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 Pathology1092-91342010-07-20 © 2010 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.annalspathology.com/article/PIIS1092913410000675/abstract?rss=yesAbstract: Paraganglioma of the mediastinum is an extremely uncommon neoplasm, and the concurrent finding of cystic changes has yet to be reported in the literature. We report a case of a 43-year-old man presenting with chest pain and left arm paresthesias. Imaging studies revealed a well-defined cystic lesion located in the anterior mediastinum, with the patient undergoing subsequent surgical resection of the mass. Grossly, the heterogenous mass measured 6.0 × 3.6 × 1.7 cm, with prominent cystic spaces and scattered solid areas. Microscopic examination revealed pseudocystic spaces with proliferation of large epithelioid cells with abundant eosinophilic cytoplasm, moderate pleomorphic nuclei, and prominent nucleoli, in a nested pattern of growth along the cysts walls. Immunohistochemical stains showed strong positivity for chromogranin, synaptophysin, and CD56 in the epithelioid cells, with negative staining for cytokeratin AE1/AE3, confirming the diagnosis of paraganglioma. S-100 was positive in the intervening sustentacular cells throughout the tumor. Cystic paraganglioma of the anterior mediastinum is a rare neoplasm, which , to our knowledge, has not yet been reported in the English literature, and should be added to the differential diagnosis of cystic lesions of the mediastinum.Cystic paraganglioma of the anterior mediastinum - Corrected ProofPablo F. Ortega, Luis Antonio Sosa, Manan Patel, Eduardo Zambrano10.1016/j.anndiagpath.2010.04.008Annals of Diagnostic Pathology (2010)2010-07-20Annals of Diagnostic Pathology2010-07-20RADIOLOGIC-PATHOLOGIC CORRELATIONShttp://www.annalspathology.com/article/PIIS1092913410000766/abstract?rss=yesAbstract: Familial gastrointestinal stromal tumor (GIST) is an extremely rare autosomal dominant disorder, and approximately 20 families have been reported to date. In this article, we present one additional family. A 25-year-old Japanese woman presented with abdominal pain, and subsequent image analyses disclosed multiple tumors measuring 12 cm in maximum diameter in the lower digestive tract. The postoperative histologic examination showed multiple GISTs and diffuse hyperplasia of interstitial cells of Cajal. Her mother had a history of GIST in the digestive tract. Three members of this family including her younger sister and mother had cutaneous hyperpigmentation of external genitalia and axilla. Their DNA samples showed identical missense mutation at exon 11 in the juxtamembrane domain of the KIT gene, and this mutation site was considered to be a hot spot in familial GIST. One year after, her younger sister suffered from multiple GISTs in the digestive tract at the age of 25 years. To correctly diagnose familial GIST, mutual information should be exchanged among clinicians, pathologists, and molecular scientists.Familial gastrointestinal stromal tumor with germ line mutation of the juxtamembrane domain of the KIT gene observed in relatively young women - Corrected ProofNaoto Kuroda, Nobuyuki Tanida, Seiichi Hirota, Ondrej Daum, Ondrej Hes, Michal Michal, Gang-Hong Lee10.1016/j.anndiagpath.2010.05.003Annals of Diagnostic Pathology (2010)2010-07-20Annals of Diagnostic Pathology2010-07-20CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000651/abstract?rss=yesAbstract: The interaction between the endothelium and malignant hematolymphoid cells within vessels of the eye can result in focal or diffuse intravascular pathology. As a result, correlation of these findings with specific clinical and ophthalmologic features can vary. We review the ophthalmic findings in two cases of hematolymphoid malignancies limited to the intravascular space and review published literature on this topic. In cases of intravascular large B-cell lymphoma, underexpression of β1-integrin and intercellular adhesion molecule-1 by the cells of intravascular large B-cell lymphoma results in diffuse ocular vascular involvement. The widespread degree of intravascular involvement correlates with clinical ophthalmologic findings and may lead to retinal and choroidal detachment that is observed postmortem. Conversely, in the context of acute leukemia, induced overexpression of certain adhesion molecules (intercellular adhesion molecule-1 and vascular cell adhesion molecule-1) in the endothelium of certain vascular beds may result in leukostasis with only selective (choroidal) ocular vessel involvement. As a result of only focal vascular activation and adhesion in the orbit, the gross findings in these cases are minimal and may not correlate with clinical ophthalmologic findings.Hematolymphoid malignancies with intraocular intravascular involvement: report of 2 cases - Corrected ProofJohn A. Papalas, Alan D. Proia, Thomas J. Cummings10.1016/j.anndiagpath.2010.04.006Annals of Diagnostic Pathology (2010)2010-07-09Annals of Diagnostic Pathology2010-07-09CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000742/abstract?rss=yesAbstract: Amphicrine tumors are defined by evidence of both glandular and neuroendocrine differentiation in the same cell. These are extremely rare tumors, with only scattered case reports in the pancreas and stomach. We here report a case of amphicrine carcinoma occurring in apparent isolation in the liver. The tumor was characterized by signet ring cell morphology, mucicarmine, and periodic acid Schiff with diastase (PASD) positivity, and expression of chromogranin, synaptophysin, villin, and CDX2. No other tumor was identified by radiological or endoscopic examination of the gastrointestinal tract. The patient is disease-free 22 months after the resection. We speculate that this represents the first reported occurrence of primary amphicrine carcinoma of the liver.Amphicrine carcinoma of the liver - Corrected ProofKarthik Ganesan, Emil Achmad, Claude B. Sirlin, Michael Bouvet, Brian Datnow, Noel Weidner, Michael R. Peterson10.1016/j.anndiagpath.2010.05.001Annals of Diagnostic Pathology (2010)2010-07-09Annals of Diagnostic Pathology2010-07-09CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000481/abstract?rss=yesAbstract: Biliary hamartomas or von-Meyenburg complexes form part of a spectrum of ductal plate malformation that includes polycystic liver disease, congenital hepatic fibrosis, and Caroli disease. These lesions are known to have neoplastic transformation. Development of intrahepatic cholangiocarcinoma is well described in these complexes. Rarely, hepatocellular carcinomas (HCCs) have been seen in association with bile duct hamartomas, however; it is not clear whether development of HCC is an epiphenomenon unrelated to the precursor lesion or biliary hamartomas may progress to liver cancers. We herein report 4 interesting cases of hepatitis C virus–, alcohol-, and nonalcoholic fatty liver disease–associated end-stage liver disease with coexisting HCC and multiple large von-Meyenburg complexes.Hepatocellular carcinoma arising in association with von-Meyenburg's complexes: an incidental finding or precursor lesions? A clinicopatholigic study of 4 cases - Corrected ProofDeepali Jain, Nabeen C. Nayak, Sanjiv Saigal10.1016/j.anndiagpath.2010.04.003Annals of Diagnostic Pathology (2010)2010-06-25Annals of Diagnostic Pathology2010-06-25ORIGINAL ARTICLEhttp://www.annalspathology.com/article/PIIS1092913410000420/abstract?rss=yesAbstract: Renal oncocytomas are benign epithelial tumors of the kidney. Histologically, they resemble certain malignant renal tumors, such as chromophobe renal cell carcinoma and the eosinophilic or granular form of clear cell renal carcinoma. It is, therefore, important to be able to differentiate among these tumors. Cytogenetic analysis is an important adjunct to the diagnosis of renal tumors, as the various subtypes have specific acquired chromosome abnormalities. Oncocytomas present either with loss of chromosome 1 and a sex chromosome, or with recurring translocations involving chromosome 11. We describe 2 patients with renal oncocytoma and a new translocation between chromosomes 6 and 9. The tumors in both patients were histologically virtually identical. The t(6;9)(p21;p23) may be a new translocation associated with renal oncocytomas.A new translocation between chromosomes 6 and 9 helps to establish diagnosis of renal oncocytoma - Corrected ProofRachel Hudacko, Michael May, Hana Aviv10.1016/j.anndiagpath.2010.03.005Annals of Diagnostic Pathology (2010)2010-06-23Annals of Diagnostic Pathology2010-06-23CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000419/abstract?rss=yesAbstract: The aim of this study was to describe 2 cases of primary peritoneal malignant mixed müllerian tumor (MMMT). Two patients with primary peritoneal MMMT were examined for their clinical and pathologic features. We describe 2 cases of primary peritoneal MMMT in which the carcinomatous and mesenchymal components were readily identifiable, predominantly involving the peritoneum, with no ovarian involvement. The peritoneum and ovaries, with their common embryologic origin, likely account for the peritoneum's ability to undergo a similar malignant transformation, with the resultant genesis of an MMMT of peritoneal origin.Malignant mixed müllerian tumor of primary peritoneal origin - Corrected ProofMargaux Kanis, Joshua P. Kesterson, Stuti Shroff, Shashikant Lele, Paulette Mhawech-Fauceglia10.1016/j.anndiagpath.2010.03.004Annals of Diagnostic Pathology (2010)2010-06-21Annals of Diagnostic Pathology2010-06-21CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000444/abstract?rss=yesAbstract: Clear cell papillary renal cell carcinoma (RCC) is a recently established disease entity. However, there are few reports on genetic study of this entity. We report such a case with focus on genetic study. A 57-year-old Japanese man was found to have 3 renal tumors. Histologically, two tumors showed findings of clear cell RCC; and the other tumor showed findings of clear cell papillary RCC that was characterized by papillary growth pattern of neoplastic cells in cystic space with purely clear cell cytology. Immunohistochemically, tumor cells of clear cell papillary RCC were diffusely positive for PAX2 and cytokeratin 7, but negative for CD10, RCC Ma, and AMACR. In fluorescence in situ hybridization study for one clear cell papillary RCC, we detected polysomy for chromosome 7 and monosomy for chromosomes 17, 16, and 20. In addition, we detected mutation of VHL gene in clear cell RCC, but found no VHL gene mutation in clear cell papillary RCC. Finally, our results provide further evidence that clear cell papillary RCC may be both morphologically and genetically distinct entity from clear cell RCC and papillary RCC.Clear cell papillary renal cell carcinoma and clear cell renal cell carcinoma arising in acquired cystic disease of the kidney: an immunohistochemical and genetic study - Corrected ProofNaoto Kuroda, Tomoyuki Shiotsu, Chiaki Kawada, Taro Shuin, Ondrej Hes, Michal Michal, Chisato Ohe, Shuji Mikami, Chin-Chen Pan10.1016/j.anndiagpath.2010.03.007Annals of Diagnostic Pathology (2010)2010-06-21Annals of Diagnostic Pathology2010-06-21CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000390/abstract?rss=yesAbstract: Recently, renal angiomyoadenomatous tumor (RAT) has been identified. However, there are no descriptions about clear cell renal cell carcinoma (RCC) with focal RAT-like features. A 33-year-old Japanese man was found to have a tumor in the left kidney. Macroscopically, the tumor extended into the perinephric fat tissue, and the cut surface showed the yellowish color. The histologic examination of the tumor consisted of 2 components of clear cell RCC and RAT-like area. The RAT-like area showed the admixture of epithelial cells with basophilic or clear cytoplasm and stromal component containing leiomyomatous stroma, fine capillary network, and pericytic network. Immunohistochemically, epithelial neoplastic cells in RAT-like area were diffusely positive for CD10 and RCC Ma. G-band karyotype showed the structural abnormality of chromosome 3 and both components of clear cell RCC and RAT-like area revealed the identical VHL gene mutation. Finally, pathologists should pay attention to the presence of clear cell RCC focally resembling RAT.Clear cell renal cell carcinoma with focal renal angiomyoadenomatous tumor-like area - Corrected ProofNaoto Kuroda, Tadanori Hosokawa, Michal Michal, Ondrej Hes, Radek Sima, Chisato Ohe, Gang-Hong Lee10.1016/j.anndiagpath.2010.03.003Annals of Diagnostic Pathology (2010)2010-06-18Annals of Diagnostic Pathology2010-06-18CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000456/abstract?rss=yesAbstract: Botryoid odontogenic cyst is a rare multilocular variant of lateral periodontal cysts. In this study, a series of 10 cases of botryoid odontogenic cysts retrieved from the archives of the Postgraduation Program in Oral Pathology, Federal University of Rio Grande do Norte (Brazil), were reviewed for epidemiologic data, clinical presentation, radiographic and histopathologic characteristics, treatment, and recurrence.Botryoid odontogenic cyst: A clinicopathologic study of 10 cases - Corrected ProofPedro Paulo de Andrade Santos, Valéria Souza Freitas, Roseana de Almeida Freitas, Leão Pereira Pinto, Lélia Batista de Souza10.1016/j.anndiagpath.2010.03.008Annals of Diagnostic Pathology (2010)2010-06-18Annals of Diagnostic Pathology2010-06-18CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000407/abstract?rss=yesAbstract: Few cases each of malignant pulmonary epithelioid hemangioendothelioma (PEH) and PEH with lymph node metastasis have been reported. Here we report a case of PEH with lymph node metastasis. A Japanese woman was found to have a 2-cm–diameter mass with small satellite nodules in the right upper lobe of the lung. Microscopic examination revealed solid destructive growth of the main tumor, with epithelioid cells showing cytologic atypia and 3 mitotic figures per 10 high-power fields. Some of the tumor cells had intracytoplasmic lumina that appeared as vacuoles. These lumina were negative for alcian blue and periodic acid Schiff, and contained erythrocytes. However, erythrocytes were seen more frequently within small but distinct vascular channels that were arranged diffusely in the periphery of the main tumor. Other satellite nodules showed conventional PEH morphology. In hilar lymph nodes, the tumor cells resembled those of the main tumor. The vascular origin of the main tumor and satellite nodules was demonstrated by positive immunoreactivity for some endothelial markers. Although the diagnostic features of malignant PEH are not clear, those for PEH in other organs have included nuclear atypia, many mitoses, presence of necrosis, large tumor size, and spindle cell proliferation. The present case met these criteria, except for large tumor size and spindle cell proliferation. In conclusion, atypical cytologic features, the presence of necrosis, a high Ki-67 labeling index, and accompanying nodules of conventional PEH in the same pulmonary lobe suggest that this case was a malignant PEH with hilar lymph node metastasis.Malignant pulmonary epithelioid hemangioendothelioma with hilar lymph node metastasis - Corrected ProofNaobumi Tochigi, Koji Tsuta, Akiko Miyagi Maeshima, Yasuo Shibuki, Hisao Asamura, Tadashi Hasegawa, Hitoshi Tsuda10.1016/j.anndiagpath.2010.02.012Annals of Diagnostic Pathology (2010)2010-06-17Annals of Diagnostic Pathology2010-06-17CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000663/abstract?rss=yesAbstract: Adamantinoma is a rare neoplasm that characteristically involves the tibia. In many instances, typical location within the tibia, very slow course, and a typical radiographic appearance can strongly suggest the correct diagnosis. We present a case that has both unusual radiographic findings and uncharacteristic histology. In this case, radiologic imaging showed a poorly defined lytic lesion within the distal, lateral tibia extending to the joint with central necrosis, overlying periosteal reaction and possible tumor spread into soft tissue. The histology of this lesion showed pronounced vascularity and surrounding large neoplastic cells with plasmacytoid morphology. The combination of these features led to an initial misdiagnosis as metastatic carcinoma from unknown primary.Adamantinoma with plasmacytoid features: expanding the spectrum of a diagnostically challenging entity - Corrected ProofMatthew P. Walters, Keith Baynes, Guillermo F. Carrera, David M. King, Dian Wang, John Charlson, Eduardo Zambrano10.1016/j.anndiagpath.2010.04.007Annals of Diagnostic Pathology (2010)2010-06-01Annals of Diagnostic Pathology2010-06-01RADIOLOGIC-PATHOLOGIC CORRELATIONShttp://www.annalspathology.com/article/PIIS1092913410000316/abstract?rss=yesAbstract: Reticular/microcystic schwannoma is a rare variant of schwannoma with a predilection for viscera, especially the gastrointestinal tract. Of the 9 cases reported thus far, 7 have occurred in female patients. The average age of presentation is 67 years. They are usually small, asymptomatic lesions ranging in size from 0.85 to 2.2 cm with a mean size of 1.35 cm. They usually occur in the stomach, small bowel, and proximal large intestine. It differs from usual schwannomas of the gastrointestinal tract by lacking the peripheral cuff of lymphocytes. The histologic appearance of slender bipolar spindle cells in a lace-like reticular pattern set within a myxoid stroma raises a wide differential diagnosis including gastrointestinal stromal tumor, perineurioma, and in more epithelioid examples, even carcinoma. Awareness of the entity and an immunohistochemical panel of markers will ensure that the correct diagnosis is made.Reticular and microcystic schwannoma: a distinctive tumor of the gastrointestinal tract - Corrected ProofRunjan Chetty10.1016/j.anndiagpath.2010.02.011Annals of Diagnostic Pathology (2010)2010-05-10Annals of Diagnostic Pathology2010-05-10CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000304/abstract?rss=yesAbstract: Postradiation sarcomas are long-term complications of radiation treatment of various forms of cancer. Osteosarcoma, specifically, occurring in patients with a history of prostate cancer is rare; but with high-dose radiotherapy now an accepted standard of care for localized prostate adenocarcinoma, it should be considered in the clinical setting of patients presenting with potential remote disease relapse. We describe an osteosarcoma of the pubic ramus in a patient previously treated 10 years prior with radiation therapy for prostate cancer. Because of the long latency period, the appearance of lytic bone lesions with soft tissue components in pelvic bony structures may mimic recurrent/metastatic prostate adenocarcinoma. The prognosis of patients developing osteosarcoma after radiotherapy for prostate cancer is similar to other radiation-induced osteosarcomas occurring in the axial skeleton, with a 50% overall mortality within the first year after diagnosis.Osteosarcoma after radiotherapy for prostate cancer - Corrected ProofJohn A. Papalas, John D. Wylie, Robin T. Vollmer10.1016/j.anndiagpath.2010.02.010Annals of Diagnostic Pathology (2010)2010-05-07Annals of Diagnostic Pathology2010-05-07CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000249/abstract?rss=yesAbstract: Biliary papillomatosis and papillary carcinoma are rare tumors of biliary tract; and because of their morphologic similarities, papillomatosis-papillary carcinoma sequel has been proposed. We report an unusual case of polypoid minimally invasive papillary carcinoma located at the junction between cystic and common bile ducts, complicated with biliary papillomatosis of gallbladder and cystic duct, showing focal areas of malignant change. Intrahepatic ducts, hepatic ducts, and distal common bile duct were spared. Both papillomatosis and papillary carcinoma showed areas of high p53 and p21 expression with high proliferative index. Patient is still alive for 4 years without evidence of disease after modified Whipple operation. Possible pathogenetic mechanisms are further discussed.Papillary carcinoma with diffuse papillomatosis of gallbladder and cystic duct - Corrected ProofKemal Kosemehmetoglu, Erhan Akpinar, Cenk Sokmensuer, Erhan Hamaloglu10.1016/j.anndiagpath.2010.02.004Annals of Diagnostic Pathology (2010)2010-04-30Annals of Diagnostic Pathology2010-04-30CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000250/abstract?rss=yesAbstract: Adrenal neoplasms composed of more than one cell type and demonstrating a mixed histologic appearance are exceedingly rare. We report the clinical and pathologic features of a morphologically distinctive tumor of the adrenal gland composed of cortical, chromaffin, and neural cells. Histologically, the tumor consisted of intermixed areas of proliferating cortical cells resembling adrenal cortical adenoma, neoplastic chromaffin cells consistent with pheochromocytoma, and a ganglioneuromatous stroma. The presence of the cortical, medullary, and neural components within the tumor was confirmed by immunohistochemical studies. The present case serves to broaden the morphologic spectrum of mixed tumors that may be encountered in the adrenal gland.Mixed cortical adenoma and composite pheochromocytoma-ganglioneuroma: an unusual corticomedullary tumor of the adrenal gland - Corrected ProofSean K. Lau, Peiguo G. Chu, Lawrence M. Weiss10.1016/j.anndiagpath.2010.02.005Annals of Diagnostic Pathology (2010)2010-04-30Annals of Diagnostic Pathology2010-04-30CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000286/abstract?rss=yesAbstract: Histiocytoid carcinoma of the breast is a rare tumor with approximately 30 cases reported, all occurring in female patients. We report the first case of histiocytoid breast carcinoma in a male patient. A 68-year-old man presented with a 2.5-cm breast mass. Microscopic examination of the needle core biopsy revealed a diffuse (lobular type) infiltration of tumor cells as angulated clusters, linear arrangements, small nests, and individual cells; there was no duct formation. The nuclei were round-oval and hyperchromatic with inconspicuous nucleoli and finely dispersed chromatin. The cytoplasm was abundant, was amphophilic, and ranged from granular to vacuolated. A subset of tumor cells contained periodic acid Schiff–positive cytoplasmic material, which was largely but incompletely removed by diastase treatment. There was minimal nuclear pleomorphism, and mitotic figures were inconspicuous. The intervening stroma was densely fibrotic, and the tumor infiltrated among tightly packed collagen bundles. Immunohistochemistry was positive for estrogen receptor, progesterone receptor, androgen receptor, vimentin, epithelial membrane antigen, and pan-cytokeratin. The tumor was negative for CK7, CAM5.2, 34BE12, AE1/AE3, GCDFP-15 (BRST-2), E-cadherin, and CD68. The mastectomy resection demonstrated similar histologic findings. Sentinel lymph node biopsy was negative. The morphology of this tumor is similar to that described for histiocytoid carcinoma of the female breast, a rare entity. Such tumors are felt to be variants of lobular carcinomas, which is supported by diffuse infiltrative growth, loss of E-cadherin expression, and strong ER positivity. We believe our case to be the first reported example of histiocytoid carcinoma in a male breast.Histiocytoid carcinoma of the male breast - Corrected ProofC. Blake Hutchinson, Joseph Geradts10.1016/j.anndiagpath.2010.02.008Annals of Diagnostic Pathology (2010)2010-04-30Annals of Diagnostic Pathology2010-04-30CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000080/abstract?rss=yesAbstract: Compared with osteosarcoma of bone, extraskeletal osteosarcoma is rare and accounts for approximately 1% to 2 % of all soft tissue sarcomas. Osteosarcoma arising in soft tissues is exceedingly rare in children. The tumor most often affects older adults, involves the lower extremity, responds poorly to chemotherapy, and carries a grave prognosis. The authors describe a 4-year-old girl with an extraskeletal osteosarcoma in the lateral abdominal wall.Extraskeletal osteosarcoma of abdominal wall in a child—a rare case report with review of literature - Corrected ProofFouzia Siraj, Deepali Jain, Prem Chopra10.1016/j.anndiagpath.2010.01.003Annals of Diagnostic Pathology (2010)2010-04-26Annals of Diagnostic Pathology2010-04-26http://www.annalspathology.com/article/PIIS1092913410000092/abstract?rss=yesAbstract: Sinonasal teratocarcinosarcoma is an uncommon, aggressive, morphologically heterogenous tumor composed of cells derived from the 3 somatic layers. A histogenetic origin from a multipotential adult somatic stem cell with divergent differentiation has been favored over a germ cell origin. This assumption has been based on the lack of germ cell elements and, until recently, the absence of demonstrable amplification of 12p. We report a case that exhibited foci of yolk sac elements with papillary structures and intracytoplasmic periodic acid-Schiff–positive, diastase-resistant, α-fetoprotein–positive, hyaline globules. An expanded area of undifferentiated cells, likely precursor cells, in the basal layer of the overlying mucosal epithelium transitions into and merges with the immature epithelial, neuroepithelial, and mesenchymal components. These previously unreported histomorphological features support the hypothesis that this tumor is a teratomatous tumor arising from pluripotent embryonic stem cells in the basal layer of the sinonasal epithelium. That notion is further supported by fluorescence in situ hybridization cytogenetic analysis, which showed a distinct subpopulation of the tumor cells with an extra copy of chromosome 12p13.Sinonasal teratocarcinosarcoma with yolk sac elements: a neoplasm of somatic or germ cell origin? - Corrected ProofJaiyeola Thomas, Patrick Adegboyega, Kenny Iloabachie, John Wesley Mooring, Timothy Lian10.1016/j.anndiagpath.2010.01.004Annals of Diagnostic Pathology (2010)2010-04-26Annals of Diagnostic Pathology2010-04-26http://www.annalspathology.com/article/PIIS1092913410000067/abstract?rss=yesAbstract: The blue nevus is a well-described benign melanocytic proliferation that generally occurs on the skin. Infrequently, blue nevi are found on mucosal surfaces. The most common location for mucosal blue nevi is the oral mucosa, with reported cases in the sinonasal mucosa and genital tract, as well as in other locations. To our knowledge, blue nevi of the rectal mucosa have not been described. Here, we describe a case of blue nevus arising in the rectal mucosa. Blue nevi are benign melanocytic proliferations with the potential for malignant transformation and should be included in the differential diagnosis of pigmented mucosal lesions of the rectum.Blue nevus of the colorectal mucosa - Corrected ProofZ. Jacob Schreiber, Timothy R. Pal, Sonya J. Hwang10.1016/j.anndiagpath.2010.01.002Annals of Diagnostic Pathology (2010)2010-04-23Annals of Diagnostic Pathology2010-04-23CASE REPORThttp://www.annalspathology.com/article/PIIS1092913410000055/abstract?rss=yesAbstract: Clear cell carcinomas are considered as high-grade tumor often with poor prognosis. We describe 2 cases of clear cell carcinomas of the ovary mimicking benign or less aggressive tumors encountered in the female genital track. The first case is mimicking a benign monodermal teratoma, the so-called struma ovarii, and the second mimicking a carcinoid tumor.Clear cell carcinoma of the ovary mimicking struma ovarii and carcinoid tumor: report of 2 cases - Corrected ProofAhmad Alduaij, M. Ruhul Quddus10.1016/j.anndiagpath.2010.02.002Annals of Diagnostic Pathology (2010)2010-04-05Annals of Diagnostic Pathology2010-04-05CASE REPORThttp://www.annalspathology.com/article/PIIS1092913409001701/abstract?rss=yesAbstract: Sialolipoma is a recently described histologic variant of lipoma and is characterized by well-demarcated proliferation of mature adipocytes with secondary entrapment of salivary gland elements. These tumors have been observed in both the major and minor salivary glands, with more than 20 cases being reported in the English literature. In general, the clinical presentation of sialolipomas of the minor salivary glands suggests a diagnostic hypothesis of salivary gland lesions, commonly neoplasms. In the major salivary glands, the clinical features suggest either a salivary gland neoplasm or a lipoma. Surgical excision is the treatment of choice for sialolipomas, with no reports of recurrence or malignant transformation. The present article reports 4 additional cases of sialolipoma, all of them affecting the minor salivary glands, and reviews the literature regarding clinicopathologic aspects, differential diagnosis, and therapeutic management of this recently recognized histologic variant of lipoma.Sialolipoma of minor salivary glands - Corrected ProofCassiano Francisco Weege Nonaka, Karuza Maria Alves Pereira, Pedro Paulo de Andrade Santos, Roseana de Almeida Freitas, Márcia Cristina da Costa Miguel10.1016/j.anndiagpath.2009.12.009Annals of Diagnostic Pathology (2010)2010-03-18Annals of Diagnostic Pathology2010-03-18CASE REPORThttp://www.annalspathology.com/article/PIIS109291341000002X/abstract?rss=yesAbstract: Spindle cell tumors of the prostate are rare and mostly primary. We report a case of retroperitoneal sarcoma, which is a low-grade fibromyxoid sarcoma involving the prostate secondarily by metastasis. The patient was a 44-year-old man who presented with progressing abdominal pain. Computed tomography showed a large retroperitoneal mass. The patient underwent surgical resection. Intraoperatively, a second smaller mass was identified in the pelvis and was left untouched. The resected retroperitoneal specimen and prostate transrectal needle biopsies taken afterward showed the same mesenchymal tumor. Radical cystoprostatectomy was performed. Metatatic tumor involving the prostate, bilateral seminal vesicles, and base of the urinary bladder was found. Microscopic examination revealed typical histomorphologic features of low-grade fibromyxoid sarcoma. The patient is without evidence of disease 3 years postoperatively. This case is the first documentation of metastatic sarcoma to the prostate and expands the list of malignant mesenchymal neoplasms that may involve this organ.Low-grade fibromyxoid sarcoma metastatic to the prostate - Corrected ProofDilek Ertoy Baydar, Fazil Tuncay Aki10.1016/j.anndiagpath.2010.01.001Annals of Diagnostic Pathology (2010)2010-03-18Annals of Diagnostic Pathology2010-03-18CASE REPORThttp://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/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/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/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/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/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/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