Annals of Diagnostic Pathology RSS feed: Articles in Press. 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//inpress?rss=yesElsevier Inc.en © 2010 Elsevier Inc. All rights reserved. Annals of Diagnostic Pathology1092-91342010-02-24 © 2010 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.annalspathology.com/article/PIIS1092913409001531/abstract?rss=yesAbstract: We report 2 cases of rectal melanoma. The patients were a 48-year-old man and an 88-year-old woman. In both cases, the tumor presented as polypoid and necrotic masses, making initial diagnostic assessment difficult because of the regressive tissue changes. Microscopically, tumors were mostly composed of epithelioid, highly atypical cells mimicking poorly differentiated carcinoma or large cell lymphoma. Tumor cells were negative for keratin, leukocyte common antigen, and epithelial membrane antigen and positive for S100 protein and several melanoma markers, although in endoscopic biopsy specimens, the positive reaction was focal due to the limited viable tissue. One patient was treated with abdominoperineal resection. Pathologic examination of the surgical specimen revealed a polypoid mass infiltrating the muscle coat of the rectum. Local lymph nodes contained metastatic deposits. Microscopic examination of the rectal mucosa adjacent to the infiltrating neoplasm revealed colonization of the intestinal crypts by atypical melanocytes. This patient is alive 1 year after surgery with no evidence of recurrent disease. The other case was not deemed amenable to radical surgery because of the patient's advanced age and evidence of diffuse metastatic disease. She was alive 6 months after the initial diagnosis but was lost to follow-up. Data indicate that the diagnosis of melanoma, although feasible in large resection specimens, may be problematic in endoscopic biopsy, especially when only small tissue fragments are available and tumor regression hampers the accuracy of immunohistochemical stains. Documentation of intracryptic atypical melanocytes in nonneoplastic mucosa conceptually corroborates claims that rectal melanoma is related to preinvasive precursors as in cutaneous melanoma.Epithelioid melanoma of the rectum: reappraisal of a deceptive microscopic simulator - Corrected ProofPierpaolo Cusati, Sandro Sulfaro, Tiziana Salviato, Giovanni Falconieri10.1016/j.anndiagpath.2009.12.004Annals of Diagnostic Pathology (2010)2010-02-24Annals of Diagnostic Pathology2010-02-24http://www.annalspathology.com/article/PIIS1092913409001695/abstract?rss=yesAbstract: Chondroblastomas are rare bone tumors, accounting for less than 2% of all bone tumors. Although generally benign, there are instances of aggressive tumor behavior with extensive soft tissue invasion and even metastasis. In this report, we detail an instance where the tumor displayed extensive soft tissue invasion. As there is tumor heterogeneity in terms of morphologic appearance as well as a varied immunohistochemistry profile, a diagnosis of chondroblastoma may not be straightforward if the initial biopsy sample did not include the more characteristic area. In our case, the tumor expressed cytokeratin, calponin, and p63 in addition to S-100, potentially raising a diagnosis of a mixed tumor. The differential diagnosis and biologic behavior of chondroblastomas are discussed.Cytokeratin-, calponin-, and p63-positive chondroblastoma with extensive soft tissue involvement and vascular invasion: a potential diagnostic dilemma - Corrected ProofYong Howe Ho, Mathew Hern Wang Cheng, Wai Ming Yap, Khoon Leong Chuah10.1016/j.anndiagpath.2009.12.008Annals of Diagnostic Pathology (2010)2010-02-24Annals of Diagnostic Pathology2010-02-24CASE REPORThttp://www.annalspathology.com/article/PIIS109291340900149X/abstract?rss=yesAbstract: Solitary synovial osteochondroma (SSO) is a rare variant of extraskeletal osteochondroma. The aim of this study was to review 5 cases of SSO, including clinical, radiographic, and histopathologic features. Five cases of SSO were retrieved from our files. Histopathologic and radiographic findings were reviewed, and a clinicopathologic correlation was performed. Patients' ages ranged from 33 to 63 years. Knee mass was the most common presentation. All cases were well circumscribed and had multiple cartilaginous lobules surrounded by fibroadipose tissue. Microscopically, lobulated adult-type hyaline cartilage with central calcification was noted. Cytologic atypia was present in one case, but malignant features were absent. Two cases were suggestive of chondrosarcoma on imaging studies. Patients underwent surgery, which was curative in cases for which follow-up was available. In conclusion, SSO is a rare lesion that may mimic low-grade chondrosarcoma at times. Correct recognition of SSO depends on radiographic and clinicopathologic analysis.Solitary synovial osteochondroma - Corrected ProofEmanuela Veras, Rania Abadeer, Hema Khurana, Donfeng Tan, Alberto Ayala10.1016/j.anndiagpath.2009.10.011Annals of Diagnostic Pathology (2010)2010-02-15Annals of Diagnostic Pathology2010-02-15http://www.annalspathology.com/article/PIIS1092913409001476/abstract?rss=yesAbstract: Compared with that of urinary bladder, urothelial carcinoma of renal pelvis is infrequent and its morphologic features and presentations have seldom been described. Fifty-nine renal pelvic urothelial carcinomas were evaluated in this study. Seventy-eight percent of these were high-grade tumors, of which 39% contained variable amount of divergent morphology. Forty-four percent of the high-grade urothelial carcinomas presented with an advanced tumor stage. Seventy-eight percent of urothelial carcinomas with divergent morphology displayed a tumor stage of pT2 and above, compared with 21% of classical urothelial carcinomas, which presented at stage pT2 and above. In summary, high-grade and unusual morphology as well as advanced tumor stage were the frequent findings in pelvicalyceal urothelial carcinomas. In addition, divergent morphology was correlated with advanced tumor stage. The clinicopathologic features of pelvicalyceal urothelial carcinomas with unusual divergent morphology were particularly emphasized in this study.Renal pelvic urothelial carcinoma with divergent morphology - Corrected ProofGuang-Qian Xiao, Pamela D. Unger10.1016/j.anndiagpath.2009.10.009Annals of Diagnostic Pathology (2010)2010-02-12Annals of Diagnostic Pathology2010-02-12http://www.annalspathology.com/article/PIIS1092913409001488/abstract?rss=yesAbstract: We report an unusual case of metastatic adult granulosa cell tumor in the head of pancreas mimicking a benign pancreatic cyst in a 43-year-old female. Clinically, it was considered a benign cyst of the pancreas based on its appearance by imaging and that repeated fine-needle aspiration and cytologic examination of cystic fluid failed to identify malignant cells. The cyst in her pancreas grew slowly during the 15 months of close follow-up. Subsequent drainage and open biopsy of the cyst wall established the diagnosis of metastatic adult granulosa cell tumor that was confirmed in pancreaticoduodenectomy specimen. Immunohistochemical study and clinical history were critical to make the correct diagnosis and to differentiate this tumor from other more commonly encountered cystic neoplasms of the pancreas.Metastatic adult granulosa cell tumor mimicking a benign pancreatic cyst - Corrected ProofRania A. Abadeer, Jason B. Fleming, Michael T. Deavers, Asif Rashid, Douglas B. Evans, Huamin Wang10.1016/j.anndiagpath.2009.10.010Annals of Diagnostic Pathology (2010)2010-02-12Annals of Diagnostic Pathology2010-02-12CASE REPORThttp://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) - Corrected ProofDennis K. Heffner10.1016/j.anndiagpath.2009.10.006Annals of Diagnostic Pathology (2010)2010-02-05Annals of Diagnostic Pathology2010-02-05COMMENTARYhttp://www.annalspathology.com/article/PIIS1092913409000872/abstract?rss=yesAbstract: The mucosal surfaces represent the third most common site of origin for melanoma, after the skin and ocular uveal tract. However, anorectal mucosal melanoma is a rare neoplasm, usually occurring in the sixth and seventh decades of life. It may often be confused clinically with other pathologic entities, such as prolapsed rectal polyps and hemorrhoids. The prognosis of anorectal melanoma is poor; this is at least in part attributable to the relatively large size that such tumors have frequently achieved at presentation, as well as their rich vascular network. In particular, anorectal melanoma in children and adolescents is extraordinarily uncommon. The authors herein report 2 examples of that tumor in 11-year-old and 19-year-old patients; one was alive and tumor-free after 6 years, whereas the other died with osseous and hepatic metastasis at the same time point. The authors emphasize the need for differential diagnostic inclusion of melanocytic malignancies when considering anorectal masses in pediatric individuals. Systematic collation and evaluation of pediatric melanomas of the anus and rectum are needed, to better define the biologic attributes of those neoplasms.Anorectal melanoma in childhood and adolescence - Corrected ProofZach M. Ellis, Ali D. Jassim, Mark R. Wick10.1016/j.anndiagpath.2009.07.003Annals of Diagnostic Pathology (2010)2010-02-04Annals of Diagnostic Pathology2010-02-04http://www.annalspathology.com/article/PIIS1092913409001440/abstract?rss=yesAbstract: Diffuse panbronchiolitis (DPB) is an idiopathic inflammatory process involving respiratory bronchioles, largely restricted to Japanese people and associated with HLA Bw54. We report a case of idiopathic bronchiolitis with DPB features in an African American with hepatitis C virus infection, correlated with postmortem anatomic findings. The 53-year-old patient presented with shortness of breath and productive cough. Examination revealed hypercapnic respiratory failure. Lung computed tomography showed diffuse centrilobular nodules and branching linear opacities, whereas lung biopsy demonstrated diffuse peribronchiolar fibrosis and chronic inflammation with bronchiolectasis. He died 37 days postadmission. Autopsy revealed numerous bronchiolocentric nodules with bronchiolectasis and sheets of foamy macrophages in alveolar septa and spaces. This is a rare example of idiopathic bronchiolitis with features of DPB in an hepatitis C virus–infected African-American patient. Hepatitis C virus infection is known to be associated with extrahepatic pulmonary manifestations, and DPB may be one of these. Early diagnosis will allow appropriate treatment and may slow the disease progression.Idiopathic bronchiolitis with features of diffuse panbronchiolitis in an African-American patient with hepatitis C virus infection - Corrected ProofNahal Boroumand, Rhonda Cooke, Curig Prys-Picard, Diana M. Palacio, Mahmoud Eltorky10.1016/j.anndiagpath.2009.11.001Annals of Diagnostic Pathology (2010)2010-02-04Annals of Diagnostic Pathology2010-02-04http://www.annalspathology.com/article/PIIS1092913409001452/abstract?rss=yesAbstract: Ameloblastic fibrosarcoma (AFS), regarded as the malignant counterpart of the benign ameloblastic fibroma, is an extremely rare odontogenic neoplasm with only 68 cases reported in the English literature up to 2009. It is composed of a benign odontogenic epithelium, resembling that of ameloblastoma, and a malignant mesenchymal part exhibiting features of fibrosarcoma. Due to the rarity of the lesion, little is known about its molecular pathogenesis; therefore, in the current study, we sought to evaluate the immunoexpression of Ki67, proliferative cell nuclear antigen, and Bcl-2 proteins in AFS, comparing the results obtained with its benign counterpart, as well as to report a new case of this rare entity affecting a 19-year-old female patient. The results obtained revealed that all the proteins evaluated were overexpressed in the malignant mesenchymal portion of AFS if compared with ameloblastic fibroma, suggesting that nuclear proliferative factors such as Ki67 and proliferative cell nuclear antigen, in association to histopathologic features, may be useful markers for identifying the malignancy and that, despite the lack of molecular analysis in the case reported, Bcl-2 alteration may play a role in AFS pathogenesis.Immunoexpression of Ki67, proliferative cell nuclear antigen, and Bcl-2 proteins in a case of ameloblastic fibrosarcoma - Corrected ProofHélder Antônio Rebelo Pontes, Flávia Sirotheau Corrêa Pontes, Brunno Santos de Freitas Silva, Sérgio Elias Vieira Cury, Felipe Paiva Fonseca, Rodrigo Alves Salim, Décio dos Santos Pinto Júnior10.1016/j.anndiagpath.2009.10.007Annals of Diagnostic Pathology (2010)2010-02-04Annals of Diagnostic Pathology2010-02-04http://www.annalspathology.com/article/PIIS1092913409001464/abstract?rss=yesAbstract: Rhabdoid tumors have been reported in many different anatomic sites as an aggressive tumor and usually present with a rhabdoid tumor component (a composite tumor) rather than a pure rhabdoid tumor. Rhabdoid tumor in the prostate has been described only once in the prostatic region as a possible epithelial origin. Rhabdoid features in prostatic stromal sarcomas (PSSs) have never been described in the literature. Here, we report a case of a PSS with rhabdoid features. A 31-year-old man presented with a 4-month history of voiding difficulty and anal pain. Computed tomography of the abdomen revealed an ovoid mass in the prostate invading rectum and urinary bladder. A needle biopsy was diagnosed as an unclassified spindle cell sarcoma, and 2 cycles of adriamycin-based neoadjuvant chemotherapy were given, followed by radical prostatectomy. The prostatectomy specimen revealed a high-grade sarcoma with fascicles of highly cellular spindle cells and numerous mitoses with hemorrhage and necrosis. In areas, the tumor also contained sheets of loosely cohesive epithelioid cells with rhabdoid tumor component. Both spindle and rhabdoid tumor cells were positive for vimentin, CD34, and progesterone receptor and negative for desmin and cytokeratin immunostainings. The rhabdoid tumor cells retained INI1 expression. The tumor recurred in the bladder, and the patient died of sepsis. To the best of our knowledge, this is the first case of PSS with rhabdoid features. The tumor showed an aggressive clinical behavior with a short-term survival (7 months after diagnosis).Prostatic stromal sarcoma with rhabdoid features - Corrected ProofJoo Young Kim, Yong Mee Cho, Jae Y. Ro10.1016/j.anndiagpath.2009.10.008Annals of Diagnostic Pathology (2010)2010-02-04Annals of Diagnostic Pathology2010-02-04CASE REPORThttp://www.annalspathology.com/article/PIIS1092913409001725/abstract?rss=yesAbstract: Vascular endothelial growth factor (VEGF) and basic fibroblastic growth factor (b-FGF) have been described as essential cytokines in the regulation of angiogenesis. Their elevation has been associated with an unfavorable outcome in different neoplasms. However, their role in angiogenesis and proliferation in B-cell non-Hodgkin's lymphoma (B-NHL) is unclear. Seventy cases of B-NHL besides 5 cases with reactive lymphadenitis were collected randomly and classified according to World Health Organization classification, Ann Arbor staging. They were subjected to immunostaining using VEGF, b-FGF, CD34, and Ki67 markers. There were a positive correlation between the proliferation and aggressiveness of the tumor as measured with Ki67 and both VEGF and b-FGF, and this was reflected on the stromal increase in microvessel density as measured by CD34. In conclusion, as the tumor becomes more aggressive, it also becomes independent of stromal paracrine factors by the establishment of an autocrine VEGF and b-FGF stimulation that can increase its angiogenesis and proliferation.Prognostic significance of vascular endothelial growth factor, basic fibroblastic growth factor, and microvessel density and their relation to cell proliferation in B-cell non-Hodgkin's lymphoma - Corrected ProofHanan AlSaeid Alshenawy10.1016/j.anndiagpath.2009.12.011Annals of Diagnostic Pathology (2010)2010-02-01Annals of Diagnostic Pathology2010-02-01REVIEW ARTICLEhttp://www.annalspathology.com/article/PIIS1092913409001245/abstract?rss=yesAbstract: Hepar lobatum carcinomatosum is an unusual cause of chronic liver failure, usually maskerading as cirrhosis. The pathogenesis of this syndrome is unclear. We report a case of liver failure revealing an occult lobular carcinoma of the breast, which offers the opportunity to gain further insight into the mechanisms of this rare cause of chronic liver disease. A 57-year-old woman, without history of malignancy, presented with hepatomegaly, ascites and altered liver tests (serum transaminase activity >5 N and hyperbilirubinemia). The transjugular liver biopsy performed at diagnosis showed an extensive fibrosis, containing scattered tumor cells, typical of metastatic lobular carcinoma of the breast. Four months later, after discovery of a rectal adenocarcinoma, a laparoscopy was performed; peritoneal carcinomatosis was discovered. A surgical biopsy of the liver was taken during the procedure: it showed histological features suggestive of chronic Budd-Chiari syndrome, with venocentric fibrosis and reversed lobulation. Intraluminal invasion of small hepatic veins and sinusoidal obstruction by neoplastic cells were observed. A small focus of lobular carcinoma was eventually discovered in the left mammary gland. The present case report expands the spectrum of clinical presentations associated with hepar lobatum carcinomatosum and points out to the importance of vascular injury in the pathogenesis of this rare cause of chronic liver disease.Hepar lobatum carcinomatosum revealing an occult metastatic lobular carcinoma of the breast - Corrected ProofIvan Graber, Jérôme Dumortier, Gilles Poncet, Pierre-Edouard Queneau, Patrice Mathevet, Jean-Yves Scoazec10.1016/j.anndiagpath.2009.10.004Annals of Diagnostic Pathology (2010)2010-01-11Annals of Diagnostic Pathology2010-01-11CASE REPORThttp://www.annalspathology.com/article/PIIS1092913409001208/abstract?rss=yesAbstract: A case of primary myxoma of the lung is presented. The patient is a 70-year-old woman who presented with a history of dyspnea, cough, and mild chest discomfort. Chest radiographic studies disclosed the presence of a well-marginated nodule in the left upper lobe. A wedge resection of the tumor mass was performed. The specimen contained a tan-gray, soft, well-circumscribed tumor nodule of approximately 1.8 cm in greatest dimension. Histologically, the tumor was characterized by a well-demarcated lesion, composed of loose spindle and stellate cells embedded in a myxoid matrix, containing thin-walled vessels. Immunohistochemical studies showed the cell to be negative for S-100, keratin, desmin, smooth muscle actin, and HMB-45. Vimentin stain showed positive staining in some of the stellate cells. No evidence of recurrence or metastatic disease was observed after 18 months.Primary myxoma of the lung - Corrected ProofNeda Kalhor, Edith M. Marom, Cesar A. Moran10.1016/j.anndiagpath.2009.09.009Annals of Diagnostic Pathology (2009)2009-12-21Annals of Diagnostic Pathology2009-12-21RADIOLOGIC-PATHOLOGIC CORRELATIONhttp://www.annalspathology.com/article/PIIS109291340900121X/abstract?rss=yesAbstract: Endolymphatic sac tumors (ELSTs) are very rare and locally aggressive low-grade neoplasm of endolymphatic system origin, which are associated with von Hippel–Lindau (VHL) disease. Evidence suggests that the specific VHL alteration influences the phenotype. Because of the rarity of ELSTs, only a small number of cases have been subjected to molecular genetic analysis. The correlation between ELSTs and the genotype of VHL remains unclear. Herein, we reported a case of ELST with VHL gene analysis who presented with a family history of VHL disease. The radiologic, histologic, and immunohistochemical features of the tumor were typical of ELST. Using the polymerase chain reaction–single-strand conformation polymorphism sequencing techniques, a germline mutation was identified as IVS1 + 1G→A at position 553 + 1. The mutation found in this case has not been previously reported in ELSTs. It is hoped that the study would contribute to a better understanding of ELSTs and the correlation between ELSTs and the genotype of VHL.Endolymphatic sac tumor with von Hippel–Lindau disease: report of a case with analysis of von Hippel–Lindau gene and review - Corrected ProofQiu Rao, Jing Zhou, Jian-dong Wang, Xing-zao Jin, Heng-hui Ma, Zhen-feng Lu, Xiao-jun Zhou10.1016/j.anndiagpath.2009.10.001Annals of Diagnostic Pathology (2009)2009-12-21Annals of Diagnostic Pathology2009-12-21http://www.annalspathology.com/article/PIIS1092913409001221/abstract?rss=yesAbstract: Basal cell proliferations within the prostate gland encompass a group of benign and malignant entities. Although basal cell hyperplasia is a common finding, basal cell carcinoma of the prostate gland is a rare tumor that can be mistaken by a benign condition and represents a diagnostic problem in genitourinary pathology. We report a case of basal cell carcinoma in a previously healthy 65-year-old man with urinary symptoms and low prostate-specific antigen. The microscopic findings are presented and the use of immunohistochemical markers classifying basal cell lesions of the prostate discussed.Basal cell carcinoma of the prostate gland: a case report and brief review of the basal cell proliferations of the prostate gland - Corrected ProofOlga L. Bohn, Nina P. Rios-Luna, Leticia Navarro, Agustin Duran-Peña, Sergio Sanchez-Sosa10.1016/j.anndiagpath.2009.10.002Annals of Diagnostic Pathology (2009)2009-12-21Annals of Diagnostic Pathology2009-12-21CASE REPORThttp://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 areas - Corrected ProofOluwole Fadare, Suzanne Lam, Christopher Rubin, Idris L. Renshaw, Craig L. Nerby10.1016/j.anndiagpath.2009.09.008Annals of Diagnostic Pathology (2009)2009-12-11Annals of Diagnostic Pathology2009-12-11CASE REPORThttp://www.annalspathology.com/article/PIIS1092913409001191/abstract?rss=yesAbstract: We report a unique case of an extramammary mammary-type myofibroblastoma of the perianal region. The patient was a 40-year old female with no significant past history, who presented with a right side painless perianal mass. Gross examination of the excised mass showed a well-circumscribed, apparently encapsulated, nodular mass weighing 30 g and measuring 5 cm. in the greatest dimension. The cut surface showed solid, yellow homogenous tissue. Microscopically, the neoplasm was composed of bland spindled cells generally arranged into short fascicles with abundant myxoid stroma. The cells stained strongly for desmin and CD34. To our knowledge, a review of the literature discloses only ten cases of extramammary, mammary-type myofibroblastoma.Perianal mammary-type myofibroblastoma - Corrected ProofYaxia Zhang, Merce Jorda, John R. Goldblum10.1016/j.anndiagpath.2009.08.005Annals of Diagnostic Pathology (2009)2009-12-09Annals of Diagnostic Pathology2009-12-09CASE REPORThttp://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 marrow - Corrected ProofAlison R. Huppmann, Min-ling Liu, Victor E. Nava10.1016/j.anndiagpath.2009.09.006Annals of Diagnostic Pathology (2009)2009-12-02Annals of Diagnostic Pathology2009-12-02CASE REPORThttp://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 literature - Corrected ProofHaitham Nasser, Robert D. Danforth, Mohamad Sunbuli, Oliver Dimitrijevic10.1016/j.anndiagpath.2009.08.004Annals of Diagnostic Pathology (2009)2009-12-02Annals of Diagnostic Pathology2009-12-02CASE REPORThttp://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 girl - Corrected ProofAtif A. Ahmed, Daniel Ostlie, Jason D. Fraser, Brandon Newell, Linda Cooley10.1016/j.anndiagpath.2009.09.007Annals of Diagnostic Pathology (2009)2009-12-02Annals of Diagnostic Pathology2009-12-02CASE REPORThttp://www.annalspathology.com/article/PIIS1092913409001178/abstract?rss=yesAbstract: Only 1% of gynecological neoplasms are vaginal, and mesenchymal tumors constitute only 2% of vaginal neoplasms. The most common form is leiomyomas. Schwannomas arise from the peripheral nerve sheath. We report a case of vaginal schwannoma associated with uterine myoma. A 52-year-old woman presented with lower abdominal pain and menorrhagia for a duration of 6 months. At sonographic examination, the patient was found to have uterine myomas and a solid mass measuring 5×4.5 cm beneath the vaginal wall. At laparotomy, the uterus with myoma was removed using our standard operation procedures. Surgical excision of the mass from vaginal aspect was also undertaken, and the histology demonstrated schwannoma. The tumor cells were vimentin (+), desmin (−), smooth muscle α-actin (−), HMB-45 (−), MART-1 (−) and S-100 (+). There is no evidence of recurrence during 6 months follow-up. The differential diagnosis of a mass in the vagina includes also schwannomas. Immunocytochemical labeling of the tumor cells is essential. Simple resection of the mass is the preferred method of treatment.Vaginal Schwannoma in a case with uterine myoma - Corrected ProofBanu Dane, Cem Dane, Serife Basaran, Murat Erginbas, Ahmet Cetin10.1016/j.anndiagpath.2009.06.012Annals of Diagnostic Pathology (2009)2009-12-02Annals of Diagnostic Pathology2009-12-02CASE REPORThttp://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 woman - Corrected ProofBelen Pérez-Mies, Rita M. Regojo Zapata, Eugenia García-Fernández, M. Nistal Serrano10.1016/j.anndiagpath.2009.07.004Annals of Diagnostic Pathology (2009)2009-11-18Annals of Diagnostic Pathology2009-11-18CASE REPORThttp://www.annalspathology.com/article/PIIS109291340900077X/abstract?rss=yesAbstract: Transplanted organs may act as a route of transmission of infectious diseases, such as Chagas' disease. The aim of this study was to describe the transmission of the Trypanosoma cruzi through a renal transplant and the anatomo-clinical evolution of the patient after treatment with benzonidazole. The patient was a 31-year-old white male from the State of Minas Gerais in Brazil. He had renal failure secondary to diabetes and later received a kidney from a cadaveric donor. The patient was undergoing immunosuppression therapy with azathioprine, cyclosporine A, and prednisone. After the transplant, he developed an acute phase of Chagas' disease and complications from diabetes and died 2 months later. In the autopsy, T cruzi amastigotes were found in the transplanted kidney, heart, bladder, liver, and pancreas. An important reduction in the parasitemia was obtained through the treatment of the infection with benzonidazole; however, the patient died due to complications from diabetes associated with tissue lesions caused by T cruzi.Acute Chagas' disease in postrenal transplant and treatment with benzonidazole - Corrected ProofAlex Eduardo Silva, Anna Carolina Fabiana Lúcia Silva, Ana Carolina Guimarães Faleiros, Camila Souza de Oliveira Guimarães, Rosana Rosa Miranda Corrêa, Flávia Aparecida Oliveira, Dalmo Correia, Alan César Teixeira, Luís Eduardo Ramirez, Vicente de Paula Antunes Teixeira, Marlene Antônia dos Reis10.1016/j.anndiagpath.2009.06.008Annals of Diagnostic Pathology (2009)2009-11-02Annals of Diagnostic Pathology2009-11-02http://www.annalspathology.com/article/PIIS109291340900118X/abstract?rss=yesAbstract: Leiomyomata are common benign smooth muscle neoplasms with a usually easily recognizable histologic pattern. However, there is a wide variety of subtypes described in the literature, characterized by predominance of a particular distinct histologic pattern. Here we describe a case of a highly vascular leiomyoma with a prominent plexiform pattern and cords and tubules of epithelioid cells that mimics a uterine tumor resembling an ovarian sex cord tumor.Vascular plexiform leiomyoma mimicking uterine tumor resembling ovarian sex cord tumor - Corrected ProofRochelle A. Simon, C. James Sung, W. Dwayne Lawrence, M. Ruhul Quddus10.1016/j.anndiagpath.2009.07.006Annals of Diagnostic Pathology (2009)2009-10-23Annals of Diagnostic Pathology2009-10-23CASE REPORThttp://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 dilemma - Corrected ProofSteven J. Ohsie, Neda A. Moatamed, Helena R. Chang, Sophia K. Apple10.1016/j.anndiagpath.2009.06.010Annals of Diagnostic Pathology (2009)2009-09-22Annals of Diagnostic Pathology2009-09-22CASE REPORThttp://www.annalspathology.com/article/PIIS1092913409000768/abstract?rss=yesAbstract: A 15-year-old girl with Turner syndrome was unexpectedly found to have a left suprarenal mass. Extensive investigations showed a clinically and biochemically inapparent mass. Computed tomography disclosed a well-defined solid lesion in the left adrenal measuring 6.5 × 5 cm with minimal contrast enhancement. Laparoscopic adrenalectomy was done. Histologic examination revealed an encapsulated mass originated from the left adrenal medulla. Tumor tissue comprised abundant collagen fibers and spindloid cells admixed with mature ganglion cells. The tumor was diagnosed as left adrenal ganglioneuroma. According to literature, we report the eighth case of ganglioneuroma complicating Turner syndrome. Patients with this syndrome are predisposed to the development of neuroblastoma and related tumors. Reasons for this predisposition might relate to genetic and hormonal factors. Given that these tumors are often limited stage and of good prognosis, we recommend their screening in all patients with Turner syndrome.Ganglioneuroma of adrenal gland in a patient with Turner syndrome - Corrected ProofMahdi Kamoun, Mouna Feki Mnif, Nabila Rekik, Neila Belguith, Nadia Charfi, Lilia Mnif, Mouna Elleuch, Fatma Mnif, Thouraya Kamoun, Zeinab Mnif, Hassen Kamoun, Tahia Sellami-Boudawara, Mongia Hachicha, Mohamed Abid10.1016/j.anndiagpath.2009.06.007Annals of Diagnostic Pathology (2009)2009-09-09Annals of Diagnostic Pathology2009-09-09http://www.annalspathology.com/article/PIIS109291340900080X/abstract?rss=yesAbstract: Only 17 cases of oncocytic adrenocortical carcinoma have been reported in the English literature. Here, we report an incidental case of oncocytic adrenocortical carcinoma. The patient was a 69-year-old man with the chief complaint of abdominal pain. Abdominal computed tomography revealed a left adrenal tumor. No hormonal symptoms were observed. The excised tumor was whitish, encapsulated, and 75 × 60 × 45 mm in size. Large polygonal tumor cells were arranged in a generally diffuse architecture and exhibited abundant eosinophilic granular cytoplasm. Nuclear atypia with atypical mitotic figures and capsular and sinusoidal invasions were observed. The tumor cells were immunopositive for vimentin, neuron-specific enolase, and synaptophysin but not for α-inhibin, melan A, or p53. Diffuse and strong immunopositivity with an antimitochondrial antibody proved that this tumor was truly oncocytic. Upon review of previous cases of oncocytic adrenocortical tumors, we reconsidered the diagnostic findings of the potential for malignancy.Oncocytic adrenocortical carcinoma: a case report and review of the literature - Corrected ProofHiroya Ohtake, Hiroshi Kawamura, Masami Matsuzaki, Eiichi Yokoyama, Masayuki Kitajima, Shiro Onizuka, Mitsunori Yamakawa10.1016/j.anndiagpath.2009.06.006Annals of Diagnostic Pathology (2009)2009-09-09Annals of Diagnostic Pathology2009-09-09http://www.annalspathology.com/article/PIIS1092913409000811/abstract?rss=yesAbstract: Lymphoepithelioma-like carcinoma (LELC) is an uncommon tumor of the urinary tract. We present a case of LELC involving the ureter of a 71-year-old male patient with gross hematuria. On biopsy, the patient was diagnosed with invasive poorly differentiated carcinoma, with a final diagnosis of LELC on subsequent nephroureterectomy. On resection, the neoplasm was solitary and consisted of undifferentiated neoplastic cells demonstrating a syncytial growth pattern, vesicular nuclei, prominent nucleoli, and an admixed polyclonal lymphoid infiltrate. Immunohistochemistry showed that the tumor cells were positive for Cam5.2 and CK7; focally positive for cytokeratinAE1/3, EMA, CK20, and p63; and negative for CK903. Epstein-Barr virus in situ hybridization was negative. No disease progression was noted at 5-month follow-up. Only 6 previous cases of LELC involving the ureter have been reported in the literature. We document an additional example of this uncommon entity and present a comprehensive review of LELC involving the ureter.Primary lymphoepithelioma-like carcinoma of the ureter - Corrected ProofDaniela S. Allende, Mihir Desai, Donna E. Hansel10.1016/j.anndiagpath.2009.05.007Annals of Diagnostic Pathology (2009)2009-09-04Annals of Diagnostic Pathology2009-09-04CASE REPORThttp://www.annalspathology.com/article/PIIS1092913409000744/abstract?rss=yesAbstract: PEComas are rare neoplasms that are sometimes associated with the tuberous sclerosis complex. They typically contain perivascular epithelioid cells that coexpress muscle and melanocytic markers. However, apart from these classical features, considerable clinical, pathologic, and immunohistochemical variation has been reported. WT1, the Wilms tumor gene product, can be expressed in various tumors from different anatomical sites, including sex-cord and other ovarian tumors with a sertoliform pattern. Neither a sex-cord–like pattern nor WT1 expression has been described in PEComas. Here, we describe a case of uterine PEComa with a pattern of infiltration into the myometrium that is similar to stromal sarcomas, characterized by tongues and endovascular growing. The architecture and cellular morphology were similar to sex-cord tumors, and the PEComa was diffusely and strongly positive for WT1. We reviewed, from our files, an additional 9 cases of PEComa from different sites, and found WT1 expression in one more soft tissue tumor. We discuss the relationship between PEComas and other uterine sarcomas.A new morphological variant of uterine PEComas with sex-cord-like pattern and WT1 expression: more doubts about the existence of uterine PEComas - Corrected ProofFilomena M. Carvalho, Jesus Paula Carvalho, Fernando C. Maluf, Carlos E. Bacchi10.1016/j.anndiagpath.2009.06.004Annals of Diagnostic Pathology (2009)2009-08-17Annals of Diagnostic Pathology2009-08-17http://www.annalspathology.com/article/PIIS1092913409000604/abstract?rss=yesAbstract: A 58-year-old man presented with epigastric pain that was refractory to analgesia. Before this, he was well and did not have manifestations of type 1 neurofibromatosis. Endoscopy revealed a 0.5-cm polypoid antral lesion that was snared and removed in total. Histological evaluation showed a submucosal myxoid spindle-cell proliferation. The tumor was arranged in whorls with distinct concentricity. Within the myxoid stroma, occasional eosinophils were present together with a delicate capillary network. There was no cytological atypia, areas of hypercellularity, or necrosis. The lesion was strongly positive for epithelial membrane antigen and also positive for CD34. All other markers including S-100, desmin, and CD117 were negative. The overall morphological and immunophenotypic features of this lesion are in keeping with a myxoid gastric perineurioma. This lesion needs to be separated from an inflammatory fibroid polyp and a gastrointestinal stromal tumor.Myxoid perineurioma presenting as a gastric polyp - Corrected ProofRunjan Chetty10.1016/j.anndiagpath.2009.06.002Annals of Diagnostic Pathology (2009)2009-08-07Annals of Diagnostic Pathology2009-08-07http://www.annalspathology.com/article/PIIS1092913407000561/abstract?rss=yesThis article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.WITHDRAWN: Rhabdomyomatous giant fibrovascular polyp of the esophagus - Corrected ProofJoseph D. Jakowski, Paul E. Wakely10.1016/j.anndiagpath.2007.04.006Annals of Diagnostic Pathology (2007)2007-10-08Annals of Diagnostic Pathology2007-10-08