Philip Daroca

Myoid hamartomas of the breast

Tumors containing smooth muscle are rare in the breast. A myoepithelial origin for the myoid component of such lesions was postulated in previous reports. Myoepithelial hyperplasia has long been recognized as a common component of some breast lesions, including sclerosing adenosis, papillomas, and fibroadenomas. Three breast tumors composed of variable admixtures of adipose tissue, fibrous tissue, and smooth muscle are described. The authors postulate that the myoid component of two of the three lesions may have arisen in a milieu of myoepithelial hyperplasia. The origin of the myoid component in the third case is not clearly defined.

Bronchogenic sarcomatoid squamous cell carcinoma with osteoclast-like giant cells

A 60-year-old man developed a widely metastatic spindle cell neoplasm with admixed osteoclast-like giant cells indistinguishable from malignant giant cell tumor of soft parts. Autopsy revealed a bronchogenic sarcomatoid squamous cell carcinoma that was the primary source of the sarcomatoid metastases. The osteoclast-like giant cells in the metastatic lesions were negative for lysozyme on immunoperoxidase staining. This finding suggested that the multinucleated giant cells were not formed as a cellular response to hemorrhage or to cellular debris induced by the tumor. Extraosseous neoplasms with osteoclast-like giant cells are rare neoplasms that may occur in a variety of organs. This case is the second reported case of a primary neoplasm in the lung that contained these osteoclast-like giant cells. These tumors may cause considerable diagnostic confusion.

Basaloid carcinoma of uterine cervix.

Basaloid carcinoma is an uncommon tumor of the uterine cervix which has received little recognition in the medical literature. It is characterized by: 1) an ulcreated infiltrating growth pattern, 2) nests or cords of small basaloid cells, 3) prominent peripheral palisading of cells in the tumor nests, and 4) no significant stromal reaction. This cervical neoplasm is an entity distinguishable from adenoid cystic carcinoma, undifferentiated small-cell carcinoma, carcinoid tumor, and regional basaloid patterns in otherwise typical squamous cell carcinoma.

Multilocular renal cyst (cystic nephroma) with müjllerian-like stroma

Multilocular renal cyst is an uncommon lesion of controversial histogenesis. The authors report a case of renal multilocular cyst with müllerian (ovarian)-like stroma. We suggest that this finding would support a dysontogenetic origin for the lesion.

Pulmonary veno-occlusive disease: Report of a case with pseudoangiomatous features

ABSTRACT A case of pulmonary veno-occlusive disease with marked pseudoangiomatous histologic features is presented. Similar histologic findings have been briefly cited in previous reports of this entity. The pseudoangiomatous features are attributable to (1) remarkably recanalized pulmonary veins, (2) marked lymphangiectasia, and (3) the development of capillary collateral channels which drain to the bronchial venous system. Hemoptysis was a prominent clinical finding in the terminal phase of this patients illness. We suggest that rupture of varices of the bronchial veins may in part ac-count for the episodes of hemoptysis. Varices of the bronchial veins have also been implicated as a source of hemoptysis in cases of mitral stenosis-another disorder which produces marked pulmonary venous hypertension.

Metastatic amelanotic melanoma simulating giant-cell tumor of bone

A case of metastatic malignant melanoma simulating a giant cell tumor of bone is reported. This case typifies the diversity of expression of malignant melanoma. Osteoclast-like giant cells were present only in the femoral head metastasis and were not present in the primary lesion. The giant cell component may be reflective of an inherent and indiscriminant expression which may be seen in a variety of neoplastic bone lesions.

Black Thyroid Associated with Thyroid Carcinoma

Objective. Black thyroid is a rare pigmented change seen almost exclusively in patients upon minocycline ingestion, and the process has previously been thought to be generally benign. There have been 61 reported cases of black thyroid. We are aware of 13 cases previously reported in association with thyroid carcinoma. This paper reports six patients with black thyroid pigmentation in association with thyroid carcinoma. Design. The medical records of six patients who were diagnosed with black thyroid syndrome, all of whom underwent thyroid surgery, were reviewed. Data on age, gender, race, preoperative fine needle aspiration biopsy (FNA), thyroid function levels, and pathology reports were collected. Main Outcome. The mean age was 60 years. There were 5 females, 4 of whom were African American. All patients were clinically and biochemically euthyroid. Black pigmentation was not diagnosed in preoperative FNA, and only one patient had a preoperative diagnosis of papillary thyroid carcinoma. The other patients underwent surgery and were found to have black pigmentation of the thyroid associated with carcinoma. Conclusions. FNA does not diagnose black thyroid, which is associated with thyroid carcinoma. Thyroid glands with black pigmentation deserve thorough pathologic examination, including several sections of each specimen.

A 47-Year-Old Man With Cough, Dyspnea, and an Abnormal Chest Radiograph

A 47-year-old man was referred to a pulmonary clinic with a 4-year history of dyspnea, productive cough, weight loss, low-grade fevers, night sweats, and occasional hemoptysis. During those 4 years, the patient had undergone multiple serologic, sputum microbiological, and radiographic studies, as well as a bronchoscopy examination; 4 months prior to referral, due to worsening in symptoms, videoassisted thoracoscopic surgery (VATS) for right lung biopsy was performed, Due to the patients clinical symptoms and abnormal radiographic findings, he had received multiple courses of antibiotics, including 2 months of RIPE therapy (ie, therapy with isoniazid, rifampin, ethambutol, and pyrazinamide) for undocumented tuberculosis, without any significant response. His medical history was positive for COPD, chronic sinusitis, recurrent pneumonias, gastroesophageal reflux disease, hepatitis C, and alcohol abuse. He did not have any history of uveitis, cervicalllumbosacral stiffness, or musculoskeletal pain. His family history was not contributory. His surgical history was remarkable for a VATS proce-

Splenic papillary angioendothelioma in a 6-year-old girl.

Papillary angioendothelioma is a rare, low-grade neoplasm of lymphatic channels that usually presents intradermally. We report the case of a 6-year-old girl with isolated splenomegaly and symptoms of early satiety and weight loss, whom was found to have a splenic papillary angioendothelioma. Preoperative abdominal computed tomography scan showed an irregular, heterogeneous mass; a tagged red cell scan ruled out a hemangioma, whereas a positron emission tomography scan showed mildly increased uptake. Subsequent surgery and pathologic assessment revealed a papillary angioendothelioma (Dabska tumor) within lymphatic spaces. The child has no evidence of recurrence or metastases 1 year postoperatively.

Sclerosing cervicitis: Report of a skull base lesion with literature review

Invasive fibrosclerotic lesions of the head and neck outside of the thyroid and orbit are extremely rare. To date 13 cases of sclerosing cervicitis have been described in the literature.