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PATHOLOGY (100 journals)

Showing 1 - 100 of 100 Journals sorted alphabetically
Academic Pathology     Open Access   (Followers: 5)
Acta Neuropathologica Communications     Open Access   (Followers: 1)
Advances in Anatomic Pathology     Hybrid Journal   (Followers: 22)
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: 33)
American Journal of Dermatopathology     Hybrid Journal   (Followers: 18)
American Journal of Forensic Medicine and Pathology     Hybrid Journal   (Followers: 30)
American Journal of Pathology     Hybrid Journal   (Followers: 33)
American Journal of Surgical Pathology     Hybrid Journal   (Followers: 39)
Analytical Cellular Pathology     Open Access   (Followers: 3)
Annals of Cytology and Pathology     Open Access   (Followers: 3)
Annals of Diagnostic Pathology     Hybrid Journal   (Followers: 15)
Annals of Oral & Maxillofacial Surgery     Open Access   (Followers: 7)
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: 31)
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: 7)
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: 24)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Case Reports in Clinical Pathology     Open Access   (Followers: 1)
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: 14)
Der Pathologe     Hybrid Journal   (Followers: 2)
Dermatopathology     Open Access   (Followers: 3)
Diagnostic Cytopathology     Hybrid Journal   (Followers: 15)
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: 30)
Human Pathology     Hybrid Journal   (Followers: 30)
Indian Journal of Pathology and Microbiology     Open Access   (Followers: 4)
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: 3)
International Journal of Oral & Maxillofacial Pathology     Open Access   (Followers: 9)
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: 5)
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: 2)
Journal of Pathology of Nepal     Open Access   (Followers: 1)
Journal of Physiology and Pathophysiology     Open Access   (Followers: 1)
Modern Pathology     Hybrid Journal   (Followers: 32)
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 Bacteriology     Open Access   (Followers: 2)
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: 12)
Pathology & Oncology Research     Hybrid Journal   (Followers: 5)
Pathology - Research and Practice     Hybrid Journal   (Followers: 4)
Pathology and Laboratory Medicine International     Open Access   (Followers: 7)
Pathology International     Hybrid Journal   (Followers: 2)
Pathology Research International     Open Access   (Followers: 1)
Pediatric and Developmental Pathology     Hybrid Journal   (Followers: 5)
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  [1092 journals]
  • Role of SMARCA4 (BRG1) and SMARCB1 (INI1) in Dedifferentiated Endometrial
           Carcinoma With Paradoxical Aberrant Expression of MMR in the
           
    • Authors: Ramandeep Kaur, Jay Mehta, Anita M. Borges
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      IntroductionDedifferentiated endometrial carcinoma is an uncommon highly aggressive uterine tumor. It comprises 2 components: a well-differentiated, low-grade epithelial carcinoma and an undifferentiated carcinoma. The undifferentiated carcinoma frequently exhibits rhabdoid cytologic features. Many of these tumors are characterized by an aberrant switch/sucrose non-fermenting (SWI/SNF) complex. They may also exhibit aberrant expression of mismatch repair (MMR) proteins. Together, these play an important role in the pathogenesis and aggressive nature of the tumor.Material and MethodsWe present a case of dedifferentiated endometrial carcinoma in a 63-year-old female showing loss of expression of SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4/BRG1), and aberrant expression of MMR proteins. We also review the literature starting from the earliest recognition of this entity and the various studies done to explain its molecular pathogenesis and prognostic importance.Results and ConclusionsRecognition of SWI/SNF complex-deficient dedifferentiated endometrial carcinoma is important as these tumors do not respond to platinum-based chemotherapy, and consideration of alternative therapies is often necessary. We also want to emphasize that though most of the studies have found MMR deficiency in the undifferentiated carcinoma component, it may be seen only in the low-grade, well-differentiated component, as observed in this case.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-09-17T11:21:04Z
      DOI: 10.1177/1066896920959453
       
  • Epithelium Involving Bilateral Axillary Lymph Nodes: Metastasis,
           Misplaced, or Mullerian!
    • Authors: Kamaljeet Singh, Ruhani Sardana, M. Ruhul Quddus, Malini Harigopal
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      During breast cancer staging, histological evaluation of axillary sentinel lymph nodes (SLN) is usually straightforward. However, the exact characterization of a small epithelial deposit in an SLN can be challenging, especially during the frozen section examination. We report the first case of endosalpingiosis involving bilateral axillary lymph nodes. We review published literature on axillary endosalpingiosis and discuss the differential diagnosis of small epithelial deposits in an axillary SLN. Pathologists should consider benign epithelial rests and displaced epithelium as differential diagnoses for the microscopic epithelial nodal deposit, especially during the frozen section examination.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-09-14T06:55:40Z
      DOI: 10.1177/1066896920958121
       
  • Mixed Invasive Apocrine Papillary/Micropapillary Carcinoma of the Breast:
           Another Brick in the Triple-Negative Wall
    • Authors: Luca Cima, Nicola Mirabassi, Chiara Sartori, Francesco Giuseppe Carbone, Luca Morelli, Gábor Cserni, Mattia Barbareschi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Pure invasive papillary carcinoma (IPC) is a rare subtype of breast carcinoma with good prognosis compared with classical invasive breast carcinoma (IBC) of no special type. The majority of IPC are estrogen receptor and progesterone receptor (ER/PR) positive and HER2 negative (luminal A-like). We report the case of a 72-year-old women who was referred to the Senology Clinic for a routine workup following surgery for an intraductal papilloma. The core needle biopsy (CNB) showed a lesion mainly composed of irregular papillae and micropapillae with apocrine epithelial cells of low-to-intermediate nuclear grade, without a myoepithelial cell layer within the papillae and at the periphery, as demonstrated with multiple immunostains. The diagnosis of apocrine papillary lesion of uncertain malignant potential was made. The subsequent lumpectomy showed an IBC with the same cyto-architectural features as the CNB. In addition, lymphovascular invasion and papillary/micropapillary apocrine in situ lesion were noted. Notably, the tumor was ER/PR and HER2 negative and strongly positive for androgen receptor. A final diagnosis of mixed apocrine papillary/micropapillary carcinoma with triple-negative status was made. To the best of our knowledge, this is the first report of an IBC with these features. Breast pathologists should be aware of this entity when dealing with CNB samples characterized by a complex papillary lesion with apocrine atypia that lacks a myoepithelial cell layer on multiple immunostains. These lesions should be classified at least as of uncertain malignant potential based on the cyto-architectural features prompting a surgery for removal.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-09-10T09:55:52Z
      DOI: 10.1177/1066896920954920
       
  • Biphasic Squamoid Alveolar Renal Cell Carcinoma of the Kidney Involved by
           Atypical CD5-Positive B-Cells
    • Authors: Xiaotun Zhang, Maria Tretiakovam
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Biphasic squamoid alveolar renal cell carcinoma (BSARCC) is a recently described kidney cancer entity with
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-09-10T09:55:31Z
      DOI: 10.1177/1066896920957089
       
  • Gynecological Sarcomas: Molecular Characteristics, Behavior, and
           Histology-Driven Therapy
    • Authors: Michela Libertini, Magnus Hallin, Khin Thway, Jonathan Noujaim, Charlotte Benson, Winette van der Graaf, Robin L. Jones
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Gynecological sarcomas represent 3% to 4% of all gynecological malignancies and 13% of all sarcomas. The uterus is the most frequent primary site (83%); less frequently sarcomas are diagnosed originating from the ovary (8%), vulva and vagina (5%), and other gynecologic organs (2%). As the classification of gynecologic sarcomas continues to diversify, so does the management. Accurate histopathologic diagnosis, utilizing appropriate ancillary immunohistochemical and molecular analysis, could lead to a more personalized approach. However, there are subtypes that require further definition, with regard to putative predictive markers and optimal management. The aim of this review is to highlight the importance of accurate diagnosis and classification of gynecologic sarcoma subtypes by the surgical pathologist in order to provide more tailored systemic treatment, and to highlight the increasing importance of close collaboration between the pathologist and the oncologist.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-09-10T09:55:12Z
      DOI: 10.1177/1066896920958120
       
  • A Tale of 2 Morphologies: Diagnostic Pitfalls in TFEB-Associated Renal
           Cell Carcinomas, Including a Novel NEAT1-TFEB Fusion
    • Authors: Aarti E. Sharma, Megan Parilla, Pankhuri Wanjari, Jeremy P. Segal, Tatjana Antic
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      AimsTranslocation-associated renal cell carcinomas (RCCs) have been extensively subcharacterized in recent years, such that each is largely recognized by the 2016 World Health Organization as categorical neoplastic entities in the genitourinary tract. Those belonging to the t(6;11) family of tumors classically have a fusion between TFEB and MALAT1/α, and display a particular histomorphology. Specifically, they show a biphasic population of both small and large epithelioid cells, the smaller component of which surrounds basement membrane-type material. Despite this apt description, the tumors have variable morphology and mimic other RCCs including those with TFE3 translocations. Therefore, a high degree of suspicion is required to make the correct diagnosis.MethodsThe 2 cases described in this article were of strikingly different appearance, and initially considered consistent with other non-translocation–associated renal tumors. These included clear cell RCC (CCRCC), perivascular epithelioid cell tumor (PEComa), and other eosinophilic RCCs (mainly papillary RCC type 2).ResultsUsing RNA sequencing techniques, they were found to harbor distinct pathogenic rearrangements involving the TFEB gene, namely, fusions with CLTC and NEAT1 (the latter partnering heretofore never reported).ConclusionsThese alterations manifested in 2 notably dissimilar lesions, underscoring the importance of including this family of carcinomas in the differential of any renal neoplasm that does not display immunophenotypic characteristics consistent with its morphology.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-09-04T01:05:28Z
      DOI: 10.1177/1066896920956272
       
  • Sex Cord Tumor With Annular Tubules–Like Histologic Pattern in Adult
           Granulosa Cell Tumor: Case Report of a Hitherto Unreported Morphologic
           Variant
    • Authors: Ruby J. Chang, Jacquelyn Reuther, Ilavarasi Gandhi, Angshumoy Roy, Shilpa Jain, Ramya P. Masand
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Adult granulosa cell tumor (AGCT) and sex cord tumor with annular tubules (SCTAT) are distinct sex cord stromal tumors with different molecular signatures. We present a unique case of an incidental ovarian tumor with mixed AGCT and SCTAT morphologic patterns. Due to the unusual co-occurrence, molecular testing was separately performed on both components. Despite minimal overlap in morphology, both the SCTAT and AGCT components were found to have an identical mutation profile, including the prototypical FOXL2 p.C134W mutation characteristic of AGCT. We thus present the first report of AGCT with SCTAT-like pattern.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-28T11:26:04Z
      DOI: 10.1177/1066896920953620
       
  • Monomorphic Epitheliotropic Intestinal T-cell Lymphoma of the Stomach: Two
           Case Reports and a Literature Review
    • Authors: Susu Lu, Gang Zhou, Min Chen, Weiping Liu, Sha Zhao
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      We describe the clinicopathologic and molecular features of 2 cases of gastric monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), which were first diagnosed from gastric biopsies, one was primary whereas the other was gastric involvement by MEITL. Both cases were older men with stomach ulcers. Case 1 was admitted for a hemorrhage in the upper digestive tract and case 2 for edema. Histology of both cases showed infiltrated monomorphic and medium-sized lymphocytes with lymphoid epithelial phenomenon. An inflammatory background and vascular hyperplasia were also observed likely due to the ulceration. Neoplastic cells expressed CD2, CD3, CD7, CD8, CD56, TIA-1, and MYC, not CD5, CD4, Granzyme B, CD20, CD30, TdT, or EBER. Both lymphomas showed TCRG gene rearrangement and c-MYC gains. Moreover, we first affirmed polysomy of chromosome 8 in case 2. For correct diagnosis of this rare tumor at the rare location, it is important that pathologists raise the possibility and exclude other differential diagnoses.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-28T11:25:45Z
      DOI: 10.1177/1066896920953906
       
  • Two Cases of Intraosseous Pseudomyogenic (Epithelioid Sarcoma-Like)
           Hemangioendothelioma With Unusual Features, Expanding the
           Clinicopathological Spectrum
    • Authors: Bharat Rekhi, Swapnil Rane, Ajay Puri
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Pseudomyogenic (epithelioid sarcoma–like) hemangioendothelioma (PMHE) is a distinct vascular neoplasm mostly observed in the lower extremities of young adults with characteristic histopathological features. In this article, we present 2 unusual cases of PMHE. Case 1: A 28-year-old male presented with pain and stiffness in his left shoulder. Radiologic examination revealed an expansile, lytic, heterogeneously enhancing, destructive lesion in his left scapula, along with multiple avid marrow lesions in his other bones. Biopsy revealed a cellular tumor composed of plump spindly and epithelioid cells arranged in fascicles and focally, in clusters, admixed with neutrophils and histiocytes, with interspersed many osteoclast-like giant cells and reactive bone. Case 2: A 63-year-old male presented pain and swelling in his right middle finger, with no other lesion elsewhere in his body. Radiologic imaging disclosed a 1.5-cm-sized lobulated, expansile, lytic, destructive lesion in the distal end of the third metacarpal bone of his right hand. Biopsy examination revealed a cellular spindle cell tumor, composed of plump spindly cells, arranged in fascicles, including “tadpole-like” or “strap-like” cells and interspersed inflammatory cells. Immunohistochemically, tumor cells in both cases were positive for AE1/AE3, CD31, and Fli1, while negative for desmin and CD34. INI11 was retained. The presented cases of PMHE, occurring at unusual locations, in an older individual in the second case, along with variable histopathological features, noted in the first case, seem to expand the clinicopathological spectrum of these uncommon neoplasms. Differential diagnoses and review of similar cases are presented.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-27T11:29:02Z
      DOI: 10.1177/1066896920951841
       
  • Recanalization-Like Neovascularization of Placental Intervillous Hematoma:
           First Two Reports
    • Authors: Fang Zhou, Alan Marcus
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Placental intervillous hematomas have not previously been reported to undergo any sort of change, maturation, or healing. In this article, we present the first 2 case reports of recanalization-like neovascularization within placental hematomas: a 0.15 cm focus in an intervillous fibrin thrombus and a 0.2 cm focus in a subchorionic hematoma. Increased recognition and further studies are needed to gain a better understanding of this seemingly rare phenomenon and the factors that govern the lack of typical organization in placental hematomas. This might lead to a deeper knowledge of the repair process in general and shed light on how to control it in diseases caused by excessive repair.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-26T09:26:43Z
      DOI: 10.1177/1066896920951914
       
  • Clinicopathologic Characteristics of Esophageal Ectopic Sebaceous Glands:
           Chronological Changes and Immunohistochemical Analysis
    • Authors: Hirotsugu Hashimoto, Hajime Horiuchi, Sakiko Miura, Shunya Takayanagi, Toshiaki Gunji, Teppei Morikawa
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Esophageal ectopic sebaceous glands are very rare lesions. A series of 5 cases in a single report has been the maximum number described in the English literature to date. We conducted a clinicopathologic study of 8 cases of esophageal ectopic sebaceous glands. The median patient age at the time of diagnosis was 60 years (range, 50-71 years), and 7 of the 8 patients were male. A focal lesion was observed in 7 cases, whereas 1 case exhibited multiple lesions throughout the esophagus. Four patients had previously undergone upper gastrointestinal endoscopy; in 3 patients, the focal lesion had not been detected. After diagnosis, 3 cases showed spontaneous regression at least once. Immunohistochemically, sebocytes of all 8 cases were negative for the estrogen receptor (ER) and the progesterone receptor (PgR), whereas sebocytes of 5 cases were positive for the androgen receptor (AR). Basal/parabasal cells were positive for AR, ER, and PgR in 5, 7, and 4 cases, respectively. GATA3 was expressed in the sebocytes and basal/parabasal cells of 6 out of 7 available cases, whereas all of 7 available cases were negative for mammaglobin and GCDFP15. Our report provides the basic clinicopathologic characteristics of esophageal ectopic sebaceous glands by the largest case series reported in English literature to date. Furthermore, the chronological changes, particularly spontaneous regression, and immunohistochemical expression of hormone receptors and GATA3 are compatible with lesions resulting from congenital misplacement under hormonal regulation. Therefore, they seem to be congenital misplacements detectable as a result of hormonal stimulated growth.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-26T09:21:50Z
      DOI: 10.1177/1066896920951844
       
  • First Molecular Genetic Characterization of Skene’s Gland
           Adenocarcinoma
    • Authors: Jiří Lenz, Michal Michal, Michael Michal, Ondřej Hes, Petra Konečná, David Lenz
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Primary urethral adenocarcinomas are very rare neoplasms accounting for
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-14T01:52:45Z
      DOI: 10.1177/1066896920947808
       
  • Cancer in Disguise!
    • Authors: Abhijeet Ingle, Roshan F. Chinoy
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-14T01:52:15Z
      DOI: 10.1177/1066896920950818
       
  • Inflammatory Pseudotumor-Like Follicular/Fibroblastic Dendritic Cell
           Sarcomas of the Spleen Are EBV-Associated and Lack Other Commonly
           Identifiable Molecular Alterations
    • Authors: Frido K. Bruehl, Elizabeth Azzato, Lisa Durkin, Daniel H. Farkas, Eric D. Hsi, Sarah L. Ondrejka
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Inflammatory pseudotumor-like follicular/fibroblastic dendritic cell sarcoma (IPT-like FFDCS) is a rare, indolent neoplasm that occurs in the spleen or liver and harbors Epstein-Barr virus (EBV) integrated into the host genome. The molecular genetic characteristics of IPT-like FFDCS have not been well studied and there are no established and actionable molecular features to guide treatment decisions or diagnosis beyond the recognition of viral genome integration. We subjected two cases of IPT-like FFDCS to a comprehensive next-generation sequencing analysis. Several variants of uncertain clinical significance were detected in both tumors. No variants of potential or strong clinical significance were detected within the targeted regions of the evaluated genes. Additionally, no fusion events were detected involving the genes in either tumor. The performed molecular analysis identified no genetic aberrations in IPT-like FFDCS and its genomic landscape remains, with the exception of a monoclonal EBV gene, largely undefined.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-13T06:54:30Z
      DOI: 10.1177/1066896920949675
       
  • Aberrant TTF-1 Expression in Peripheral T-Cell Lymphomas: A Diagnostic
           Pitfall
    • Authors: Sheng-Tsung Chang, Shang-Wen Chen, Bo-Jung Chen, Shien-Tung Pan, Kennosuke Karube, Shih-Sung Chuang
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      BackgroundThyroid transcription factor-1 (TTF-1) is a useful marker for identifying thyroid and lung cancers in diagnostic pathology, particularly for the investigation of unknown primary cancers. However, some other tumors such as colorectal cancer might aberrantly express TTF-1, particularly with the less specific clone SPT24. Occasional diffuse large B-cell lymphoma (DLBCL) cases have been reported to be TTF-1-positive, yet there is no information on TTF-1 expression in peripheral T-cell lymphoma (PTCL).MethodsWe investigated a series of PTCL and DLBCL by immunohistochemistry for TTF-1 expression using 2 commercially available clones.ResultsWe found that 33% (5/15) adult T-cell leukemia/lymphomas (ATLLs) and 25% (2/8) angioimmunoblastic T-cell lymphomas (AITLs) were positive by clone SPT24 and only 2ATLL cases were positive by clone 8G7G3/1. Overall TTF-1 expression rates of PTCL by SPT24 and 8G7G3/1 were 16% (7/43) and 5% (2/43), respectively. All DLBCLs were negative.ConclusionAlthough TTF-1 is a relatively specific marker for thyroid and lung cancers, it might be expressed in some lymphomas, particularly PTCL when using clone SPT24. Pathologist should be aware of this possible diagnostic pitfall when using TTF-1 in investigating tumors of unknown origin.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-10T09:43:22Z
      DOI: 10.1177/1066896920946835
       
  • Giardia Is Often Overlooked on Histopathologic Examination: A High-Volume,
           Single-Institution Experience
    • Authors: Minqian (Jasmine) Shen, Lysandra Voltaggio, Scott Robertson
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Aims. Giardiais sometimes missed by the pathologist, and we sought to determine how often this occurs at our institution—a large tertiary care center with a subspecialty gastrointestinal pathology service and what certain clinical and histologic clues can be used to flag cases with a higher likelihood of infection, targeting them for greater scrutiny.Methods and ResultsWe identified a set of patients who tested positive for Giardia with a stool-based test, and who also received a small bowel biopsy at a similar time-point. These biopsies were retrospectively reviewed for Giardia, finding 8 positive cases. The organism was prospectively detected in 4 cases (50%) but overlooked in the remaining 4 cases (50%). Three of the 4 cases missed cases showed only rare organisms. The detected cases tended to more frequently have prominent lymphoid aggregates (3 detected cases, 0 overlooked cases) and intraepithelial lymphocytosis (3 detected cases, 0 overlooked cases). Certain clinical and histologic clues can be used to flag cases with a higher likelihood of infection. Specifically, we found abnormalities of the mucosa (active inflammation, intraepithelial lymphocytosis, villous expansion, prominent lymphoid aggregates) in each case, and 4 of 8 cases were from immunocompromised patients. Finally, 2 of 8 cases were terminal ileum biopsies.ConclusionsBiopsies with a histologic abnormality or those from immunocompromised patients should receive greater attention. Routinely looking for Giardia at that terminal ileum is necessary.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-10T09:42:52Z
      DOI: 10.1177/1066896920947795
       
  • Small Cell Carcinoma of the Ovary: Clinicopathologic and
           Immunohistochemical Analysis of 7 New Cases of a Rare Malignancy
    • Authors: Parikshaa Gupta, Gargi Kapatia, Nalini Gupta, Pranab Dey, Manish Rohilla, Ankita Gupta, Bhavana Rai, Vanita Suri, Arvind Rajwanshi, Radhika Srinivasan
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      BackgroundSmall cell carcinoma of ovary (SCCO) is extremely rare. Two types of SCCO are recognized, the pulmonary type (SCCOPT) and the hypercalcemic type (SCCOHT). Establishing an accurate diagnosis is challenging, owing to its rarity and paucity of data describing the distinctive histopathologic and immunohistochemical (IHC) features.MethodsThis was a retrospective study conducted over a period of 4 years. All cases reported as SCCO on histopathology were retrieved. All the available clinical, histopathological, and IHC features were studied in detail.ResultsA total of 7 cases of SCCO were diagnosed during the study period. There were 4 cases of SCCOPT and 3 cases of SCCOHT and with mean age of 57.25 and 22 years, respectively. All the cases presented as stage IV disease. Among the SCCOPT cases, 3 showed bilateral involvement with 1 showing concurrent uterine endometrioid adenocarcinoma. Microscopy revealed small hyperchromatic cells with brisk mitosis and multifocal necrosis. On IHC, these were consistently positive for chromogranin, CD56, and synaptophysin. All the SCCOHT cases showed unilateral involvement. Microscopically, in addition to small hyperchromatic cells, larger “rhabdoid” tumor cells were also seen. On IHC, chromogranin was negative, with positivity for vimentin and epithelial membrane antigen. The expression of SMARCA4/BRG1 was lost while SMARCB1/INI1 was retained in all cases. All of these patients developed recurrence and died due to disease progression despite treatment.ConclusionsSCCO is an extremely infrequent ovarian malignancy with poor prognosis. Knowledge about its characteristic features is important for accurate tissue diagnosis and appropriate management.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-10T09:42:23Z
      DOI: 10.1177/1066896920947788
       
  • A Novel Case of Mammary-Type Myofibroblastoma With Sarcomatous Features
    • Authors: Alexander M. Strait, Konstantinos Linos, Laura J. Tafe, Kristen E. Muller
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Mammary-type myofibroblastoma (MFB) is a benign spindle cell tumor of the breast and soft tissue characterized by 13q14 alterations leading to loss of Rb-1 protein expression, a feature shared among spindle cell lipoma and cellular angiofibroma. In this article, we present a novel case of MFB arising in the left breast of a 70-year old man that microscopically showed an abrupt transition from classic MFB morphology to an area with cytologic atypia and mitotic activity, akin to sarcomatous transformation described in cellular angiofibromas. A thorough workup of the molecular underpinnings of both components using chromosomal microarray and next-generation sequencing platforms supported a clonal relationship. Nearly identical copy number changes, including a single copy loss of 13q14, were found in both components; in addition, the sarcomatous component harbored biallelic TP53 alterations. It is important for pathologists to recognize that sarcomatous features can occur in mammary-type MFB to arrive at the correct diagnosis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-05T07:35:12Z
      DOI: 10.1177/1066896920947465
       
  • Thyroid Adenoma of Probable Ultimobranchial Body Origin: A Case Report
    • Authors: K. K. W. Yuen, A. N. H. Chan, J. K. C. Chan, W. Cheuk
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Solid cell nests are generally believed to represent remnants of the ultimobranchial body, which can be found in the normal thyroid gland, occasionally associated with other branchial pouch remnants such as salivary gland, cartilage, and adipose tissue. We describe the case of a 44-year-old man incidentally found to have a large tumor in the left lobe of the thyroid. The tumor was a circumscribed growth consisting of distinctly lobulated proliferation of solid to cystic epidermoid cell nests and thyroid follicles in a fibromatous stroma, which merged into abundant adipose tissue and focally myxoid matrix. The solid epidermoid cell nests resembled solid cell nests and exhibited a p63+, GATA3+, galectin-3+, TTF1−, PAX8−, thyroglobulin− phenotypes, while the follicles were p63−, GATA3−, galectin-3−, TTF1+, PAX8+, and thyroglobulin+. RAS mutations were not found. This thyroid tumor may represent a hitherto undescribed “ultimobranchial body adenoma” in human.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-08-04T07:46:44Z
      DOI: 10.1177/1066896920946444
       
  • Oral Amelanotic Melanomas: Clinicopathologic Features of 8 Cases and
           Review of the Literature
    • Authors: Ciro Dantas Soares, Román Carlos, Bruno Augusto Benevenuto de Andrade, John Lennon Silva Cunha, Michelle Agostini, Mário José Romañach, Juan Carlos Hernandez-Guerrero, Adalberto Mosqueda-Taylor, Oslei Paes de Almeida, Jacks Jorge
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Mucosal melanomas are aggressive tumors, rarely observed in the oral cavity. The diagnosis is based on the clinical and microscopical features. Often these tumors had variable amounts of melanin pigmentation. However, when melanin is absent, the tumors are denominated amelanotic, presenting a tendency to misdiagnosis and delayed treatment. The aim of this study was to describe the clinicopathologic features of a series of oral amelanotic melanomas (OAM). Records of all cases of OAM were retrospectively retrieved from oral pathology services from January 2002 to January 2019. Data regarding the clinical features, morphological aspects, immunohistochemical reactions, treatment, and follow-up status were collected. Eight cases of OAM were included, 6 in men and 2 in women (ratio of 3:1) ranging in age from 33 to 77 years (mean 53.6 years). Clinically, the tumors presented as masses or ulcerated swellings. The most common intraoral locations of the tumors were gingiva and palate. Cervical lymph node metastasis was detected in 3 patients at the first examination. All but one patient died from complications of the tumors after a mean follow-up period of 8.5 months. In conclusion, OAM is a very aggressive malignant tumor, and when melanin is absent, an immunohistochemical panel comprising S100, melan A, HMB45, and SOX10 should be performed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-31T11:52:19Z
      DOI: 10.1177/1066896920946435
       
  • “Two to Tango” in Mitosis
    • Authors: Lavina Tikamchand Loungani, Rajesh Mundhe, Roshan F. Chinoy
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-31T11:52:19Z
      DOI: 10.1177/1066896920946832
       
  • Conjunctival Stromal Tumor: Report of 2 New Cases and Review of the
           Literature
    • Authors: Jonathan Lam, Andrea Ang, Tersia Vermeulen, Nima Mesbah Ardakani
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Conjunctival stromal tumor (COST) is an emerging entity with only a limited number of cases reported in the literature. In this report, we describe 2 additional cases, review the accumulative clinical and histopathological features and expand on the immunophenotypic property of this entity. COST appears to have a sporadic presentation, affecting both sexes and patients of variable ethnicity and age group and predominantly occurring on the bulbar conjunctiva as a slow-growing asymptomatic or slightly tender mass-like lesion. Histopathologically, COST is characterized by singly dispersed spindle to round cells, often with some degree of degenerative nuclear atypia, within a myxomatous to collagenous stroma. Lesional cells are characteristically positive for CD34 and vimentin, negative for S100, SOX10 and STAT6 and show a normal pattern of staining with RB1 by immunohistochemistry. The reported cases to date have shown an indolent biological behavior, reliably treated by a complete surgical excision.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-29T09:47:08Z
      DOI: 10.1177/1066896920945783
       
  • Response to “‘Dysplastic Lipoma’ Is Probably Not a Separate Entity
           but Rather Belongs to the Morphological Spectrum of Atypical Spindle
           Cell/Pleomorphic Lipomatous Tumor”
    • Authors: Michael A. den Bakker
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-28T10:59:00Z
      DOI: 10.1177/1066896920946174
       
  • Mucinous Adenomyomatous Pulmonary Hamartoma: Clinicopathologic,
           Immunohistochemical, and Molecular Features of 6 Cases
    • Authors: Giulio Rossi, Alberto Cavazza, Camilla Comin, Genny Jocollé, Agita Jukna, Matteo Rotellini, Fabio Davoli, Thomas Colby
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Pulmonary hamartoma (PH) may show various combinations of mesenchymal tissues with entrapment of respiratory epithelium. An uncommon variant of PH prevalently consisting of smooth muscle with mucinous proliferation has been reported in literature under several definitions as sporadic reports. We collected a series of 6 leiomyomatous PH associated with mucinous growth from consultation files (3 cases) and multicentric revision of archival files among 128 consecutive surgically resected PH. The lesions have a prevalence for male gender (5:1) and lower lobes (5:1), with a mean age at diagnosis of 61 years. All cases were incidentally disclosed in asymptomatic patients and had an indolent behavior. At histology, 2 cases consisted uniquely of smooth muscle and 4 also showed mature adipose tissue. The mucinous proliferation consisted of a monotonous growth of columnar cells lacking p63-positive basal cells and expressing pan-CKs, MUC5A, and CK7, but negative with TTF-1, napsin, MUC1, MUC2, MUC6, CK20, and CDX2. Smooth muscle was negative with hormonal receptors. Molecular analysis using a multiplex gene panel did not reveal gene mutations, while ALK, BRAF, and ROS1 were negative. In conclusion, we describe a small series of uncommon PH with prevalent leiomyomatous mesenchymal component associated with a mucinous growth (mucinous adenomyomatous hamartoma). Despite the lack of basal cells coating mucinous proliferation and irregular architecture, the favorable outcome and lack of molecular alterations most likely lay for a benign/low-grade tumor. Pathologists should be aware of this unusual occurrence to prevent a diagnosis of overt malignancy, particularly in frozen section, small biopsy, and cytology.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-27T09:16:21Z
      DOI: 10.1177/1066896920945016
       
  • Atypical Teratoid/Rhabdoid Tumor: Revisiting Histomorphology and
           Immunohistochemistry With Analysis of Cyclin D1 Overexpression and MYC
           Amplification
    • Authors: Akash Pramod Sali, Sridhar Epari, T. S. Nagaraj, Ayushi Sahay, Girish Chinnaswamy, Prakash Shetty, Aliasgar Moiyadi, Tejpal Gupta
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Objectives. Atypical teratoid/rhabdoid tumor (AT/RT) is a rare malignant pediatric brain tumor, characterized by inactivation of INI1/hSNF5 gene and loss of its protein. We studied the histomorphological and immunohistochemical spectrum of this tumor including cyclin D1 expression and MYC gene amplification. Methods. Cases with INI1 loss by immunohistochemistry (IHC; from 2005 to 2018) were retrieved, reviewed, and evaluated for cyclin D1 expression by additional IHC and fluorescence in situ hybridization for MYC genes. Results. A total of 66 cases were identified. Age ranged from 1 to 20 years (≤3 years, 44 cases;>3 years, 22). Male to female ratio was 1.7:1. Tumor locations were as follows: posterior fossa: 30; supratentorial: 31; spinal: 5. AT/RT in patient ≤3 years was frequently located in the posterior fossa, composed of primitive embryonal morphology (P = .02), rarely had ample rhabdoid cells (P = .05), and had a negative impact on overall survival (P = .04). The rhabdoid cells was a conspicuous component of posterior fossa tumors compared with the supratentorial ones (P = .06). The supratentorial tumors (P = .06), absence of rhabdoid cells (P = .06), and the presence of immunological divergent differentiation (P = .11) had a comparatively better outcome. Cyclin D1 overexpression (n = 46) was noted in 32 cases and was frequently seen in the posterior fossa tumors (P = .02). CMYC (n = 42) amplification was seen in 1 case and the NMYC (n = 42) amplification in none. Conclusion. AT/RT can occur in the noninfantile age group, at nonconventional sites and frequently overexpress cyclin D1. The MYC alterations are almost nonexistent in AT/RT.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-24T08:13:25Z
      DOI: 10.1177/1066896920943289
       
  • Feather in the Cap
    • Authors: Roshan Chinoy
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-22T01:41:28Z
      DOI: 10.1177/1066896920943963
       
  • Primary Histiocytic Sarcoma in Adult Polycystic Kidney Disease: Case
           Report and Review of Literature
    • Authors: Kritika Krishnamurthy, Ruben Delgado, Jyotsna Kochiyil, Ana Maria Medina
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Genetically driven tissue destruction followed by remodeling in adult polycystic kidney disease (APKD) raises the possibility of malignant transformation. Renal cell carcinoma (RCC) associated with APKD has been frequently reported in the literature; however, only a few cases of nonepithelial neoplasms arising in APKD have been described so far. Histiocytic sarcoma (HS) is a lymphohematopoietic malignant neoplasm that accounts for less than 1% of hematologic malignancies. In this article, we describe a case of primary HS occurring in a 61-year-old man with end-stage renal disease secondary to APKD. This is the first reported case of primary HS in the setting of APKD. The aberrant h-caldesmon expression seen in this case is another novel finding that has previously not been described. This case highlights the importance of morphology in guiding diagnostic workup and reiterates the necessity of maintaining a high index of suspicion for neoplastic entities in APKD.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-17T10:32:22Z
      DOI: 10.1177/1066896920942891
       
  • Carcinoma Showing Thymus-Like Differentiation (CASTLE) Arising in the
           Sublingual Gland
    • Authors: Laura Ardighieri, Michele Tomasoni, Simonetta Battocchio, Fabio Facchetti, Roberto Maroldi, Piero Nicolai, Davide Lombardi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Carcinoma showing thymic-like differentiation (CASTLE) is a rare tumor most commonly occurring in the thyroid and soft tissues of the neck. We report the first case of CASTLE occurring in the sublingual gland. The patient, a 35-year-old healthy man, presented with a submucosal lesion located in the anterior right floor of the oral cavity and an ipsilateral neck mass. The lesion had been previously investigated by neck computed tomography and ultrasound-guided fine needle aspiration cytology and diagnosed as metastatic squamous cell carcinoma. After oral cavity magnetic resonance imaging, positron emission tomography, and a non-diriment, fine needle aspiration cytology of the sublingual mass, the patient was treated as affected by a sublingual gland malignancy with removal of primary tumor and neck dissection. Morphological and immunohistochemical findings were diagnostic for primary sublingual gland CASTLE. The patient received adjuvant radiotherapy and is free of disease 2 years after treatment. We describe the pathological features of the lesion and discuss the possible differential diagnoses.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-16T09:31:07Z
      DOI: 10.1177/1066896920941604
       
  • Collision Lesions of Calcifying Pseudoneoplasm of the Neuraxis and
           Rheumatoid Nodules: A Case Report With New Pathogenic Insights
    • Authors: Jian-Qiang Lu, Snezana Popovic, John Provias, Aleksa Cenic
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unclear pathogenesis. Collision lesions of CAPNONs with neoplasms are occasionally reported. In this article, we report the first case of collision lesions between CAPNON and rheumatoid nodules (RNs) in a patient with systemic lupus erythematosus. The patient was a 51-year-old female who presented with lower back pain and subsequently a lower back mass over 2 years. Spinal magnetic resonance imaging demonstrated a heterogeneous, partially calcified mass centered in the L3-4 paravertebral regions. A biopsy of the mass was diagnostic of CAPNON. As the mass grew over the following 5 months, it was resected en bloc. Its pathological examination revealed collision lesions of RNs at different histopathological stages and CAPNON lesions, and transitional lesions exhibiting combined RN and CAPNON features, with immune cell infiltrates. Our findings provide new evidence for an immune-mediated reactive process and insights into the pathogenies of CAPNON.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-15T11:18:03Z
      DOI: 10.1177/1066896920941939
       
  • Thyroid-Like Follicular Carcinoma of the Kidney With Low-Grade Sarcomatoid
           Component: A Hitherto Undescribed Case
    • Authors: Vidya Rao, Santosh Menon, Ganesh Bakshi, Gagan Prakash, Archi Agarwal, Sangeeta Desai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Thyroid-like follicular carcinoma of the kidney (TLFCK) is a rare subtype of renal cell carcinoma, which closely resembles follicular neoplasms of the thyroid and has a distinctive indolent clinical behavior. Until now, a single case of TLFCK with extensive sarcomatoid differentiation has been documented with aggressive clinical course. We present an unusual case of sarcomatoid TLFCK with a low-grade spindle cell component in a 34-year-old male patient, with an indolent course following radical nephrectomy and regional node dissection.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-10T10:51:51Z
      DOI: 10.1177/1066896920940406
       
  • Primary Renal Sarcoma With BCOR-CCNB3 Gene Fusion in an 18-Year-Old Male:
           A Rare Lesion With a Diagnostic Quandary
    • Authors: Sasan Setoodeh, Doreen N. Palsgrove, Jason Y. Park, Ivan Pedrosa, Payal Kapur, Liwei Jia
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Primary renal sarcoma with BCOR-CCNB3 gene fusion is a rare tumor with only 7 cases reported in the English literature. The morphologic features of this tumor strikingly overlap with clear cell sarcoma of the kidney and synovial sarcoma. Accurate diagnosis can be challenging. In this article, we report a case of an 18-year-old male who presented with hematuria. Subsequent imaging study showed a left renal mass with level II (infra-hepatic) inferior vena cava thrombus, which was resected. Detailed pathologic findings and immunohistochemical and molecular studies revealed an ovoid to spindle cell renal mass with a BCOR-CCNB3 gene fusion.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-10T10:50:11Z
      DOI: 10.1177/1066896920941087
       
  • Here Be Dragons!
    • Authors: Roshan F. Chinoy, Sanjay A. Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-08T08:02:07Z
      DOI: 10.1177/1066896920940385
       
  • USP6-Associated Neoplasms: A Rapidly Expanding Family of Lesions
    • Authors: Laura S. Hiemcke-Jiwa, Joost M. van Gorp, Cyril Fisher, David Creytens, Paul J. van Diest, Uta Flucke
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Nearly 20 years ago, the first description of a translocation involving chromosome 17 on which USP6 resides was described. Since then, not only the culprit gene but also many fusion partners, leading to transcriptional activation of USP6, have been detected. The first neoplasm known to harbor USP6 rearrangements was aneurysmal bone cyst. Since then, other entities like nodular fasciitis, myositis ossificans, fibro-osseous pseudotumor of digits, and a subgroup of fibromas of tendon sheath, probably representing tenosynovial nodular fasciitis, have been added to the list of USP6-rearranged lesions. Remarkably, all of them share clinical as well as morphological characteristics, and authors have suggested that these entities actually belong to the same spectrum. This review summarizes the current knowledge regarding USP6-rearranged lesions and further elaborates on how these neoplasms relate to one another. We propose to call these lesions UAN (Usp6-associated neoplasm).
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-08T08:01:38Z
      DOI: 10.1177/1066896920938878
       
  • “Dysplastic Lipoma” Is Probably Not a Separate Entity but Rather
           Belongs to the Morphological Spectrum of Atypical Spindle Cell/Pleomorphic
           Lipomatous Tumor
    • Authors: David Creytens
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-07T07:38:11Z
      DOI: 10.1177/1066896920939657
       
  • Seed Heads of Dandelion Flowers in Histological Sections
    • Authors: Maria Castillo-Vallejos, Sergio Jara-Rosales, Carlos Godoy-Guzmán
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-07T07:38:01Z
      DOI: 10.1177/1066896920939660
       
  • Intraarticular Inflammatory Myofibroblastic Tumor of the Left Knee With
           ALK-CARS Fusion Detected With Archer Fusionplex Sarcoma NGS Panel: Case
           Report and Literature Review
    • Authors: Janet Pineda-Díaz, Irit Solar, Dov Hershkovitz, Ido Drukman, Osnat Sher
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Inflammatory myofibroblastic tumor (IMT) is a lesion of intermediate biological potential with local recurrences and rare metastases found in multiple anatomical locations. We present a case of a pure intraarticular IMT of the knee, a location that has not been previously documented, with genetic confirmation of ALK-CARS fusion detected with next-generation sequencing. A 20-year-old healthy male was admitted to the orthopedic oncology department due to several months of pain and restriction in movement of his left knee. On magnetic resonance imaging, multiple intraarticular nodular lesions were seen. The patient underwent 2 synovectomies within the course of 1 year. The initial biopsy was interpreted as nodular fasciitis. The second biopsy revealed exuberant tissue displaying compact fascicles of spindle cells intermixed with myxoid areas in a background of inflammatory cells, highly suggestive for IMT. Due to the unusual intraarticular location, equivocal ALK immunostaining and the differential diagnosis with nodular fasciitis, we performed targeted next-generation sequencing using Archer FusionPlex Sarcoma panel, which can identify multiple fusions in a single assay. An ALK-CARS fusion was found, supporting the diagnosis of IMT. This report emphasizes the added value of broad molecular analysis in cases with unusual clinical presentation, equivocal immunohistochemistry, and a wide differential diagnosis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-07T07:37:42Z
      DOI: 10.1177/1066896920937770
       
  • EWSR1-SMAD3-Positive Fibroblastic Tumor
    • Authors: Oliver Foot, Magnus Hallin, Robin L. Jones, Vaiyapuri P. Sumathi, Khin Thway
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      EWSR1-SMAD3-positive fibroblastic tumor is a recently characterized neoplasm with distinct clinicopathologic features and recurrent EWSR1-SMAD3 gene fusion. ESFT typically presents as a small, painless tumor in extremity subcutaneous tissues. Their behavior is benign, although they are prone to local recurrence. They typically comprise two components: intersecting fascicles of overlapping, uniform plump spindle cells, and less cellular hyalinized areas containing stippled calcifications. Immunohistochemically, the cells consistently show diffuse ERG nuclear expression, while other markers are negative. The morphology of this neoplasm can lead to histologic confusion with both benign and malignant soft tissue tumors, including monophasic synovial sarcoma, malignant peripheral nerve sheath tumor, and spindle cell sarcoma, not otherwise specified. Correct identification of ESFT is critical, most importantly to avoid unnecessary overtreatment as sarcoma.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-03T07:07:04Z
      DOI: 10.1177/1066896920938124
       
  • SMARCA4-Deficient Thoracic Sarcoma
    • Authors: Oliver Foot, Magnus Hallin, Robin L. Jones, Khin Thway
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-01T11:11:06Z
      DOI: 10.1177/1066896920938134
       
  • Superficial CD34-Positive Fibroblastic Tumor
    • Authors: Oliver Foot, Magnus Hallin, Silvia Bagué, Robin L. Jones, Khin Thway
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Superficial CD34-positive fibroblastic tumor (SCPFT) is a recently described entity that, despite significant pleomorphism, carries a good prognosis. We briefly describe this tumor and its principal differential diagnoses. Recognition of SCPFTs, including the clinical context in which they arise, is important to avoid confusion with other pleomorphic soft tissue tumors, particularly neoplasms in the group of pleomorphic sarcomas, which are typically aggressive tumors that could lead to unnecessary overtreatment.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-01T11:09:44Z
      DOI: 10.1177/1066896920938133
       
  • E-Cadherin Expression in Blastic Plasmacytoid Dendritic Cell Neoplasms: An
           Unrecognized Finding and Potential Diagnostic Pitfall
    • Authors: Patrick Shenjere, Richard Chasty, Anshuman Chaturvedi, Michael W. Dennis, Angelia Ong, Daniel H. Wiseman, Lia P. Menasce
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      E-cadherin is expressed in hematopoietic erythroid precursors, but to our knowledge, its expression in blastic plasmacytoid dendritic cell neoplasm (BPDCN) has not been described. We report a case of BPDCN showing strong expression of E-cadherin, arising in a patient with history of primary myelofibrosis. Four more cases of BPDCN tested all showed strong expression of E-cadherin. Lack of awareness of this pattern of expression may lead to erroneous diagnosis of acute erythroid leukemia. It is increasingly becoming important to correctly identify this group of neoplasms, as approved new anti-CD123–targeted therapies are becoming available.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-01T11:08:44Z
      DOI: 10.1177/1066896920938130
       
  • Sebaceous Carcinoma of the Breast: Fact or Fiction' A Case Report and
           a Review of the Literature
    • Authors: Ludovica De Vincentiis, Maria Paola Mariani, Anna Maria Cesinaro, Anna Maria Dalena, Gerardo Ferrara
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Introduction. Previously considered an exceedingly rare entity, sebaceous carcinoma of the breast is now regarded in the World Health Organization 2019 classification as a “special histopathological pattern” of invasive breast carcinoma of no special type. Case Description. In this article, we report the case of a fine needle aspiration cytology and the histopathological features of a breast carcinoma with clear-cut morphological features suggesting sebaceous differentiation, but showing no positive staining with the anti-adipophilin antibody. Conclusions. A morphologically clear-cut sebaceous differentiation is not invariably associated with adipophilin positivity; moreover, in breast carcinoma, adipophilin positivity does not automatically imply sebaceous differentiation. At present, immunomorphological evidence for the recognition of sebaceous carcinoma as a “special type” breast carcinoma subtype is too weak.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-07-01T11:07:04Z
      DOI: 10.1177/1066896920937784
       
  • Corrigendum to Xanthogranulomatous Ureteritis Mimicking Ureteral
           Involvement by Cancer in a Radical Cystectomy Specimen
    • Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-24T06:18:11Z
      DOI: 10.1177/1066896920940657
       
  • Surgical Pathology Findings in Patients Who Have Undergone Radical
           Cystectomy/Cystoprostatectomy With Extended Versus Standard Lymph Node
           Dissection for Urothelial Carcinoma of the Bladder: A Contemporary
           Analysis
    • Authors: Joshua Kagan, Mehrdad Alemozaffar, Bradley Carthon, Adeboye O. Osunkoya
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Radical cystectomy/cystoprostatectomy with pelvic lymph node dissection (with or without neoadjuvant chemotherapy) is the gold standard in the management of patients with urothelial carcinoma (UCa) with muscularis propria (detrusor muscle) invasion. However, it remains controversial how extensive the lymph node dissection should be. In this article, we analyzed the clinicopathologic findings in patients who had radical cystectomy/cystoprostatectomy with extended versus standard lymph node dissection. A search was made through our Urologic Pathology files for radical cystectomy/cystoprostatectomy cases with extended and standard lymph node dissection for UCa. A total of 264 cases were included in the study (218 cystoprostatectomy and 46 cystectomy specimens). Mean patients age was 68 years (range = 32-92 years). Patients in all stage categories had more extended lymph node dissection performed compared with standard lymph node dissection: pT0 (20 vs 7), pTis (40 vs 12), pTa (8 vs 4), pT1 (27 vs 5), pT2 (39 vs 8), pT3 (51 vs 17), and pT4 (18 vs 8). In cases with neoadjuvant therapy there was a 19% lymph node positivity rate compared with a 24% positivity rate in those with no presurgical therapy. The only cases categorized as pT2 and below with positive lymph node metastasis were those that had extended lymph node dissection performed. Positive lymph nodes were more frequently detected in cases that had extended lymph node dissection. More than 35% of the positive lymph nodes were in nonregional distribution. Extended lymph node dissection should be considered in patients with UCa even in the low stage or post-neoadjuvant chemotherapy setting.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-23T11:57:53Z
      DOI: 10.1177/1066896920937072
       
  • Multinucleated Epithelial Giant Cells in the Colonic Mucosa
    • Authors: John Dermot Coyne, Seema Thampy, Vinita Charan
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-23T07:26:37Z
      DOI: 10.1177/1066896920935992
       
  • Pathological Findings of Postmortem Biopsies From Lung, Heart, and Liver
           of 7 Deceased COVID-19 Patients
    • Authors: Mohammad Taghi Beigmohammadi, Behnaz Jahanbin, Masoomeh Safaei, Laya Amoozadeh, Meysam Khoshavi, Vahid Mehrtash, Bita Jafarzadeh, Alireza Abdollahi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background. A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been affecting almost all nations around the world. Most infected patients who have been admitted to intensive care units show SARS signs. In this study, we aimed to achieve a better understanding of pathological alterations that take place during the novel coronavirus infection in most presumed affected organs. Methods. We performed postmortem core needle biopsies from lung, heart, and liver on 7 deceased patients who had died of coronavirus disease 2019. Prepared tissue sections were observed by 2 expert pathologists. Results. Diffuse alveolar damage was the main pathologic finding in the lung tissue samples. Patients with hospitalization durations of more than 10 days showed evidence of organization. Multinucleated cells in alveolar spaces and alveolar walls, atypical enlarged cells, accumulation of macrophages in alveolar spaces, and congestion of vascular channels were the other histopathologic alteration of the lung. None of our heart biopsy samples met the criteria for myocarditis. Liver biopsies showed congestion, micro- and macro-vesicular changes, and minimal to mild portal inflammation, in the majority of cases. Conclusions. Similar to the previous coronavirus infection in 2003, the main pathologic finding in the lung was diffuse alveolar damage with a pattern of organization in prolonged cases. The SARS-CoV-2 infection does not cause myocarditis, and the ischemia of myocardium is the most probable justification of the observed pathologic changes in the heart. Liver tissue sections mostly showed nonspecific findings; however, ischemia of the liver can be identified in some cases.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-19T11:03:15Z
      DOI: 10.1177/1066896920935195
       
  • “Baby Spleen Sleeping in a Cradle”: An Intrapancreatic
           Accessory Spleen
    • Authors: W. Cheuk, J. Liao, J. K. C. Chan
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-19T09:26:21Z
      DOI: 10.1177/1066896920935586
       
  • Hydrophilic Polymer in Thrombus Specimens Obtained During Thrombus
           Aspiration in the Setting of Percutaneous Interventions in Japan
    • Authors: Masashi Miyaoka, Kazuhito Hatanaka, Naoya Nakamura
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Although hydrophilic polymer (HP) is used on vascular catheters to prevent medical device–related complications, HP emboli are well established as a potentially fatal iatrogenic phenomenon. HP embolus is thromboembolism by HP, which is mechanically disrupted from catheter during procedure. We reviewed 119 thrombus specimens obtained by percutaneous interventions from the coronary artery, vessels of inferior and superior limbs, cerebral artery, carotid artery, and renal vein. The frequency of HP was 28.6% (34/119 cases); 26.4% (24/91 cases), coronary artery; 50% (6/12 cases), artery of the lower limb; 28.6% (2/7 cases), vein of the lower limb; 0% (0/2), artery of the upper limb; 33.3% (1/3 cases), cerebral artery; 50% (1/2 cases), pulmonary artery; 0% (0/1 case), carotid artery; and 0% (0/1 case), renal vein. The range of numbers and diameter of HP was 1 to 127 per case and 10 to 934 µm, respectively. This is the first study concerning HP in thrombus specimens in Japan. We think that this study is significant because HP in thrombus specimens obtained from coronary artery in Japan seems to be of lower frequency than that of Europe. Although we suspect that the difference was caused by types of catheter, protocol, and procedure time of percutaneous interventions, we could not investigate correlation of HP in thrombus specimens with these factors. For future investigation, we should accumulate thrombus specimens obtained by routine procedure and device to clarify specific device-associated risk of disruption of HP.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-19T09:25:51Z
      DOI: 10.1177/1066896920934867
       
  • Secondary Angiosarcoma With C-MYC Amplification Following Prophylactic
           Bilateral Mastectomy and Autologous Breast Reconstruction: Report of a
           Case and Review of the Literature
    • Authors: Chrisopher Webb, Natalia Partain, Prasad Koduru, Helena Hwang, Venetia R. Sarode
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      In this article, we report a very rare case of secondary angiosarcoma in a young woman with no prior history of breast cancer who had bilateral prophylactic mastectomies with autologous reconstruction due to a strong family history of breast cancer and BRCA1 gene variant of uncertain significance. The surgery was complicated by recurrent fat necrosis requiring several excisions and additional reconstruction followed by the development of localized lymphedema and subsequent angiosarcoma in the reconstructed breast 10 years later. The angiosarcoma was high grade with prominent epithelioid features associated with abundant tumor-infiltrating lymphocytes. Amplification of C-MYC locus 8q21.24 was demonstrated by fluorescence in situ hybridization study. We postulate that chronic trauma from several surgeries including tissue hypoxia and impaired lymphatic drainage may have provided a milieu for angiogenesis and mutagenic transformation. Amplification of C-MYC locus 8q21.24 was most likely a strong oncogenic driver of angiosarcoma. To the best of our knowledge, this is the first report of its kind in the literature.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-18T04:10:29Z
      DOI: 10.1177/1066896920930100
       
  • Metaplastic Potential of Müllerian Epithelia in Full Display!
    • Authors: Renan Ribeiro e Ribeiro, C. James Sung, M. Ruhul Quddus
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-16T06:19:26Z
      DOI: 10.1177/1066896920932981
       
  • Pancreatic Endocrine Heterotopia Involving Meckel’s Diverticulum: A
           Potential Mimic of Neuroendocrine Tumor
    • Authors: Daniel J. Rowan, Lizhi Zhang, Valentina Logunova
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Pancreatic heterotopia most commonly occurs in the upper gastrointestinal tract, but can occur in other sites, including Meckel’s diverticulum. When multiple histologic elements of the pancreatic tissue (acini, ducts, and endocrine cells) are present, the diagnosis is typically straightforward. In this article, we report a rare case of pure endocrine pancreatic heterotopia involving a Meckel’s diverticulum, a potential mimic of a well-differentiated neuroendocrine tumor. Several features were useful in making the distinction, including lack of desmoplasia and mass forming lesion, and immunohistochemical staining in a physiological pattern similar to that of islets of Langerhans. It is important for pathologists to be aware of this entity and its features to avoid misdiagnosis of a neuroendocrine tumor.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-15T05:59:34Z
      DOI: 10.1177/1066896920934009
       
  • Cerebral Hemangioblastoma Without Von Hippel-Lindau Syndrome: A Report of
           6 Cases
    • Authors: Limei Qu, Chuanqi Lv, Tiefeng Ji, Yinping Wang, Jinlu Yu
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background. Hemangioblastoma occurs mainly in the cerebellum and rarely in the cerebrum. Objective. The present study aimed to analyze the clinical manifestations and radiological and pathological features of cerebral hemangioblastoma, and to improve the recognition of this tumor and avoid misdiagnosis. Methods. The characteristics of 6 patients with cerebral hemangioblastoma were analyzed, and a retrospective review of cerebral hemangioblastoma reported in the literature was performed. Results. All 6 patients were female, aged from 22 to 70 years (55 years on average), and all cases were wild-type sporadic, in which 4 cases occurred in the frontal lobe and 2 cases occurred in the parietal lobe. Imaging revealed a solid tumor in 4 cases, a cystic tumor in 1 case, and a mixed tumor in 1 case. Microscopically, the morphology and immunophenotype of tumor cells were not different from those of classical hemangioblastoma. All 6 patients survived tumor free during the follow-up period. Conclusions. Cerebral hemangioblastoma often simulates the imaging characteristics of meningioma or glioma. Enough attention should be paid to differential diagnosis before the operation, and exact diagnosis relies on the pathological examination.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-15T05:58:46Z
      DOI: 10.1177/1066896920933998
       
  • Periductal Stromal Tumors and Phyllodes Tumors Represent a Spectrum of
           Fibroepithelial Lesions: What Is in a Name'
    • Authors: Amélie Wabik, Mieke R. Van Bockstal, Martine Berlière, Christine Galant
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Periductal stromal tumors (PSTs) of the breast are considered as a rare subtype of phyllodes tumors. These rare fibroepithelial lesions display a biphasic morphology, characterized by a cellular stroma surrounding benign ducts. Unlike phyllodes tumors, they do not present with a leaflike architecture, rendering a biopsy diagnosis of a PST very challenging. In this report, we compare the histopathological features of a PST with those of a borderline phyllodes tumor. We discuss the differences and similarities between both entities, and we highlight the potential pitfalls of the respective biopsies. Both cases illustrate that PSTs and phyllodes tumors are part of the same spectrum. This biological spectrum implies that “hybrid” lesions do exist, which can be hard to classify.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-10T05:23:15Z
      DOI: 10.1177/1066896920929086
       
  • Bilateral and Multifocal Acquired Cystic Disease–Associated Renal Cell
           Carcinomas in Patient With End-Stage Renal Disease Caused by Systemic
           Lupus Erythematosus
    • Authors: Magdalena Chrabańska, Ryszawy Jakub, Drozdzowska Bogna
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      The disease entity of acquired cystic disease–associated renal cell carcinoma (ACD-RCC) has been recently incorporated into the international renal tumor classification. We performed a clinicopathologic study of a patient with bilateral and multifocal ACD-RCCs. The patient received long-term hemodialysis in the end-stage renal disease caused by systemic lupus erythematous. First left-sided nephrectomy and after 6 months right-sided nephrectomy was performed. None of the preoperative radiologic examinations revealed lesions suspected of malignancy. All of the 6 tumors were incidentally found on grossing radical nephrectomy specimens. Histologically, tumors consisted of a variety of growth patterns (including papillary and cribriform) of neoplastic cells with granular eosinophilic cytoplasm and intratumoral oxalate crystals. Neoplastic cells were positive for AMACR, CK AE1/AE3, and CD10; focally positive for CK7; and negative for PAX8. Seven months after the first nephrectomy, the patient still receives dialysis. There was no evidence of lymph node or distant metastases.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-09T06:49:10Z
      DOI: 10.1177/1066896920928586
       
  • Fibrolamellar Carcinoma With Predominantly Pseudoglandular Architecture: A
           Potential Diagnostic Pitfall
    • Authors: Mariëtte du Toit, Alessandro Pietro Aldera
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Biopsies of liver mass lesions are encountered frequently in general surgical pathology practice. The clinical differential diagnosis is typically hepatocellular carcinoma (HCC) versus metastatic adenocarcinoma. There are a variety of HCC variants that show a range of morphological appearances. The presence of malignant glands in the liver prompts the pathologist to consider adenocarcinoma, either metastatic or primary intrahepatic cholangiocarcinoma. It is important to remember that some variant patterns of HCC can show pseudoglandular growth. In this article, we present a case of fibrolamellar carcinoma that showed predominantly pseudoglandular growth to highlight the importance of a systematic approach and the routine use of a panel of immunohistochemical stains (HepPar1, CK7, and CD68).
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-08T05:24:06Z
      DOI: 10.1177/1066896920933344
       
  • An EWSR1-CREB3L1 Fusion Gene in Extraskeletal Undifferentiated Round Cell
           Sarcoma Expands the Spectrum of Genetic Landscape in the “Ewing-Like”
           Undifferentiated Round Cell Sarcomas
    • Authors: Caroline Bissonnette, Konstantin Shilo, David Liebner, Alan Rogers, Raphael E. Pollock, O. Hans Iwenofu
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      The molecular findings in Ewing sarcoma have greatly expanded in recent years. Furthermore, this is particularly true for the subset termed “Ewing-like” undifferentiated round cell sarcomas in which new translocations have been reported since the fourth edition of the WHO Classification of Tumours of Soft Tissue and Bone. Amid this expanding genetic landscape, we report a case of extraskeletal undifferentiated round cell “Ewing-like” sarcoma in a 27-year-old female. The patient presented with a large lung mass accompanied on staging imaging by deposits suspicious for metastatic disease in the humerus, calvarium, and lymph nodes of the neck and chest. Biopsy of the lung mass revealed a densely packed monotonous proliferation of round, uniform neoplastic cells with scant cytoplasm. By immunohistochemistry, the tumor cells were diffusely positive for CD99, synaptophysin, TLE1, EMA, and MUC4 and negative for FLI1, PAX7, AE1/3, S100, SOX10, WT1, p63, desmin, and HMB45. Fluorescence in situ hybridization demonstrated rearrangement of the EWSR1 gene. Next-generation sequencing based assay revealed an EWSR1-CREB3L1 fusion. Taken together, the histomorphologic and molecular findings were considered consistent with an undifferentiated round cell sarcoma with an EWSR1-CREB3L1 fusion. Although described in entities such as sclerosing epithelioid fibrosarcoma, low-grade fibromyxoid sarcoma, and small cell osteosarcoma, this has not been previously described in undifferentiated round cell (“Ewing-like”) sarcoma. This finding adds to the growing list of undifferentiated round cell sarcomas with Ewing-like morphologic phenotype–associated fusion genes and may contribute to further defining and characterizing the different subset of tumors in the Ewing family of tumors.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-08T04:24:39Z
      DOI: 10.1177/1066896920929081
       
  • Cystic Trophoblastic Tumor in a Primary Central Nervous System
           Post-Chemotherapy Germ Cell Tumor: The First Case Report
    • Authors: Ramya Gadde, Kanika Arora, Michelle Madden Felicella, Sohrab Arora, Liang Cheng, Hakmin Park, Nilesh S. Gupta, M. Shahriar Salamat, Sean R. Williamson
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Cystic trophoblastic tumor (CTT) is an uncommon trophoblastic proliferation of germ cell tumor origin, mostly reported in post-chemotherapy metastases of testicular germ cell tumors and rarely primary untreated testicular tumors. To date, we are not aware of occurrence in a non-testicular tumor. A 12-year-old boy presented with limb swelling, increased appetite, weight gain, and precocious puberty. Evaluation revealed right frontal lobe mass and elevated α-fetoprotein and β-human chorionic gonadotrophin. After response to neoadjuvant chemotherapy, the tumor was resected. Microscopically, the resection contained predominantly smooth muscle tissue with scattered small foci of glandular teratoma and CTT. Immunohistochemistry (SALL4, glypican 3) revealed no residual yolk sac tumor. Fluorescence in situ hybridization revealed gain of chromosome 12p. The patient has been disease-free for 13 years. This report expands the spectrum of primary central nervous system germ cell tumors with the occurrence of CTT in this site.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-05T04:56:20Z
      DOI: 10.1177/1066896920929751
       
  • Xanthogranulomatous Ureteritis Mimicking Ureteral Involvement by Cancer in
           a Radical Cystectomy Specimen
    • Authors: Sean R. Williamson, Shannon A. Rodgers
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Xanthogranulomatous pyelonephritis is well established as a renal mass-forming inflammatory process. However, a ureteral counterpart is minimally recognized. In this article, we present a case of xanthogranulomatous ureteritis in an 81-year-old woman, mimicking ureteral involvement by cancer in a radical cystectomy specimen for invasive urothelial carcinoma. Similar to the pathogenesis of xanthogranulomatous pyelonephritis, the patient was noted to have ureteral obstruction by calculus and had urine culture positive for Klebsiella pneumoniae. To our knowledge, this is the first report of xanthogranulomatous ureteritis associated with this pathogen and the only report associated with concurrent bladder cancer. Increased pathologist and urologist awareness of xanthogranulomatous ureteritis expands the spectrum of pseudotumoral processes of the ureter.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-04T05:10:16Z
      DOI: 10.1177/1066896920930805
       
  • “Pauci-Hemosiderotic” Fibrolipomatous Tumor: A Mimicker of
           Various Lipomatous Lesions
    • Authors: C. Y. Pang, Edmund Wong, J. W. Liao, John K. C. Chan, Wah Cheuk
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Hemosiderotic fibrolipomatous tumor is a rare soft tissue tumor that preferentially affects the dorsum of foot, shows recurrent t(1;10) translocation targeting TGFBR3 and OGA (MGEA5) genes, and has a high recurrence potential. Hemosiderin deposits, mature adipocytes, and interspersed spindle cells are the 3 cardinal morphologic features of this tumor. We describe a “pauci-hemosiderotic” example involving the left wrist of a 45-year-old female, posing a diagnostic pitfall. The tumor comprised mature adipose tissue traversed by variably thick fibrous septa containing short fascicles of spindle cells. Prominent small- to medium-sized blood vessels were present, often with perivascular fibrosis or aggregates of foamy histiocytes, sometimes associated with red cell extravasation. Hemosiderin was not conspicuous, but fine deposits could be found focally on careful search and with the aid of Perls stain. The diagnosis was further confirmed by diffuse expression of CD34 and presence of OGA translocation by fluorescence in situ hybridization. Pathologists should be aware that hemosiderin deposition can be scanty and focal in hemosiderotic fibrolipomatous, but the rich vasculature with a “damaged” appearance is a useful diagnostic clue.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-04T05:09:05Z
      DOI: 10.1177/1066896920930799
       
  • A Case of Inv(1)(q23q31) TPR-NTRK1 Fusion-Positive Spindle Cell Neoplasm
           in an Infant—Uncovered by Next-Generation Sequencing: Diagnostic
           Challenge, Review, and Therapeutic Implications
    • Authors: Bharat Rekhi, Omshree Shetty, Prachi Bapat, Mamta Gurav, Sajid Qureshi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Lately, NTRK-positive mesenchymal tumors are being increasingly identified, mostly in pediatric patients, in view of associated treatment implications, especially in recurrent and unresectable tumors. A 1-year-old male child presented with a rapidly growing tumor mass in his cervical region of 2 months duration. Radiologic imaging disclosed a tumor measuring 11 cm in size, almost filing his right neck spaces. Review of biopsy sections revealed a cellular tumor comprising spindle cells arranged in sheets and fascicles with interspersed collagenous strands and areas of adipocytic, myxoid, and hyaline degeneration. Immunohistochemically, tumor cells were diffusely positive for CD34 and S100 protein. Subsequently, on testing the tumor for a solid tumor gene panel by next-generation sequencing, it was found to be positive for inv(1)(q23q31) TPR-NTRK1 fusion. Furthermore, tumor cells displayed NTRK1 gene rearrangement by fluorescence in situ hybridization technique. The patient was offered chemotherapy; however, he had a rapid local progression, leading to respiratory obstruction; he then succumbed to the disease. The present case underpins the value of next-generation sequencing as a useful technique for uncovering NTRK-fusion–positive mesenchymal tumors. Review of similar cases, diagnostic challenge, and treatment implications in such cases are discussed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-03T10:10:33Z
      DOI: 10.1177/1066896920927467
       
  • A Hairbrained Mature Cystic Ovarian Teratoma: With Bone Marrow, Meninges,
           and Intraglial Hair
    • Authors: Sanjay A. Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-03T10:01:53Z
      DOI: 10.1177/1066896920927460
       
  • Syphilitic Pulmonary Inflammatory Pseudotumor: A Diagnostic Challenge
    • Authors: Dhirendra Govender, Christopher Jackson, Dharshnee Chetty
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      A 46-year-old man presented with nonproductive cough and lower limb swelling. Chest radiograph showed a left lower lobe lung mass and multiple subpleural nodules. Other investigations revealed that he had nephrotic syndrome. Core biopsies of the left lower lobe lung mass showed features of inflammatory pseudotumor with endarteritis obliterans and a lymphoplasmacytic infiltrate. Immunohistochemical stain for Treponema pallidum was positive. Resolution of the lung mass and nephrotic syndrome was achieved after treatment with intramuscular benzathine benzylpenicillin. The differential diagnosis of pulmonary inflammatory pseudotumor, manifestations of pulmonary syphilis, and a literature review of secondary syphilis of the lung are discussed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-03T04:53:18Z
      DOI: 10.1177/1066896920928584
       
  • A Rare Case of Well-Differentiated Neuroendocrine Tumor Arising From a
           Jejunal Pancreatic Heterotopia
    • Authors: Ryan L. Sappenfield, Kathleen Byrnes
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Pancreatic heterotopia is a well-described entity occurring at multiple abdominal sites, most commonly the stomach and small intestine. They can develop similar disease processes as the pancreas ranging from acute pancreatitis, cyst formation, or neoplasms, most commonly ductal adenocarcinoma. Neuroendocrine tumors (NETs) arising in pancreatic heterotopias are exceedingly rare with only 3 prior published cases. In this article, we describe the first reported case of a NET arising in a jejunal pancreatic heterotopia in a 59-year-old woman presenting with abdominal pain and diarrhea. The submucosal tumor was composed of a well-differentiated NET (World Health Organization grade 1) directly intermixed with a heterotopic pancreas consisting of acinar cells, islet cells, and ducts. This case illustrates that NETs can occur in association with pancreatic heterotopias at any site. Also, the importance for pathologists to recognize that pancreatic heterotopias can give rise to a variety of neoplasms and is not limited to ductal adenocarcinoma.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-03T04:52:18Z
      DOI: 10.1177/1066896920928126
       
  • Thyroid-Like Follicular Carcinoma of the Kidney With Oncocytic Cells: A
           Case Report and Review of Metastatic and Non-metastatic Tumors
    • Authors: Vinita Agrawal, Zafar Neyaz, Rakesh Kapoor
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Thyroid-like follicular carcinoma of kidney (TLFCK) is a morphological subtype of renal cell carcinoma, which is included as an emerging/provisional entity in the classification of renal tumors, with only about 40 cases reported in literature. It has a distinct histological appearance and immunohistochemical profile as compared with other renal cell cancers. However, these tumors, while appearing distinctive, have not been characterized fully either morphologically or by ancillary techniques. The reported cases show variable demographical and clinical features. Most are indolent, while some present with metastasis. The histological, immunohistochemical, and ultrastructural features of a case of TLFCK with clusters of oncocytic cells and pseudosarcomatous stroma are presented. Follow-up of 5 years was uneventful. A review of literature to analyze features in metastatic as compared with non-metastatic TLFCK is discussed. We report a patient of TLFCK and compare the clinicopathological features of metastatic and non-metastatic tumors.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-02T09:54:39Z
      DOI: 10.1177/1066896920930283
       
  • Clinicopathologic Analysis of Chondroblastoma in Adults: A
           Single-Institution Case Series
    • Authors: Stefano Negri, Sintawat Wangsiricharoen, Leslie Chang, John Gross, Adam S. Levin, Carol D. Morris, Edward F. McCarthy, Aaron W. James
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Chondroblastoma is a rare benign tumor of immature cartilage cells that generally occurs in an epiphyseal location of skeletally immature individuals. However, a few studies have reported cases in older patients. The purpose of this study was to evaluate the clinical, radiographic, and pathologic features of chondroblastoma in an adult population. The pathology archives of our institution were searched for cases of chondroblastoma diagnosed in patients ≥25 years of age. Of 14 patients identified, 8 were male and 6 were female with a median age of 34 years (range = 29-54 years). Most lesions occurred in short bones of hands and feet (N = 7, 50%), followed by the long tubular bones (N = 4, 28%). All demonstrated typical histologic features of chondroblastoma, but more extensive calcification, necrosis, and degenerative changes were also seen. At follow-up (median = 73.5 months), 2 patients (17%) had local recurrence. None had metastasis. In summary, chondroblastoma in adults tends to involve the short bones of the hands and feet and demonstrate histologic changes associated with long-standing growth of a benign tumor.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-02T09:53:04Z
      DOI: 10.1177/1066896920927794
       
  • Conjunctival Adenosquamous Carcinoma Lacks MAML2 Translocation: A Variant
           of Squamous Cell Carcinoma With Mucoepidermoid Differentiation and
           Aggressive Behavior'
    • Authors: Allie Lee, Hunter Kwok Lai Yuen, Clement C. Y. Tham, Wah Cheuk
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Conjunctival adenosquamous carcinoma, also known as mucoepidermoid carcinoma (MEC), is a rare tumor that preferentially affects the perilimbal area of the conjunctiva with aggressive local invasion. Consisting of infiltrative proliferation of squamous cells and mucous cells, its morphologic features are reminiscent of the salivary gland-type MEC except for the absence of intermediate cells and frequent keratin production. We reported 2 cases of conjunctival adenosquamous carcinoma and, for the first time, studied the MAML2 translocation status of this rare entity. The 2 patients were women, aged 45 and 42 years, presenting with an erythematous lesion in the left lower palpebral conjunctiva and a pigmented nodule over the left nasal conjunctiva, respectively. One tumor recurred 6 months after the initial biopsy. Excision with lid reconstruction and postoperative radiotherapy was performed for margin involvement and perineural invasion. This patient was disease free at 3-year follow-up. The other patient was lost to follow-up after tumor excision. Fluorescence in situ hybridization and reverse transcription polymerase chain reaction failed to demonstrate MAML2 translocation and CRCT1-MAML2 transcripts in both tumors. The absence of this characteristic translocation and reappraisal of the cellular composition, morphologic features, and precursor lesion suggest that conjunctival MEC may represent a variant of conjunctival squamous cell carcinoma but not related to the salivary gland-type MEC.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-01T06:14:34Z
      DOI: 10.1177/1066896920918944
       
  • Head-to-Head Comparison of p63 and p40 in Non-Neuroendocrine Carcinomas of
           the Tubal Gut
    • Authors: Ahmed M. Bakhshwin, Ilyssa O. Gordon, Kathryn Bock Brown, Xiuli Liu, Daniela S. Allende
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Objectives.With targeted agents, characterizing carcinomas of the gastrointestinal (GI) tract has become more important. We aim to determine the usefulness of p40 in classifying GI tract carcinomas.Methods.Seventy-five GI carcinomas including 28 squamous cell carcinomas (SCC), 2 adenosquamous carcinomas (ASCA), 21 poorly differentiated carcinomas (PDCA), and 24 adenocarcinomas (AdCA; control group) were stained for p40, p63, and CK5/6. Tumors were scored from 0 to 5 based on extent of staining and marked as positive (score>2) or negative.Results.p63 was positive in 100% of SCC/ASCA and 12.5% of AdCA. p40 was positive in 92.5% of SCC/ASCA and 4.1% of AdCA. In the PDCA subset, a panel including p63, p40, and MOC31 was the best way to accurately classify most cases.Conclusions.p63 and CK5/6 are more sensitive but less specific than p40 for SCC/ASCA in GI carcinomas. In PDCA, a panel approach including p63, CK5/6, and p40 may be best in classifying these cases.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-29T06:52:12Z
      DOI: 10.1177/1066896920924821
       
  • A Rare Case Report of Encephalocele with Numerous Ependymal Components: A
           Potential Diagnostic Pitfall
    • Authors: Chenglong Wang, Jin Zhu, Yan Zeng, Xue Qin, Yiwen Tan, Min Zeng, Lijuan Wang, Xiaojing Cao, Lingfeng Zou, Youde Cao
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Different cellular constituents of the central nervous system occurring in encephaloceles or neuroglial heterotopias (NGHs) have been reported, but the ependymal morphology has rarely been described in the previous literature, let alone the related histological images. To determine the ependymal morphology in encephaloceles or NGHs, we report a rare case of encephalocele with numerous ependymal components. Radiological examination showed that a 6.2 × 3.1 cm nasal dorsum mass-forming encephalocele in a 24-year-old woman, who had an intracranial connection through a frontal bone defect. This patient underwent a resection of the encephalocele under nasal endoscopy and a reconstruction of the cranial base. The patient had a good prognosis with no postoperative complications during follow-up. Microscopically, the ependymal components entrapped in a collagenized background showed numerous slit-like spaces lined by columnar cells with abundant palely eosinophilic cytoplasm and apical surface microvilli. With immunohistochemistry, in addition to the expression of EMA along with the slit-like spaces, GFAP and S100 were diffusely expressed in the slit-like spaces. In conclusion, the ependymal component in either encephaloceles or NGHs may present slit-like spaces arranged in an anastomosing pattern. The unusual morphology of ependyma continues to be underrecognized by pathologists and is easily misdiagnosed; therefore, an awareness of the morphological change in ependyma is necessary.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-29T05:25:01Z
      DOI: 10.1177/1066896920925146
       
  • Kaposi Sarcoma With Intravascular Primary Effusion Lymphoma in the Skin: A
           Potential Pitfall in HHV8 Immunohistochemistry Interpretation
    • Authors: Cassandra Bruce-Brand, Jonathan Rigby
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Primary effusion lymphoma is a rare, clinically aggressive large B-cell neoplasm universally associated with human herpesvirus 8 that occurs in the setting of immune compromise. It is classically described as a lymphomatous effusion occurring within body cavities. Recently, however, solid tumor masses, and rarely an intravascular form, have been described. We report a case of a cutaneous intravascular primary effusion lymphoma occurring within ectatic vascular spaces of a Kaposi sarcoma skin lesion in a human immunodeficiency virus–positive adult. Human herpesvirus 8 immunohistochemistry was positive in the nuclei of the Kaposi sarcoma spindled cells as well as within large intravascular plasmacytoid cells. This unusual case highlights the importance of careful assessment of the nature of human herpesvirus 8–positive staining cells in an otherwise typical Kaposi sarcoma. A careful search for dual pathology in immune-compromised patients as well as the importance of histologic assessment of skin lesions in human immunodeficiency virus–positive patients is also highlighted.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-28T04:56:27Z
      DOI: 10.1177/1066896920917212
       
  • Immunostaining With Immunoglobulin G Subclass Antibody Cocktail for
           Diagnosis of Type 1 Autoimmune Pancreatitis
    • Authors: Rie Nakata, Takeshi Uehara, Mai Iwaya, Shiho Asaka, Shota Kobayashi, Mitsutoshi Sugano, Kayoko Higuchi, Yukiko Kusama, Koh Nakazawa, Masato Nakaguro, Mikiko Kobayashi, Ayako Tateishi, Mutsuki Makino, Kenji Kawaguchi, Toshitaka Maejima, Keiko Ishii, Kenji Sano, Hisashi Shimojo, Atsushi Hori, Toshiaki Otsuki, Hideaki Hamano, Shigeyuki Kawa, Hiroyoshi Ota
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background.Immunoglobulin (Ig) G4-related diseases (RDs) are systemic diseases in which serum IgG4 levels are frequently elevated. They can cause diffuse or focal tumor formation, organ swelling, and tissue thickening in organs infiltrated by IgG4+ plasma cells. The diagnostic criteria for IgG4-RDs include an IgG4/IgG ratio>40%, but counting IgG+ cells can be difficult because of the weakness of IgG staining density. We hypothesized that an antibody cocktail of mixed IgG1, IgG2, IgG3, and IgG4 (AC-IgG) might give immunohistochemistry results comparable with those of IgG in IgG4-RD.Methods.We compared AC-IgG reactivity with IgG expression in type 1 autoimmune pancreatitis (AIP), a representative IgG4-RD. We compared immunohistochemistry results using AC-IgG and IgG-only in 10 cases of AIP. The coefficient of variation (Cv) was used to analyze differences between AC-IgG and IgG findings in AIP by 13 board-certified pathologists.Results.Although mean values for IgG+ cells did not significantly differ between AC-IgG (34.3; range = 27.4-37.1) and IgG (30.0; range = 23.0-45.6; P = .6254), Cv was lower for AC-IgG (33.4%) than for IgG (51.4%; regression equation; y[IgG] = 0.988x + 0.982; correlation coefficient = 0.907). The data showed that the results of both methods were largely consistent.Conclusion.AC-IgG could replace IgG to count IgG+ cells because of its lower Cv.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-27T05:54:37Z
      DOI: 10.1177/1066896920924781
       
  • Melanotic Schwannoma, a Deceptive Misnomer for a Tumor With Relative
           Aggressive Behavior: A Series of 7 Cranial and Spinal Cases
    • Authors: Ayushi Sahay, Sridhar Epari, Priyanka Gupta, JayantSastri Goda, Prakash Shetty, Vijay Patil, Jyoti Bajpai, Aliasgar Moiyadi, Tejpal Gupta
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      The authors present in this article a series of 7 intracranial/spinal cases of melanotic schwannomas that highlight the aggressive nature of these tumors. The series comprises 2 males and 5 females, age range 19 to 50 years, with spinal/paraspinal location in 4/7 (57%), and intracranial (along the trigeminal nerve) location in 3/7 (43%). There was no association with Carney’s complex. All the cases showed similar histology of epithelioid to spindled cytomorphology with vesicular nuclei (including prominent nucleoli) and conspicuous intracytoplasmic melanin pigment. Mitotic activity was seen in 3/7 cases (43%), 2 of which showed atypical forms. Immunohistochemically, all the cases were positive for S100 protein, HMB-45, melan-A and p16 protein; while negative for PDL1. Ki-67 labeling index was>5% in cases with mitotic activity. Two cases were asymptomatic (after 2.5 and 5 years postsurgery), 2 cases (one was mitotically active, while the other had no mitosis) had recurrence 6 months and 3.5 years after initial surgery, respectively, probably suggesting that mitosis alone may not be a robust predictor of biological behavior. These patients were treated with various adjuvant modalities and were alive for 4 years and 3 years of post-therapy period, respectively. Three patients were offered adjuvant radiotherapy, based on presence of aggressive histological features or significant residual tumor. One showed good clinical response. This series highlights the variability of clinical behavior of these neoplasms belying a deceptively bland nomenclature and also highlights the lack of correlation between histological features and biological behavior.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-27T05:52:04Z
      DOI: 10.1177/1066896920923146
       
  • Isolated Intraductal Carcinoma of the Prostate in Prostatectomy Specimens:
           Report of 2 Cases and Review of the Literature
    • Authors: Ioanna Maria Grypari, Souzana Logotheti, Andreas C. Lazaris, Panagiotis Kallidonis, Eleutherios Fokaefs, Maria Melachrinou, Vasiliki Zolota, Vasiliki Tzelepi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Intraductal carcinoma of the prostate (IDCp) is a distinct neoplastic entity, and although recognized for some time, it was included for the first time in the histologic classification of prostate cancer in the 2016 publication of World Health Organization. IDCp represents an intraductal or intra-acinar proliferation of malignant cells, with preservation of the basal cell layer. Even though IDCp is usually accompanied by a high-grade invasive component, low-grade invasive carcinoma can rarely be seen adjacent to the lesion. Even rarer is the incidence of isolated IDCp in needle biopsies, while a few such cases have been reported in prostatectomy specimens. We report 2 cases with isolated IDCp without any invasive component. A review of the literature is performed including the diagnostic challenges of IDCp and its morphologic mimics, immunohistochemical markers, molecular aspects, and prognostic implications. Even though it is not yet clear whether IDCp represents an intraductal spread of invasive cancer or a precursor of invasive carcinoma, the existence of isolated IDCp reinforces the idea that, at least in some of the cases, IDCp is a precancerous lesion. Further molecular studies need to be performed in order to clarify its pathogenesis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-27T05:48:58Z
      DOI: 10.1177/1066896920920357
       
  • Pigmented Ependymoma of the Fourth Ventricle—A Curious Entity: Report of
           a Rare Case With Review of Literature
    • Authors: Ankit Malhotra, Shilpa Rao, Rashmi Santhoshkumar, Nufina Muralidharan, Saikat Mitra, Sathwik Shetty
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      A 16-year-old boy presented with a tumor located in fourth ventricle, which showed histological features of an ependymoma replete with perivascular pseudorosettes and true ependymal rosettes. Interestingly, many of the tumor cells exhibited abundant cytoplasm stuffed with a grayish brown pigment. Histochemical stains showed the pigment to be acid fast and periodic acid–Schiff positive and negative for Masson-Fontana melanin stain. Additionally, the pigment displayed brilliant autofluorescence under ultraviolet light of a fluorescent microscope. Ultrastructure examination of the pigment revealed a non–membrane-bound biphasic structure with an electron-dense core and electron-lucent periphery. Only few similar case reports mention such pigmented ependymomas to contain a mixture of neuromelanin and lipofuscin while others mention it to be melanin itself. Our workup suggests the pigment to represent lipofuscin or its derivative. Generally known to be a pigment of wear and tear, the significance of finding it in a tumor with such abundance remains to be understood and explored.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-26T06:12:38Z
      DOI: 10.1177/1066896920926700
       
  • Primary Well-Differentiated Liposarcoma of the Orbit
    • Authors: T. C. Lam, Hunter Kwok Lai Yuen, Wah Cheuk
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-26T06:08:20Z
      DOI: 10.1177/1066896920925168
       
  • Hidden Carcinoma: Pitfalls in the Diagnosis of Lymphoepithelioma-Like
           Cholangiocarcinoma
    • Authors: Maria Mostyka, Meaghan M. Birch, Benjamin Samstein, Meredith E. Pittman
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Lymphoepithelioma-like intrahepatic cholangiocarcinoma is a rare variant of cholangiocarcinoma that is associated with the Epstein-Barr virus. The intimate relationship between the malignant epithelial cells and the numerous lymphoid cells can make the diagnosis challenging on limited tissue samples. We present 2 cases in which the presence of a dense hematolymphoid infiltrate served to mask the diagnosis of carcinoma on initial frozen section and biopsy review, respectively. We bring awareness to this potential diagnostic pitfall and offer morphologic and immunohistochemical clues that may aid in recognition of this unusual and sometimes perplexing carcinoma.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-20T05:38:30Z
      DOI: 10.1177/1066896920921560
       
  • Histomorphometric Analysis of Pre- and Post-Denosumab–Treated Giant
           Cell Tumor of Bone
    • Authors: Nasir Ud Din, Masood Umer, Yong-Koo Park
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Context. Denosumab is a monoclonal antibody against RANK ligand. Its administration in giant cell tumor of bone (GCTB) cases results in elimination of giant cells and new bone formation. Neoplastic stromal cells of GCTB harbor mutation of histone 3.3 and have pre-osteoblastic properties and thus express SATB2. Objectives. To (1) analyze histological changes in post-denosumab–treated GCTB, (2) analyze expression of H3.3G34W and SATB2 in pre- and post-denosumab–treated samples, and (3) to discuss why changes occur in the expression of not only H3.3G34W but also SATB2. Materials and Methods. Hematoxylin and eosin slides of 19 cases of denosumab-treated GCTB were reviewed. Immunohistochemical stains H3.3G34W and SATB2 were performed. The number of positive mononuclear cells were counted and graded. Results. Complete absence of osteoclast-like giant cells (OCLGCs) was noted in most cases along with a fibro-osseous component merging with peripheral shell of reactive bone. Irregular trabeculae of woven bone and osteoid with focal osteoblastic rimming was seen. Spindle cells were arranged predominantly in fascicular pattern. Morphometric analysis of H3.3G34W showed a mean of 68.8% positive stromal cells in pretreatment and a mean of 26.9% positive stromal cells in posttreated specimens with a statistically significant P value (.001). Mean percentage of SATB2-positive stromal cells in the pre- and posttreatment specimens was 36.46% and 20.8%, respectively. Conclusions. Our study validates that denosumab treatment results in marked reduction of OCLGCs with increased osteoblastic activity. Decreased expression of H3.3G34W in posttreatment may be a result of decreased antigenicity of neoplastic mononuclear cells. No significant change in SATB2 expression was noted.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-20T05:38:19Z
      DOI: 10.1177/1066896920920716
       
  • Follicular Cholecystitis: Reappraisal of Incidence, Definition, and
           Clinicopathologic Associations in an Analysis of 2550 Cholecystectomies
    • Authors: Burcu Saka, Bahar Memis, Ipek Erbarut Seven, Burcin Pehlivanoglu, Serdar Balci, Pelin Bagci, Michelle Reid, Nevra Dursun, Oscar Tapia Escalano, Juan Carlos Roa, Juan Carlos Araya, So Yeon Kong, Olca Basturk, Jill Koshiol, N. Volkan Adsay
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Context.Follicular cholecystitis (FC) is a poorly characterized entity.Objective.To determine its frequency/clinicopathologic associations.Design.A total of 2550 cholecystectomy specimens were examined. Two hundred three of these were consecutive routine cholecystectomies submitted entirely for microscopic examination to determine the relative frequency of incidental pathologies in gallbladders (GBs). The remainder had representative sampling. Underlying conditions were nonobstructive pathologies (1270 nonspecific cholecystitis), obstructive (62 distal biliary tract tumors, 35 primary sclerosing cholangitis, and 31 autoimmune pancreatitis), and neoplastic (n = 949). FC was defined as 3 distinct lymphoid follicles (LFs)/centimeter.Results.In the GBs totally submitted for microscopic examination, the true frequency of FC was found to be 2.5% (5/203), and in the representatively sampled group, it was 1.9%, with similar frequencies in nonobstructive, obstructive, and neoplastic cases (2.3%, 3.1%, and 1.3%, respectively, P = .77). When the 39 FC in nonneoplastic GBs contrasted with ordinary chronic cholecystitis, they were associated with older age (68 vs 49 years, P < .0001), similar gallstone frequency (68 vs 81%), female/male ratio (2.7 vs 2.6), and wall thickness (4 mm for both). None had lymphoma/parasites/Salmonella infection. Of 17 cases who had undergone gastric biopsy, 5 had chronic gastritis (2 with Helicobacter pylori). Microscopically, the LFs were the main inflammatory process often with minimal intervening inflammation. IgG4-positive plasma cell density was low (
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-19T05:20:15Z
      DOI: 10.1177/1066896920924079
       
  • Primary High-Grade Angiosarcoma of the Breast in a Young Woman With Breast
           Implants: A Rare Case and a Review of Literature
    • Authors: Daniela Russo, Maria Raffaela Campanino, Rima Cepurnaite, Annarita Gencarelli, Filippo De Rosa, Antonio Corvino, Marsela Menkulazi, Vincenzo Tammaro, Mariano Fuggi, Luigi Insabato
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Primary angiosarcoma (AS) of the breast is an extremely unusual variant of breast malignancies, and its incidence is about 0.05% of all primary breast tumors. In this article, we present a rare case of a primary AS that developed in a young woman with breast implants. This case report emphasizes importance of early investigation for accurate diagnosis and proper management of the breast AS, along with a correlation of histopathologic, radiologic, and clinical findings.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-19T05:18:27Z
      DOI: 10.1177/1066896920924087
       
  • Cervical Awareness Rabbit (CARA)
    • Authors: Fang Zhou, Alan Marcus
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-19T04:58:33Z
      DOI: 10.1177/1066896920923036
       
  • Local PEComatosis of the Appendix: New Insights Into the Histogenesis of
           Nodular Granular Muscle Degeneration and Granular Cells/Granular Cell
           Lesions of the Appendix
    • Authors: Tien Anh N. Tran, Na’im Fanaian
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Nodular granular muscle degeneration (NGMD) of the appendix is a rare histologic curiosity characterized by distinctive nests of polygonal epithelioid cells with abundant pale-pink eosinophilic granular cytoplasm, mostly distributed in the inner layer of the muscularis propria or submucosa of the appendix. Although the nature of the cells of interest in NGMD of the appendix has not been completely elucidated, it is believed that they denote degenerative smooth muscle cells of the appendiceal muscularis propria, a histologic finding described as granular cells/granular cell lesions of the appendix in the 1960s. In this article, we described a new case of NGMD of the appendix and documented for the first time that this peculiar lesion actually represents a form of perivascular epithelioid cell proliferation based on its dual immunopositivity for myogenic and melanocytic markers. We also analyzed the old medical literature on granular cells/granular cell lesions of the appendix to shed some light on this ill-defined morphologic finding and its relationship to NGMD of the appendix. Since NGMD of the appendix is a lesion of perivascular epithelioid cells, the term NGMD is a misnomer, and hence, the designation “local PEComatosis of the appendix” is proposed for this unusual phenomenon.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-19T04:57:15Z
      DOI: 10.1177/1066896920922589
       
  • Foamy Plasma Cells in Oligosecretory Multiple Myeloma
    • Authors: Gerardo Ferrara, Irene Broglia, Maria Paola Mariani
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-18T06:53:15Z
      DOI: 10.1177/1066896920924115
       
  • “Corkscrew”-Associated Gastritis: A Form of Zoonosis!
    • Authors: K. M. Sadeq Islam, C. James Sung, M. Ruhul Quddus
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-18T06:48:11Z
      DOI: 10.1177/1066896920921556
       
  • Histologic Features of Polyvinyl Alcohol Following Bronchial Artery
           Embolization for Hemoptysis
    • Authors: Cassandra Bruce-Brand, Jonathan Rigby
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-13T06:22:05Z
      DOI: 10.1177/1066896920918930
       
  • Vegetable Cells as a Clue to the Biopsy Diagnosis of Rectovaginal Fistula:
           A Significant, Unexpected Value
    • Authors: Jyothi V. Shenoy, Sathish Narayanaswamy, Sanjay A. Pai
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-11T06:20:12Z
      DOI: 10.1177/1066896920921450
       
  • Black Esophagus: A Pigment Hint
    • Authors: Badr AbdullGaffar, Huda Querishi
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-11T06:19:22Z
      DOI: 10.1177/1066896920921478
       
  • Ovarian Fibroma With Bizarre Nuclei: A Rare Finding
    • Authors: Christine Salibay, Oluwole Fadare
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-11T05:31:13Z
      DOI: 10.1177/1066896920919988
       
  • Ocular Sebaceous Carcinoma In Situ With Biphenotypic Differentiation: A
           Reappraisal of the Alternative Origin of the Tumor
    • Authors: C. L. Yim, S. C. Lam, Hunter Kwok Lai Yuen, Wah Cheuk
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Ocular sebaceous carcinoma is an uncommon, aggressive tumor arising from the Meibomian gland, Zeis gland, or sebaceous glands in the caruncle or eyelashes. We described a rare case of sebaceous carcinoma in situ in a 51-year-old female that was characterized by intraepithelial growth of sebaceous carcinoma cells with no invasive carcinoma in the underlying sebaceous glands. Early stromal invasion was identified that featured 2 distinctive but focally intermixed populations of sebaceous carcinoma cells and squamous carcinoma cells. The 2 populations of cells exhibited their respective distinct immunophenotype but both showed strong overexpression of p53. This case provides evidence to support the hypothesis that some ocular sebaceous carcinoma may arise from intraepithelial pluripotent stem cells.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-04T09:12:14Z
      DOI: 10.1177/1066896920917445
       
  • Hooklets Are Important Clues in Echinococcosis Diagnosis
    • Authors: Gil Patrus Pena, Cynthia Koeppel Berenstein, Sonia Boechat e Oliveira, Rodrigo Fabiano Guedes Leite, Carlos Alberto Ribeiro
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-04-30T06:48:29Z
      DOI: 10.1177/1066896920918304
       
  • Multinucleated Stromal Giant Cells in a Benign Fibroadenoma: Do Not Make a
           Mountain Out of a Molehill!
    • Authors: Jérémy Schoelinck, Christine Galant, Martine Berlière, Mieke R. Van Bockstal
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-03-20T05:00:45Z
      DOI: 10.1177/1066896920914077
       
  • Benign Lymphoepithelial Cyst of the Parotid Gland: Mind the Underlying
           Cause
    • Authors: Magda Zanelli, Maurizio Zizzo, Francesca Sanguedolce, Valerio Annessi, Stefano Ascani
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-03-19T08:21:21Z
      DOI: 10.1177/1066896920913620
       
  • Isolated CEP17 Copy Number Gain in Invasive Breast Cancer Results in a
           “Reverse” Amplification Status
    • Authors: Mieke R. Van Bockstal, Dominique Dubois, Stéphanie Talpe, Christine Galant
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-03-05T06:50:09Z
      DOI: 10.1177/1066896920911421
       
  • Do Not Ignore Those Chunks: Pill Fragment-Esophageal Injury
    • Authors: Badr AbdullGaffar, Khalid Bamakramah
      Abstract: International Journal of Surgical Pathology, Ahead of Print.

      Citation: International Journal of Surgical Pathology
      PubDate: 2020-03-05T06:49:05Z
      DOI: 10.1177/1066896920911086
       
  • 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
       
  • 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 Practical Approach to Investigating Cross-Contaminants in the Anatomical
           Pathology Laboratory
    • Authors: Anjelica J. Hodgson, Yan Ming Shang, Patrice Boulianne, Michelle R. Downes, David Hwang, Elzbieta Slodkowska
      First page: 700
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Tissue contaminants in anatomical pathology are not uncommon. While issues related to the presence of extraneous tissue on glass slides are often easily resolved, this is not always the case and several factors may contribute to diagnostic difficulty. Because of this, familiarity with the different steps involved in handling specimens in the anatomical pathology laboratory is essential when troubleshooting possible cross-contaminants. Most commonly, the specimen constituting the source of cross-contamination is handled before the actual contaminated case; however, this is not always so. In this article, we review the steps involved in processing pathology specimens as they pertain to cross-contamination; share an approach covering how to troubleshoot and prevent tissue contaminants in a systematic and practical manner; present some examples from our own experiences; and compare our experience to what is reported in the literature. The information included in this article will be of use to all members of the anatomical pathology team including medical laboratory technologists, laboratory managers and supervisors, pathologist assistants, trainees in pathology, and pathologists.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-03-19T06:42:35Z
      DOI: 10.1177/1066896920913110
       
  • Expression of TdT in Myoepithelial Cells: Investigation in Breasts, Sweat
           Glands, and Salivary Lesions Emphasizing the Never-Documented
           Immunohistochemical Findings
    • Authors: Jun Zhou, Haimin Xu, Hong Zeng, Hongjun Ma, Jingjing Yu, Xia Liu, Zhulei Sun, Luting Zhou, Saifang Zheng, Xue Wang, Anran Wang, Chaofu Wang
      First page: 711
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background. The expression of terminal deoxynucleotidyl transferase (TdT) in myoepithelial cells (MECs) within the breast was recently incidentally observed in our routine practice. This study aimed to elucidate the expression of TdT in MECs. Methods. TdT immunostaining was performed on 180 mammary, 89 cutaneous, and 94 salivary tissues or lesions. Other myoepithelial markers, including P63, calponin, and SMA as well as double staining for TdT and calponin, were also evaluated in some cases. Selected lesions with basal or myoid differentiation were also included in the investigation. Results. MECs were positive for TdT in mammary lesions that contained MECs (132/135) but negative when they did not contain MECs (45/45). MECs in sweat glands (24/30) and their neoplastic counterparts, including those in hidradenoma papilliferum (2/9), spiradenoma (6/6), and cutaneous mixed tumor (9/9), showed weak to moderate TdT positivity. MECs were variably immunolabeled for TdT in salivary or salivary gland–type tumors with myoepithelial differentiation (pleomorphic adenoma, 24/25; basal cell adenoma, 6/7; adenoid cystic carcinoma, 7/7; Warthin tumor, 0/6; mucoepidermoid carcinoma, 0/8; acinic cell carcinoma, 0/4), but MECs in normal salivary gland barely stained for TdT (30/32). Conclusions. Our findings indicate that TdT may be eligible as an additional auxiliary immunohistochemical marker as P63, but not a surrogate, to identify the MECs in the breast with limited cross-reactivity, particularly in lesions with a prominent proportion of MECs. Positivity for TdT, along with other relevant markers, in a subset of sweat gland lesions and salivary tumors may contribute to their diagnosis.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-04T08:40:24Z
      DOI: 10.1177/1066896920916792
       
  • Primary Renal Mesenchymal Neoplasms in Nephrectomy Specimens: A 16-Year
           Survey of Primary and Incidental Cases From a Single Institution
    • Authors: Fatimah I. Alruwaii, Muhammad Idrees, Omer Saeed, Shaoxiong Chen
      First page: 721
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Context. Primary renal mesenchymal neoplasms are rare but diverse. Several neoplasms of mesenchymal derivation can arise as a primary renal mass; however, incidental tumors are identified in nephrectomies performed for end-stage renal disease or other malignant epithelial renal neoplasms. In this article, we document their frequencies with demographic information in nephrectomy specimens. Design. We retrospectively searched our database for nephrectomy specimens from the year 2000 to 2016. Results. A total of 224 cases were identified with an incidence rate of 4.4% (224/5128). One hundred ninety (85%) neoplasms were benign, 27 (12%) were malignant, and 7 (3%) were of intermediate biologic behavior. The majority of cases occurred in adults (93%, 208/224), and 39% of cases represented an incidental finding. The most common neoplasms were angiomyolipoma (58%) and renomedullary interstitial cell tumor (17%). Malignant mesenchymal kidney tumors are rare (0.39% of nephrectomy specimens). The most common adults’ malignant tumors in our survey were synovial sarcoma and Ewing’s sarcoma. Conclusion. Primary renal mesenchymal tumors are rare and are mostly benign in nature with many incidentally identified lesions. They arise in different age groups with malignant lesions usually presenting at a younger mean age.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-04T08:39:17Z
      DOI: 10.1177/1066896920916780
       
  • Papillary Renal Neoplasm With Reverse Polarity: A Clinicopathologic Study
           of 7 Cases
    • Authors: Luting Zhou, Jiankun Xu, Suying Wang, Xiaoqun Yang, Chuanying Li, Jun Zhou, Peipei Zhang, Haimin Xu, Chaofu Wang
      First page: 728
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Papillary renal neoplasm with reverse polarity is a form of recently described tumor. These tumors are defined by GATA3 positivity, negative vimentin staining, and the presence of both papillary structures and a layer of eosinophilic cells with apical nuclei and a granular cytoplasm. In the present report, we review 7 cases of papillary renal neoplasm with reverse polarity that were GATA3+ and vimentin−, consistent with past reports. In all 7 of these cases, we found that these tumors were additionally positive for 34βE12. All 7 of these tumors were categorized as stage pT1. On histological examination, these tumors exhibited branching papillae with apical nuclei. All 7 of these patients were alive on most recent follow-up, with 6 being disease free and one having developed prostate cancer. Together, this overview of 7 additional cases of papillary renal neoplasm with reverse polarity offers further insight into this rare and poorly understood disease.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-14T06:35:11Z
      DOI: 10.1177/1066896920918289
       
  • Gastrointestinal Tract Plasmablastic Lymphoma in HIV-Infected Adults: A
           Histopathological Review
    • Authors: Absalom Mwazha, Gamalenkosi Bonginkosi Nhlonzi, Pedzisai Mazengenya
      First page: 735
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background.Plasmablastic lymphoma (PBL) is an aggressive B-cell lymphoma that is characterized by the expression of plasma cell antigens and loss of pan B-cell antigens. The neoplasm is extensively reported in the oral cavity and anorectal region but rarely in the gastrointestinal tract, where only isolated case reports and small case series have been reported. In the current study, morphologic, immunohistochemical, and molecular features of 17 cases of gastrointestinal tract PBL were reviewed.Methods.Ten-year retrospective study that reappraised the histomorphological and immunophenotypical profiles of HIV-associated PBLs in the gastrointestinal tract.Results.The mean age of the study patients was 41 years with a 3:1 ratio of males to females. The most common site of tumor origin was the small intestine (42%), followed by the stomach (29%) and the colon (29%). Majority of the cases showed a predominant diffuse (82%) growth pattern. Immunoblasts and plasmablasts were observed in all cases. Plasmacytic differentiation was seen in 5 (29%) cases. Additional observations not previously described or emphasized in literature includes pseudo-alveolar growth pattern, centroblast-predominance, multinucleated giant cells, and clear cell change. Immunohistochemistry revealed absence of pan B-cell antigens and expression of plasma cell antigens in all cases. Epstein-Barr virus–encoded RNA was expressed in 53% of the cases.Conclusions.This study highlights the spectrum of histopathological features seen in gastrointestinal tract PBLs. Awareness of this entity and its histopathological features in the gastrointestinal tract is essential for making a timely and accurate diagnosis and improving patient outcomes.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-06-17T09:44:16Z
      DOI: 10.1177/1066896920932272
       
  • Dedifferentiated Liposarcoma With Meningothelial-Like Whorls: Five
           Additional Cases and Review of the Literature
    • Authors: Muhammad Usman Tariq, Naila Kayani, Tariq Moatter, Nasir Ud Din
      First page: 749
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background. Diagnosis of dedifferentiated liposarcoma (DDL) can sometimes be challenging due to a wide variety of histological features. “Meningothelial-like” whorl is an uncommon histological feature of DDL, which is also observed in neural tumors and follicular dendritic cell sarcoma. This feature is frequently associated with metaplastic bone formation. We conducted this study to describe the clinicopathological features of DDL with meningothelial-like whorls that would aid in establishing accurate diagnosis. Material and Methods. Microscopic glass slides of 5 cases of DDL with meningothelial-like whorls, diagnosed between January 2010 and December 2019, were reviewed. Results. Paratesticular region was the most common site. Whorls occupied 10% to 75% of tumor area and ranged in size from 2 cm. In 1 case, these whorls coalesced to form large areas of dedifferentiation. The cells forming whorls were spindle to epithelioid shaped and lacked significant nuclear pleomorphism and increased mitoses. Metaplastic bone formation was observed in 4 cases and cartilage formation in 3 cases. p16 and α-smooth muscle actin (α-SMA) immunohistochemical stains were positive in 2 cases, when performed. MDM2 gene amplification was observed in all cases by fluorescence in situ hybridization technique. These tumors showed aggressive behavior, similar to that of DDL without meningothelial-like whorls. Two patients died, 1 developed recurrence, 1 presented as recurrent tumor, and 1 developed metastasis. Conclusion. Meningothelial-like whorls in DDL most likely represent an early stage of dedifferentiation. Presence of well-differentiated liposarcoma areas, metaplastic bone formation, positive expressions for p16 and α-SMA immunohistochemical stains, and MDM2 gene amplification are useful diagnostic clues. These tumors have the potential to behave aggressively.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-18T06:50:10Z
      DOI: 10.1177/1066896920921950
       
  • Composite Hemangioendothelioma With Neuroendocrine Marker Expression:
           Report of a “Paraganglioma-Like” Paravertebral Case
    • Authors: W. Cheuk, K. S. Shum, W. K. Ng, John K. C. Chan
      First page: 759
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Composite hemangioendothelioma is a rare vascular tumor morphologically comprising several distinct vascular components and exhibits a borderline malignant potential. We described the case of a 53-year-old female who presented with an infiltrative mass in the paravertebral soft tissue. The tumor showed discrete nests of synaptophysin-expressing epithelioid cells accompanied by rich vasculature, features highly reminiscent of sympathetic paraganglioma. Further analysis revealed areas resembling spindle cell hemangioma, retiform hemangioendothelioma, cavernous hemangioma/lymphangioma, and epithelioid hemangioendothelioma without the myxohyaline matrix in the tumor, and a final diagnosis of composite hemangioendothelioma with synaptophysin expression was made. Critical appraisal of this recently described entity and its possible pathogenic relationship with retiform hemangioendothelioma were discussed.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-18T07:24:10Z
      DOI: 10.1177/1066896920924120
       
  • Anal Fibroepithelial Polyp With Epithelial Vascular Pseudoinvasion
    • Authors: Giovanni Fellegara, Nicoletta Di Mari
      First page: 764
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      In this article, we report a case of anal fibroepithelial polyp with benign squamous cell vascular pseudoinvasion. The patient was a 38-year-old Caucasian man, who presented at our institution for recurrent episodes of anal discomfort. Clinical evaluation revealed the presence of 2 pedunculated anal polyps that were resected and submitted for histological evaluation. On microscopic evaluation, one of the polyps shows epithelial endovascular displacement associated with morphological signs of traumatism. The differential diagnosis and possible pathogenetic mechanisms explaining the presence of such findings are discussed. To the best of our knowledge, this is the first case reported of an anal fibroepithelial polyp with epithelial vascular pseudoinvasion.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-21T09:01:37Z
      DOI: 10.1177/1066896920925919
       
  • Intestinal Graft Versus Host Disease Involving Brunner’s Glands
    • Authors: Andreas Kreft, Daniel-Christoph Wagner, Helmut Neumann
      First page: 772
      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
       
  • Myeloid Sarcoma Mimicking Endocarditis: An Autopsy Case
    • Authors: Konstantin Bräutigam, Anja Hohl, Ekkehard Hewer, Rupert Langer, Stephan Jakob
      First page: 774
      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
       
  • Primary Mammary-Analogue Secretory Carcinoma of the Lung: A Rare Entity
           With an Unusual Location
    • Authors: Josean Ramos, Waqas Mahmud, Fernando Alekos Ocampo, Gillian Alex, Paolo Gattuso
      First page: 775
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      This is a case of a 55-year-old female with past medical history of tobacco smoking, hypertension, and lupus who presented with a left lung nodule, found on computed tomographic scan of the chest during workup for a recently diagnosed squamous cell carcinoma in a cervical lymph node. Resection of the lung nodule showed a 2.3-cm well-defined pale-tan mass, and histologic examination showed a well-circumscribed lesion with papillary, solid, and gland-like architectural patterns, with eosinophilic secretions, areas of comedonecrosis, and increased mitotic activity. Immunohistochemical stains showed the lesion to be positive for cytokeratin 7, S100 protein, and focally positive for mammaglobin. Fluorescence in situ hybridization studies confirmed rearrangement of the ETV6 gene at 12p13.2. To date, our case is the second reported case of a primary mammary-analogue secretory carcinoma arising in the lung, and the first to show evidence of tumor necrosis: an unusual feature in an unusual location.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-04-13T04:24:59Z
      DOI: 10.1177/1066896920914975
       
  • Desmoplastic Small Round Cell Tumor of Parotid Gland: A Rare Entity With
           Diagnostic Challenge
    • Authors: Zhenjian Cai, Lin Zhang, Ron J. Karni, Karan Saluja, Jing Liu, Hui Zhu
      First page: 782
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Desmoplastic small round cell tumor (DSRCT) is a rare malignant mesenchymal neoplasm that typically affects young patients and presents as large intraabdominal masses. We report a rare case of parotid gland DSRCT in a 38-year-old man. The tumor cells were large sized and form irregular nests embedded in abundant desmoplastic stroma. Immunohistochemically, the tumor cells were positive for cytokeratin, GATA3, p40, and p63. Working differential diagnosis included squamous cell carcinoma, myoepithelial carcinoma, hyalinizing clear cell carcinoma, NUT (nuclear protein of the testis) carcinoma, and adamantinoma-like Ewing sarcoma. The characteristic morphologic features and presence of EWSR1-WT1 gene fusion are diagnostic of DSRCT. Salivary gland DSRCT is an exceedingly rare entity, with only 6 cases reported in the literature.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-04-03T07:30:48Z
      DOI: 10.1177/1066896920913109
       
  • Mucoepidermoid Carcinoma of the Breast With MAML2 Rearrangement: A Case
           Report and Literature Review
    • Authors: Mingfei Yan, Hannah Gilmore, Aparna Harbhajanka
      First page: 787
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Mucoepidermoid carcinoma is one of the most common malignancies in salivary glands. In comparison, breast mucoepidermoid carcinoma is a very rare entity, with limited reports and understanding of its clinical behaviors to date. In this article, we report a case of low-grade breast mucoepidermoid carcinoma of a 60-year-old female patient. Histologic and immunohistochemical patterns were demonstrated. Fluorescence in situ hybridization test was also conducted to identify MAML2 rearrangement in this case, indicating a similar molecular abnormality as mucoepidermoid carcinoma in the salivary gland. Five-year follow-up of the patient showed no local recurrence or distant metastasis of the carcinoma, indicating the indolent behavior of low-grade breast mucoepidermoid carcinoma. Besides, a 40-year literature review from 1979 to 2019 was also performed to better characterize the prognosis and molecular abnormalities of the lesion.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-04T08:38:33Z
      DOI: 10.1177/1066896920916779
       
  • Anisometric Cell and Dysplastic Lipomas in a Retinoblastoma Patient
    • Authors: Michael A. den Bakker, Dorine T. den Toom, Tim H. C. Damen, Hein F. B. M. Sleddens, Isabella C. Meijssen, Stijn Deloose, Mike Kliffen, Winand N. M. Dinjens
      First page: 793
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Anisometric cell lipoma (ACL) and dysplastic lipoma (DL) are underrecognized subtypes of benign lipomatous tumors, with wide variation in cell size, microscopic fat necrosis, and no or mild nuclear changes (DL). ACL/DL appear more commonly in retinoblastoma patients, in whom an increased incidence of lipomas has been established. The occurrence of ACL/DL in retinoblastoma patients suggests that RB1 aberrations play a role in its pathogenesis, similar to spindle cell/pleomorphic lipoma. In this article, we present a patient with a history of retinoblastoma with multiple lipomas histologically consistent with ACL/DL. Analysis of the lipomas supports involvement of RB1 in the development of ACL/DL. Dysplastic changes were only seen in a single lipoma, which harbored an additional TP53 mutation. While providing further support for the occurrence of ACL/DL in retinoblastoma patients, we also suggest that DL is an ACL with TP53 mutation.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-04T08:42:09Z
      DOI: 10.1177/1066896920917220
       
  • Chondromyxoid Fibroma of the Sacral Spine
    • Authors: Vincent Dodson, Neil Majmundar, Leroy Sharer, Valerie A. Fitzhugh, Rachid Assina
      First page: 799
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Background and Importance. Chondromyxoid fibromas are rare tumors of cartilaginous origin typically found in long bones. They usually present during the second and third decades of life. In this case report, we describe the case of a 60-year-old male who presented with back pain and was later found to have a sacral mass. Further immunohistochemical analysis determined that the mass was a chondromyxoid fibroma. Clinical Presentation. A 60-year-old male presented with worsening lower back pain over the course of 2 years. Magnetic resonance imaging demonstrated a destructive mass centered at S4 with heterogeneous enhancement. The patient underwent an S3-to-Co1 laminectomy for gross total resection of the tumor. Histology demonstrated a biphasic, lobulated appearance, characteristic of a chondromyxoid fibroma. The tissue stained faintly positive for multicytokeratin, and it was negative for markers S-100 protein and brachyury, indicating that it was not a chordoma. Conclusion. Only 8 cases have documented sacral chondromyxoid fibroma. As these are exceedingly rare tumors, especially within the sacral spine, the differential diagnosis includes other malignant tumors more likely to be found in the spine, particularly chordomas and chondrosarcomas. Immunohistochemistry and histology are essential in making a definitive diagnosis. This case provides a comprehensive illustration of the clinical presentation, radiographic findings, and immunohistochemistry of sacral chondromyxoid fibroma.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-04T08:40:03Z
      DOI: 10.1177/1066896920916784
       
  • Intrasinusoidal HHV8-EBV–Positive Large B-Cell Lymphoma With Features of
           Germinotropic Lymphoproliferative Disorder
    • Authors: Carolina Martinez-Ciarpaglini, Andrey Valkov, Mercedes Hurtado, Jaime Agustí, Giomer Malave, Antonio Ferrández
      First page: 804
      Abstract: International Journal of Surgical Pathology, Ahead of Print.
      Germinotropic lymphoproliferative disorder (GLPD) is a poorly characterized lymphoproliferative entity, recently included in the World Health Organization classification of hematolymphoid neoplasms. The histological pattern of this disease comprises monotypic plasmablasts that involve the germinal centers of the lymphoid follicles (germinotrophism), forming confluent aggregates positive for both human herpes virus type 8 (HHV8) and Epstein-Barr virus. Currently, after 17 years of its first description, only 18 cases have been reported. In this article, we describe a case of a GLPD presenting in an immunocompetent 79-year-old woman with localized axillary lymphadenopathy, showing a prominent sinusoidal growth pattern, with no evidence of germinotrophism or extrasinusoidal spread. Stinking pleomorphism in tumor cells was also noted. An extension study has not revealed involvement of other groups of lymph nodes or extralymphoid sites. The patient is alive and has shown no relapse after 8 years follow-up (the longest follow-up reported period for this entity). This previously unrecognized pure sinusoidal growth pattern along with the striking pleomorphism in neoplastic cells closely mimics the appearance of an anaplastic large cell lymphoma. GLPD is not usually considered in such a setting, but it should be included in the differential diagnosis of sinusoidal proliferations. Our findings contribute to the expansion of the morphological spectrum of HHV8-associated lymphoproliferative lesions and aids in the characterization of the very infrequent GLPD entity.
      Citation: International Journal of Surgical Pathology
      PubDate: 2020-05-19T04:55:58Z
      DOI: 10.1177/1066896920921238
       
 
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