Pub Date : 2022-01-01DOI: 10.1097/PCR.0000000000000481
Abberly A. Lott Limbach, P. Wakely
Abstract Adrenal cysts are becoming more commonly identified because of advances in imaging techniques. The differential diagnosis of adrenal cysts is broad, and an uncommon finding in the cyst is papillary endothelial hyperplasia (PEH). Papillary endothelial hyperplasia is a benign endothelial proliferation which is most commonly described in the skin, and is uncommonly seen in visceral organs. We report a case of a 36 year old woman who presented with abdominal pain and subsequent imaging revealed an adrenal cyst. The patient then underwent surgery with removal of a 3.6 cm cystic adrenal gland. Histologic examination revealed numerous papillary structures covered by benign endothelial cells (CD34, CD31, ERG positive) consistent with PEH. Given the rarity of PEH as the predominant finding in the adrenal gland, recognition of PEH as a benign entity is important. In this report we present our case in the context of the literature and review differential diagnosis of PEH in the adrenal gland.
{"title":"Papillary Endothelial Hyperplasia of the Adrenal Gland: A Case Report and Review of the Literature","authors":"Abberly A. Lott Limbach, P. Wakely","doi":"10.1097/PCR.0000000000000481","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000481","url":null,"abstract":"Abstract Adrenal cysts are becoming more commonly identified because of advances in imaging techniques. The differential diagnosis of adrenal cysts is broad, and an uncommon finding in the cyst is papillary endothelial hyperplasia (PEH). Papillary endothelial hyperplasia is a benign endothelial proliferation which is most commonly described in the skin, and is uncommonly seen in visceral organs. We report a case of a 36 year old woman who presented with abdominal pain and subsequent imaging revealed an adrenal cyst. The patient then underwent surgery with removal of a 3.6 cm cystic adrenal gland. Histologic examination revealed numerous papillary structures covered by benign endothelial cells (CD34, CD31, ERG positive) consistent with PEH. Given the rarity of PEH as the predominant finding in the adrenal gland, recognition of PEH as a benign entity is important. In this report we present our case in the context of the literature and review differential diagnosis of PEH in the adrenal gland.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"113 1","pages":"22 - 24"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91358039","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000498
A. Gama, J. Novo
Abstract Metastatic cancers to the breast are rare and can be diagnostically challenging. We present the case of a 59-year-old woman, previously diagnosed with lung adenocarcinoma, who developed breast masses. Her medical history was not known to the pathologist, and the case was misdiagnosed as invasive ductal carcinoma of the breast. Following communication with the clinical team, ancillary tests were performed, and the report was amended to metastatic lung adenocarcinoma to the breast, highlighting the importance of specimen transfer of care and communication of key clinical data.
{"title":"When Blind Pathologists Lead Mute Clinicians: Autopsy of a Misdiagnosis Involving a Metastatic Lung Adenocarcinoma to the Breast Mimicking Primary Invasive Ductal Carcinoma","authors":"A. Gama, J. Novo","doi":"10.1097/PCR.0000000000000498","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000498","url":null,"abstract":"Abstract Metastatic cancers to the breast are rare and can be diagnostically challenging. We present the case of a 59-year-old woman, previously diagnosed with lung adenocarcinoma, who developed breast masses. Her medical history was not known to the pathologist, and the case was misdiagnosed as invasive ductal carcinoma of the breast. Following communication with the clinical team, ancillary tests were performed, and the report was amended to metastatic lung adenocarcinoma to the breast, highlighting the importance of specimen transfer of care and communication of key clinical data.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"32 1","pages":"63 - 65"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86761930","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000460
E. O'Donnell, Kalpana M. Devaraj, M. Post
Abstract Hepatobiliary cystadenocarcinoma is a rare malignancy associated with ovarian-like stroma and overtly malignant glands that has a favorable prognosis if completely resected, analogous to minimally invasive adenocarcinoma arising in mucinous cystic neoplasms of the pancreas. Ovarian mucinous neoplasms may have a similar histologic appearance and are known to occasionally contain mural nodules of anaplastic carcinoma. We report a case of hepatobiliary cystadenocarcinoma that subsequently presented as metastatic disease mimicking a primary gynecological malignancy. The 30-year-old patient had a history of a completely resected hepatobiliary cystadenocarcinoma 2 years prior to presentation, without adjuvant therapy. She presented to her gynecologist with pelvic pain and vaginal bleeding. Physical examination revealed diffuse nodularity along the anterior vaginal wall, and imaging showed a 5.8 × 4.1 cm pelvic mass with diffuse metastatic disease. Biopsies of the vaginal wall and an inguinal lymph node showed nests of pleomorphic cells with squamoid and glandular features concerning for metastatic ovarian carcinoma; however, immunohistochemistry was negative for PAX8 and ER, but positive for CDX2. Subsequent review of the patient's prior resection revealed a cystic mucinous neoplasm with mural nodules of adenosquamous and anaplastic carcinoma, the latter previously reported only rarely in hepatobiliary cystadenocarcinoma. This case highlights the histologic overlap between hepatobiliary and ovarian neoplasms, which may present a diagnostic challenge, particularly in the setting of incomplete history. In addition, the unusual presence of an anaplastic component in the patient's original tumor portends a worse prognosis; therefore, additional therapy should be considered in these patients.
{"title":"Metastatic Hepatobiliary Cystadenocarcinoma Mimicking a Gynecologic Malignancy","authors":"E. O'Donnell, Kalpana M. Devaraj, M. Post","doi":"10.1097/PCR.0000000000000460","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000460","url":null,"abstract":"Abstract Hepatobiliary cystadenocarcinoma is a rare malignancy associated with ovarian-like stroma and overtly malignant glands that has a favorable prognosis if completely resected, analogous to minimally invasive adenocarcinoma arising in mucinous cystic neoplasms of the pancreas. Ovarian mucinous neoplasms may have a similar histologic appearance and are known to occasionally contain mural nodules of anaplastic carcinoma. We report a case of hepatobiliary cystadenocarcinoma that subsequently presented as metastatic disease mimicking a primary gynecological malignancy. The 30-year-old patient had a history of a completely resected hepatobiliary cystadenocarcinoma 2 years prior to presentation, without adjuvant therapy. She presented to her gynecologist with pelvic pain and vaginal bleeding. Physical examination revealed diffuse nodularity along the anterior vaginal wall, and imaging showed a 5.8 × 4.1 cm pelvic mass with diffuse metastatic disease. Biopsies of the vaginal wall and an inguinal lymph node showed nests of pleomorphic cells with squamoid and glandular features concerning for metastatic ovarian carcinoma; however, immunohistochemistry was negative for PAX8 and ER, but positive for CDX2. Subsequent review of the patient's prior resection revealed a cystic mucinous neoplasm with mural nodules of adenosquamous and anaplastic carcinoma, the latter previously reported only rarely in hepatobiliary cystadenocarcinoma. This case highlights the histologic overlap between hepatobiliary and ovarian neoplasms, which may present a diagnostic challenge, particularly in the setting of incomplete history. In addition, the unusual presence of an anaplastic component in the patient's original tumor portends a worse prognosis; therefore, additional therapy should be considered in these patients.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"97 1","pages":"2 - 4"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75747026","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000485
Venkatesh Dhanasekaran, B. Srinivas, D. Basu, B. Dubashi, D. Gochhait
Abstract Anaplastic large cell lymphoma (ALCL) of the breast is an extremely rare hematolymphoid malignancy and is characteristically associated with breast implants. Among the primary hematolymphoid malignancies arising from the breast, T-cell lymphomas are extremely rare, and among T-cell lymphomas, ALCL has a better prognosis. We present the case of a 30-year-old woman with a diagnosis of ALCL without any breast implants and with simultaneous involvement of bone marrow and peripheral blood. Pathologists should be aware of this entity and should include it in the differential diagnoses when evaluating a breast biopsy that shows a high-grade anaplastic morphology.
{"title":"Anaplastic Large Cell Lymphoma of the Breast With Simultaneous Peripheral Blood and Marrow Involvement","authors":"Venkatesh Dhanasekaran, B. Srinivas, D. Basu, B. Dubashi, D. Gochhait","doi":"10.1097/PCR.0000000000000485","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000485","url":null,"abstract":"Abstract Anaplastic large cell lymphoma (ALCL) of the breast is an extremely rare hematolymphoid malignancy and is characteristically associated with breast implants. Among the primary hematolymphoid malignancies arising from the breast, T-cell lymphomas are extremely rare, and among T-cell lymphomas, ALCL has a better prognosis. We present the case of a 30-year-old woman with a diagnosis of ALCL without any breast implants and with simultaneous involvement of bone marrow and peripheral blood. Pathologists should be aware of this entity and should include it in the differential diagnoses when evaluating a breast biopsy that shows a high-grade anaplastic morphology.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"7 1","pages":"25 - 28"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79149931","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000483
Mercedes Bravo-Taxa, Rafael Garatea-Grau, Ulises Nuñez-Romero, Lourdes Huanca-Amesquita
Abstract Sclerosing epithelioid fibrosarcoma (SEF) is a rare fibrosarcoma variant that features rounded carcinoma-like epithelioid cells arranged into compact nests, cords, and single-cell patterns within a highly sclerotic stroma and has a consistent translocation (EWSR1-CREB3L1/2). To our knowledge, there are 110 cases of pure SEF reported, to date, with 15 occurring at intra-abdominal sites. Primary SEF of the kidney is exceptionally rare. We present a case of SEF that arose in the kidney. Histological examination revealed densely hyalinized epithelioid tumor suggestive of SEF. The diffuse immunohistochemical staining of MUC4 by neoplastic cells and the presence of EWSR1 gene rearrangement by fluorescence in situ hybridization analysis confirmed the histological diagnosis.
{"title":"Primary Sclerosing Epithelioid Fibrosarcoma of the Kidney: A Case Report and Review of the Literature","authors":"Mercedes Bravo-Taxa, Rafael Garatea-Grau, Ulises Nuñez-Romero, Lourdes Huanca-Amesquita","doi":"10.1097/PCR.0000000000000483","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000483","url":null,"abstract":"Abstract Sclerosing epithelioid fibrosarcoma (SEF) is a rare fibrosarcoma variant that features rounded carcinoma-like epithelioid cells arranged into compact nests, cords, and single-cell patterns within a highly sclerotic stroma and has a consistent translocation (EWSR1-CREB3L1/2). To our knowledge, there are 110 cases of pure SEF reported, to date, with 15 occurring at intra-abdominal sites. Primary SEF of the kidney is exceptionally rare. We present a case of SEF that arose in the kidney. Histological examination revealed densely hyalinized epithelioid tumor suggestive of SEF. The diffuse immunohistochemical staining of MUC4 by neoplastic cells and the presence of EWSR1 gene rearrangement by fluorescence in situ hybridization analysis confirmed the histological diagnosis.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"11 1","pages":"13 - 17"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90443717","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000496
Barina Aqil, Amandeep Kaur
Abstract Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is most prevalent in Asia and has been increasingly recognized in other parts of the world. It usually occurs more frequently in females and presents as fever and localized cervical lymphadenopathy. It resolves spontaneously, usually over a period of several weeks up to 6 months. Its initial clinical features are commonly similar to that of a lymphoma, and it can be misdiagnosed both by clinicians and pathologists. Kikuchi disease has been associated with systemic lupus erythematosus. We report a case of Kikuchi disease that occurred in a 25-year-old female patient that masqueraded as a T-cell lymphoma.
{"title":"Kikuchi Disease Masquerading as a T-Cell Lymphoma","authors":"Barina Aqil, Amandeep Kaur","doi":"10.1097/PCR.0000000000000496","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000496","url":null,"abstract":"Abstract Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is most prevalent in Asia and has been increasingly recognized in other parts of the world. It usually occurs more frequently in females and presents as fever and localized cervical lymphadenopathy. It resolves spontaneously, usually over a period of several weeks up to 6 months. Its initial clinical features are commonly similar to that of a lymphoma, and it can be misdiagnosed both by clinicians and pathologists. Kikuchi disease has been associated with systemic lupus erythematosus. We report a case of Kikuchi disease that occurred in a 25-year-old female patient that masqueraded as a T-cell lymphoma.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"1 1","pages":"80 - 83"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90763609","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000484
Youssef Khafateh, C. Preciado, D. Elder, L. Litzky, D. Vaughn, S. Singhal, P. Lal, M. Palmer
Abstract Primary mediastinal germ cell tumors (GCTs) account for a small subset of all GCTs. Teratoma is the most common GCT of the mediastinum and usually occurs in adults from 20 to 40 years of age. Malignant somatic transformation is a rare phenomenon that has been described in both primary and metastatic mediastinal GCTs. The most common types of malignant somatic transformation described in mediastinal GCTs are sarcomas and carcinomas, with very few cases of melanoma found in the literature. We report the case of a 21-year-old male patient who presented with anterior mediastinal mass that on initial biopsy and workup revealed a mediastinal mixed GCT with teratoma and yolk sac components. Following chemotherapy, the resected mass demonstrated residual teratoma with malignant transformation into melanocytic, neuroectodermal, and undifferentiated sarcomatous elements. The patient rapidly developed metastases to the lung, liver, spleen, and spine. Biopsy of the bone marrow and liver confirmed metastatic dissemination by melanocytic transformed GCT. Molecular analysis for BRAF mutation was negative. The rapid multiorgan pattern of metastatic spread indicates a very aggressive phenotype. This case represents the second reported case of malignant melanocytic tumor as part of multilineage malignant differentiation arising from mediastinal GCT.
{"title":"Malignant Melanoma Arising in a Primary Mediastinal Teratoma: Case Report of a Rare Phenomenon and Review of the Literature","authors":"Youssef Khafateh, C. Preciado, D. Elder, L. Litzky, D. Vaughn, S. Singhal, P. Lal, M. Palmer","doi":"10.1097/PCR.0000000000000484","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000484","url":null,"abstract":"Abstract Primary mediastinal germ cell tumors (GCTs) account for a small subset of all GCTs. Teratoma is the most common GCT of the mediastinum and usually occurs in adults from 20 to 40 years of age. Malignant somatic transformation is a rare phenomenon that has been described in both primary and metastatic mediastinal GCTs. The most common types of malignant somatic transformation described in mediastinal GCTs are sarcomas and carcinomas, with very few cases of melanoma found in the literature. We report the case of a 21-year-old male patient who presented with anterior mediastinal mass that on initial biopsy and workup revealed a mediastinal mixed GCT with teratoma and yolk sac components. Following chemotherapy, the resected mass demonstrated residual teratoma with malignant transformation into melanocytic, neuroectodermal, and undifferentiated sarcomatous elements. The patient rapidly developed metastases to the lung, liver, spleen, and spine. Biopsy of the bone marrow and liver confirmed metastatic dissemination by melanocytic transformed GCT. Molecular analysis for BRAF mutation was negative. The rapid multiorgan pattern of metastatic spread indicates a very aggressive phenotype. This case represents the second reported case of malignant melanocytic tumor as part of multilineage malignant differentiation arising from mediastinal GCT.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"22 1","pages":"33 - 36"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84461032","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000497
J. Rytych, Carissa LaBoy
Abstract Benign inclusions in lymph nodes are a rare phenomenon that has been described throughout the body. These foci of nonneoplastic, ectopic tissue in the axillary lymph nodes can mimic low-grade metastatic breast carcinomas and result in a diagnosis of false-positive nodes that would lead to unnecessary treatment. We present a challenging case of a patient with a left breast grade 1 invasive ductal carcinoma undergoing an intraoperative axillary sentinel lymph node frozen-section consultation that contained numerous small tubules in the subcapsular space. The lymph node was interpreted as positive for carcinoma, and the patient underwent an axillary lymph node dissection. On permanent sections, myoepithelial cells and surrounding basement membranes were identified around some of the tubules, and a large, squamous inclusion cyst became visible. Immunohistochemical stains were performed that showed that p63 and smooth muscle myosin heavy chain highlighted myoepithelial cells around the tubules, whereas cytokeratin 5/6 and estrogen receptor stains showed a mosaic pattern of positivity. Combined, these findings supported a revised diagnosis of benign glandular and benign squamous inclusions. This case underscores the importance of thoroughly examining the location and histologic and cytologic features of a low-grade–appearing epithelium before determining lymph node positivity and, if it is unclear, deferring the diagnosis to permanent sections where immunohistochemical stains can be performed. Knowledge of this uncommon finding is important to avoid false-positive results, unnecessary treatments, and their associated comorbidities.
{"title":"A Case of Benign Breast Inclusions in an Axillary Sentinel Lymph Node Mimicking a Low-Grade Carcinoma","authors":"J. Rytych, Carissa LaBoy","doi":"10.1097/PCR.0000000000000497","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000497","url":null,"abstract":"Abstract Benign inclusions in lymph nodes are a rare phenomenon that has been described throughout the body. These foci of nonneoplastic, ectopic tissue in the axillary lymph nodes can mimic low-grade metastatic breast carcinomas and result in a diagnosis of false-positive nodes that would lead to unnecessary treatment. We present a challenging case of a patient with a left breast grade 1 invasive ductal carcinoma undergoing an intraoperative axillary sentinel lymph node frozen-section consultation that contained numerous small tubules in the subcapsular space. The lymph node was interpreted as positive for carcinoma, and the patient underwent an axillary lymph node dissection. On permanent sections, myoepithelial cells and surrounding basement membranes were identified around some of the tubules, and a large, squamous inclusion cyst became visible. Immunohistochemical stains were performed that showed that p63 and smooth muscle myosin heavy chain highlighted myoepithelial cells around the tubules, whereas cytokeratin 5/6 and estrogen receptor stains showed a mosaic pattern of positivity. Combined, these findings supported a revised diagnosis of benign glandular and benign squamous inclusions. This case underscores the importance of thoroughly examining the location and histologic and cytologic features of a low-grade–appearing epithelium before determining lymph node positivity and, if it is unclear, deferring the diagnosis to permanent sections where immunohistochemical stains can be performed. Knowledge of this uncommon finding is important to avoid false-positive results, unnecessary treatments, and their associated comorbidities.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"55 1","pages":"66 - 68"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86892709","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000492
T. Bronson, B. Choy
Abstract The morphologic overlap between low-grade spindle cell lesions can lead to diagnostic dilemmas, particularly when attempting to interpret limited material. Evaluation of such specimens frequently requires correlating with clinical and imaging findings, as well as ancillary studies. We discuss the case of a 78-year-old woman with a remote history of breast carcinoma who presented with a left base of neck nodule. While imaging findings were highly suggestive of schwannoma, fine-needle aspiration biopsy of the nodule was performed for diagnostic confirmation. The patient reported tingling and an electrical shock sensation traveling down her arm during the fine-needle aspiration procedure. Cytomorphologic findings demonstrating a low-grade spindle cell neoplasm further supported a diagnosis of schwannoma, despite early immunohistochemistry results not being supportive. A last-minute suggestion that the differential diagnosis be broadened prompted additional immunohistochemical workup and follow-up molecular testing that confirmed an alternative diagnosis of solitary fibrous tumor. This case demonstrates the importance of correlating clinical, radiologic, and pathologic findings when approaching the differential diagnosis of low-grade spindle cell lesions on fine-needle biopsy specimens. Ancillary testing including immunohistochemistry, molecular studies, or fluorescence in situ hybridization is frequently utilized to establish a definitive diagnosis.
{"title":"Wolves in Sheep's Clothing and Vice Versa: Fine-Needle Aspiration of Low-Grade Spindle Cell Lesions","authors":"T. Bronson, B. Choy","doi":"10.1097/PCR.0000000000000492","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000492","url":null,"abstract":"Abstract The morphologic overlap between low-grade spindle cell lesions can lead to diagnostic dilemmas, particularly when attempting to interpret limited material. Evaluation of such specimens frequently requires correlating with clinical and imaging findings, as well as ancillary studies. We discuss the case of a 78-year-old woman with a remote history of breast carcinoma who presented with a left base of neck nodule. While imaging findings were highly suggestive of schwannoma, fine-needle aspiration biopsy of the nodule was performed for diagnostic confirmation. The patient reported tingling and an electrical shock sensation traveling down her arm during the fine-needle aspiration procedure. Cytomorphologic findings demonstrating a low-grade spindle cell neoplasm further supported a diagnosis of schwannoma, despite early immunohistochemistry results not being supportive. A last-minute suggestion that the differential diagnosis be broadened prompted additional immunohistochemical workup and follow-up molecular testing that confirmed an alternative diagnosis of solitary fibrous tumor. This case demonstrates the importance of correlating clinical, radiologic, and pathologic findings when approaching the differential diagnosis of low-grade spindle cell lesions on fine-needle biopsy specimens. Ancillary testing including immunohistochemistry, molecular studies, or fluorescence in situ hybridization is frequently utilized to establish a definitive diagnosis.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"54 1","pages":"73 - 76"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78844522","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 : 2022-01-01DOI: 10.1097/PCR.0000000000000499
Erika Hissong, R. Yantiss
Abstract Desmoplastic small round cell tumor (DSRCT) is a rare but aggressive malignancy that usually occurs within the intra-abdominal cavities of young adult males. Most DSRCTs can be reliably diagnosed based on the presence of characteristic morphology; coexpression of epithelial, myogenic, and neural markers; and detection of the reciprocal translocation t(11;22)(p13:21) associated with the EWS::WT1 fusion. However, occasional tumors lack classic features, affect older adults, or are located outside the abdominal cavity. Mucosal biopsy samples can pose challenges when both the stromal and epithelial components are not represented. Herein, we present a case of DSRCT that simulated clinical and histologic features of a colonic adenocarcinoma. Biopsy sampling revealed nests of cytokeratin-positive epithelioid cells that simulated a high-grade carcinoma with neuroendocrine features. This case report emphasizes the importance of considering this rare entity when presented with high-grade epithelioid tumors that occur in young patients.
{"title":"Desmoplastic Small Round Cell Tumor Is an Important Mimic of High-Grade Carcinoma in Colonic Biopsy Samples","authors":"Erika Hissong, R. Yantiss","doi":"10.1097/PCR.0000000000000499","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000499","url":null,"abstract":"Abstract Desmoplastic small round cell tumor (DSRCT) is a rare but aggressive malignancy that usually occurs within the intra-abdominal cavities of young adult males. Most DSRCTs can be reliably diagnosed based on the presence of characteristic morphology; coexpression of epithelial, myogenic, and neural markers; and detection of the reciprocal translocation t(11;22)(p13:21) associated with the EWS::WT1 fusion. However, occasional tumors lack classic features, affect older adults, or are located outside the abdominal cavity. Mucosal biopsy samples can pose challenges when both the stromal and epithelial components are not represented. Herein, we present a case of DSRCT that simulated clinical and histologic features of a colonic adenocarcinoma. Biopsy sampling revealed nests of cytokeratin-positive epithelioid cells that simulated a high-grade carcinoma with neuroendocrine features. This case report emphasizes the importance of considering this rare entity when presented with high-grade epithelioid tumors that occur in young patients.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":"85 1","pages":"44 - 47"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83981893","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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