by the patient's preexisting conditions of old myocardial infarction and TKI therapy. This case underscores the multifactorial nature of SIC, suggesting that preexisting old myocardial infarction and TKI therapies can significantly impact the disease's pathogenesis and progression. It highlights the need for comprehensive management strategies in patients with complex medical histories and the importance of further research to elucidate the underlying mechanisms of SIC.

Medicolegal death investigation (MDI) includes sudden and unexpected deaths, with the most common being cardiovascular deaths, cerebral, pulmonary, and cancer causes. Less commonly, gastrointestinal conditions can occur, and most conditions are symptomatic. Occasionally, pain is masked or absent. Of the many intestinal conditions that may cause death, intestinal volvulus occurs in all ages and is part of the larger intestinal obstruction disease states. The individual in our report was an active, articulate 85-year-old female in excellent health; her medical history was positive only for hypothyroidism, treated for over 30 years with Synthroid. She died following vague abdominal complaints and nausea following a meal. At autopsy, a volvulus of the ileum and adjacent mesentery was present. The ileum was necrotic, and 700 cc of bloody, dark peritoneal fluid was present. Major arteries, including celiac, superior, and inferior mesenteric arteries, were patent. A volvulus occurs when the bowel twists upon its associated mesentery, causing obstruction within the intestine, vascular compromise of the supporting vessels in the mesentery, and ultimate distal ischemia of the affected bowel. Correct assessment in this case provided answers for the family and allowed correct death certificate classification.

Collision tumors are rare neoplasms composed of two histologically distinct components without a transitional zone. Only nine cases involving periampullary adenocarcinoma and neuroendocrine tumor (NET) have been reported. A 55-year-old male presented with recurrent fever and jaundice. Imaging and biopsy revealed a periampullary lesion diagnosed as tubule-villous adenoma with high-grade dysplasia. He underwent pylorus-preserving pancreatoduodenectomy. Histology revealed moderately differentiated intestinal-type adenocarcinoma (pT2N1) with regional lymph node metastasis. Additionally, a 2-mm well-differentiated NET was found 2.5 cm proximal to the primary tumor, also with nodal metastasis. Immunohistochemistry confirmed distinct lineages, fulfilling the criteria for a collision tumor. This case represents a rare periampullary collision tumor with both adenocarcinoma and NET components showing independent lymph node metastases. The absence of transitional zones rules out MiNEN. This report underscores the importance of thorough pathological assessment and adds to the limited literature on the behavior and prognosis of periampullary collision tumors.

Pulmonary mucinous adenocarcinomas are rare, and the knowledge about them is gleaned from case reports and small case series. To support the growing recognition of these rare tumors, we present two cases: one of a low-grade mucinous tumor and another of a colloid adenocarcinoma to illuminate the underreported differences between these two mucinous tumors.

Primary intracranial pure yolk sac tumors (YSTs) are rare, and their typical histological findings have been documented in the literature. We report a case of a 20-year-old young man with an intra-axial primary YST exhibiting a unique sarcomatoid morphology. This case demonstrates that primary intracranial YSTs present uncommon patterns underscoring the importance of including YSTs in the differential diagnosis of midline masses. To the best of our knowledge, this is the first reported pure primary intracranial YST showing sarcomatoid histology.