Abundant Eosinophilic Granular Cytoplasm Research Articles

A 50-Year-Old Man with an Uncommon Polyp

Purpose: A 50-year-old asymptomatic man came for repeat colonoscopy. One year before, he underwent a screening colonoscopy during which a diminutive polyp was found in the cecum. The polyp was removed with moderate difficulty. The biopsy showed a mucosal fragment with focal erosion. His gastroenterologist recommended repeat colonoscopy in 1 year. During repeat endoscopy, a 4 mm yellowish sessile hard polyp was found in the cecum. The Jumbo forceps could not excise the polyp, so polypectomy with a hot snare was performed successfully. There were no complications. Histological examination revealed a completely excised granular cell tumor. Methods: Granular cell tumor (GCT) is a relatively rare soft tissue neoplastic tumor of neural derivation, which commonly occurs in the oral cavity and subcutaneous tissue and is uncommon in the colon and rectum. The GI tract harbors approximately 5% of all GCTs. The most common site for GCT in the GI tract is the esophagus, followed by the duodenum, anus and stomach. Lesions can be incidental findings, or they may give rise to obstructive or pressure symptoms when large enough and in a critical location. Malignancy is rare and has been found to correlate with tumor size (more than 60% of metastatic GCTs were larger than 4 cm). Since colonic GCTs are usually benign, endoscopic removal is the most appropriate therapy. Results: Diagnosis is based on histopathological findings: (1) small, uniform nuclei without mitotic figures; (2) histiocyte-like bland-looking neoplastic cells with abundant granular eosinophilic cytoplasm containing acidophilic, PAS-positive, diastase-resistant granules; (3) stain positively for S-100 protein, neuron-specific enolase, and NK1-C3 in almost all cases. The tumor cells are non-immunoreactive for epithelial, muscle, endothelial and glial cell markers. This is useful for differentiating a granular cell tumor from other diagnostic possibilities. The found lesion had the typical characteristics of GCT. Since the patient was asymptomatic we did not pursue further work-up. He will have a repeat colonoscopy in 1 year. Conclusion: In conclusion, GCTs of the colon can be found incidentally during colonoscopy and endoscopic removal of the tumor is a safe and feasible treatment. Endoscopists should consider GCTs in the differential diagnosis of submucosal tumors of the colon.

Multiple Granular Cell Tumors of Ascending Colon

Purpose: Granular cell tumor (GCT), also known as Granular cell Schwannoma or Abrikossoff tumor, is rare in the colon. It is commonly seen in the subcutaneous tissue and other soft tissue in the body. In the GI tract, it usually presents in the oral cavity or esophagus. Most GCTs are small submucosal benign tumors with maximal reported size of 1.5 cm in colon; however, a malignant counterpart has been reported. It is almost impossible to differentiate it from other benign or malignant epithelial cell tumors and other submucosal tumors by endoscopy. Here we report the first case of an aggregate of multiple GCTs with the largest tumor more than 1.5 cm in the ascending colon. A 39-year-old male patient underwent a screening colonoscopy. Two other polyps detected and removed from cecum and sigmoid had normal histology. Several large flat lesions in ascending colon with largest one of 1.5 × 2.0 cm were biopsied (Fig. 1). Pathological examination reported a benign submucosal granular cell tumor (Fig. 2). The tumor consisted of nests of neoplastic cells with abundant granular eosinophilic cytoplasm and strong expression of S-100 protein (Fig. 3). Since there were multiple GCTs in aggregates with benign histology, endoscopic removal did not appear feasible. It was elected to observe the patient with repeat colonoscopy in 2–3 years. GCT should be in the differential diagnosis of colonic tumors.Figure

Granulomatous Pneumonia, Lymphadenopathy, and Hepatopathy in an Adult Horse with Repeated Injection of BCG

R. van den Boom, E.J.B. Veldhuis Kroeze, W.R. Klein, D.J. Houwers, A.G.M. van der Zanden, and M.M. Sloet van Oldruitenborgh-Oosterbaan

Cytologic and immunohistochemical characterization of a lung carcinoid in a dog

An 11-year-old neutered male Yorkshire Terrier was presented to the Haemaru Referral Animal Hospital with a history of unresponsive tracheal collapse and an incidental finding of a lung nodule in the left caudal lung lobe on radiography. Thorough physical examination and imaging studies revealed no other masses. Cytologic examination of C-arm mobile fluoroscopy-guided fine-needle aspirates revealed numerous free nuclei and a low number of small round cells with moderate to abundant pale basophilic cytoplasm. Some cells contained indistinct basophilic granules in their cytoplasm, and extracellular pink material was noted. A caudal lung lobectomy was performed, and histologic evaluation of the mass revealed round to polygonal cells with abundant eosinophilic granular cytoplasm and round nuclei with mild anisokaryosis and 0-3 mitotic figures per high-power field. Cells were arranged in packets separated by fine fibrovascular stroma, suggestive of a pulmonary neuroendocrine neoplasm, specifically a carcinoma/carcinoid. The cells were immunoreactive for chromogranin A and neuron-specific enolase, and negative for cytokeratin, synaptophysin, calcitonin, thyroglobulin, parathyroid hormone, CD79a, light lambda, and vimentin. With these findings the tumor was diagnosed as a primary lung carcinoid. Eleven months after resection, there was no evidence of tumor regrowth or metastasis. The absence of necrosis, few mitotic figures, minimal pleomorphism, and benign behavior of this tumor resembled those of a typical carcinoid in humans.

Multiple congenital oral granular cell tumours in a newborn black female: a case report

IntroductionCongenital oral granular cell tumour of the newborn is an uncommon benign tumour of uncertain origin. The typical clinical appearance is of a single nodule occurring on the anterior maxillary ridge. In 10% of cases there are multiple lesions. The occurrence of congenital epulis in non-Caucasians is rare.Case presentationTwo firm pedunculated nodular lesions were noticed in the mouth of a 3-day-old black female: one on the anterior maxillary ridge and the other further posteriorly in the midline of the palate. Both lesions were excised when the baby was nine days old. Microscopic examination of the lesions showed densely packed round to oval cells with abundant granular eosinophilic cytoplasm and uniform nuclei. The diagnosis was congenital granular cell tumour.ConclusionCongenital oral granular cell tumour occurs almost exclusively in Caucasian newborns but also rarely in black infants. The parents should be assured of the benign nature and the simple treatment of the condition.

Cytologic findings of acquired cystic disease‐associated renal cell carcinoma: A report of two cases

Renal tumors may arise in the setting of end-stage renal cell disease. The risk is 100 times that of the normal population with an incidence ranging from 3-7%. The most common malignant tumor to arise in the setting of acquired cystic disease of the kidney is the acquired cystic disease-associated renal cell carcinoma (ACD-associated RCC). The cytomorphologic features of ACD-associated RCC, which has not been described previously, show moderately cellular specimens composed of clusters of cells with papillary configuration. The cells ranged from polygonal to columnar and contained abundant eosinophilic granular cytoplasm. The nuclei were round and centrally located, and the chromatin was finely granular with prominent central nucleoli that corresponded to Fuhrman's grade 3 nucleolar size. The main differential diagnosis is type 2 papillary renal cell carcinoma, from which it can be distinguished based on clinical findings only at this moment.

Gross Cystic Disease Fluid Protein—(GCDFP-15)

A total of 211 cases of primary lung adenocarcinoma were tested for expression of gross cystic disease fluid protein-15 (GCDFP-15) and only 11 cases (5.2%) were positive. The cases occurred with an equal sex distribution in older individuals whose carcinomas were frequently identified on screening radiographs. The adenocarcinomas were peripheral lesions and had an average size of 2.9 cm (range, 1.1 to 7.0). Histologically, they were usually mixed acinar and papillary adenocarcinomas with abundant extracellular mucin production, with the neoplastic cells having a polygonal shape, round to oval nuclei, diffuse powdery chromatin, and abundant eosinophilic granular cytoplasm. Clear cells and apocrinelike cells with prominent central nucleoli were common. GCDFP-15 was expressed in conjunction with thyroid transcription factor-1 in 81% of cases and synaptophysin was seen in 65%. Estrogen and progesterone receptors were not expressed. EGFR gene amplification and mutations of exons 19 and 21 were rare. KRAS mutations and HER2 gene amplification were not seen. This report details the first 11 cases of pulmonary adenocarcinoma to express GCDFP-15 and their distinctive morphology with frequent mucin production and coexpression of thyroid transcription factor-1 and synaptophysin.

涙嚢に発生したオンコサイトーマ例

An 82-year-old man was referred to our hospital with bloody rhinorrhea on the right side of 3 months' duration. There was no history of bloody tears, nasal pain and nasal obstruction. On physical examination, a mobile and elastic soft mass was slightly palpable in the area of the right lacrimal sac. Nasal endoscopic examination revealed a soft reddish mass located in the right inferior nasal meatus. CT scan showed an enhanced soft tissue mass filling the right nasolacrimal duct from the orbit to the nasal cavity. There was no bone destruction. MRI showed a low-intensity mass on T1-weighted images and a high-intensity mass on T2-weighted images. The tumor was enhanced by gadolinium. A biopsy was performed from the tumor in the inferior nasal meatus. On histology, the tumor consisted of large cells with abundant granular cytoplasm and an oval nucleus, which formed a solid and occasionally trabecular pattern. These findings were interpreted as suspected acinic cell carcinoma. The tumor was excised en bloc by a right medial maxillectomy with lateral rhinotomy, removing the medial wall of the maxillary sinus and the medial part of the orbit. The resectioned dark-brown tumor was 4×10×8mm and possessed a well-defined capsule. Histrologically, the tumor was composed of large cells with abundant eosinophilic granular cytoplasm and an oval nucleus, which formed a solid and occasionally trabecular pattern. Neither nuclear atypia nor mitosis was found. Immunohistochemically, tumor cells were positive for antimitochondrial antibody, cytokeratin (AE1/AE3). The Ki-67 labeling index was <1%. Taken together, the tumor was diagnosed as oncocytoma. He remained disease free at 13 months' follow-up.

Imprint Cytology of Hibernoma -A Case Report-

Hibernoma is a rare, benign adipose tumor composed of brown fat cells with eosinophilic granular or multivacuolated cytoplasm. The cytologic features of hibernoma have been rarely reported and may mimic other polygonal cell neoplasms. We report the imprint cytologic features of a case of hibernoma in the left thigh of a 68-year-old woman. Microscopic examination showed large, round, or polygonal brown fat cells. The cells were arranged in fragments or clusters. The nuclei were uniformly round with finely granular chrornatin. The cytoplasm was multivacuolated or univacuolated. The abundant eosinophilic granular cytoplasm was also present. No nuclear atypia were present. Immunohistochemical staining showed that cells were positive for S-100 protein.

Granular cell tumor of the neurohypophysis: Report of a case with intraoperative cytologic diagnosis

Cytological techniques including touch and smear preparations are very useful diagnostic modality in the evaluation of central nervous system (CNS) lesions and, in many instances, may be effectively used as the sole modality of tissue preparation for intraoperative consultation. Cytologic preparations offer many advantages over frozen sections for CNS specimens. These include selective examination of multiple areas from small biopsy specimens, superior preservation and details of cellular morphology, fewer artifacts, faster results, and improved cost-effectiveness. We describe the cytologic diagnosis of a granular cell tumor (GCT) of the neurohypophysis in a 33-year-old male who presented with headache and blurred vision. CT scan revealed an enlarged sella with a 2.15 x 2.0 cm pituitary lesion. Transsphenoidal resection of the mass was performed and submitted for intraoperative consultation. Smears and touch preparations were made on a portion of the mass that showed uniform polygonal cells with round to ovoid nuclei and abundant eosinophilic granular cytoplasm. An intraoperative cytological diagnosis of "favor GCT" was rendered. The histologic sections of the remaining material confirmed the diagnosis. Although GCT of the neurohypophysis is very rare, a specific intraoperative cytological diagnosis is possible. We report the clinical, cytological, and pathological findings of a GCT affecting the neurohypophysis.

Extramedullary plasmacytoma of the tonsil diagnosed by fine-needle aspiration cytology

A case of tonsillar extramedullary plasmacytoma in a 53-year-old man with a complaint of lump sensation in the throat is presented. Examination of the oral cavity showed enlargement of the left tonsil. Magnetic resonance imaging demonstrated a solid mass, measuring 3.2 x 2.0 x 3.8 cm, in the left tonsil. Cytologic smear obtained by fine-needle aspiration biopsy appeared highly cellular and was composed of clusters of plasma cells with varying maturity. Atypical plasma cells had prominent eccentric nuclei with nucleoli and finely granular cytoplasm. Binucleated cells and mitotic figures were also identified. The cytoplasm of mature-looking small plasma cells was also finely granular without a perinuclear halo. A cytologic diagnosis of plasmacytoma was made. Excisional biopsy showed sheets of plasmacytoid cells with abundant eosinophilic granular cytoplasm. Occasional binucleated and pleomorphic cells with giant nuclei and prominent nucleoli were observed. These plasmacytoid cells were diffusely immunoreactive for lambda light chain and IgG, partially positive for epithelial membrane antigen. Metastatic examination finding was negative for multiple myeloma, and the patient was diagnosed as having extramedullary plasmacytoma. Although the diagnosis of plasmacytoma on cytologic smear may be difficult, in the current case, fine-needle aspiration cytology provided a rapid and accurate diagnosis.

Alveolar soft part sarcoma of the endometrium with expression of CD10 and hormone receptors

Alveolar soft part sarcoma (ASPS) is a rare tumor of uncertain histogenesis, mainly localized in the extremities. ASPS originating in the uterine corpus is quite rare; only eight such cases have been reported in the literature. We here present another case of ASPS found in the endometrium in a 50-year-old woman. Metastatic malignant tumor, including ASPS from other organs, was excluded by physical examination and imaging modalities. Thallium 201 was only localized in the uterus. The tumor showed characteristic histological features of ASPS: alveolar architecture with fibrovascular septa and abundant eosinophilic granular cytoplasm with periodic acid-Schiff-positive crystalline material. Diffuse nuclear immunoreactivity for TFE3, a marker recently reported to be specific for ASPS, further supported the diagnosis of ASPS. Interestingly, this tumor was negative for myogenic markers, but positive for CD10, progesterone receptor, and estrogen receptor. These immunohistochemical results and the tumor location suggest a possible link between endometrial stromal cells and the development of this tumor.

Granular Cell Tumors of the Abdominal Wall

Granular cell tumors (GCT) are found in virtually any body site, including the tongue, skin, subcutaneous tissue, breast, rectum and vulva. However, they are rarely seen in the abdominal wall. We report here on a rare case of GCT in the rectus muscle of the abdominal wall. A 44-year-old woman presented with a non-tender, hard mass in the right lower abdominal wall. Upon microscopic examination, the tumor was found to comprise of large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining, the large cells showed S-100 and CD68 positive granular aggregates in the cytoplasm. Many lysosomes of variable size were observed in the cytoplasm.

Pseudogranular Cell Tumor Of The Skin

A skin biopsy from a nasal lesion showed a dermal infiltrating neoplasm composed of polygonal cells with small nuclei and abundant coarsely granular eosinophilic cytoplasm. Light microscopic features were that of a granular cell tumor. However, the results of the immunohistologic studies and the observations of the electron microscopic studies did not identify the nature of the cells nor did they confirm that it was a granular cell tumor. We interpret the lesion as a pseudogranular cell tumor of the skin. SOURCE OF SUPPORT None REPORT OF A CASE A 66-year-old white female presented with a painless skin papule located on the right side of her nose that had been present for unknown period of time. There were no other symptoms and her past medical history was unremarkable. The biopsied skin lesion showed an intact normal epidermis. The dermis showed a proliferation of polygonal cells with abundant coarsely granular eosinophilic cytoplasm and small round or ovoid nuclei (Figs. 1 and 2) leading to an impression of a granular cell tumor. Figure 1 Figure 1: Dermal proliferation of polygonal cells with eosinophilic granular cytoplasm (low power). Figure 2 Figure 2: High power view of the tumor. Immunohistochemical stains showed that the tumor cells were positive for CD34, CD68, and vimentin and negative for S100 protein, Melan A, HMB45, Factor VIIIa, pancytokeratin, desmin, and SMA. Ultrastucturally (Fig. 3), the dermal polygonal cells showed numerous intracytoplasmic phagosome-like vesicles, many containing electron-dense irregular material. The mitochondria and endoplasmic reticulum were scarce. The cells did not show any features of melanocyte, Schwann cell or classic mitochondria-rich granular cells. Pseudogranular Cell Tumor Of The Skin 2 of 3 Figure 3 Figure 3: Electron microscopic picture showing numerous cytoplasmic phagosome-like vesicles. Mitochondria are scarce. No melanosomes or dense core granules are seen. 5000X. COMMENT Granular cell tumors are neural-derived tumors commonly arising in the upper aerodigestive tract and skin. A typical granular cell tumor of the skin is composed of polyhedral cells with large amount of granular eosinophilic cytoplasm involving the dermis. The cells are typically immunoreactive for S-100 protein signifying a neural origin and are negative for epithelial, muscle, and endothelial markers [1]. In our case, the polygonal dermal cells with eosinophilic granular cytoplasm, on immunostains, are not suggestive of a neural, melanocytic, epithelial, or smooth muscle origin. Electron microscopic observation of a lack of abundant lysosomes is unlike that of a granular cell tumor. Other primitive mesenchymal cell tumors may present as a granular cell proliferations. The CD34 and CD68 reactivity in our case may suggest that the polygonal cells are fibroblastic in origin. CD-34 positive and S-100 negative granular cell dendrocytosis has been described as a congenital lesion [2]). Another possibility considered was a possible oncocytic change in a dermal melanocytic nevus [3]. However, the cells in such cases are S-100 positive and ultrastucturally they show numerous mitochondria near the melanosomes. Other non-neural tumors showing nonspecific granular change include dermatofibroma, fibroxanthoma, leiomyoma, leiomyosarcoma, angiosarcoma, and basal cell carcinoma [4]. Our case did not show any microscopic, immunohistochemical, or ultrastuctural features of any of these tumors. The true origin of our tumor has not been established with certainty. Some of the nuclear changes observed in the ultrastrucural study may be indicative of apoptosis and the granular changes in the cytoplasm may represent degenerative changes. Pseudogranular cell tumor may be a reasonable descriptive name for such a lesion. CORRESPONDENCE TO Deba P Sarma, MD Department of Pathology Creighton University Medical Center Omaha, NE 68131 Tel: 402-449-4951 debasarma@creighton.edu

Surgical Resection of Locally Advanced Granular Cell Tumor of the Orbit

We report a case of locally advanced granular cell tumor of the orbit treated by a multidisciplinary surgical approach. A 49-year-old woman with a recently biopsied granular cell tumor of the orbit was referred to our tertiary care cancer center for evaluation of a right-sided globe ptosis and a palpable mass in the right orbit that had been present for approximately two years. Magnetic resonance imaging showed a large orbital mass that extended posteriorly to the orbital apex and anteriorly to the levator and superior rectus muscle complex. A workup including computed tomography of the chest, abdomen, and pelvis did not show any metastatic foci. Surgical resection of the mass was undertaken via a frontozygomatic craniotomy supplemented by an anterior orbitotomy to repair the levator aponeurosis and the superior oblique tendon, which were partially resected with the mass. Histologic evaluation of the mass revealed solid nests of polygonal cells that had centrally located, round nuclei with abundant eosinophilic granular cytoplasm. The cytoplasmic granules were positive on the periodic acid-Schiff reaction and were diastase-resistant. Immunohistochemical staining was positive for S-100 protein. During the most recent follow-up visit six months after surgery, the patient had no clinical evidence of tumor recurrence, had minimal residual ptosis and exposure keratopathy, and had stable visual function.

Paraganglioma of the Ovary

Paraganglioma is one of the rarest neoplasms to involve the ovary, whether primary or metastatic, with only two previous reports. We describe three examples that occurred in patients 22, 58, and 68 years of age. Two patients had hypertension. Two tumors involved the left ovary and one the right ovary; they ranged from 8 to 22 cm, were solid, and were tan, brown, or yellow. One tumor was confined to the ovary; in the second case, there were tumor deposits on the posterior surface of the uterus and the contralateral ovary; in the other case, there was peri-aortic lymph node involvement and peritoneal deposits. In all cases, however, radiologic investigations did not reveal an alternative primary site. On microscopic examination, all three tumors showed a predominantly nested "zellballen" pattern with groups of cells surrounded by a vascular stroma. Tumor cells largely had abundant granular eosinophilic cytoplasm with, in 2 cases, focal clear cell areas. In 1 case, bizarre tumor giant cells were present. Immunohistochemically, all neoplasms were cytokeratin negative and diffusely positive with neuroendocrine markers. In 1 case, there was an S-100-positive population of sustentacular cells. Two cases were positive for inhibin, one focal and one diffuse, and the other was focally positive for calretinin. Electron microscopy performed in 2 cases revealed dense core neuroendocrine granules. One patient has been followed up for 15 years and is alive and well. Although metastatic spread from an undetected primary outside the ovary cannot be totally excluded for the 2 cases with extraovarian disease, we think that the neoplasms most likely represent primary ovarian paragangliomas. Because various neoplasms in the sex cord-stromal and steroid categories are likely to enter into the differential diagnosis, inhibin and calretinin positivity represents a significant potential diagnostic pitfall. The differential is broad and may include many other ovarian tumors, particularly those with an oxyphilic cell type. Possible theories of histogenesis of primary ovarian paraganglioma include an origin from extra-adrenal paraganglia in the region of the ovary or unidirectional differentiation within a teratoma.

Small-cell variant of renal oncocytoma with dominating solid growth pattern: a potential diagnostic pitfall

Dear Editor, Renal oncocytoma is a distinct benign renal tumour accounting approximately for 4% of all renal tumours. This neoplasm is easily recognizable in its classic form— polygonal cells with abundant granular eosinophilic cytoplasm, arranged in tubuloalveolar cystic pattern— whereas diagnostic difficulties may arise when it exhibits small cells with scant cytoplasm and hyperchromatic nuclei (so-called “oncoblasts”) [2]. Although these small cells are rarely detectable in an otherwise classic renal oncocytoma [1, 3], there is the possibility that they may represent the dominating cell component [2]. One of us (MM), by reviewing a large series of renal oncocytomas, found only 3 out of 134 tumours with a prominent (80% of the entire tumours in two cases and 50% in the other case) small-cell component, and the term “small-cell variant of renal oncocytoma” was proposed for these cases [2]. We report a rare case of renal oncocytoma with a predominant small-cell component, accounting for about 80% of the entire tumour. The unusual extensive solid growth pattern of the tumour may represent a potential diagnostic pitfall with primary or metastatic malignant small cell tumours. A 58-year-old woman presented with a vague right-flank pain. Ultrasonography and computerized tomography examination revealed a renal mass, measuring 3.5 cm in greatest dimension and located in the upper pole. A radical nephrectomy with abdominal lymph node dissection was performed. Grossly, a well-circumscribed, nonencapsulated tumour mass, tan in colour, was observed. No central scar or haemorraghic or necrotic areas were seen. Histologically, the tumour was mainly (about 80% of the entire tumour) composed of small cells with scant pale to slightly eosinophilic cytoplasm and small hyperchromatic round-shaped nuclei, arranged in a solid growth pattern (Fig. 1a,b). Only focally, the tumour cells exhibited a tubular and alveolar growth pattern. After an extensive search, in some tumour areas, we observed that neoplastic small cells gradually merged with larger cells with abundant granular eosinophilic cytoplasm similar to oncocytes as seen in classic oncocytoma (Fig. 1c). In other areas, the transition between the small cells and the classic oncocytes was abrupt (Fig. 1d). Only the small foci of tumour were composed exclusively of typical oncocytes (Fig. 1e). Nuclear pleomorphism was focally observed in classical oncocytes, as well as binucleation. Mitoses, necrosis, and nuclear pleomorphism were absent. Perirenal adipose tissue invasion and lymph node metastasis were not seen. The patient is well, without evidence of tumour after a 2-year follow-up. Immunohistochemical analyses revealed a faint immunoreactivity to antimitochondrial antibody MITO-113 (Biogenex) in the small-cell component (Fig. 1f), whereas a stronger staining was observed in typical oncocytes. All neoplastic cells were positive to epithelial membrane antigen and pancytokeratins. No reactivity was obtained with chromogranin A, synaptophysin, CD56, neuron-specific enolase, leucocyte common antigen, CD34 and CD99. Differential diagnosis mainly revolved around malignant small-cell tumours. Among these, metastatic or primary neuroendocrine carcinomas (small cell G. Magro (*) Dipartimento G.F. Ingrassia, Anatomia Patologica, Universita di Catania, Via S. Sofia 87, 95123 Catania, Italy e-mail: g.magro@unict.it Tel.: +39-95-3782024 Fax: +39-95-3782023

Calcium Oxalate Deposition in Renal Cell Carcinoma Associated With Acquired Cystic Kidney Disease

The main complication of acquired cystic kidney disease (ACKD) is frequent development of renal tumors, including renal cell carcinoma (RCC). Intratumoral deposition of calcium oxalate (CaOx) is a distinct feature of ACKD-associated RCCs, but several features of this type of RCC are not known. Features of the 30 end-stage renal disease (ESRD)-associated RCCs identified within a 13-year period, including eight with CaOx deposition, were analyzed. Pathologic and clinical features of CaOx positive (+) and negative (-) RCCs were evaluated and compared. The CaOx+ RCCs showed higher tendency for bilaterality and multifocality. Seven tumors displayed distinctive morphologic features characterized by tumor cells with ill-defined cell membrane, abundant granular eosinophilic cytoplasm, large nuclei, and prominent nucleoli. One tumor was of clear cell type. Regardless of histologic type, all tumors displayed a proximal tubular differentiation. No significant difference was noted for tumors' stage, proliferation, and apoptosis rate between the CaOx+ and CaOx- RCCs. CaOx+ RCCs account for a significant portion of all ESRD-associated RCCs. The majority of these RCCs display a distinctive morphologic profile. Proximal tubular cell differentiation in conjunction with ESRD-mediated high serum level may be pathogenetically important for intratumoral CaOx deposition. These RCCs seems to have a relatively good prognosis.

Der interessante Fall Nr. 70

We will report two cases of newborn girls, who could not be breast fed because of a benign tumour in their oral cavity. These polypoid lesions were located in both cases in the labial aspect of the dental ridge. Tumours were fleshy, firm, dark-brown with a broad-based attachment to the alveolar ridge. The underlying bone was not affected. The size of neoplasm was in one case 3 x 2 cm, in the other one 2 x 1.5 cm. Excision was performed in both cases at the day after birth. The postoperative course was uncomplicated. A regular oral feeding was immediately possible. Histological findings showed large tumour cells with abundant granular eosinophilic cytoplasm and a prominent vascularity. Cells did not show immunostaining for laminin or S-100 protein. All these findings are characteristic of congenital granular cell tumour and its synonym congenital epulis. There is a strong predilection for newborn females. It differs from adult granular cell tumours by its prominent vascularity, the presence of scattered remnants of odontogenic epithelium, and the strong phosphatase activity. These lesions are always cured by local excision. The exact nature of this condition is still not clear, and there is little support for its originating from odontogenic epithelial cells.

Granular cell tumor of the penis: clinicopathologic evaluation of 9 cases

The occurrence of granular cell tumor (GCT) in penile tissue is very rare, with only 9 examples reported to date in the English-language literature. Herein, we describe the clinicopathologic and immunohistochemical findings in 9 additional cases. The patients ranged in age from 20 to 60 years (mean, 42 years; median, 40 years) at time of diagnosis. All penile tumors were solitary and arose in the dermis of the penile shaft (n=4), prepuce (n=3), and corona (n=2). A patient had a history of multiple cutaneous GCTs. Duration of symptoms before surgery ranged from 5 days to 2 years with the presence of an asymptomatic nodule representing the most common tumor-related complaint (n=8). The lesions ranged in size from 0.6 to 2.5 cm (mean, 1.5 cm; median, 1.5 cm). Microscopically, the tumors were moderate to highly cellular and were composed of oval to polygonal-shaped cells with abundant coarsely granular eosinophilic cytoplasm. Tumor cells grew in infiltrating nests, cords, and trabeculae and showed neural (n=2) and vessel wall (n=1) invasion or formed a relatively well-marginated solid nodule. Bland cytological features with only rare cells showing nucleomegaly (n=7) or spindling (n=3) were exhibited by 8 tumors. A tumor demonstrated diffuse nuclear atypia and was classified as "atypical." Mitotic activity ranged from 0 to 8 mitoses (mean, 1.4 mitoses) per 50 high-powered fields with no atypical division figures identified. All tumors tested showed moderate to strong immunohistochemical expression of S100 protein (n=6) and low-affinity nerve growth factor receptor (n=5), which was useful for detecting small deposits of tumor and helpful in evaluating surgical margins. Focal tumor cell immunoreactivity was observed for calretinin (4/6 cases) and glial fibrillary acidic protein (1/6 cases). All patients underwent simple (local) excision of their tumor. Complete follow-up data (mean, 21 years; interval range, 0.5-28 years) were available for 6 patients. No patient experienced recurrence or metastatic spread of tumor although surgical margins were microscopically involved by tumor in 5 cases. Benign GCT involving superficial soft tissue of the penis can be adequately managed by a simple excision. Patients with microscopically involved surgical margins can be clinically followed without immediate additional surgery.