Alexandros Iliadis

Thyroid transcription factor‐1 and epithelial membrane antigen expression in four cases of subependymal giant cell astrocytoma

Sir: Subependymal giant cell astrocytoma (SEGA) is an uncommon primary brain tumour with indolent clinical course that typically affects young patients with tuberous sclerosis complex (TSC). The histogenesis of SEGA remains enigmatic, but the overall immunophenotype of the tumours implies a glio-neuronal differentiation profile. In routine practice, we have recently encountered a case of SEGA with intense nuclear immunopositivity for thyroid transcription factor 1 (TTF-1, also known as NK2 homeobox 1), using clone SPT24 (Novocastra, Newcastle upon Tyne, UK; dilution 1:80). This finding proved to be consistent in three more cases of SEGA retrieved from the archives of our department (Figure 1, Table 1). In a recent review, Ordό~ nez notes that expression of TTF-1 has been reported in glioblastomas, pituicytomas, granular cell tumours of the neurohypophysis, spindle cell oncocytomas and, rarely, central neurocytomas, ependymomas, choroid plexus tumours and pituitary adenomas. SEGAs are not mentioned. Furthermore, there are discrepancies in the reported immunohisto-

TdT expression in normal and neoplastic sebaceous cells

Terminal deoxynucleotidyl transferase (TdT) is a DNA polymerase expressed in immature, normal and neoplastic, lymphoid or haematopoietic cells and in neuroendocrine carcinomas, such as Merkel cell carcinoma and small‐cell carcinoma. It has not yet been described in cells of epithelial origin. After observing TdT immunoreactivity in normal sebaceous glands, we analysed its spectrum of expression in cases of sebaceous cell hyperplasia (SGH) and sebaceous cell neoplasm.

A rare case of a spontaneous neck hematoma in a patient with type 1 neurofibromatosis

Neurofibromatosis type 1 (NF-1) is a genetic disorder that affects one in 3000 individuals. Although NF-1 notably involves nerves and connective tissue, vascular involvement in large series is estimated to range from 0.4% to 6.4%. Jugular vein involvement in these patients is rare. Spontaneous neck hematomas and hemorrhages are also unusual. We present a case of a NF-1 patient with a spontaneous neck hematoma with possible leakage from the left internal jugular vein, presenting as a lateral neck mass. The fragility of the vein wall and the surrounding tissue led patient to a severe intraoperative bleeding. Pathological examination revealed degenerated neurofibroma which was in contact with or infiltrated the vein wall. ENT and other clinicians should be aware of this potentially fatal entity considering that it may present as a lateral neck mass.

Bilateral Aleukemic Myeloid Sarcoma of the Eyelids With Indolent Course

Abstract:Leukemic infiltrates may be seen in the skin in the absence of detectable bone marrow involvement. Leukemia cutis may exceptionally occupy the eyelids. An unusual case of a 58-year-old man presenting bilateral erythematous eyelid lesions, proven to be aleukemic leukemia cutis, is reported. Biopsy was conducted and hematoxylin/eosin stained sections were histologically evaluated. Immunohistochemistry was also performed.Light microscopy revealed cutaneous infiltration by a neoplastic population consisting of medium-sized cells. These cells infiltrated the overlying epidermis leading to focal microulcerations. The morphological and immunohistochemical characteristics of the neoplastic population were compatible with myeloid leukemia cutis. The bone marrow biopsy was normocellular for the patients age. Although chemotherapy was advised, the patient refused any treatment. He remains free of leukemia or evolution of eyelid lesions approximately 1 year after diagnosis. Leukemia cutis of the eyelids is a rare manifestation of acute leukemia and may remain aleukemic in adults for an indefinite period of time.

A 74-Year-Old Female with a Well Circumscribed Parietal Lobe Mass: Correspondence

1 Pathology Department, Medical School, Aristotle University, Thessaloniki, Greece. 2 Pathology Department, “Papageorgiou” General Hospital, Thessaloniki, Greece. 3 Department of Molecular Biology and Genetics, Health Sciences School, Democritus University of Thrace, Alexandroupolis, Greece. 4 Radiology Department, “Papageorgiou” General Hospital, Thessaloniki, Greece. 5 University of Nicosia Medical School, Nicosia, Cyprus.

PTTG-1 (Securin) immunoexpression in meningiomas correlates with tumor grade and proliferation rate: potential use as a diagnostic marker of malignancy

This study essentially aims to contribute to the immunohistochemical investigation of the use of pituitary tumor transforming gene (PTTG) as a marker of cell proliferation or advanced tumor grade in meningiomas of various WHO grades. In all, 51 cases were recovered in total, 21 Grade‐I, 23 Grade‐II and 7 Grade‐III meningiomas. Mitotic index (MI), Ki‐67/MiB‐1 positivity percentage and PTTG expression were analyzed in correlation to each other as well as to the tumor WHO grades. All three biomarkers showed a high diagnostic significance and a strong association with WHO grades. In comparison, PTTG expression was on a par with the other two indices, and performed very well regarding identification of advanced grade tumors. PTTG may be considered an important diagnostic tool and serve in the future as a novel prognosticator of the biological behavior of all grade meningiomas as well as a useful high‐risk patient selection tool.

Aberrant expression of T-cell marker CD7 in HIV negative intestinal plasmablastic lymphoma

ticle in press as: Iliadis A, et al., Aberrant expression of T-cell m doi.org/10.1016/j.pathol.2016.07.014 incidence in human immunodeficiency virus (HIV) positive or iatrogenically immunosuppressed adult males with mostly intraoral localisation, but also in other extranodal sites, and there have been cases reported in immunocompetent elderly patients. Herein, a case of PBL of the small intestine with exceptional immunophenotypic characteristics in a HIV negative, EBV negative patient is presented. A 77-year-old male without clinical or laboratory evidence of immunodeficiency and with a history of Billroth II surgery almost 30 years previously presented an ulcer in the anastomotic abducent loop of the jejunum. The partial enterectomy specimen showed an ulcerative, intramural, tumorous, whitish

Breast implant-associated anaplastic large cell lymphoma vs. anaplastic large cell lymphoma in a patient with breast implant effusion history: a diagnostic dilemma

Breast implant-associated anaplastic large cell lymphoma is a rare tumor, affecting patients in the post-breast implant setting, first reported in 1997. We report an extraordinary case of anaplastic large cell lymphoma presenting not as a breast mass but as a spinal tumor, and thus in distant disease stage if considered breast implant-associated. A 35-year-old female, who had undergone bilateral breast augmentations over a decade ago and recent implant removal, complained of back pain with an anterior thoracic projection bilaterally. Clinical and radiological work-up revealed pleural nodules, T6 vertebral/costal infiltration, enlarged left axillary lymph nodes, and extradural spinal masses bilaterally, from which tumor samples were studied morphologically and immunohistochemically. There was diffuse infiltration by enlarged, neoplastic lymphoid cells with eosinophilic cytoplasm and large, irregular, partially embryoid, or multi-lobulated nuclei with distinctive nucleoli. The findings were interpreted as soft tissue and bone infiltration by an aggressive CD30+, ALK− anaplastic large cell lymphoma. Since cytological or histological analysis on the initial peri-prosthetic inflammation tissue and effusion was not performed, the diagnosis of breast implant-associated anaplastic large cell lymphoma is critically difficult. If the clinical setting is not regarded coincidental, then it strongly favors the diagnosis of what could be a rare aggressive undetected form of breast implant-associated anaplastic large cell lymphoma. If so, the importance of awareness of this probable clinical entity among female patients and their surgeons as well as of the recognition and cytological study of peri-prosthetic effusions is emphasized, so as to enable early detection of a possible lymphomatous proliferation.

The cellular microenvironment and neoplastic population in mycosis fungoides skin lesions: a clinicopathological correlation

BackgroundThe cellular microenvironment has been proven to play a crucial role in solid tumours and seems to be important in haematologic malignancies, however, it has not been adequately investigated in primary cutaneous T cell lymphomas.ObjectivesThe aim of this study was to register the composition of the cellular microenvironment in mycosis fungoides skin lesions and correlate the composing parameters with the clinical data and follow-up results.Materials and methodsThe presence of eosinophilic polymorphonuclear leukocytes, B lymphocytes, CD68+ macrophages, and CD1a+ epidermal Langerhans and antigen-presenting dermal dendritic cells, as well as their relation to clinicopathological parameters, were studied in 16 mycosis fungoides cases of different disease stages. The presence and nature of the participating T cell populations was also investigated.ResultsCD8+ tumour infiltrating T cells and CD56+ cells were found among neoplastic CD4+ T cells in the lesions. Generally, eosinophils and B lymphocytes were absent or in low numbers, regardless of clinical presentation, contrary to tumourous lesions. Macrophages and CD1a+ cells were constantly present, even in early-stage mycosis fungoides. The reduced presence of the CD1a+ population was associated with resistance to therapy (x2; p = 0.012).ConclusionThere is a striking difference in cellular microenvironment composition between early and advanced mycosis fungoides lesions.

Parathyroid Adenoma with Prominent Lymphocytic Infiltrate

Only very few previously reported cases of pronounced lymphocytic infiltration in parathyroid adenoma can be found in the English medical literature. The objective of this report is to present such a rare case and to investigate to a certain extent the immunohistochemical profile of this rare histologic observation. The lymphoid cell population within the tumour was composed of nodule-forming B-cells and different subsets of infiltrating T-cells and caused minimal destruction of neoplastic tissue.