International Journal of Surgical Pathology recent issues

Reduced p16 and Increased Cyclin D1 and pRb Expression Are Correlated With Progression in Cutaneous Melanocytic Tumors

Wed, 23 Sep 2009 01:56:06 PDT

The immunohistochemical expression of cell cycle proteins p16, cyclin D1, and pRb was assessed in 112 benign and malignant melanocytic tumors and correlated with tumor progression, prognosis, and outcome. Comparing benign and malignant tumors, there were significant differences in the median score for all 3 proteins, with decreased p16 (P = .000001), increased cyclin D1 (P = .01), and increased pRb in melanomas (P = .01). There was a progressive loss of expression of p16 with progression from benign naevi to primary melanomas and to metastases. p16 was significantly decreased in primary tumors from melanoma patients who developed recurrent disease (P = .0000013). Cyclin D1 and pRb showed a progressive increase in expression from benign to malignant tumors but with relative decreases in the more advanced tumors (thick primaries and metastatic melanomas). Alterations in cell cycle proteins involved in G1/S transition are implicated in melanocytic tumor progression and have a potential role in diagnosis and prognostication.

Thyroid Transcription Factor-1 and "Basal Marker"--Expressing Small Cell Carcinoma of the Breast

Ersahin, C., Bandyopadhyay, S., Bhargava, R. — Wed, 23 Sep 2009 01:56:06 PDT

Small cell carcinoma of the breast is a very rare entity that is histologically indistinguishable from small cell carcinomas of other organs. The presence of an in situ component is the most important feature that indicates the primary nature of the breast tumor. Thyroid transcription factor-1 (TTF-1) is a marker specific to lung and thyroid but is also expressed in small cell carcinoma of pulmonary and extrapulmonary origin. TTF-1 expression in breast small cell carcinoma has been reported only rarely. This reported case is unique because of the characteristic morphological features and immunohistochemical profile. The invasive tumor demonstrated neuroendocrine differentiation morphologically and immunohistochemically, expressed by TTF-1, EGFR, and basal-type cytokeratins. An unequivocal in situ component was identified intimately admixed with the invasive carcinoma. To the authors’ knowledge, this is the first report of breast small cell carcinoma showing the expression of "basal markers."

CDX2 Expression in Yolk Sac Component of Testicular Germ Cell Tumors

Bing, Z., Pasha, T., Tomaszewski, J. E., Zhang, P. — Wed, 23 Sep 2009 01:56:06 PDT

CDX2 has been detected in the majority of colorectal adenocarcinoma cases and may be useful in determining the sites of origin of tumors. In this study, the authors evaluated CDX2 expression in germ cell tumors (GCTs) by immunohistochemistry. Forty cases of testicular GCTs and 8 cases of metastatic GCTs were retrieved for study. In the 40 cases of testicular GCTs, 13 were pure seminomas and 27 mixed GCTs. Yolk sac tumor (YST) was identified by morphology and glypican 3 staining in 20 testicular mixed GCTs. Of these 20 cases, 8 cases showed 1+ positivity for CDX2. Other primitive components of GCTs were negative. For the 6 cases of metastatic mixed GCT with YST, 4 cases were positive, 2+ in 2 cases and 1+ in 2 cases. The positivity of CDX2 in GCTs warrants including YST in the differential diagnosis of adenocarcinoma of unknown origin.

Merits of the PMiT (Papillary Microtumor) Terminology in the Definition of a Subset of Incidental Papillary Microcarcinomas of the Thyroid

Asioli, S., Odasso, C., Macri, L., Palestini, N., Bussolati, G. — Wed, 23 Sep 2009 01:56:06 PDT

An exponential increase in the detection of papillary thyroid microcarcinomas (PTMCs) has been observed in recent times, possibly because of recent improvements in the management of thyroid lesions and extensive histological examination. However, no definitive treatment guideline has been developed for PTMC, resulting in patients undergoing overtreatment. In 2003, the term papillary microtumor of the thyroid (PMiT) was proposed for small (≤1 cm) intrathyroidal tumors with excellent prognostic prospects along with strict definition criteria. Since then, the term PMiT has been adopted by clinicians and surgeons. In this article, the authors report a series of 50 consecutive cases of PMiT collected and treated at the University Hospital of Turin, Italy. From the authors’ experience, this terminology, which demarks a subset of PTMC, should be widely adopted as it is biologically sound, well accepted by both clinicians and patients, decreases the danger of overtreatment, minimizes the psychological anxiety engendered by a diagnosis of carcinoma, and maintains the patient’s eligibility for health insurance.

Sclerosing Angiomatoid Nodular Transformation (SANT) of the Spleen: A Report of 3 Cases

Koreishi, A. F., Saenz, A. J., Fleming, S. E., Teruya-Feldstein, J. — Wed, 23 Sep 2009 01:56:06 PDT

The authors describe 3 cases of sclerosing angiomatoid nodular transformation (SANT) of the spleen diagnosed at Memorial Sloan-Kettering Cancer Center within a 1-year period (July 2008 to June 2009). All patients were female, older than 50, with lesions ranging in size from 2 to 4 cm. All were alive and well after splenectomy. All the cases showed characteristic histological and immunophenotypical findings as previously described in the literature, including scattered IgG4positive plasma cells in the fibrosclerotic stroma. Of the 3 patients, 2 had a history of carcinoma, and metastasis was of concern, but a PET scan in one of these patients showed minimal to absent FDG activity suggesting that this process was of a benign indolent nature. However, in 1 patient, a PET scan revealed positive FDG activity, heightening clinical concern for malignancy.

Vascular Endothelial Growth Factor Expression and Neovascularization in Non--Small Cell Lung Carcinoma

Ozbudak, I. H., Ozbilim, G., Kucukosmanoglu, I., Dertsiz, L., Demircan, A. — Wed, 23 Sep 2009 01:56:06 PDT

The prognostic significance of microvascular density (MVD) and vascular endothelial growth factor (VEGF) expression were investigated in 15 patients with adenocarcinoma (AC) and 15 patients with squamous cell carcinoma (SCC). Immunohistochemically, VEGF and factor VIII were applied. The average microvessel counts were given as MVD, and VEGF expression was given as VEGF percentage area and VEGF staining degree. Higher values of MVD were obtained in patients with AC (11.47 ± 3.48) when compared with patients with SCC (7.47 ± 2.50; P = .001) and also in patients at early stages of disease (10.77 ± 3.24) when compared with patients at advanced stages (8.47 ± 3.64; P = .050). A significant correlation was shown between MVD and VEGF percentage area (P = .006) and between VEGF percentage area and VEGF staining degree (P = .000). No significant difference was found in VEGF percentage area between patients with SCC and AC and between patients at early and advanced stages. In conclusion, VEGF or MVD should not be regarded as a solitary prognostic factor but should be supported by other prognostic factors.

Ovarian Malignancies With Cytologically Negative Pleural and Peritoneal Effusions: Demons' or Meigs' Pseudo-syndromes?

Peparini, N., Chirletti, P. — Wed, 23 Sep 2009 01:56:06 PDT

The authors reviewed the original reports of the association of malignant ovarian tumors with cytologically negative pleural and peritoneal effusions, commonly known as Meigs’ pseudo-syndrome and challenged the recent attribution of this disease to Demons. They underlined the historical and clinical interest of the reports of Demons and Meigs and concluded that the term pseudo-Meigs’ syndrome, and not pseudo-Demons’ syndrome, must be used for malignant ovarian lesions with effusions with negative cytology because Demons did not describe a similar syndrome caused by malignant tumors.

Small-Cell Plasmacytoma With Prominent Myxoid Stroma Mimicking a Soft-Tissue Neoplasm

Lara-Torres, C. O, Gomez-Plata, E., Ortiz-Hidalgo, C. — Wed, 23 Sep 2009 01:56:06 PDT

A Large Esophageal Leiomyoma

Angus, A., Slesser, P., Shaw, I. — Wed, 23 Sep 2009 01:56:06 PDT

Histiocytic Corona Around a Glomeruloid Intrafollicular Polyp of the Thyroid

Singh, C., Manivel, J. C., Pambuccian, S. E. — Wed, 23 Sep 2009 01:56:06 PDT

Starry Thyroid

Alsharif, M., Pambuccian, S. — Wed, 23 Sep 2009 01:56:06 PDT

Microarray-based Gene Expression Profiling as a Clinical Tool for Breast Cancer Management: Are We There Yet?

Correa Geyer, F., Reis-Filho, J. S. — Tue, 21 Jul 2009 21:10:56 PDT

Breast cancer is a heterogeneous disease, encompassing several histological types and clinical behaviors. Current histopathological classification systems are based on descriptive entities with prognostic significance. Few prognostic and predictive markers beyond those offered by histopathological analysis are available. High-throughput molecular technologies are reshaping our understanding of breast cancer, of which microarray-based gene expression has received most attention. This method has been used to derive a molecular taxonomy for breast cancer, which has provided interesting insights into the biology of the disease. Class prediction studies have generated a multitude of prognostic/predictive signatures, which herald the promise for an improvement in treatment decision making. However, most of the signatures developed to date seem to have discriminatory power almost restricted to estrogen receptor—positive disease. This review addresses the contribution of gene expression profiling to our understanding of breast cancer and its clinical management.

Complementary Value of the Ki-67 Proliferation Index to the Oncotype DX Recurrence Score

Gwin, K., Pinto, M., Tavassoli, F. A — Tue, 21 Jul 2009 21:10:56 PDT

Oncotype DX is a 21-gene assay that quantifies the recurrence risk in estrogen receptor—positive breast cancer, which is expressed as the recurrence score (RS). Studies have shown that patients with a high-risk RS will most likely benefit from adjuvant chemotherapy, but there is no proven advantage for patients with a low-risk RS who still face an average recurrence risk of 7%. In this study, the relationship between the RS and the cell cycle—related antigen Ki-67 was assessed in 32 breast carcinomas and evaluated for a potential association. Comparison of the RS with tumor type, grade, and the Ki-67 proliferation index (PI) revealed an overall concordance. However, some tumors with a low RS revealed a surprisingly high Ki-67 PI. These cases may correspond to the 7% of low-risk RS carcinomas that recur. Therefore, the authors propose a combined evaluation of the RS and Ki-67 PI to identify tumors with high recurrence potential from the low-risk and intermediate-risk RS groups.

Review Article: Aneurysmal Bone Cysts of the Jaws

Sun, Z.J., Sun, H.L., Yang, R.L., Zwahlen, R.A., Zhao, Y.F. — Tue, 21 Jul 2009 21:10:56 PDT

Aneurysmal bone cyst (ABC) is a osteolytic bone lesion that rarely involves the jaws. To date, a total of 92 cases of JABCs have been described in detail in English literature. They prevalently occur in the first 2 decades (72.8%) with slight female predilection. It affects the mandible more often (68.5%) with a predominant location in the mandibular ramus (31.3%) and its posterior regions (20.4%). A painless (54.7%) or painful (43.2%) bone swelling is the most frequent clinical sign. Radiologically 93.8% of the lesions present as a radiolucency; in 69.4% multilocular in appearance. 15.2% of JABCs were secondary in nature, including 8 cases associated with fibrous dysplasia. The recurrence rate (13.3%) did not differ significantly when comparing the surgical technique (curettage, 15.2%; resection, 11.8%). JABCs are known for their different clinical and radiographic features, therefore often posing a diagnostic dilemma. Some JABC's may be secondary in nature. Careful curettage is considered to be suitable as treatment for JABCs.

Diagnostic Accuracy and Prognostic Value of Core Biopsy in the Management of Breast Cancer: A Series of 542 Patients

Richter-Ehrenstein, C., Muller, S., Noske, A., Schneider, A. — Tue, 21 Jul 2009 21:10:56 PDT

Purpose. Core biopsy is considered to be a highly accurate method for gaining preoperative diagnosis of breast cancer. The purpose of this study is to compare the results of core biopsy with those of the surgical excision specimen. Experimental design. A total of 567 core biopsies with subsequent surgical excision were performed. Results. In 488 patients, invasive breast cancer was diagnosed in the preoperative biopsy and in 486 patients (99.6%) the surgical specimen showed identical results. In 160 of the 502 patients (32%) with invasive breast cancer, DCIS was found in the surgical specimen but was not diagnosed in the biopsy. Estrogen and progesterone receptor demonstrated a high rate of agreement, Her2/neu analysis showed a complete concordance in 54% of patients. Conclusions. Core biopsies allow diagnosis of invasive breast cancer with high accuracy. Levels of agreement have to be improved for the detection of DCIS and Her2/neu status.

Immunohistochemical Expression of the Human Sodium/Iodide Symporter Distinguishes Malignant From Benign Gastric Lesions

Farnedi, A., Eusebi, L. H., Poli, F., Foschini, M. P. — Tue, 21 Jul 2009 21:10:56 PDT

Aim. Sodium/iodide symporter (NIS) is a transmembrane protein that mediates the transport of I^–. The aim was to evaluate the immunohistochemical expression of the human homolog of NIS (hNIS) in a wide spectrum of gastric lesions. Materials and methods. Seventy-seven samples were stained immunohistochemically with a monoclonal antibody for hNIS, including 14 with normal gastric mucosa, 14 with chronic atrophic gastritis with foveolar hyperplasia, 15 with chronic atrophic gastritis with intestinal metaplasia, 6 with chronic atrophic gastritis with atypical regenerative hyperplasia, 8 with chronic atrophic gastritis with dysplasia, 15 with invasive adenocarcinoma, 3 with well-differentiated neuroendocrine tumor, and 2 with gastrointestinal stromal tumors (GISTs). Results. hNIS stained the basolateral cytoplasmic portion of foveolae in normal mucosa, in 13 cases of chronic atrophic gastritis with foveolar hyperplasia, and in only 1 case of regenerative atypical hyperplasia. hNIS was consistently absent in intestinal metaplasia, in dysplastic glands, and in the cells constituting invasive carcinoma, well-differentiated neuroendocrine tumors, and GIST. Conclusion. It seems that lack of hNIS can be useful in distinguishing foveolar hyperplasia from dysplastic glands.

Pleomorphic Adenoma With Mucinous and Squamous Differentiation: A Mimicker of Mucoepidermoid Carcinoma

Guo, S.P., Cheuk, W., Chan, J. K. C. — Tue, 21 Jul 2009 21:10:56 PDT

Pleomorphic adenoma with foci of squamous and mucinous differentiation can potentially be misdiagnosed as low-grade mucoepidermoid carcinoma. The circumscribed borders of the tumor, gradual merging of mucoepidermoid foci into areas typical of pleomorphic adenoma, and presence of keratinization are features against the latter diagnosis.

Collision Renal Tumors

Vasuri, F., Fellegara, G. — Tue, 21 Jul 2009 21:10:56 PDT

Colonic Adenoma With Squamous Metaplasia

Pantanowitz, L. — Tue, 21 Jul 2009 21:10:56 PDT

Squamous metaplasia arising within colon adenomas is a rare occurrence, with a 0.4% incidence noted predominantly in elderly males. A case of squamous metaplasia arising in a tubulovillous adenoma of the cecum, associated with adenocarcinoma, is described. Squamous metaplasia was immunoreactive for beta-catenin, but negative for cytokeratin 20, CDX2, p63, estrogen receptor, progesterone receptor, p16, and human papilloma virus. Squamous differentiation may serve as a precursor lesion for squamous neoplasia of the colorectum.

"Dedifferentiated" Adrenal Cortical Neoplasm

Trezzi, R., Poli, F., Fellegara, G. — Tue, 21 Jul 2009 21:10:56 PDT

Puppy in a Cyst: "I'm Trapped! Help Please!"

Coffin, R. R., Sidhu, J. S. — Tue, 21 Jul 2009 21:10:56 PDT

Langerhans Cell Sarcoma Involving Gallbladder and Peritoneal Lymph Nodes: A Case Report

Tue, 21 Jul 2009 21:10:56 PDT

Langerhans cell sarcoma (LCS) is a rare proliferation of Langerhans cells with overtly malignant cytologic features and spreads aggressively. LCSs show a multiorgan involvement, including skin, lymph nodes, lung, and bone. The authors report an LCS in a 74-year-old woman that involved the gallbladder and the peritoneal lymph nodes. Imaging revealed a tumor in the gallbladder and the peritoneal lymph nodes. The tumor cells were positive for CD1a, S-100 protein, and Langerin (CD207). Although the ultrastructural analysis failed to demonstrate any Birbeck granules, the histomorphological and immunohistochemical findings supported the diagnosis of LCS. After surgical resection, she showed no recurrent or metastatic signs for 8 months without any other adjuvant therapy. This is the first case of LCS involving the gallbladder and the peritoneal lymph nodes. This report also includes a review of the literature concerning this rare disease.

Are Invasive Micropapillary Carcinomas of Breast Really Composed of Papillae?

Patriarca, C., Giunta, P. — Tue, 21 Jul 2009 21:10:56 PDT

Correlation Between Thymidylate Synthase Protein Expression and Gene Polymorphism with Clinicopathological Parameters in Colorectal Carcinoma

Thu, 14 May 2009 16:11:47 PDT

5-Fluorouracil (5-FU) represents the basis of chemotherapy for colorectal carcinoma, inhibiting thymidylate synthase (TS), an essential enzyme for DNA replication. Previous studies have associated high TS protein expression by tumor cells with poor outcome of patients with colorectal carcinoma, but others have refuted these findings. In view of the potential role of TS as predictive parameter and the lack of consensus in the literature, the present study compared 2 methods: protein expression and gene polymorphism, correlating them with clinicopathological findings. Immunohistochemical detection of TS in tumor cells and detection of gene polymorphism in the blood were performed in 32 patients with colorectal carcinoma treated with 5-FU. No correlation was found between TS protein expression and gene polymorphism. Neither method correlated with survival, tumor staging, and tumor histological grading. This result possibly reflects a complex tumor response to 5-FU therapy, where TS is just one of the involved proteins.

RET/PTC Rearrangement Occurring in Primary Peritoneal Carcinoma

Thu, 14 May 2009 16:11:47 PDT

RET/PTC rearrangements are initiating events in the development of a significant proportion of papillary thyroid carcinomas. Activated RET/PTC mutations are thought to be restricted to thyroid disease, but this study proposes that these events may also occur in nonthyroid tumors. A total of 57 nonthyroid papillary tumors were examined for RET/PTC rearrangements using interphase fluorescence in situ hybridization, Taqman reverse transcriptase polymerase chain reaction, and immunohistochemistry. Taqman single nucleotide polymorphism detection was used to analyze for expression of mutated BRAF T1799A. In all, 20% (3/15) of primary peritoneal carcinoma had detectable RET/PTC1 rearrangements by all 3 methodologies. A further case of similar histotype had an alternate RET/ PTC rearrangement. No RET/PTC1 rearrangements were detected in the remaining tumor cohort. All 57 tumors were homozygous for wild-type BRAF. The results indicate that RET/PTC rearrangements occur in a small subset of nonthyroid papillary tumors. These rearrangements may not be directly implicated in tumor growth; rather representing "passenger" mutations reflecting RET instability in secondary tumor subclones.

Role of Polysomy 17 in Transitional Cell Carcinoma of the Bladder: Immunohistochemical Study of HER2/neu Expression and FISH Analysis of c-erbB-2 Gene and Chromosome 17

Simonetti, S., Russo, R., Ciancia, G., Altieri, V., De Rosa, G., Insabato, L. — Thu, 14 May 2009 16:11:47 PDT

This study investigates the potential clinical significance of c-erbB-2 gene and chromosome 17 alterations by fluorescence in situ hybridization (FISH) analysis and HER2/neu overexpression by immunohistochemical staining in transitional cell carcinoma (TCC) of urinary bladder correlating the results with tumor stage and grade categories and with clinical behavior. Sixty-three cases of TCC retrieved from the files of 2 institutions were analyzed for chromosome 17 aberrations and c-erbB-2 amplification by FISH analysis and evaluated immunohistochemically for HER2/neu overexpression. Five tumors were G1, 29 intermediate grade (G2), and 29 tumors high grade (G3); 32 tumors had stage Ta, 18 tumors T1, and 13 tumors T2. We found polysomy of chromosome 17 in 58.7% of TCC with average chromosome copy number >2.26; increased number of HER2/neu gene copy was observed in 66.7% of tumors. C-erbB-2 amplification occurred in 6.3% of tumors. Immunohistochemically, 60.3% of TCC overexpressed HER2/neu and 39.7% of tumors were negative. All tumors with polysomy showed simultaneously increase of HER2/neu gene copy number of which 34/37 with protein overexpression. A statistically significant correlation between polysomy of chromosome 17 and tumor stage (P = .0003) and tumor grade (P < .0001) was found; polysomy was not seen in G1 tumors; however, 8/29 G2 tumors and 29/29 G3 tumors revealed polysomy of chromosome 17; in 8/32 Ta tumors, 14/18 T1 and 13/13 of deeply invasive tumors (T2) polysomy 17 was observed. Moreover, it was found that 7 superficial tumors (1 Ta and 6 T1) showed high polysomy with average of chromosome 17 copy number ≥3.76 as observed in all invasive tumors. The data suggest that although HER2/neu amplification, found in high grade and invasive tumors, is a rare event in TCC, polysomy of chromosome 17 is an important factor correlated with tumor stage and grade categories and could be considered a molecular marker of tumor progression with interesting diagnostic implications.

Review Article: A Reevaluation of the Clinical Significance of Histological Subtyping of Non--Small-Cell Lung Carcinoma: Diagnostic Algorithms in the Era of Personalized Treatments

Rossi, G., Pelosi, G., Graziano, P., Barbareschi, M., Papotti, M. — Thu, 14 May 2009 16:11:47 PDT

The classification of lung cancer has always been primarily based on the morphologic assessment of routinely stained histological sections, but this approach may be difficult or even unfeasible in cytological preparations or small biopsies. Moreover, the simplistic dichotomization between small-cell carcinoma and non-small cell carcinoma (NSCLC) should be overcome, as new drugs have been discovered that are effective in specific subtypes of lung cancer. A more accurate characterization of NSCLC, however, may be hard in carcinomas lacking clear-cut signs of differentiation. The incorporation into the diagnostic algorithm of poorly differentiated carcinomas of an immunohistochemical panel including markers of squamous (high-molecular-weight cytokeratins, p63) and glandular (TTF-1, cytokeratin 7) cell differentiation seems the most promising approach. The evaluation of lung cancer for gene mutations, gene amplification, tumor-related angiogenesis, expression levels of DNA repair genes and genomic or proteomic profiles represents an exciting challenge for the pathologist in the near future.

The Histology of Pulmonary Sarcoidosis: A Review with Particular Emphasis on Unusual and Underrecognized Features

Thu, 14 May 2009 16:11:47 PDT

The pathologist is frequently involved in the diagnostic approach to the patient with suspected sarcoidosis. Although the histologic diagnosis is generally not difficult, atypical and underrecognized features may occasionally occur and may result in diagnostic problems. The authors review the histology of pulmonary sarcoidosis, focusing particularly on these unusual problematic findings.

Diverticulosis and Diverticulitis of the Appendix

AbdullGaffar, B. — Thu, 14 May 2009 16:11:47 PDT

Diverticulosis of the appendix is a relatively rare pathological finding. The majority are acquired pseudodiverticula. True congenital diverticula are very rare. Appendiceal diverticulosis is usually an incidental finding and clinically asymptomatic. When symptomatic, it is usually complicated by acute or chronic diverticulitis with or without acute appendicitis. It presents with atypical abdominal signs and symptoms, mostly in adult males. Appendiceal diverticulitis is a distinct entity with several clinical and pathological differences from acute appendicitis. It has a more rapid progression to perforation and a higher rate of mortality. Therefore, appendiceal diverticulitis should be considered in the clinical differential diagnosis, especially in adult males with chronic abdominal pain. Appendiceal diverticulosis demonstrates a significant association with obstructing or incidental appendiceal neoplasms. It may play an important role in the development of pseudomyxoma peritonei, which is associated with appendiceal mucinous tumors. Therefore, meticulous gross examination and thorough histological examination of the entire appendicectomy specimen are essential. When discovered either by preoperative radiological investigations or during an exploratory operation, prophylactic appendicectomy is advocated to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm.

A Novel Method of Obtaining Prostate Tissue for Gene Expression Profiling

Sooriakumaran, P., Henderson, A., Denham, P., Langley, S. EM. — Thu, 14 May 2009 16:11:47 PDT

Gene expression profiling by DNA microarray analysis is a technique with great promise in cancer biology. The multifocality and heterogeneity of many prostate cancers makes the collection of adequate biological samples for such profiling particularly challenging. Current methods, such as laser capture microdissection, are not widely available and can have significant limitations. In this article, a novel method of prostatic sampling, which does not affect the histopathological assessment of the surgical specimen and provides adequate RNA yield for microarray analysis is described. This method is simple, inexpensive, easily reproducible, and has been validated as having >95% sensitivity and 99% specificity for histological prediction of tissue obtained. This method can be adopted by other investigators to perform DNA microarray analysis on prostate tumors.

Tissue Eosinophilia and its Association with Tumoral Invasion of Oral Cancer

Thu, 14 May 2009 16:11:47 PDT

This study investigated if tumor-associated tissue eosinophilia (TATE) could be associated with the process of tissue invasion in oral squamous cell carcinomas (OSCCs) and its influence on patient's prognosis. Forty-three patients treated for OSCCs with or without lymph nodes involvement, at A. C. Camargo Cancer Hospital, Brazil, were selected for TATE analysis. Two degrees of tissue eosinophilia were established in OSCC: absent/mild and intense. The TATE was evaluated in relation to the clinicopathological features and prognostic value using ² test and the Kaplan—Meier method. Most of the patients with OSCC in advanced clinical stage presented muscular infiltration and significantly intense TATE whereas those with tumors in early stage frequently showed absent/mild eosinophilia (P = .009). The TATE showed no prognostic value for 5-year and 10-year survival rates of the OSCC. These findings suggest that intense TATE seems to reflect the stromal invasion of the OSCCs that occur in advanced clinical stage.

Extrapleural Solitary Fibrous Tumor: A Clinicopathologic Study of 19 Cases

Insabato, L., Siano, M., Somma, A., Gentile, R., Santangelo, M., Pettinato, G. — Thu, 14 May 2009 16:11:47 PDT

This study reports a series of 19 extrapleural solitary fibrous tumors. The patients included 6 men and 13 women with age ranging from 27 to 86 years. Three patients showed local recurrence. In 2 tumors, a diagnosis of malignancy was made. All of the tumors were strongly positive for CD34, and 3 of them expressed high levels of progesterone receptor. Solitary fibrous tumors are fairly rare, occurring in many parts of the body, and their behavior is unpredictable.

The Correlation of the World Health Organization Histologic Classification of Thymic Epithelial Tumors and Its Prognosis: A Clinicopathologic Study of 108 Patients From China

Thu, 14 May 2009 16:11:47 PDT

This study retrospectively reviewed the clinicopathological features of thymic epithelial tumors in 108 patients, and evaluated World Health Organization (WHO) histologic classification of thymic tumors. Other prognostic factors, including age, gender, clinical stage, and completeness of tumor resection were also analyzed. Seven type A tumors, 19 type AB, 23 type B1, 19 type B2, 27 type B3, and 13 thymic carcinomas were studied. The 5-year and 10-year survival rates were 100% after resection of tumor types A and AB; 93% and 81% for B1; 83% and 70% for B2; and 43% and 33% for B3. The overall 5-year and 10-year survival rates were 72.0% and 63.0%, respectively. Tumor classification was highly significant in predicting survival (P .001) and also reflected the clinical behavior of tumors. The Masaoka stage was the most important independent prognostic index in thymomas. The WHO histologic subtype and completeness of resection were also important prognostic factors.

Dye-Containing Histiocytes in Frozen Section of Sentinel Lymph Node: A Potential Mimicker of Carcinoma

Wu, L.-L., Cheuk, W., Poon, M., Chan, J. K. C. — Thu, 14 May 2009 16:11:47 PDT

Subepithelial Pelvic Hematoma (Antopol--Goldman Lesion) Simulating Renal Neoplasm: Report of a Case and Review of the Literature

Thu, 14 May 2009 16:11:47 PDT

The Antopol-Goldman lesion is a subepithelial pelvic hematoma simulating a renal neoplasm. We report the clinico-pathological features of a single case and a review of the literature. A 76-year-old man presented with flank pain and hematuria. Computed tomography showed a hypodense lesion of 6 cm at the left kidney with filling defect at pyelogram. The patient underwent nephroureterectomy for suspected neoplasm. Macroscopically, a mass of 6 cm was present impinging on the pelvi-caliceal system. Microscopically, the lesion was composed by hemorragic material with feature of an hematoma. A diffuse eosinophilic amorphous material suspicious for amyloid was observed among intra- and extraparenchymal vessels. The Congo-Red staining verified the presence of amyloid. The diagnosis was subepithelial pelvic hematoma with severe amyloidosis. Antopol-Goldman lesion should be kept in mind as a possible differential diagnosis of upper urinary tract lesion to avoid unnecessary nephrectomies. The anamnestic knowledge of amiloydosis may increase this diagnostic hypothesis.

"Giant" Solid Cell Rest of the Thyroid: A Hyperplastic Change?

Fellegara, G., Dorji, T., Bajineta, M. R., Rosai, J. — Thu, 14 May 2009 16:11:47 PDT

Sickle Cell Disease

Gheorghe, G., Rollins-Raval, M., Reyes-Mugica, M. — Thu, 14 May 2009 16:11:47 PDT

Single Thyroid Follicle Involved by Papillary Carcinoma: Partially Classic and Partially Oncocytic

Poli, F., Trezzi, R., Rosai, J. — Thu, 14 May 2009 16:11:47 PDT

Nutmeg Liver

Lasitschka, F., Warth, A. — Thu, 14 May 2009 16:11:47 PDT

Re: Acinic Cell Carcinoma of Salivary Gland with Massive Deposits of Globular Amyloid

Daneshbod, Y., Negahban, S., Khademi, B. — Thu, 14 May 2009 16:11:47 PDT

Added Value of Combined Gene and Protein Expression of CK20 and CEA in Non--macroscopically Involved Lymph Nodes of Colorectal Cancer

Wed, 18 Mar 2009 17:52:06 PDT

A methacarn fixation permits an approach that comprises multiple techniques. In this study the procedure is used to examine 100 mesenteric lymph nodes from patients with colon cancer by means of histology, immunohistochemistry (IHC), and reverse transcriptase polymerase chain reaction (RT-PCR). The evaluated nodes are found to be grossly free of metastases. The combined expression of both messenger RNA (mRNA) and protein is investigated to validate the presence of structural (cytokeratin 20, or CK20) and tumor-specific (carcinoembrionic antigen, or CEA) markers. Histological analysis shows micrometastases on 4 nodes. IHC analysis identifies isolated (CK20 and CEA positive) tumor cells on 14 other nodes. In this group, none of the nodes that are positive for CK20 IHC express the related mRNA. RT-PCR confirms the CEA IHC positivity in 50% of the cases. The double CEA IHC/RT-PCR positivity would have up-staged 33% of the pN0 cases to pN1. This approach offers a technological framework for further studies that aim to validate the clinical significance of protein/mRNA expression of tumor markers in colorectal cancer sentinel lymph nodes.

Cell Discohesion and Multifocality of Carcinoma In situ of the Bladder: New Insight From the Adhesion Molecule Profile (e-Cadherin, Ep-CAM, and MUC1)

Wed, 18 Mar 2009 17:52:06 PDT

Urothelial cell carcinoma in situ (CIS) of the bladder is a superficially diffusive and highly discohesive disease. The authors analyzed the expression of some adhesion molecules (e-cadherin and Ep-CAM) and MUC1 in 32 unifocal and multifocal bladder urothelial cell CIS in an attempt to clarify this discohesion. E-cadherin was strongly expressed, in more than 75% of the cases. The presence of methylation of the CDH1 e-cadherin promoter gene was also investigated, but methylation was found in only one case. Ep-CAM was present in all the cases with a heterogeneous staining pattern. Similarly, MUC1/episialin was variously present in 94% of the cases without a polarized staining pattern and was expressed more strongly in cases with multifocal disease. Because loss of MUC1 polarization leads to interference with cell—cell adhesion mechanisms mediated by cadherins, these findings help explain why bladder urothelial cell CIS often shows a discohesive morphology and multifocality despite a strongly expressed adhesion molecule profile. Finally, Ep-CAM expression might provide some support for future target therapy trials.

Review Articles: Pathogenesis and Diagnostic Significance of Nuclear Grooves in Thyroid and Other Sites

Batistatou, A., Scopa, C. D. — Wed, 18 Mar 2009 17:52:06 PDT

Nuclear grooves are longitudinal invaginations of the nuclear envelope bilayer, which constitute a characteristic feature of papillary thyroid carcinoma. Their pathogenesis is not yet clear, but there is evidence for the involvement of a signaling pathway downstream of the protooncogene RET. The presence of nuclear grooves is not specific for papillary thyroid carcinoma because it has been documented in other types of thyroid neoplasms, in nonneoplastic thyroid lesions, in ovarian neoplasms (Brenner, adult granulosa cell, and transitional cell tumors), in breast carcinomas, in cervicovaginal and endometrial smears, in papillary neoplasms of several organs (such as papillary transitional cell carcinoma of the bladder, papillary renal cell carcinoma, papillary endometrioid carcinoma of the prostate), in thymic carcinomas, and in nonepithelial tumors.

Teratoid Cyst of Floor of the Mouth: A Clinicopathologic Study of 20 Chinese Patients

Mohd Jamal Alsharif, , Yifang Zhao, — Wed, 18 Mar 2009 17:52:06 PDT

The aim of this study is to document the clinicopathologic features of teratoid cyst of the floor of the mouth in 20 Chinese patients, who were treated in Wuhan University. The 20 teratoid cysts were analyzed. All cases were confirmed by pathology. English literature was also reviewed. Our investigations showed that both sexes were equal to have these cysts. The age at diagnosis ranged from 25 days to 34 years, and the greatest frequency was within the first decade. It was found that the congenital cysts were most commonly diagnosed in the midline. All cases were treated by cystectomy, using 1 of the 2 approaches: extraoral or intraoral. Whenever, combined approaches were used in 2 cases. In all, 16 patients were followed-up, and 2 patients had recurrences. The intraoral approach was also effective for the treatment of large lesions and led to very good cosmetic and functional results.

Amebic Colitis Can Mimic Tuberculosis and Inflammatory Bowel Disease on Endoscopy and Biopsy

Pai, S. A. — Wed, 18 Mar 2009 17:52:06 PDT

Biopsies of 11 patients with histopathologically diagnosed amebic colitis was evaluated; endoscopically, they were suspected to have tuberculosis or inflammatory bowel disease. Amebiasis was suggested in the differential diagnosis in only 3 cases. Three patients had purely rectal or sigmoid involvement, whereas the others had ileocecal, cecal, ascending, or transverse colon disease. The biopsies showed cryptitis and depletion of mucin but no crypt branching. Crypt abscesses were seen in one biopsy. Trophozoites of Entamoeba histolytica were seen in the exudate in all cases. The trophozoites were round to oval, approximately 25 to 40 µm in diameter and had a single, round nucleus and periodic acid-Schiff—positive cytoplasm. Phagocytosed erythrocytes were present in the trophozoites. Some features of ulcerative colitis and infectious colitis, such as cryptitis and crypt abscesses, are also seen in amebic colitis. Amebic colitis must be included in the differential diagnosis of all patients with suspected inflammatory bowel disease and tuberculosis.

Benign Fibro-Osseous Lesions of the Jaws: A Study of 127 Chinese Patients and Review of the Literature

Mohd Jamal Alsharif, , Sun, Z.-J., Chen, X.-M., Wang, S.-P., Zhao, Y.-F. — Wed, 18 Mar 2009 17:52:06 PDT

The aim of this study is to analyze all the cases of benign fibro-osseous lesions treated at School and Hospital of Stomatology, Wuhan University, to compare the results obtained in this study with those previously documented by other authors. The 127 cases diagnosed as a fibro-osseous lesion were retrieved, and information about these lesions was documented. In all, 127 cases of benign fibro-osseous lesions were surgically treated. Of these, 55 were cemento-ossifying fibroma, 43 ossifying fibroma, and 29 fibrous dysplasia. Cemento-ossifying fibromas mostly occur in men of the second decades, mostly in the mandible. Ossifying fibromas had almost equal sex predilection and age distribution peaked in the second decades, mostly in the mandible. Fibrous dysplasia also had equal sex predilection, and age distribution peaked in the second and third decades, with equal occurrence in both jaws. The tumors needed to have a regular follow-up after the surgery.

Alveolar Rhabdomyosarcoma With Neuroendocrine/Neuronal Differentiation: Report of 3 Cases

Wed, 18 Mar 2009 17:52:06 PDT

The aim of this study is to report the clinicopathologic characteristics of 3 cases of alveolar rhabdomyosarcoma with neuroendocrine/neuronal differentiation. Specimens of 3 cases of alveolar rhabdomyosarcoma were studied using histologic, immunohistochemical, ultrastructural, and molecular genetic techniques. The patients were a 19-year-old man with metastatic alveolar rhabdomyosarcoma in a groin lymph node, a 16-year-old girl with alveolar rhabdomyosarcoma of the perineum, and a 20-year-old man with recurrent orbital alveolar rhabdomyosarcoma. Microscopically, case 1 was composed of compact sheets of medium to large tumor cells. Cases 2 and 3 were small blue round cell tumors. Cases 1 and 3 were solid throughout, whereas case 2 demonstrated alveolar and solid architecture. By immunohistochemistry, the following markers were positive: desmin (3/3), myogenin (3/3), synaptophysin (3/3), and chromogranin (2/3). Ultrastructurally, sarcomeric filaments were seen in all cases, while neuroendocrine granules were detected only in case 1. PAX:FKHR fusion transcript was identified in case 2, case 3 had a variant PAX3 transcript, and case 1 was negative. The data presented expands the known differentiation of alveolar rhabdomyosarcoma.

Mixed Tumour of the Skin With Extensive Ossification and Bone Marrow Formation on the Scalp of a Young Patient

Covello, R., Licci, S., Ferrari, A., Spriano, G., Catricala, C. — Wed, 18 Mar 2009 17:52:06 PDT

Multifocal Sclerosing Thyroiditis

Poli, F., Trezzi, R., Fellegara, G., Rosai, J. — Wed, 18 Mar 2009 17:52:06 PDT

Even the Bone Smiles!

Arena, V., Vita, G., Siciliano, P., Capelli, A. — Wed, 18 Mar 2009 17:52:06 PDT

Art Exemplified in Pathology

Coyne, J. D., Whooley, B. — Wed, 18 Mar 2009 17:52:06 PDT

Myxoid Epithelioid Sarcoma: Clinicopathologic Analysis of 2 Cases

Fadare, O. — Wed, 18 Mar 2009 17:52:06 PDT

In the nearly 4 decades since its original delineation as a distinct clinicopathologic entity, several morphologic variations of epithelioid sarcoma have been described. Proximal, angiomatoid, and fibroma-like variants have been reported, as have cases displaying significant hyalinization, calcification, and/or ossification. Furthermore, it has long been recognized that epithelioid sarcoma may display focal myxoid change. Herein, the authors describe 2 examples of epithelioid sarcoma that displayed diffuse myxoid change. Both cases were otherwise typical, both morphologically and immunophenotypically, of epithelioid sarcoma. The tumors in both cases were localized, and the patients were treated with wide local excision followed by adjuvant radiotherapy. The patients are free of disease recurrence after 25 and 37 months of follow-up. Differential considerations that may arise because of the composite of morphologic and immunophenotypic findings noted in these cases are discussed, especially if encountered in a small biopsy. These cases further expand the morphologic spectrum of epithelioid sarcoma.

Pigmented Oral Squamous Cell Carcinoma: A Case Report and Brief Review of the Literature

Wed, 18 Mar 2009 17:52:07 PDT

Melanin impregnation in squamous cell carcinoma (SCC) is an uncommon histological finding. Rare nonmelanocytic entities were previously described as having melanocyte colonization. A 57-year-old Brazilian woman was referred with a pigmented lesion in the lower lip and alveolar ridge with a prior clinical diagnosis of melanoma. The incisional biopsy of the tumor revealed an SCC with strong colonization of melanocytes in the stroma. The authors report a case of an unusual SCC variant and a brief review of the literature.

A Case of Liver Metastasis From an Oncocytoma With a Focal Area of Chromophobe Renal Cell Carcinoma: A Wolf in Sheep's Clothing

Wed, 18 Mar 2009 17:52:07 PDT

In 2004, the World Health Organization classified the renal oncocytomas as benign neoplasms of the kidney. There are reports of subtypes of renal tumors, with similar histological morphology to oncocytoma, but with malignant potential, one of these tumors is the eosinophilic variant of chromophobe renal cell carcinoma. It is important to characterize the histological features and the subtype of tumor, as this predicts biological behavior and cancer-specific survival rate. A rare case of a liver metastasis from a focal area of eosinophilic variant of chromophobe renal cell carcinoma mixed in oncocytoma in a 69-year-old woman is reported. Although some renal tumors may contain oncocytoma and eosinophilic variant of chromophobe renal cell carcinoma histology, caution should be exercised while diagnosing oncocytomas in needle biopsies as there may be unsampled area of chromophobe carcinoma which has a potential for metastatic spread representing a wolf in sheep's clothing.

Plasmablastic Lymphoma Affecting the Lung and Bone Marrow With CD10 Expression and t(8;14)(q24;q32) Translocation

Khoon Leong Chuah, , Siok Bian Ng, , Poon, L., Wai Ming Yap, — Wed, 18 Mar 2009 17:52:07 PDT

Plasmablastic lymphoma is a rare variant of a diffuse, large B-cell lymphoma, which typically presents in the oral cavity in immunocompromised patients. In HIV positive patients, this tumor has a tendency to manifest in extramedullary sites. In this report, we document a rare instance in which this neoplasm besides affecting the bone marrow also involved the lung. In addition, the lymphoma in our case disclosed CD10 positivity on immunohistochemistry and t(8;14)(q24;q34) translocation on cytogenetic analysis, mimicking a Burkitt/atypical Burkitt lymphoma. The problems in diagnosis are discussed.

Heavily Pigmented Renal Cell Carcinoma: A Case Report, With Review of the Literature and Differential Diagnosis

Rossi, G., Cadioli, A., Costantini, M., Grazia Del Buono, M., Oleari, G. — Wed, 18 Mar 2009 17:52:07 PDT

Clear cell carcinoma is the most common histotype among renal cell tumors. The prominent vascular network of sinusoidal vessels lined by delicate endothelial cells may often lead to hemorrhagic areas with secondary deposition of chunky birefringent hemosiderin granules. The finding of pigmentation other than iron, and in particular melanin deposits, in renal tumors is a rare occurrence that should lead to differential diagnosis with other primary and metastatic tumors of the kidney.

Multilocular Cystic Nephroma and Multicystic Clear Cell Carcinoma: Two Faces of the Roman God Janus?

Stamatiou, K. N., Sofras, F. — Wed, 18 Mar 2009 17:52:07 PDT

Micropapillary-Type Invasion in Low-Grade Mammary Carcinomas

Zamecnik, M. — Wed, 18 Mar 2009 17:52:07 PDT