Lymphoblastic Transformation of Follicular Lymphoma: A Case Report and Review of the Literature
We describe a patient initially diagnosed with low-grade FL with relapsed disease presenting as acute renal failure due to diffuse abdominal lymphadenopathy. Excisional biopsy of an inguinal lymph node at relapse showed high-grade areas with sheets of immature-appearing lymphoid cells adjacent to nodular areas characteristic of low-grade FL. Cells of both components were positive for BCL2 and CD19. The cells of the high-grade component were positive for CD99 and TdT and negative for CD20, whereas cells of the low-grade component were positive for CD20 and negative for CD99 and TdT. Fluorescence in situ hybridization studie...
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Large B-Cell Lymphoma With IRF4 Rearrangement: From Theory to Practice
We report a rare case of a 19-year-old female patient presenting with a large B-cell lymphoma with IRF4 rearrangement located in the right tonsil, with characteristic histologic appearance and the phenotype of neoplastic cells. The presence of an IGH-IRF4 rearrangement was also confirmed, using a fluorescence in situ hybridization analysis with 2 successive hybridizations on the same slide. Patient was treated with 6 cycles of R-CHOP with no evidence of recurrence. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

The Enigma of Goblet Cell Tumors of the Appendix: Erratum.
No abstract available (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Erratum Source Type: research

Richter-like Pleomorphic Mantle Cell Lymphoma Composed of Epstein-Barr Virus–Positive Hodgkin-like Cells, a Diagnostic Challenge
Mantle cell lymphoma (MCL) is an aggressive non-Hodgkin lymphoma with distinctive clinicopathologic features including the presence of t(11;14)(q13;q32) in almost all cases. Histologically identifiable variants are well described. Most MCLs are the classic variant, although more aggressive variants including blastoid and pleomorphic exist. The pleomorphic variant is a morphologic subtype composed predominantly of large atypical lymphoid cells. This variant can arise de novo or occur in patients with previous history of MCL as result of disease progression and clonal evolution. Mantle cell lymphoma is characteristically Eps...
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Transformed Follicular Lymphoma: The Role of the Pathologist in Aiding Therapeutic Decision Making
Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma. Follicular lymphoma is generally an indolent disorder, and despite being incurable with standard chemotherapy, recent advances in treatment strategies have improved clinical outcomes and survival. Over time, FL could acquire additional genetic mutations and transform into diffuse large B-cell lymphoma, a more aggressive B-cell neoplasm, which markedly reduces survival. Treatment of transformed FL is based on combination chemotherapy and immunotherapy. Rituximab has changed the treatment landscape in FL. However, novel approaches to treatmen...
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Marginal Zone Lymphoma, Immune Dysregulation, and High-Grade Transformation
This article features a case-based approach to explore factors related to MZL progression in a patient with a complex history of autoimmunity and immune suppression. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Posttransplant Classic Hodgkin Lymphoma: Richter Transformation or Posttransplant Lymphoproliferative Disorder?
In this report, we describe a patient whose initial CLL/SLL transformed to diffuse large B-cell lymphoma, who then received allo-SCT. Subsequent development of classic Hodgkin lymphoma proved to be a diagnostic conundrum, for which PTLD and disease progression/recurrence were both reasonable considerations. This case illustrates the diagnostic dilemma and semantic confusion faced by both pathologists and clinicians when lymphoproliferative disorders emerge within the immunologically complex interface of CLL/SLL, RT, and allo-SCT. As molecular technologies are becoming more commonplace in routine diagnostics, subpopulation ...
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Transformation of Monoclonal B Lymphocytosis to Epstein-Barr Virus–Positive Large B-Cell Lymphoma With Intermediate Features Between Diffuse Large B-cell Lymphoma and Classic Hodgkin Lymphoma
Transformation of chronic lymphocytic leukemia (CLL) to an aggressive lymphoma, so-called Richter syndrome, usually includes diffuse large B-cell lymphoma and classic Hodgkin lymphoma. The transformation can be clonally related to the underlying CLL and is often Epstein-Barr virus (EBV) associated. Here we report the case of an 86-year-old woman with a newly identified CLL-like monoclonal B-lymphocytosis who developed diffuse lymphadenopathy. Biopsy of the left axillary lymph node showed EBV-positive large B-cell lymphoma with morphologic and immunophenotypic features intermediate between diffuse large B-cell lymphoma and ...
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Transformed Nodular Lymphocyte-Predominant Hodgkin Lymphoma: Histologic Features and Relationship to T-Cell/Histiocyte–Rich Large B-Cell Lymphoma
We present a patient with NLPHL and transformation to DLBCL at 7 years after initial diagnosis, who ultimately developed a therapy-related myeloid neoplasm. We review the histologic spectrum of transformed NLPHL, its relationship with THRLBCL, and recent developments in its molecular pathogenesis. Cases of transformation may prove valuable in understanding complex biologic relationships between a spectrum of overlapping lymphoma entities and may ultimately help refine therapy and improve prognosis. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Transformed Mycosis Fungoides and Mimics: Exploring the Landscape of CD30: +: Cutaneous T-Cell Lymphomas
In this report, we present a case of CD30+ transformed MF and discuss the clues that allow us to make the challenging distinction between transformed MF and other CD30+ CTCLs. We review histologic and clinical features of these different disorders, with a focus on the revised World Health Organization classification of primary cutaneous lymphomas. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

B-Lymphoid Blast Phase of Chronic Myeloid Leukemia: A Case Report and Review of the Literature
Chronic myeloid leukemia (CML) is a clonal hematopoietic stem cell disorder characterized by a reciprocal translocation, t(9;22)(q34.1;q11.2). This leads to fusion of the BCR and ABL1 genes, encoding an active tyrosine kinase that causes unregulated proliferation of the myeloid lineage. The BCR/ABL1 fusion protein is found not only in CML, but also in a subset of de novo B-lymphoblastic leukemia (B-LL). However, the fusion protein in CML is characteristically the slightly longer p210 variant, whereas the p190 variant is more frequently found in B-LL. Without treatment, CML will progress to accelerated and/or blast phase (B...
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Usual and Unusual Patterns of Transformation Among Lymphoid Neoplasms: Diagnostic Considerations for Pathologists
No abstract available (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 28, 2019 Category: Pathology Tags: Editorial Source Type: research

High-Grade Serous Carcinoma Arising in Retroperitoneal Endosalpingiosis: A Case Report and Brief Review of Peritoneal Serous Metaplasia and Neoplasia
We report a case of high-grade serous carcinoma arising in retroperitoneal endosalpingiosis in a patient with a history of ovarian high-grade serous carcinoma, followed by a brief review of peritoneal serous metaplasia and neoplasia. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Desmoplastic Small Round Cell Tumor: The Value of Cytology, Immunohistochemistry, and Molecular Features in the Diagnosis of This Challenging Diagnostic Entity
We present the case of a 16-year-old boy with unusually rapidly fatal desmoplastic small round cell tumor of the peritoneum with emphasis on the cytologic features. Recent advances in imaging techniques have resulted in increased number of cytologic preparations from unusual tumors or tumors in unusual locations. Morphologically, these tumors often display a divergent phenotype and immunophenotype. Immunohistochemistry plays a pivotal role in the characterization of these tumors and discrimination from other mimickers, particularly other “blue cell tumors.” Once suspected, identification of the characteristic t...
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Pseudomyxoma Peritonei Arising From a Low-Grade Mucinous Neoplasm of the Urachus
We report a patient who presented with abdominal distension and had raised tumor markers. A computed tomography scan revealed a calcified cystic lesion of the bladder dome together with features of PMP. These findings were confirmed at laparotomy, and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was performed. Histologically, the urachal lesion was a low-grade urachal mucinous tumor (mucinous cystic tumor of low malignant potential). The peritoneal disease was associated with ovarian involvement and omental cake and was designated low-grade mucinous carcinoma peritonei on histology. The immunoprofil...
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Low Grade Mesothelial Tumors of the Peritoneum: Multicystic Mesothelioma, Well-Differentiated Papillary Mesothelioma, and Adenomatoid Tumor
Low-grade neoplasms of the peritoneum are rare but include 2 entities that are more often encountered in the peritoneum than the pleura, namely, multicystic mesothelioma and well-differentiated papillary mesothelioma. Adenomatoid tumor is most common in the genital tract, but can occur in the peritoneum where it is sometimes found as a component of either multicystic mesothelioma or well-differentiated papillary mesothelioma. Indeed, all 3 tumors can occur in combination. The histological differential diagnosis of these neoplasms can include reactive mesothelial proliferations, malignant mesothelioma, and metastatic carcin...
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Case Reviews Source Type: research

Nonneoplastic Mimics of Appendiceal Mucinous Neoplasms
With the widespread acceptance of the term low-grade appendiceal mucinous neoplasm (LAMN) for relatively bland mucinous tumors of the appendix with pushing invasion and a propensity to disseminate to the peritoneal cavity, there has been increasing concern among pathologists of overlooking one of these tumors when an appendix shows extrusion of mucin into the wall or onto the serosa. The increased awareness of LAMN and its histologic features has caused some benign entities to be misinterpreted as LAMN based largely on the presence of mucin extrusion and hyperplastic and reactive appendiceal mucosa. The misinterpretation o...
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Reviews Source Type: research

The Enigma of Goblet Cell Tumors of the Appendix
The term goblet cell carcinoid was first proposed in 1974 by Subbuswamy et al for a rare tumor of the appendix. Since then, it has been debated whether these tumors should be regarded as adenocarcinomas or as neuroendocrine tumors. Research on these neoplasms has been hampered by their rarity and the low density of tumor cells. However, their particular morphology legitimates their classification as an entity specific for the appendix. In this review the morphology, immunohistochemical profile and differential diagnosis are discussed. Recent literature on grading and molecular profiling is reviewed. These data show that gr...
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Reviews Source Type: research

The Molecular Pathology of Appendiceal Neoplasms
We review the molecular pathological changes of appendiceal neoplasms, in part using the consensus terminology agreed by the Peritoneal Surface Oncology Group International (Am J Surg Pathol 2016;40(1):14–26; Histopathology 2017;71(6):847–858), with appendiceal neoplasms subcategorized as hyperplastic polyps and serrated lesions (with and without dysplasia), appendiceal mucinous neoplasms (low and high grade), adenocarcinoma, goblet cell tumors, and neuroendocrine neoplasms. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Reviews Source Type: research

Pseudomyxoma Peritonei: Pathology, a Historical Overview, and Proposal for Unified Nomenclature and Updated Grading
Pseudomyxoma peritonei (PMP) is a clinically distinctive form of malignancy that typically arises from the appendix and is characterized by bulky accumulation of mucinous tumor deposits in the peritoneal cavity. It has defied stable pathologic categorization ever since first being described in the late 19th century. Since the early 20th century, many accounts have emphasized the bland histology of those cases arising from appendiceal precursors that had been considered benign, in contrast to higher-grade cases with more conventionally malignant histology. Beginning in the late 20th century, this was exemplified by divided ...
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Reviews Source Type: research

Hot Topics in Appendiceal and Peritoneal Pathology
No abstract available (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - April 26, 2019 Category: Pathology Tags: Editorial Source Type: research

Ectopic Thymoma of the Right Atrium: A Case Report
We report a rare case of a right atrial ectopic thymoma. A 61-year-old woman presented with puffiness of face and shortness of breath. Cardiac computed tomography revealed a large right atrial mass with near-total occlusion of the chamber and extension into the superior vena cava and inflow tract of the right ventricle. She underwent resection of the right atrial mass. The final pathological diagnosis was intracardiac ectopic thymoma. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Case Reports Source Type: research

Endometrial Stromal Sarcoma With High-Grade Morphology and a JAZF1 Gene Rearrangement Presenting as Colonic and Cardiac Metastases: A Case Report and Review of the Literature
We report a case of an endometrial stromal sarcoma with a JAZF1 gene rearrangement by fluorescence in situ hybridization and high-grade cytology presenting as cardiac and colonic metastases, in a patient with a remote history of hysterectomy for to “leiomyomas.” (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Case Reports Source Type: research

Sarcomatoid Hepatocellular Carcinoma: A Case Report and Review of the Differential Diagnosis of Malignant Spindle Cell Lesions of the Liver
Sarcomatoid hepatocellular carcinoma is a rare aggressive variant of hepatocellular carcinoma that typically shows a conventional component of hepatocellular carcinoma admixed with a malignant spindle cell proliferation. In small biopsy specimens, the conventional component may not always be present; therefore, knowledge of the differential diagnosis of malignant spindle cell lesion presenting in the liver is necessary to ensure accurate diagnosis. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Case Reports Source Type: research

A Case of Small Cell Carcinoma With Adenocarcinoma Found in a Rectal Fissure
We present the case of a 51-year-old man with a history of pain with bowel movements and recent weight loss. Colonoscopy was performed, which revealed a rectal fissure with a lesion involving the rectum and anal canal. Biopsy of the lesion revealed invasive carcinoma with 2 distinct morphologies, a poorly differentiated small cell component and a minor adenocarcinoma component. We discuss the differential diagnosis of small cell carcinoma that includes mixed adenoneuroendocrine carcinomas and other neuroendocrine neoplasms. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Case Reports Source Type: research

Incidental Collision Tumor: Two Common Metastases Meet in the Neck
We present a case of intranodal collision between HPV-positive oropharyngeal squamous cell carcinoma and incidental papillary thyroid carcinoma. These two common lesions of the head and neck highlight an emergent area of complicated histology and raise interesting questions about tumor biology. We briefly review the variations of composite lesions described in the head and neck, as well as the potential prognostic implications between different types and role of ancillary testing and molecular diagnostics in their separation. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Case Reports Source Type: research

RET/PTC1 Rearrangement in Hashimoto Thyroiditis: Canonical WNT Expression Up-regulation for Neoplastic Promotion
Conclusions The expression of RET/PTC1 highlights the link between inflammatory processes such as HT and neoplastic conditions such as HTA and PTC. The limited expression of TCF4, AKT, ERK1, and β-catenin supports the notion that the canonical WNT/β-catenin pathway plays a pivotal role in the development of this neoplasm. It is important to note that at this time, gene expression alone is not sufficient to make a distinction between benign and malignant thyroid lesions. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Case Reports Source Type: research

Role of Dynamic Markers in the Molecular Testing of Indeterminate Thyroid Nodules
Molecular testing of fine-needle aspirates of indeterminate thyroid nodules is now standard and consists mainly of mutational analysis of the most frequent point mutations and chromosomal rearrangements occurring in advanced thyroid tumors with the goal of determining these genetic alterations early in the neoplastic process. However, mutation panels, even extended ones, face challenges; namely, genetic alterations in cytologically indeterminate categories are represented at relatively low percentage, and with the exception of strong driver mutations, the mere presence of a mutation does not reliably predict malignancy. C...
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Reviews Source Type: research

Cytology Slides for Molecular Analysis Can Address Both Interobserver Variability and Sample Heterogeneity: Overview of Thyroid Molecular Testing
Studies have shown that a high degree of inter and intraobserver variability, in addition to the heterogeneity of the sample itself, can inhibit the accuracy of cytopathological assessment of thyroid nodules. Guidelines have recommended the use of molecular analysis, used in conjunction with cytology, to assist in the guidance of patient management. Currently, there are several commercially available molecular tests offered to better assess overall malignancy risk, each now with updated and expanded capability. The collaboration between molecular pathology and cytopathology is critical to better understand the biology of t...
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Reviews Source Type: research

Editorial
No abstract available (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - January 1, 2019 Category: Pathology Tags: Editorial Source Type: research

Poorly Differentiated/Anaplastic Chordoma in a Child—Case Report and Review of the Literature
We present the case of a 3-year-old girl with a 5.0-cm sacrococcygeal mass. Magnetic resonance imaging showed a lobulated, heterogeneous mass attached to S5. Chordomas are very rare at this age; therefore, it is very important to distinguish this tumor from other more common neoplasms that occur in this location and age range because when they are identified their immunogenetic profile may suggest a worse prognosis. Histological, immunohistochemical, molecular characteristics, and differential diagnosis of this variant of chordoma are discussed. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Call for Papers 2017 Source Type: research

Phosphaturic Mesenchymal Tumor: A Single Case Report Discussing Diagnostic and Therapeutic Challenges of Tumor-Induced Osteomalacia
This report highlights the need for multidisciplinary diagnostic effort, effectiveness, of early surgical intervention, and emphasizes the importance of including this rare but damaging disease process in the differential diagnosis of osteomalacia. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Call for Papers 2017 Source Type: research

A Case Report of Pediatric Clear Cell Carcinoma of the Urinary Bladder Associated With Polyomavirus
We describe a urinary bladder tumor in an 8-year-old girl, which demonstrated similar features to clear cell carcinoma of the female genital tract with additional strong expression of SV40 large T antigen by immunohistochemistry. The patient had a history of severe infantile Crohn’s disease refractory to medical therapy, necessitating eventual stem cell transplant, complicated by graft-versus-host disease. Subsequent magnetic resonance enterography showed an incidental mass arising from the bladder dome, for which a partial cystectomy was performed. Histologically, the tumor demonstrated high-grade cytologic features...
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Review Source Type: research

Primary Renal Well-differentiated Neuroendocrine Tumor—Report of a Case With Cytological-Histopathologic Correlation and Review of Literature
Renal well-differentiated neuroendocrine tumor (WDNET; also known as carcinoid), although considered as a distinct entity in the World Health Organization classification, continues to be an enigma to the pathologists and clinicians because of its rarity. In this case report, we describe a case of primary renal WDNET in a 54-year-old man. The tumor was initially diagnosed as a urothelial carcinoma. After a second review and a broad-spectrum immunopanel, a revised diagnosis of WDNET was rendered. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Report Source Type: research

Renal Cell Carcinoma With (Angio)Leiomyomatous Stroma in a Patient With TSC2 Mutation: A Case Report
This report describes a unique presentation of a rare entity and brings attention to an evolving diagnostic field. We discuss problems and controversy surrounding the diagnosis of renal cell carcinoma with (angio)leiomyomatous stroma, its relationship to clear cell papillary renal cell carcinoma and other tumors, and how it correlates with newly discovered genetic mutations. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Call for Papers 2017 Source Type: research

Human Polyomavirus 7 and WU Polyomavirus-Associated Lymphocytic Bronchitis/Bronchiolitis in Native and Allograft Lung Biopsies From Immunocompromised Patients: Report of 3 Cases and Review of Literature
In this report, 3 transbronchial biopsies showed viral inclusions on histologic examination and were evaluated for anti-SV40 large T antigen (SV40 T Ag) by immunohistochemistry (IHC), in situ hybridization, and viral genome sequencing by polymerase chain reaction. Patients 1 and 2 were immunosuppressed lung transplant recipients. Patient 1 presented with diffuse pruritic rash and respiratory failure, and patient 2 with PyV viremia. Patient 3 had chronic lymphocytic leukemia/small lymphocytic lymphoma and presented with cough and shortness of breath. Histologic examination of all 3 lung biopsies were similar and revealed pr...
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Call for Papers 2017 Source Type: research

Expanding the Spectrum of Ciliated Muconodular Papillary Tumor of the Lung: A Case Showing Nonpapillary and Purely Glandular Morphology
We report an unusual case of a subpleural bronchiolar/glandular proliferation in a 76-year-old Hispanic woman with microscopic features reminiscent of those of the so-called ciliated muconodular papillary tumor (CMPT). The lesion presented radiologically as a solitary subpleural nodule measuring 2.7 × 1.2 cm with low standard uptake value (SUV) of 1.4. Microscopically, it was circumscribed but unencaspulated and consisted of mucous-filled spaces lined by cytologically bland cuboidal to low columnar cells, including goblet cells and ciliated epithelium, with underlying nodular collections of basaloid cells. The lining...
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Report Source Type: research

Isolated Pulse Granuloma in a Mesenteric Lymph Node: Unusual Nodal Manifestation Associated With Crohn Disease Complicated by Ileal Adenocarcinoma
We describe a solitary pulse granuloma in a mesenteric lymph node of a 74-year-old male patient with Crohn disease, who presented with an ileal adenocarcinoma, but without demonstrable fistula or perforation. To our knowledge, this is only the second reported example of Crohn disease associated with a pulse granuloma in a mesenteric node and also only the second example of a nodal location for any documented pulse granuloma. We postulate that mesenteric lymph node pulse granuloma may represent a unique and unusual type of morphology associated with Crohn disease. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Reviews Source Type: research

Pancreatic-Type Mixed Acinar Neuroendocrine Carcinoma Arising in the Common Bile Duct: A Case Report
We present a case of a 70-year-old woman with constipation, abdominal discomfort, and jaundice. Imaging studies revealed a 1.8-cm solid mass in the common bile duct causing dilatation of intrahepatic and extrahepatic bile ducts, which was resected. Microscopically, the tumor was limited to the wall of the bile duct, without involvement of the pancreas, and was composed of solid sheets and nests of relatively monomorphic cells with minimal to moderate amounts of cytoplasm, granular chromatin, focally prominent nucleoli, and up to 160 mitoses per 10 high-power fields. Immunohistochemistry showed equal to or greater than 30% ...
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Reviews Source Type: research

Brown Bowel Syndrome Presenting as a Small Bowel Obstruction
We report a case of BBS in a patient with previously undiagnosed primary intestinal lymphangiectasia. The patient had a longstanding history of malnutrition as well as bilateral lower extremity lymphedema and chylous ascites. He presented to our hospital with small bowel obstruction (SBO). Initial magnetic resonance enterography revealed a dilated duodenum, which when biopsied revealed only lymphangiectasia and lymphedema. He was managed conservatively and discharged following resolution of the obstruction. The patient presented again 1 month later with SBO that failed to resolve with conservative treatment. Subsequent exp...
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Reviews Source Type: research

A Composite Lymphoma Consisting of a Mantle Cell Lymphoma and a Peripheral T-Cell Lymphoma: A Rare Case With Literature Review
A composite lymphoma (CL) is defined as 2 or more morphologically and immunophenotypically distinct lymphomas or lymphoid neoplasms that occur in the same organ or tissue. Many types of CL have been described in the literature, including 52 cases of CL with a component of mantle cell lymphoma (MCL) and only 2 cases of CL consisting of MCL and T-cell lymphoma. We hereby present a case of CL consisting of MCL and peripheral T-cell lymphoma, not otherwise specified. Morphologic features and flow cytometry analysis were both instrumental in the diagnosis of CL. In addition, we reviewed 52 reported cases of CL with MCL as a com...
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Source Type: research

Follicular Dendritic Cell Sarcoma With NF2 Mutation
Follicular dendritic cell sarcoma (FDCS) is recognized as a diagnostically challenging neoplasm requiring rigorous exclusion of more common entities and high index of suspicion for diagnosis. Here, we report an aggressive case of FDCS arising in the mediastinum, which due to sampling limitations and the inherent difficulty of diagnosis required extensive workup with multiple samples prior to definitive classification. The patient was a 35-year-old woman who presented with progressive dyspnea and mediastinal mass on imaging studies. The initial sampling of the lesion had histologic features raising consideration of FDCS, bu...
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Case Review Source Type: research

Whole-Slide Imaging: Thinking Twice Before Hitting the Delete Key
No abstract available (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Letter to the Editor Source Type: research

Rare but important diagnostic entities: potpourri of case reports with teachable moments
No abstract available (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - November 1, 2018 Category: Pathology Tags: Editorial Source Type: research

Benign Hepatic Lesions Arising in Accessory Hepatic Lobes
We report the histologic and immunohistochemical features of 3 cases of resected accessory hepatic lobes, all of which contained benign hepatic lesions (2 hepatic adenomas [HAs] and 1 focal nodular hyperplasia). All accessory lobes were connected to the liver by a pedicle. Histologically, all lesions demonstrated no cytologic or architectural atypia. Based on immunohistochemical analysis, 1 HA was classified as inflammatory type (positive for C-reactive protein and serum amyloid A), and 1 was unclassified type (negative for C-reactive protein, serum amyloid A, glutamine synthetase, and β-catenin and positive for liver...
Source: Pathology Case Reviews - August 29, 2018 Category: Pathology Tags: Review Source Type: research

Incidental Hepatic Granulomas in a Young Woman
Hepatic granulomas are identified in approximately 3% to 4% of liver biopsies in the Western world. Their presence raises a broad differential diagnosis for the pathologist to consider, including infectious, immune-mediated, and drug-induced etiologies. Certain histologic features of granulomas and the adjacent liver parenchyma can help narrow the differential diagnosis, although clinical and laboratory correlation is often necessary to establish a definitive diagnosis. The purpose of this article is to review the morphologic classification of hepatic granulomas and to discuss hepatic sarcoidosis, one of the most common im...
Source: Pathology Case Reviews - August 29, 2018 Category: Pathology Tags: Case Reviews Source Type: research

Budd-Chiari Syndrome: What Pathologists Need to Know About Hepatic Venous Outflow Obstruction
Hepatic venous outflow obstruction, known as Budd-Chiari syndrome, is a rare but significant cause of hepatic dysfunction. Worldwide, the most common cause of hepatic venous outflow obstruction is thrombosis of the hepatic veins and/or inferior vena cava secondary to an inherited or acquired hypercoagulable state (eg, factor V Leiden deficiency). Depending on the extent and acuity of the thrombosis, patients with Budd-Chiari syndrome may present in acute liver failure or as chronic compensated cirrhosis; almost all will have the classic (but nonspecific) pairing of abdominal pain and ascites. Histologic findings in the liv...
Source: Pathology Case Reviews - August 29, 2018 Category: Pathology Tags: Case Reviews Source Type: research

Liver Transplant in a 71-Year-Old Man With a Diagnosis of Nonalcoholic Steatohepatitis
We report a case of a 71-year-old man who underwent liver transplantation for nonalcoholic steatohepatitis. The explanted liver showed evidence of coexisting α1-antitrypsin deficiency disorder. The clinicopathologic features and epidemiology of fatty liver disease and α1-antitrypsin deficiency disorder are discussed, along with other possible coexisting disease. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 29, 2018 Category: Pathology Tags: Case Reviews Source Type: research

A 64-Year-Old Woman With Posttransplant Hepatitis
We report a case of a 64-year-old woman who underwent liver transplantation for chronic hepatitis C infection with cirrhosis. Several months after transplantation, she underwent a liver biopsy as part of a workup for abnormal serologic studies and transaminase elevation. The biopsy showed nonspecific hepatitis. Eventually, additional serologic testing demonstrated hepatitis E viral infection. Causes of hepatitis and other forms of posttransplant liver disease, including hepatitis E, are discussed. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - August 29, 2018 Category: Pathology Tags: Case Reviews Source Type: research

Hyperbilirubinemia in a Hepatitis C Virus Patient After Liver Transplantation
Fibrosing cholestatic hepatitis C virus is a rare, cholestatic hepatitis that can occur in the setting of immunosuppression or after transplantation in individuals with active hepatitis C infection. Its onset is heralded by hyperbilirubinemia and rapidly progresses to graft failure without treatment. It is characterized histologically by ballooning hepatocyte degeneration, bile duct proliferation, cholestasis, and perisinusoidal fibrosis. It is important to distinguish fibrosing cholestatic hepatitis from other common causes of hyperbilirubinemia in the posttransplant setting, including biliary obstruction and acute cellul...
Source: Pathology Case Reviews - August 29, 2018 Category: Pathology Tags: Case Reviews Source Type: research