Annals of Diagnostic Pathology RSS feed: Current Issue. A peer-reviewed journal devoted to the publication of articles dealing with traditional morphologic studies using standard diagnostic techniques and stressing clinicopathological correlations and scientific observation of relevance to the daily practice of pathology. Special features include pathologic-radiologic correlations and pathologic-cytologic correlations.http://www.annalspathology.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Annals of Diagnostic Pathology1092-9134144August 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.annalspathology.com/article/PIIS109291341000081X/abstract?rss=yesMasthead10.1016/S1092-9134(10)00081-XAnnals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1IFCIFChttp://www.annalspathology.com/article/PIIS1092913409001439/abstract?rss=yesAlthough dermal and subcutaneous angiosarcomas on or near the nose certainly do occur, angiosarcomas of the internal sinonasal tract proper seem to be quite rare. Indeed, compared with the nonneoplastic vascular changes that can occur in the sinonasal tract and which sometimes can be mistaken for angiosarcomas, actual angiosarcomas of this anatomic area are probably “vanishingly” rare. It is likely that most of the few literature reports of sinonasal angiosarcomas are mistaken diagnoses.Sinonasal angiosarcoma? Not likely (a brief description of infarcted nasal polyps)Dennis K. Heffner10.1016/j.anndiagpath.2009.10.006Annals of Diagnostic Pathology 14, 4 (2010)2010-02-05Annals of Diagnostic Pathology2010-02-05144S1092-9134(10)X0004-1Opinions in Pathology233234http://www.annalspathology.com/article/PIIS1092913410000298/abstract?rss=yesAbstract: Schwannomas, also known as neurilemmomas, are uncommon neoplasms apparently derived from Schwann cells. The growth of these tumors causes displacement and compression of the nerve of origin. Schwannomas are usually solitary lesions but can be multiple when associated with neurofibromatosis. Anti-S100 protein is the most widely used antibody for the identification of this neoplasm. Surgical excision is the treatment of choice for schwannomas, with few and controversial reports of recurrence or malignant transformation. The present article reports 7 additional cases of oral schwannoma, and the literature is reviewed regarding clinicopathologic features, immunohistochemical findings, differential diagnosis, and therapeutic management of this benign neural tumor.Clinicopathologic analysis of 7 cases of oral schwannoma and review of the literaturePedro Paulo de Andrade Santos, Valéria Souza Freitas, Leão Pereira Pinto, Roseana de Almeida Freitas, Lélia Batista de Souza10.1016/j.anndiagpath.2010.02.009Annals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1Original Contributions235239http://www.annalspathology.com/article/PIIS1092913410000389/abstract?rss=yesAbstract: Hepatic angiomyolipoma (AML) may demonstrate a marked histologic diversity. We report 5 cases of hepatic AML exhibiting prominent inflammatory cells in the background (inflammatory AML). The patients were 4 females and 1 male, with age ranged from 21 to 48 years (mean, 39.2 years). Three tumors were in the left lobe and 2 in the right lobe. The tumor size was from 5.5 to 10 cm in the greatest dimension (mean, 7.46 cm). No patient had clinical features of tuberous sclerosis. Histologically, the striking feature was the infiltration of numerous inflammatory cells in the background of the tumors, including small lymphocytes, plasma cells, and histiocytes. The percentage of tumor area with heavy inflammatory infiltration was more than 50% in all cases. The myoid cells were spindled and epithelioid in shape, with eosinophilic or clear cytoplasm, and were arranged in fascicles and clusters. Scattered adipose cells and sinusoidal and thick-walled blood vessels were variably present in all tumors. Focal trabecular arrangement was present in 2 of the 5 tumors. There was no nuclear atypia, and mitotic figures were rare. The myoid cells were diffusely positive for vimentin, smooth muscle actin, and HMB-45 in all cases. All patients showed no evidence of disease after the initial surgical excision during a follow-up period from 3 to 9 years. The inflammatory AMLs should be distinguished from other tumors with inflammatory background such as inflammatory myofibroblastic tumor and follicular dendritic cell tumor.Inflammatory angiomyolipomas of the liver: a clinicopathologic and immunohistochemical analysis of 5 casesHuaiyin Shi, Dengfeng Cao, Lixin Wei, Lu Sun, Aitao Guo10.1016/j.anndiagpath.2010.03.002Annals of Diagnostic Pathology 14, 4 (2010)2010-06-14Annals of Diagnostic Pathology2010-06-14144S1092-9134(10)X0004-1Original Contributions240246http://www.annalspathology.com/article/PIIS1092913410000432/abstract?rss=yesAbstract: Gonadoblastomas are unusual benign neoplasias that frequently appear in the dysgenetic gonads of women with chromosome Y anomaly. In this study, we reviewed 3 gonadoblastoma cases, 2 of which were bilateral, in patients 21, 17, and 18 years of age. Two of them presented 46 XY karyotype and gonadal dysgenesis, whereas the third presented 46 XX karyotype. Besides, 2 of the cases were associated to dysgerminomas. In all the cases, the histologic examination showed germ cell proliferation and sex cords derivatives frequently surrounding small round deposits containing amorphous hyaline material resembling Call-Exner bodies. One of the patients died at 8 years from diagnosis because of dysgerminoma multiple metastases, one is alive with no evidence of disease at the second year of follow-up, and the evolution of the third patient remains unknown.Gonadoblastoma: an unusual ovarian tumorMario Gorosito, Belén Pancera, Sandra Sarancone, Ana Lía Nocito10.1016/j.anndiagpath.2010.03.006Annals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1Original Contributions247250http://www.annalspathology.com/article/PIIS109291341000047X/abstract?rss=yesAbstract: Lobular neoplasia including lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) may be identified in breast core needle biopsies as incidental findings or associated with microcalcifications. There are no general consensus guidelines for follow-up management in patients when lobular neoplasia is the only abnormal finding on core needle biopsy. The aim of this study was to evaluate our experience in the follow-up of these patients. A total of 3163 breast core needle biopsies were retrieved from the surgical pathology files between 2003 and 2009; among them, 56 (1.8%) cases were identified with a diagnosis of ALH or LCIS. Eleven cases were excluded because of the presence of a concurrent more severe lesion in the biopsies that mandated excision. The remaining 45 cases contained only ALH or LCIS and otherwise benign breast tissue; 27 had surgical excision follow-up. In the surgical excision specimens, 5 (19%) of 27 cases showed more severe lesions or were “upgraded” (3 invasive ductal carcinomas, 1 invasive lobular carcinoma, and 1 ductal carcinoma in situ). Histologic features of the lobular neoplasia on the cores, including association with microcalcifications, pagetoid involvement of ducts, and extensive lobular involvement, were retrospectively evaluated. These histologic features were found to have no predictive value for a more severe lesion in the subsequent excision. We suggest that patients with LCIS/ALH on core needle biopsy should be considered for surgical excision to rule out a more significant lesion regardless of the histologic features.Lobular carcinoma in situ/atypical lobular hyperplasia on breast needle biopsies: does it warrant surgical excisional biopsy? A study of 27 casesMaura O’Neil, Rashna Madan, Ossama W. Tawfik, Patricia A. Thomas, Fang Fan10.1016/j.anndiagpath.2010.04.002Annals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1Original Contributions251255http://www.annalspathology.com/article/PIIS1092913410000754/abstract?rss=yesAbstract: Helicobacter pylori infection is associated with gastritis, gastric ulcer, gastric adenocarcinoma, and mucosal associated lymphoid tissue lymphoma. Documenting the presence of H pylori in a gastric biopsy is essential for appropriate patient care. Several special stains and immunohistochemistry (IHC) stain for H pylori are available, and many laboratories are routinely using one of them. We introduced routine IHC for H pylori about a year ago, and this study aims to investigate the value of this protocol. A total of 224 patients qualified for the study criteria during this period. The diagnoses were chronic active gastritis (68), chronic gastritis (76), no pathologic abnormality (50), reactive gastropathy (24), and polyps (6). Fifty-four cases were positive for H pylori on IHC, including 50 chronic active gastritis and 4 chronic gastritis. The IHC positive rate was 73.5% (50/68) in chronic active gastritis, 5.3% (4/76) in chronic gastritis, and 0% (0/80) in other diagnoses. The sensitivity/specificity of finding H pylori by blindly reviewing hematoxylin and eosin slides was 100%/100%, 100%/100%, 95%/100%, and 100%/100% from the 4 authors. Our results showed that many gastric biopsies (35.7%, 80/224) had no pathologic abnormality or reactive gastropathy and did not need a routine IHC for H pylori. Hematoxylin and eosin slide review had a very good sensitivity and specificity with all levels of observers. In summary, IHC for H pylori should not be routinely used, especially during these economically challenging times. Immunohistochemistry should be reserved for unexplained gastritis and previously treated patients with likely low organism density.The role of routine immunohistochemistry for Helicobacter pylori in gastric biopsyXiaohong I. Wang, Songlin Zhang, Fleurette Abreo, Jaiyeola Thomas10.1016/j.anndiagpath.2010.05.002Annals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1Original Contributions256259http://www.annalspathology.com/article/PIIS1092913409000835/abstract?rss=yesAbstract: Breast cancer is the leading cause of cancer in women and the third leading cause of cancer mortality in the United States. We report a case of a patient who underwent bilateral simple mastectomies and right sentinel node biopsy for invasive lobular carcinoma in the right breast. An ipsilateral sentinel lymph node showed a microscopic focus of ductal elements. Although residual lobular carcinoma was identified in the right breast, no ductal carcinoma was identified in either breast. The ducts were discrete distributed in a 3-mm focus in the lymph node parenchyma as well as the subcapsular sinus. By immunohistochemistry, the ducts were positive for cytokeratin, estrogen receptor/progesterone receptor and did not show a myoepithelial layer by P63 or smooth-muscle myosin heavy-chain staining. The differential diagnosis includes heterotopic epithelial inclusions and benign mechanical transport. Mechanical transport of the breast tissue was ruled out because primary tumor type in the breast and the ductal structures in the lymph nodes were of different types. The diagnosis of occult metastatic tumor was based on the lack of the myoepithelial layers associated with the ductal structures. The diagnostic dilemma of the differential diagnoses is discussed, and pertinent literature is reviewed.Heterotopic breast tissue versus occult metastatic carcinoma in lymph node, a diagnostic dilemmaSteven J. Ohsie, Neda A. Moatamed, Helena R. Chang, Sophia K. Apple10.1016/j.anndiagpath.2009.06.010Annals of Diagnostic Pathology 14, 4 (2010)2009-09-22Annals of Diagnostic Pathology2009-09-22144S1092-9134(10)X0004-1Case Reports260263http://www.annalspathology.com/article/PIIS1092913409001075/abstract?rss=yesAbstract: Most teratomas involving the thyroid gland are benign and occur in children. However, the adult cases reported are mostly malignant. Many of the cases previously described in the medical literature have fatal outcome because of spread of the tumor refractory to treatment. We report a case of primary malignant teratoma of the thyroid in a 38-year-old pregnant black woman. She was treated with a combination of surgery, and postoperative chemotherapy with good initial response.Malignant teratoma of the thyroid in a pregnant womanBelen Pérez-Mies, Rita M. Regojo Zapata, Eugenia García-Fernández, M. Nistal Serrano10.1016/j.anndiagpath.2009.07.004Annals of Diagnostic Pathology 14, 4 (2010)2009-11-18Annals of Diagnostic Pathology2009-11-18144S1092-9134(10)X0004-1Case Reports264267http://www.annalspathology.com/article/PIIS1092913409001129/abstract?rss=yesAbstract: The diagnoses of Hodgkin lymphoma and multiple myeloma have rarely been made simultaneously in the same patient. We present a case of an 82-year-old man who rapidly developed pancytopenia and liver failure with coagulopathy. Serum protein electrophoresis and immunofixation revealed an unequivocal immunoglobulin Gκ and immunoglobulin Gλ biclonal gammopathy. Bone marrow biopsy showed involvement by classic Hodgkin lymphoma with an inflammatory background including 49% mature plasma cells. Unfortunately, the patient died 14 days after admission. To our knowledge, a case of concurrent Hodgkin lymphoma and biclonal multiple myeloma has not previously been reported. Detection of severe bone marrow plasmacytosis in the background of Hodgkin lymphoma should alert the pathologist to the possibility of collision with a plasma cell neoplasm, warranting a complete diagnostic workup.Concurrent diagnoses of Hodgkin lymphoma and biclonal myeloma in the bone marrowAlison R. Huppmann, Min-ling Liu, Victor E. Nava10.1016/j.anndiagpath.2009.09.006Annals of Diagnostic Pathology 14, 4 (2010)2009-12-02Annals of Diagnostic Pathology2009-12-02144S1092-9134(10)X0004-1Case Reports268272http://www.annalspathology.com/article/PIIS1092913409001130/abstract?rss=yesAbstract: Malignant granular cell tumor is a rare neoplasm reported to occur at various sites in the body. Histogenesis of these tumors is still vaguely understood; however, their metastatic potential and adverse prognosis is well-described in the literature. The histologic criteria of malignancy proposed by Fanburg-Smith et al are still debatable amongst pathologists, with metastasis being the sole criterion of malignancy with unanimous agreement. To our knowledge, no specific karyotype characterizes these tumors. Hence, the importance of detecting characteristic cytogenetic alterations in these tumors which might serve, in the future, as a possible aid in diagnosis or therapy. We report a new case of malignant granular cell tumor of the thigh with metastases to abdominal wall and both lungs causing severe dyspnea. Cytogenetic analysis demonstrated that 60% of cultured tumor cells display the following karyotype 46,XX,+X,dic(5;15).Malignant granular cell tumor: case report with a novel karyotype and review of the literatureHaitham Nasser, Robert D. Danforth, Mohamad Sunbuli, Oliver Dimitrijevic10.1016/j.anndiagpath.2009.08.004Annals of Diagnostic Pathology 14, 4 (2010)2009-12-02Annals of Diagnostic Pathology2009-12-02144S1092-9134(10)X0004-1Case Reports273278http://www.annalspathology.com/article/PIIS1092913409001142/abstract?rss=yesAbstract: Dermatofibrosarcoma protuberans (DFSP) is a low-grade dermal and subcutaneous spindle cell neoplasm that most commonly occurs in the extremities and trunk of adults. It is rare in children and infants, and only few cases are reported as congenital. A 2-year-old girl presented with a rapidly enlarging left breast mass. The histology of the excised mass revealed a moderately cellular spindle cell tumor with large hypercellular fibrosarcoma-like areas, few myxoid areas, and other areas with multinucleated giant cells. By immunohistochemistry, the tumor cells were focally positive for CD34 and were negative in the fibrosarcomatous areas. The diagnosis of DFSP was confirmed by demonstrating an unbalanced translocation der(22)t(17;22)(q21.3;q13.1) by conventional cytogenetic and fluorescence in situ hybridization analyses. Positive immunoreactivity with PDGFR-β antibody indicated constitutional activation of PDGF receptor and provided an alternate indirect method of confirming the presence of dysregulated PDGF gene involved in this translocation. Although DFSP has been described in the adult female breast, this is the first such case in the breast of a 2-year-old girl. Dermatofibrosarcoma protuberans should be considered in the differential diagnosis of subcutaneous/dermal spindle cell tumors in children regardless of the site. CD 34 immunostaining should not be relied on, as it may be negative in fibrosarcomatous areas. Confirmation of the diagnosis in unusual sites requires identification of the characteristic t(17;22) chromosomal translocation.Dermatofibrosarcoma protuberans in the breast of a 2-year-old girlAtif A. Ahmed, Daniel Ostlie, Jason D. Fraser, Brandon Newell, Linda Cooley10.1016/j.anndiagpath.2009.09.007Annals of Diagnostic Pathology 14, 4 (2010)2009-12-02Annals of Diagnostic Pathology2009-12-02144S1092-9134(10)X0004-1Case Reports279283http://www.annalspathology.com/article/PIIS1092913409001154/abstract?rss=yesAbstract: Papillary renal cell carcinoma may display some unusual morphologic variations, including diffuse oncocytic change not otherwise specified, oncocytic change associated with an inverted nuclear pattern or nonoverlapping low-grade nuclei, low-grade spindle cells, and diffuse clear cells. Tumors comprised predominantly of thyroid-like follicles and inspissated eosoinophilic, colloid-like secretions (thyroid-like follicular carcinoma of the kidney) have been recently recognized. We report herein an unusual renal carcinoma that displayed diffuse clear cells, papillary architecture, foamy histiocytes, psammomatous calcifications, and large areas (approximately 20% of tumor volume) with thyroid macrofollicular-like structures and eosinophilic, colloid-like secretions. The tumor was diffusely positive for alpha-methylacyl-CoA racemase, cytokeratin 7 and CD10, and was entirely negative for CD15, thyroglobulin, thyroid-transcription factor-1, TFE3, and renal cell carcinoma antigen. Fluorescence in situ hybridization using centromeric DNA probes for chromosomes 7, 17, 3, and 3p25 showed gains only in chromosome 7 and no other aberrations. The tumor was accordingly classified as an unusual morphologic variation of papillary renal cell carcinoma. This case affirms the potential for papillary renal cell carcinoma to display a diffuse complement of clear cells, and documents the heretofore unreported finding of large areas of thyroid macrofollicular structures and eosinophilic, colloid-like secretions in this histotype.Papillary renal cell carcinoma with diffuse clear cells and thyroid-like macrofollicular areasOluwole Fadare, Suzanne Lam, Christopher Rubin, Idris L. Renshaw, Craig L. Nerby10.1016/j.anndiagpath.2009.09.008Annals of Diagnostic Pathology 14, 4 (2010)2009-12-11Annals of Diagnostic Pathology2009-12-11144S1092-9134(10)X0004-1Case Reports284291http://www.annalspathology.com/article/PIIS1092913409001166/abstract?rss=yesAbstract: Auer rods define neoplastic blasts of myeloid origin. However, azurophilic, needle-shaped, Auer rod–like inclusions have rarely been reported in the neoplastic cells of patients with B-cell malignancies, including chronic lymphocytic leukemia/small lymphocytic lymphoma. Here, we report a case of low-grade B-cell leukemia most consistent with chronic lymphocytic leukemia/small lymphocytic lymphoma that displayed numerous intracytoplasmic, needle-shaped, azurophilic rods resembling Auer rods. Furthermore, we review the literature on Auer rod–like structures in B-cell neoplasms.Auer rod–like inclusions in a low-grade B-cell leukemiaAlexandra C. Hristov, Andrew Saladino, Victor E. Nava, Christopher D. Gocke10.1016/j.anndiagpath.2009.07.005Annals of Diagnostic Pathology 14, 4 (2010)2010-04-05Annals of Diagnostic Pathology2010-04-05144S1092-9134(10)X0004-1Case Reports292295http://www.annalspathology.com/article/PIIS1092913410000353/abstract?rss=yesAbstract: Unlike their counterparts in other organ systems, primary vascular neoplasms of the lung are rare. Most of these lesions have only been reported as isolated case studies or small series. When dealing with malignant lesions, metastasis from extrapulmonary sites will have to be excluded before a primary location in the lungs can be confirmed. In this review, the clinicopathologic, immunophenotypical, ultrastructural, and molecular biologic characteristics of primary vascular tumors of the lungs are discussed. The tumoral conditions that will be addressed include hemangioma, lymphangioma, epithelioid hemangioendothelioma, angiosarcoma, and Kaposi's sarcoma. Their respective differential diagnoses will also be discussed.Primary vascular tumors of the lungs: a reviewAnnikka Weissferdt, Cesar A. Moran10.1016/j.anndiagpath.2010.03.001Annals of Diagnostic Pathology 14, 4 (2010)2010-06-21Annals of Diagnostic Pathology2010-06-21144S1092-9134(10)X0004-1Review Article296308http://www.annalspathology.com/article/PIIS1092913410000833/abstract?rss=yesTable of Contents10.1016/S1092-9134(10)00083-3Annals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1FrontmatterA1A2http://www.annalspathology.com/article/PIIS1092913410000821/abstract?rss=yesEditorial Board10.1016/S1092-9134(10)00082-1Annals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1FrontmatterA3A3http://www.annalspathology.com/article/PIIS1092913410000845/abstract?rss=yesInstructions to Authors10.1016/S1092-9134(10)00084-5Annals of Diagnostic Pathology 14, 4 (2010)2010-08-01Annals of Diagnostic Pathology2010-08-01144S1092-9134(10)X0004-1FrontmatterA4A5