Antonio D'Antonio

Warthin-like tumour of the thyroid gland : RET/PTC expression indicates it is a variant of papillary carcinoma

Three cases with features of so‐called ‘Warthin‐like tumour’ of the thyroid (WaLTT) are described, in order to evaluate its relationship with papillary carcinoma (PC).

KSHV- and EBV-associated germinotropic lymphoproliferative disorder: a rare lymphoproliferative disease of HIV patient with plasmablastic morphology, indolent course and favourable response to therapy.

We describe a case of an unusual lymphoproliferative disease in a 60-year-old man. He presented at Hospital ‘‘Cardarelli’’ in March 2004 with fever, fatigue and weight loss. Physical examination and CT scan revealed a cervical lymphadenopaty, involving right laterocervical lymph node without enlargement of other lymph nodes. Laboratory serum tests for the common microrganisms and HIV were negative. A cervical lymph node biopsy was performed. Immediate post-operative follow-up with radiological studies and bilateral bone marrow biopsies did not reveal systemic involvement, nor evidence of monoclonal gammopathy found. No additional therapy was done. Later, the patient was dismissed for further evaluation. Today, after two years of diagnosis, there is no clinical evidence of relapse. For light microscopic examination, 4-mm-thick, formalin-fixed, paraffin-embedded tissue sections of case were stained with hematoxylin-eosin, periodic acid-Schiff and Giemsa. Consecutive sections were stained with antibodies to Ig heavy chains, light chains k, l, and CD10, CD20, CD19, CD22, CD21, CD30, CD79a, CD138, BCL2, BCL6, MUM1 and Ki67 (Dako, Glostrup, Denmark). For HHV-8 immunodetection was used in the monoclonal antibody for the latent nuclear antigen LNA-1 (clone 13B10, Cell Marque, Hot Springs, AR). Infection by EBV was investigated by in situ hybridization for EBV early RNA (EBER). For immunoglobulin gene rearrangements, we amplified DNA from whole paraffin sections of the CDRIII region of the rearranged IgVH gene using a mixture of seven framework 3 (FR3) family-specific primers and a consensus fluorescent primer for the JH gene. The surgical specimen consisted of a right cervical lymph node that measured 2.861.2 cm in diameter and had a fleshy cut surface. Histological examination showed the lymph node architecture partially effaced by a vaguely nodular infiltrate [Figure 1(a)] of atypical large cells resembling plasmablasts or immunoblasts, in small clusters or large sheets with involving the centre of lymphoid follicles [Figure 1(b)]. The ‘‘germinotropism’’ was confirmed by the presence of KSHV-positive cells within a meshwork of follicular dendritic cells CD21þ. Plasmablasts were also found in the mantle and interfollicular zones, often admixed with scattered individual large lymphoid cells and small aggregates of mature plasma cells [Figure 1(c)]. Residual atrophic lymphoid follicles were present. Immunohistochemical study showed that the plasmablasts were strongly positive for KSHV LNA-1 and co-expressed EBV as revealed by EBVencoded RNA (EBER) in situ hybridization

Monotypic epithelioid angiomyolipoma of the adrenal gland: an unusual site for a rare extrarenal tumor.

Epithelioid angiomyolipoma (AML) is an uncommon renal mesenchymal tumor with malignant potential and is frequently associated with tuberous sclerosis. Extrarenal AMLs are rare, and to the best of our knowledge, this is the first reported case of a primary monotypic epithelioid AML of adrenal gland in a patient without evidence of tuberous sclerosis. The patient is a 42-year old man who presented with retroperitoneal hemorrhage resulting from spontaneous rupture of adrenal mass. Histologically, the tumor showed a prominent component of epithelioid smooth muscle cells with slightly pleomorphic nuclei, sometimes with prominent nucleoli and eosinophilic cytoplasm resembling oncocytic tumors. Epithelioid cells were positive for melanoma (HMB45 and positive MelanA) and smooth muscle markers (alpha-smooth muscle-specific actin), but not for epithelial markers (cytokeratin, EMA). Differential diagnosis from renal cell carcinoma, adrenal gland carcinoma, and metastatic carcinoma is often challenging because of its epithelioid morphology. Because primary and secondary malignant tumors are much more common and aggressive neoplasms, establishing the correct diagnosis has important therapeutic and prognostic implications.

Rapidly growing intraparotid mass in a young child.

Abstract Nodular fasciitis (NF) is a pseudosarcomatous lesion typically involving the subcutaneous tissue and fascia; rarely, it has been observed within a parotid gland. We report a case of NF in an 8-year-old boy who presented with a rapidly growing nodule in the right parotid gland. A preoperative fine-needle aspiration suggested a diagnosis of nodular (pseudosarcomatous) fasciitis. After fine-needle aspiration, the surgical excision of nodule with a conservative approach was made. Intraparotid NF was diagnosed by histopathologic examination confirming the former cytologic diagnosis. This case demonstrates that NF, although rarely may occur in unusual site as parotid gland, in cases of rapidly growing tumor masses in the parotid, a correct cytologic diagnosis in the fine-needle aspirate might spare unnecessary aggressive surgical treatment.

Fine needle aspiration biopsy of intraparotid spindle cell lipoma: A case report

Intraparotid spindle cell lipoma (SCL) of the salivary gland is a rare entity. Review of the literature revealed only two previous reports describing its cytological features. We report a case of a 44‐year‐old man who complained for a slowly growing, asymptomatic mass in the left parotid gland that since 12 months. Fine needle aspiration biopsy (FNAB) showed a loose collections of bland‐appearing spindle cells in a myxoid background admixed with capillary fragments and some mature fat cells suggesting a diagnosis of SCL. A cytological diagnosis of mesenchymal myxoid spindle cell tumor with lipomatous differentiation, possibly an intraparotideal SCL was performed. Histological examination of the mass and the positive immunostaining for CD34 and negativity for S‐100, CK‐cocktail, and actin confirmed the diagnosis of SCL. The diagnosis of intraparotid SCL can be made by examining cytologic material containing mature fat with bland spindle cells in a myxoid background. FNAB diagnosis on SCL also allows to rule out other primary salivary gland tumors that may be clinically and instrumentally indistinguishable and thereby permits an appropriate surgical procedure to ensue. Diagn. Cytopathol. 2013.

Vulvar lymphoedematous pseudotumours mistaken for aggressive angiomyxoma: report of two cases.

Background: We describe 2 cases of vulvar pseudotumour due to lymphatic obstruction with chronic lymphoedema of unknown cause that presented as a solitary mass that mimicked aggressive angiomyxoma. Material and Methods: Both patients presented with a vulvar mass without medical history of trauma, surgery in the anogenital region or skin diseases. One patient was overweight (BMI = 26). Both surgically resected vulvar specimens were represented by a polypoid mass with a soft and a gelatinous cut surface. Results: Histologically, the presence of an abundant oedematous stroma with spindle-shaped cells and numerous thin-walled small-to-medium vessels may be confused with an aggressive angiomyxoma. The diagnostic key was represented by the massive oedema, rather than myxoid stroma, with the presence of dilated, tortuous lymphatic channels (some surrounded by clusters of lymphocytes) in the dermis. Conclusion: The recognition of these lesions is important because they may be the cause of problems in differential diagnosis and therapeutic management. In fact, such lesions can be mistaken from both the clinical and histological perspective as a primitive tumour of the vulva-like aggressive angiomyxoma. However, these lesions are not true neoplasms and are likely due to lymphatic obstruction with lymphoedema. A simple surgical excision with vulvoplasty is curative.

Multicystic Mesothelioma of the Liver with Secondary Involvement of Peritoneum and Inguinal Region

A case of multicystic mesothelioma of the liver with secondary involvement of the pelvic peritoneum and the inguinal region is presented. The case is of interest because of its unusual location and peculiar biological behavior.

A minute focus of extranodal marginal zone B-cell lymphoma arising in Hashimoto thyroiditis diagnosed with PCR after laser capture microdissection: a case report

BackgroundPrimary thyroid gland lymphomas are uncommon tumours that occur in the setting of lymphocytic thyroiditis or Hashimotos disease in almost all cases. In this condition a distinction between an inflammatory lymphoid infiltrate and a low grade lymphoma may be extremely difficult and precise criteria are necessary for a correct diagnosis.Patient and methodsWe report a case of a minute focus of primary extranodal marginal zone B-cell lymphoma (EMZBCL), incidentally discovered in a 63-year-old man with Hashimoto thyroiditis (HT) and diagnosed by means of polymerase chain reaction (PCR) after laser capture microdissection.The histological examination of surgical specimen confirmed the diagnosis of HT and showed a minute focus of dense lymphoid infiltrate (less than 4 mm in diameter), composed by centrocyte-like cells forming MALT balls. Immunoistochemistry was not useful. A microscopic focus of EMZBCL was suspected on the basis of morphological features. PCR assays revealed the rearrangement of the heavy chain of immunoglobulins only in the microdissected suspicious area, confirming the diagnosis of EMZBCL.ConclusionOur finding suggests that in cases of autoimmune thyroiditis a careful examination of the thyroid specimen is warranted, in order to disclose areas or small foci of lymphomatous transformation. Furthermore, in difficult cases with doubtful immunohistological findings, ancillary techniques, such as molecular studies, are necessary for a conclusive diagnosis.

Small cell neuroendocrine carcinoma of the endometrium with pulmonary metastasis: A clinicopathologic study of a case and a brief review of the literature

Neuroendocrine carcinomas (NEC) of the female genital tract are aggressive and rare tumors that usually involve the cervix and ovary, and are seen rarely in the endometrium in perimenopausal or postmenopausal women. We presented a case of a73 year-old postmenopausal woman with vaginal bleeding and abdominal pain. A subsequent computerized tomography (CT) scan of pelvis showed an enlarged uterus (20,0 × 12,0 cm) with para-aortic and pelvic lymph node metastases. She underwent surgical debulking and staging of an endometrial tumor with omental metastasis and positive lymph nodes. The pathological diagnosis was primary small cell carcinoma (SCC) combined with endometrioid carcinoma of uterine corpus. Her final FIGO stage was IVB. Three months after surgery CT-total body showed a metastasis to left lung of SCC. Because the small-cell component of endometrial tumor showed a strong positivity for TTF1 as pulmonary counterpart a differential diagnosis with a primary small cell carcinoma of the lung should be made. Identifying an appropriate therapeutic management for SCC of endometrium is challenging since these are extremely rare tumors. An optimal initial therapeutic approach to this rare disease, especially at an advanced stage, has not yet been clearly defined. However, in these a multidisciplinary therapy, including surgery, chemotherapy, and radiotherapy represent until this time the only therapeutic option.

Nonpolypoid Intestinal Mantle Cell Lymphoma Resembling MALT Lymphoma with Successful Response to Rituximab

Two unusual cases of mantle cell lymphoma are reported. They involved the ileum and right colon without multiple lymphomatous polyposis and morphologically resembled an extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type.