Valentina Natella

Radiofrequency-Assisted Partial Nephrectomy for Metanephric Adenoma A Case Report and Literature Review

Metanephric adenoma (MA) is a rare benign tumor, diagnosis of which is often carried out after surgical treatment. In case of peripheral lesions, a partial nephrectomy (PN)—either open or laparoscopic may be preferred—and, furthermore, a radiofrequency (RF)-assisted procedure may facilitate adequate hemostasis. In November 2010, the authors performed a RF-assisted PN, according to Habib’s technique, using a 4-needle bipolar device, on a woman affected by a small exophytic MA of the right kidney. Fibrin glue was applied on the cut surface. Postoperative course was uneventful, and discharge was on postoperative day 4. MA is an extremely rare benign tumor with a favorable prognosis. In case of a preoperative cytological diagnosis, a careful follow-up has to be considered. PN represents the standard of care for small exophytic MA, and RF-assisted procedures allow an excellent hemostasis and a rapid conservative resection, with very low morbidity.

Symplastic glomus tumor: Report of a challenging lesion with literature review

Glomus tumors are uncommon mesenchymal tumors whose cells closely resemble those of a normal glomus body, and are found most commonly in the hand. Recently, a symplastic form exhibiting marked nuclear atypia, in the absence of any other malignant features, has been described. To date, only 14 cases of symplastic glomus tumor have been reported in the literature; hence, very little information is available about its diagnosis, treatment, and biological behavior. The case reported here concerns a symplastic glomus tumor occurring in the right index finger of a 62-year-old woman. We reviewed the literature concerning previously reported cases, placing emphasis on the documented biological behavior, treatment, and demographic trend. Physicians must be aware of this morphological variation of glomus tumor to avoid the mistake of malignancy, which results in over-treatment of the patient.

MASC is indistinguishable from acinic cell carcinoma, papillary‐cystic variant on salivary gland FNA cytomorphology: case report with histological and immunohistochemical correlates

1. Barroeta JE, Farkas T. Merkel cell carcinoma and chronic lymphocytic leukemia (collision tumor) of the arm: a diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol 2007;35:293–5. 2. Soares FA, Potenciano O, Saldanha JC, Laemmel A. Fine needle aspiration of squamous cell carcinoma of the skin metastatic to the site of leukemic lymphadenopathy. A case report. Acta Cytol 1992;36:407–9. 3. McElroy C, Velilla R, Chaudhary H, Al-Abbadi MA. Fine-needle aspiration diagnosis of squamous cell carcinoma in a lymph node involved with small lymphocytic lymphoma: case report and review of the literature. Diagn Cytopathol 2009;37:48–50. 4. Flezar MS, Prevodnik VK, Kirbis IS, Strojan P. Cutaneous squamous cell carcinoma metastatic to chronic lymphocytic leukaemia: diagnostic potential of fine needle aspiration cytology. Cytopathology 2006;17:288–94. 5. Caraway NP, Wojcik EM, Saboorian HM, Katz RL. Concominant lymphoma and metastatic carcinoma in a lymph node: diagnosis by fine-needle aspiration biopsy in two cases. Diagn Cytopathol 1997;17:287–90. 6. Engels EA, Pfeiffer RM, Fraumeni JF Jr et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA 2011;306:1891–901.

A case of intravascular large B cell lymphoma: New clinical and immunohistochemical findings

Intravascular large B cell lymphoma (IVLBCL) is a rare extranodal non‐Hodgkin lymphoma characterized by proliferation of malignant cells within the lumen of small vessels, with a predilection for the CNS and the skin. IVLBCL clinical course is highly aggressive, clinical signs and symptoms are not specific and may consist of neurological and cognitive impairment, fever of unknown origin and cutaneous lesions, lacking of a typical neuroimaging pattern. For all these reasons the diagnosis is commonly missed and the exitus is frequent, therefore post mortem evaluation is necessary to clarify the clinical history. We present a case of IVLBCL in a 62‐year‐old woman with unusual symptomatology, mimicking a vascular, multi‐infarctual cerebropathy. Hachinski Ischemic Score was 7 suggesting a vascular dementia. Autopsy was unable to define the nature of the disease. Immunohistochemical analysis for cluster of differentiation 20 (CD20) revealed the ubiquitous presence of malignant lymphoid B‐cells into the vessel of all organs analyzed, allowing the definitive diagnosis of IVLBCL. The atypical cells expressed high levels of anti‐apoptotic proteins B‐cell lymphoma 2 (Bcl‐2) and Galectin‐3, and showed cellular myelocytomatosis (c‐Myc) staining in <50% of tumor nuclei. Conversely, cells were immunonegative for multiple myeloma‐1 (MUM1), CD3, CD44, CD30, CD34 and CD133. Fluorescent in situ hybridization analysis for MYC rearrangements was negative. The high expression of Galectin‐3 provides new insights in the understanding of molecular pathogenesis of IVLBCL; indeed, such a finding represents a prognostic factor for other types of lymphoma and should, in the same way, be taken into account in IVLBCL.

Molluscum Contagiosum Diagnosis on Nipple Scraping Sample

the 2010 and 2011 mammograms. Despite the possibility that these findings could be attributable to the injections, the findings were considered to be suspicious for malignancy. Stereotactic biopsy of right breast was performed 2 weeks later. The pathology results of focal laminated and nonpolarizable luminal debris with no malignant cells suggested that the mammographic findings were due entirely to the hyaluronic acid injections. Short-term follow-up diagnostic mammography was recommended. Injectable stabilized hyaluronic acid-based gel of nonanimal origin (NASHA) is manufactured by cross-linking hyaluronic acid chains. The result is a molecular network that remains biocompatible but has a significantly longer half-life than endogenous hyaluronic acid. NASHA injection in the breast is most commonly performed as a nonsurgical cosmetic procedure for breast augmentation. In this procedure, hyaluronic acid is injected into a potential space between the pectoralis major muscle and the glandular breast tissue. Hyaluronic acid has also been injected into the reconstructed nipple with the goal of improved nipple contour. However, there are no published studies which evaluate hyaluronic acid injection into the nipple, nor are there any publications regarding the imaging appearance of hyaluronic acid injection into the nipple. The retroareolar branching irregular densities that result from intra-nipple hyaluronic acid injection may lead to biopsy to exclude malignancy. However, awareness of this potential complication may allow biopsy to be avoided, and may lead to future recommendations regarding care of patients who have had intra-nipple hyaluronic acid injection.

Primary Peritoneal Clear Cell Carcinoma Versus Ovarian Carcinoma Versus Malignant Transformation of Endometriosis A Vexing Issue

Peritoneum is a site for both primary and secondary tumors. Primary peritoneal tumors are fairly rare. The most common primary tumors of the peritoneum are malignant mesothelioma and serous papillary adenocarcinoma. Clear cell carcinoma of the peritoneum is extremely rare and often misdiagnosed as mesothelioma, serous carcinoma, or metastatic adenocarcinoma, so it represents a diagnostic challenge for both clinicians and pathologists. Up to date, to the best of our knowledge, only 11 cases of primary peritoneal clear cell carcinoma have been reported in the English literature. Distinguishing this tumor of the peritoneum versus ovarian carcinoma can be problematic. Herein, we report a rare case of primary peritoneal clear cell carcinoma occurring in a 49-year-old woman, along with a review of the literature.

MRI findings of a remote and isolated vaginal metastasis revealing an adenocarcinoma of the mid-sigmoid colon.

Summary A remote vaginal metastasis from a colo-rectal carcinoma is extremely rare. Only few cases have been described in the literature. The radiological appearances of a vaginal metastasis from colon-rectal cancer have not been extensively investigated. We report the MRI findings with clinical and pathological correlations of a remote and isolated vaginal metastasis revealing a mid-sigmoid adenocarcinoma in a 67 years old woman.

Mast cell sarcoma of the scalp: the first sign of undisclosed systemic mastocytosis?

Mastocytosis is a neoplastic disease of mast cells and their CD34+ precursors, including a heterogeneous group of disorders. It is characterized by abnormal growth and accumulation of mast cells in one or more organ systems. Mast cell sarcoma is an extremely rare and aggressive disease characterized by local proliferation of atypical mast cells, destructive growth and poor prognosis, without systemic involvement. Very few clinical cases describing this entity have been reported in the literature. In this paper, we report a case of a mast cell sarcoma, localized in the scalp of a 63-year-old woman; it appears to be the first manifestation of undisclosed systemic mastocytosis.

Surprising autopsy diagnosis in unclear initial situation. A case of intravascular B cell lymphoma

Intravascular large B cell lymphoma (IVLBCL) is a rare extranodal non-Hodgkin lymphoma characterized by proliferation of malignant cells within the lumen of small vessels, with a predilection for the central nervous system and the skin [1]. IVLBCL clinical course is highly aggressive, clinical signs and symptoms are not specific and may consist in neurological deficits, fever of unknown origin, cutaneous lesions, lacking of a typical neuroimaging pattern [1]. For all these reasons the diagnosis is frequently missed and the exitus is frequent, therefore post-mortem evaluation is necessary to clarify the clinical history. We present a case of IVLBCL in a 62-year-old female with unusual symptomatology, mimicking a vascular multinfarctual cerebropathy; post-mortem autopsy was diriment to define the nature of the disease. Immu- nohistochemical analysis for anti-CD20 revealed the ubiquitary presence of malignant lymphoid B-cells into the vessels of all organs analyzed, allowing the definitive diag- nosis. Although the diagnostic procedure for such pathology is still a matter for fur- ther studies, adequate interpretation of neuro-imaging and morphological findings, as well as of systemic symptoms can provide a right diagnostic hypothesis, suggest- ing focused biopsy in vivo .

Metastasis to the Kidney From a B2 Thymoma Report of a Case

Thymomas are tumors with an indolent behavior and long clinical course, usually confined to the anterior mediastinum. Local recurrence is frequent while distant metastases are extremely rare. We report an unusual case of a B2 thymoma with a single renal metastasis The challenge in this case was the frozen section intraoperative diagnosis because of the clinical suspicion of malignant lymphoma. This report also highlights the role of surgical removal of solitary metastases.