Case Reports in Pathology最新文献

Background: Myoepithelioma-like tumor of the vulvar region (MELTVR) is a rare mesenchymal tumor that typically arises in the female vulva. Case Presentation: Here, we report a case of a 48-year-old woman who presented with a 2-year history of subcutaneous mass in the vulvar region. As the mass rapidly increased in the last 2 months, personal slight swelling pain appeared. Histologically, the tumor exhibited a distinctive feature of abundant tumor cells and sparse mucus regions. While each region appeared alternately, the sparse mucus region was about 30% of the whole tumor. The tumor had two types of cells, namely, epithelioid and spindle cells. The tumor-rich region demonstrated a cell type of epithelioid, showing hermaphroditic cytoplasm, the center-located nucleus, and abundant chromatin of fasciculate or cord-braid arrangement, whereas the cell of the mucus region was fusiform or epithelioid with partial vacuole-shaped and small visible nucleolus, exhibiting red-stained cytoplasm and loose chromatin. Immunohistochemically, vimentin, smooth muscle actin (SMA), and P16 were diffuse positive in tumor cells, whereas desmin, cytokeratin (CK), P40, P63, CK5, HMB45, MyoD1, myogenin, S100, and SOX10 were all negative. While the proliferation index of Ki-67 was about 7%, the expression of SMARCBl/lNI-1 protein was absent. The pathological diagnosis is myoepithelioma-like tumor of the vulva (right labia majora). Finally, the tumor was surgically and completely removed, and no recurrence or metastasis was found after 6 months of follow-up. Conclusions: Histologically, the morphology of MELTVR is changeable and variation existed for each individual tumor. Moreover, it needs to be differentiated from various other types of tumors, whereas more reports and studies are required to further clarify MELTVR.

Appendiceal neoplasms are usually asymptomatic or associated with mild, nonspecific symptoms. Due to the rarity of the disease and the lack of specific symptoms, this clinical entity escapes the diagnostic consideration of the gynecologist, when women come in with right iliac fossa pain. A case is presented of a 56-year-old woman with a mass in the right small pelvis, which was preoperatively diagnosed as originating from the ovary. An exploratory laparotomy followed in which the uterus and appendages were found to be macroscopically normal, while the mass described above came from the appendix, extended into the anatomical area of the right accessory, and was in contact with the atrophic right ovary. The appendix vermiformis was removed intact. The final pathologic examination confirmed an acellular mucinous tumor of the appendix. Accurate preoperative diagnosis of mucoceles is extremely difficult to make. The formation is discovered in a random imaging test, and the diagnosis is confirmed only intraoperatively.

Background: Intracerebellar schwannoma is an extremely rare disease entity with only 21 case reports described in the literature. Case Description: A 68-year-old male presented with chronic headaches, dizziness, gait imbalance, and incoordination. Previous MRI had revealed a cystic lesion in the right cerebellum; however, patient was lost to follow-up. Updated MRI revealed dramatic enlargement of the lesion in addition to worsening clinical status. The patient underwent successful surgical resection. Conclusion: Intracerebellar schwannoma can be challenging to diagnose preoperatively due to its rare occurrence; however, it should be included in the differential diagnosis of cystic lesions in the cerebellum, and most cases can be successfully treated with complete surgical resection. Pathological examination revealed a spindle cell neoplasm with other typical histopathological features of schwannoma.

We herein report an autopsy case of a fulminant Clostridium perfringens (C. perfringens or Welch bacilli) infection in a healthy adult. A 72-year-old, immunocompetent man visited the emergency department with lower back pain, and blood test revealed hemolytic attack. His condition rapidly worsened with severe acidosis and anemia, and he died despite symptomatic treatment. An autopsy examination demonstrated an abscess with necrosis and air spaces in the right lobe of his liver. Numerous Gram-positive bacilli were seen in the liver and bone marrow, and C. perfringens was identified in culture of the antemortem blood sample. Of note, a mucosal epithelium of the ileum showed loss of tight junctions (claudin 4), suggesting the involvement of C. perfringens toxins with its systemic spreading. Welch toxins were suggested to be involved in serious pathological conditions such as hemolytic anemia and systemic infections, and it is necessary to raise Welch infection as one of the differential diagnoses for fulminant systemic infections even in healthy individuals.

Low-grade endometrial stromal sarcomas (LGESSs) are indolent tumors with a slow progression rate that tend to recur locally. They represent up to 10% of all primary sarcomas of the uterus and endometrium and only 0.2% of all genital tract tumors. They are commonly present in a younger demographic compared to other uterine tumors, with patients' ages typically between 42 and 58 years old. Although the overall 5-year survival rate is excellent, it has a natural history of delayed metastases which may manifest even decades after the disease was first diagnosed. They typically present as poorly defined lesions infiltrating the myometrium, along with extensive engagement of surrounding vascular structures. LGESS may display variants of different morphologies such as smooth muscle, fibromyxoid, sex cord-like, and endometrioid-type gland differentiation. These variations can pose a diagnostic challenge. The occurrence of this differentiation in a metastatic focus rather than in the primary tumor is seldom recorded in the literature. We present a case of a 51-year-old lady with a history of LGESS who was treated with surgery and radiotherapy and then presented after 12 years with an inferior vena cava (IVC) mass, which was confirmed histologically to be metastatic LGESS. Immunohistochemistry studies reveal strong positivity for CD10, WT1, and PR. These markers were negative in the sex cord and endometrioid gland-like differentiation counterparts. The patient had her initial follow-up appointment after the IVC mass resection, and she was in good health with no complications. To the best of our knowledge, this case represents a unique instance of metastatic LGESS exhibiting both sex cord and endometrioid gland-like differentiation that has not been observed in the primary tumor.

Nasopharyngeal carcinoma is an endemic entity with a strong association with Epstein-Barr virus and a new recognition of human papilloma virus-mediated effects in nonendemic areas. Here, we discuss a nasopharyngeal carcinoma suspected as based on imaging results with metastasis to the lymph nodes, lung, spleen, bone, and liver. Gross and microscopic findings from the autopsy were clinicopathologically correlated with antemortem clinical studies and investigations. The authors report a case of EBV- and HPV-negative nonendemic, multisite metastatic nasopharyngeal carcinoma, shown to be nonkeratinizing undifferentiated subtype.

Primary malignant melanoma of the gallbladder is an extremely rare tumor with approximately 39 cases described in the literature so far. However, since the first case was reported in 1907, it remains controversial whether gallbladder involvement in malignant melanoma is primary or metastatic. Here, we report a case of primary malignant melanoma of the gallbladder. A 52-year-old male presented to the emergency department with right upper quadrant abdominal pain and was found to have tumefactive sludge filling the majority of the gallbladder with possible gallbladder wall thickening on ultrasonography. A laparoscopic cholecystectomy was performed for presumed acute cholecystitis. Histopathologic examination of the gallbladder revealed malignant melanoma arising from the mucosa of the gallbladder. Further clinical investigation excluded other primary sites, supporting a diagnosis of primary malignant melanoma of the gallbladder.