Sergio Fernandez-Aguilar

Neuroma of the clitoris after female genital cutting

BACKGROUND Nerve tumors of the clitoris and particularly neuromas are extremely rare. CASE A 27-year-old infibulated African woman suffering from chronic vulvar pain increasing with sexual intercourse presented for gynecologic care. Examination revealed a painful clitoral tumor. The tumor was surgically excised. The diagnosis of amputation neuroma of the clitoris was made by microscopic examination. CONCLUSION This is the first well-documented case of clitoral amputation neuroma occurring after female genital cutting. Considering the high number of genital cuttings practiced, these tumors are probably under-reported in the literature.

Tubular carcinoma of the breast and associated intra-epithelial lesions: a comparative study with invasive low-grade ductal carcinomas.

Ductal intra-epithelial lesions of the breast are associated with invasive neoplasms and comprise a large spectrum of histological patterns. We have examined 23 cases of pure tubular carcinomas (TCs) of the breast and 53 cases of invasive ductal low-grade carcinomas to determine the relationship and distribution of intra-epithelial lesions, mainly of ductal in situ carcinoma type, but including also lobular intra-epithelial neoplasia (LIN) in both entities. Eleven cases of TC showed flat epithelial atypia (FEA) (47.8%), and, in 14 and 6 cases, micropapillary and cribriform low-grade ductal carcinoma in situ (DCIS) were present (60.7 and 26.1%, respectively). On the opposite, in ductal grade I invasive carcinomas, the most frequent architectural pattern was low-grade DCIS growing in arcades in 26 cases (49%). While absent in TCs, low-grade DCIS of solid type was found in five (9.4%) cases of ductal invasive carcinomas, where FEA were present in seven (13.2%) cases. LIN lesions were present in four (17.4%) cases of TC, whereas they represented 7.5%, as reported by Carstens et al. (Am J Clin Pathol 58:231–238, 1972), of cases of low-grade carcinomas. These results suggest that invasive pure TC and low-grade ductal carcinomas of the breast are different lesions, and support the fact that TC, of low histopathological grade, is a particular distinct tumoural entity.

Proliferating activity in columnar cell lesions of the breast

With the introduction of mammographic screening, columnar cell lesions (CCLs) are observed more and more frequently because they are often associated with microcalcifications. Until now, the proliferative activity of these lesions has not been previously evaluated. Ki67 index was performed by immunohistochemistry in CCLs without atypia [columnar cell change (CCC) n = 20 and columnar cell hyperplasia without atypia (CCH without atypia) n = 20], flat epithelial atypia (FEA DIN1A n = 20), low-grade intraductal carcinoma (DIN1C n = 20), high-grade intraductal carcinoma (DIN 2–3 n = 20). Adjacent terminal duct-lobular unit (TDLU) of normal breast tissue served as control. Ki-67 index is extremely low and close in CCLs without atypia (CCC mean 0.1% and CCH mean 0.76%) and paradoxically is lower than in normal TDLU (mean 2.4%) (p < 0.001). In the FEA, in comparison with normal TDLU and CCLs without atypia, the Ki67 is higher (mean 8.2%) (p < 0.001) but extremely close to those of DIN1C (mean 8.9%) (p = 0.6 NS). Lastly, the Ki67 index is higher in DIN 2–3 (mean 25.4%) than in CCLs without atypia and FEA (p < 0.001). CCLs are disparate lesions having in common cells with columnar configuration but different proliferative characteristics. These data represent findings of biological interest which could help us to better understand these controversial lesions.

Laminin-5γ2 chain expression in cervical intraepithelial neoplasia and invasive cervical carcinoma

Background.  To analyze the expression of laminin‐5γ2 chain, a protein which plays a major role in keratinocyte migration, in cervical intraepithelial neoplasia (CIN), and invasive cervical carcinoma associated with high‐risk oncogenic human papillomaviruses (HR‐HPVs).

Myolipoma of soft tissue: An unusual tumor with expression of estrogen and progesterone receptors. Report of two cases and review of the literature

Tumors composed of an admixture of smooth muscle and mature adipose tissues (myolipomas, lipoleiomyomas and fibrolipoleiomyomas) are very rare in the genital tract and are most often located in the uterus. We report here two cases of myolipoma: one arising in the left fallopian tube of a 43-yearold Belgian woman and the other occurring in the right broad ligament of a 69-year-old Belgian woman. Histologically, both tumors are composed of an admixture of entirely mature adipose tissue with interspersed regular smooth muscle cell bundles. This muscle component was strongly positive for actin, desmin and caldesmone antibodies and contained both numerous estrogen and progesterone receptors. Amazingly, the mature adipose cells also expressed these receptors. Interestingly, the myolipoma observed in the fallopian tube is until now, to the best of our knowledge, the first described in such a location. The myolipoma found in the broad ligament is the second to be reported in the literature to date. The differential diagnosis as well as the pathogenesis of this entity on the basis of its particular immunohistochemical profile are discussed. Mesenchymal tumors of adipose differentiation are the most common soft tissue neoplasms in adults. However, mixed mesenchymal neoplasms of the broad ligament and of the fallopian tube characterized by an admixture of adipose and smooth muscle tissue in varying proportions are extremely rare and the only previously described case is a leiomyoma with fatty degeneration of the broad ligament (lipoleiomyoma) (1). Myolipoma is a distinctive and rare tumor, which usually occurs within the abdominal cavity and the retroperitoneum (2). Histologically it is composed of an admixture of entirely mature adipose tissue with a variable amount of interspersed regular smooth muscle bundles. We describe two similar tumors occurring in the left fallopian tube and in the right broad ligament of two Belgian women.

Cavernous lymphangioma of the vulva

Cavernous lymphangioma also known as cystic lymphangioma, cystic hygroma, or lymphangioma cavernosum is a benign tumor characterized by large dilated lymphatic channels with an attenuated endothelial lining which could be in some case surrounded by an irregular discontinuous smooth muscle layer (1). This benign tumor, in the majority of cases described, is either congenital or present in early infancy but is very rare in adulthood (1). Its sites of predilection are the neck and upper trunk (1). In the vulva, to the best of our knowledge, only three cases have been described before (2 4). We report here two additional cases occurring, respectively, in two young white women who presented a history of a gradually expanding vulvar masses.

IgM plasma cell myeloma with amyloidosis presenting as mammary microcalcifications.

We report the case of an otherwise healthy 67‐year‐old woman who presented with bilateral breast masses and calcifications. Bilateral mammary biopsies showed infiltration by monoclonal neoplastic plasma cells and diffuse osseous metaplasia. Congo red stains and immunohistochemistry showed amyloid deposits. This case illustrates why multiple myeloma should be kept in mind in the diagnosis of mammary calcifications.

Tumeur phyllode maligne du sein avec cellules géantes de type ostéoclastique : à propos d’un cas

Breast tumors, particularly of stromal origin, containing multinucleated osteoclast-like giant cells (OLGC) are rarely reported in the literature. We report here the first case of a malignant phyllodes tumor associated with OLGC occurring in a 43 year-old African woman who presented with a painful palpable mass of the outer upper quadrant of the right breast. After surgical excision, histological examination showed a malignant phyllodes tumor in which the stromal component displayed evident sarcomatous changes and was densely populated with benign multinucleated OLGC. These cells expressed the CD68 histiocytic marker. No evidence of osseous or cartilaginous differentiation was seen throughout the lesion. This lesion ressembles giant cell tumor of bone. However, the nature of the OLGC is not well precised yet.Resume La presence de cellules geantes multinucleees de type osteoclastique (CGTO) dans les tumeurs mammaires, et en particulier en association avec des neoplasies stromales, est peu frequente. Nous rapportons a notre connaissance le premier cas de tumeur phyllode maligne avec des cellules geantes de type osteoclastique chez une femme africaine de 43 ans admise pour une masse palpable et douloureuse localisee au niveau du quadrant supero-externe du sein droit. Apres resection chirurgicale, l’examen histologique montrait une tumeur phyllode maligne dont la composante stromale, d’aspect sarcomateux, etait accompagnee d’une riche population de cellules geantes multinucleees de type osteoclastique. A l’examen immunohistochimique, ces cellules exprimaient le marqueur histiocytaire CD68. Aucune zone de differentiation osseuse ou cartilagineuse n’a ete mise en evidence. Cette entite particuliere ressemble aux tumeurs a cellules geantes de l’os. Toutefois, la nature des CGTO n’est pas encore bien etablie.

Apport de la protéine p63 dans le diagnostic du carcinome tubuleux mammaire

Resume Objectifs Evaluer l’expression de la proteine p63 par rapport a l’actine musculaire lisse dans les carcinomes tubuleux (CT) mammaires et ses principaux diagnostics differentiels majeurs, a savoir les lesions de cicatrice radiaire (CR)/lesion sclerosante complexe (LSC). Materiel et methodes Dix cas de CT et 15 cas de CR/LSC ont ete teste par immunohistochimie avec la proteine p63 et l’actine musculaire lisse. Resultats Tous les cas de CR/LSC contenaient des cellules myoepitheliales exprimant de maniere diffuse l’actine et la proteine p63. L’immunomarquage anti p63 presentait une localisation nucleaire. A l’oppose, aucun marquage pour la p63 n’a pu etre demontre dans tous les cas de CT. Le marquage pour l’actine musculaire n’a pas identifie de cellules myoepitheliales dans les cas de CT mais s’est cependant revelee positif dans les structures vasculaires et les myofibroblastes du stroma peritumoral, rendant l’interpretation morphologique plus delicate. Conclusions La sensibilite de la proteine p63 et de l’actine musculaire lisse est equivalente dans le diagnostic differentiel entre le CT et les lesions de CR/LSC. La specificite de la proteine p63 apparait cependant superieure a l’actine musculaire lisse car elle ne marque ni les myofibroblastes ni les muscles lisses des vaisseaux. Cette specificite accrue, associee aux avantages d’un marquage nucleaire avec cette proteine, rend le diagnostic differentiel entre le CT et les lesions de CR/LSC plus aise.