Abundant Eosinophilic Cytoplasm Research Articles

Squamous Cell Carcinoma Arising in Lesions of Discoid Lupus Erythematosus in a Patient with Overlap Syndrome: A Chronic Rare Complication.

Squamous Cell Carcinoma Arising in Lesions of Discoid Lupus Erythematosus in a Patient with Overlap Syndrome: A Chronic Rare Complication.

Epithelioid trophoblastic tumor: A case series.

An epithelioid trophoblastic tumor (ETT) is an extremely rare gestational trophoblastic tumor. Cases of ETT present with abnormal vaginal bleeding in women of reproductive age group with marginally elevated beta human chorionic gonadotrophin (B-hCG) levels. Here, we describe a series of four patients (all were females) including histomorphology, immunoprofiles, and diagnostic difficulty of this rare entity. All cases were in their reproductive age group. The mean pre-treatment hCG level was 665.24 (mIU/mL). Microscopically, all cases had a tumor showing an epithelioid appearance arranged in large nests and sheets. Individual tumor cells were round to polygonal with abundant eosinophilic cytoplasm, with central vesicular nuclei and prominent nucleoli. Areas of hemorrhage, necrosis, and intercellular hyaline-like material deposition were identified in all cases (100%). Immunohistochemically, tumor cells in all cases showed diffuse positivity for AE1/AE3 and p63 (100%). GATA3 was available in one case (25%), which was positive in the tumor cells. In one case (25%), hPL was focally positive, and in one case (25%), it was negative. SALL4 was performed in two cases (50%) and was negative in tumor cells. The mean Ki67 labeling index was 19.2 (range 10-30%). All four patients underwent surgical intervention and were treated with hysterectomy. The mean follow-up in this series was 39.4 months (range 6-70), and all patients are alive to date with a mean survival of 32.8 months (range, 4-67).

The Compact Bleb-Eosinophilic Solid and Cystic Renal Cell Carcinoma

The contemporary, indolent, Eosinophilic solid and cystic renal cell carcinoma configures as a predominantly solitary neoplasm delineating solid and cystic pattern of tumour evolution. Neoplastic cells are incorporated with abundant Eosinophilic cytoplasm and intracytoplasmic inclusions or basophilic stippling. Tumour cells display frequent somatic loss of function genetic mutations confined to TSC1 (9q34.13) gene or TSC2 (16p13) gene. Eosinophilic tumour cell clusters appear admixed with macroscopic cysts or microscopic tubules and cystic structures coated with singular layer of hobnail cells. Neoplastic cells are permeated with abundant, granular, eosinophilic cytoplasm. Tumour cells appear immune reactive to PAX8, CK20, AMACR, CD10, SDHB, fumarate hydratase, vimentin, cathepsin K and Melan A.

Festered and Fenced-Lymphoepithelial Carcinoma Lung

Lymphoepithelial carcinoma is an exceptionally discerned, primary pulmonary carcinoma with a distinct syncytial pattern of tumour evolution. Lymphoepithelial carcinoma incriminates centric or peripheral pulmonary parenchyma with equivalent predilection. Median age of disease emergence is 51 years to 57 years. Lymphoepithelial carcinoma lung occurs due to Epstein Barr virus (EBV) infection and malignant metamorphosis triggered by dysregulation of NFkB pathway, loss of type I interferon (IFN) genes and concordant signatures by APOBEC family of genes. Tumefaction is composed of enlarged, polygonal cells pervaded with abundant or variable eosinophilic cytoplasm, vesicular nuclei and prominent, eosinophilic nucleoli. Tumour cells are circumscribed by quantifiably variable lymphoid and plasma cell infiltrate. Tumour cells appear immune reactive to squamous epithelial cell biomarkers as CK5/6, p40 or p63 whereas in situ hybridization (ISH) for discerning Epstein Barr encoded small RNAs (EBER) appears optimal. Lymphoepithelial carcinoma lung requires segregation from neoplasms such as poorly differentiated adenocarcinoma, NUT pulmonary carcinoma, malignant melanoma, lymphoma confined to pulmonary parenchyma, metastatic undifferentiated carcinoma of nasopharynx or metastatic medullary carcinoma arising from breast of colon. Stage I and stage II neoplasms are subjected to comprehensive surgical extermination whereas stage II, stage III or advanced grade neoplasms may be managed with surgical eradication in combination with adjuvant radiotherapy or chemotherapy.

An Intriguing Case of Chronic Peristomal Ulcer.

An Intriguing Case of Chronic Peristomal Ulcer.

A pediatric case of anaplastic pleomorphic xanthoastrocytoma (Grade 3)

Pleomorphic xanthoastrocytoma (PXA) is a glial tumor which accounts for less than 1% of astrocytomas. PXA most commonly occurs in the temporal lobe in the outer cortex of brain and usually seen in young adults and children. As per 2020 WHO classification of CNS tumors, PXA with a mitotic activity ≥5 mitoses/10 HPF is defined as anaplastic pleomorphic xanthoastrocytoma (APXA), WHO grade 3. Here we present a rare case of Anaplastic Pleomorphic Xanthoastrocytoma developing in a female child of 11 years of age.A 11 years old female child presented with symptoms of continuous headache, giddiness, fever and vomiting since last 15 days. Computed Tomography of her brain revealed a soft tissue density mass lesion in right temporal lobe involving the insular cortex and capsuloganglionic region. The radiological differential diagnosis was a neoplastic lesion, most likely glioma. The patient underwent surgery for removal of temporal lobe tumor and the resected tumor bits were sent for histopathological assessment. Microscopically, many multinucleated lipidized giant cells were seen having eccentrically pushed nuclei, conspicuous nucleoli and abundant eosinophilic granular cytoplasm. A second population of few spindled cells with less amount of cytoplasm was also noted in the intervening parenchyma. Immunohistochemical workup showed the tumor to be positive for GFAP, S-100, Synaptophysin, p53 and CD-68. The tumor was negative for CD34. Ki-67 index was 15-20%. A final diagnosis of Anaplastic Pleomorphic Xanthoastrocytoma (grade 3) was made.APXA is a rare astrocytic tumor and has relatively more aggressive radiological and histomorphological features than pleomorphic xanthoastrocytomas and therefore it needs to be identified and treated separately.

Clinicopathological features of verrucous type dysplasia of esophagus

Objective: To investigate the clinicopathological features of verrucous type (squamous) dysplasia of esophagus. Methods: The clinicopathological data of 18 verrucous type dysplasia of esophagus patients in the 989th Hospital of the Joint Logistics Support Force of the People's Liberation Army (formerly 152 Central Hospital) and Beijing Chaoyang Hospital Affiliated to Capital Medical University from 2009 to 2021 were retrospectively collected. The histomorphologic characteristics and immunophenotype were observed, and human papillomavirus (HPV) genotyping was detected by PCR-fluorescence probe. The relevant literature was reviewed. Results: The median age of the 18 patients was 68 years (range 53-76 years); there were 13 males and 5 females. There were four cases in the upper esophagus, seven in the middle esophagus and seven in the lower esophagus. The median diameter of the lesion was 18 mm (range 6-54 mm). According to the Paris Classification, 11 cases were 0-Ⅱa, one case was 0-Ⅱa+Ⅰ, five cases were 0-Ⅱb, and one case was 0-Ⅱb+Ⅰ. White light endoscopy showed that the surface of the lesion was white plaque, red areas between the plaques, and papillary surface structure could be seen. In narrow-band imaging, some mucosal areas of lesions were opaque or patchy and light brown, and papillary microsurface structures were different in shapes and sizes. Intraepithelial microvessels were elongated, dilated, twisted and varied in diameter. Lugol iodine stain showed nil to faint staining. Histologically, the atypia cells were large with rounded to irregular nuclei, coarse chromatin, mitotic figures, and abundant eosinophilic cytoplasm. The basal cells showed increased atypia, crowding, increased nuclear-cytoplasmic ratio, and active mitosis. The cells were arranged haphazardly. Single cell keratinization, binuclear cells, and hollow-out-like cells, as well as surface epithelial keratinization and parakeratosis were observed in three cases. There were obvious verrucous or papillary structures in the epithelial layer. Five patients had local verrucous carcinoma. Immunohistochemical staining showed that the mutant expression of p53 protein in 6/10 cases; p16 was positive in 5/10 cases; abnormal Ki-67 distribution pattern in 10/10 cases. HPV was negative in all 10 cases tested. The original pathologic diagnosis of preoperative biopsy was high-grade dysplasia in 8 cases, low-grade dysplasia in 6 cases and atypical squamous epithelial cells in 4 cases. Conclusions: Esophageal verrucous dysplasia tumor cells are well differentiated with obvious verrucous or papillary structures. The unique morphological features suggest that it represents a histological subtype of esophageal squamous high-grade dysplasia and it is a precursor of verrucous carcinoma. Its preoperative biopsy diagnosis is challenging.

Bronchial salivary gland-type intraductal carcinoma with KIAA1217::RET gene fusion composed of intercalated and oncocytic components.

Salivary gland-type intraductal carcinoma (IC) is a rare malignant salivary gland neoplasm. Primary salivary gland-type IC has never been described in the lung. Herein, we present a primary pulmonary IC in a 63-year-old woman. The tumor originated in the bronchus wall of the right middle lobe. The tumor consisted of two histological types, intercalated component and oncocytic component. The intercalated component showed tubular/cystic pattern composed of column to cube-shaped cells and scattered mucous cells. The oncocytic component showed solid nests composed of large cells with abundant eosinophilic granular cytoplasm. Immunohistochemically, both histological components were positive for cytokeratin 7 (CK7), S-100 protein, SOX10, and mammaglobin. The rimming myoepithelial cells were highlighted by p63 and smooth muscle actin (SMA). The tumor cells were negative for androgen receptor (AR), HER-2, Dog-1, TTF-1, napsin A, GCDFP-15, and GATA3. In the present case, we detected KIAA1217::RET fusion via DNA-based next-generation sequencing (NGS) and RT-PCR, which established the diagnosis of IC at a molecular level. The present case expands the categories of bronchopulmonary salivary gland-type tumors.

Uterine Leiomyoma with Bizarre Nuclear Morphology: Report of a Rare Case

Abstract Introduction/Objective Sporadic fumarate hydratase (FH)-deficient leiomyoma occurs as a result of somatic inactivation of the FH gene and has been found to represent 1% of uterine leiomyomas. Germline inactivation of the FH gene is associated with a rare autosomal dominant syndrome known as hereditary leiomyomatosis and renal cell carcinoma (HLRCC). Women with HLRCC develop cutaneous and uterine leiomyomas and an aggressive renal cell carcinoma, with 57% reported to undergo hysterectomy at 30 years of age or younger. All FH-deficient leiomyomas display a distinct histology characterized by scattered bizarre nuclei, eosinophilic cytoplasmic inclusions, conspicuous eosinophilic nucleoli, and perinuclear clearing. Immunohistochemically, the neoplastic cells do not express FH while they are positive for S-(2-succino)-cysteine (2SC), a metabolite that accumulates when FH is inactivated. Methods/Case Report We present a 48-year-old woman who underwent supracervical hysterectomy for a symptomatic uterine leiomyoma. She was status post left salpingo-oophorectomy for left adnexal endometriosis. Grossly, the hysterectomy specimen was significant for one 8.0 cm intramural uterine corpus tumor with a tan-white whorled cut surface. Histology showed a smooth muscle neoplasm in the myometrium composed of spindled cells with abundant eosinophilic cytoplasm, occasional enlarged prominent nucleoli with perinuclear halos, intracytoplasmic eosinophilic globules, focal bizarre nuclear atypia and thin-walled staghorn vessels with widespread hyaline necrosis with no mitotic activity. Immunohistochemical studies demonstrated that the neoplastic cells expressed desmin, SMA, SMMH, and 2SC and were negative for FH; consistent with a FH-deficient leiomyoma. Results (if a Case Study enter NA) NA Conclusion Although rarely seen, pathologists should be cognizant of FH-deficient neoplasms. Genetic counseling and close follow up of the individuals harboring germline inactivating mutations of the FH gene could lead to early detection of the RCC in these patients and their family members.

Undifferentiated Melanoma: A Rare Phenomenon and a Challenging Diagnosis

Abstract Introduction/Objective Undifferentiated melanoma is defined as a primary or metastatic melanoma lacking histologic and immunophenotypic features of melanoma. Dedifferentiated melanoma shows transition between undifferentiated and conventional melanoma components. Dedifferentiation and transdifferentiation (implying dedifferentiation with heterologous elements) in melanoma are exceedingly rare and occur mostly in metastatic deposits. The purpose of this report is to describe a case of undifferentiated melanoma that proved to be a diagnostic challenge and to highlight the importance of the multimodality approach and utilization of advanced diagnostic tools in reaching an accurate diagnosis. Methods/Case Report Methods: A 43-year-old white male who was diagnosed with metastatic melanoma on the right axillary biopsy at a local hospital presented to our institution with a rapidly enlarging 30 cm peritoneal mass. He underwent debulking surgery to lower his tumor burden. On pathologic evaluation, the tumor showed a heterogeneous appearance ranging from highly cellular fascicles of spindle cells to sheets of primitive round cells and epithelioid cells with abundant eosinophilic cytoplasm. One metastatic focus showed heterologous cartilaginous differentiation. This morphologic appearance elicited the differential diagnosis of metastatic melanoma, primitive neuroectodermal tumor, synovial sarcoma, and metastatic germ cell tumor with somatic transformation. Immunochemical staining showed the tumor cells to be positive for SALL4, CD99 (patchy), and TLE1 (patchy) and negative for pan-cytokeratin, S100, SOX- 10, HMB-45, desmin, myogenin, DOG1, CD 117, CDX2, TTF-1, PAX-8, CK7, CK20, chromogranin, CD30, and OCT4. Fluorescence in situ hybridization for EWSR1, SS18(SYT), and isochromosome 12p were negative. BRAF gene mutation analysis detected p.V600E / p.V600D. Subsequently, a diagnosis of undifferentiated melanoma was rendered after expert consultation. Unfortunately, the patient passed away 1 month after surgery. Results (if a Case Study enter NA) NA. Conclusion Diagnosis of undifferentiated melanoma by the conventional H&E and immunohistochemical profile is extremely challenging. Multimodality approach and utilization of advanced diagnostic tools such as molecular studies are helpful in this regard.

Papillary Renal Cell Carcinoma with Massive Hemorrhage: An Autopsy Case Report

Abstract Introduction/Objective Spontaneous renal hemorrhage is a rare complication of various kidney pathologies. It can be due to renal artery aneurysms, arteriovenous malformations, cystic renal diseases, renal calculus, coagulation disorders, as well as neoplastic lesions like angiomyolipoma and renal cell carcinoma (RCC). Individuals present with sudden flank or scapular pain, hypovolemic shock, termed as Wunderlich syndrome (WS). 30-35% cases of WS are from spontaneously ruptured RCC, commonly clear cell variant (70%) followed by papillary (10-15%) and chromophobe variant (4-6%). We present an autopsy case of a papillary variant RCC identified as a small kidney mass with a pathogenetic correlation behind the intractable bleeding. Methods/Case Report An 81-year-old Caucasian man with a history of atrial fibrillation, on long-term Xarelto treatment, was found to have a 1.2 cm incidental mass in the right kidney. He started experiencing right-sided scapular pain, then rapidly became hypotensive, drowsy. CT scan revealed a large right-sided perinephric and retroperitoneal hematoma (17.5 x 5.7 x 8.9 cm) extending in the pelvis. Despite receiving blood products, other supportive treatment, and successful angio-embolization, his condition worsened to acute kidney injury, bowel ischemia, and persistent lactic acidosis leading to death. On autopsy, bloody ascites, clots on mesenteric root insertion, and bulging in retroperitoneal spaces were seen. The perinephric spaces had organized clots. The bleeding originated from a 2.0 x 2.0 cm brown mass in the middle pole of the right kidney. There was a slit-like vessel at the interface of the kidney and the mass. Microscopic examination of the mass shows trabecula of abnormal cells with abundant eosinophilic cytoplasm in the hemorrhagic and necrotic background. These cells are positive for PAX8, CK7, CD10, dim positive for CAIX, and negative for CD117, which is consistent with renal cell carcinoma, papillary variant. Results (if a Case Study enter NA) NA. Conclusion Papillary RCC is much less vascular and less aggressive than clear cell RCC. However, necrosis or bleeding into renal vessels may occur. In this case, blood-leaks and accumulation in enclosed space followed by necrosis, fibrosis, and hyalinization cause neovascularization forming a negative spiral for re-bleeding. Anticoagulants can lead to profuse sustained bleeding from even very small size RCC.

S-100 Negative Granular Cell Tumor of Oral Cavity with Aggressive Clinical Behavior

Abstract Introduction/Objective Granular cell tumors (GCTs) are neoplasms with neuroectodermal (Schwann cell) differentiation that is typically benign and cured by surgical excision. These tumors characteristically display strong expression of S-100 protein. Similar tumors without expression of S-100 protein are called “S-100 negative granular cell tumors.” The few reported cases of S-100 negative GCT in the oral cavity describe indolent clinical behavior. We report a case of a 49-year-old male with recurrent S-100 negative GCT in the oral cavity. Methods/Case Report The patient presented initially with a mass in the hard palate, which was resected and diagnosed as an S-100 negative GCT. One year later, the patient developed severe epistaxis and anemia (hemoglobin 7.2 g/dL). A large tumor of the hard palate was the source of bleeding. It was resected and diagnosed as recurrent S-100 negative GCT. Histologically, this tumor consists of small nests of epithelioid to spindled cells with moderately abundant granular eosinophilic cytoplasm, round central nuclei with vesicular chromatin and distinct eosinophilic nucleoli, and significant mitotic activity. The cells are immunoreactive for SOX10 and negative for S-100, melan-A, keratin AE1/AE3, p40, synaptophysin, smooth muscle actin, desmin, and myogenin. Results (if a Case Study enter NA) N/A Conclusion S-100 negative GCTs are rare, and only a few case reports describe their involvement in the oral cavity. We report this case because of its rarity and aggressive clinical behavior. Recognition of this entity and its potential for locally aggressive growth is important. Management of this tumor by complete excision seems advisable.

FNA as a Powerful Modality to Detect Granular Cell Tumor in Male Breast: A Report and Review of Literature

Abstract Introduction/Objective Granular cell tumor (GCT) is a benign mesenchymal tumor of Schwannian origin. Granular cell tumor is an uncommon tumor of the breast with a prevalence of 1:1000 to 6.7:1000 of all breast tumors. Most cases are diagnosed on surgical resection. When reported that are most commonly in middle-aged premenopausal women. Diagnosis of GCT on fine needle aspiration (FNA) in male patients is, however, extremely rare. We present here an unusual case of GCT of the breast in a male patient clinically mimicking malignancy. Methods/Case Report A 34-year-old male patient presented with a palpable lump in the left breast. An imaging study showed a 0.6 cm hypoechoic mass with microlobulated borders and no internal vascularity suspicious for breast carcinoma (BIRAD-4). Fine needle aspiration (FNA) of the mass was performed. Rapid onsite specimen evaluation was performed and additional passes were performed to collect sample for cell block to perform ancillary studies. FNA revealed clusters of polygonal cells with abundant eosinophilic granular cytoplasm and poorly defined borders. Those cells had round to ovoid nuclei with vesicular chromatin pattern and prominent nucleoli. A differential diagnosis of GCT, apocrine metaplasia, and lesions rich in histiocytes such as granulomatous inflammation, fat necrosis and duct ectasia were considered. Immunohistochemical staining with S100 and CD68 was performed which stained granular cytoplasm in tumor cells of GCT. A review of literature from the past 5 years shows 23 cases of GCT of the breast are reported in the literature and of these only 3 (13%) are reported in males. These tumors ranged from 20-68 years with tumor size ranging from 5- 28 mm. Only 1(4%) cases were preoperatively diagnosed using FNA. No cases of GCT were preoperatively diagnosed on FNA samples from the breast. Results (if a Case Study enter NA) N/A. Conclusion We show here that a powerful relatively noninvasive and rapid modality like FNA can be effectively utilized to detect very rare benign tumor like GCT in the male breast where imaging studies suspect breast cancer.

Multiple painful skin papules, uterine leiomyomas and hysterectomy.

A 38-year-old woman presented with multiple papules and nodules. Her mother and maternal grandmother had similar lesions, and all three women had undergone hysterectomy at a young age. Histopathogical analysis revealed dense dermal nodules composed of eosinophilic spindle cells, and exposed elongated cells with abundant eosinophilic cytoplasm arranged in fascicles.

Epithelioid and Clear Cell Solitary Fibrous Tumors: Clinicopathologic, Immunohistochemical, and Molecular Genetic Study of 13 Cases.

Solitary fibrous tumors (SFTs) are ubiquitous soft tissue neoplasms known for their protean histology and potentially aggressive behavior. Although most cases are composed of a monotonous proliferation of spindle cells, some tumors show unusual cytologic features. We have studied 13 SFTs that were characterized by a predominant population of round epithelioid cells with abundant eosinophilic cytoplasm and clear cell changes. The tumors occurred in 8 women and 5 men, aged 36 to 80 years (mean=63y), and were located within the orbit (3), lower extremity (3), retroperitoneum (2), abdominal cavity (2), and superficial soft tissues of the neck, pelvis, and pubis (1 each). The tumors measured from 3.5 to 24.5cm. Using a risk assessment system, 6 cases were stratified as low-risk tumors; 3 of these showed no evidence of recurrence or metastases from 6 to 18 years, and 1 tumor in the orbit recurred and led to the patient's demise. Five cases were of intermediate risk; clinical follow-up showed no evidence of recurrence or metastases from 3 to 4 years in 3 patients, and 1 patient suffered a recurrence 4 years after diagnosis. Two cases were high risk; 1 patient died after 1 year and the second patient experienced local recurrence at 4 years. Immunohistochemical studies showed nuclear positivity for STAT6 in 10 cases. CD34 immunohistochemistry was positive in 11 cases. A NAB2::STAT6 rearrangement was present in all cases. Epithelioid and clear cell SFT should be considered in the differential diagnosis of soft tissue neoplasms with epithelioid and clear cell morphology.

S2505 Holy Cow! When Cecal “Polypectomy” Specimen Shows Cow’s Liver

Introduction: Patients with history of colon tubular adenomas need surveillance colonoscopies to decrease the risk of colon neoplasia. Sometimes, contamination of polypectomy specimen with ingested food can create confusion while interpreting the results. We present an interesting case of a cecal "polypectomy" specimen that showed liver tissue, that on further investigation was attributed to a cow's liver that the patient ingested the day before his procedure. Case Description/Methods: A 72-year-old White male with past medical history of colon tubular adenomas, chronic constipation, hypertension, obstructive sleep apnea and class III obesity was referred for surveillance colonoscopy. His constipation was well-controlled with linaclotide 72 mcg daily. He did not report any hematochezia or weight loss. His physical examination including vital signs and abdominal examination was unremarkable. Colonoscopy was performed after a 4-liter polyethylene glycol bowel preparation which revealed 3 polyps. These included a 5 mm Paris 0-1s polyp which was removed via cold snare polypectomy (Figure A), and 2 2 mm sessile polyps in the ascending and descending colon (removed via biopsy forceps). The ascending and descending colon polyps were tubular adenomas on histological examination. We were notified by the reading pathologist that the cecal "polyp" showed liver tissue (Figure B, C) with the concern for iatrogenic perforation of the colon during colonoscopy and accidental biopsy of patient's liver. The patient denied any symptoms suggestive of colonic perforation. Upon further discussion, he informed us that he ate fried cow's liver the day before the procedure which was inadvertently suctioned in the trap after cold snare polypectomy of his cecal polyp. Discussion: Identification of liver tissue in colonoscopy polypectomy specimens should raise possibility of catastrophic complication such as a perforation or simply a possibility of contamination of specimen with ingested food. Following-up with the patient to clarify the situation is important. A careful review of patient’s dietary intake before the colonoscopy procedure can help correctly interpret the unexpected pathology results.Figure 1.: 1A: Paris 0-1s 5 mm cecal polyp during surveillance colonoscopy. Figure 1B: At low power the section shows an eosinophilic homogenous tissue without surface epithelium. Figure 1C: At higher power: sheets of polygonal cells with round, centrally located nuclei, and abundant eosinophilic cytoplasm compatible with hepatocytes. The hepatocytes arranged in plates extend from central vein to portal triad.

Eosinophilic solid and cystic renal cell carcinoma: a single Indian tertiary center experience of three cases of a newly described entity

BackgroundAmong adult malignant tumors, renal cell carcinoma accounts for 2–3% and has the worst prognosis among common urologic tumors. Recently, an eosinophilic, solid and cystic (ESC) renal cell carcinoma (RCC) histological subtype has been described and proposed as an entity separate than the 16 subtypes described in the 2016 WHO classification. The aim of the present study is to share our experience of three such cases of this newly described entity.MethodsWe retrospectively reviewed our cases of renal cell carcinoma and describe the presentation, diagnosis and management with follow-up details of ESC RCC.ResultsOur three patients presented at an advanced stage with flank pain or mass, and one patient had metastasis. All patients underwent radical nephrectomy, diagnosis proved by histopathological examination with immunohistochemistry (IHC), with abundant eosinophilic cytoplasm in all three cases. On IHC, CK 20 was positive in two cases and one patient with CK 20, CK 7 negative and PAX 8 positive.ConclusionsESC RCC is a newly described entity, with increasing incidence probably due to better diagnosis. Previously, 66 such cases are described, with female predominance, lower stage and indolent behavior. Only four cases with metastasis are described.

Rhabdoid tumor of cheek in an adult patient: A rare case report

Rhabdoid tumor is relatively rare highly malignant tumor in adult older than 40 years, therefore treatment regimens often throwing from pediatric age group. It is characterized by extremely aggressive behavior, rapid metastasis to other organ, low survival rate and no targeted therapy. So, early diagnosis is necessary for better treatment and reduce mortality outcome. A 42 years male suffering from a right side cheek mass of 5x3cm associated with tongue displacement to left side and difficulty in swallowing. After complete removal of lesion for histopathological examination, revealed grossly the tumor is well defined gray-white, round, lobulated 5x3cm in size having infiltrating borders. Cut surface shows gray-white to gray-brown, solid areas. Microscopically H&E stained section revealed, sheets of tightly packed large, discohesive, polygonal cells having abundant eosinophilic cytoplasm with eccentrically placed round nuclei showing distinct prominent vesicular nucleoli separated by thin fibrous septae with blood vessels. These cells lie in myxoid background. These tumor cells have deeply acidophilic having finely granular abundant cytoplasm with small, peripherally placed nuclei and abundant intra-cytoplasmic vacuoles along with nuclear pleomorphic, no mitotic figure seen. Histologically, the adult type tumor proliferating as sheet of tightly packed large, discohesive, polygonal cells having abundant eosinophilic cytoplasm with eccentrically placed round nuclei showing distinct prominent vesicular nucleoli separated by thin fibrous septae with blood vessels lie in fibromyxoid background. These tumor cells have deeply acidophilic, finely granular cytoplasm with small, peripherally placed nuclei with occasional intra-cytoplasmic vacuoles along with cross striations, no mitotic figures seen. Study concludes that adult type Rhabdoid tumors have extremely aggressive behavior, rapid metastasis spread to other organs, low survival rate and no targeted therapy. Usually males older than 40years of age are affected. It is crucial to make a rapid correct diagnosis and early treatment may improve the outcome.

PLASMACYTOMA AND MULTIPLE MYELOMA OF THE ORAL CAVITY: A CASE SERIES

Plasma cell neoplasms represent the proliferation of single clone of plasma cells with production of monoclonal immunoglobulins. This study aims to report a case series of plasmacytoma (PMC) and multiple myeloma (MM) of the oral cavity. Data were retrospectively retrieved and clinical, radiographic, microscopic, immunohistochemistry, and follow-up status were collected. Eight cases were included (3 PMC and 5 MM) with a mean age of 53.6 years old (range, 27-78) and a male predilection. Lesions mostly presented as painful swellings in the mandible. Radiographic aspects evidenced multilocular poorly defined lesions and microscopic examinations showed proliferation of plasma cells with abundant eosinophilic cytoplasm. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, with kappa light chain monoclonality predominance. Overall survival was poor, and 6 patients died, with a mean follow-up time of 5.7 months (range, 1-22). PMC and MM are aggressive neoplasms with a poor prognosis.

Embryonal Rhabdomyosarcoma of the Uterine Cervix: A Clinicopathologic Study of 94 Cases Emphasizing Issues in Differential Diagnosis Staging, and Prognostic Factors.

Embryonal rhabdomyosarcoma of the uterine cervix (cERMS) is rare and frequently associated with DICER1 mutations. We report 94 tumors that arose in patients aged 7 to 59 (median=23) years and presented with vaginal bleeding (52), protruding vaginal mass (17), cervical polyp (8), or expelled tumor fragments per vagina (5). Nine had DICER1 syndrome, 8 of whom had other syndromic manifestations including ovarian Sertoli-Leydig cell tumor (7), multinodular goiter (3), pleuropulmonary blastoma (2), pineoblastoma (1), and osteosarcoma (1). Syndromic patients were younger than nonsyndromic patients (16 vs. 24y). Tumor size ranged from 2 to 24 (median=4.5)cm. Ninety-two tumors were polypoid, most being grape-like (77 of 92). They were characterized by aggregates of primitive cells, almost always exhibiting a cambium layer, within a variably myxoedematous stroma and were hypocellular (63), moderately cellular (22), or hypercellular (9). Entrapped glands, typically scant, were present in 84 tumors. Primitive hyperchromatic ovoid to spindled cells with minimal cytoplasm predominated but differentiated rhabdomyoblasts with abundant eosinophilic cytoplasm (having cross-striations in 30) were seen in 83 tumors; they were often sparse but predominated in three. Nine tumors showed areas of intersecting fascicles and 4 zones with densely cellular (solid) growth. Cartilage was present in 38. Anaplasia was seen in 15 tumors, as was necrosis. Mitotic activity ranged from 1 to 58/10 high-power fields (median=8). The varied microscopic features resulted in a spectrum of differential diagnostic considerations, mainly typical and cellular forms of fibroepithelial polyps, Mullerian adenosarcoma, and other sarcomas. Follow-up was available for 79 patients ranging from 6 to 492 (median=90) months. Treatment information was available in 62 and included polypectomy in 6 patients (2 also received chemotherapy), limited resection in 26 (14 also received chemotherapy), hysterectomy in 29 (15 with adjuvant chemotherapy), and biopsies only in 1 (with chemotherapy). Staging was possible in 56 tumors; according to the "uterine sarcoma" system (tumor size and extent) they were: stage I (10/56; could not be further subclassified as size not available), IA (22/56), IB (18/56), IIA (2/56), IIB 3/56), IIIC (1/56). According to the "adenosarcoma" system (depth of invasion and extent) they were: stage IA (26/56), IB (14/56), IC (10/56), IIA (2/56), IIB (3/56), IIIC (1/56). Eight patients had local recurrence following incomplete excision (10%). Eleven of 79 patients had extrauterine recurrences (14%) and 9 died of disease (11%). Older age was associated with extrauterine recurrence (median 44 vs. 22; P =0.002) and decreased disease-specific survival (median 44 vs. 22; P =0.02). For patients with tumors initially confined to the cervix, the adenosarcoma staging system was superior to the uterine sarcoma staging system for predicting survival ( P =0.02). Three patients with DICER1 syndrome who underwent fertility-preserving surgery developed a second primary cERMS 7, 7, and 12 years after their primary tumor. All 9 patients with DICER1 syndrome had tumors confined to the cervix and none died of disease. This study highlights the intriguing clinical aspects of cERMS including its long-known tendency to occur in the young but also more recently appreciated association with DICER1 syndrome. Establishing the diagnosis may still be difficult because of the hazard of sampling a neoplasm which in areas may appear remarkably bland and also because of its potential confusion with other neoplasms. This study indicates that this tumor has a good prognosis at this site and in selected cases a conservative surgical approach is a realistic consideration.