Luca Morelli

Human nasal rhinosporidiosis: an Italian case report

BackgroundRhinosporidiosis is a disease affecting primarily the mucosa of nose, conjunctiva and urethra. It is endemic in some Asiatic regions, affecting people of any age and sex. Its manifestation is a polypoid mass growing inside the affected cavity and the only treatment is surgical excision. Rhinosporidium seeberi is the aetiological agent. Many discussions arouse regarding the taxonomic classification of the microorganism, recent studies established it is an aquatic protistan parasite. The lesion may recur and sometimes cause osteolytic bone lesions. In endemic areas it is not easy to establish if recurrent lesions are due to relapse or reinfection.Case presentationA 26-year-old male patient from India, resident in Italy since 2005, presented in March 2006 with a history of nasal obstruction of three months duration. Physical examination showed an erythematous, papillomatous mass, 3 cm in diameter, obstructing the right nasal cavity. A microscopic diagnosis of rhinosporidiosis was made. Few Italian human cases of this disease have been previously reported in the literature.ConclusionRhinosporidiosis is a condition which both clinicians and pathologists should keep in mind when managing patients from endemic countries with nasal masses. Moreover, it is very interesting in such cases to follow the clinical course: an eventual recurrence of the lesion in our patient would mean a true relapse, excluding the possibility of a reinfection, more probable in the endemic areas.

Pulmonary congenital cystic adenomatoid malformation, type I, presenting as a single cyst of the middle lobe in an adult: case report

BackgroundCongenital cystic adenomatoid malformation (CCAM) of the lung is an uncommon fetal development anomaly of the terminal respiratory structures. The large cyst type usually occurs in stillborn infants or newborn infants with respiratory distress. Cases of CCAM have been previously described in adulthood, more often type I with multiloculated cystic lesions.Case presentationWe report a case of type I CCAM presenting as a single, expansive cystic mass in the middle pulmonary lobe in a 38-year-old man, revealed by persistent cough and haemoptysis. Computed tomographic scan showed a single cyst with air fluid level, occupying the lateral segment of the lobe. When the type I CCAM is a single cyst, other cystic pulmonary lesions must be excluded. The intrapulmonary localization and the absence of cartilage in the cyst wall are conclusive findings of CCAM. The pathogenesis, management and differential diagnosis with other lung malformations are discussed along with a review of the literature.ConclusionThe literature data confirm that surgical resection is the treatment of choice in all cases of CCAM and in the cases of cystic pulmonary lesions with uncertain radiological findings, in order to perform a histological examination of the lesion and to prevent infection and the potential neoplastic transformation.

Renal Cell Carcinoma With Sarcomatoid Features and Peritumoral Sarcoid-Like Granulomatous Reaction: Report of a Case and Review of the Literature:

Granulomatous inflammation with multinucleated giant cells is observed in various infectious and noninfectious diseases. It has been found in association with malignant tumors and designated sarcoid-like reaction. The distinction between a tumor-related granulomatous reaction and a true sarcoidosis can be a problematic issue. A case of renal cell carcinoma with sarcomatoid features (Fuhrman nuclear grade IV) with an extensive peritumoral sarcoid-like reaction and a critical review of the few cases of this association described in the literature have been reported, and the problematic clinical and pathological assessments of such lesions are discussed.

Herpesvirus 8-associated Penile Kaposi's Sarcoma in an Hiv-negative Patient: First Report Of A Solitary Lesion

&NA; Kaposis sarcoma is a neoplastic vascular lesion. Its form of onset is frequently disseminated, especially in HIV‐positive patients. Its association with the infection caused by a virus of the Epstein‐Barr family, human herpesvirus 8 (HHV‐8), has been recently demonstrated. In this article we discuss the unusual presentation of a solitary manifestation of Kaposis sarcoma on the penis of a 53‐year‐old HIV‐negative patient. Polymerase chain reaction analysis of the tumor tissue was positive for HHV‐8 in the tumor cells but not in the reactive stroma cells surrounding the tumor. The case is interesting for its unusual site of presentation, the young age of onset, the association with HHV‐8 infection, the HIV‐negative serology, and the benign course of the disease.

Russell Body Gastritis Associated with Helicobacter pylori Infection in an HIV-Positive Patient : Case Report and Review of the Literature

In 1998 Tazawa and Tsutsumi described for the first time a case of Helicobacter pylori (HP)-related gastritis characterized by the presence of a conspicuous plasma cell infiltrate with Russell bodies, and coined the term Russell body gastritis (RBG). A 59-year-old HIV-positive man complaining of recurrent epigastric pain underwent an upper gastrointestinal endoscopy revealing in the stomach only hyperemia in the antral portion. Histology showed a moderate glandular atrophy associated with an expansion of the lamina propria due to an infiltration of monomorphous cells with eosinophilic cytoplasm inclusions and eccentric nuclei, somewhat resembling plasma cells. A diagnosis of HP-related RBG was made, after excluding, by means of histochemical, immunohistochemical stainings and molecular studies, a neoplastic process. A review of all cases of RBG previously described in the English literature is reported in order to examine the clinical, endoscopic and microscopic features of this histopathological entity and the possible pathogenetic mechanisms.

Prevalence and significance of psammoma bodies in cervicovaginal smears in a cervical cancer screening program with emphasis on a case of primary bilateral ovarian psammocarcinoma

Background The purpose of our study was to determine the prevalence and significance of psammoma bodies (PBs) in the cervicovaginal smears of the screening population of Trento district (Italy), with the description of the cytological presentation of an asymptomatic bilateral ovarian psammocarcinoma. Methods From 1993 to 2006, women with PBs detected on consecutively screened cervical smears were identified from the computerized pathology database of Rovereto Hospital. The follow-up period was set from the time of cytological diagnosis to May 31st, 2007. Clinical information was obtained from retrospective review of womens medical records. The source of PBs was identified with adequate diagnostic procedures. Results PBs were found in six of the 201,231 Papanicolaou screening smears (0.0029%). Benign conditions (intrauterine device, inclusion ovarian cysts and ovarian cystoadenofibroma with PBs) were found in four patients. In two cases, PBs were associated with malignant cells; a bilateral ovarian malignancy was diagnosed in both cases, a serous adenocarcinoma and a psammocarcinoma. Conclusion PBs in the cervicovaginal smears are a rare finding, associated more often with benign conditions than with malignancies. Moreover, to our knowledge, our case of primary ovarian psammocarcinoma is the first report in which the presence of malignant cells and PBs in the cervicovaginal and endometrial smears represents the first manifestation of disease.

Primary myxopapillary ependymoma of the cerebellopontine angle: report of a case

Myxopapillary ependymoma is a rare variant of ependymoma, almost exclusively occurring in the region of the cauda equina and filum terminale. We describe a myxopapillary ependymoma located in the left cerebellopontine angle of a young man suffering from peripheral vertigo and left sensorineural hearing loss for years. The patient underwent surgical removal of the tumour. Microscopic examination showed histological and immunohistochemical features consistent with a diagnosis of myxopapillary ependymoma. Imaging studies of the spine yielded normal findings, confirming the lesion’s primary nature. To the best of our knowledge, this is the first case of primary intracranial myxopapillary ependymoma described in this location.

Concurrent occurrence of three primary neoplasms with different hystotype in the same kidney, associated with an adenoma of the omolateral adrenal gland : First case report

Abstract  We present an unusual case of concurrent occurrence of three synchronous primary tumors in the same kidney (oncocytoma, chromophobe renal cell carcinoma, angiomyolipoma) associated to an adenoma of the omolateral adrenal gland in a patient with no evident clinical symptoms. The immunohistochemistry showed a positivity for KIT in oncocytoma and chromophobe cell carcinoma, and a weak positivity in the angiomyolipoma, only in the cells positive for HMB‐45. This is the first report of this kind of presentation.

Non-Hodgkin Lymphomas Concurrent with HHV8-Associated Kaposi’s Sarcoma in the Same Lymph Node in AIDS and Non-AIDS Patients

Background: The association between lymphomas and Kaposi’s sarcoma has been described since 1920. The simultaneous presence of the 2 pathologic entities within the same lymph node is a rare and interesting occurrence. In the few cases described, the presence of human herpesvirus 8 (HHV8) and Epstein-Barr virus (EBV) in the different neoplastic areas was investigated only by immunohistochemistry and in situ hybridization studies. Methods: Two cases of concurrent non-Hodgkin lymphoma and Kaposi’s sarcoma in the same lymph node are described: a diffuse large B cell lymphoma in an AIDS patient and a T cell-rich large B cell lymphoma in a HIV-negative patient, complete with the clinical, immunohistological and molecular features, the latter ones defined after isolation of the different neoplastic areas by laser capture microdissection. Results: Polymerase chain reaction assays revealed HHV8 DNA sequences only in the microdissected Kaposi’s sarcoma areas and EBV DNA sequences only in the lymphomatous areas in both cases, confirming the HHV8 infection only in the neoplastic sarcomatous cells and evidencing the EBV infection only in the lymphomatous cells. Conclusion: This study represents a further confirmation of the supposed different etiopathogenic mechanisms of the 2 neoplasias, suggesting a coincidental occurrence even when localized in the same lymph node, independently from HIV infection.

Primary mantle cell lymphoma of the testis

Dear Editor, A 45-year-old man presented with a 3-week history of right lower quadrant pain radiating to the right inguinal area and testis. Physical examination revealed an enlarged right testis. An ultrasound examination of the right testicle showed a hypoechoic mass involving almost the entire organ and consistent with a neoplastic lesion. Biochemical assays for alpha fetoprotein and beta human chorionic gonadotrophin were within normal limits. A right orchifuniculectomy was performed and histological examination revealed the neoplastic mass was represented by a diffuse proliferation of predominantly medium-sized monotonous lymphoid cells resembling lymphoblasts with dispersed chromatin, scant cytoplasm, and a high mitotic rate (25 per ten high-power field) (Fig. 1a, b). Seminiferous tubules, which appeared entrapped in the lymphomatous tissue, were immature and lacking spermatogenesis (Fig. 1a, b). On immunohistochemistry, the neoplastic cells expressed CD45, CD20 (Fig. 1c), CD5, cyclin D1 (Fig. 1d), bcl-2, and focally, CD43 with no expression of CD3, CD10, bcl6, CD23, TdT, CD34, MUM1/IRF4, and CD138. The proliferation index measured by immunostaining with monoclonal antibody MIB1 (anti-Ki-67 nuclear antigen) was high, with more than 60% of the cells staining positive. Morphological and immunohistochemical features were consistent with a mantle cell lymphoma (MCL), blastoid variant. A fluorescence in situ hybridization revealed that more than 75% of the cells contained t(11; 14). Biochemical and hematological tests were normal, and computed tomography scans of the head and neck, thorax, abdomen, and pelvis were unremarkable. A bilateral bone marrow biopsy revealed no infiltration by lymphoma. On the basis of all these findings, a diagnosis of primary MCL of the testis, blastoid variant, was made. The patient underwent localized radiotherapy and six cycles of CHOP chemotherapy (doxorubicin, cyclophosphamide, vincristine, prednisone). Currently, 10 months after completion of the therapy, he continues to be healthy with no apparent manifestation of the disease by physical examination and total body computed tomography. MCL is a B cell non Hodgkin lymphoma (NHL) of older adults with a male preponderance. Most patients present with disseminated disease, with lymphadenopathy often with splenomegaly, and frequent involvement of the bone marrow. A minority of patients present with extranodal disease most often involving the gastrointestinal tract [1] and, occasionally, Waldeyer’s ring [2] but rarely involving other sites such as the skin [3] or the ocular adnexa [4]. Nearly all patients with extranodal presentation of MCL will be found to have lymphadenopathy or more widespread disease on staging. However, cases of primary extranodal MCL have been described. The most frequent site is represented by the gastrointestinal tract [5], with the characteristic clinicopathological presentation of a multiple lymphomatous polyposis. Other primary MCLs have been reported in the skin [3, 6], the oral cavity [7], and the conjunctiva [8], but they can be considered extremely rare. Primary testicular lymphoma represents 1–2% of all NHLs [9]. This entity is chiefly a disease of the elderly with 85% of the cases occurring in patients older than 60 among whom it is the most common testicular tumor [9]. Almost S. Licci (*) Department of Pathology, Santo Spirito Hospital, Lungotevere in Sassia, 1, 00193 Rome, Italy e-mail: stefano.licci@hotmail.it