Degree Of Atypia Research Articles

Treatment of Digital Melanonychia with Atypia.

Melanonychia of the digit is uncommon in the Caucasian population and is concerning because of potential malignant transformation. Several histologic changes occur before malignant transformation, including melanocytic atypia. The authors evaluated patients with melanonychia with melanocytic hyperplasia to determine the risk factors for malignant transformation. The authors retrospectively reviewed records for patients older than 18 years that underwent biopsy for melanonychia. They identified 22 patients with melanocytic hyperplasia with a median age of 61 years (interquartile range, 44 to 71 years). A bivariate analysis was performed to evaluate whether the degree of atypia was associated with malignant transformation and whether treatment choices by surgeons were based on melanocytic atypia. Following biopsy, patients were followed for a median of 41.0 months (interquartile range, 4.8 to 100.6 months). Melanocytic atypia was present in nine patients and transformed into a malignancy in three: in two patients it became a melanoma in situ, and in one it became an acral lentiginous melanoma. Moderate-severe and severe melanocytic atypia was associated with malignant transformation. After initial biopsy, 14 patients were monitored (11 without atypia and three with atypia). One patient with slight atypia, two patients with moderate-severe atypia, and two patients with severe atypia underwent additional treatment. Patients with melanocytic hyperplasia without atypia were monitored more often (78.6 percent versus 21.4 percent). Melanonychia presents a challenge to the hand surgeon, as some patients may be monitored and some should undergo additional resection. Patients with moderate-severe melanocytic atypia following biopsy should undergo resection, and those with mild to slight atypia can most often be monitored clinically. Therapeutic, IV.

Cytohistological discrepancies of cervico-vaginal smears and HPV status.

Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytolo-gy negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the dis-crepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification. A total of 52 women, patients of the University Hospital between 2013-2015, with cytohistologi-cal or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop exci-sion of the transformation zone (LLETZ). A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result. In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention.

Langerhans Cell Sarcoma: A Case Report Demonstrating Morphological and Immunophenotypical Variability within a Single Lesion

Langerhans cells are antigen presenting dendritic cells and tumours arising from these are rare. The tumours arising from these dendritic cells are divided into two categories according to a WHO classification: Langerhans cell histiocytosis and Langerhans cell sarcoma. It is the degree of atypia and clinical aggressiveness that distinguishes the two subtypes. Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells which can occur in skin, bone marrow, lymph nodes, spleen, liver, and lung. LCS can present with multiple cutaneous and systemic lesions. We present a case of Langerhans cell sarcoma with a unique morphological appearance and variable immunohistochemical profile within a single cutaneous lesion. LCS is a rare malignancy and its diagnosis is based on morphology, immunophenotypical examination, and ultrastructural analysis by electron microscopy. Our case highlights a unique morphological description of LCS wherein the pleomorphic neoplastic cells show epidermotropism and are surrounded by a variable amount of inflammatory infiltrate within a single cutaneous lesion. A single cutaneous lesion of Langerhans cell sarcoma with variable immunohistochemical profile has not been described so far.

Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: Clinicopathologic-Sonographic Characteristics, Follow-Up and Recurrence.

BackgroundUterine smooth muscle tumor of uncertain malignant potential (STUMP) is rare tumor, and regarded as sub-classification in uterine smooth muscle tumors between benign and malignant criteria. In this study, we evaluated characteristics of cases with STUMP diagnosis in a 10-year period.MethodsWe retrospectively evaluated medical records of patients with histopathological STUMP diagnosis in Istanbul Training and Research Hospital, a tertiary center. We analyzed preoperative demographic, clinical features and postoperative follow-up. Preoperative sonographic data were re-evaluated.ResultsThe mean age was 42 years. One patient was postmenopausal, and five patients were premenopausal. All of them had a complaint of meno-metrorrhagia. We re-evaluated preoperative sonographic images of patients, and defined 83.3% as well-defined margins, 66.7% hyperechoic, 100% heterogeneous, 66.7% non-cystic, 50% calcification and 66.7% acoustic shadowing. Pathologic features showed mean number of mitosis 8, mild atypia 66.7%, and necrosis 33.3%. In a 24-year-old unmarried female patient with myomectomy, we detected recurrance of tumor in sonographic and MRI studies after 11 months, and confirmed the diagnosis via tru-cut biopsy. There was no relevance between sonographic findings and atypia, necrosis and mitosis. The recurrence was not in relationship with mitosis, degree of atypia and necrosis. We found no relevance between tumor diameter and mitosis, atypia, necrosis and recurrence.ConclusionsSTUMP is classified as an intermediate form, histopathologically so calling it benign or malignant for sure is not possible. Singulary, solidity, hyperechogenicity, heterogenecity and features of acoustic shadowing and margins can guide us to preoperative sonographic diagnosis. Recurrence/metastasis after many years from operation can be seen, and those patients should be followed long term.

Clustering Multivariate Longitudinal Observations: The Contaminated Gaussian Hidden Markov Model

The Gaussian hidden Markov model (HMM) is widely considered for the analysis of heterogenous continuous multivariate longitudinal data. To robustify this approach with respect to possible elliptical heavy-tailed departures from normality, due to the presence of outliers, spurious points, or noise (collectively referred to as bad points herein), the contaminated Gaussian HMM is here introduced. The contaminated Gaussian distribution represents an elliptical generalization of the Gaussian distribution and allows for automatic detection of bad points in the same natural way as observations are typically assigned to the latent states in the HMM context. Once the model is fitted, each observation has a posterior probability of belonging to a particular state and, inside each state, of being a bad point or not. In addition to the parameters of the classical Gaussian HMM, for each state we have two more parameters, both with a specific and useful interpretation: one controls the proportion of bad points and one specifies their degree of atypicality. A sufficient condition for the identifiability of the model is given, an expectation-conditional maximization algorithm is outlined for parameter estimation and various operational issues are discussed. Using a large-scale simulation study, but also an illustrative artificial dataset, we demonstrate the effectiveness of the proposed model in comparison with HMMs of different elliptical distributions, and we also evaluate the performance of some well-known information criteria in selecting the true number of latent states. The model is finally used to fit data on criminal activities in Italian provinces. Supplementary materials for this article are available online

Dysplastic (or Atypical) Nevi Showing Moderate or Severe Atypia With Clear Margins on the Shave Removal Specimens Are Most Likely Completely Excised.

Dysplastic nevi (DN) are graded by their degree of atypia into 3 categories of mild, moderate, and severe. In many practices, DN with moderate or severe atypia are generally excised regardless of the status of the shave specimen margins. With a new approach toward the margins on the shave removal specimens (SRS), the goal herein is to assess whether the shave removal procedure can sufficiently remove DN with moderate or severe atypia. A total of 426 SRS diagnosed with DN showing moderate or severe atypia between January and December 2015 along with their post-shave excision specimens were reviewed. Based on the author's experience, clear or negative margins on the SRS were defined as neoplastic melanocytes confined within >0.2 mm of the lateral and deep specimen margins. The biopsy specimens were accompanied by Melan-A highlighting the subtle neoplastic cells. With a negative predictive value (NPV) of 98.4% (confidence interval: 97.2% to 100%, P < .001), DN showing moderate or severe atypia with clear margins are most likely removed by the shave procedure. Routine excision of DN showing moderate or severe atypia with clear margins on SRS is not necessary. Regular surveillance is sufficient.

Progesterone Receptor Expression Is an Independent Prognosticator in FIGO Stage I Uterine Leiomyosarcoma.

To analyze the clinical role of hormone receptors in a large uterine sarcomas series with long-term follow-up. Protein expression of estrogen receptor (ER) and progesterone receptor (PR) by immunohistochemistry was studied in tissue microarrays from 294 patients diagnosed with uterine sarcoma in Norway from 1970 to 2000 and analyzed for an association with clinicopathologic parameters and outcome. ER and PR were detected in 136 of 291 and 184 of 291 tumors (three noninformative cases each), respectively. Expression was unrelated to histology, patient age, tumor diameter, the degree of atypia, the presence of necrosis or vascular invasion, or mitotic counts. ER and PR expression was unrelated to survival in the analysis of the entire cohort. When survival analysis was confined to stage I leiomyosarcoma (n = 147), higher PR score was significantly related to longer overall survival (OS) (P = .042). Clinicopathologic prognosticators in this group were age (P = .041), tumor diameter (P = .001), and mitotic count (P = .007), with a trend for atypia (P = .087). In Cox multivariate analysis, PR score (P = .019), tumor diameter (P = .013), and mitotic count (P = .002) were independent prognosticators of OS. Hormone receptor expression is not informative of outcome in the analysis of uterine sarcomas of all stages and histologic types. PR expression identifies patients with longer survival in stage I leiomyosarcoma.

Incidence of atypical nevi in Olmsted County: an epidemiological study.

The association of atypical nevi with melanoma and other forms of skin cancer has not been clearly defined. We studied 631 patients with first lifetime diagnosis of mild, moderate or severely atypical nevus from 2000 through 2005, identified through a population-based approach. Age at first diagnosis differed significantly between men and women (p<.001). Incidence rates peaked in the second through fourth decades in women and in the third, sixth and seventh decades in men. From 2000 through 2005, the overall age- and sex-adjusted incidence rate of all degrees of atypical nevi was 76.0 per 100,000 person-years. There were no statistically significant associations identified between the degree of atypia and the future development of basal cell carcinoma, squamous cell carcinoma or MM (p = 0.51, p = 0.28 and p = 0.19, respectively). There is no association between atypical nevi and the subsequent development of non-melanoma skin cancer and MM. Incidence rates of atypical nevi are higher among younger women and older men. The association between degree of atypia and malignant melanoma warrants further study.

Noncommunicating cystic pancreatic lesions (i.e. serous and mucinous cystadenoma + rare lesions)

Mucinous cystic neoplasm (MCN) occurs predominantly in women (>95%) with a mean age of approximately 45 years and most commonly is located in the pancreatic body or tail. The mass is lined by mucin-producing columnar epithelium with a fibrous ovarian-type stroma. The epithelial lining can contain various degrees of atypia, ranging from adenoma to invasive carcinoma. The CT and MR appearance is that of at hick walled cystic mass with septa and/or mural nodules. The contour of the mass is smooth, and the wall or septa may contain calcification. Endoscopic ultrasound with fine needle aspiration of the cyst fluid to assess CEA level may be helpful in distinguishing MCN from serous cystadenoma. CEA 192 ng/mL favors MCN, with an accuracy of approximately 80% [1]. The overall risk of malignancy in one series was 17.5%, and all malignant tumors were either >4 cm or contained mural nodules [2]. Treatment of MCN is surgical resection, and patients without extracapsular or diffuse intracapsular infiltration have an excellent prognosis [2]. Serous cystadenoma (SCA) also occurs predominantly in women (approximately 75%), but the mean age is older (mid 50s to early 60s). It is lined by glycogen-rich cuboidal epithelium and is considered a benign neoplasm, although rare cases of malignant SCA have been reported. The typical appearance is that of a lobulated mass consisting of numerous tiny cysts which give it a honeycomb appearance. Larger lesions may contain a central stellate scar and calcifications. Oligocystic or macrocystic SCA is an uncommon variant comprised of a small number of larger cysts. Distinction between macrocystic SCA and MCN can be made based on the lobulated contour of SCA, its multiple clustered cyst configuration and homogeneity of each locule on T1 weighted MR images [3]. Surgical resection generally is reserved for symptomatic patients, although some authors recommend periodic imaging to assess the rate of growth, with consideration given to surgical resection of lesions with doubling time of 80%), with a median age 30-38 years [5,6]. It is not a true cystic neoplasm in that the cystic component lacks an epithelial lining. Rather, the cystic component represents necrotic degeneration of the mass, with various amounts of internal blood and debris. SPN appears as a well-circumscribed round or oval thick-walled mass with solid and cystic components, but it can appear completely solid or completely cystic. CT demonstrates calcification in nearly half of SPNs [6]. MR often demonstrates a thick T2 hypointense or enhancing rim and internal blood products. Treatment is surgical resection, and the prognosis is excellent, with metastases developing in <5% of patients [6]. Cystic neuroendocrine neoplasm of the pancreas most commonly occurs in patients with multiple endocrine neoplasia type I and usually is nonfunctional [7]. It generally appears as a cystic mass with an enhancing rim and may contain septa or a solid component. Treatment usually is surgical resection, although observation may be a viable alternative approach [8].

Loss of endoplasmic reticulum calcium pump expression in choroid plexus tumours

Sarco/Endoplasmic Reticulum Calcium ATPase-type calcium pumps (SERCA enzymes) control cell activation by sequestering calcium ions from the cytosol into the endoplasmic reticulum. Although endoplasmic reticulum calcium signalling plays an important role in the regulation of choroid plexus epithelial function, SERCA expression in the choroid plexus has not been investigated so far. In this work we investigated the expression of the SERCA3-type calcium pump in choroid plexus epithelial cells grown in vitro, and in normal and hyperplastic choroid plexus tissue, in choroid plexus papillomas displaying various degrees of atypia, and in choroid plexus carcinoma by immunohistochemistry in situ. Whereas normal choroid plexus epithelial cells express SERCA3 abundantly, SERCA3 expression is strongly decreased in papillomas, and is absent in choroid plexus carcinoma, while expression in hyperplastic epithelium is high, similarly to normal epithelium. SERCA3 expression was detected also in normal primary choroid plexus epithelial cells grown in vitro, and expression was markedly enhanced by short-chain fatty acid-type cell differentiation inducing agents, including valproate. These observations show that SERCA3 is a new phenotypic marker of normal choroid plexus epithelial differentiation, and that SERCA3 constitutes an early tumour marker 'by loss of expression' in the choroid plexus that may be useful to distinguish hyperplastic processes from papillomas. Endoplasmic reticulum calcium homeostasis becomes anomalous, due to loss of SERCA3 expression, already in benign neoplastic lesions of the choroid plexus epithelium.

Histological and morphometric characteristics of supratentorial meningiomas of the brain

The development of modern methods of clinical diagnosis and surgical treatment of CNS tumors necessitates reliable morphological verification of the tumor lesion with the definition of its histogenesis, morphological variant and degree of malignancy. Works on computer analysis of morphometric data of CNS tumors are rare. Meanwhile, histomorphometric studies have potential value for diagnostic purposes in the study of brain tumors.Goal: to conduct histological and morphometric analysis of the cellular composition of meningiomas, needed to improve their differential diagnosis.Material and methods. We studied surgically removed meningiomas in 39 patients aged from 40 to 66 years. 7 meningothelial meningiomas, 4 angiomatous, 6 fibrous, 7 transitional, 6 psammomatous, 2 atypical and 7 anaplastic meningiomas were included in the study.Histomorphometric analysis was performed on hematoxylin and eosin (H&amp;E)-stained histological sections. Calculation of quantitative indices was conducted using a computer system for digital image analysis KS 200 (Kontron Elektronik,Germany, lic. № 0200299). Studied objects (cell nuclei) were examined using morphometric measurements: cross-sectional area (AREA), the diameter of the object (the diameter of irregularly shaped objects was calculated through their equivalent area – parameter DCIRCLE). Coefficients (indices) of the form (FC) and elongation (EC) were used as additional morphometric characteristics of the studied objects.Results. Meningothelial meningiomas were represented by large cells with light nuclei with diffusely located fine chromatin. Most cells had a polygonal shape and did not have clear boundaries. The cell density in the field of vision averaged 55±5, cross-sectional area of the nuclei 45,24±4,77 µm2, FC and EC respectively 0,87±0,02 and 0,71±0,1.Transitional meningiomas were characterized by combined areas of meningothelial, syncytial type and areas with typical fibroblastic differentiation of cells. Two groups of cells were identified which differed in morphometric parameters: a cross-sectional area of nuclei, respectively 49,78±5,93 and 30,59± 4,16 µm2 and FC 0,87±0,05 and 0,67±0,10. EC were respectively 0,54±0,13 and 0,43±0,11.The predominant cell type in fibrous meningiomas were fibroblast-like arachnoendotheliocytes with oval, elongated nuclei containing fine chromatin, hyperchromic nuclei were frequent. Cells formed bundles going in different directions, concentric structures and psammoma bodies were often met. Tumor cell density was 46,6±13,22. In areas with fibrous extracellular matrix cells with cross-sectional area of the nuclei 37,13±4,47 µm2 dominated.Atypical meningiomas were characterized by increased cellularity – 82 cells in the field of view, more pronounced nuclear polymorphism, mitosis and the presence of small areas of necrosis. The cross sectional area of the nuclei of tumor cells was 65,78±16,97 µm2.The cross sectional area of the nuclei is significantly increased in atypical and anaplastic meningiomas, which reflects the increase in the degree of atypia (linear relationship between the degree of increasing area of the nuclei and Grade - strong positive correlation, Pearson coefficient r=0,89, p&lt;0.05).Conclusions. Conducted investigation indicates the feasibility of using a morphometric method for improving the diagnosis of various meningiomas. Prospects for further research in this area suggest the selection of reliable morphometric criteria for estimation of the recurrence rate and aggressiveness of meningiomas growth.

Warthin tumor with extensive squamous and mucinous metaplasia: Pathologist′s dilemma

Secondary changes in Warthin tumor (WT) are not uncommon. Diagnostic error in Fine Needle Aspiration (FNA) is caused by a lack of typical features and the presence of individual atypical squamous cells in a necrotic background, mimicking carcinoma. Mucoepidermoid carcinoma, squamous cell carcinoma, and oncocytoma are the commonest tumors diagnosed in place of WT, the source of error being the presence of squamous metaplasia in the former two and the absence of the lymphoid cells in the latter. We report a case of WT with extensive squamous and mucinous metaplasia with desmoplasia and a certain degree of atypia which was diagnosed on FNA as Low Grade Mucoepidermoid Carcinoma (LGMEC). Prior FNA of the lesion may be the reason for the extensive metaplasia, desmoplasia, as well as atypia in our case. An extensive histopathological examination of the superficial parotidectomy specimen helped us arrive at the correct diagnosis.

The MPATH-Dx reporting schema for melanocytic proliferations and melanoma

The histologic diagnosis of melanoma and nevi can be subject to discordance and errors, potentially leading to inappropriate treatment and harm. Diagnostic terminology is not standardized, creating confusion for providers and patients and challenges for investigators. We sought to describe the development of a pathology reporting form for more precise research on melanoma and a diagnostic-treatment mapping tool for improved patient care and consistency in treatment. Three dermatopathologists independently reviewed melanocytic lesions randomly selected from a dermatopathology database. Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) reporting schema evolved from iterative case review and form revision. Differences in diagnostic thresholds, interpretation, and nomenclature contributed to development of the MPATH-Dx histology reporting form, which groups lesions by similarities in histogenesis and degrees of atypia. Because preliminary results indicate greater agreement regarding suggested treatments than for specific diagnoses, the diverse terminologies of the MPATH-Dx histology reporting form were stratified by commonalities of treatments in the MPATH-Dx diagnostic-treatment mapping scheme. Without transformative advances in diagnostic paradigms, the interpretation of melanocytic lesions frequently remains subjective. The MPATH-Dx diagnostic-treatment mapping scheme could diminish confusion for those receiving reports by categorizing diverse nomenclature into a hierarchy stratified by suggested management interventions.

Pancreatic ductal adenocarcinomas with multiple large cystic structures: A clinicopathologic and immunohistochemical study of seven cases

Background/objectivesPancreatic ductal adenocarcinoma (PDA) with cystic change is classified into several types according to the features of the cysts; however, those tumors do not constitute a uniform group, and the classification is controversial. In this study, we have described a series of cystic PDAs that show distinctive and previously unreported morphologic and immunohistochemical features. MethodsWe analyzed 200 cases of PDA treated surgically at a single institution, and extracted the clinical and histopathological features of 7 tumors showing multiple large cystic (MLC) structure. ResultsPreoperative radiographic images revealed a multilocular mass in the pancreas which was similar to intraductal papillary mucinous neoplasm or mucinous cystic neoplasm. These tumors were associated with more than 5 large cystic structures and numerous intratumoral microcysts lined by epithelial cells with various degrees of atypia. The average maximal diameter of the cysts (3.7 cm) was much larger than that of previously reported. Immunohistochemically, the cyst-lining epithelia were almost negative for mucin core protein (MUC) 1, MUC2, and MUC6, and showed only focal staining for MUC5AC. Maspin, CEA, and p53 were strongly positive, and the Ki-67 labeling index was high in both cells in solid areas and cyst-lining epithelia. ConclusionWe considered the MLC structures in PDA to be a mixture of ectatic neoplastic glands and retention cysts with ductal cancerization or pancreatic intraepithelial neoplasia (PanIN); however, they might represent a new entity of cystic PDA because of the unusually large size of the dilated cysts.

Pancreatic Cystic Neoplasms: Management and Unanswered Questions

Approximately 10% of persons 70 years old or older are now diagnosed with pancreatic cysts, but it is not clear which ones require additional analysis, interventions, or follow-up. Primary care doctors rely on gastroenterologists for direction because no one wants to miss a diagnosis of pancreatic cancer, but meanwhile there is pressure to limit use of diagnostic tests and limit costs. We review the different cystic neoplasms of the pancreas and diagnostic strategies based on clinical features and imaging data. We discuss surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines. Intraductal papillary mucinous neoplasm (particularly the branch duct variant) is the lesion most frequently identified incidentally. We report what is known about its pathology, its risk of developing into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk. We also review surgical treatment and strategies for surveillance of pancreatic cysts.

Malignant change in seborrhoeic keratoses in a region with high solar ultraviolet levels

Regions with high solar UV levels and high skin cancer rates may experience a greater incidence of malignancy in association with seborrhoeic keratoses (SebK) than in low UV regions. Previous reports have indicated that basal cell carcinoma is the most common neoplasm with reported rates of up to 4 per cent of excised SebK. The rates of such compound lesions occurring in our practice were reviewed, indicating that Bowen's disease was the most frequently observed neoplasm with a rate of 7 per cent. In total, 10 per cent of all excised specimens showed either frank malignancy or some degree of atypia.

Follicular mucinosis and follicular mycosis fungoides: clinicopathological evaluation of seven cases

Follicular mucinosis is a disease characterized by follicular degeneration and mucin accumulation. It can be seen in mycosis fungoides, although idiopathic or forms associated with other diseases are also known. Follicular mycosis fungoides is a type of mycosis fungoides with different clinicopathological and prognostic features. Seven cases with follicular centered lesions and multiple biopsies (2-6) were included. Cases were evaluated according to their clinical, histological and immunophenotypical features and follow-up data. All cases were male, and the mean age was 40.3 (range 18-61). Clinical complaints were follicular prominence, erythema and alopecia at head and neck, trunk, and lower limbs. Follicular mucinosis (6/7), and dermal lymphoid infiltration showing minimal-intensive folliculotropism accompanied by eosinophils was seen. Lymphoid infiltration was composed of small-medium sized cells, with scattered hyperchromatic nuclei in six cases. In one case there was only minimal cytological atypia. Intense folliculotropism of atypical lymphocytes and dense dermal infiltration without follicular mucinosis was seen in one case. Local and/or systemic treatments were applied and partial remission was achieved histologically. In three cases new and increasing lesions were seen. Density of infiltration and atypia were increased. The findings supported the opinion that follicular mucinosis is an important finding seen in mycosis fungoides. There can be important differences concerning the amount of infiltration and degree of atypia. In cases where the density of infiltration associated with follicular mucinosis is not diagnostic for MF, there can be progression over time. Long-term follow up is necessary in such cases where the differential diagnosis is difficult.

Digital papillary adenocarcinoma: a case report

Introduction Digital papillary adenocarcinomas are rare tumours of eccrine sweat gland origin usually occurring on the fingers and toes and adjacent parts of the palms and soles. Men are more commonly affected than women with a mean age of incidence of 52 years. They can have an indolent course and patients usually present with a painless solitary mass. Reports show they have a high recurrence rate and a tendency for deep infiltration into soft tissue and bone with about 15% of patients developing metastatic disease. These tumours were thought to have a benign counterpart, i.e., digital papillary adenoma, but none of the histological or clinical parameters examined in a study of 67 cases was predictive of recurrence or metastatic potential, thus all lesions are considered to be potentially malignant. Treatment is by wide local surgical excision which may result in amputation of the digit. Clinical history The case of digital papillary adenocarcinoma is reported in a 53-year-old gentleman who was referred by his GP to the surgeons for excision of a right fingertip lesion that was thought to be an intraepidermal cyst. A wide excision was performed. Pathological features Macroscopically the lesion was cystic and measured 10 mm in diameter containing tan mucoid material. Sections showed an encapsulated cystic tumour lined by a multilay-ered epithelium with pseudopapillary and solid glandular growth patterns. The solid glandular areas had a cribriform architecture. Squamous metaplasia, focal necrosis and numerous mitotic figures were present. No soft tissue or bone involvement was seen in this case. Conclusion The indolent clinical course of these tumours and occasional benign morphology increases the chances of a mistaken diagnosis of a benign lesion, making it quite important to recognise this entity, thus ensuring patients receive appropriate therapy and follow-up. In this case, despite the degree of atypia, the lesion was well clear of the surgical margins and there was no invasion into blood vessels, surrounding soft tissue or bone.

Clinical Outcome of Atypical Endometrial Hyperplasia Diagnosed on an Endometrial Biopsy

The aims of this study were: (1) to review the rate of concurrent endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia (AEH); and (2) to determine the features of concurrent endometrial carcinoma and their impact on the subsequent management of AEH. We reviewed a retrospective series of 219 AEHs diagnosed locally in routine practice, over 24 years, and followed by a repeat biopsy or hysterectomy. Another series of 65 cases with a malignant diagnosis on preoperative sampling was included as a control group. Clinicopathologic parameters were obtained. In addition, published data on the risk of malignancy and features of malignant tumors after a diagnosis of AEH were collected and analyzed. This study reported on 2571 patients diagnosed in 31 published studies in addition to the current one. This showed a wide variation in the positive predictive value (PPV) of AEH in detecting endometrial cancer (6% to 63%) with an overall PPV of 37%. This variation is not only based on the differences among studies but also on the degree of atypia [mild/moderate (PPV 13%) or severe (PPV 50%)], the type of subsequent intervention (biopsy vs. hysterectomy), and more importantly the time period of diagnosis (around 20% in studies published before 1990s and up to 40% to 48% in recently published cases). Of the benign outcome cases, nearly 40% to 50% showed AEH with a potential risk of progressing to invasive carcinoma in 25% of cases. Malignant tumors after AEH diagnosis are associated with features of good prognosis with endometrioid morphology, lower grade, and early stage. Although the overall PPV of AEH is 37%, a figure of 40% to 48% is expected in the cases currently diagnosed in routine practice. Providing qualifying criteria for AEH will help identify its different associated risks and therefore should be included in routine pathology reports whenever possible. Unless there is a clinical contraindication, hysterectomy should be performed to treat concurrent carcinoma and to reduce the risk of subsequent carcinoma in nonmalignant cases with residual AEH.

Seasonal variation in dysplastic naevi

There is a relationship between sunlight and the development of melanocytic neoplasms. Because the incidence and excision of melanocytic neoplasms varies according to season, we sought to determine if dysplasia and/or intraepidermal melanocytic expression differed in a cohort of dysplastic naevi (DN) removed in January compared with a similar cohort removed in August. The DN were graded based on the degree of dysplasia, and the number of intraepidermal melanocytes were counted after immunohistochemical staining with HMB-45 and Melan-A. There was no seasonal difference in the grading of the dysplastic naevi in either season (P = 0.08). Comparing 85 cases from August and 86 from January, there was a larger number of Melan-A-positive melanocytes in the August samples (P < 0.02), and a larger number of HMB-45-positive melanocytes in January (P < 0.01). This difference may be related to seasonal variations such as exposure to ultraviolet light exposure; however, there was no difference between the two groups in the degree of atypia seen.