Gabriel Acosta-Gonzalez, M. Cho, R. Rogers, F. Mariz, Leon Pachter, A. G. Neto
Purpose: To describe a case of histologically and immunohistochemically confirmed primary hepatic solitary fibrous tumor (SFT) associated with pregnancy. Case Report: A 40-year-old Caucasian woman G3P1021 with history of oral contraceptive use and no other known significant past medical history delivered via C-section in November of 2012. Two months post delivery, she noted that her abdomen did not decrease in size and sought medical attention. As part of the work-up, an abdominal MRI revealed a 15.9 cm mass centered in segment 4b of the liver with extension into segments 5 and 8 within the right lobe. In addition, an exophytic component extending inferiorly from the liver into the right mid abdomen was noted. The patient underwent an uncomplicated hepatic segmentectomy with cholecystectomy. Grossly, the tumor consisted of a firm tan-white well-circumscribed and partially encapsulated mass. Histologically, the tumor was composed of cytologically bland spindle cells with a patternless architecture with hypocellular and hypercellular areas embedded within a collagenous fibrous stroma with occasional dilated branching thin-walled blood vessels. The tumor showed no infiltrative margins or necrosis and a mitotic count of 1/10HPF. Tumor cells were strongly and diffusely positive for CD34, BCL-2, and vimentin; weakly positive for STAT6 (nuclear distribution); and focally positive for CD99 and β-Catenin. In addition, estrogen and progesterone receptors (ER and PR) were also performed and showed positive staining. The diagnosis of SFT was confirmed. To date, 36 months post-resection, our patient has been followed with imaging, showing no evidence of residual or recurrent disease. Conclusions: Primary hepatic SFT is exceedingly rare and even more so in association with pregnancy. Positive immunohistochemical staining of tumor cells for progesterone and estrogen receptors may indicate hormonal stimulation as a driver of neoplastic cell proliferation.
{"title":"A rare case of primary hepatic solitary fibrous tumor associated with pregnancy","authors":"Gabriel Acosta-Gonzalez, M. Cho, R. Rogers, F. Mariz, Leon Pachter, A. G. Neto","doi":"10.5430/CRCP.V3N3P66","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P66","url":null,"abstract":"Purpose: To describe a case of histologically and immunohistochemically confirmed primary hepatic solitary fibrous tumor (SFT) associated with pregnancy. Case Report: A 40-year-old Caucasian woman G3P1021 with history of oral contraceptive use and no other known significant past medical history delivered via C-section in November of 2012. Two months post delivery, she noted that her abdomen did not decrease in size and sought medical attention. As part of the work-up, an abdominal MRI revealed a 15.9 cm mass centered in segment 4b of the liver with extension into segments 5 and 8 within the right lobe. In addition, an exophytic component extending inferiorly from the liver into the right mid abdomen was noted. The patient underwent an uncomplicated hepatic segmentectomy with cholecystectomy. Grossly, the tumor consisted of a firm tan-white well-circumscribed and partially encapsulated mass. Histologically, the tumor was composed of cytologically bland spindle cells with a patternless architecture with hypocellular and hypercellular areas embedded within a collagenous fibrous stroma with occasional dilated branching thin-walled blood vessels. The tumor showed no infiltrative margins or necrosis and a mitotic count of 1/10HPF. Tumor cells were strongly and diffusely positive for CD34, BCL-2, and vimentin; weakly positive for STAT6 (nuclear distribution); and focally positive for CD99 and β-Catenin. In addition, estrogen and progesterone receptors (ER and PR) were also performed and showed positive staining. The diagnosis of SFT was confirmed. To date, 36 months post-resection, our patient has been followed with imaging, showing no evidence of residual or recurrent disease. Conclusions: Primary hepatic SFT is exceedingly rare and even more so in association with pregnancy. Positive immunohistochemical staining of tumor cells for progesterone and estrogen receptors may indicate hormonal stimulation as a driver of neoplastic cell proliferation.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"66"},"PeriodicalIF":0.0,"publicationDate":"2016-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P66","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71209584","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}
Limei Xu, Juan Li, Z. Ye, Xiao-yan Wang, He-hua Wang, Haihe Wang, X. Tong
IgG4-related disease (IgG4-RD) is an immune-mediated disorder hallmarked with lymphoplasmacytic tissues infiltrated with abundant IgG4-positive plasma cells, which has various clinical features and easily to be misdiagnosed. Here, we described a case with symptoms of body weight loss and multiple lymph node enlargements in a patient’s groin, axilla, mediastinum, and retroperitoneum at the first admission. Both F-fluorodeoxyglucose (FDG)-position emission tomography (PET) and lymph node biopsies supported the possible diagnosis of this case as a T-cell lymphoma, but no TCR gene rearrangement observed. Further examinations showed that serum IgG4 level of the patient was elevated and large amount of IgG4+ plasmocyte infiltration was detected in the involved lymph nodes, indicating this case as a possible IgG4-RD. However, the possibility of this disease as a T-cell lymphoma still could not be excluded. Tentatively, the patient was first treated as IgG4-RD with oral prednisone combined with methotrexate to avoid the unnecessary side effect of chemotherapy and economy burden. After three weeks treatment, the serum IgG4 level of the patient is evidently decreased and the enlarged lymph nodes disappeared as well. Eventually, we characterized this case as an atypical IgG4-related lymphadenopathy with 20 months’ follow-up.
{"title":"A case of IgG4-related disease seemingly presenting as a T-cell lymphoma","authors":"Limei Xu, Juan Li, Z. Ye, Xiao-yan Wang, He-hua Wang, Haihe Wang, X. Tong","doi":"10.5430/CRCP.V3N3P60","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P60","url":null,"abstract":"IgG4-related disease (IgG4-RD) is an immune-mediated disorder hallmarked with lymphoplasmacytic tissues infiltrated with abundant IgG4-positive plasma cells, which has various clinical features and easily to be misdiagnosed. Here, we described a case with symptoms of body weight loss and multiple lymph node enlargements in a patient’s groin, axilla, mediastinum, and retroperitoneum at the first admission. Both F-fluorodeoxyglucose (FDG)-position emission tomography (PET) and lymph node biopsies supported the possible diagnosis of this case as a T-cell lymphoma, but no TCR gene rearrangement observed. Further examinations showed that serum IgG4 level of the patient was elevated and large amount of IgG4+ plasmocyte infiltration was detected in the involved lymph nodes, indicating this case as a possible IgG4-RD. However, the possibility of this disease as a T-cell lymphoma still could not be excluded. Tentatively, the patient was first treated as IgG4-RD with oral prednisone combined with methotrexate to avoid the unnecessary side effect of chemotherapy and economy burden. After three weeks treatment, the serum IgG4 level of the patient is evidently decreased and the enlarged lymph nodes disappeared as well. Eventually, we characterized this case as an atypical IgG4-related lymphadenopathy with 20 months’ follow-up.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2016-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P60","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71209464","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}
Iwayemi Olayeye, Tulani Washington-Plaskett, Chisom J. Mbonu, Kimberly Point du Jour, Nicolas Bakinde
Metastasis to the adrenal gland has been observed in several malignancies; however, adrenal insufficiency as the presenting sign seems rare in these patients. This is a case of a patient presenting with nausea, vomiting, generalized fatigue, and hyponatremia. CT scan demonstrated left upper lobe opacity and bilateral adrenal masses. A biopsy of the adrenal gland revealed non-small cell lung cancer (NSCLC) with metastatic involvement of the adrenal glands. The non-specific symptoms and relative adrenal insufficiency in patients with lung masses should heighten the suspicion for metastatic involvement of the adrenals.
{"title":"Adrenal insufficiency: An uncommon presentation of non-small cell lung cancer","authors":"Iwayemi Olayeye, Tulani Washington-Plaskett, Chisom J. Mbonu, Kimberly Point du Jour, Nicolas Bakinde","doi":"10.5430/CRCP.V3N3P56","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P56","url":null,"abstract":"Metastasis to the adrenal gland has been observed in several malignancies; however, adrenal insufficiency as the presenting sign seems rare in these patients. This is a case of a patient presenting with nausea, vomiting, generalized fatigue, and hyponatremia. CT scan demonstrated left upper lobe opacity and bilateral adrenal masses. A biopsy of the adrenal gland revealed non-small cell lung cancer (NSCLC) with metastatic involvement of the adrenal glands. The non-specific symptoms and relative adrenal insufficiency in patients with lung masses should heighten the suspicion for metastatic involvement of the adrenals.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"56"},"PeriodicalIF":0.0,"publicationDate":"2016-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P56","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71209694","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}
Desmoplastic squamous cell carcinoma (SCC) and spindle cell SCC is very rare in skin. An 86-year-old woman presented a skin tumor of face. The tumor measured 1.8 cm × 1.6 cm × 0.6 cm. An excisional biopsy was performed. Histologically, malignant spindle cells with hyperchromatic nuclei and nucleoli were seen to proliferate together with marked solar elastosis and desmoplasia. Mitotic figures were scattered. Immunohistochemically, the malignant cells were positive for pancytokeratin AE1/3, pancytokeratin WSS, cytokeratin (CK) 5/6, CK34BE12, CK14, vimentin, S100 protein, α-smooth muscle actin, p53, p63, and Ki-67 (labeling = 70%). They were negative for EMA, pancytokeratin CAM5.2, CK7, CK8, CK18, CK19, CK20, desmin, HMB45, Melan-A, SOX10, MITF, myoglobin, CEA, CA19-9 and CD34. The lesion recurred two times and showed neck lymph node metastasis during the following 2 years. The patient died of other diseases 3 years after the first presentation.
结缔组织增生鳞状细胞癌(SCC)和梭形细胞SCC在皮肤中非常罕见。86岁女性，面部皮肤肿瘤。肿瘤大小为1.8 cm × 1.6 cm × 0.6 cm。行切除活检。组织学上可见细胞核和核仁深染的恶性梭形细胞增生，并伴有明显的太阳弹性增生和结缔组织增生。有丝分裂象分散。免疫组化结果显示，恶性细胞中泛细胞角蛋白AE1/3、泛细胞角蛋白WSS、细胞角蛋白(CK) 5/6、CK34BE12、CK14、vimentin、S100蛋白、α-平滑肌肌动蛋白、p53、p63、Ki-67阳性(标记率为70%)。EMA、全细胞角蛋白CAM5.2、CK7、CK8、CK18、CK19、CK20、desmin、HMB45、Melan-A、SOX10、MITF、肌红蛋白、CEA、CA19-9和CD34均阴性。病变复发2次，2年内出现颈部淋巴结转移。患者首次发病3年后死于其他疾病。
{"title":"Desmoplastic spindle cell squamous cell carcinoma of skin","authors":"T. Terada","doi":"10.5430/CRCP.V3N3P52","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P52","url":null,"abstract":"Desmoplastic squamous cell carcinoma (SCC) and spindle cell SCC is very rare in skin. An 86-year-old woman presented a skin tumor of face. The tumor measured 1.8 cm × 1.6 cm × 0.6 cm. An excisional biopsy was performed. Histologically, malignant spindle cells with hyperchromatic nuclei and nucleoli were seen to proliferate together with marked solar elastosis and desmoplasia. Mitotic figures were scattered. Immunohistochemically, the malignant cells were positive for pancytokeratin AE1/3, pancytokeratin WSS, cytokeratin (CK) 5/6, CK34BE12, CK14, vimentin, S100 protein, α-smooth muscle actin, p53, p63, and Ki-67 (labeling = 70%). They were negative for EMA, pancytokeratin CAM5.2, CK7, CK8, CK18, CK19, CK20, desmin, HMB45, Melan-A, SOX10, MITF, myoglobin, CEA, CA19-9 and CD34. The lesion recurred two times and showed neck lymph node metastasis during the following 2 years. The patient died of other diseases 3 years after the first presentation.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"52"},"PeriodicalIF":0.0,"publicationDate":"2016-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P52","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71209644","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}
Herein reported is the first case of epithelial/myoepithelial carcinoma (EMC) of breast. An 83-year-old woman noticed a circa 1.0 cm tumor of left breast. Core needle biopsies were diagnosed as invasive ductal carcinoma. Mastectomy with axillary lymph node dissection was performed, and gross examination revealed a circa 1 cm × 1 cm tumor. Microscopically, the tumor was composed of invasive malignant cells forming tubular or cords structures with a scirrhous collagenous stroma. The malignant cells were composed by the following two elements; one was malignant epithelial cells and the other was malignant myoepithelial cells with clear or vacuolated cytoplasm. Immunohistochemically, the myoepithelial element was positive for p63, CD10, cytokeratin (CK) 34BE12, and CK5/6, S100 protein and alpha-smooth muscle actin. Both elements were positive for CK7, p53, and Ki67 (labeling: 16%), estrogen receptor, progesterone receptor. Both elements were negative for CK20 and HER2/neu. The sentinel and level 1 lymph node were negative for metastasis (0/6). The tumor was pT1pN0cM0 and the stage was stage 1. The patient had booster hormone therapy and is now alive 14 months without recurrence after the operation.
{"title":"Epithelial/myoepithelial carcinoma of breast: A report of hitherto unreported case","authors":"T. Terada","doi":"10.5430/CRCP.V3N4P15","DOIUrl":"https://doi.org/10.5430/CRCP.V3N4P15","url":null,"abstract":"Herein reported is the first case of epithelial/myoepithelial carcinoma (EMC) of breast. An 83-year-old woman noticed a circa 1.0 cm tumor of left breast. Core needle biopsies were diagnosed as invasive ductal carcinoma. Mastectomy with axillary lymph node dissection was performed, and gross examination revealed a circa 1 cm × 1 cm tumor. Microscopically, the tumor was composed of invasive malignant cells forming tubular or cords structures with a scirrhous collagenous stroma. The malignant cells were composed by the following two elements; one was malignant epithelial cells and the other was malignant myoepithelial cells with clear or vacuolated cytoplasm. Immunohistochemically, the myoepithelial element was positive for p63, CD10, cytokeratin (CK) 34BE12, and CK5/6, S100 protein and alpha-smooth muscle actin. Both elements were positive for CK7, p53, and Ki67 (labeling: 16%), estrogen receptor, progesterone receptor. Both elements were negative for CK20 and HER2/neu. The sentinel and level 1 lymph node were negative for metastasis (0/6). The tumor was pT1pN0cM0 and the stage was stage 1. The patient had booster hormone therapy and is now alive 14 months without recurrence after the operation.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2016-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N4P15","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71210005","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}
Herein reported is the rare case of serous surface papillary cystadenoma (SSPC) of fallopian tube who presented with signs and symptoms of ectopic pregnancy. A 31-year-old woman presented with abdominal pain and elevation of serum human chorionic gonadotropin (hCG) (2,530 IU/L). Pelvic ultrasound examination suggested a rupture of right tubal pregnancy. Emergency laparotomy was performed, and right fallopian tube was resected. Pathologically, the fallopian tube was totally replaced by SSPC, but no evidence for pregnancy (chorionic villi, fetus, decidua, amnion, and cord) was seen. The SSPC was unilocular, and was surrounded by multiple papillary proliferations of serous cells with fibro-vascular cores, which were recognized both in the surface areas and in the intracystic inner aspects. The tumor cells of the SSPC were negative for hCG. After operation hCG returned to the normal range, and the patient was recovered with no complications. A rare case of SSPC of fallopian tube with pseudo-manifestations of ectopic pregnancy is reported. The raised serum hCG and its return to the normal ranges after the tube resection are completely unclear and enigma.
{"title":"Serous surface papillary cystadenoma of fallopian tube clinically presenting with ectopic pregnancy","authors":"T. Terada","doi":"10.5430/CRCP.V3N3P48","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P48","url":null,"abstract":"Herein reported is the rare case of serous surface papillary cystadenoma (SSPC) of fallopian tube who presented with signs and symptoms of ectopic pregnancy. A 31-year-old woman presented with abdominal pain and elevation of serum human chorionic gonadotropin (hCG) (2,530 IU/L). Pelvic ultrasound examination suggested a rupture of right tubal pregnancy. Emergency laparotomy was performed, and right fallopian tube was resected. Pathologically, the fallopian tube was totally replaced by SSPC, but no evidence for pregnancy (chorionic villi, fetus, decidua, amnion, and cord) was seen. The SSPC was unilocular, and was surrounded by multiple papillary proliferations of serous cells with fibro-vascular cores, which were recognized both in the surface areas and in the intracystic inner aspects. The tumor cells of the SSPC were negative for hCG. After operation hCG returned to the normal range, and the patient was recovered with no complications. A rare case of SSPC of fallopian tube with pseudo-manifestations of ectopic pregnancy is reported. The raised serum hCG and its return to the normal ranges after the tube resection are completely unclear and enigma.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2016-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P48","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71208965","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}
M. Bartoli, G. Baiocchi, A. Celotti, N. Portolani, S. Giulini
Purpose: The purpose of this article is to propose an effective approach for giant abdominal wall defects repair in a contaminated field, using a combination of porcine dermal collagen graft (Permacol) and omental interpositional flap. Case: We report a case of a 41-year-old woman submitted to emergency laparotomy, splenectomy and hepatic haemostasis for massive hemoperitoneum. She developed enteric fistula, cutaneous, muscolar and fascial necrosis leading to evisceration. At the fourth intervention we finally reconstructed abdominal wall defect using a combination of Parmacol and omental flap. Conclusion: The reconstruction of large, full-thickness, eventually contaminated abdominal wall defects is often a challenging undertaking. Similar difficulties are usually encountered with early abdominal wall closure after damage-control surgery and/or open-abdomen management. In these situations the use of synthetic mesh is contrindicated; adsorbable mesh can be used as temporary solution and some techniques of autologous tissue repair have been suggested. Therefore no ideal operative repair technique or prosthetic material for reconstruction of the fascial defect is currently available in the literature. Recently, the development of biologic meshes has shown successful rates in the management of these parietal wall defects. Also in this patient, porcine dermal collagen mesh combined with omental flap allowed us to reconstruct large abdominal wall defect.
{"title":"Complex abdominal wall repair using a combination of porcine dermal matrix and omentum flap in patient with digestive tract fistula: report of a case and review of the literature","authors":"M. Bartoli, G. Baiocchi, A. Celotti, N. Portolani, S. Giulini","doi":"10.5430/CRCP.V3N3P42","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P42","url":null,"abstract":"Purpose: The purpose of this article is to propose an effective approach for giant abdominal wall defects repair in a contaminated field, using a combination of porcine dermal collagen graft (Permacol) and omental interpositional flap. Case: We report a case of a 41-year-old woman submitted to emergency laparotomy, splenectomy and hepatic haemostasis for massive hemoperitoneum. She developed enteric fistula, cutaneous, muscolar and fascial necrosis leading to evisceration. At the fourth intervention we finally reconstructed abdominal wall defect using a combination of Parmacol and omental flap. Conclusion: The reconstruction of large, full-thickness, eventually contaminated abdominal wall defects is often a challenging undertaking. Similar difficulties are usually encountered with early abdominal wall closure after damage-control surgery and/or open-abdomen management. In these situations the use of synthetic mesh is contrindicated; adsorbable mesh can be used as temporary solution and some techniques of autologous tissue repair have been suggested. Therefore no ideal operative repair technique or prosthetic material for reconstruction of the fascial defect is currently available in the literature. Recently, the development of biologic meshes has shown successful rates in the management of these parietal wall defects. Also in this patient, porcine dermal collagen mesh combined with omental flap allowed us to reconstruct large abdominal wall defect.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2016-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P42","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71208913","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}
Primary cutaneous lymphoplasmacytic lymphoma (LPL) is rare. The author herein reports a case of LPL-like B-cell neoplasm with acute inflammation and epidermal cell atypia. A 69-year-old man presented skin ulcer of neck. The lesion appeared granulation tissue with surface fibrin deposition; an inflammatory process was suggested. Peripheral blood data showed no abnormalities, including the segments of leukocytes. No plasmacytosis was seen. No M-proteins, macroglubulins, or cryoglobulins were noted in serum and urine. The clinical diagnosis was non-specific skin ulcer. A wide biopsy was taken. It showed a destructive proliferation of atypical small lymphocytes, atypical plasmacytoid lymphocytes, and atypical plasma cells in dermis and subcutaneous tissue. The biopsy also showed acute inflammatory features; foci of many neutrophils were scattered in neoplastic cells. Some of them showed microabscesses. In addition, foci of atypical squamous cells were seen in the epidermis. Immunohsitochemically, the tumor cell showed B-cell lineage. The tumor cells were diffusely positive for vimentin, CD45, CD20, CD79, bcl-2, CD38, and CD138. The tumor cells were only focally positive for CD3 and CD45RO. A few tumor cells were positive for CD30, CD56, and CD10. Some of the tumor cells were positive for p53 and Ki-67 antigen (labeling index = 35%). The tumor cells were negative for pancytokeratin AE1/3, pancytokeratin CAM5.2, CD5, CD23, CD43, and cyclinD1. The tumor cells were positive for κ-chain but negative for λ-chain, indicating that the tumor cells have plasmacytic characteristics and that there was a light chain restriction which indicates monoclonal nature of the tumor plasma cells. The tumor cells were negative for Epstein-Barr virus (EBV) associated molecules such as EBV latent membrane protein-1 (LMP-1) and EBV early RNAs (EBER). A pathological diagnosis made by the author was cutaneous LPL-like B-cell malignant tumor. The author thought that this tumor could not be definitely diagnosed a primary cutaneous LPL, because other small-sized B-cell lymphomas with plasmacytoid differentiaton could not be excluded. The current tumor was also characterized by acute inflammatory features and epidermal squamous cell atypia suggestive of squamous cell carcinoma. Imaging modalities including CT identified no other tumors and lymphoadenopathy in the body. The systemic bones were free of myeloma features. No bone marrow study was performed after the pathological diagnosis. The tumor cured and the patient discharged from the hospital 3 months after the first presentation.
{"title":"Primary cutaneous lymphoplasmacytic lymphoma-like B-cell neoplasm with features of acute inflammation and epidermal atypical cells","authors":"T. Terada","doi":"10.5430/CRCP.V3N3P31","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P31","url":null,"abstract":"Primary cutaneous lymphoplasmacytic lymphoma (LPL) is rare. The author herein reports a case of LPL-like B-cell neoplasm with acute inflammation and epidermal cell atypia. A 69-year-old man presented skin ulcer of neck. The lesion appeared granulation tissue with surface fibrin deposition; an inflammatory process was suggested. Peripheral blood data showed no abnormalities, including the segments of leukocytes. No plasmacytosis was seen. No M-proteins, macroglubulins, or cryoglobulins were noted in serum and urine. The clinical diagnosis was non-specific skin ulcer. A wide biopsy was taken. It showed a destructive proliferation of atypical small lymphocytes, atypical plasmacytoid lymphocytes, and atypical plasma cells in dermis and subcutaneous tissue. The biopsy also showed acute inflammatory features; foci of many neutrophils were scattered in neoplastic cells. Some of them showed microabscesses. In addition, foci of atypical squamous cells were seen in the epidermis. Immunohsitochemically, the tumor cell showed B-cell lineage. The tumor cells were diffusely positive for vimentin, CD45, CD20, CD79, bcl-2, CD38, and CD138. The tumor cells were only focally positive for CD3 and CD45RO. A few tumor cells were positive for CD30, CD56, and CD10. Some of the tumor cells were positive for p53 and Ki-67 antigen (labeling index = 35%). The tumor cells were negative for pancytokeratin AE1/3, pancytokeratin CAM5.2, CD5, CD23, CD43, and cyclinD1. The tumor cells were positive for κ-chain but negative for λ-chain, indicating that the tumor cells have plasmacytic characteristics and that there was a light chain restriction which indicates monoclonal nature of the tumor plasma cells. The tumor cells were negative for Epstein-Barr virus (EBV) associated molecules such as EBV latent membrane protein-1 (LMP-1) and EBV early RNAs (EBER). A pathological diagnosis made by the author was cutaneous LPL-like B-cell malignant tumor. The author thought that this tumor could not be definitely diagnosed a primary cutaneous LPL, because other small-sized B-cell lymphomas with plasmacytoid differentiaton could not be excluded. The current tumor was also characterized by acute inflammatory features and epidermal squamous cell atypia suggestive of squamous cell carcinoma. Imaging modalities including CT identified no other tumors and lymphoadenopathy in the body. The systemic bones were free of myeloma features. No bone marrow study was performed after the pathological diagnosis. The tumor cured and the patient discharged from the hospital 3 months after the first presentation.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2016-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P31","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71209230","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}
Primary extra-nodal NK-cell lymphoma of skin is extremely rare. A 55-year-old man presented with an elevated plaque of trunk. The dermatologists’ diagnosis was sporotrycosis and a biopsy was taken, which showed diffuse dense infiltrations of medium-sized and large atypical malignant lymphocytes. Epidermal hyperplasia and erosions were also seen. Immunohistochemically, the atypical lymphocytes were positive for CD45, CD56, CD57, p53 and Ki-67 (labeling index = 82%). They were negative for CD20, CD79, CD10, bcl-2, κ-light chain, λ-light chain, CD3, CD4, CD5, CD21, CD23, CD38, CD43, CD68, CD138, CD15, CD30, TdT, and cyclin D1. EBER was positive. The pathological diagnosis was primary cutaneous NK-cell lymphoma, nasal type. The post-biopsy blood test identified no leukemia findings. Post-biopsy imaginings revealed no mass and lymphadenopathy in the body. The skin lesions of the patient almost improved (complete remission) by chemotherapy (CHOP) followed by local radiation, and the patient is now followed up.
{"title":"Primary cutaneous extra-nodal NK-cell lymphoma, nasal type","authors":"T. Terada","doi":"10.5430/crcp.v3n3p38","DOIUrl":"https://doi.org/10.5430/crcp.v3n3p38","url":null,"abstract":"Primary extra-nodal NK-cell lymphoma of skin is extremely rare. A 55-year-old man presented with an elevated plaque of trunk. The dermatologists’ diagnosis was sporotrycosis and a biopsy was taken, which showed diffuse dense infiltrations of medium-sized and large atypical malignant lymphocytes. Epidermal hyperplasia and erosions were also seen. Immunohistochemically, the atypical lymphocytes were positive for CD45, CD56, CD57, p53 and Ki-67 (labeling index = 82%). They were negative for CD20, CD79, CD10, bcl-2, κ-light chain, λ-light chain, CD3, CD4, CD5, CD21, CD23, CD38, CD43, CD68, CD138, CD15, CD30, TdT, and cyclin D1. EBER was positive. The pathological diagnosis was primary cutaneous NK-cell lymphoma, nasal type. The post-biopsy blood test identified no leukemia findings. Post-biopsy imaginings revealed no mass and lymphadenopathy in the body. The skin lesions of the patient almost improved (complete remission) by chemotherapy (CHOP) followed by local radiation, and the patient is now followed up.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2016-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/crcp.v3n3p38","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71209286","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}
L. Strazzulla, Nina Schatz-Siemers, Ioannis S. Hatzaras
In this case we report a 54-year-old man presenting with a large fungating mass that had been identified as a pilomatrixoma on a biopsy from an outside hospital. Based on the atypical clinical and radiographic findings we were concerned that the lesion may have aggressive features and decided to perform a wide local excision with 2 centimeter margins to manage this patient’s risk of recurrence. On surgical pathology, the lesion did have characteristics that were concerning for progression to a pilomatrix carcinoma, however, a definitive invasive component was not identified. This case emphasizes the preferred management in pilomatrixoma with atypical features is a wide local excision.
{"title":"Management of a pilomatrixoma with atypical features","authors":"L. Strazzulla, Nina Schatz-Siemers, Ioannis S. Hatzaras","doi":"10.5430/CRCP.V3N3P28","DOIUrl":"https://doi.org/10.5430/CRCP.V3N3P28","url":null,"abstract":"In this case we report a 54-year-old man presenting with a large fungating mass that had been identified as a pilomatrixoma on a biopsy from an outside hospital. Based on the atypical clinical and radiographic findings we were concerned that the lesion may have aggressive features and decided to perform a wide local excision with 2 centimeter margins to manage this patient’s risk of recurrence. On surgical pathology, the lesion did have characteristics that were concerning for progression to a pilomatrix carcinoma, however, a definitive invasive component was not identified. This case emphasizes the preferred management in pilomatrixoma with atypical features is a wide local excision.","PeriodicalId":90463,"journal":{"name":"Case reports in clinical pathology","volume":"3 1","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRCP.V3N3P28","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71209039","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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