Expression Of Epithelial Membrane Antigen Research Articles

Primary pulmonary myxoid sarcoma in the interlobar fissure of the left lung lobe: a case report

BackgroundPrimary pulmonary myxoid sarcoma (PPMS) is a rare, low-grade malignant tumor, constituting approximately 0.2% of all lung tumors. Despite its rarity, PPMS possesses distinctive histological features and molecular alterations, notably the presence of EWSR1-CREB1 gene fusion. However, its precise tissue origin remains elusive, posing challenges in clinical diagnosis.Case demonstrationA 20-year-old male patient underwent a routine physical examination 6 months prior, revealing a pulmonary mass. Following surgical excision, microscopic evaluation unveiled predominantly short spindle-shaped tumor cells organized in a fascicular, beam-like, or reticular pattern. The stromal matrix exhibited abundant mucin, accompanied by lymphocytic and plasma cell infiltration, with Russell bodies evident in focal areas. Immunophenotypic profiling revealed positive expression of vimentin and epithelial membrane antigen in tumor cells, whereas smooth muscle actin and S-100, among others, were negative. Ki-67 proliferation index was approximately 5%. Subsequent second-generation sequencing identified the characteristic EWSR1-CREB1 gene fusion. The definitive pathological diagnosis established PPMS. The patient underwent no adjuvant chemotherapy or radiotherapy and remained recurrence-free during a 30-month follow-up period.ConclusionsWe report a rare case of PPMS located within the left lung lobe interlobar fissure, featuring Russell body formation within the tumor stroma, a novel finding in PPMS. Furthermore, the histomorphological characteristics of this case highlight the diagnostic challenge it poses, as it may mimic inflammatory myofibroblastic tumor, extraskeletal myxoid chondrosarcoma, or hemangiopericytoma-like fibrous histiocytoma. Therefore, accurate diagnosis necessitates an integrated approach involving morphological, immunohistochemical, and molecular analyses.

Squamoid eccrine ductal carcinoma: clinical, histological and immunohistochemical features.

Squamoid eccrine ductal carcinoma (SEDC) is a cutaneous adnexal malignancy that is histologically challenging to distinguish from squamous cell carcinoma. We report three cases of this rare entity and review the present literature regarding clinical, histological, and immunohistochemical features. Patients presented with a single nodule or plaque lesion on their back and temple. The shave biopsies for Patient A and C were interpreted as SEDC. Patient B's initial shave biopsy was interpreted as probable surface of squamous cell carcinoma, and subsequent excision revealed SEDC. Ductal differentiation was confirmed by positive expression of epithelial membrane antigen and carcinoembryonic antigen immunostains in all three patients. Review of the 67 previously reported cases emphasizes the importance of diagnosing SEDC accurately and promptly given its potential for distant metastasis and mortality. Perineural or lymphatic invasion is associated with higher rate of recurrence or metastasis. There should be high pathologic suspicion for SEDC in an elderly patient presenting with a palpable lesion, even if located outside of the head and neck area, particularly when there is suggestion of ductal differentiation in a sample of a squamous neoplasm.

Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)?

Pulmonary minute meningothelial-like nodules (MMNs) are common incidental findings in surgical specimens, consisting of tiny proliferation (usually no larger than 5-6 mm) of bland-looking meningothelial cells showing a perivenular and interstitial distribution, sharing morphologic, ultrastructural, and immunohistochemical profiles with meningiomas. The identification of multiple bilateral MMNs leading to an interstitial lung disease characterized by diffuse and micronodular/miliariform patterns radiologically allows the diagnosis of diffuse pulmonary meningotheliomatosis (DPM). Nevertheless, the lung is the most common site of metastatic primary intracranial meningioma, and differential diagnosis with DPM may be impossible without clinic-radiologic integration. Herein, we report four cases (three females; mean age, 57.5 years) fitting the criteria of DPM, all incidentally discovered and histologically evidenced on transbronchial biopsy (2) and surgical resection (2). All cases showed immunohistochemical expression of epithelial membrane antigen (EMA), progesterone receptor, and CD56. Notably, three of these patients had a proven or radiologically suspected intracranial meningioma; in two cases, it was discovered before, and in one case, after the diagnosis of DPM. An extensive literature review (44 patients with DPM) revealed similar cases with imaging studies excluding intracranial meningioma in only 9% (4 of 44 cases studied). The diagnosis of DPM requires close correlation with the clinic-radiologic data since a subset of cases coexist with or follow a previously diagnosed intracranial meningioma and, thus, may represent incidental and indolent metastatic deposits of meningioma.

Highlighting the immunohistochemical differences of malignant mesothelioma subtypes via case presentations.

Malignant mesothelioma (MM) is a rare tumor of mesothelial cells, with an increasing incidence both in developed and developing countries. MM has three major histological subtypes, in order of frequency, according to the World Health Organization (WHO) Classification of 2021: epithelioid, biphasic, and sarcomatoid MM. Distinction may be a challenging task for the pathologist, due to the unspecific morphology. Here, we present two cases of diffuse MM subtypes to emphasize the immunohistochemical (IHC) differences, and to facilitate diagnostic difficulties. In our first case of epithelioid mesothelioma, the neoplastic cells showed cytokeratin 5/6 (CK5/6), calretinin, and Wilms-tumor-1 (WT1) expression, while remaining negative with thyroid transcription factor-1 (TTF-1). BRCA1 associated protein-1 (BAP1) negativity was seen in the neoplastic cells' nucleus, reflecting loss of the tumor suppressor gene. In the second case of biphasic mesothelioma, expression of epithelial membrane antigen (EMA), CKAE1/AE3, and mesothelin was observed, while WT1, BerEP4, CD141, TTF1, p63, CD31, calretinin, and BAP1 expressions were not detected. Due to the absence of specific histological features, the differentiation between MM subtypes could be a challenging task. In routine diagnostic work, IHC may be the proper method in distinction. According to our results and literature data, CK5/6, mesothelin, calretinin, and Ki-67 should be applied in subclassification.

Epithelial membrane antigen-reactive feline chordoid meningioma in a European wildcat (Felis silvestris)

Meningioma is the most frequent intracranial neoplasm in cats. Here we describe the first case of chordoid meningioma (CM), a rare grade II meningioma subtype, in a 5.5-year-old European wildcat (Felis silvestris) from a Swiss zoo. The wildcat was found dead after a clinical history of neurological signs and clinical suspicion of a carcinoma in the right external ear canal with concurrent chronic otitis. Post-mortem examination revealed a large intracranial, extra-axial and intradural neoplasm that invaded into the right ear canal and had histological features compatible with CM, which has been only reported in humans and dogs. Neoplastic cells expressed vimentin but were negative for glial fibrillary acidic protein, S100 and pancytokeratin. Immunohistochemistry revealed epithelial membrane antigen (EMA) expression in neoplastic cells. To the best of our knowledge, we provide the first evidence of EMA expression in feline meningioma.

Extranodal Mesenteric Follicular Dendritic Cell Sarcoma Expressing Keratin Antigens: What Pitfalls Initiate Diagnostic Clues.

Extranodal follicular dendritic cell sarcomas are infrequent diagnostically challenging tumors. Because of their rarity, heterogeneous histomorphologic features and variable histologic grades a significant number of extranodal lesions are prone to be misdiagnosed. Even though they have a characteristic immunoprofile, expression of a range of nonspecific markers is well documented. Even though they are typically negative for keratins, few authors have reported lesions expressing keratin. Keratin expressing tumors are more likely to be misinterpreted by pathologists further deterring their inclusion in the differential diagnosis. We report an intraabdominal mesenteric follicular dendritic cell sarcoma in a 44-year-old male that immunophenotypically expressed keratin antigens. The lesion showed a high-grade pleomorphic epithelioid appearance and the initial differential diagnosis included lymphoma, sarcomas, melanoma, and carcinomas. Follicular dendritic cell sarcoma was not considered. Expression of epithelial membrane antigen and keratin further deterred the diagnosis which was reached only after extensive use of immunomarkers. The tumor cells expressed CD21, CD23, and D2-40. Morphologically, the tumor showed some thymoma-like features with occasional TDT-expressing background T-lymphocytes. These features were hints to reconsider our differential diagnosis to include follicular dendritic cell tumors. Awareness of this aberrant staining of epithelial immunomarkers and attention to certain clues should encourage pathologists to consider this entity. Speculative assumptions may explain this unusual keratin expression in some lesions. The histomorphologic and immunohistochemical heterogeneity may suggest different variants and grades of follicular dendritic cell sarcomas. The prevalence, importance, and histogenesis of keratin expression in follicular dendritic cell sarcomas warrant further studies.

Clinicopathologic features of a patient with primary monophasic synovial sarcoma of the jejunum.

A case of primary synovial sarcoma of the jejunum was collected and analyzed retrospectively. A 19-year-old man who presented to hospital with abdominal pain. The CT scan showed a large mixed abdominal mass with bleeding. Laparotomy revealed that the tumor originated from the jejunum, accompanied by rupture and hemorrhage. Microscopically, the tumor was composed of spindle cells. The tumor cells demonstrated diffuse expression of vimentin, transducin-like enhancer (TLE)-1, B-cell lymphoma protein (Bcl)-2, CD99 and focal expression of epithelial membrane antigen (EMA). The presence of specific SS18 gene rearrangement was confirmed in tumor cells. The patient received 6 cycles of chemotherapy after jejunal tumor resection. And 12 months later, the patient presented pancreatic metastasis and had radiotherapy. The patient died 15 months after the diagnosis.

The role of epithelial membrane antigen (EMA) overexpression in the prognosis of prostatic adenocarcinoma.

Prostatic adenocarcinoma is the second-most common cancer in men and the fifth most common cause of cancer death. Its incidence increases with age; 75% of patients are 65 years and older. The aim of the study was to assess epithelial membrane antigen (EMA) expression in prostatic adenocarcinoma as a poor prognostic marker and its correlation to some pathological parameters. The formalin-fixed, paraffin-surrounded tissue blocks were retrospectively collected from 40 men diagnosed with prostate carcinoma. All cases were collected from Al Hilla Teaching Hospital and some private labs between October 2018 – November 2020, with ages ranging from 30–89 years. Statistical analysis was done using SPSS 22, frequency and percentage were used for categorical data, and Chi-square was used to evaluate connotation between variables. P-value ≤0.05 was significant. The blocks were sectioned for EMA immunohistochemical staining using monoclonal mouse anti-human EMA protein. EMA protein overexpression was detected in 75% (n=30/40) of prostatic adenocarcinoma cases. EMA expression showed no correlation with the patient's age (P=0.09) and a positive correlation with the cancer grade (P=0.003). In prostatic adenocarcinoma patients, EMA could be seen as a potential prognostic predictor for disease progression.

Expression of epithelial membrane antigen and cytokeratin among Indian workers exposed to cotton fibre dust in textile industries.

In India, around 20 million workers are engaged in the textile industries. However, the prevalence of byssinosis has been little reported. To determine the prevalence of byssinosis and other respiratory disorders among workers exposed to cotton dust in textile mills in Delhi, India. Sputum samples were collected from 156 workers employed in 15 cotton textile mills, and expression of epithelial membrane antigen (EMA) and cytokeratin (CK) marker proteins was investigated. Information regarding respiratory symptoms, certain personal characteristics and occupational history was also gathered. Symptoms were observed in 56.41% of the workers. Expression of EMA and CK was observed in 27.5% and 50% of the workers, respectively. Expression of EMA and CK was significantly associated with smoking and duration of employment. Measures are needed to reduce dust levels in the workplace, and to discourage smoking and alcohol consumption among the textile workers.

CD13 is a useful tool in the differential diagnosis of meningiomas with potential biological and prognostic implications

Meningiomas are common tumors of the central nervous system. Although their histological diagnosis is usually straightforward, their differential diagnosis versus other tumors may be challenging at times. The objective of this study is to assess the diagnostic value of CD13 immunoexpression in the differential diagnosis between meningiomas and their morphological mimics. Immunohistochemical analysis for CD13, epithelial membrane antigen, SOX10, and STAT6 was carried out in a large cohort of primary meningeal tumors comprising 225 meningiomas, 15 schwannomas, and 20 solitary fibrous tumor/hemangiopericytomas. Within the meningioma group, the expression of CD13 and epithelial membrane antigen was distinguished in three categories using a semiquantitative score. Most of meningiomas expressed CD13 (94%) and epithelial membrane antigen (96%) while none of the schwannomas nor of the solitary fibrous tumor/hemangiopericytomas was positive for either the two markers. Diffuse positivity for CD13 and epithelial membrane antigen was more common in low-grade meningiomas than in anaplastic ones, which were also more often negative for such markers, especially for CD13 (32%). CD13 is a helpful immunohistochemical marker for the differential diagnosis of meningiomas and their mimics, achieving in combination with epithelial membrane antigen maximal sensitivity (100%) and showing statistically relevant difference of expression in comparison with both schwannomas (p < 0.0001) and solitary fibrous tumor/hemangiopericytomas (p < 0.0001). Furthermore, loss of CD13 expression could be related to outcome as it is associated with worrisome histological findings, mainly in the setting of anaplastic meningiomas.

A study of epithelial-mesenchymal transition immunohistochemical markers in primary oral squamous cell carcinoma

To analyze markers of epithelial-mesenchymal transition (EMT) in oral squamous cell carcinoma (SCC) using E-cadherin, epithelial membrane antigen (EMA), vimentin, and smooth muscle actin (SMA), and their association with tumor metastasis and grade. This was a retrospective study, which included 45 diagnosed cases of primary oral SCC with known lymph node status, taken from the archives of the Department of Pathology along with their clinical profile. Histomorphologic evaluation and immunohistochemical (IHC) analysis for E-cadherin, EMA, vimentin, and SMA were performed. IHC expression of these markers was compared with tumor differentiation as well as lymph node metastasis. We observed that reduced E-cadherin expression and positive expression of SMA were significantly higher in tumors having lymph node metastasis and loss of tumor differentiation, respectively. Reduced EMA expression was associated with the presence of lymph node metastasis but not with the histologic differentiation. Vimentin positivity did not show any correlation with lymph node metastasis or histologic differentiation. This study emphasizes the importance of EMT in the pathogenesis of oral SCC. The use of biomarkers like E-cadherin, EMA, and SMA might be a valuable tool for predicting patient outcomes and therapy.

Coexisting Metastatic Papillary Carcinoma Thyroid and Clear Cell Neuroendocrine Tumour in Thyroid- A Rare Case Report

Coexisting Metastatic Papillary Carcinoma Thyroid and Clear Cell Neuroendocrine Tumour in Thyroid- A Rare Case Report

Diagnostic utility of BRCA1-associated protein 1 (BAP1), Programmed Cell Death4 (PCD4) and Epithelial membrane antigen (EMA) expression in differentiation of malignant mesothelioma from reactive mesothelial cell hyperplasia in both cytology and cell block

Background: Malignant pleural mesothelioma (MPM) is the most lethal tumor arising from the mesothelial cells. Sometimes, it is difficult to be diagnosed based on morphology alone as reactive mesothelial hyperplasia (RMH) and some metastatic carcinomas may be confused with mesothelioma. Aim of the study: Our study aims to evaluate diagnostic utility of BRCA1 “Breast Cancer gene” associated protein-1 (BAP1), Programmed Cell Death (PCD4), and Epithelial membrane antigen (EMA) in differentiation of malignant mesothelioma (MM) from reactive mesothelial hyperplasia (RMH) by immunohistochemistry (IHC).Material and methods: Retrospective study, include 60 patients, was carried out in Chest and Pathology Departments of Zagazig University from October 2016 till August 2020. The expression levels of BAP1, PCD4and EMA were investigated using cytological analysis compared with cell block method in all cases of MPMs and RMHResults: BAP1loss was detects malignant mesothelioma confirmed by cytology in 19 out of 20 patients with sensitivity of 95%, specificity 92.5%, PCD4 was positive in 39 out of 40 patients of RMH and can diagnose reactive mesothelioma with a sensitivity of sensitivity of 85.7%, specificity 100%. EMA was positive 95% in MM confirmed by cytology and can diagnose malignant mesothelioma with a sensitivity of 95%, specificity 97.5%. Conclusion: Increased sensitivity of diagnosis by cell block method was observed in cases that were reported as reactive mesothelial hyperplasia by conventional smears. BAP1 loss, negative PCD4 immunostaining and positive EMA favor mesothelioma.Keywords: BAP1, PCD4, EMA, malignant mesothelioma.

Histomorphological and immunophenotypical spectrum of cutaneous myoepitheliomas: A series of 35 cases.

Myoepithelial tumors comprise a group of mesenchymal lesions that show heterogeneous histomorphological features, including dual epithelial, neural, and myoid differentiation. Cutaneous myoepithelioma is a rare neoplasm that is composed primarily of myoepithelial cells and represents one end of a histopathological spectrum of cutaneous myoepithelial neoplasms including chondroid syringoma and myoepithelial carcinoma. These tumors display a wide histopathological spectrum and immunophenotypical profile often showing epithelial and myoepithelial differentiation. In this series, we studied 35 cases of cutaneous myoepitheliomas. Our cases highlighted the broad histopathological range where most cases showed a non-infiltrative and non-encapsulated tumor exclusively located in the dermis and with no subcutaneous involvement. The majority of our cases had a solid growth pattern (syncytial pattern) and the remainder of cases had a multinodular growth pattern. The tumor cells were epithelioid in 23 cases, spindled in eight cases and there was a mixture of epithelioid and spindled cells in four cases. Mitotic figures ranged from 0 to 5 per 10 HPF. By immunohistochemistry epithelial membrane antigen (EMA) was expressed in 59% of cases S100 was positive in 88% of cases, CAM 5.2 was positive in 16% of cases, AE1/AE3 was positive in 44% of cases, p63 was positive in 17% of cases, smooth muscle actin was positive in 38% of cases, desmin was positive in 6% of cases, calponin was positive in 22% of cases, and glial fibrillary acidic protein was positive in 36% of cases. In addition, there were five cases without EMA, keratin, or p63 expression that only showed S100 expression. We describe a large series of cutaneous myoepitheliomas delineating their histomorphological spectrum and immunophenotypical profile. Awareness of some of the unusual histopathological features and the heterogeneous immunohistochemical may pose difficulties for the diagnosis.

Immunohistochemical expression of Olig2, CD99, and EMA to differentiate oligodendroglial-like neoplasms.

This study has assessed the diagnostic ability of oligodendrocyte-2 (Olig2), CD99, and epithelial membrane antigen (EMA) immunohistochemical stains to diagnose oligodendroglial-like neoplasms as central neurocytoma, ependymoma, or oligodendroglioma. An immunohistochemistry (IHC) panel of Olig2, EMA, and CD99 was performed on 18 central neurocytomas, 46 ependymomas, and 28 oligodendrogliomas. Aquantitative labelling index of stained tumor cells was assessed using ascoring system, and its diagnostic predictability was evaluated with multinomial logistic regression. Significant differences in IHC expression patterns were observed between all tumor groups (p < 0.001). The labeling indices of the histochemical expression of Olig2, EMA, and CD99 were related to diagnostic predictability. Olig2 was unlikely to differentiate ependymoma from central neurocytoma (p = 0.154), while EMA and CD99 were significant in diagnosing these two tumors (p < 0.05). Olig2 was aspecific marker of oligodendroglioma, differentiating it from ependymoma and central neurocytoma (p 0.05), but CD99 significantly differentiated ependymoma from oligodendroglioma (p = 0.022). These labelling indices were used to re-assess the diagnostic accuracy, regardless of tumor location and histology, and yielded significantly different tumor diagnoses. The IHC panel of Olig2, EMA, and CD99 should be used to differentiate oligodendroglial-like neoplasms. Olig2 is aspecific IHC marker to diagnose oligodendroglioma and differentiate it from ependymoma and central neurocytoma. Lack of Olig2 expression rules out oligodendroglioma and suggests the diagnosis of ependymoma rather than central neurocytoma if the EMA labelling index shows diffuse/partial expression. CD99 is considered asensitive marker for ependymoma but not central neurocytoma.

Spindle cell carcinoma of the parotid- A rare case entity with review of literature

Spindle cell carcinoma of the salivary gland is very rare. Spindle cell carcinoma is a variant of squamous cell carcinoma with an aggressive course. We present a rare case of spindle cell carcinoma of the parotid in a54-year-old male, who presented with a rapidly enlarging mass in the right parotid gland. Histopathologically, the tumour was composed of foci of squamous cell carcinoma with sheets of malignant squamoid cells and spindle cell sarcoma with scattered pleomorphic, plump to spindle- shaped cells with foci of bone formation. Immunohistochemical studies revealed cytokeratin positivity and vimentin negativity in the squamous cell carcinoma component with focal positivity for epithelial membrane antigen and negative expression of cytokeratin and vimentin positivity in the sarcomatoid component. A final diagnosis of primary spindle cell carcinoma of the parotid gland was given. Our patient is alive and well with no clinical or radiological evidence of recurrence or metastatic disease after 12 months of follow up period.

Retinal Ependymoma: A Rare Extra-Axial Presentation

Abstract Introduction/Objective Ependymomas are well-demarcated and slow-growing neuroepithelial neoplasms that comprise 3–9% of primary CNS tumors. The vast majority of ependymomas arise either intracranially, mostly in children, or in the spinal cord and are associated with ependymal lining. Histologic hallmarks are perivascular pseudorosettes, ependymal rosettes and alternating zones of nuclear crowding and nuclear free zones composed of coarse cell processes. In high grade ependymomas increased mitoses, necrosis and nuclear pleomorphism may be seen. Methods We present the case of a 63-year-old woman in with a past medical history of retinopathy of prematurity, glaucoma and right eye enucleation. She presented with a painful blind left eye refractory to medical treatment and subsequently underwent left eye enucleation. Results On histologic examination, an incidental retinal ependymoma was identified. The neoplastic cells were fusiform and had long coarsely fibrillar cell processes. Characteristic periodicity of nuclear crowding and scarcity was observed. In places, neoplastic cell processes extended radially to delicate and sometimes hyalinized blood vessels, forming so-called perivascular pseudorosettes. Definite ependymal rosettes were not recognized in the examined sections. Stigmata of chronicity were found, such as ischemic type necrosis, blood vessels with dystrophic calcifications and foci of ossification replete with fibroadipose tissue in the marrow spaces. The neoplastic cells labeled with antibodies against glial fibrillary acidic protein (GFAP), thus confirming glial lineage in the neoplastic cell. Additionally, there was scattered intracytoplasmic expression of epithelial membrane antigen (EMA) in a dot-like or circular pattern. The latter is well described in ependymomas and often used to support the diagnosis. Conclusion Ependymomas rarely occur at extracranial sites, such as the chest, abdomen and pelvis. We are presenting the fourth case of retinal ependymoma reported in literature. The tumor had classical immunomorphologic findings.

Immunoexpression of epithelial membrane antigen in canine meningioma: Novel results for perspective considerations.

Epithelial membrane antigen (EMA) is one of the most widely used diagnostic immunohistochemical markers for human meningioma. To date, no published study on EMA expression in formalin-fixed paraffin-embedded (FFPE) tissue samples of canine meningioma is available. Here, we describe the results of an immunohistochemical study on 25 FFPE canine meningiomas using a monoclonal anti-human EMA antibody. All meningiomas showed positive staining for EMA with cytoplasmic pattern, in nine cases associated with membranous staining. Area and intensity of staining were highly variable among cases. No clear relationships between tumour subtype/grade and area/intensity of staining were found. However, epithelial-like patterns showed a higher affinity for EMA compared to the mesenchymal one. The present study provides the basis to explore the potential diagnostic application of this marker in canine meningioma. To investigate EMA expression in other central nervous system tumours of dogs are necessary to assess the specificity of this marker.

Epithelial Membrane Antigen in Papillary Thyroid Carcinoma and Multinodular Goiter; a Marker of Discrimination

Background: Papillary thyroid cancer is the most common type of thyroid malignancies. For a more accurate diagnosis, immunohistochemistry has been used widely in recent years. Epithelial membrane antigen has been detected in several benign and malignant lesions, and its use as a marker of malignancy has been sought in some studies. Objectives: The current study aimed to determine the presence and level of expression of epithelial membrane antigen in papillary thyroid carcinoma and multinodular goiter. Methods: Eighty-five samples of papillary thyroid carcinoma and 40 cases of multinodular goiter were stained histochemically for epithelial membrane antigen. The intensity of staining was classified in a semi-quantitative manner (1+ to 4+). Demographic data of the index cases, history of metastasis, and lymph node involvement, if any, were collected as well. Results: All PTCs and 87.5% of MNGs were positive for EMA. EMA was expressed more strongly in PTCs than in MNGs (P &lt; 0.00). EMA reactivity was directly associated with lymph node involvement, capsular invasion, and size of the tumor (P = 0.008, P &lt; 0.001, and P &lt; 0.001, respectively). The intensity level of 2 or higher had high specificity for differentiating PTC from MNG. Conclusions: Strong expression of EMA may be a good marker of malignancy in differentiating PTC from MNG. This marker may also be regarded as an index of invasive behavior of PTC.

Perineal mass in a 50-year-old man

A man in his fifties presented with a lump in his left anal/perineal region, which was clinically thought to be a lipoma and was excised. No preoperative imaging was available....