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PATHOLOGY (97 journals)

Showing 1 - 97 of 97 Journals sorted alphabetically
Academic Pathology     Open Access   (Followers: 5)
Acta Neuropathologica Communications     Open Access   (Followers: 2)
Advances in Anatomic Pathology     Hybrid Journal   (Followers: 21)
Advances in Molecular Pathology     Hybrid Journal   (Followers: 1)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
American Journal of Clinical Pathology     Full-text available via subscription   (Followers: 28)
American Journal of Dermatopathology     Hybrid Journal   (Followers: 17)
American Journal of Forensic Medicine and Pathology     Hybrid Journal   (Followers: 28)
American Journal of Pathology     Hybrid Journal   (Followers: 32)
American Journal of Surgical Pathology     Hybrid Journal   (Followers: 37)
Analytical Cellular Pathology     Open Access   (Followers: 3)
Annals of Diagnostic Pathology     Hybrid Journal   (Followers: 15)
Annals of Oral & Maxillofacial Surgery     Open Access   (Followers: 6)
Annals of Tropical Pathology     Open Access  
Annual Review of Pathology Mechanisms of Disease     Full-text available via subscription   (Followers: 7)
Archives of Pathology & Laboratory Medicine     Full-text available via subscription   (Followers: 30)
Assessment and Treatment of Child Psychopathology and Developmental Disabilities     Full-text available via subscription   (Followers: 4)
Basic and Applied Pathology     Open Access   (Followers: 3)
BMC Clinical Pathology     Open Access   (Followers: 8)
Brain Pathology     Hybrid Journal   (Followers: 5)
Brain Tumor Pathology     Hybrid Journal   (Followers: 6)
Bulletin de la Société de pathologie exotique     Hybrid Journal   (Followers: 1)
Cancer Cytopathology     Partially Free   (Followers: 22)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Case Reports in Pathology     Open Access   (Followers: 7)
Clinical Neuropathology     Full-text available via subscription   (Followers: 1)
Clinical Pathology     Open Access   (Followers: 3)
Comparative Clinical Pathology     Hybrid Journal   (Followers: 3)
Critical Values     Full-text available via subscription  
Cytopathology     Hybrid Journal   (Followers: 12)
Der Pathologe     Hybrid Journal   (Followers: 1)
Dermatopathology     Open Access   (Followers: 3)
Diagnostic Cytopathology     Hybrid Journal   (Followers: 13)
Diagnostic Histopathology     Full-text available via subscription   (Followers: 14)
Diagnostic Pathology     Open Access   (Followers: 13)
Egyptian Journal of Pathology     Partially Free   (Followers: 1)
Endocrine Pathology     Hybrid Journal   (Followers: 4)
Experimental and Molecular Pathology     Hybrid Journal   (Followers: 5)
Experimental and Toxicologic Pathology     Hybrid Journal   (Followers: 10)
Fetal and Pediatric Pathology     Hybrid Journal   (Followers: 4)
Folia Neuropathologica     Open Access  
Forensic Science, Medicine, and Pathology     Hybrid Journal   (Followers: 34)
Frontiers in Pathology and Genetics     Open Access   (Followers: 3)
Head and Neck Pathology     Hybrid Journal   (Followers: 7)
Hepatoma Research     Open Access   (Followers: 2)
Histopathology     Hybrid Journal   (Followers: 26)
Human Pathology     Hybrid Journal   (Followers: 30)
Indian Journal of Pathology and Microbiology     Open Access   (Followers: 3)
Inflammation and Cell Signaling     Open Access   (Followers: 3)
International Journal of Clinical and Experimental Pathology     Open Access   (Followers: 2)
International Journal of Experimental Pathology     Hybrid Journal   (Followers: 1)
International Journal of Gynecological Pathology     Hybrid Journal   (Followers: 9)
International Journal of Ophthalmic Pathology     Hybrid Journal   (Followers: 2)
International Journal of Oral & Maxillofacial Pathology     Open Access   (Followers: 8)
International Journal of Surgical Pathology     Hybrid Journal   (Followers: 9)
Iranian Journal of Pathology     Open Access  
Journal of Clinical & Experimental Pathology     Open Access   (Followers: 3)
Journal of Clinical Pathology     Hybrid Journal   (Followers: 13)
Journal of Clinical Pathology and Forensic Medicine     Open Access   (Followers: 9)
Journal of Comorbidity     Open Access  
Journal of Comparative Pathology     Hybrid Journal   (Followers: 5)
Journal of Cutaneous Pathology     Hybrid Journal   (Followers: 11)
Journal of Depression and Anxiety     Open Access   (Followers: 2)
Journal of Diagnostic Pathology     Open Access   (Followers: 9)
Journal of Hematopathology     Hybrid Journal   (Followers: 4)
Journal of Morphological Sciences     Open Access  
Journal of Neuropathology & Experimental Neurology     Hybrid Journal   (Followers: 1)
Journal of Oral and Maxillofacial Pathology     Open Access   (Followers: 3)
Journal of Oral Pathology & Medicine     Hybrid Journal   (Followers: 5)
Journal of Pathology     Hybrid Journal   (Followers: 13)
Journal of Pathology : Clinical Research     Open Access   (Followers: 1)
Journal of Pathology Informatics     Open Access   (Followers: 1)
Journal of Pathology of Nepal     Open Access   (Followers: 1)
Journal of Physiology and Pathophysiology     Open Access   (Followers: 1)
Modern Pathology     Hybrid Journal   (Followers: 31)
Molecular and Cellular Biomedical Sciences     Open Access   (Followers: 3)
Molecular Diagnosis & Therapy     Hybrid Journal   (Followers: 3)
Neuropathology     Hybrid Journal   (Followers: 1)
Neuropathology and Applied Neurobiology     Hybrid Journal  
Ocular Oncology and Pathology     Full-text available via subscription  
Open Journal of Pathology     Open Access   (Followers: 3)
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology     Full-text available via subscription   (Followers: 9)
Pathogenesis     Open Access  
Pathology     Hybrid Journal   (Followers: 11)
Pathology & Oncology Research     Hybrid Journal   (Followers: 4)
Pathology - Research and Practice     Hybrid Journal   (Followers: 4)
Pathology and Laboratory Medicine International     Open Access   (Followers: 6)
Pathology International     Hybrid Journal   (Followers: 2)
Pathology Research International     Open Access   (Followers: 1)
Pediatric and Developmental Pathology     Hybrid Journal   (Followers: 4)
Revista de Patologia do Tocantins     Open Access  
Revista de Senología y Patología Mamaria     Full-text available via subscription  
Seminars in Diagnostic Pathology     Hybrid Journal   (Followers: 10)
Seminars in Immunopathology     Hybrid Journal   (Followers: 3)
Surgical Pathology Clinics     Full-text available via subscription   (Followers: 9)
Ultrastructural Pathology     Hybrid Journal   (Followers: 1)
Патологія     Open Access  
Similar Journals
Journal Cover
International Journal of Surgical Pathology
Journal Prestige (SJR): 0.441
Citation Impact (citeScore): 1
Number of Followers: 9  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1066-8969 - ISSN (Online) 1940-2465
Published by Sage Publications Homepage  [1087 journals]
  • Blastic Plasmacytoid Dendritic Cell Neoplasm: An Uncommon Entity to
           Consider in the Differential Diagnosis of Cutaneous Lymphoma
    • Authors: Alessandro Pietro Aldera, Lerinza van den Worm, Michael Louis Locketz
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Cutaneous lymphomas are encountered infrequently in general surgical pathology practice, and the broad array of pathological entities poses a diagnostic challenge. Integration of clinical information, results of additional laboratory investigations, and an extensive immunohistochemical panel are essential in arriving at the correct diagnosis. We present a case of blastic plasmacytoid dendritic cell neoplasm that occurred in an unusual clinical setting. This case highlights the need for a broad differential diagnosis and an extensive immunohistochemical workup when approaching a cutaneous lymphoma.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-14T04:46:02Z
      DOI: 10.1177/1066896920906468
       
  • Primary Mammary-Like Carcinoma of the Lung: A Case Report of a Distinct
           Type of Primary Lung Carcinoma
    • Authors: Kaleigh E. Lindholm, Cesar A. Moran
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      A case of a primary lung carcinoma with histologic and immunohistochemical features of a mammary carcinoma is presented. The patient is a 72-year-old man who presented with symptoms of cough and dyspnea. Diagnostic imaging showed a bronchial tumor in the left lower lobe that was surgically resected by a left lower lobectomy. The tumor was characterized by a homogenous cellular proliferation composed of small to medium-sized cells with round nuclei and inconspicuous nucleoli. Multiple immunohistochemical stains were performed, and the tumor was notably positive for estrogen receptor, progesterone receptor, GATA3, and pan-keratin, while molecular analysis showed somatic mutation in ARID1A. Clinical follow-up showed that the patient is alive and well 18 months post-surgical resection without evidence of recurrence or metastatic disease. Based on the overall features of this neoplasm, we consider that the tumor herein presented represents an unusual type of lung carcinoma that we refer to as primary mammary-like carcinoma of the lung.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-13T06:23:55Z
      DOI: 10.1177/1066896920906473
       
  • Myxoid Spindle Cell Sarcoma With LMNA-NTRK Fusion: Expanding the
           Morphologic Spectrum of NTRK-Rearranged Tumors
    • Authors: Yik Ka So, Chit Chow, Ka Fai To, John K. C. Chan, W. Cheuk
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Neurotrophic tyrosine receptor kinase (NTRK)-rearranged spindle cell neoplasm is a recently described soft tissue tumor entity that occurs predominantly in children and young adults. The diagnosis of this tumor is difficult due to the nonspecific and highly variable morphology, yet it is of clinical relevance because of the availability of highly effective TRK inhibitors. In this article, we report the case of a 40-year-old female who presented with a mass in the left calf. Histologic examination revealed a low-grade sarcoma consisting of monomorphic spindle cells accompanied by abundant myxoid stroma, a feature that had not been emphasized in the reported cases of NTRK-rearranged tumors. The tumor cells expressed CD34 and S100 but not SOX10, and they showed positive staining for pan-TRK. Next-generation sequencing showed the presence of LMNA-NTRK1 fusion. The patient developed several episodes of lung metastases that eventually became unresectable. TRK inhibitor was given that led to near-complete resolution of the tumors.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-13T06:23:15Z
      DOI: 10.1177/1066896920905888
       
  • Sarcoid-Like Granulomatosis in a Patient With Breast Cancer Mimicking
           Refractory Metastatic Disease
    • Authors: Maria Mostyka, Jose Jessurun, Cathleen Matrai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Sarcoid-like granulomatosis is a known but rare adverse reaction to immune checkpoint inhibitors and chemotherapy in the treatment of advanced solid tumors. We present a case of a 29-year-old female with a pathologically confirmed poorly differentiated invasive ductal carcinoma of the breast with presumed metastases to the lungs, hilar lymph nodes, liver, and spleen. Despite appropriate chemotherapy, the patient developed pulmonary lesions that were interpreted on imaging studies as progression of malignancy. Autopsy revealed disseminated sarcoid-like granulomatosis with multiple noncaseating granulomata with associated fibrosis in the lungs, liver, and spleen. No residual invasive carcinoma or metastatic disease was identified. This case illustrates the difficulty in differentiating this nonneoplastic process from progressive disease in the clinical setting.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-13T06:22:15Z
      DOI: 10.1177/1066896920905887
       
  • Cystic Squamous Cell Carcinomas of the Jaws: Twelve Cases Highlighting
           Histopathological Pitfalls
    • Authors: Andrew W. Barrett, Montey Garg, Daniel Armstrong, Brian S. Bisase, Lawrence Newman, Paul M. Norris, Michael Shelley, John V. Tighe, Nicholas C. Hyde, Nicola J. Chaston, Aakshay Gulati
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Cystic squamous cell carcinomas (SCCs) of the jaws, including carcinoma cuniculatum, are rare, slow growing, and relentlessly invasive. The aim of this article is to present 12 cases, 4 of which were designated as carcinoma cuniculatum on the basis of deeply endophytic, anastomosing channels of cystic stratified squamous epithelium and keratin microabscesses. The other 8 were also cystic, but more heterogeneous morphologically and were diagnosed as well differentiated SCCs. Six patients were female, 6 were male (mean age = 74.0 years, range = 50-94 years). Six tumors affected the mandible, 6 the maxillary alveolus with or without extension into the hard palate. All patients underwent primary resection with neck dissection and were staged as T4a N0 M0. In 4 patients, diagnosis was delayed as a result of superficial biopsies and/or confusing histopathology. Cystic SCCs of the jaws can be difficult to diagnose and clinicoradiological correlation is essential. Long-term follow-up is mandatory.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-12T06:24:32Z
      DOI: 10.1177/1066896920903388
       
  • Periapical Cyst and Odontogenic Remnants on Osseous Mandibulectomy
           Margins: Two Diagnostic Pitfalls
    • Authors: Simon F. Roy, Jérémie Berdugo
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      In this article, we describe 2 high-stake diagnostic pitfalls that occurred in a single patient having undergone partial glossectomy and marginal mandibulectomy for invasive squamous cell carcinoma. Margins were grossly uninvolved. Histopathology showed a moderately differentiated squamous cell carcinoma. Microscopic evaluation of margins was challenging, as the inferior osseous margin submitted en face showed spongiotic epithelium with mixed chronic and acute inflammation, representing a periapical cyst after correlation with the gross examination. Another section of the osseous margin showed a small non-atypical epithelial nest, consistent with an odontogenic epithelial rest. We wish to raise awareness of these diagnostic pitfalls as a bone margin with such epithelial foci could be misinterpreted as positive, with serious therapeutic consequences.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-07T11:33:45Z
      DOI: 10.1177/1066896920905085
       
  • Colonic Neurogenic Lesion: An Admixture of Mucosal Neurofibromatous Lesion
           and Submucosal Ganglioneuromatous Lesion With Transition
    • Authors: Hirotsugu Hashimoto, Hirotomo Koda, Hajime Horiuchi, Maho Takayama, Junya Toyoda, Masashi Momiyama, Yasushi Harihara, Teppei Morikawa
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Benign neural tumors or tumor-like lesions are rarely detected in the gastrointestinal tract. In this article, we present the case of a neural lesion of the sigmoid colon, which was incidentally detected in a 68-year-old man treated with laparoscopic low anterior resection for an advanced carcinoma of the rectosigmoid junction. Within the resected specimen, a submucosal tumor-like protruding lesion was found in the sigmoid colon. Histologically, the growth was composed of mucosal neurofibromatous and submucosal ganglioneuromatous lesions, between which there was transition. Immunohistochemical analysis revealed a rupture of the perineurium in the area of transition, along with a proliferation of Schwann cells and supporting cells extending into the deep mucosa. This transition indicated that the mucosal and submucosal lesions comprised a single lesion, and that a diagnosis of neurofibroma or ganglioneuroma would be inadequate in this case. Because we could not classify it as an established single entity, we diagnosed the mass as an unclassifiable colonic neurogenic lesion. In summary, we report the case of an extremely rare occurrence of an unclassifiable colonic neurogenic lesion comprising an admixture of transitioning mucosal neurofibromatous and submucosal ganglioneuromatous lesions.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-07T04:32:56Z
      DOI: 10.1177/1066896920904158
       
  • Cytoplasmic p16 Is Expressed in Normal Brown Fat and Hibernomas
    • Authors: Georgia Karpathiou, Jean Marc Dumollard, Zoe Evangelou, Anna Batistatou, Michel Peoc’h, Alexandra Papoudou-Bai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      White adipose tissue browning has emerged as a putative therapy of obesity, and studies in mice have shown that Cdkn2a is implicated in white-to-brown transition. However, the role of Cdkn2a product p16 has been never studied in human brown fat tissue. The aim of the study is to investigate the expression of p16 in normal brown fat and in hibernoma, a lipoma containing brown fat-like adipocytes. Ten normal brown fat tissues and 5 hibernomas were immunohistochemically studied for p16 expression. Nearby white adipose tissue was used for comparison. All brown fat and hibernomas specimens express p16 in a cytoplasmic manner. Neighboring white adipose tissue is negative for p16 expression. Thus, cytoplasmic p16 may be associated with fat tissue browning.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-05T08:48:07Z
      DOI: 10.1177/1066896920904423
       
  • Seminal Vesicle Adherent to Rectal Wall Following Neoadjuvant
           Chemoradiotherapy: A Potential False-Positive Diagnostic Pitfall
    • Authors: Samia Liaquat, Michael O. Idowu, Bryce S. Hatfield
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      The standard of care for stage T3 and stage T4 rectal adenocarcinomas involves neoadjuvant chemoradiotherapy followed by either low anterior resection or abdominopelvic resection. The presence of residual adenocarcinoma or positive surgical margins provides useful prognostic information and can influence ongoing adjuvant therapy. Although uncommon, mimics of treated adenocarcinoma may be present in the surgical specimen. A high index of suspicion is critical in avoiding potential false-positive pitfalls, and the exclusion of mimics of treated adenocarcinoma is paramount to accurate diagnosis and treatment. Seminal vesicle epithelium has long been a challenge in differentiating prostatic adenocarcinoma from benign epithelium. However, the role of incidental seminal vesiculectomy in rectal resections due to fibrous adhesion to the rectal wall secondary to chemoradiation has not been studied. As the seminal vesicle epithelium can show markedly atypical nuclei with radiation-type effect at baseline, the potential risk of misinterpretation as residual adenocarcinoma is high. In this article, we present 2 case reports of rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy followed by transabdominal resection (low anterior resection or abdominopelvic resection) with incidental seminal vesiculectomies mimicking either residual adenocarcinoma or residual adenocarcinoma at a margin of resection.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-02-03T05:11:09Z
      DOI: 10.1177/1066896920903109
       
  • Mammary Extranodal Rosai-Dorfman Disease With and Without Associated
           Axillary Lymphadenopathy: Insights for Practitioners of Breast Pathology
    • Authors: Sindhu Shetty, Nidhi Sharma, Christine N. Booth, Olaronke Oshilaja, Erinn P. Downs-Kelly, Jesse K. McKenney, Charles D. Sturgis
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Rosai-Dorfman disease is a rare proliferative histiocytic disorder of lymph nodes that is descriptively known as sinus histiocytosis with massive lymphadenopathy. Extranodal involvement of the parenchyma of the breast is uncommonly reported, with fewer than 50 cases of mammary extranodal disease detailed in the English-language literature. We characterize a retrospective series of adult female patients from a single institution with Rosai-Dorfman disease of the breast and axillary lymph nodes. Because Rosai-Dorfman disease of the breast and axillary lymph nodes may clinically, radiographically, and histologically mimic breast carcinoma and other conditions, we present an illustrated review of the disease and its relevant differential diagnoses in hopes of raising awareness and allowing for accurate management of affected patients.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-29T05:31:02Z
      DOI: 10.1177/1066896920901770
       
  • Collision Tumor of Endometrial Large Cell Neuroendocrine Carcinoma and
           Low-Grade Endometrial Stromal Sarcoma: A Case Report and Review of the
           Literature
    • Authors: Glorimar Rivera, Shuang Niu, Hao Chen, Dina Fahim, Yan Peng
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Large cell neuroendocrine carcinoma (LCNEC) of the endometrium is an exceedingly rare histologic subtype of endometrial cancer (0.8%). These tumors are highly aggressive with a propensity for metastasis and have a poor prognosis. Among the 17 cases reported to date, 9 cases were pure large cell neuroendocrine tumors and 8 were collision tumors of LCNEC with endometrial carcinomas (7 endometrioid and 1 serous). In this article, we report a case of collision tumor composed of an endometrial LCNEC and a low-grade endometrial stromal sarcoma (LGESS). The patient was a 48 year-old woman who presented with a large abdominal mass for about 10 years and underwent total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking. Microscopic evaluation demonstrated an LGESS with extensive osseous metaplasia that penetrated through the myometrium and invaded into pelvic and abdominal cavity, forming a 40.0-cm mass. Cytogenetic analysis of the LGESS revealed an abnormal female karyotype (45, XX) with multiple structural abnormalities. Incidentally, small foci of LCNEC were identified within the endometrium. The LCNEC focally invaded the myometrium with involvement of the endocervix, extensive lymph-vascular space invasion, and metastases to bilateral ovaries. Subsequently, the patient was treated with cisplatin/etoposide chemotherapy and had been doing well for about a year until presenting with recurrence of LCNEC in the abdomen. She passed away a month later due to medical complications. This report reveals an extremely rare endometrial collision tumor with unusual pathologic features and clinical presentations.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-29T05:29:54Z
      DOI: 10.1177/1066896920901764
       
  • A Rare Case of an Aggressive Clear Cell Variant of Calcifying Epithelial
           Odontogenic Tumor in the Posterior Maxilla
    • Authors: José Alcides Almeida de Arruda, Diego Antônio Costa Arantes, Lauren Frenzel Schuch, Carla Mosconi, Lucas Guimarães Abreu, Bruno Augusto Benevenuto de Andrade, Mario José Romañach, Ricardo Alves Mesquita, Tarcília Aparecida Silva, Aline Carvalho Batista, Elismauro Franscisco Mendonça
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      A clear cell variant of calcifying epithelial odontogenic tumor is a rare benign odontogenic neoplasm, accounting for 33 cases described in the literature. In this article, we report a challenging example of clear cell variant of calcifying epithelial odontogenic tumor of the posterior maxilla in a 45-year-old female patient showing locally aggressive growth and recurrence. Microscopically, islands of polyhedral cells containing abundant cytoplasm, well-developed intercellular bridges blended with clear cells were observed. The nuclei were frequently pleomorphic and permeated by hyaline calcified material. Immunohistochemistry revealed positivity for pan-cytokeratin (AE1/AE3), cytokeratins (CK-14 and CK-19), Bcl-2, p53, and p63. The Ki-67 proliferative index was ~10%. As odontogenic tumors are rare, when a significant clear cell component is observed, the differential diagnosis with other lesions of the jaws with similar morphology, including other odontogenic tumors with prominent clear cell component, clear cell odontogenic carcinomas, and metastatic tumors, is difficult.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-28T04:38:19Z
      DOI: 10.1177/1066896920901755
       
  • A Case of Cystoisospora (Isospora) belli Infection With Multiple Life
           Stages Identified on Endoscopic Small Bowel Biopsies
    • Authors: Daniel J. Rowan, Samar Said, Audrey N. Schuetz, Bobbi S. Pritt
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-27T06:01:42Z
      DOI: 10.1177/1066896920901589
       
  • Luschka Ducts of the Gallbladder in Adults: Case Series Report and Review
           of the Medical Literature
    • Authors: Adriana Handra-Luca, Habib Mohamed Ben Romdhane, Seung-Mo Hong
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Luschka ducts (LD) of the gallbladder (GB) are rare congenital lesions. They are defined as bile ducts that connect directly the hepatic bile duct system to the GB. We aimed to present the characteristics of 55 cases of GB LDs as diagnosed on cholecystectomy specimens. Surgically resected GBs (55) were analyzed for LD morphological features (length, morphological pattern, and epithelial lesions) as well as for immunohistochemical features. The age varied between 24 and 88 years. The gender ratio was 30:25 (female–male). The diagnosis was acute and subacute/chronic cholecystitis (21 and 34 cases, respectively). GB abnormalities of Rokitansky-Aschoff sinus, adenomyoma, septate, and subserosal-liver types were present in 36, 6, 22, and 12 GBs, respectively, while adenocarcinoma was present in 2 GBs. A history of renal cyst, pancreatitis, and colon diverticulosis was observed in 8, 11, and 4 cases, respectively. The LDs were detected at subserosal, resection, or both sites (25, 4, and 26 cases, respectively). The length varied between
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-27T05:08:49Z
      DOI: 10.1177/1066896920901334
       
  • Topographical Evaluation of Penile Lichen Sclerosus Reveals a Lymphocytic
           Depleted Variant, Preferentially Associated With Neoplasia: A Report of
           200 Cases
    • Authors: Adriano Piris, Diego F. Sanchez, Maria José Fernandez-Nestosa, Sofía Cañete-Portillo, Tania Campagnoli, Lorena Gonzalez Stark, Patricia Zarza, Sabrina Oneto, Cecilia Lezcano, Ingrid Rodriguez, Elsa F. Velazquez, Martin Mihm, Antonio L. Cubilla
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Since the seminal study of Hart and Helwig in 1975, there are few detailed pathological studies of lichen sclerosus (LS). The aims of this study were to provide a detailed histopathological description of penile LS, as well as to explore its relationship with penile intraepithelial neoplasia (PeIN) or invasive carcinoma. We evaluated 200 patients and designed a topographical approach for the histological evaluation focusing in alterations of the following anatomical layers: squamous epithelium, lamina propria, dartos, and corpus spongiosum. We documented the quantity and topographical location of stromal lymphocytes. The prevalent lesions found were epithelial hyperplasia, atrophy, PeIN, basal cell vacuolization, lamina propria sclerosis, and variable patterns of lymphocytic infiltration. Various unique patterns of stromal sclerosis were described: perivascular, globular, linear, and solid fibrosis/hyalinization; any of them were found to be diagnostic for LS. The variation in the topography and density of lymphocytes was determinant for the identification of LS morphological variants: lichenoid, band-like, lymphocytic depleted, and mixed. A major finding was the identification of the variant designated as lymphocytic depleted LS, which we considered as the morphological prototype of LS associated with penile neoplasia. The detailed description of this complex lesion presented in this study may help pathologists in practice to identify and better define LS. The identification of the special variants suggests a role of the stromal lymphocytes in the process of carcinogenesis. Confirmation of the observations with more studies is necessary to determine the significance of these findings.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-23T04:53:09Z
      DOI: 10.1177/1066896920901333
       
  • Glomus Tumor of Sella Turcica With Synaptophysin Expression Mimicking
           Pituitary Adenoma
    • Authors: Jason C. H. Tsang, C. S. Ng, C. F. Fung, John K. C. Chan, Wah Cheuk
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Glomus tumor can rarely arise in the central nervous system as a sella turcica mass. In this article, we report a case of sellar glomus tumor in a female patient who presented at the age of 8 years with visual impairment. The tumor recurred at 4 years and 26 years after initial excision and gamma knife therapy. Histologic examination showed a monotonous population of oval cells accompanied by delicate blood vessels, features mimicking pituitary adenoma. The tumor showed histologic progression at the second recurrence. Synaptophysin staining was positive, but chromogranin and CD56 were negative. The tumor cells were negative for epithelial markers but expressed actin and SMA. Awareness of the rare occurrence of glomus tumor at this region, careful analysis of morphology, and appropriate immunohistochemical workup are essential to solve this diagnostic challenge. The clinicopathologic features of all previously reported cases are reviewed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-17T06:44:45Z
      DOI: 10.1177/1066896919900550
       
  • Scrotal Tumoral Calcinosis: A Rare and Easily Misdiagnosed Situation
    • Authors: Zhenhua Liu, Xiao Xu, Baoyue Liu
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-14T06:46:21Z
      DOI: 10.1177/1066896919900551
       
  • A Malignant Neoplasm From the Jejunum With a MALAT1-GLI1 Fusion and
           26-Year Survival History
    • Authors: Owen William John Prall, Christopher Robert Edward McEvoy, David John Byrne, Amir Iravani, Judy Browning, David Yew-Huong Choong, Bhargavi Yellapu, Sophie O’Haire, Kortnye Smith, Stephen James Luen, Paul Leslie Ross Mitchell, Jayesh Desai, Stephen Bernard Fox, Andrew Fellowes, Huiling Xu
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      The transcription factor GLI1 is a critical effector of the sonic hedgehog pathway. Gene fusions that activate GLI1 have recently been reported in several tumor types including gastroblastoma, plexiform fibromyxoma, a subset of pericytomas, and other soft tissue tumors. These tumors arise in a wide variety of anatomical origins and have variable malignant potentials, morphologies, and immunohistochemistry profiles. In this case report, we describe a malignant tumor from the jejunum with a MALAT1-GLI1 gene fusion that expressed a truncated constitutively active GLI1 protein and GLI1 targets that were detectable by immunohistochemistry. The tumor showed high-grade epithelioid and spindle cell morphology, strongly expressed CD56, and focally expressed other neuroendocrine markers and cytokeratins, but not S100 protein or SMA. The tumor recurred multiple times in liver, soft tissue, and lung over the course of 26 years, the longest reported follow-up for a GLI1 fusion-associated tumor. These metastatic tumors were also composed of epithelioid and spindle cells, but showed lower morphological grade than the primary tumor. The metastatic tumors resembled the recently reported “malignant epithelioid neoplasms with GLI1 rearrangements.” The tumor also had a relatively high tumor mutation burden for a sarcoma. This case report expands the sites of origin for GLI1 rearranged neoplasms and shows that despite being associated with high-grade morphology, these malignancies can be associated with very long-term survival.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-14T06:45:21Z
      DOI: 10.1177/1066896919900548
       
  • Myeloid Sarcoma Mimicking Endocarditis: An Autopsy Case
    • Authors: Konstantin Bräutigam, Anja Hohl, Ekkehard Hewer, Rupert Langer, Stephan Jakob
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-13T04:56:08Z
      DOI: 10.1177/1066896919900011
       
  • Intestinal Graft Versus Host Disease Involving Brunner’s Glands
    • Authors: Andreas Kreft, Daniel-Christoph Wagner, Helmut Neumann
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-01-10T06:24:33Z
      DOI: 10.1177/1066896919899159
       
  • Diagnostic Utility of BCOR Antibody in Clear Cell Sarcomas of Kidney
    • Authors: Muhammad Zeeshan Khan, Noreen Akhtar, Usman Hassan, Sajid Mushtaq
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Purpose. Clear cell sarcoma of the kidney (CCSK) is an uncommon malignant renal tumor. It is the second most common renal pediatric renal malignancy after Wilms tumor. It exhibits a heterogeneous morphology, with overlapping features with its close differentials, which results in diagnostic challenges. There was no specific immunohistochemical marker in the past, to help in this regard. BCOR antibody has recently been suggested to be helpful in the differential diagnosis. We aim to study the utility of the BCOR antibody in the diagnosis of CCSK. Methods. We selected a total of 27 cases of CCSK (n = 12), Wilms tumor (n = 12), and congenital mesoblastic nephroma (n = 3). All cases were evaluated for the extent and intensity of nuclear labeling for BCOR antibody by immunohistochemistry (IHC). Results. We found that BCOR IHC was positive in 11 out of 12 cases with diffuse and strong staining in 8 of the cases. None of the cases of Wilms tumor and congenital mesoblastic nephroma were positive. Only 2 cases of Wilms tumor showed minimal and weak staining in
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-26T09:32:24Z
      DOI: 10.1177/1066896919895119
       
  • An Emoji for a Tunica Vaginalis Hydrocele
    • Authors: Sanjay A. Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-24T05:29:23Z
      DOI: 10.1177/1066896919896628
       
  • Cystic Neutrophilic Granulomatous Mastitis: A Clinicopathological Study
           With 16s rRNA Sequencing for the Detection of Corynebacteria in
           Formalin-Fixed Paraffin-Embedded Tissue
    • Authors: Madhavi A. Naik, Aruna Korlimarla, Smrithi T. Shetty, Anisha M. Fernandes, Sanjay A. Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Cystic neutrophilic granulomatous mastitis (CNGM) is a histologically characterized variant of granulomatous lobular mastitis that is associated with lipophilic Corynebacterium species. It remains a largely underrecognized entity in India. Our aim was to study CNGM in the Asian Indian population and explore if 16s rRNA sequencing could be used on formalin-fixed paraffin-embedded (FFPE) tissue to identify the causative organism. We studied 24 cases with histological features of CNGM with hematoxylin and eosin, Gram, Ziehl-Neelsen, and Periodic acid–Schiff stains. Tuberculosis-polymerase chain reaction and 16s rRNA gene sequencing on DNA extracted from FFPE was attempted (N = 23). Gram-positive bacilli were seen in 20/24 cases. Routine culture with prolonged incubation yielded Corynebacterium species in 8 cases; 7 of these cases were evaluated by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for species identification. C matruchotti was identified in one case by BD Phoenix. MALDI-TOF MS identified the remaining 7 cases as C kroppenstedtii (N = 4) and C tuberculostearicum (N = 2), with no identification in one. Corynebacteria were identified by 16s rRNA sequencing on DNA extracted from FFPE in 12/23 cases using a primer targeting the V5-V6 region that was found to be more conserved in Corynebacterium species. All cases were negative for the diagnosis of tuberculosis. CNGM can be identified by routine stains. Culture using routine media with prolonged incubation is often adequate to isolate the organism. 16s rRNA sequencing on DNA extracted from FFPE tissue can help make an etiological diagnosis in some cases where only paraffin blocks are available.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-24T05:28:43Z
      DOI: 10.1177/1066896919896021
       
  • Young-Onset Ischemic Colitis: A Condition of Elusive Etiology Frequently
           Associated With Immune Dysregulation
    • Authors: Kathleen Byrnes, Armen Khararjian, Abul A. S. R. Mannan, Michael Arnold, Lysandra Voltaggio
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Ischemic colitis (IC) associates with older age, hypertension, and heart disease, among others. Young-onset IC is rare. We aimed to delineate clinical characteristics of young patients (
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-24T05:28:03Z
      DOI: 10.1177/1066896919894671
       
  • Perivascular Epithelioid Cell Tumor of the Urinary Bladder: A Systematic
           Review
    • Authors: Ameer Hamza, Charles C. Guo
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Perivascular epithelioid cell tumor (PEComa) of the urinary bladder is a rare neoplasm showing distinct melanocytic and smooth muscle differentiation. We aimed to review the clinicopathologic features of bladder PEComa using all the available cases in the literature, along with 2 new cases from our database. The patients included 15 females and 15 males with a mean age of 39.2 ± 15.3 years. Painless hematuria was the most common clinical presentation. The tumors were usually well circumscribed with a mean tumor size of 4.4 ± 2.7 cm. Bladder PEComas demonstrated nests, trabeculae, or sheets of epithelioid cells with intermixed spindled cells and numerous thin-walled vessels. Immunohistochemical studies showed that the tumors were positive for HMB45 (27/27), cathepsin (4/4), SMA (20/22), and caldesmon (3/3) and were negative for pan cytokeratin (0/18) and EMA (0/4). Molecular studies revealed that PEComa was associated with the TFE3 (n = 3) and EWSR1 (n = 1) gene rearrangements. Treatment included partial cystectomy (n = 18), transurethral resection (n = 8), and radical cystectomy (n = 4). Twenty patients had no evidence of disease during a mean follow-up time of 19.4 ± 17.2 months. Two patients had recurrence, and 1 patient died of metastatic disease. In conclusion, bladder PEComas demonstrate distinct morphologic and immunohistochemical features. Although most tumors follow a benign course, a small subset may develop metastasis and cause death.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-23T05:03:46Z
      DOI: 10.1177/1066896919895810
       
  • Malignant Pleural PEComa: A Previously Undocumented Site
    • Authors: Rebecca Tian Mei Au, Aneez D. B. Ahmed, Bernard Chi Shen Ho, Clarence Hai Yi Teo, Khoon Leong Chuah
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Perivascular epithelioid cell (PEC) tumors are rare tumors of mesenchymal origin and can affect many anatomic regions. Although these tumors are usually benign, malignant variants exist. We document for the first time a malignant PEComa arising from the pleura of a 43-year-old Malay woman. The pathology of the tumor as well as differential diagnoses is discussed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-23T05:02:46Z
      DOI: 10.1177/1066896919893074
       
  • Enterobius vermicularis in a Tubulovillous Adenoma
    • Authors: John Dermot Coyne, Vinita Charan, Abdul Ganjifrockwala
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-23T05:00:26Z
      DOI: 10.1177/1066896919888586
       
  • Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia, Mimicking
           Pulmonary Metastasis
    • Authors: Soyoung Im, Hyang Sook Jeong, Deog Gon Cho, Jinyoung Yoo
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-19T05:21:16Z
      DOI: 10.1177/1066896919895118
       
  • Parasitic Microcalcifications of the Breast
    • Authors: Sanica Bhele, Lanu Stoddart, Christine Petersen, Janet Baum, Christopher N. Otis
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-19T05:19:56Z
      DOI: 10.1177/1066896919894687
       
  • Counting Intraepithelial Lymphocytes: A Comparison Between Routine
           Staining and CD3 Immunohistochemistry
    • Authors: Rosalin Cooper, Neil James Papworth, Chloe Harris, Joanne Horne, Jacqueline Lai, Joyce Lai, Rushda Rajak, Katy Marie Valentine, Sam Otieno Gaya, Norman John Carr
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Counting intraepithelial lymphocytes (IELs) is a key part of the assessment of duodenal biopsies. Immunohistochemistry (IHC) for CD3 can aid identification of lymphocytes in this context, but it is not evident that counts on hematoxylin and eosin (H&E) and CD3 are comparable. This study aimed to compare the IEL counts in duodenal biopsies using H&E stains and CD3 IHC, and to examine the interobserver variability. Thirty-five paired H&E and CD3 sections were reviewed by 6 pathologists who counted the number of IELs per 100 enterocytes. The counts were categorized into groups: normal (40 lymphocytes). CD3 IHC was associated with significantly higher IEL counts than H&E. Four cases with normal H&E counts had raised counts with CD3. There was moderate agreement between observers for both H&E and CD3. Lack of concordance between CD3 and H&E IEL counts suggests that counts derived from the 2 methods may not be comparable to each other and should not be considered equivalent. There was no significant improvement in interobserver variability with CD3 IHC.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-18T05:11:01Z
      DOI: 10.1177/1066896919894644
       
  • Ewing Sarcoma in Older Adults: A Clinicopathologic Study of 50 Cases
           Occurring in Patients Aged ≥40 Years, With Emphasis on Histologic Mimics
           
    • Authors: Khadijeh Jahanseir, Andrew L. Folpe, Rondell P. Graham, Caterina Giannini, Steven I. Robinson, William Sukov, Karen Fritchie
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Objective. We explore the clinicopathologic features of Ewing sarcoma (ES) presenting in older adulthood. Methods. Cases of molecularly confirmed ES arising in patients aged ≥40 years were evaluated. Results. Fifty patients were identified (33 males/17 females; 41-86 years). The majority of tumors (41) arose at extraskeletal sites, while 9 were bone primaries. Twenty-eight cases showed nested architecture, while the remaining cases showed sheet-like growth. Tumor cytology was categorized as conventional (n = 39), crushed (n = 5), clear cell (n = 4), rhabdoid (n = 3), and epithelioid (n = 2). Fifty percent had necrosis, while rosettes were noted in 1 case. Immunostains performed ranged from 1 to 28 (median = 10). Follow-up (n = 43, 1-147 months) revealed 15 patients with metastasis. Conclusion. Although rare, ES should be considered in the differential diagnosis for round cell malignancies in older adult patients. In this cohort, ES is most often extraskeletal, and may show unusual morphologic features, closely simulating more common neoplasms in this age group.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-18T05:09:59Z
      DOI: 10.1177/1066896919893073
       
  • Merry Christmas - A pareidolia!
    • Authors: Sanjay A Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-17T09:22:39Z
      DOI: 10.1177/1066896919896875
       
  • Yttrium-90 Microsphere Selective Internal Radiation Therapy–Induced
           Cholecystitis
    • Authors: Robert Pantaleon Vasquez, Dipti M. Karamchandani
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-13T05:05:25Z
      DOI: 10.1177/1066896919892589
       
  • Pseudocystic Nevus
    • Authors: Joško Bezić, Merica Glavina Durdov, Marina Ćaleta Rade
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-11T05:10:20Z
      DOI: 10.1177/1066896919893436
       
  • Tubulopapillary Carcinoma: An Aggressive Variant of Invasive Breast
           Carcinoma With a Micropapillary DCIS-Like Morphology
    • Authors: Claudio Guerrieri, Rachel Hudacko
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Tubulopapillary carcinoma is a recently described variant of breast carcinoma characterized by a proliferation of elongated and anastomosing tubular glands exhibiting intraluminal micropapillary and sometimes papillary epithelial projections. We have recently encountered a patient with invasive breast carcinoma displaying a prominent tubulopapillary component. The histomorphology in our case had an uncanny resemblance to micropapillary ductal carcinoma in situ, but the invasive nature of the glands was confirmed not only by the lack of myoepithelial cells but also by the presence of identical metastatic foci within ipsilateral axillary lymph nodes. This case was made all the more intricate by the simultaneous presence of invasive micropapillary carcinoma in the opposite breast and a carcinosarcoma of the uterus with a serous papillary carcinoma component. As noted in the only prior report on tubulopapillary carcinoma of the breast, our case confirms the aggressive nature of this form of invasive carcinoma, the histological features of which appear to be easily identifiable and reproducible.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-11T05:09:39Z
      DOI: 10.1177/1066896919892699
       
  • Squamous Lesions of the Stomach
    • Authors: Badr AbdullGaffar, Hoda Quraishi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-11T05:08:20Z
      DOI: 10.1177/1066896919892691
       
  • Primary Cutaneous Adenomyoepithelioma Ex Spiradenoma With Malignant
           Histologic Features, Epithelial-Myoepithelial Carcinoma Type: A First Case
           Report With Molecular Studies
    • Authors: Tien Anh N. Tran, Julia A. Bridge, Sophie J. Deharvengt, Donald C. Green, Konstantinos Linos
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Adenomyoepithelioma is an extremely rare primary cutaneous neoplasm. Although there is ample evidence on the existence of malignant adenomyoepithelioma in the breast, a malignant counterpart in the skin has not been documented. We report a primary cutaneous adenomyoepithelioma (pcAME) with malignant features arising from a spiradenoma in a 39-year-old female patient. The tumor was solid-cystic in appearance and entirely located in the subcutaneous tissue. Histologically, the tumor displayed foci of adenomatous changes and adenomyoepitheliomatous hyperplasia adjacent to a minute spiradenoma. Gradual increase of architectural complexity, cytologic atypia, mitotic activity, and infiltrative growth were observed in a significant portion of the neoplasm, indicative of transformation to adenomyoepithelioma and subsequently low- to high-grade salivary-type epithelial-myoepithelial carcinoma (EMCA). The intimate dual populations of ductal and myoepithelial cells were highlighted by a panel of immunohistochemical stains in all different components of the tumor. Molecular studies revealed a PIKCA3 mutation, a genetic aberration that has been documented in EMCA, particularly of breast origin. The current case documents for the first time a pcAME with malignant features arising from a spiradenoma and suggests adenomyoepithelioma ex spiradenoma as a possible tumorigenesis pathway of this rare cutaneous tumor.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-09T09:57:23Z
      DOI: 10.1177/1066896919888579
       
  • Molecular Characterization of a Rare Dedifferentiated Liposarcoma With
           Rhabdomyosarcomatous Differentiation in a 24 Year Old
    • Authors: Nicholas Olson, Rodrigo Gularte-Mérida, Pier Selenica, Arnaud Da Cruz Paula, Barbara Alemar, Britta Weigelt, Joel Lefferts, Konstantinos Linos
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Aims. The aim of this study was to identify potential driver genetic alterations in a dedifferentiated liposarcoma (DDLPS) with rhabdomyosarcomatous differentiation. Methods and Results. A 24-year-old female underwent resection of an abdominal mass, which on a previous biopsy demonstrated rhabdomyosarcomatous differentiation concerning for embryonal rhabdomyosarcoma. Histologically the resected tumor displayed a high-grade sarcoma with rhabdomyosarcomatous differentiation in the background of well-differentiated liposarcoma consistent with DDLPS. Fluorescence in situ hybridization confirmed MDM2 amplification, as did array-based copy number profiling. Whole-exome sequencing revealed a somatic FGFR1 hotspot mutation and RNA sequencing an LMNB2-MAP2K6 fusion only within the dedifferentiated component. Conclusions. This study represents an in-depth examination of a rare DDLPS with rhabdomyosarcomatous differentiation in a young individual. Additionally, it is also instructive of a potential pitfall when assessing for MDM2 amplification in small biopsies. Despite exhaustive analysis, mutation and gene copy number analysis did not identify any molecular events that would underlie the rhabdomyoblastic differentiation. Our understanding of what causes some tumors to dedifferentiate as well as undergo divergent differentiation is limited, and larger studies are needed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-05T05:26:23Z
      DOI: 10.1177/1066896919890401
       
  • Metastatic “Ductal Carcinoma In Situ–Like” Lobular Carcinoma in a
           Lymph Node: A Case Report and Review of the Literature
    • Authors: Sidiq Tijani, Kirti Sharma, Henry Yuen, Abeer Shaaban
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Metastatic breast cancer resembling ductal carcinoma in situ (DCIS) is a rare phenomenon. In this article, we present a unique case of metastatic lobular carcinoma with DCIS-like morphology in the left axillary lymph nodes of a 52-year-old female. She presented with 2 lesions in the left breast on mammography, and a mastectomy with axillary lymph node dissection was performed. Gross examination showed a 3.5 × 2.5 × 1.0 cm indistinct tumor in the lower outer quadrant and a 2.5 × 2.5 × 1.8 cm tumor in the upper outer quadrant. Microscopic assessment revealed a pleomorphic lobular carcinoma in the lower outer quadrant and a grade 2 invasive ductal carcinoma in the upper outer quadrant. Sixteen of the 17 axillary lymph nodes showed metastatic lobular carcinoma with foci of solid and comedo-type DCIS-like features. Immunohistochemical analysis of the primary and metastatic lobular carcinoma showed no expression of E-cadherin and p63 antibodies. To our knowledge, metastatic lobular carcinoma exhibiting this pattern has not been reported. The case suggests that lobular carcinoma can morphologically recreate a primary microenvironment at a distant site and simulate in situ growth. Recognition of this pattern is important to avoid misdiagnosis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-02T07:14:17Z
      DOI: 10.1177/1066896919888744
       
  • Odontogenic Carcinosarcoma: Clinicopathologic Features of 2 Cases
    • Authors: Ciro Dantas Soares, Wilson Delgado-Azañero, Thayná Melo de Lima Morais, Oslei Paes de Almeida, Hugo Ghersi Miranda
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      This study reports 2 odontogenic carcinosarcomas, including the clinicopathologic and immunoprofile characteristics of these rare tumors. The first case occurred in a 22-year-old male presenting a bilobular mass involving the gingiva and bone of the premolar region of the left mandible, with paresthesia of the lower lip. Microscopic examination revealed a tumor similar to ameloblastic fibrosarcoma, with atypical mesenchymal cells; however, the odontogenic epithelium also showed atypia. In the second case, a 16-year-old female had a painless, asymptomatic, large intraosseous mandibular lesion. The patient received radiotherapy to treat a rhabdomyosarcoma of the parotid 13 years before. The tumor was composed of atypical spindle cells, positive for vimentin and smooth muscle actin, intermingled with malignant odontogenic epithelium. Both epithelial and mesenchymal components of the tumors showed high index of p53- and Ki67-positive cells. The first case was diagnosed as odontogenic carcinosarcoma possibly originated from an ameloblastic fibrosarcoma, and the second as de novo odontogenic carcinosarcoma possibly caused by previous radiotherapy.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-12-02T04:58:20Z
      DOI: 10.1177/1066896919888578
       
  • Tenosynovial Giant Cell Tumor, Localized Type With Extensive Chondroid
           Metaplasia: A Case Report With Immunohistochemical and Molecular Genetic
           Analysis
    • Authors: Mamiko Nagase, Asuka Araki, Noriyoshi Ishikawa, Nahoko Nagano, Makiko Fujimoto, Kyoko Biyajima, Nobuo Yamagami, Soichiro Yamamoto, Riruke Maruyama
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Tenosynovial giant cell tumor (TSGCT) of localized type is a common disease occurring mostly in the hands. Diagnosis of this tumor is relatively easy to render with hematoxylin-eosin–stained sections as compared with that of TSGCT of diffuse type. However, very rare cases with chondroid metaplasia that have recently been reported mainly in diffuse type can make pathological differentiation from soft tissue cartilaginous tumors extremely difficult. In this article, the authors present the second reported case of TSGCT of localized type showing extensive chondroid metaplasia. Pathological interpretation was difficult without utilizing immunohistochemistry and fluorescence in situ hybridization. One must be careful not to misdiagnose this lesion as cartilaginous tumors of soft tissue, and we suspect at least some chondroblastoma-like chondroma could be reclassified as TSGCT of localized type with extensive chondroid metaplasia. Morphological, immunohistochemical, and molecular genetic characteristics are presented and discussed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-27T05:29:22Z
      DOI: 10.1177/1066896919889672
       
  • Correlation Between Digital and Manual Determinations of Ki-67/MIB-1
           Proliferative Indices in Human Meningiomas
    • Authors: Duc-Tien Pham, Ivar Skaland, Theo L. Winther, Øyvind Salvesen, Sverre H. Torp
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Objective. Proliferative activity in tumor tissues is assessed as the percentage of Ki-67/MIB-1-positive cells, or the proliferative index (PI). The PI is routinely assessed manually. However, the subjectivity of manual assessments might result in poor reproducibility. We hypothesized that digital assessments might reduce the error. Method. In our study, we assessed Ki-67/MIB-1 PIs, both manually and digitally, with tissue microarrays constructed from 141 human meningioma samples. Spearman-rank correlation and κ statistics were applied for correlation and agreement analyses, respectively. Mann-Whitney U tests were used to compare MIB-1 PIs between groups. Prognostic ability was assessed with Kaplan-Meier and Cox regression analyses. Results. We found a significant, high correlation (Spearman ρ = 0.832, P < .01) and moderate agreement (κ coefficient = 0.617, observed agreement = 80.9%) between the 2 methods. Both methods found significantly different Ki-67/MIB-1 PIs for different World Health Organization grades (P < .05). Neither method showed significant prognostic value. Conclusion. Digital determinations of Ki-67/MIB-1 PIs in human meningiomas are feasible for the daily routine.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-27T05:28:02Z
      DOI: 10.1177/1066896919889148
       
  • Histopathologic Spectrum of Neuromuscular and Vascular Hamartoma With
           Special Reference to the Vasculopathic Phenomenon
    • Authors: Pavithra Ayyanar, Suvendu Purkait, Tushar Subhadarshan Mishra, Susama Patra, Suvradeep Mitra
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Neuromuscular and vascular hamartoma (NMVH) is an unusual lesion presenting as intestinal obstruction by stricture formation. It is characterized by a hamartomatous mass comprising haphazardly arranged mesenchymal tissue native to the intestinal mucosa and submucosa. We aimed to characterize the clinicohistopathological spectrum of NMVH in adult subjects with a search for an etiological clue. We reviewed 84 resected specimens (adult cases) of intestinal obstruction in our institute and diagnosed 4 cases with NMVH. A panel of special stains (Masson trichrome, Verhoeff-van-Gieson, and periodic acid–Schiff) and immunohistochemistry (smooth muscle actin, S100, Bcl2, CD34, vimentin, desmin, CD117, and CD3) were performed in all cases. All cases of NMVH showed characteristic hamartomatous mounds comprising haphazardly arranged smooth muscle, nerves, ganglia, vessels, and collagen with overlying mucosal ulceration. Adjacent bowel showed submucosal fibrosis, muscularis mucosae thickening, and duplication along with vasculopathy. A typical vasculopathy (“vessel-in-vessel” appearance) was seen in the submucosal and/or subserosal veins. Besides, different other forms of vasculopathic changes like obliterative venopathy and concentric myohypertrophy were also seen. One case had vasculitis and the patient died despite successful surgery. One other case was associated with lymphocytic ganglioneuronitis and granulomatous etiology. We conclude that NMVH can be multifactorial in origin although ischemia resulting from vasculopathy appears to be directly causative. The characteristic vasculopathy in the submucosal location may aid in the diagnosis of NMVH in small biopsy samples.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-25T04:43:40Z
      DOI: 10.1177/1066896919890129
       
  • Trichoblastic Carcinosarcoma Arising From the Vagina: A Case Report With
           Comprehensive Immunophenotypic Analysis
    • Authors: Joshua Jing Xi Li, Joanna Ka Man Ng, Paul Cheung Lung Choi, Jacqueline Ho Sze Lee, Mei-yung Yu
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      A 54-year-old woman presented with abdominal pain. Magnetic resonance imaging revealed an upper vaginal mass with no pelvic side wall involvement, nodal, or distant metastasis. Radical hysterectomy was performed. Histology showed trichoblastic carcinoma with hair follicle structures and malignant sarcomatous and carcinomatous components. Hair follicular differentiation was confirmed by positivity to hair follicle markers (Bcl-2, TLE1, CD56/NCAM, and TDAG51) and presence of CD10-positive trichogenic stroma. The tumor involved the vaginal muscularis only (FIGO [International Federation of Gynecology and Obstetrics] stage I) and was excised with clear margins. The patient remained disease free at 3-month follow-up. This is the first case of cutaneous-type carcinosarcoma reported in the vagina, highlighting the difference in histology, immunophenotype, and behavior compared with gynecologic carcinosarcomas.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-21T05:32:05Z
      DOI: 10.1177/1066896919887803
       
  • Comparison of Human Papillomavirus Genotypes in Penile Intraepithelial
           Neoplasia and Associated Lesions: LCM-PCR Study of 87 Lesions in 8
           Patients
    • Authors: María José Fernández-Nestosa, Nuria Guimerà, Diego F. Sanchez, Sofía Cañete-Portillo, Antonella Lobatti, Elsa F. Velazquez, David Jenkins, Wim Quint, Antonio L. Cubilla
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Penile intraepithelial neoplasia (PeIN) is currently classified in human papillomavirus (HPV)- and non-HPV-related subtypes with variable HPV genotypes. PeINs are frequently associated with other intraepithelial lesions in the same specimen. The aim of this study was to detect and compare HPV genotypes in PeINs and associated lesions using high-precision laser capture microdissection-polymerase chain reaction and p16INK4a immunostaining. We evaluated resected penile specimens from 8 patients and identified 33 PeINs and 54 associated lesions. The most common subtype was warty PeIN, followed by warty-basaloid and basaloid PeIN. Associated lesions were classical condylomas (17 cases), atypical classical condylomas (2 cases), flat condylomas (9 cases), atypical flat condylomas (6 cases), flat lesions with mild atypia (12 cases), and squamous hyperplasia (8 cases). After a comparison, identical HPV genotypes were found in PeIN and associated lesions in the majority of the patients (7 of 8 patients). HPV16 was the most common genotype present in both PeIN and corresponding associated lesion (50% of the patients). Nonspecific flat lesions with mild atypia, classical condylomas, and atypical condylomas were the type of associated lesions most commonly related to HPV16. Other high-risk HPV genotypes present in PeIN and associated nonspecific flat lesion with mild atypia were HPV35 and HPV39. In this study of HPV in the microenvironment of penile precancerous lesions, we identified identical high-risk HPV genotypes in PeIN and classical, flat, or atypical condylomas and, specially, in nonspecific flat lesions with mild atypia. It is possible that some of these lesions represent hitherto unrecognized precancerous lesions.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-18T04:28:41Z
      DOI: 10.1177/1066896919887802
       
  • Synchronous Oncocytic Papillary Cystadenoma and Warthin Tumor of the
           Parotid Gland
    • Authors: Aanchal Kakkar, Arshad Zubair, Nisha Sharma, Rabia Monga, Suresh C. Sharma
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Warthin tumor (WT) is the second most common benign salivary gland neoplasm. It is also the most frequent salivary gland tumor to occur synchronously or metachronously with another salivary gland neoplasm, in the same gland or on the other side. Oncocytic papillary cystadenomas (OPCs) are rare neoplasms that are more common in minor salivary gland locations and in women. We describe in detail the case of a 73-year-old male smoker with synchronous OPC and WT of the parotid gland. On microscopy, both tumors resembled each other considerably, with the only difference being that the OPC lacked the tumor-associated lymphoid proliferation characteristic of WT. These findings highlight that OPC bears considerable similarity to WT. While this morphological similarity may lead to misdiagnosis on rare occasions, it does not affect patient management, as clinical behavior of both these tumors is similar.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-08T06:48:41Z
      DOI: 10.1177/1066896919886370
       
  • Arteritis and Plexiform Lesion in Intralobar Pulmonary Sequestration: The
           First Case With Such Two Distinct Complex Lesions Associated With Local
           Pulmonary Hypertension
    • Authors: Hirotsugu Hashimoto, Jun Matsumoto, Masashi Kusakabe, Genki Usui, Noriko Hiyama, Hirokazu Yamaguchi, Hajime Horiuchi, Teppei Morikawa
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      In intralobar pulmonary sequestrations, vascular changes similar to those in pulmonary hypertension (PH) are generally observed, such as intimal proliferation and plexiform lesions. However, to our knowledge, a sequestrated lung manifesting vascular changes with both arteritis and a plexiform lesion has never been reported. A 25-year-old man was diagnosed with intralobar pulmonary sequestration. Pathologically, both arteritis and a plexiform lesion were observed in the sequestrated lung. Systemic vasculitis syndrome was clinically excluded, and the pathological findings appeared to be associated with local PH. Arteritis is an extremely rare finding; only one case of arteritis associated with local PH has been reported in intralobar sequestration. In this case, the artery near the plexiform lesion had milder inflammation and fibrosis, suggesting that the arteritis formed prior to the plexiform lesion. This is the first case of arteritis and a plexiform lesion co-occurring in intralobar pulmonary sequestration associated with local PH. This case may shed light on the formation of plexiform lesions and their association with arteritis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-07T06:35:23Z
      DOI: 10.1177/1066896919886663
       
  • A Deceptive Spread: Myoinvasion of Endometrial Carcinoma Imitating Adenoma
           Malignum
    • Authors: Pratik Q. Deb, Jenna Z. Marcus, Yasmin Abedin, Debra S. Heller
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Endometrioid type of endometrial carcinoma is the most common form of uterine malignancy. The majority of patients in the developed world present with the low-grade, low-stage type of this malignancy. The current treatment of early-stage endometrioid carcinoma provides most patients with a favorable outcome. One of the important factors that determine the outcome of early-stage endometrial carcinoma is the involvement of cervical stroma. One of the very rare forms of cervical stromal involvement by endometrioid carcinoma is termed “adenoma malignum type” invasion due to its similarity to the infamously deceptive type of cervical adenocarcinoma called adenoma malignum. Since adenoma malignum is often discovered incidentally, finding adenoma malignum type of myoinvasion may deceive a pathologist to diagnose the simultaneous presence of endometrial carcinoma and adenoma malignum in the same patient as 2 separate entities. Also, this type of myoinvasion may be missed altogether for its subtle nature. In this article, we report a case of low-grade, low-stage endometrioid carcinoma with adenoma malignum type of myoinvasion. We have pointed out the subtle nature of this lesion and the important features to remember to successfully identify it.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-06T05:14:13Z
      DOI: 10.1177/1066896919886113
       
  • Prognostic Implication of pN Stage Subdivision Using Metastatic Lymph Node
           Ratio in Resected Pancreatic Ductal Adenocarcinoma
    • Authors: Jung-Soo Pyo, Nae Yu Kim, Byoung Kwan Son, Kwang Hyun Chung
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      In this meta-analysis, we aimed to evaluate the prognostic implication of the metastatic lymph node ratio (mLNR) and its optimal criterion in pancreatic ductal adenocarcinoma (PDAC) with lymph node metastasis (LNM). The present study included 3735 patients with PDAC who had LNM, from 11 eligible studies. We carried out a meta-analysis to determine the correlation between a high mLNR and PDAC prognosis. The estimated mean numbers of examined and metastatic lymph nodes were 22.396 (95% confidence interval [CI] = 19.681-25.111) and 6.496 (95% CI = 4.646-8.345), respectively. A high mLNR was significantly correlated with worse overall survival (hazard ratio = 1.344, 95% CI = 1.276-1.416). In 3 subgroups based on high mLNR criteria (>0 and
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-06T05:10:41Z
      DOI: 10.1177/1066896919886057
       
  • The Rare Phenomenon of Loss of INI1 Expression at Recurrence/Progression
           of Primary Central Nervous System Tumors: Report of 3 Cases
    • Authors: Akash Pramod Sali, Vishal Chaubey, Duhita Kodare, Ayushi Sahay, Sridhar Epari
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      It is extremely rare for loss of immunohistochemical expression of INI1 to occur primarily at recurrence/progression with retained expression at the primary/initial presentation of central nervous system (CNS) tumor. In this article, we present 3 such cases showing loss of INI1 expression primarily at recurrence. All patients were males, aged 7 years (case 1), 11 years (case 2), and 35 years (case 3), diagnosed with low-grade glial/glioneuronal tumor, not otherwise specified (case 1), craniopharyngioma (case 2), and glioblastoma (case 3); all showed retained INI1 protein expression. Case 1 at 12 months recurrence showed a high-grade tumor with relative undifferentiated morphology, case 2 after 104 months showed a sarcomatous progression, and case 3 recurred after 4 months with the presence of relative undifferentiated round cells. All these recurrences showed loss of INI1 expression. Loss of SMARCB1/INI1 gene function resulting in complete loss of INI1 protein expression is not a well-accepted genetic mechanism for transformation/progression as this series emphasizes.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-04T06:22:09Z
      DOI: 10.1177/1066896919883942
       
  • Corrigendum to A Clinicopathological Study of Small Lung Adenocarcinoma 1
           cm or Less in Size Emphasis on Histological Subtypes Associated With Lymph
           Node Metastasis and Recurrence
    • Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-01T10:20:14Z
      DOI: 10.1177/1066896919887271
       
  • Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma With Features
           Mimicking Spindle Cell Lipoma
    • Authors: Judith A. S. Jebastin, Kyle D. Perry, Dhananjay A. Chitale, Michael P. Mott, Jessica Sanchez, Karen J. Fritchie, Nallasivam Palanisamy, Sean R. Williamson
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and spindle cell lipoma are lipomatous tumors with distinct clinical, molecular, and prognostic features. Although histological and immunophenotypic features can overlap between ALT/WDL and spindle cell lipoma, the oncogenesis and clinical behavior are markedly different. In borderline cases, molecular analysis for MDM2 or CDK4 amplification can aid in distinguishing ALT/WDL from spindle cell lipoma. Although dedifferentiated liposarcoma has been reported to harbor both MDM2 amplification and loss of the RB1 region, we are not aware of a reported RB1 loss in well-differentiated ALT/WDL. In this article, we present a 69-year-old woman with a lipomatous tumor in the gluteal region that histologically, immunohistochemically, and molecularly mimicked spindle cell lipoma (with positive immunohistochemical staining for CD34 and loss of the RB1 gene region), yet harbored amplification of MDM2 and CDK4 confirmed by fluorescence in situ hybridization, supporting classification as ALT/WDL. This case strengthens the argument that in atypical clinical contexts, molecular studies for MDM2/CDK4 should be considered in tumors resembling spindle cell lipoma.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-01T05:26:04Z
      DOI: 10.1177/1066896919884648
       
  • Be Aware of a Potential Pitfall in Oral and Dental Specimens: Alvogyl
           Fibers
    • Authors: Badr AbdullGaffar, Farzad Awadhi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Alvogyl dressing is used to help control hemostasis, foster healing, and prevent complications after certain oral procedures. It is a paste composed of different antiseptic and analgesic substances, and fern-derived Penghawar djambi fibers that have styptic properties. It is claimed to be a resorbable and self-eliminating paste with little complications. However, some studies have demonstrated detrimental effects. We report 3 cases of postextraction nonhealing sockets after Alvogyl dressing. Histologically, they demonstrated residual Alvogyl fibers with foreign body giant cell stromal reaction and complications that were clinically confused with abscess, cysts, infections, and neoplastic lesions. Being unaware of their histopathologic appearances, the foreign bodies in 2 cases were initially confused with fungal hyphae, parasitic ova, vegetable material, and other surgical and nonsurgical materials. To add to our confusion, they were periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) positive, septated, spiked, and calcified. A history of Alvogyl dressing was retrospectively found. Learning from our mistakes and being aware of the histologic manifestations of Alvogyl fibers, the third case was correctly spotted. Because Alvogyl fibers are undissolvable and are not spontaneously eliminated, they may, if left for a long period, elicit tumefactive foreign body giant cell stromal and epithelial reactions that can be confused with inflammatory, infectious, and neoplastic lesions. Histologically, they can mimic infectious agents and noninfectious materials. Because history of dressing is not always provided, pathologists should be familiar with their histomorphologic features to avoid pitfalls and guide clinicians to correct diagnosis and management. In absence of history, certain histologic features are helpful hints.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-11-01T05:25:04Z
      DOI: 10.1177/1066896919884647
       
  • Low-Grade Appendiceal Mucinous Neoplasms: A Single Institution Experience
           of 64 Cases With Clinical Follow-up and Correlation With the Current
           (Eighth Edition) AJCC Staging
    • Authors: Mary Wong, Brad Barrows, Alexandra Gangi, Stacey Kim, Richard B. Mertens, Deepti Dhall
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background. In this single-institution study, we applied the current (eighth edition) American Joint Committee on Cancer pathologic staging criteria to 64 low-grade mucinous neoplasms of the appendix (LAMNs), examined their histopathologic features, and studied the patients’ clinical outcomes. Design. Sixty-four LAMNs, with a median follow-up of 52 months, were reviewed. Results. The distribution of pathologic stages was pTis (n = 39), pT3 (n = 1), pT4a (n = 5), pT4aM1a (n = 8), and pT4aM1b (n = 11). Recurrence was observed in only 2 patients (both with pT4aM1b disease), one of whom died of disease. All remaining patients were disease-free after a median clinical follow-up of 60 months. Conclusions. Our study confirms that pTis LAMNs have an excellent prognosis and suggests that pT4a and pT4aM1a LAMNs may also have a low risk of developing progressive disease.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-24T08:15:31Z
      DOI: 10.1177/1066896919883679
       
  • The Utility of ERBB4 and RB1 Immunohistochemistry in Distinguishing
           Chromophobe Renal Cell Carcinoma From Renal Oncocytoma
    • Authors: Tong Sun, Lloyd Hutchinson, Amy G. Zhou, Qingqing Liu, Ediz F. Cosar, Maryann St. Cyr, Nicole Ninteau, Karen Dresser, Liang Cheng, Zhong Jiang, Kristine M. Cornejo
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Objectives. Differentiating renal oncocytoma (RO) from chromophobe renal cell carcinoma (ChRCC) can occasionally be challenging. We evaluated the expression of RB1 and ERBB4 in RO and ChRCC, and compared the immunohistochemistry (IHC) results to RB1 and ERBB4 gene abnormalities detected by fluorescence in situ hybridization (FISH). Materials and Methods. Fifty-three kidney resections (ChRCC, n=28; RO, n=25) were stained for RB1 and ERBB4 IHC and FISH was performed to evaluate gene copy number analysis. Results. A loss of RB1 staining was identified in 64% (18/28) of ChRCCs, which was not found in any ROs (0/25; P
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-23T06:33:29Z
      DOI: 10.1177/1066896919883016
       
  • Primary Low-Grade B-Cell Lymphoma of Skull With Translocation Between
           Immunoglobulin and Interferon Regulatory Factor 4 Genes
    • Authors: Mansoor M. Nasim, David J. Chalif, Alexis M. Demopoulos, Judith Brody, Rova Lee-Huang, Silvia G. Spitzer, Jonathan E. Kolitz, Xinmin Zhang
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Low-grade B-cell lymphoma with immunoglobulin (IG) and interferon regulatory factor 4 (IRF4) gene rearrangement is extremely rare, with only 4 cases being previously reported. In this article, we report one additional case that arises from the skull and review the literature. The patient was a 69-year-old man who presented with recurrent and disabling vertigo and was found to have a 5.0 × 1.7 cm lesion within the left posterior parietal bone. Histological examination revealed a bone lesion with diffuse lymphoid infiltrate comprising of mostly small lymphocytes with scant cytoplasm, slightly irregular nuclei and inconspicuous nucleoli, and scattered larger cells resembling prolymphocytes and paraimmunoblasts. Immunohistochemical studies showed that the neoplastic cells were positive for CD20, CD79a, PAX5, CD23, CD43, BCL-2, BCL-6, MUM-1, LEF-1, and IgM and negative for CD5, CD10, cyclinD1, SOX11, and IgD. Flow cytometric analysis identified CD5 negative and CD10 negative monoclonal B cells with lambda light chain restriction. Fluorescence in situ hybridization analysis revealed del(13q) abnormality, but was negative for IGH/BCL2, IGH/CCND1, and BIRC3/MALT1 translocations. Next-generation sequencing identified IGK-IRF4 rearrangement and BRD4 E1113 del abnormalities. Given a low clinical stage (IE) of the disease, the patient did not receive additional treatments and was free of disease at 1 year after the diagnosis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-21T06:05:21Z
      DOI: 10.1177/1066896919883013
       
  • Uneven Distribution of Histologic Changes of “Blue Liver” Induced
           After Oxaliplatin-Based Chemotherapy for Colon Cancer
    • Authors: Akiko Fujii, Teppei Tateoka, Takashi Okuyama, Jun Matsushima, Taiki Sato, Yuko Ono, Shinichi Ban
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-18T05:05:10Z
      DOI: 10.1177/1066896919883407
       
  • Microscopic Placental Metastasis in Triple Negative Breast Carcinoma
    • Authors: Tiffany Renee Miller, Ashlie Elizabeth Rubrecht, Jaya Ruth Asirvatham, Mehmet R. Genc, Archana Shenoy
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-16T06:59:11Z
      DOI: 10.1177/1066896919880964
       
  • Poorly Cohesive (Signet Ring Cell) Carcinoma of the Ampulla of Vater
    • Authors: Deniz Tuncel, Olca Basturk, Kyle T. Bradley, Grace E. Kim, Yue Xue, Michelle D. Reid, Serdar Balci, Ipek Erbarut, Volkan Adsay
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      In the ampulla of Vater, carcinomas with “diffuse-infiltrative”/“signet ring cell” morphology, designated as “poorly cohesive carcinoma” (PCC) in the WHO classification, are very rare and poorly characterized. Nine cases with a classical PCC morphology constituting>50% of the tumor were identified. Mean age was 64.8 years (vs 64.6 in ampullary carcinomas [ACs]) and 6 were males, 3 females. The mean invasive tumor size was 2.5 cm (vs 1.9 in ACs). Other morphologic patterns displayed included cord-like infiltration (n=2), plasmacytoid cells (n=2), and microglandular component (n=4), including goblet cell adenocarcinoma-like foci. None of the cases were associated with dysplasia. By immunohistochemistry, the carcinomas did not show intestinal differentiation (CDX2 0/9, CK20 1/9, MUC2 3/9), MUC1 was positive in 4/9, MUC5AC was positive in 7/8. E-cadherin loss was noted in 4/9. All cases were advanced stage (6/9-pT3, 3/9-pT4) (vs 43% in ACs). Lymph node metastases were identified in 44% (vs 45% in AC). Six patients (67%) died of disease at a median of 25 months, 3 were alive at 13, 15, and 60 months. Overall median survival was significantly worse than that of intestinal-type ACs (26 vs 122 months, P = .006) and trended toward worse than pancreatobiliary type (26 vs 42 months, P = .1). In conclusion, PCCs constitute 2.45% of all ACs. These present as advanced tumors and express upper-gastrointestinal immunoprofile with frequent MUC5AC labeling, which may be helpful in identifying subtle infiltration in the surface mucosa since MUC5AC is not expressed in the ampullary mucosa. Patients have poor prognosis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-15T11:34:12Z
      DOI: 10.1177/1066896919880968
       
  • Angiosarcoma in Collision With a Merkel Cell Carcinoma: Case Report and
           Literature Review
    • Authors: Sean Hacking, Hector Chavaria, Leonard Khan, Kasturi Das
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Merkel cell carcinoma (MCC) is a rare entity that most commonly arises from the skin. Angiosarcoma (AS) is a rare malignancy with a predilection for elderly males, has endothelial differentiation and a notoriously poor prognosis despite aggressive therapy. Herein, we report an angiosarcoma colliding with a MCC, in a patient with a past medical history of squamous cell carcinoma, status-post radiation therapy. More specifically, our case represents a collision tumor, a rare entity composed of two histologically distinct neoplasms which coincide together at the same location. This case represents the first documented report of such a presentation. With that being said, its clinical course, prognosis, pathogenesis, and molecular profile, currently remains unclear. Importantly, neoplasms are increasingly being found to be associated with radiation therapy, of which our patient had received. Ultimately, however, with the lack of c-MYC immunohistochemical staining, and a short duration between radiation exposure and presentation, the AS in our case was likely coincidental.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-11T05:05:41Z
      DOI: 10.1177/1066896919880260
       
  • Mycobacterium Spindle Cell Pseudotumor Caused by Mycobacterium xenopi: A
           First Described Association of a Rare Entity Presenting in the Lung
    • Authors: Karina Furlan, Prih Rohra, Fatima Mir, Shenon Sethi, Abdullah Almajnooni, Paolo Gattuso, Nicholas Moore
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Mycobacterial spindle cell pseudotumor (MSP) is a rare benign lesion characterized by a proliferation of bland spindle-shaped histiocytes with vague granulomatous formation, positive for acid-fast bacilli staining. This lesion is usually reported in the lymph nodes and skin of immunocompromised patients; only 6 cases primary in the lung have been reported in the English literature to this date. In this article, we present the case of a 42-year-old female status post failed kidney-pancreas transplant with subsequent multiple kidney transplants, on chronic immunosuppression, who developed a mass in the left lower lobe consistent with MSP. Mycobacterium xenopi was identified in lung tissue culture, an association never previously described in literature. This case report alerts for the possible association of this rare form of non-tuberculous mycobacteria in the pathogenesis of MSP and highlights the importance of this differential diagnosis in lung masses of immunocompromised patients.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-11T04:52:44Z
      DOI: 10.1177/1066896919879745
       
  • Upper Urinary Tract Adenocarcinoma Arising in Tubular Adenoma—A Rare
           Entity: Report of 2 Cases and Review of Literature
    • Authors: Kaniyappan Nambiyar, Tushar Pandey, Debajyoti Chatterjee, Uma N. Saikia, Ravimohan S. Mavuduru
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Tubular adenoma of the urinary tract is a recently recognized entity, and there is a paucity of clinicopathological information. We describe 2 rare cases of adenocarcinoma of upper urinary tract arising in the background of tubular adenoma with high-grade dysplasia. The first case was an extremely uncommon combination of multifocal tubular adenomas involving ureter and renal pelvis and adenocarcinoma of kidney in a patient with renal calculi. The second case was of adenocarcinoma of kidney arising from tubular adenoma of renal pelvis in the right moiety of horseshoe kidney. There was no microsatellite instability. These findings indicate, probably, an adenoma-carcinoma pathway is also followed in the urinary tract similar to the gastrointestinal tract. To the best of our knowledge, no such observations are reported in the English literature previously.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-09T06:55:41Z
      DOI: 10.1177/1066896919880263
       
  • Myxoinflammatory Fibroblastic Sarcoma of Eyeball in an Infant: A Rare
           Presentation
    • Authors: Ekta Jain, Lata Kini, Rita Alaggio, Sarangarajan Ranganathan
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare soft tissue neoplasm most commonly occurring in the distal extremities of adult patients. It is a low-grade neoplasm with high rate of local recurrence but low rate of metastasis. We describe a case of MIFS of eyeball in an infant. An enucleation surgery was performed, and on the basis of histopathological and immunohistochemical evaluation, a diagnosis of MIFS was rendered. Till date more than 400 cases of MIFS have been reported with only a single case report of MIFS in an adult in iris. To the best of our knowledge, ours is the first case of MIFS in the eye in a child. Considering its rarity in children and especially in an infant (this seems to be the youngest patient in the literature), close follow-up is essential as the biology of these lesions cannot be predicted.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-09T06:53:31Z
      DOI: 10.1177/1066896919879497
       
  • Verruciform Xanthoma of the Esophagus: Two Case Reports With Review of the
           Literature
    • Authors: Hirotsugu Noguchi, Ikumi Kitazono, Kazumasa Hamada, Takako Tanaka, Takashi Tasaki, Hiroshi Shirahama, Yoshimasa Yamamoto, Akihide Tanimoto
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Verruciform xanthoma is a rare benign verrucopapillary lesion that develops in the oral mucosa and genital skin. Its development in the esophagus is extremely rare, with only 5 reported cases. We present 2 cases of verruciform xanthoma of the esophagus. Case 1 involved a 91-year-old woman, who had hypertension and chronic gastritis with Helicobacter pylori infection, with a 12-year history of a 10-mm white-yellow elevated lesion on the esophagus, 35 cm from the incisor teeth. Case 2 involved a 70-year-old man with fundic gland polyp, hyperlipidemia, and lung cancer, who had a 10-mm whitish granular/verrucoid lesion on the esophagus, 28 cm from the incisor teeth. Microscopically, these lesions show verrucous and papillomatous epithelial hyperplasia with neutrophilic intraepithelial exocytosis. The histological hallmark is the presence of numerous foamy histiocytes infiltrating the elongated squamous epithelial papillae. Although its etiology is unknown, irritation or trauma caused by radiotherapy has been suggested.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-09T06:32:51Z
      DOI: 10.1177/1066896919879495
       
  • Hematosalpinx: A Rare Yet Important Sign to Recognize
    • Authors: Badr AbdullGaffar
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-07T04:38:12Z
      DOI: 10.1177/1066896919880276
       
  • Intravascular Large B-Cell Lymphoma Involving Multinodular Goiter and
           Mimicking Carcinoma
    • Authors: Bryan Rea, Robert L. Peel, Min Han, N. Paul Ohori, Nidhi Aggarwal
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-30T06:49:37Z
      DOI: 10.1177/1066896919882121
       
  • A Breast Mouse or a Harebrained Fantasy'
    • Authors: Dhruv Jain, Honey Sachdeva
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-27T11:54:14Z
      DOI: 10.1177/1066896919877957
       
  • Fetal Glomeruli in a Mature Ovarian Teratoma: A Developmental Anomaly
           Within a Developmental Anomaly'
    • Authors: Sanjay A. Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-27T04:42:09Z
      DOI: 10.1177/1066896919877505
       
  • Localized Crystal-Storing Histiocytosis Involving Lower Rectum
    • Authors: Maurizio Zizzo, Loredana De Marco, Magda Zanelli, Valerio Annessi, Antonio Manenti, Stefano Ascani, Claudio Pedrazzoli
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-10T06:14:57Z
      DOI: 10.1177/1066896919874407
       
  • Just Blow It Off Because It’s Apocrine'
    • Authors: Daniel H. Russell
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-09T05:12:39Z
      DOI: 10.1177/1066896919873070
       
  • Intraoral Pleomorphic Adenoma With Extensive Bone Formation
    • Authors: Maria Eduarda Pérez-De-Oliveira, Amanda Almeida Leite, Thayná Melo de Lima Morais, Marcio Ajudarte Lopes, Oslei Paes de Almeida, Pablo Agustin Vargas
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-09T05:11:18Z
      DOI: 10.1177/1066896919872816
       
  • A Janus-Faced Uterus
    • Authors: Sanjay A. Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-08-26T05:53:09Z
      DOI: 10.1177/1066896919870863
       
  • Bronchoalveolar Lavage Findings in a Pediatric Patient With Primary
           Pulmonary Alveolar Proteinosis
    • Authors: Sameer Shivji, Reshma Amin, Juan Putra
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-08-23T06:08:57Z
      DOI: 10.1177/1066896919870598
       
  • Undifferentiated Pleomorphic Sarcoma With Emperipolesis
    • Authors: Charisse Liz Baste, Steven Garzon, Suman Setty
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-08-22T10:03:09Z
      DOI: 10.1177/1066896919869486
       
  • Clear Cell Endometrial Carcinoma In Situ (CCEIC) Exists!
    • Authors: K. M. Sadeq Islam, W. Dwayne Lawrence, M. Ruhul Quddus
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-08-16T07:22:09Z
      DOI: 10.1177/1066896919868021
       
  • Concomitant Gouty and Tuberculous Granulomatous Arthritis
    • Authors: Badr AbdullGaffar, Basem Abdul Hameed, Suleiman Fodeh, Rao Sreeram
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-07-29T09:28:51Z
      DOI: 10.1177/1066896919865778
       
  • The Impact of Extramural Venous Invasion in Colorectal Cancer: A Detailed
           Analysis Based on Tumor Location and Evaluation Methods
    • Authors: Young-Min Shin, Jung-Soo Pyo, Mee Ja Park
      First page: 120
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      This study aimed to elucidate the prognostic implications of extramural venous invasion (EMVI) in colorectal cancer (CRC) through a meta-analysis. Eighteen eligible studies were included in this meta-analysis. Data on the prevalence of EMVI and the correlation between EMVI and survival were collected from these studies. In addition, a subgroup analysis was conducted based on tumor location and evaluation methods. The estimated prevalence of EMVI was 28.3% (95% confidence interval [CI] = 23.1% to 34.0%) in patients with CRC. The estimated prevalence of EMVI in patients with colon cancer and rectal cancer was 23.0% (95% CI = 17.6% to 29.6%) and 35.7% (95% CI = 22.3% to 51.6%), respectively. Based on the evaluation method, the estimated prevalence of EMVI were 28.3% (95% CI = 23.2% to 34.1%) and 27.3% (95% CI = 8.4% to 60.6%) in pathologic and radiologic examinations, respectively. The correlation of EMVI with worse overall and disease-free survival rates was significant (hazard ratio = 1.773, 95% CI = 1.483-2.120, and hazard ratio = 2.059, 95% CI = 1.683-2.520, respectively). However, in the subgroup analysis with radiologic examination, there was no significant difference in survival rates between patients with and without EMVI. Our study showed that EMVI was frequently detected in 28.3% of patients with CRC and was correlated to worse survival. The detection of EMVI can be useful for predicting the prognosis of patients with CRC.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-23T05:33:31Z
      DOI: 10.1177/1066896919874493
       
  • A Distinctive Genomic and Immunohistochemical Profile for NOTCH3 and
           PDGFRB in Myofibroma With Diagnostic and Therapeutic Implications
    • Authors: Selene C. Koo, Katherine A. Janeway, Marian H. Harris, Christy J. Fryer, Jon C. Aster, Alyaa Al-Ibraheemi, Alanna J. Church
      First page: 128
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Introduction. Myofibromas are rare tumors of pericytic lineage, typically affecting children, and are sometimes aggressive. A subset of sporadic and familial myofibromas have activating variants in PDGFRB. The relationship of myofibroma and PDGFRB to the NOTCH pathway has not yet been described. Methods. Ten myofibroma cases were sequenced with a targeted panel of 447 genes, including copy number variation and selected fusions. Immunohistochemical analysis of total NOTCH3 and activated NOTCH3 was assessed for all 10 myofibroma cases, and a series of histologic mimics (n = 20). Results. Alterations identified by next-generation sequencing included PDGFRB sequence variants in 8/10 cases (80%), a NOTCH3 variant in 1/10 cases (10%), and a NOTCH2 variant in 1/10 cases (10%). All 10 cases also showed a pattern of low-amplitude (1.5- to 2-fold) copy number alterations including gains in PDGFRB and NOTCH3. Ten of 10 myofibromas (100%) showed cytoplasmic staining for total NOTCH3 and 9 of 10 cases (90%) showed nuclear staining for activated NOTCH3. Within the control cohort of histologic mimics, 3 of 3 nodular fasciitis cases (100%) were positive for activated and total NOTCH3, and the remaining 17 cases were negative for pan NOTCH3, while 3 of 3 desmoid-type fibromatosis cases (100%) showed patchy weak nuclear staining for activated NOTCH3. Discussion. Our findings suggest a common pathway of PDGFRB/NOTCH3 activation in myofibromas, even in cases that lack PDGFRB sequence variants. These results support the pericytic lineage of myofibroma. Identification of the characteristic genomic alterations or immunohistochemical staining pattern may facilitate a difficult pathologic diagnosis, and support the use of targeted treatments.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-30T06:44:17Z
      DOI: 10.1177/1066896919876703
       
  • Immunohistochemical and Molecular Diagnosis of Mucocutaneous and Mucosal
           Leishmaniasis
    • Authors: Celeste Sánchez-Romero, Hercílio Martelli Júnior, Vania Lúcia Ribeiro da Matta, Larisse Miranda Freitas, Carina de Mattos Soares, Fernanda Viviane Mariano, Oslei Paes de Almeida, Sibele Nascimento de Aquino
      First page: 138
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Leishmaniasis is a parasitic infection transmitted by the bite of infected female sandflies. It principally affects the skin, and the frequency of mucosal involvement is about 5% to 20%. Considering the rarity of leishmaniasis affecting the upper aerodigestive tract mucosa, we evaluated the characteristics of mucocutaneous leishmaniasis and mucosal leishmaniasis and the diagnostic difficulty when the parasites are scarce in tissue samples. The clinical, histopathological, histochemical, immunohistochemical, and molecular features of 17 cases of mucocutaneous leishmaniasis and mucosal leishmaniasis were assessed. Mucosal disease was principally found in the soft palate, oropharynx, and nose, manifesting mainly as a solitary ulcer. In hematoxylin and eosin–stained sections, 10 cases revealed abundant amastigotes within the macrophages. Giemsa staining was not shown to be helpful to confirm the diagnosis in 6 cases with scarce or nondetectable amastigotes. Immunohistochemistry (IHC) showed high sensitivity by positive staining in 14 out of 17 cases (82.3%). Polymerase chain reaction was shown to be more sensitive than IHC with 13 out of 14 (92.8%) positive cases, including the 3 IHC negative cases; however, this technique is not available in many endemic regions. In summary, we suggest that the IHC is a simple technique with rapid results and relatively low cost, when compared with other laboratorial procedures; thus, IHC is a helpful tool that should be implemented in the routine diagnosis of leishmania.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-30T06:45:17Z
      DOI: 10.1177/1066896919876706
       
  • Pure Discrete Punctate Nuclear Staining Pattern for MLH1 Protein Does Not
           Represent Intact Nuclear Expression
    • Authors: Qingzhao Zhang, Gloria Q. Young, Zhaohai Yang
      First page: 146
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Immunohistochemical staining for DNA mismatch repair (MMR) proteins is commonly used to screen for Lynch syndrome. Several laboratories have noticed a discrete punctate nuclear staining pattern for MLH1 that caused confusion in interpretation. This study was designed to investigate whether this particular staining pattern represents intact nuclear expression of MLH1. MMR proteins immunostaining and follow-up testing in 161 consecutive colorectal adenocarcinoma cases (86 biopsies, 75 resections) were retrospectively reviewed. Both discrete punctate nuclear staining and diffuse nuclear staining patterns for MLH1 were observed in internal control cells in 76 biopsies and 27 resections. Only diffuse nuclear staining was seen in the remaining 10 biopsies and 48 resections (P < .0001). Pure discrete punctate nuclear staining pattern for MLH1 was observed in 11 tumors (9 biopsies, 2 resections), and completely negative staining was seen in 13 tumors (2 biopsies, 11 resections; P = .003). Those 24 tumors (21 patients) invariably showed loss of PMS2. Three patients whose biopsies showed pure punctate staining for MLH1 underwent repeat testing on resections: 1 retained the punctate staining and 2 showed complete loss of MLH1. Nine patients who showed loss of PMS2 and pure punctate MLH1 staining underwent molecular testing: 4 had BRAF V600E mutations and 1 had MLH1 gene mutation. Our data showed that discrete punctate nuclear staining for MLH1 is more commonly seen in biopsy specimens. Pure discrete punctate staining pattern is paired with loss of PMS2 expression and may be associated with BRAF or MLH1 gene mutation, thus it should not be interpreted as intact nuclear expression.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-30T06:47:24Z
      DOI: 10.1177/1066896919878830
       
  • A Comparison of Hysterectomies for Bleeding With Hysterectomies for Pain
    • Authors: Bradley M. Turner, Stewart F. Cramer, Debra S. Heller
      First page: 153
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Objectives. We recently suggested that increased intramural pressure may often explain pain and/or bleeding. Hysterectomies for bleeding tend to have outward bulges and endometrial vascular ectasia, while hysterectomies for pain tend to have deflection of pressure inward by subserosal ridges, which promote inner myometrial elastosis (IME). Study design. We analyzed causes of increased intramural pressure in 58 hysterectomies for pain and/or bleeding, excluding clinically fibroid uteri and prolapsed uteri. Postfixation photographs were used to avoid missing grossly obvious myometrial hyperplasia (MMH). Results. The most common cause of increased intramural pressure was grossly obvious MMH in 40/58 cases (69%). Other causes included clinically occult myomas (3 cases), adenomyosis (6 cases), and multifactorial causes (7 cases). Hysterectomies for bleeding weighed more than hysterectomies for pain (P = .035). Hysterectomies for pain had more IME than hysterectomies for bleeding (P = .029). Conclusions. When subserosal ridges deflect pressure inward, bulky MMH may cause pelvic pain and IME, but when they do not, bulkier MMH in heavier uteri may lead to both outward bulges and abnormal bleeding from endometrial vascular ectasia.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-15T11:32:04Z
      DOI: 10.1177/1066896919879980
       
  • Leiomyomatosis Peritonealis Disseminata: A Clinical Analysis of 13 Cases
           and Literature Review
    • Authors: Juan Li, Shuyan Dai
      First page: 163
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Objective. Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease that is characterized by numerous small muscle nodules disseminated in the abdominal and pelvic cavity. This study analyzed the clinical features, pathologic characteristics, and prognosis of LPD. Methods. We retrospectively analyzed the clinical data of 13 patients with pathologically diagnosed LPD in Shengjing Hospital of China Medical University from January 2001 to January 2018. Results. Overall, 13 cases were collected. The mean age of the 13 patients was 42.23 years (range = 26-51 years). In all 13 female patients, 11 had a surgical history related to uterine leiomyoma, and only 2 had no history of treatment. Most of them were asymptomatic. Thirteen patients underwent resections of the tumors by laparoscopy or laparotomy. Pathological reports of 13 cases indicated LPD. Twelve cases were followed up, and 1 case was lost to follow-up. The median follow-up time was 65.67 months, and 2 patients showed evidence of recurrence. Conclusions. LPD is a rare disease in women of reproductive age. LPD manifests atypical symptoms, which can be easily misdiagnosed and confirmed by the pathological diagnosis. Surgery is the main treatment. Although LPD is a benign disease, a few patients had a tendency for recurrence or malignancy. Therefore, strict follow-up is needed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-16T06:57:45Z
      DOI: 10.1177/1066896919880962
       
  • Invasive Lobular Carcinoma With Extensive Clear Cells: A Pitfall in
           Diagnosis
    • Authors: Mark H. Kavesh, Daniel Sanchez, Jaya Ruth Asirvatham
      First page: 169
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Carcinomas in the breast with a predominantly clear cytoplasm are rare. In this article, we review the differential diagnosis of clear cell breast neoplasms and report a case of invasive lobular carcinoma with extensive clear cell morphology that was diagnosed as invasive ductal carcinoma, not otherwise specified, on ultrasound-guided biopsy. Lobular carcinomas with extensive clear cell change are unusual, but must be considered when evaluating a clear cell neoplasm in the breast.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-17T06:05:48Z
      DOI: 10.1177/1066896919881705
       
  • Mesonephric Remnants With Epididymis-Like Virilization in a Postmenopausal
           Woman
    • Authors: Andrea Hernandez, Alan Marcus
      First page: 173
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-05-30T06:35:26Z
      DOI: 10.1177/1066896919851209
       
  • Juniperus chinensis–Like Art-ifact on a Grocott-Gomori Methenamine
           Silver Stain
    • Authors: Fang Zhou, Alan Marcus
      First page: 175
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-06-04T10:48:39Z
      DOI: 10.1177/1066896919851184
       
  • Appendix Cyst
    • Authors: Adriana Handra-Luca, Mohamed Habib Ben Romdhane
      First page: 176
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-06-24T11:49:37Z
      DOI: 10.1177/1066896919857149
       
  • Sertoli Cell Tumor With Ossification and Adipose Tissue Differentiation
    • Authors: Nasma K. Majeed, Anastasia Sorokina, Nicholas Ree
      First page: 178
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-07-17T05:28:06Z
      DOI: 10.1177/1066896919860589
       
  • Odontogenic Carcinoma With Dentinoid in Long-Term Follow-up With 2
           Recurrences
    • Authors: Fernanda Viviane Mariano, Rogério Oliveira Gondak, João Figueira Scarini, Eduardo Caetano Albino da Silva, Gisele Caravina, Cristovam Scapulatempo-Neto, Oslei Paes Almeida, Albina Altemani, Adalberto Mosqueda Taylor
      First page: 181
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Dentinoid has been mentioned as a frequent component in several types of benign odontogenic tumors; however, there are some other very rare dentinoid-producing odontogenic tumors that have been described, which are not recognized in the current World Health Organization Histological Classification of Odontogenic Tumours. In this context, we report an unusual malignant odontogenic tumor containing dentinoid located in the left maxilla of a 41-year-old man. The lesion was initially diagnosed and treated as a cemento-ossifying fibroma. After 7 years, a tumor was noted at the same location and was diagnosed as pleomorphic adenoma. The patient developed a new lesion 2 years later. Histological features included an epithelial proliferation of basaloid and clear cells, some with peripheral palisading, which were scattered both in a fibrous stroma and within an amorphous eosinophilic dentinoid product. Because of doubts about the first 2 diagnoses and the current situation, all histopathological slides were reviewed in our service as a consultation case, and the findings were consistent with the diagnosis of an odontogenic carcinoma with dentinoid. Immunohistochemical analysis was performed and an ultrastructural study by scanning electronic microscopy and energy-dispersive X-ray microanalysis was made to characterize dentinoid material. After 1 year of follow-up, the patient is alive and free of the disease. This case highlights the wide variability regarding cytological evidence of malignancy, and adds a new case of odontogenic carcinoma with dentinoid, which represents a distinct entity with locally aggressive behavior and should be considered be included in a future World Health Organization Histological Classification of Tumours.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-05T10:47:27Z
      DOI: 10.1177/1066896919871662
       
  • Multi-Region Sequence Analysis of a Pregnancy-Related Oral Squamous Cell
           Carcinoma Exhibiting Low-Level Aggressive Behavior
    • Authors: Davide Bartolomeo Gissi, Andrea Gabusi, Achille Tarsitano, Roberto Rossi, Tiziana Balbi, Luca Morandi
      First page: 188
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      We analyzed the genetic and epigenetic profiles of an oral squamous cell carcinoma affecting a 41-year-old pregnant female. The patient presented with an oral mass located at the hard and soft palate with bone involvement and lymph node metastases (T4N1M0). She had been treated with multimodal radiotherapy and chemotherapy, and she is currently alive with no evidence of disease 8 years after treatment. DNA methylation and DNA mutation analyses were used to analyze multiple samples from the tumor mass and from the non-neoplastic mucosa to verify tumor heterogeneity. Genetic and epigenetic analyses revealed the presence of one shared TP53 driver mutation with the same DNA methylation profile in each of the 3 areas of the tumor mass; only 2 additional passenger mutations were detected, suggesting a simple clonal homogeneous carcinoma, which usually is associated with low-level aggressive behavior. Additionally, no genetic or epigenetic alteration in the non-neoplastic oral mucosa was detected, demonstrating the absence of field cancerization. The low aggressiveness of the lesion was confirmed by the patient being free of disease at a long-term follow-up examination. These data suggest a different molecular transformation pathway in pregnancy-related oral squamous cell carcinomas, providing new perspectives for further investigation.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-23T05:53:39Z
      DOI: 10.1177/1066896919876058
       
  • Tumor-to-Tumor Metastasis: Prostate Carcinoma Metastatic to Soft Tissue
           Sarcoma, a Previously Unreported Event
    • Authors: Virginia Miller, Jason Shih Hoellwarth, Margaret Lydia Hankins, Richard McGough, Karen Schoedel
      First page: 196
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Tumor-to-tumor metastasis is an unusual phenomenon wherein one distinct malignancy is present within the substance of another independent tumor. This event is rare, difficult to detect with imaging, and, due to conflicting terminology in the literature, can be challenging to classify. This article reports the first documented case of tumor-to-tumor metastasis involving prostatic adenocarcinoma and myxoid liposarcoma, reviews the available literature for carcinoma metastatic to sarcoma, and discusses the current situation within the context of the established criteria for the classification of combination tumors.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-06T12:00:02Z
      DOI: 10.1177/1066896919872805
       
  • Deceptive Giant Dedifferentiated Liposarcoma of the Esophagus: An
           Extremely Rare Surgical Case
    • Authors: Xiao-Xin Shi, Meng-Ying Liao, Li-Li Tao, Xin-Gen Wang, Wei-Hua Yin
      First page: 200
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Dedifferentiated liposarcoma rarely occurs in the esophagus. It always has atypical clinical manifestations and different pathologic features, which usually lead to misdiagnosis and mistreatment. Given its poor prognosis, early and accurate diagnosis is of the utmost importance. The accumulation of similar cases is critical for surgeons and pathologists to raise awareness of such tumors. This report aims to discuss the diagnosis and provide a reference for the clinical diagnosis and treatment for pathologists and clinicians.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-17T11:26:50Z
      DOI: 10.1177/1066896919873078
       
  • Sarcina Organisms in the Upper Gastrointestinal Tract: A Report of 3 Cases
           With Varying Presentations
    • Authors: Robert Propst, Laura Denham, Jeremy K. Deisch, Tejinder Kalra, Salman Zaheer, Kimberly Silva, Shino Magaki
      First page: 206
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Sarcina species are anaerobic gram-positive cocci rarely seen in the upper gastrointestinal tract and associated with delayed gastric emptying. We present 3 cases of Sarcina infection with varying clinical presentations including the first reported case of Sarcina in a patient with eosinophilic esophagitis. Although the pathogenesis of Sarcina is unclear, awareness of the bacteria is important as they can usually only be detected on histopathologic examination of upper gastrointestinal biopsies. Treatment in symptomatic patients may prevent severe complications such as emphysematous gastritis and gastric perforation.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-09T05:14:57Z
      DOI: 10.1177/1066896919873715
       
  • Mammary Paget’s Disease of the Male Breast: A Rare Case With an Unusual
           Immunohistochemical Profile
    • Authors: Samantha A. Moore, Hollis M. Notgrass, Travis W. Vandergriff, Sunati Sahoo
      First page: 210
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Mammary Paget’s disease is rare and comprises about 0.62% of all breast cancer cases, only 1.65% of which occur in male patients. This case report involves a 76-year-old man who presented to his primary care physician with an itching, scaly, unilateral lesion involving the nipple skin. He underwent wide local excision of the lesion for a diagnosis of Bowen’s disease (squamous cell carcinoma in situ). Histologic examination of the specimen revealed mammary Paget’s disease with ductal carcinoma in situ in the underlying breast tissue. A panel of immunohistochemical stains revealed the Paget cells to be positive for cytokeratin 7, MUC1, GATA3, and androgen receptor and negative for cytokeratins 5/6, p63, SOX10, and MART-1/Melan-A. Paget cells were also negative for estrogen receptor and progesterone receptor, and positive for HER2/neu. However, the underlying ductal carcinoma in situ was positive for both estrogen receptor and progesterone receptor and negative for HER2/neu. This discordance, supported by the current literature, suggests an alternative etiology for Paget’s disease in certain cases that cannot be explained by the well-established epidermotropic and transformative theories of Paget’s disease evolution.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-13T06:48:15Z
      DOI: 10.1177/1066896919874878
       
  • Chronic Myelogenous Leukemia Diagnosed in the Setting of Untreated Chronic
           Lymphocytic Leukemia/Small Lymphocytic Lymphoma
    • Authors: Kartik Viswanathan, Gail Roboz, Amy Chadburn, Susan Mathew
      First page: 216
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Chronic myeloid leukemia (CML) is rarely reported to occur in treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). In this article, we report a woman in her 70s, diagnosed with CLL/SLL in 2000, untreated, who subsequently presented 12 years later with de novo CML, BCR-ABL1+. Her IGHV mutated CLL/SLL based on the initial sample in our laboratory showed homozygous and heterozygous 13q14.3 deletions, whereas her CML, at presentation, showed a 46,XX,t(9;22)(q34;q11.2)[7]/46,XX[18] karyotype with a p190 BCR-ABL1 transcript. The tumor burden of each clone varied with treatment, including when treated with dasatinib, used to target both clones. In addition, the cytogenetic abnormalities evolved over time and treatments and included acquisition of an extra chromosome 8 in the CML clone and a novel K1992T ATM missense mutation (47% allele frequency) in the CLL/SLL clone. The patient’s last bone marrow biopsy, 5 years after her CML diagnosis and 17 years after the CLL/SLL diagnosis, showed residual CML with extensive involvement by CLL/SLL (80%). Cytogenetic studies showed a 46,XX karyotype, while FISH identified 13q14.3 deletion and the BCR-ABL1 translocation in the CLL/SLL and CML clones, respectively. To date, this is the fourth case of concurrent CML, BCR-ABL1+ arising in untreated CLL/SLL. Here we show dynamic variation in the size of the 2 clonal processes reflecting the variable responsiveness to specific therapies. In addition to the unusual BCR-ABL1+ p190 transcript in the patient’s CML, a novel ATM K1992T mutation was identified in the CLL/SLL population.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-23T05:54:18Z
      DOI: 10.1177/1066896919876704
       
  • Recurrent Pleomorphic Myxoid Liposarcoma in a Patient With Li-Fraumeni
           Syndrome
    • Authors: Somaye Y. Zare, Mariah Leivo, Oluwole Fadare
      First page: 225
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Pleomorphic myxoid liposarcoma is an extremely rare, clinically aggressive subtype of liposarcoma that has been primarily reported in young patients. In this article, we report a case of a pleomorphic myxoid liposarcoma that presented as a second primary neoplasm in a 34-year-old man with history of primary mediastinal large B-cell lymphoma. During the clinical workup, the patient was diagnosed with a germline TP53 gene mutation and Li-Fraumeni syndrome. The tumor, a 2.9 × 2.3 × 2.0 cm well-demarcated and solid mass, was centered in the anterior chest wall soft tissue. Histologically, most of the tumor displayed abundantly myxoid stroma, low cellularity of mostly bland spindle cells, delicate branching capillaries, and lipoblasts; these areas transitioned to small areas whose features were reminiscent of pleomorphic liposarcoma. As assessed by fluorescence in situ hybridization, the tumor showed no DDIT3 (CHOP) (12q13) rearrangements or MDM2 gene amplification. Clinically, the tumor progressed with multiple recurrences and metastasis to the humerus bone. To our knowledge, this is the first case of pleomorphic myxoid liposarcoma diagnosed in an adult with Li-Fraumeni syndrome.
      Citation: International Journal of Surgical Pathology
      PubDate: 2019-09-27T11:59:23Z
      DOI: 10.1177/1066896919878804
       
  • Corrigendum to Odontogenic Carcinoma With Dentinoid in Long-Term Follow-up
           With 2 Recurrences
    • First page: 229
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2019-10-21T10:28:28Z
      DOI: 10.1177/1066896919884470
       
 
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