Nebojsa Arsenovic

Lupus mastitis mimicking a breast tumor

Lupus mastitis represents a subset of breast‐limited lupus panniculitis, and occurs very rarely in patients with systemic lupus erythematosus. We report a case of a 33‐year‐old white woman with a previous history of systemic lupus erythematosus, complaining of an acute tenderness and pain in the right breast associated with localized skin erythema. Ultrasound and mammography reports from a private breast clinic, where she was scheduled for core needle biopsy, aroused suspicion of a breast tumor. Clinically the patient had a painful mass suggestive of an inflammatory lump with an abscess. Her double‐stranded DNA antibody level, white blood cell count and erythrocyte sedimentation rate (ESR) were increased; and her renal function was impaired and serology findings negative. All other laboratory tests were within the normal ranges. The patient underwent urgent surgical incision and excisional biopsy of the lesion, and histology revealed lupus mastitis. Lupus mastitis very rarely may appear as a breast lump and therefore presents a great diagnostic challenge for clinicians, occasionally for radiologists and rarely for pathologists.

Mammary-type myofibroblastoma of soft tissue

A 40-year-old woman presented with a 1 year history of a painless, subcutaneous lump on the right buttock. Clinical examination showed an approximately 6 cm large subcutaneous mass covered by apparently normal-looking skin. No inguinal lymphadenopathy was found. The mass was excised with the clinical diagnosis of fibroma. Histologically, the lesion was consistent with mammary-type myofibroblastoma of soft tissue, a very rare, benign mesenchymal neoplasm with myofibroblastic differentiation. After surgical excision she was free of recurrence over a period of 8 months. This article also challenges the theory that suggests the origin of this tumor to be from the embryonic mammary tissue, adding another case of a site other than the milk lines.

Fatal carbamazepine induced fulminant eosinophilic (hypersensitivity) myocarditis: Emphasis on anatomical and histological characteristics, mechanisms and genetics of drug hypersensitivity and differential diagnosis

The most severe adverse reactions to carbamazepine have been observed in the haemopoietic system, the liver and the cardiovascular system. A frequently fatal, although exceptionally rare side effect of carbamazepine is necrotizing eosinophilic (hypersensitivity) myocarditis. We report a case of hypersensitivity myocarditis secondary to administration of carbamazepine. Acute hypersensitivity myocarditis was not suspected clinically, and the diagnosis was made post-mortem. Histology revealed diffuse infiltration of the myocardium by eosinophils and lymphocytes with myocyte damage. Clinically, death was due to cardiogenic shock. To best of our knowledge this is the second case of fatal carbamazepine induced myocarditis reported in English literature.

Risk of malignancy index validity assessment in premenopausal and postmenopausal women with adnexal tumors

OBJECTIVE The aim of this study was to investigate the validity of the risk of malignancy index (RMI) in premenopausal and postmenopausal patients with adnexal masses. MATERIALS AND METHODS The study involved all women treated for adnexal tumors throughout an 18-month period in the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia (Belgrade, Serbia). On admission, detailed anamnestic and laboratory data were obtained and an expert ultrasound scan was performed. The RMI was calculated for all patients and the obtained data were related to histopathological findings of the tumors. For statistical analysis, we used descriptive and analytical statistics methods and an SPSS computer program. RESULTS From a total number of 540 women, 85 women had malignant tumors; 20 women, borderline tumors; and 435 women, benign adnexal tumors. The RMI was reliable in 84.6% of all patients; in 77% of premenopausal patients, and in 81.1% of postmenopausal patients. The sensitivity of the RMI in the overall population was 83.81%; the specificity was 77.24%; the positive predictive value (PPV) was 47.06%, and the negative predictive value (NPV) was 95.18%. In premenopausal women, the RMI sensitivity was 83.87%; specificity, 80.31%; PPV, 28.89%; and NPV, 98.12%. In postmenopausal women the RMI sensitivity was 83.78%; specificity, 68.18%; PPV, 63.92%; and NPV, 74.71%. CONCLUSION The RMI was a reliable factor for differentiating benign from malignant adnexal masses in premenopausal and postmenopausal patients.

Symplastic Glomangioma Information Review and Addition of a New Case

Glomus tumors are neoplasms differentiating toward specialized cells found in the glomus body, a structure involved in thermoregulation. Although the vast majority is benign, the occurrence of malignant glomus tumors is well recognized. Criteria for prediction of malignant potential include a deep location, large size, infiltration, necrosis, and nuclear atypia. Symplastic glomus tumors are benign neoplasms showing striking nuclear pleomorphism in the absence of other malignant criteria. Recognition of this rare morphologic aberration would prevent an inadvertent diagnosis of malignancy.

Trichilemmal Cyst With Carcinoma In Situ Within an Atypical Fibroxanthoma

A 91-year-old lady presented with an 8-month history of a slow growing keratotic nodule on the forehead, which was excised. Histological examination showed a well-defined lesion with marked cellular pleomorphism. Numerous mitoses were present. The cells stained positively with CD10 and CD68 and weakly with smooth muscle actin. However, the tumor was negative for cytokeratins (AE1/AE3), epithelial membrane antigen (EMA), S100, Melan A, HMB45, leukocyte common antigen (LCA), desmin, and CD31. Therefore, the lesion was designated as atypical fibroxanthoma (AFX) by exclusion. Within the AFX, there was also a cyst lined by squamous epithelium showing pilar keratinization. The epithelium showed full-thickness dysplasia with increased mitotic activity and was stained positively with AE1/AE3, thus supporting our view of carcinoma in situ within the wall of the cyst. To the best of our knowledge, this article describes the first case of trichilemmal cyst with carcinoma in situ arising within an AFX.

Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis?

OBJECTIVE The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. METHODS Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. RESULTS The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). CONCLUSIONS Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.

Melanoma markers-negative primary melanoma with melanoma markers-positive metastasis.

Concordant loss of all 3 commonly used melanocytic markers (ie, S-100, HMB-45, and Melan-A) in a primary malignant melanoma with expression of the same in the metastatic lesion is very rare. To the best of the authors’ knowledge, they documented the second case of this unusual and rare phenomenon.

Angiomatosis: A Case With Metaplastic Ossification

Angiomatosis is defined as a hemangioma that affects a large segment of the body in a contiguous fashion, either by vertical extension to involve multiple tissue planes (eg, skin, subcutis, muscle, bone) or by crossing muscle compartments to involve similar tissue types (eg, multiple muscles). Such lesions usually present in the first 2 decades of life and have a highly characteristic but not totally specific histological pattern. Histology usually shows a haphazard mixture of small and medium-sized vessels, fat, connective tissue, and lymphatics. Large amounts of mature fat frequently accompany the vascular elements, suggesting that the lesion may possibly be a more generalized mesenchymal proliferation rather than an exclusively vascular lesion. Here we present what we believe to be the first case of angiomatosis showing osseous metaplasia.

Synchronous presence of cellular angiofibroma and lipoma in vulvoinguinal region: a unique case report.

A 26-year-old woman presented with a 7-month history of a slowly growing right-sided, well-circumscribed, subcutaneous, soft, painless, large vulvoinguinal lump that now measured up to 12 cm. Adjacent to but separate from this was a well-circumscribed, soft, painless, mobile, large inguinal tumor 8 cm in diameter that had been present unchanged for 2 years. Both lesions were completely excised. Histologically, the first mass was consistent with cellular angiofibroma, whereas the second one had the typical features of lipoma. According to the available literature, this is the first case of synchronous presence of cellular angiofibroma and lipoma in one patient.