Flavia Rosado

Occasional Staining for p63 in Malignant Vascular Tumors: A Potential Diagnostic Pitfall

Expression of p63, a putative marker for epithelial or myoepithelial differentiation, has been used to distinguish spindle cell carcinoma from sarcoma. The specificity of p63 for epithelial differentiation has not been thoroughly evaluated however, since p63 expression has been explored in only a handful of mesenchymal tumors. After observing unexpected immunohistochemical staining for p63 in an angiosarcoma of the breast, we evaluated a series of benign and malignant vascular tumors to determine the frequency of such a finding. Nuclear immunoreactivity to p63 was detected, at least focally, in 24% of malignant vascular tumors other than Kaposi sarcoma, which was uniformly negative. Benign vascular tumors were also negative for p63. Although p63 expression in tumors of vascular differentiation is unusual, it may be seen occasionally in some malignant vascular tumors. Thus, p63 is not entirely specific for epithelial differentiation. Since soft tissue angiosarcomas and hemangioendotheliomas sometimes express cytokeratins, the finding of nuclear p63 represents another potential pitfall in the differential diagnosis between poorly-differentiated carcinomas and vascular neoplasms.

Hepatic uterus-like mass misdiagnosed as hepatic abscess

Background. Hepatic endometriosis/uterus-like mass is rare and may be overlooked during hepatic cyst workups. We report a case of uterus-like mass, misdiagnosed as hepatic abscess. Case Report: A 47-year-old woman developed abdominal pain and vomiting. Infectious colitis with hepatic abscess was diagnosed, and remained antibiotic-refractory. Fine-needle aspiration and core biopsies showed benign contents. The patient presented to our institution with symptoms and normal blood work. Laparoscopic excision demonstrated a 1.4-cm cyst composed of endometrial glands (estrogen receptor+ and progesterone receptor+) and stroma (CD10+) with smooth muscle actin (SMA+), arranged in an organoid fashion. The patient, status-post hysterectomy, had no history or symptoms of endometriosis. Conclusion. This rare case illustrates the merit of considering uterus-like mass/endometriosis in the differential diagnosis of antibiotic-refractory hepatic cysts. Cyst heterogeneity may confound needle biopsy. We report the first instance of a hepatic uterus-like mass, with a review of related entities, postulated histogenesis, and important clinical associations.

Long-term complete clinical and hematological responses of the TEMPI syndrome after autologous stem cell transplantation

Long-term complete clinical and hematological responses of the TEMPI syndrome after autologous stem cell transplantation

Ileal mucosa-associated lymphoid tissue lymphoma presenting with small bowel obstruction: a case report

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT Lymphoma) of the gastrointestinal tract commonly involves the stomach in the setting of concurrent Helicobacter pylori (H. pylori) infection. Primary ileal MALT lymphoma is rare, and has not been associated with a specific infectious disease. We report a case of a 58-year-old man who presented to the emergency department with constipation and abdominal distension, and signs of an obstructing mass on computed tomography scan. A small bowel resection was performed which revealed an 8xa0cm saccular dilatation with thickened bowel wall and subjacent thickened tan-yellow tissue extending into the mesentery. Histologically, there was a diffuse lymphoid infiltrate consisting of small atypical cells with monocytoid features. These cells were CD20-positive B-lymphocytes that co-expressed BCL-2 and were negative for CD5, CD10, CD43, and cyclin D1 on immunohistochemical studies. Kappa-restricted plasma cells were also identified by in situ hybridization. The overall proliferation index was low with Ki-67 immunoreactivity in approximately 10xa0% of cells. No areas suspicious for large cell or high grade transformation were identified. The pathologic findings were diagnostic of an extranodal marginal zone lymphoma involving the ileum, with early involvement of mesenteric lymph nodes. Small hypermetabolic right mesenteric and bilateral hilar lymph nodes were identified by imaging. The bone marrow biopsy showed no evidence of involvement by lymphoma. The patient was clinically considered advanced stage and opted for therapy with rituximab infusions. After six months of therapy, follow-up radiologic studies demonstrated significant decrease in size of the mesenteric lymph nodes.

The Role of the Programmed Death Receptor-1/Programmed Death Ligand-1: Immunologic Checkpoint in Human Papillomavirus–Associated Head and Neck Squamous Cell Carcinoma

CONTEXTn- There has been increasing interest in understanding the role of programmed death receptor-1 (PD-1)/programmed death ligand-1 (PD-L1) pathway in cancer biology and its clinical significance in cancer therapy.nnnOBJECTIVEn- To discuss the studies of the PD-1/PD-L1 pathway in human papillomavirus-positive head and neck squamous cell carcinoma, focusing on the pathogenesis of cancer, characterization of the tumor microenvironment, and the effect of such studies in laboratory medicine.nnnDATA SOURCESn- Data sources included peer-reviewed literature and reputable online sources.nnnCONCLUSIONSn- To date, there are few studies of PD-1 and PD-L1 in human papillomavirus-positive head and neck squamous cell carcinoma. There is evidence that the PD-1/PD-L1 pathway has a role in this type of cancer; however, further studies are needed to better characterize the effect of the human papillomavirus and its use as a marker of therapy response.

Human Papillomavirus–Related Malignancies in the Setting of Posttransplantation Immunosuppression

CONTEXTn- The use of immunosuppression to avoid allograft rejection within the host creates the opportunity for unchecked development of malignancy in the posttransplantation setting. These malignancies frequently show association with human papillomavirus. Within this specific patient population, understanding the oncogenic role of this virus is vital for prompt recognition and treatment of malignancy and precursor lesions as well as the institution of appropriate preventive measures.nnnOBJECTIVEn- To review the role of human papillomavirus in the development of malignancies and their precursor lesions in the posttransplantation setting.nnnDATA SOURCESn- The study comprised a review of the literature.nnnCONCLUSIONSn- The development of human papillomavirus-related malignancies in transplantation patients is dependent on several factors, such as virus subtype, length of immunosuppression, and type of immunosuppressive therapy. Malignancies within these patients differ from those in the general population in terms of pathogenesis, frequency, and recurrence rate, and therefore require further understanding to allow for optimal surveillance and clinical management.