Pub Date : 2021-01-01DOI: 10.1097/PCR.0000000000000464
B. Zelman, Hannah H. Chen, S. Pambuccian, Razan Massarani‐Wafai, S. Mehrotra, V. Ananthanarayanan
Abstract Nuclear protein in testis (NUT) carcinoma is a rare, aggressive, poorly differentiated malignant neoplasm. NUT carcinoma (NC) is hallmarked by its chromosomal translocation involving the NUT/NUTM1 gene, which leads to a fusion oncoprotein that blocks epithelial differentiation and maintains proliferation in tumor cells. The translocation occurs with members of the BET (bromodomain and extraterminal domain) protein family, with 70% of the cases forming the NUTM1-BRD4 fusion. It most frequently involves the thoracic cavity followed by the head and neck, with a preference for midline areas of the body, especially the sinonasal tract and mediastinum. This led to NC formerly being known as NUT midline carcinoma. However, studies have shown that NC can occur widely throughout the body, thus leading to the updated name. NUT carcinoma is histologically defined as a tumor of primitive appearing round monomorphic cells with possible foci of abrupt keratinization. Given its rarity and its morphologic and immunohistochemical overlap with other tumors, NC has been largely underdiagnosed and misdiagnosed in the past few decades. However, with the improvement of genetic testing and the availability of an anti-NUT monoclonal antibody for diagnostic immunohistochemistry, the number of cases classified as NCs has vastly increased in the recent past.
{"title":"A Rare Case of NUT Carcinoma and Review of the Literature","authors":"B. Zelman, Hannah H. Chen, S. Pambuccian, Razan Massarani‐Wafai, S. Mehrotra, V. Ananthanarayanan","doi":"10.1097/PCR.0000000000000464","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000464","url":null,"abstract":"Abstract Nuclear protein in testis (NUT) carcinoma is a rare, aggressive, poorly differentiated malignant neoplasm. NUT carcinoma (NC) is hallmarked by its chromosomal translocation involving the NUT/NUTM1 gene, which leads to a fusion oncoprotein that blocks epithelial differentiation and maintains proliferation in tumor cells. The translocation occurs with members of the BET (bromodomain and extraterminal domain) protein family, with 70% of the cases forming the NUTM1-BRD4 fusion. It most frequently involves the thoracic cavity followed by the head and neck, with a preference for midline areas of the body, especially the sinonasal tract and mediastinum. This led to NC formerly being known as NUT midline carcinoma. However, studies have shown that NC can occur widely throughout the body, thus leading to the updated name. NUT carcinoma is histologically defined as a tumor of primitive appearing round monomorphic cells with possible foci of abrupt keratinization. Given its rarity and its morphologic and immunohistochemical overlap with other tumors, NC has been largely underdiagnosed and misdiagnosed in the past few decades. However, with the improvement of genetic testing and the availability of an anti-NUT monoclonal antibody for diagnostic immunohistochemistry, the number of cases classified as NCs has vastly increased in the recent past.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80788334","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000454
D. Berry, D. Ornan, M. Lopes
Supplemental digital content is available in the text. Abstract Ectopic pituitary adenomas (EPAs) are uncommon sinonasal neoplasms that present a diagnostic challenge in practice. We present a case of a patient presenting with progressive headache. Workup revealed an enhancing mass on magnetic resonance imaging at the anterior clivus with extension into the sphenoid sinus. Resection of the tumor was performed, and microscopic examination showed a neuroendocrine tumor composed of monomorphic cells arranged in nests. The tumor expressed synaptophysin, chromogranin, growth hormone, prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, α-subunit of the glycoproteins, and transcription factors steroidogenic factor 1 and Pit-1, diagnosed as a plurihormonal pituitary adenoma. Given the radiologic and surgical impression of an intact and uninvolved pituitary gland, the lesion was identified as a pituitary adenoma arising in ectopic adenohypophyseal tissue. This case demonstrates the multitude of possible tissue types involved in tumor histogenesis in the sinonasal cavity. We highlight the radiographic, intraoperative, cytologic, and histologic features of sinonasal pituitary adenoma to emphasize the role of an expanded differential, including central nervous system lesions, for neoplasms in this anatomic region.
{"title":"Diagnosis of Sinonasal Ectopic Pituitary Adenomas","authors":"D. Berry, D. Ornan, M. Lopes","doi":"10.1097/PCR.0000000000000454","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000454","url":null,"abstract":"Supplemental digital content is available in the text. Abstract Ectopic pituitary adenomas (EPAs) are uncommon sinonasal neoplasms that present a diagnostic challenge in practice. We present a case of a patient presenting with progressive headache. Workup revealed an enhancing mass on magnetic resonance imaging at the anterior clivus with extension into the sphenoid sinus. Resection of the tumor was performed, and microscopic examination showed a neuroendocrine tumor composed of monomorphic cells arranged in nests. The tumor expressed synaptophysin, chromogranin, growth hormone, prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, α-subunit of the glycoproteins, and transcription factors steroidogenic factor 1 and Pit-1, diagnosed as a plurihormonal pituitary adenoma. Given the radiologic and surgical impression of an intact and uninvolved pituitary gland, the lesion was identified as a pituitary adenoma arising in ectopic adenohypophyseal tissue. This case demonstrates the multitude of possible tissue types involved in tumor histogenesis in the sinonasal cavity. We highlight the radiographic, intraoperative, cytologic, and histologic features of sinonasal pituitary adenoma to emphasize the role of an expanded differential, including central nervous system lesions, for neoplasms in this anatomic region.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91334123","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000463
Doreen N. Palsgrove, P. Wilson, B. R. Oliai, J. Bishop
Abstract Hyalinizing clear cell carcinoma (HCCC) is a rare but well-recognized low-grade salivary gland malignancy. In addition to being a morphologically distinct neoplasm with cords and nests of predominantly clear cells in hyalinized fibrous stroma, it harbors a characteristic EWSR1 gene rearrangement that can be readily exploited as a diagnostic marker to help distinguish it from other salivary gland tumors with overlapping histomorphology. We herein report a pediatric case of salivary HCCC arising in the oral cavity of an 11-year-old girl. The tumor cells contained moderate amounts of eosinophilic to clear cytoplasm and hyperchromatic nuclei. The stroma was notable for a biphasic spatial arrangement alternating between fibrocellular regions and hyalinized basement membrane–like areas immediately adjacent to tumor cell nests. By immunohistochemistry, the tumor was positive for p40 and negative for SOX10, S100 protein, and smooth muscle actin. Fluorescence in situ hybridization was positive for an EWSR1 chromosomal rearrangement. This is the first reported, molecularly confirmed pediatric case of HCCC. It further expands the diagnostic age range of HCCC to include the pediatric population and highlights the potential risk of misdiagnosis.
{"title":"Salivary Hyalinizing Clear Cell Carcinoma: Report of a Genetically Confirmed Pediatric Case and Review of the Literature","authors":"Doreen N. Palsgrove, P. Wilson, B. R. Oliai, J. Bishop","doi":"10.1097/PCR.0000000000000463","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000463","url":null,"abstract":"Abstract Hyalinizing clear cell carcinoma (HCCC) is a rare but well-recognized low-grade salivary gland malignancy. In addition to being a morphologically distinct neoplasm with cords and nests of predominantly clear cells in hyalinized fibrous stroma, it harbors a characteristic EWSR1 gene rearrangement that can be readily exploited as a diagnostic marker to help distinguish it from other salivary gland tumors with overlapping histomorphology. We herein report a pediatric case of salivary HCCC arising in the oral cavity of an 11-year-old girl. The tumor cells contained moderate amounts of eosinophilic to clear cytoplasm and hyperchromatic nuclei. The stroma was notable for a biphasic spatial arrangement alternating between fibrocellular regions and hyalinized basement membrane–like areas immediately adjacent to tumor cell nests. By immunohistochemistry, the tumor was positive for p40 and negative for SOX10, S100 protein, and smooth muscle actin. Fluorescence in situ hybridization was positive for an EWSR1 chromosomal rearrangement. This is the first reported, molecularly confirmed pediatric case of HCCC. It further expands the diagnostic age range of HCCC to include the pediatric population and highlights the potential risk of misdiagnosis.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75929067","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000429
Gloria H Sura, Nicole R. Jackson, Shirley Yodzis, S. Fox
Abstract Heterotopic ossification is a rare, reactive condition, sometimes classified as a “pseudotumor,” involving the formation of bone within the soft tissues (Int J Surg Case Rep 2014;5:476–479), This process can occur as an undesirable pathologic sequela of trauma and surgery (J Am Acad Orthop Surg 2004;12:116–125). The few cases reported in the literature are almost exclusively in men with a predominance in people of African ancestry (J Am Acad Orthop Surg 2004;12:116–125; Bone Joint J 2016;98-B:761–766; Case Rep Surg 2019;2019:4036716). Reports of heterotopic ossification have been described in medical literature since 1692 as myositis ossificans progressiva (JBJS 1938;20:661–674). It was not until 1999 that the term “heterotopic mesenteric ossification” was formally used by Wilson et al to describe a complication found in post–abdominal surgical patients (Am J Surg Pathol 1999;23:1464–1470). Although the exact pathologic mechanism of heterotopic mesenteric ossification has not been elucidated, some hypotheses include differentiation of mesenchymal progenitor cells toward an osteogenic lineage, as well as proliferation of dislocated fragments of bone from other regions of the body (J Gastrointest Surg 2015;19:579–580). Since the late 1900s, fewer than 40 cases of mesenteric ossification have been reported. Limited gross and histologic description is available for pathologists and surgeons to identify this phenomenon; however, further data can be acquired at autopsy. Awareness of this condition on the part of clinicians, and early review and recognition by pathologists, may alter surgical management decisions and improve upon morbidity and mortality in these patients. We present gross and histologic examination of an advanced case of heterotopic ossification at autopsy, with a review of current management recommendations.
异位骨化是一种罕见的反应性疾病，有时被归类为“假肿瘤”，涉及软组织内骨的形成(Int J surgery Case Rep 2014;5:47 76 - 479)，这一过程可能作为创伤和手术的不良病理后遗症发生(J Am Acad Orthop surgery 2004; 12:116-125)。文献中报道的少数病例几乎全部发生在男性中，以非洲血统的人为主(J Am Acad Orthop surgery 2004; 12:16 - 125;骨关节[J]; 2016; 38 - b: 761-766;病例报告外科2019;2019:4036716)。自1692年以来，异位骨化在医学文献中被描述为进行性骨化性肌炎(JBJS 1938; 20:661-674)。直到1999年Wilson等人才正式使用“异位肠系膜骨化”一词来描述腹部手术后患者的并发症(Am J Surg Pathol 1999; 23:1464-1470)。虽然异位肠系膜骨化的确切病理机制尚未阐明，但一些假说包括间充质祖细胞向成骨谱系的分化，以及来自身体其他部位的脱位骨碎片的增殖(J Gastrointest Surg 2015; 19:579-580)。自20世纪后期以来，报道的肠系膜骨化病例不到40例。有限的大体和组织学描述可供病理学家和外科医生识别这种现象;然而，进一步的数据可以在尸检中获得。临床医生对这种情况的认识，以及病理学家的早期检查和认识，可能会改变手术管理决策，并改善这些患者的发病率和死亡率。我们在尸检中对一例晚期异位骨化病例进行大体和组织学检查，并对目前的治疗建议进行回顾。
{"title":"Heterotopic Ossification of the Mesentery: A Rare Postoperative Complication","authors":"Gloria H Sura, Nicole R. Jackson, Shirley Yodzis, S. Fox","doi":"10.1097/PCR.0000000000000429","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000429","url":null,"abstract":"Abstract Heterotopic ossification is a rare, reactive condition, sometimes classified as a “pseudotumor,” involving the formation of bone within the soft tissues (Int J Surg Case Rep 2014;5:476–479), This process can occur as an undesirable pathologic sequela of trauma and surgery (J Am Acad Orthop Surg 2004;12:116–125). The few cases reported in the literature are almost exclusively in men with a predominance in people of African ancestry (J Am Acad Orthop Surg 2004;12:116–125; Bone Joint J 2016;98-B:761–766; Case Rep Surg 2019;2019:4036716). Reports of heterotopic ossification have been described in medical literature since 1692 as myositis ossificans progressiva (JBJS 1938;20:661–674). It was not until 1999 that the term “heterotopic mesenteric ossification” was formally used by Wilson et al to describe a complication found in post–abdominal surgical patients (Am J Surg Pathol 1999;23:1464–1470). Although the exact pathologic mechanism of heterotopic mesenteric ossification has not been elucidated, some hypotheses include differentiation of mesenchymal progenitor cells toward an osteogenic lineage, as well as proliferation of dislocated fragments of bone from other regions of the body (J Gastrointest Surg 2015;19:579–580). Since the late 1900s, fewer than 40 cases of mesenteric ossification have been reported. Limited gross and histologic description is available for pathologists and surgeons to identify this phenomenon; however, further data can be acquired at autopsy. Awareness of this condition on the part of clinicians, and early review and recognition by pathologists, may alter surgical management decisions and improve upon morbidity and mortality in these patients. We present gross and histologic examination of an advanced case of heterotopic ossification at autopsy, with a review of current management recommendations.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77386432","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000427
Melanie H Hakar, C. Chapman, B. Hansford, Jessica L. Davis
Abstract Fibrous dysplasia is a dysplastic disorder of bone caused by missense mutations of the GNAS1 gene. Fibrocartilaginous dysplasia (also known as fibrochondrodysplasia or fibrous dysplasia with extensive cartilaginous differentiation) is a rare variant of fibrous dysplasia with extensive cartilaginous differentiation that shows a predilection for the lower extremities and can affect one or multiple bones. Although benign, this entity causes progressively expansile lesions that can lead to deformity and ultimately pathologic fracture. On imaging, this entity can show features consistent with a variety of benign and malignant cartilage-forming tumors. We present the case of a 16-year-old male patient who presented with clinical history of Ollier disease and multiple presumed enchondromas. He underwent below-the-knee amputation for progressive tibial deformity, pathologic fracture, and pain. Microscopic examination of multiple lower-extremity bones revealed a fibro-osseous lesion with massive cartilaginous differentiation consistent with fibrocartilaginous dysplasia.
{"title":"Polyostotic Fibrous Dysplasia With Extensive Cartilaginous Differentiation: A Rare Case Clinically Mimicking Ollier Disease","authors":"Melanie H Hakar, C. Chapman, B. Hansford, Jessica L. Davis","doi":"10.1097/PCR.0000000000000427","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000427","url":null,"abstract":"Abstract Fibrous dysplasia is a dysplastic disorder of bone caused by missense mutations of the GNAS1 gene. Fibrocartilaginous dysplasia (also known as fibrochondrodysplasia or fibrous dysplasia with extensive cartilaginous differentiation) is a rare variant of fibrous dysplasia with extensive cartilaginous differentiation that shows a predilection for the lower extremities and can affect one or multiple bones. Although benign, this entity causes progressively expansile lesions that can lead to deformity and ultimately pathologic fracture. On imaging, this entity can show features consistent with a variety of benign and malignant cartilage-forming tumors. We present the case of a 16-year-old male patient who presented with clinical history of Ollier disease and multiple presumed enchondromas. He underwent below-the-knee amputation for progressive tibial deformity, pathologic fracture, and pain. Microscopic examination of multiple lower-extremity bones revealed a fibro-osseous lesion with massive cartilaginous differentiation consistent with fibrocartilaginous dysplasia.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76413371","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000438
Ravikant Singh, Geunyoung Jung, Erin G. Brooks
Abstract The COVID-19 pandemic has been a major cause of mortality worldwide. While respiratory pathology seems to be the major mechanism of disease, cardiovascular pathology has increasingly been reported to play a role in adverse outcomes. A variety of different cardiovascular histopathologies have been reported at postmortem examination including myocarditis. Because of limited autopsy numbers and lack of standardized reporting of such cases, however, the prevalence of COVID-19 (2019 coronavirus disease)–associated myocarditis is unknown. The current autopsy case report illustrates how COVID-19 pulmonary pathology can be accompanied by right ventricular myocarditis. The discussion reviews the pathophysiology of myocarditis, as well as diagnostic strategies, adding to the growing body of literature describing myocarditis in association with COVID-19 disease.
{"title":"SARS-CoV-2–Associated Myocarditis at Autopsy","authors":"Ravikant Singh, Geunyoung Jung, Erin G. Brooks","doi":"10.1097/PCR.0000000000000438","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000438","url":null,"abstract":"Abstract The COVID-19 pandemic has been a major cause of mortality worldwide. While respiratory pathology seems to be the major mechanism of disease, cardiovascular pathology has increasingly been reported to play a role in adverse outcomes. A variety of different cardiovascular histopathologies have been reported at postmortem examination including myocarditis. Because of limited autopsy numbers and lack of standardized reporting of such cases, however, the prevalence of COVID-19 (2019 coronavirus disease)–associated myocarditis is unknown. The current autopsy case report illustrates how COVID-19 pulmonary pathology can be accompanied by right ventricular myocarditis. The discussion reviews the pathophysiology of myocarditis, as well as diagnostic strategies, adding to the growing body of literature describing myocarditis in association with COVID-19 disease.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77213057","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000428
Bronson Wessinger, Justin C Morse, J. Lewis, J. Shinn, R. Chandra
Introduction Rhabdomyosarcoma (RMS) is a malignant soft tissue neoplasm differentiating into primitive mesenchymal cells with partial skeletal muscle differentiation. It is rare, especially in the sinonasal cavity. We review available literature on sinonasal RMS and present a case report involving spindle cell sinonasal RMS, one of the rarest subtypes. Case Report A 73-year-old man with months of right-sided epiphora and nasal obstruction had abnormal soft tissue and calcification in the right nasal cavity on computed tomography. Nasal endoscopy revealed a smooth, firm mass involving the inferior turbinate. The mass was removed en bloc via endoscopic partial medial maxillectomy and ethmoidectomy. Gross pathologic examination revealed a mottled red, tan, firm, bosselated, and glistening mass, with irregular fragments of soft tissue and bone. Histologic examination showed a variably myxoid and fibrous neoplasm with hyalinization. Tumor cells were spindled with moderate pleomorphism and low mitotic activity. Immunohistochemistry was extensively positive for desmin and myoD1 and focally positive for smooth muscle actin. A diagnosis of sinonasal RMS, grade 2, was made. Discussion/Conclusion This is the first reported case of spindle cell RMS originating from the inferior turbinate. Sinonasal RMS has the worst prognosis of all primary sites, especially with age older than 65 years, alveolar subtype, primary tumor greater than 5 cm, high stage/group, and distant metastases. While the risk stratification system accounts for surgical and pathologic factors, more research is needed to determine how this guides selection of resection and/or chemoradiation.
{"title":"Spindle Cell Sinonasal Rhabdomyosarcoma in a 73-Year-Old Man: A Case Report","authors":"Bronson Wessinger, Justin C Morse, J. Lewis, J. Shinn, R. Chandra","doi":"10.1097/PCR.0000000000000428","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000428","url":null,"abstract":"Introduction Rhabdomyosarcoma (RMS) is a malignant soft tissue neoplasm differentiating into primitive mesenchymal cells with partial skeletal muscle differentiation. It is rare, especially in the sinonasal cavity. We review available literature on sinonasal RMS and present a case report involving spindle cell sinonasal RMS, one of the rarest subtypes. Case Report A 73-year-old man with months of right-sided epiphora and nasal obstruction had abnormal soft tissue and calcification in the right nasal cavity on computed tomography. Nasal endoscopy revealed a smooth, firm mass involving the inferior turbinate. The mass was removed en bloc via endoscopic partial medial maxillectomy and ethmoidectomy. Gross pathologic examination revealed a mottled red, tan, firm, bosselated, and glistening mass, with irregular fragments of soft tissue and bone. Histologic examination showed a variably myxoid and fibrous neoplasm with hyalinization. Tumor cells were spindled with moderate pleomorphism and low mitotic activity. Immunohistochemistry was extensively positive for desmin and myoD1 and focally positive for smooth muscle actin. A diagnosis of sinonasal RMS, grade 2, was made. Discussion/Conclusion This is the first reported case of spindle cell RMS originating from the inferior turbinate. Sinonasal RMS has the worst prognosis of all primary sites, especially with age older than 65 years, alveolar subtype, primary tumor greater than 5 cm, high stage/group, and distant metastases. While the risk stratification system accounts for surgical and pathologic factors, more research is needed to determine how this guides selection of resection and/or chemoradiation.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88700159","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000468
B. Thakkar, Wesley D. Carlisle, S. Redfield, Andrew T. Meram
There has been a resurgence of syphilis, and the diagnosis should be considered in the differential diagnosis of masses in the head and neck region. Abstract Syphilis is one of the most common sexually transmitted diseases. In recent years, a resurgence of syphilis has been described in the literature, with a 71.4% increase in documented cases in the United States from 2014 to 2018. Tertiary syphilis remains rare in developed countries. We report a case of tertiary laryngeal syphilis in a middle-aged man presenting with cervical lymphadenopathy and an oropharyngeal mass with clinical features suggestive of malignancy. Precise pathologic examination with laboratory testing revealed the final diagnosis. We review the imaging and pathologic findings to emphasize the importance of taking syphilis into consideration in the differential diagnosis of oropharyngeal masses.
{"title":"Tertiary Syphilis Involving the Larynx: A Rare Case Report","authors":"B. Thakkar, Wesley D. Carlisle, S. Redfield, Andrew T. Meram","doi":"10.1097/PCR.0000000000000468","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000468","url":null,"abstract":"There has been a resurgence of syphilis, and the diagnosis should be considered in the differential diagnosis of masses in the head and neck region. Abstract Syphilis is one of the most common sexually transmitted diseases. In recent years, a resurgence of syphilis has been described in the literature, with a 71.4% increase in documented cases in the United States from 2014 to 2018. Tertiary syphilis remains rare in developed countries. We report a case of tertiary laryngeal syphilis in a middle-aged man presenting with cervical lymphadenopathy and an oropharyngeal mass with clinical features suggestive of malignancy. Precise pathologic examination with laboratory testing revealed the final diagnosis. We review the imaging and pathologic findings to emphasize the importance of taking syphilis into consideration in the differential diagnosis of oropharyngeal masses.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72780381","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000447
H. Hosseini, Jordan M. Steinberg, Fanni Ratzon, P. Unger, Alyssa Yurovitsky
Abstract Metastatic involvement of the cervix by nongynecologic malignancies is an extremely rare occurrence. We report a case of metastatic lung adenocarcinoma to the cervix. The patient is a 70-year-old woman who was admitted because of acute kidney injury. Imaging studies revealed left-sided hydronephrosis and a 3.2-cm heterogeneous pelvic mass involving the left pelvic wall. The patient underwent hysteroscopy with dilatation and curettage. Specimens labeled with endometrial and endocervical curettings were notable for tumor cells infiltrating the fibromuscular tissue. Immunohistochemical studies showed that the tumor cells were positive for CK7, napsin A, and TTF1, whereas they were negative for PAX8, p16, p40, p53, GATA3, and ER. This immunophenotype was consistent with a metastatic adenocarcinoma of the lung primary.
{"title":"Lung Adenocarcinoma Metastatic to the Cervix: Report of a Rare Case and Review of the Literature","authors":"H. Hosseini, Jordan M. Steinberg, Fanni Ratzon, P. Unger, Alyssa Yurovitsky","doi":"10.1097/PCR.0000000000000447","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000447","url":null,"abstract":"Abstract Metastatic involvement of the cervix by nongynecologic malignancies is an extremely rare occurrence. We report a case of metastatic lung adenocarcinoma to the cervix. The patient is a 70-year-old woman who was admitted because of acute kidney injury. Imaging studies revealed left-sided hydronephrosis and a 3.2-cm heterogeneous pelvic mass involving the left pelvic wall. The patient underwent hysteroscopy with dilatation and curettage. Specimens labeled with endometrial and endocervical curettings were notable for tumor cells infiltrating the fibromuscular tissue. Immunohistochemical studies showed that the tumor cells were positive for CK7, napsin A, and TTF1, whereas they were negative for PAX8, p16, p40, p53, GATA3, and ER. This immunophenotype was consistent with a metastatic adenocarcinoma of the lung primary.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88315554","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 : 2021-01-01DOI: 10.1097/PCR.0000000000000443
R. Fanaroff, T. Legesse, K. Geisinger
Abstract The diagnosis and staging of lung malignancies increasingly rely on the use of cytologic sampling techniques, particularly endobronchial ultrasound-guided transbronchial needle aspiration. Endobronchial ultrasound-guided transbronchial needle aspiration is minimally invasive and cost-effective and, most significantly, has been shown to be equivalent to conventional sampling methods. As the role of endobronchial ultrasound-guided transbronchial needle aspiration and other cytologic sampling methods, including transthoracic fine-needle aspiration and bronchoalveolar lavage, expands, diagnostic dilemmas arise that may pose a challenge to the cytopathologist. This review discusses 3 cases that illustrate 3 differential diagnoses, with an emphasis on distinguishing lung carcinoma from benign entities.
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