Basic and applied pathology最新文献

We report a case of IgG4-related inflammatory pseudotumor of lung, which coexisted with autoimmune pancreatitis. A 65-year-old man was admitted with left lung mass and left upper abdominal pain. A biopsy was performed for the lung mass under suspicion of malignancy. Microscopic examination demonstrated the proliferation of spindle cells, fibrosis and heavy infiltration of plasma cells, which were strongly immunoreactive for IgG4. Diffusely enlarged pancreas in abdominal computed tomography scan and elevated serum IgG4 level suggested the patient also had an autoimmune pancreatitis. We concluded this patient had the pulmonary inflammatory pseudotumor, as well as the autoimmune pancreatitis. These features were manifestations of the so-called IgG4-related sclerosing disease, which is a recently proposed clinicopathological entity, characterized by extensive IgG4-positive plasma cell infiltration and sclerosing inflammation in various organs.

Secretory carcinomas of the endometrium are uncommon tumors representing only 1–2% of endometrial carcinomas and have received very little attention in the literature. These are usually grade 1 tumors architecturally and cytologically. We report a case of secretory carcinoma endometrium in a 42-year-old woman presenting with irregular vaginal bleeding and underwent a hysterectomy revealing secretory carcinoma endometrium. The histological features of secretory carcinoma are reminiscent of normal early secretory endometrium (17–22 days), displaying a well differentiated glandular pattern having columnar cells with subnuclear or supranuclear vacuolization containing clear glycogenated cytoplasm. It is extremely important to distinguish secretory carcinoma from clear cell carcinoma in view of the excellent prognosis of the former and the unfavorable prognosis of the latter.

Gangliocytic paraganglioma (GP) is a rare tumor, which occurs nearly exclusively in the second portion of the duodenum. Generally, this tumor has a benign clinical course, although rarely, it may recur or metastasize to regional lymph nodes. We present a case of duodenal GP treated first by local resection followed by pancreaticoduodenectomy. Frozen section examination of the first specimen was diagnosed as low grade mesenchymal tumor. Formalin fixed paraffin section histology revealed composite tumor composed of three characteristic histologic components: epithelioid, ganglion, and spindle cell. Immunohistochemistry tumor cells were positive for neuron specific enolase, synaptophysin, chromgranin, S100, and neurofilament protein. Cytokeratin and bcl-2 were focally positive. Single mitotic figure was noted. Ki67 labeling index was < 3–4%. In the subsequent pancreaticoduodenectomy specimen, there was no residual tumor in the periampullary area. We discuss the differential diagnosis and review the current published literature on GP.

Lymphangioleiomyoma (LAM) is a rare benign tumor characterized by a disorganized smooth muscle cell proliferation within the walls of pulmonary, mediastinal, and retroperitoneal lymphatic vessels. The mesenteric LAM is a quite unusual presentation. A 47-year-old woman was admitted to our hospital with a 7-year history of abdominal mass. A computed tomography showed a well marginated mass with soft tissue attenuation. Laparoscopic excision was performed. The specimen revealed a well circumscribed dark cystic mass. The cut surface showed a thin walled cystic tumor with haphazardly distributed trabeculated septa. Microscopically, the tumor showed variable sized ectatic spaces lined by flattened endothelial cells and surrounded by epithelioid or spindle-shaped cells. The lining cells were positive for D2-40, CD31, and CD34. The surrounding cells were positive for alpha-smooth muscle actin and human melanoma black-45. The final diagnosis was a solitary LAM arising in the mesentery. The patient showed an uneventful postoperative course for 10 months.

Angiomyolipoma (AML) in the oral cavity is extremely rare. Their histological features are characterized by admixtures of blood vessels, smooth muscles and mature adipose tissues. We report a case of sporadic AML in the lower lip of a 56-year-old man. Clinically, it presented as a mucocele-like lesion. An excised specimen showed a well-circumscribed, 1.3 cm × 1.0 cm × 0.8 cm-sized, yellowish mass, composed of blood vessels, smooth muscles and mature adipose tissues. These were not epithelioid cells and immunohistochemical stain for human melanoma black (HMB)-45 was negative. Extrarenal AML usually is not associated with tuberous sclerosis and has no HMB-45 immunoreactive cells although it shares the terminology with renal AML. It is regarded as benign. Surgical excision is considered curative.

Background and aim: Various immunohistochemical stains are used in pathological diagnosis, but the present method of reading the results is somewhat subjective and has the likelihood of error. We tried immunohistochemical analysis with semiquantitative assays to improve the objectivity in the reading. Methods: We used 44 cases of invasive lobular carcinoma (ILC) and 79 cases of invasive ductal carcinoma (IDC). We read the immunohistochemical stains using a semiquantitative manual counting method (IMT i-Solution, ver. 7.5). The immunohistochemical results of estrogen receptor (ER), progesterone receptor (PR), p53 and Ki-67 labeling index were correlated with the tumor grade, tumor size and metastasis. Results: ER, PR and p53 had statistically significant correlation with the tumor grade for IDC. The Ki-67 labeling index had positive correlation with the tumor grade and tumor size for IDC. The ILC showed no such relations, except for the relationship between the Ki-67 labeling index and the nuclear grade. Conclusions: The results of the correlations were similar to the previous studies which had been using the subjective reading method. We think that the semiquantitative reading method is reliable, can overcome the possibility of subjective interpretation errors and allows a numerical report system.