Anita Achan

Renal Anastomosing Hemangiomas With a Diverse Morphologic Spectrum: Report of Two Cases and Review of Literature.

Benign vascular lesions have a diverse appearance and can be extremely difficult to classify. We present renal anastomosing hemangiomas from 2 patients that exemplify the potential diverse range of appearances that can occur in this recently described, rare variant of capillary hemangioma. The lesion from one patient was an intravenous hemangioma with closely packed, fenestrated vascular channels that were reminiscent of the splenic red pulp. Also, the endothelial cells contained hyaline globules. On the other hand, the second patient had multifocal tumor. The lesions showed more extensive hyalinization and vascular ectasia reminiscent of cavernous hemangioma. Extramedullary hematopoiesis was a feature in all the tumors, particularly in the second patient where numerous immature blasts were present within vascular spaces.

Rosette-forming glioneuronal tumour of the lateral ventricle in a patient with neurofibromatosis 1

We report a 33-year-old man with neurofibromatosis type 1 (NF-1) with a rosette-forming glioneuronal tumour (RGNT) in the lateral ventricle. The patient had been treated with radiotherapy and chemotherapy for a typical juvenile pilocytic astrocytoma of the hypothalamus seven years prior. MRI revealed a contrast-enhancing mass in the anterior horn of the left lateral ventricle. Histological examination demonstrated two distinct regions characterised by a rosette-forming neurocytic component and an astrocytic predominant component. Immunohistochemical studies showed glial fibrillary acidic protein and S-100 positivity in the astrocytic component and neuron-specific enolase was positive in the neurocytic cells. Although RGNT has been reported at other sites within the central nervous system, this report documents a previously undescribed lateral ventricular location of a rare RGNT in an asymptomatic patient with NF-1.

Acquired cystic disease-associated renal cell carcinoma: Correspondence

dence of intestinal perforation. She is non-diabetic and had not taken any antibiotics for more than 6 months and was not treated with any immunosuppressive therapies, a serological test for HIV was negative. Her initial PD effluent WCC was 390/μL with 80% neutrophils and she was treated empirically with intraperitoneal vancomycin and aztreonam. As the growth of yeast in the PD fluid culture was reported on day 3, oral administration of fluconazole was added. However, she showed no clinical response, PD effluent WCC rose to 1020/μL and β-D-glucan detection test was positive with 112.48 pg/mL on day 7. The fungal identified in PD fluid culture were finally confirmed to be Candida krusei and the PD catheter was removed on day 8, both the catheter tip and exit site swab were negative for culture. Based on susceptibility testing, fluconazole was stopped and according to the IDSA guideline in 2016, intravenous caspofungin (LD 70 mg, MD 50 mg/ day) was started and continued for 2 weeks. Oral voriconazole (200 mg q12h) as step-down therapy was given on day 16. She improved clinically over the next 5 days. During the step-down, she made an uneventful recovery. On day 28, the dosage of voriconazole was reduced at 100 mg q12h. She transferred to haemodialysis and has been in good condition after completing total 6 weeks of antifungal treatment. Previous peritonitis episodes, prior use of antibiotics, immunosuppressed state, diabetes mellitus, malnutrition are common risk factors for FP. However, our patient did not have significant risk factors. A possible explanation for this episode might be a history of habitual constipation and a long-term laxative use. According to China Hospital Invasive Fungal Surveillance Net study report in 2015, among all C. krusei isolates, the MIC range for caspofungin was 0.12–0.5 and no resistance to echinocandins was found. The updated IDSA guideline strongly recommends an echinocandin as initial therapy and voriconazole as step-down oral therapy for selected cases due to C. krusei when managing intra-abdominal candidiasis. Further studies regarding the selection of antifungal agents, efficacy of various regimens and optimal duration of the treatment for PD related FP are warranted.

Collagenofibrotic Glomerulopathy: Correspondence

A 65-year-old Croatian man was referred for assessment of elevated creatinine of 118 μmol/L and proteinuria (urine protein to creatinine ratio 270 mg/mmol) without haematuria. The only significant past medical history was hypertension for 12 months treated with an angiotensin II receptor blocker. The family history and serologic work-up were not contributory. Renal biopsy was undertaken and images provided in Figure 1. Light microscopy showed markedly expanded mesangial matrix occupied by amorphous eosinophilic material. This was accompanied by thickening of the capillary basement membranes, and narrowing of the capillary lumens. Congo red staining was negative for amyloid. Immunofluorence was not diagnostic for immune mediated processes. Electron microscopy showed markedly thickened glomerular basement membrane. There was marked accumulation of fibrillar material in the extracellular space of the mesangium, lamina lucida and subendothelial space of the glomerular basement membrane. The fibrils demonstrated a transverse banded structure with periodicity of approximately 60 nm. There was reduplication of the capillary basement membrane secondary to mesangial interpositioning. No discrete electron-dense immune complex-type deposits or microtubular structures were seen. Further immunohistochemical staining for Collagen Type III was moderately positive in the nodular expanded mesangial matrix and most capillary loops. The diagnosis of collagenofibrotic glomerulopathy was made. Collagenofibrotic glomerulopathy, also known as collagen type III glomerulopathy, is an extremely rare idiopathic glomerular disease characterized by massive accumulation of atypical type III collagen in the glomeruli. It was initially thought to be a glomerular limited form of nail–patella syndrome. However, it is now clear that these two conditions are unrelated. The most common presenting feature of collagenofibrotic glomerulopathy is proteinuria and hypertension. There is generally no extrarenal manifestation. Renal function is usually only mildly impaired or normal. Electron microscopy features are diagnostic of this condition. The collagen fibre is typically curved rather than straight. It has a transverse band structure with periodicity of approximately 60 nm, similar to normal type III collagen. There is no specific treatment for this condition. The disease course is variable with a significant percentage of patients progressing to end-stage kidney disease. There have been reports of patients with this condition who received renal transplant with no evidence of recurrence. In conclusion, collagenofibrotic glomerulopathy is a rare disease, the diagnosis of which can be easily missed if the nephrologist or pathologist is unaware of this condition. This case report serves as a reminder that this condition is to be considered in the differential diagnosis of glomerulopathies with organised deposits.

A Vaginal Angiomyofibroblastoma as a Rare Cause of a Prolapsing Vaginal Mass: A Case Report and Review of the Literature

Introduction Angiomyofibroblastoma (AMFB) is a rare, benign, mesenchymal cell tumour which presents as a slow-growing mass. It is most commonly seen in the vulva and is often mistaken for Bartholins abscess. It is histologically diagnosed by the presence of stromal cells intermingled with small blood vessels. It is morphologically similar to cellular angiofibroma and aggressive angiomyxoma, the latter of which is locally invasive and has a possibility of metastasis and a high risk of local recurrence. There is one reported case of an AMFB undergoing sarcomatous transformation. Case Report We report a case of a multiparous, 36-year-old woman with an anterior vaginal mass which was inappropriately treated as a vaginal prolapse prior to definitive surgical management. This is only the second reported case of an AMFB presenting as a prolapsing mass.

Metastatic Small-Cell Neuroendocrine Carcinoma Simulating Circumscribed Choroidal Hemangioma.

Aim: To report a case of metastatic small-cell neuroendocrine carcinoma presenting as an isolated choroidal mass and initially misdiagnosed as a circumscribed choroidal hemangioma. Methods: The clinical history, fundus findings, imaging, cytology and immunohistochemical features are described. Results: An otherwise healthy 66-year-old man was referred for a left nasal scotoma and a diagnosis of circumscribed choroidal hemangioma. Cytology showed cohesive clusters of small-to-intermediate malignant cells. The atypical cells stained positively for chromogranin, thyroid transcription factor-1 and synaptophysin consistent with small-cell neuroendocrine carcinoma. Conclusion: Small-cell neuroendocrine carcinoma metastatic to the choroid is extremely rare; however, it is particularly aggressive and should be included in the differential diagnosis of isolated choroidal lesions, even in otherwise healthy patients.

Intravascular renal haemangioma resembling the red pulp of spleen arising from within the renal vein: a case report

Vascular tumours are very uncommon in the kidney and most of these have been described in single case reports. Some of these can be diagnosed radiologically so the histological features of many of these tumours are not well recognised. We report a case of a haemangioma arising from within the renal vein in a patient with chronic renal failure and bilateral adrenal cortical hyperplasia. The tumour has an unusual sinusoidal architecture and focal extrame-dullary haematopoiesis reminiscent of the spleen. As expected, the endothelial cells stain positively for CD31 and CD34 but negative for CD8. We will also briefly discuss the clinical and histological features of this unusual tumour based on literature reviews.

Primary small cell carcinoma of pulmonary type of the fallopian tube: a case report

To the best of our knowledge, there has been no report of primary small cell carcinoma (pulmonary type) of the fallopian tube in the English literature. Our case is a 60-year-old woman who presented with profuse brownish PV (per vagina) discharge over several months. The patient underwent hysterectomy and bilateral salpingo-oophorectomy, after which the diagnosis of small cell carcinoma (pulmonary type) of the right fallopian tube was made. On immunohistochemistry, the carcinoma revealed posi-tivity for chromogranin, CD56, synaptophysin, TTF-1, CK-7 and EMA, and negativity for WT-1, P53, inhibin, CD-31, S100, HMB-45, CA-125, SMA, desmin, CK-20, Oestrogen, Napsin-A and CD-99. Here, for the first time, we present a case of small cell carcinoma (pulmonary-type) of the fallopian tube, and discuss its clinical presentation, imaging findings and histopatho-logical features.

Urothelial carcinoma of the ovary: privary versus metastatic. a case report and literature review

The ovaries are common sites for intra-abdominal metastasis. About 6% of ovarian cancers found at laparotomy are secondary tumours from other sites. 1 However, metastatic transitional cell carcinoma (TCC) involving the ovary from the urinary bladder or elsewhere within the urinary tract is extremely rare. Primary TCC accounts for 1–2% of all ovarian tumours. 2 TCC of the ovary is a recently recognised subtype of ovarian surface epithelial-stromal cancer. Microscopically, metastatic urothelial carcinoma of ovary is very similar to a primary ovarian TCC. The presence of a component of benign or borderline Brenner tumour confirms an ovarian primary. 3 The distinction between metastatic TCC of urothelial origin and a borderline or malignant Brenner tumour and a primary ovarian TCC can be difficult or sometimes impossible. We present a case of ovarian metastasis from urothelial carcinoma of the bladder. The patient developed bilateral bulky ovarian metastases 7 years after the diagnosis of the primary bladder tumour. The history of primary tumour was not available initially. We favoured metastatic ovarian tumours for the following reasons: (a) definite histological evidence of a primary bladder tumour, (b) bilateral ovarian involvement, and (c) lack of residual Brenner tumour. Although rare, possibility of metastasis from urothelial carcinoma should be considered as a differential diagnosis in cases of transitional cell carcinoma of ovary. Relevant clinical information is vital for accurate diagnosis. Careful histological and histochemical analysis may help to differentiate between the two.

Fine‐needle aspiration cytology features of a recurring plexiform fibrohistiocytic tumor in the upper limb and review of the literature

Plexiform fibrohistiocytic tumor is a rare soft tissue tumor that has a propensity to occur in the extremities in adolescents and young adults. Its cytologic features are not well documented, with only two case reports available in the literature. We present the case of a recurrent plexiform fibrohistiocytic tumor in a 19‐year‐old male, the cytologic features of which mimic that of a high‐grade sarcoma. We discuss the likely differential diagnosis based on the cytologic findings and a review of the current literature on this highly unusual tumor is also performed. Diagn. Cytopathol. 2011;39:49–53.