Pub Date : 2022-05-01DOI: 10.1097/PCR.0000000000000505
Shaymaa E Hegazy, R. Bhargava, Somak Roy, E. Elishaev
Background Diagnosis of the primary ovarian mucinous neoplasms occasionally poses a challenge because historically most tumors diagnosed as primary ovarian were documented as metastases from gastrointestinal and pancreatobiliary tracts. This challenge is attributed to the overlapping histologic features, the gray zone, between primary and metastatic mucinous neoplasms in the ovary. While presentation of both primary and metastatic mucinous tumors manifests by the presence of an ovarian mass, determination of the site of origin is clinically significant, because most treatment guidelines are based on the tissue of origin. Case Presentation We present an unusual case of mucinous adenocarcinoma of the ovary and the appendix with diagnostic pitfalls and challenges of immunohistochemical profile. Conclusion Utilization of molecular analysis in challenging cases of ovarian neoplasms helps to narrow down the gray zone and lessens the misdiagnosis of primary ovarian mucinous tumors.
{"title":"Synchronous Mucinous Carcinomas of Ovary and Appendix: A Case Report With Diagnostic Pitfalls and Review of Corresponding Literature","authors":"Shaymaa E Hegazy, R. Bhargava, Somak Roy, E. Elishaev","doi":"10.1097/PCR.0000000000000505","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000505","url":null,"abstract":"Background Diagnosis of the primary ovarian mucinous neoplasms occasionally poses a challenge because historically most tumors diagnosed as primary ovarian were documented as metastases from gastrointestinal and pancreatobiliary tracts. This challenge is attributed to the overlapping histologic features, the gray zone, between primary and metastatic mucinous neoplasms in the ovary. While presentation of both primary and metastatic mucinous tumors manifests by the presence of an ovarian mass, determination of the site of origin is clinically significant, because most treatment guidelines are based on the tissue of origin. Case Presentation We present an unusual case of mucinous adenocarcinoma of the ovary and the appendix with diagnostic pitfalls and challenges of immunohistochemical profile. Conclusion Utilization of molecular analysis in challenging cases of ovarian neoplasms helps to narrow down the gray zone and lessens the misdiagnosis of primary ovarian mucinous tumors.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"114 1","pages":"103 - 106"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89398999","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 : 2022-05-01DOI: 10.1097/PCR.0000000000000500
A. Wiles, Sadia Sayeed
Abstract Variant anatomy and cytomorphological overlap between benign and malignant conditions can coincide to produce diagnostic error. We report the case of an unusually shaped thyroid gland bearing a follicular adenoma interpreted as a metastatic papillary thyroid carcinoma. The shape of the gland had a striking resemblance to The Scream, a painting by Edvard Munch, and directly contributed to the misdiagnosis. We discuss the known embryological mechanisms of thyroid development, ultrasound radiological characteristics of thyroid examination, and the cytomorphologic interpretation of thyroid tissue. The constellation of these elements and the resultant error is eloquently illustrated by Munch’s artistic inspiration.
{"title":"The Scream: Benign Thyroid Tissue as a Lateral Neck Mass","authors":"A. Wiles, Sadia Sayeed","doi":"10.1097/PCR.0000000000000500","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000500","url":null,"abstract":"Abstract Variant anatomy and cytomorphological overlap between benign and malignant conditions can coincide to produce diagnostic error. We report the case of an unusually shaped thyroid gland bearing a follicular adenoma interpreted as a metastatic papillary thyroid carcinoma. The shape of the gland had a striking resemblance to The Scream, a painting by Edvard Munch, and directly contributed to the misdiagnosis. We discuss the known embryological mechanisms of thyroid development, ultrasound radiological characteristics of thyroid examination, and the cytomorphologic interpretation of thyroid tissue. The constellation of these elements and the resultant error is eloquently illustrated by Munch’s artistic inspiration.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"24 1","pages":"128 - 131"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78111439","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 : 2022-05-01DOI: 10.1097/PCR.0000000000000509
Barina Aqil, J. Ramos
Abstract Flow cytometry (FC) is a powerful tool for characterizing hematopoietic cells and plays a critical role in the diagnosis and classification of hematopoietic neoplasms. However, its accuracy rate alone without morphology is questionable. It is imperative to always have clinical and morphologic correlation. Herein, we describe a case of nasal mass, which could have been misdiagnosed as a hematologic malignancy based on FC alone without morphologic examination.
{"title":"Flow Cytometry: a Helpful Ancillary Tool in the Hematopathologist World But Can Be Misleading Without Morphology","authors":"Barina Aqil, J. Ramos","doi":"10.1097/PCR.0000000000000509","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000509","url":null,"abstract":"Abstract Flow cytometry (FC) is a powerful tool for characterizing hematopoietic cells and plays a critical role in the diagnosis and classification of hematopoietic neoplasms. However, its accuracy rate alone without morphology is questionable. It is imperative to always have clinical and morphologic correlation. Herein, we describe a case of nasal mass, which could have been misdiagnosed as a hematologic malignancy based on FC alone without morphologic examination.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"31 1","pages":"116 - 118"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82340970","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 : 2022-05-01DOI: 10.1097/PCR.0000000000000506
Allen P Burke, Naomi Hardy, Rachel Fanaroff, Teklu Legesse
Sarcomatoid mesotheliomas can be challenging to diagnose on small biopsy specimens, where limited material may preclude definitive assessment of invasion and lesional cells can have relatively bland cytology with no mesothelial marker expression. We report a case of a patient who presented with a pleural effusion and had subsequent pleural biopsy that showed a bland, uniform spindle cell proliferation in a mildly myxoid background. There was little if any collagen; no chest wall, soft tissue, or fat; and mesothelial markers were negative. The cells were positive for pancytokeratin and GATA3 by immunohistochemistry, and in situ hybridization showed a "negative" result for homozygous loss of CDKN2A; however, there was partial (heterozygous) loss of one allele. A diagnosis of atypical spindle cell proliferation was made based on these findings. Several months later, the patient had a repeat pleural biopsy that showed spindled cells with more pleomorphism, areas of invasion into the chest wall, and the same partial loss of CDKN2A, consistent with a sarcomatoid mesothelioma. This case underscores the challenges present on small biopsy specimens, the fact that sarcomatoid mesotheliomas can be relatively bland appearing with focal pleomorphism, and that heterozygous loss of CDKN2A should be considered a positive result indicative of a neoplastic process.
{"title":"Sarcomatoid Mesothelioma with Bland Histologic Features: A Potential Pitfall in Diagnosis.","authors":"Allen P Burke, Naomi Hardy, Rachel Fanaroff, Teklu Legesse","doi":"10.1097/PCR.0000000000000506","DOIUrl":"10.1097/PCR.0000000000000506","url":null,"abstract":"<p><p>Sarcomatoid mesotheliomas can be challenging to diagnose on small biopsy specimens, where limited material may preclude definitive assessment of invasion and lesional cells can have relatively bland cytology with no mesothelial marker expression. We report a case of a patient who presented with a pleural effusion and had subsequent pleural biopsy that showed a bland, uniform spindle cell proliferation in a mildly myxoid background. There was little if any collagen; no chest wall, soft tissue, or fat; and mesothelial markers were negative. The cells were positive for pancytokeratin and GATA3 by immunohistochemistry, and in situ hybridization showed a \"negative\" result for homozygous loss of CDKN2A; however, there was partial (heterozygous) loss of one allele. A diagnosis of atypical spindle cell proliferation was made based on these findings. Several months later, the patient had a repeat pleural biopsy that showed spindled cells with more pleomorphism, areas of invasion into the chest wall, and the same partial loss of CDKN2A, consistent with a sarcomatoid mesothelioma. This case underscores the challenges present on small biopsy specimens, the fact that sarcomatoid mesotheliomas can be relatively bland appearing with focal pleomorphism, and that heterozygous loss of CDKN2A should be considered a positive result indicative of a neoplastic process.</p>","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"27 3","pages":"87-93"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10398945/pdf/nihms-1788899.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9942898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1097/PCR.0000000000000510
Lucy Jager, E. Morency, B. Choy
Abstract The main purpose of urine cytology is the detection of high-grade urothelial carcinoma (HGUC). When malignant cells of nonurothelial origin are present, it is often misdiagnosed as HGUC due to the rarity of this event and difficulty in distinguishing subtle cytomorphologic differences. To arrive at the appropriate diagnosis, evaluation of urine cytology specimens requires correlation with clinical and radiologic findings and utilization of cytologic-histologic correlation. We present the case of a 64-year-old woman with gross hematuria. Imaging located an infiltrative mass involving the left renal pelvis, highly suggestive of urothelial carcinoma. Lymphadenopathy and multiple bony lesions in the spine were concerning for metastatic disease. Urine cytology specimens taken during cystoscopy contained malignant cells, which were interpreted as HGUC. The workup of a subsequent lymph node biopsy showed a metastatic high grade carcinoma of renal origin with SMARCB1 loss. This finding led to the reexamination of the urine cytology specimens, revealing the malignant cells were not HGUC but rather renal carcinoma. This case highlights a potential pitfall in the evaluation of urine cytology and the importance of cytologic-histologic correlation.
{"title":"Malignant Cells in Urine Cytology: Not Always High-Grade Urothelial Carcinoma","authors":"Lucy Jager, E. Morency, B. Choy","doi":"10.1097/PCR.0000000000000510","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000510","url":null,"abstract":"Abstract The main purpose of urine cytology is the detection of high-grade urothelial carcinoma (HGUC). When malignant cells of nonurothelial origin are present, it is often misdiagnosed as HGUC due to the rarity of this event and difficulty in distinguishing subtle cytomorphologic differences. To arrive at the appropriate diagnosis, evaluation of urine cytology specimens requires correlation with clinical and radiologic findings and utilization of cytologic-histologic correlation. We present the case of a 64-year-old woman with gross hematuria. Imaging located an infiltrative mass involving the left renal pelvis, highly suggestive of urothelial carcinoma. Lymphadenopathy and multiple bony lesions in the spine were concerning for metastatic disease. Urine cytology specimens taken during cystoscopy contained malignant cells, which were interpreted as HGUC. The workup of a subsequent lymph node biopsy showed a metastatic high grade carcinoma of renal origin with SMARCB1 loss. This finding led to the reexamination of the urine cytology specimens, revealing the malignant cells were not HGUC but rather renal carcinoma. This case highlights a potential pitfall in the evaluation of urine cytology and the importance of cytologic-histologic correlation.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"41 1","pages":"132 - 134"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88311735","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 : 2022-05-01DOI: 10.1097/PCR.0000000000000502
M. Kallen, A. Emadi, V. Duong, M. Baer, Y. Ning, Z. Singh, R. Koka
Abstract Mixed phenotype acute leukemias (MPALs) are a rare category of acute leukemia with biologic and genetic heterogeneity and a prognosis generally inferior to those of single lineage leukemias. The diagnosis depends on immunophenotypic assessment with a comprehensive panel of monoclonal antibodies by multiparameter flow cytometry and lineage assignment by the World Health Organization criteria. CD19 assessment is required for establishing a B-cell component in MPALs, as is determination of its intensity of expression, and assessment of the additional B-cell markers CD79a, cytoplasmic CD22, and CD10. We report the case of an MPAL, initially classified as an acute myeloid leukemia with weak CD19 expression and later reclassified upon clear demonstration of a B-cell component; such cases highlight a pitfall in classification of acute leukemias, particularly given heterogeneous antigen expression between fluorochromes and subjectivity in judgment of intensity. Practical take-away points include the need for hypervigilance in marker performance patterns in flow cytometry, both between fluorochromes and over time, the benefits of repeat sampling and blast assessment between laboratories, and the potential quality improvements unlocked by expanded flow cytometry panels in diagnostic hematopathology.
{"title":"When Flow Is Turbulent: CD19 Intensity Is a Pitfall in Acute Leukemia Classification","authors":"M. Kallen, A. Emadi, V. Duong, M. Baer, Y. Ning, Z. Singh, R. Koka","doi":"10.1097/PCR.0000000000000502","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000502","url":null,"abstract":"Abstract Mixed phenotype acute leukemias (MPALs) are a rare category of acute leukemia with biologic and genetic heterogeneity and a prognosis generally inferior to those of single lineage leukemias. The diagnosis depends on immunophenotypic assessment with a comprehensive panel of monoclonal antibodies by multiparameter flow cytometry and lineage assignment by the World Health Organization criteria. CD19 assessment is required for establishing a B-cell component in MPALs, as is determination of its intensity of expression, and assessment of the additional B-cell markers CD79a, cytoplasmic CD22, and CD10. We report the case of an MPAL, initially classified as an acute myeloid leukemia with weak CD19 expression and later reclassified upon clear demonstration of a B-cell component; such cases highlight a pitfall in classification of acute leukemias, particularly given heterogeneous antigen expression between fluorochromes and subjectivity in judgment of intensity. Practical take-away points include the need for hypervigilance in marker performance patterns in flow cytometry, both between fluorochromes and over time, the benefits of repeat sampling and blast assessment between laboratories, and the potential quality improvements unlocked by expanded flow cytometry panels in diagnostic hematopathology.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"25 1","pages":"112 - 115"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73900118","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 : 2022-03-21DOI: 10.1097/PCR.0000000000000493
Pouya Jamshidi, Matthew McCord, C. Horbinski, L. Jennings, Lucas Santana dos Santos, I. Fudyma, M. DeCuypere, K. Yap, P. Rathbun, Nitin R. Wadhwani
Abstract We describe a pediatric patient with an intra-axial tumor; histopathologic examination of the resected specimen was unable to establish a precise diagnosis. While the initial targeted next-generation sequencing (NGS) panel was also nondiagnostic, genomic DNA methylation profiling indicated that the tumor was an astroblastoma, MN1-altered. A more comprehensive NGS panel was then run, which confirmed an MN1-BEND2 fusion. This case displays the limitations and pitfalls of a histological and immunohistochemical-based diagnosis in a case of an infrequently encountered pediatric brain tumor. Furthermore, it highlights the growing need for performing DNA methylation, paired with a comprehensive NGS panel, to ensure an accurate diagnosis in modern surgical neuropathology.
{"title":"Methylation Profiling Improves the Care of Pediatric Brain Tumor Patients","authors":"Pouya Jamshidi, Matthew McCord, C. Horbinski, L. Jennings, Lucas Santana dos Santos, I. Fudyma, M. DeCuypere, K. Yap, P. Rathbun, Nitin R. Wadhwani","doi":"10.1097/PCR.0000000000000493","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000493","url":null,"abstract":"Abstract We describe a pediatric patient with an intra-axial tumor; histopathologic examination of the resected specimen was unable to establish a precise diagnosis. While the initial targeted next-generation sequencing (NGS) panel was also nondiagnostic, genomic DNA methylation profiling indicated that the tumor was an astroblastoma, MN1-altered. A more comprehensive NGS panel was then run, which confirmed an MN1-BEND2 fusion. This case displays the limitations and pitfalls of a histological and immunohistochemical-based diagnosis in a case of an infrequently encountered pediatric brain tumor. Furthermore, it highlights the growing need for performing DNA methylation, paired with a comprehensive NGS panel, to ensure an accurate diagnosis in modern surgical neuropathology.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"1 1","pages":"e1 - e4"},"PeriodicalIF":0.0,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87061310","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 : 2022-03-01DOI: 10.1097/PCR.0000000000000494
Naomi L Hardy, J. Jacobs, Paul N. Staats, A. Burke, Kristen M. Stashek, Laura Malone
Abstract Typical and atypical carcinoids account for 2% of all pulmonary neoplasms and are usually diagnosed based on characteristic neuroendocrine granules, architecture, and overall bland cytomorphology. However, there are rare carcinoids with unusual morphology mimicking features seen in non–small cell lung carcinoma, which can be a significant challenge on small biopsy or cytology specimens with major therapeutic implications. We report a case of a transbronchial needle aspirate that was initially misinterpreted as non–small cell lung carcinoma due to the presence of cohesive clusters of tumor cells showing striking pleomorphism and prominent nucleoli in a background of necrosis. In addition, tumor cells showed multifocal brown cytoplasmic melanin pigment that has rarely been reported in carcinoids. The diagnostic pitfalls of a pleomorphic carcinoid and the possible limitations of reaching this diagnosis on small biopsy specimens are discussed.
{"title":"Pleomorphic Carcinoid: A Pitfall in Diagnosis on Small Biopsy Specimens","authors":"Naomi L Hardy, J. Jacobs, Paul N. Staats, A. Burke, Kristen M. Stashek, Laura Malone","doi":"10.1097/PCR.0000000000000494","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000494","url":null,"abstract":"Abstract Typical and atypical carcinoids account for 2% of all pulmonary neoplasms and are usually diagnosed based on characteristic neuroendocrine granules, architecture, and overall bland cytomorphology. However, there are rare carcinoids with unusual morphology mimicking features seen in non–small cell lung carcinoma, which can be a significant challenge on small biopsy or cytology specimens with major therapeutic implications. We report a case of a transbronchial needle aspirate that was initially misinterpreted as non–small cell lung carcinoma due to the presence of cohesive clusters of tumor cells showing striking pleomorphism and prominent nucleoli in a background of necrosis. In addition, tumor cells showed multifocal brown cytoplasmic melanin pigment that has rarely been reported in carcinoids. The diagnostic pitfalls of a pleomorphic carcinoid and the possible limitations of reaching this diagnosis on small biopsy specimens are discussed.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"47 1","pages":"69 - 72"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76783936","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 : 2022-03-01DOI: 10.1097/PCR.0000000000000495
C. Felicelli, Luis Z. Blanco
Abstract Ovarian neoplasms are a common specimen received for intraoperative consultation (frozen section) as an accurate diagnosis is necessary to determine the next steps in surgery. We present the case of a 79-year-old woman with a 5.3-cm right ovarian lesion as well as a large appendiceal mass. The frozen section of the ovarian lesion showed a high-grade tumor with areas of luminal necrosis. These morphologic findings, along with the presence of a colonic mass, led to an intraoperative consultation diagnosis of “high grade adenocarcinoma, favor metastasis from gastrointestinal tract primary,” and to the surgery ending after removal of the appendix and cecum. However, the permanent section revealed high-grade serous carcinoma. We review the differential diagnosis of high-grade ovarian lesions on frozen section, examine the challenges that can occur, and discuss the potential downstream effects and consequences for patient care.
{"title":"High-Grade Ovarian Epithelial Tumor and Intraoperative Frozen Section: Consequences of a Discordant Diagnosis","authors":"C. Felicelli, Luis Z. Blanco","doi":"10.1097/PCR.0000000000000495","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000495","url":null,"abstract":"Abstract Ovarian neoplasms are a common specimen received for intraoperative consultation (frozen section) as an accurate diagnosis is necessary to determine the next steps in surgery. We present the case of a 79-year-old woman with a 5.3-cm right ovarian lesion as well as a large appendiceal mass. The frozen section of the ovarian lesion showed a high-grade tumor with areas of luminal necrosis. These morphologic findings, along with the presence of a colonic mass, led to an intraoperative consultation diagnosis of “high grade adenocarcinoma, favor metastasis from gastrointestinal tract primary,” and to the surgery ending after removal of the appendix and cecum. However, the permanent section revealed high-grade serous carcinoma. We review the differential diagnosis of high-grade ovarian lesions on frozen section, examine the challenges that can occur, and discuss the potential downstream effects and consequences for patient care.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"16 1","pages":"77 - 79"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88485132","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 : 2022-03-01DOI: 10.1097/PCR.0000000000000491
A. Burke, T. Legesse, A. Paulk
Abstract We report a renal tumor originally diagnosed as oncocytoma that recurred with biopsy-proven multiple liver metastases. Review of the initial tumor revealed a predominantly CK7-negative neoplasm that had areas resembling oncocytoma, areas resembling eosinophilic chromophobe renal cell carcinoma, and areas with intermediate features. The case illustrates that the distinction between eosinophilic chromophobe renal cell carcinoma and “oncocytic tumor of uncertain malignant potential” is in some cases subjective. Criteria need better definition and should not be based on cytokeratin 7 staining pattern alone. A discussion of the current classification of oncocytic renal tumors is included, as well as a discussion of the differential diagnosis of renal neoplasms with eosinophilic cytoplasm.
{"title":"Low-Grade Oncocytic Renal Tumor With Massive Liver Metastasis: Do Not Trust a Negative CK7 and Misdiagnose Oncocytoma: A Cautionary Tale and Current Classification of Oncocytic Renal Tumors","authors":"A. Burke, T. Legesse, A. Paulk","doi":"10.1097/PCR.0000000000000491","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000491","url":null,"abstract":"Abstract We report a renal tumor originally diagnosed as oncocytoma that recurred with biopsy-proven multiple liver metastases. Review of the initial tumor revealed a predominantly CK7-negative neoplasm that had areas resembling oncocytoma, areas resembling eosinophilic chromophobe renal cell carcinoma, and areas with intermediate features. The case illustrates that the distinction between eosinophilic chromophobe renal cell carcinoma and “oncocytic tumor of uncertain malignant potential” is in some cases subjective. Criteria need better definition and should not be based on cytokeratin 7 staining pattern alone. A discussion of the current classification of oncocytic renal tumors is included, as well as a discussion of the differential diagnosis of renal neoplasms with eosinophilic cytoplasm.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"70 1","pages":"51 - 62"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84421329","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}
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