Multinodular Appearance Research Articles

Morphological and Immunohistochemical Characterization of an Oral Metastatic Carcinosarcoma in a Cat

A 15-year-old neutered male mixed breed Domestic Shorthair cat was presented for a rapidly growing, intraoral soft gingival mass on the left mandibular region. The neoplastic tissue consisted histologically of two distinct malignant cell populations: spindle cells arranged in bands and epithelioid cells arranged in cords. A few multinucleated giant cells were scattered among the neoplastic cells. Spindle cells and multinucleated giant cells strongly expressed vimentin while epithelial cells strongly expressed pancytokeratins. On the basis of the histological and immunohistochemical results, a diagnosis of oral carcinosarcoma was made. After 2 months, due to the extent of disease and poor prognosis, the cat was euthanized. Necropsy revealed a markedly enlarged, multilobulated white-pink neoplastic mass that had originated from the left side of the sublingual region and involved the coronoid process of the left mandibular bone. The cut surface of the enlarged left submandibular lymph node was glistening, whitish-tan in colour with a multinodular appearance, suggestive of metastasis and confirmed by histological examination. Oral carcinosarcoma is uncommonly recorded in humans and dogs and, to the best of our knowledge, this is the first reported case in a cat.

1053 Primary Acinic Cell Carcinoma in a Young Female: A Case Report

Abstract Background Acinic cell carcinoma (ACC) is a rare, low-grade tumour, accounting for about 5% of all primary salivary gland malignancies. ACCs predominate in the parotid gland, seen in the fifth and sixth decades of life and has a female predilection. Well-differentiated and low-grade tumours are associated with a favourable prognosis. Case Description We report a case of a 16-year-old female, presenting with a right parotid lump, slowly increasing over the last year. Clinical examination revealed a 1.5cm right parotid nodule with no facial nerve involvement and presence of cervical lymphadenopathy. Past medical history was unremarkable. Findings Radiological investigations revealed a well-circumscribed lobulated lesion in the anterior right parotid gland with presence of reactive lymph nodes bilaterally. Differential diagnoses included Warthin's tumour, which would have been unusual in this age group, and the patient underwent a right partial parotidectomy. Histological examination showed a multinodular appearance with some marked granular cytoplasm with oncolytic and lymphoid infiltrate. Immunohistochemistry was negative for S100, positive with DOG-1. There were widespread PAS-D-resistant granules throughout the tumour cells, with ki67 proliferation index of approximately 5%. Results The tumour was completely excised, and the patient made a full recovery and considered to have a good long-term prognosis. Conclusion This is an unusual case of ACC seen in this age group and gender, where less than 4% of cases of ACC have been reported in patients younger than 20. It is important to consider differential diagnoses of salivary gland pathology, such as ACC in the young female patient.

Infiltrating mammary carcinoma in a cat with a congenital disorder: prognostic interest of histological examination

This report describes the handling and clinical evolution of a malignant feline mammary carcinoma (FMC) in an eight-year-old female crossbred cat with a congenital disorder. Hence, the efficacy of tumor mass removal and the case prognosis was established by postoperative routine histological examination. A 6 cm diameter lump in the left thoracic mammary gland of multinodular appearance and purulent exudate with a reddish hue was excised after the entire mastectomy. The histopathological analysis showed the presence of numerous lymphovascular tumor emboli and frequently mitotic cells with hyperchromatic nuclei. These were consistent with an aggressive malignancy with a poor prognosis explaining the patient's death within 7 weeks after surgery. Histology and cytology findings are of critical importance to clinicians in the management of the most common mammary malignancies in cats, to provide the best possible relief to animals with life-threatening cancer. It could also serve as a cancer model for advancing knowledge in congenitally affected humans.

Plexiform Schwannoma at an Unusual Site Involving the Angle of Mouth

Plexiform schwannoma (PS) is a rare benign encapsulated peripheral nerve sheath tumor characterized by a plexiform pattern of intraneural growth often with a multinodular appearance. It usually presents as a solitary mass with a strong predilection for young adults between 20 and 50 years. Despite its common presentation in the head and neck region, involvement of the lip is extremely rare. Multiple cutaneous PSs are commonly associated with Neurofibromatosis type 2 or Schwannomatosis. To date, only a few cases of PS involving the lip have been reported. Here in we report another unusual case of PS involving the angle of mouth which was removed completely by surgical excision without any recurrence seen at 1-year post-surgery.

PRIMARY ACINIC CELL CARCINOMA IN A YOUNG FEMALE PATIENT: A CASE REPORT

<h3>Background</h3> Acinic cell carcinoma (ACC) is a rare, low-grade tumor, accounting for about 5% of all primary salivary gland malignancies. ACCs predominate in the parotid gland, are seen in the fifth and sixth decades of life, and have a female predilection. Well-differentiated and low-grade tumors are associated with a favorable prognosis. <h3>Description</h3> We report a case of a 16-year-old female patient presenting with a right parotid lump that had been slowly increasing over the past year. Clinical examination revealed a 1.5-cm right parotid nodule with no facial nerve involvement and presence of cervical lymphadenopathy. Her past medical history was unremarkable. <h3>Findings</h3> Radiological investigations revealed a well-circumscribed, lobulated lesion in the anterior right parotid gland with presence of reactive lymph nodes bilaterally. Fine-needle aspiration showed granular cells with a differential diagnosis of oncocytoma, Warthin's tumor, or acinic cell carcinoma. Histologic examination showed a multinodular appearance with some marked granular cytoplasm with oncolytic and lymphoid infiltrate. The results of immunohistochemistry were negative for S100 and positive with DOG-1. There were widespread periodic acid-Schiff diastase-resistant granules throughout the tumor cells, with a Ki67 proliferation index of approximately 5%. <h3>Outcome</h3> The tumor was completely excised, and the patient made a full recovery and was considered to have a good long-term prognosis. <h3>Conclusions</h3> This is an unusual case of ACC seen in this age group and gender, where less than 4% of cases of ACC have been reported in patients younger than 20. It is important to consider differential diagnoses of salivary gland pathology, such as ACC, in the young female patient.

Atypical pulmonary alveolar proteinosis - A diagnostic challenge

Pulmonary alveolar proteinosis (PAP) is a rare syndrome, characterized by ground‑glass opacities associated with reticulations giving a characteristic crazy paving appearance which is diagnostic but not pathognomonic in imaging. A 47-year-old male presented with breathlessness and dry cough. Arterial blood gas (ABG) showed hypoxemia and respiratory alkalosis with Alveolar- arterial (A-a) O gradient of 82. HRCT thorax suggestive of crazy paving pattern along with solitary nodules of low density in right upper and lower lobes giving suspicion of malignancy with secondary PAP. The clinical probability of malignancy was moderate hence surgical lung biopsy was performed which suggested PAP. Granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibody concentration was 118.7mcg/ml suggestive of autoimmune PAP. Patient was treated with inhalational GM-CSF with significant clinical response ((A-a) O gradient improved to 24). Though crazy paving is characteristic for PAP, speculated low density atypical multi nodular appearance may also be possible which mandates biopsy for confirmation.

Gross mucinous multinodular appearance aids in the identification of ovarian metastases in low-grade appendiceal mucinous neoplasms during intraoperative consultation

Ovarian metastases of low-grade appendiceal mucinous neoplasms (LAMNs) show grossly abundant nodular mucous cells, with a gross mucinous multinodular appearance and a histological resemblance to primary ovarian mucinous tumors (POMTs). This study aimed to elucidate the utility of gross features including the gross mucinous multinodular appearance and available clinical information at the time of intraoperative consultation, in distinguishing the ovarian metastases of LAMNs from POMTs or the ovarian metastases of colorectal cancer (CRC). In total, 776 patients with primary ovarian tumor and 68 patients with ovarian metastases underwent intraoperative consultation during 1998–2018. Of the total cases, 4 ovarian metastases of LAMNs, 19 ovarian metastases of CRC, and 50 POMTs (36 borderline tumors and 14 carcinomas) were identified. The gross features including the gross mucinous multinodular appearance were analyzed based on the gross photographs obtained before formalin fixation and the available clinical information collected during intraoperative consultation. The analysis indicated that the ovarian metastases of LAMNs significantly presented with gross mucinous multinodular appearance (4/4 vs. 0/50, P < 0.0001), extraovarian disease (4/4 vs. 2/50, P < 0.0001), ovarian surface involvement (3/4 vs. 2/50, P = 0.0016), and abnormal appendix (4/4 vs. 0/50, P < 0.0001) as compared to POMT. Moreover, the gross mucinous multinodular appearance was a distinguishable feature between the ovarian metastases of LAMNs and ovarian metastases of CRC (4/4 vs. 0/19, P = 0.0001). Based on these results, we proposed an algorithm to diagnose ovarian tumors using the gross mucinous multinodular appearance. Thus, recognizing unique gross features including the gross mucinous multinodular appearance would be useful for both pathologists and surgeons to accurately diagnose ovarian metastases of LAMNs during intraoperative consultation.

SUN-608 A Rare Miliary Tuberculosis-Like Presentation of Papillary Thyroid Cancer: A Case Report with Literature Review

Papillary thyroid cancer (PTC) is the most common thyroid cancer with a very favorable prognosis [1]. It commonly presents as a palpable thyroid nodule or an incidental finding of thyroid nodule(s) seen on imaging. The most common site of metastases in PTC is lung, however, the incidence is very low. Presence of metastasis can drastically affect the prognosis of PTC [2]. We discuss here a case of an asymptomatic 34-year-old male, who initially presented with positive tuberculin skin test and was found to have diffuse micronodular pulmonary disease on chest imaging. Initially being diagnosed with pulmonary TB, he received 6 months of empiric anti-tuberculous therapy, although, repeated sputum and blood cultures for acid-fast bacilli remained negative. However, patient had no improvement of pulmonary lesions on interval imaging. Another interesting incidental finding, seen on lung CT, was the presence of multinodular appearance of the thyroid gland which prompted further imaging of the neck. CT scan of the neck showed multiple enhancing necrotic masses in the right thyroid gland with similar lesions in cervical lymph nodes. Considering the patient’s preliminary diagnosis of pulmonary TB, these lesions were thought to be secondary to tuberculosis. However, given that different types of thyroid malignancies can have a similar presentation, further workup was initiated. Subsequent FNA was positive for PTC on the right thyroid nodule. A total thyroidectomy with neck dissection was performed and confirmed the presence of a 2 cm PTC with cervical lymph node metastases. Post-operative non-stimulated thyroglobulin was very high at 2858. Thyroglobulin antibody was negative. The post radioactive iodine therapy (RAI) whole body scan (WBS) showed impressive bilateral lung uptake. Widespread pulmonary nodules, similar to that seen in miliary TB, is a rare initial presentation of PTC. However, as our case highlights, the added presence of thyroid nodules should prompt further investigation to rule out PTC as the cause of pulmonary lesions. 1. Aschebrook-Kilfoy, B., et al., Thyroid cancer incidence patterns in the United States by histologic type, 1992-2006. Thyroid, 2011. 21(2): p. 125-34. 2. Lang, B.H., et al., Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg, 2007. 245(3): p. 366-78.

Multicentric intrahepatic cholangiocellular carcinoma in a budgerigar (Melopsittacus undulatus): a case report

Cholangiocarcinoma or intrahepatic bile duct carcinoma is a malignant neoplasm of biliary epithelium which occurs mainly in wild animals rather than domestic ones. An adult 4-year-old male budgerigar was referred with symptoms of lethargy, decreased activity, and vomiting with undigested food in feces. Supportive care was tried for 3 months, but the bird did not show any signs of recovery and was finally euthanized. Necropsy revealed hepatomegaly in one lobe of the liver while the other lobe was dwindled. The remaining large lobe had a multinodular appearance with white to gray, non-umbilicated foci ranging from 2 mm to 3 cm in diameter which was scattered throughout the parenchyma. The histopathological examination revealed multiple foci or masses of less differentiated cholangiocellular carcinoma. The large tumor masses had tubular, acinar, and solid arrangements with a center of necrosis. The masses were composed of neoplastic cells of biliary epithelium similar to the normal cuboidal ductal lining cells with moderate eosinophilic cytoplasm and round to oval vesicular nuclei. Multinuclear tumor giant cells were not seen; however, karyomegaly was rarely observed and infrequently in some foci. Based on histopathological characteristics, multicentric intrahepatic cholangiocellular carcinoma was confirmed. It seems that the probable cause of the tumor in this bird was chronic exposure to toxins such as aflatoxins.

Clinical and pathological aspects of idiopathic pulmonary fibrosis in cats

ABSTRACT: Interstitial lung diseases are a group of diffuse parenchymal lung diseases that include interstitial lung fibrosis. The aim of this study is to characterize the clinical and pathological findings of idiopathic pulmonary fibrosis in three cats and to investigate possible etiological agents through bacteriological and mycological exams and immunohistochemistry. All three cats were female and aged from 10 to 14 years old, they presented with a clinical history of weight loss and dyspnea. The radiographic changes were similar in all cats and included increased pulmonary radiopacity with a mixed bronchointerstitial pattern progressing to an alveolar pattern. Two cats died during lung biopsy procedures. At necropsy, the lesions were limited to the pulmonary parenchyma and were firm, hypocrepitant with a multinodular appearance on the pleural surface; they failed to completely collapse when the thorax was opened. In the pleural region, there were multifocal star-shaped scarring lesions, with parenchymal retraction. Microscopically, all three cats had multifocal-to-coalescing fibrosis, type II pneumocyte hyperplasia, hypertrophy or hyperplasia of the smooth muscle tissue of terminal bronchioles and an accumulation of macrophages within the alveolar spaces. There was no growth on bacteriological or mycological cultures, and the immunohistochemical evaluations for the presence of viral etiological agents (FIV, FeLV, FCoV, FCV and FHV-1) were also negative.

Microcystic/reticular schwannoma of the adrenal gland: a case report and literature review

Microcystic/reticular schwannoma is a recently described, rare, distinctive histological variant of schwannoma with a predilection for the gastrointestinal tract [1]. Unlike classic Schwannoma, most microcystic/reticular Schwannoma had an incomplete fibrous capsule, two distinctly different areas - hypercellular areas and myxoid areas, Microcystic/reticular schwannoma occurs in the internal organs, especially in the digestive tract and a rare case occurs in the adrenal glands [1–3]. Herein, we report a case of microcystic/reticular schwannoma of the adrenal gland, in a 60-year-old male with 7.0 cm × 6.0 cm × 5 cm mass in the left adrenal gland. The tumor showed a vague multinodular appearance with a pushing border and arranged in a microcystic and reticular growth pattern with anastomosing and intersecting strands of spindle cells in a myxoid or collagenous/hyalinized stroma. Tumor cells showed diffuse nuclear and cytoplasmic positivity for S-100.

An analysis of clinical characteristics of twelve cases of mesenteric panniculitis

Objective: Mesenteric panniculitis is an idiopathic, uncommon disease involving the adipose tissue of mesentery. The etiology, diagnosis and treatment are still unnoticed. We thus reported a case series to improve the understanding of this rare disorder. Methods: We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation, diagnosis, treatment and prognosis. Results: We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis. The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12). Physical examination was unremarkable in the majority of patients (8/12). C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients. CT findings were of much diagnostic value. All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density. Pseudo-capsule sign (8/12) and fat halo sign (6/12) were common. Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis. Six cases all received prednisone, 2 with combined cyclophosphamide, 1 with azathioprine, 1 with tripterygium wilfordii. Short-term clinical response was achieved in all cases, but two patients relapsed. Conclusions: Mesenteric panniculitis occurs predominantly in middle-aged and elderly. Abdominal pain is the leading symptom. Inflammatory markers are often normal while computed tomography is the most important diagnostic tool. Surgery combined with cortical steroid and immunosuppressant agents is effective.

COMPARISONS AMONG COMPUTED TOMOGRAPHIC FEATURES OF ADIPOSE MASSES IN DOGS AND CATS.

A better understanding of the CT features of different forms of canine and feline adipose tumors would be valuable for improving patient management and treatment. The purpose of this retrospective, cross-sectional study was to describe and compare the CT features of pathologically confirmed lipomas, infiltrative lipomas, and liposarcomas in a sample of canine and feline patients. A total of 50 animals (46 dogs, four cats) and a total of 60 lesions (23 lipomas, 20 infiltrative lipomas, and 17 liposarcomas) were included in the study. Lipomas appeared as round to oval-shaped (n = 21), well-marginated (n = 20) fat-attenuating lesions. Infiltrative lipomas appeared as homogeneous, fat-attenuating masses but, unlike lipomas, they were most commonly characterized by an irregular shape (75%; P < 0.001), and linear components, hyperattenuating relative to the surrounding fat (100%; P < 0.05). Liposarcomas were represented exclusively by heterogeneous lesions with soft tissue attenuating components with a multinodular appearance (76.5%; P < 0.05). Regional lymphadenopathy (n = 10) and amorphous mineralization (n = 4) were also observed in association with liposarcomas. Computed tomography can provide useful information regarding disease location, extent, and involvement of the adjacent structures. Tumor definition and shape were the most useful parameters to differentiate between lipomas and infiltrative lipomas. The presence of a heterogeneous mass, with a multinodular soft tissue component and associated regional lymphadenopathy and mineralization, were features favoring a diagnosis of liposarcoma.

Multinodular thyroid gland hypertrophy in a camel

This case report include the clinical, haematology, radiology, ultrasound and cytology results of the multinodular thyroid hyperplasia in a camel. A fourteen-year-old, Tulu breed, male camel was presented with the complaint of respiratory sounds and gradually enlarging a swelling under the neck for one year. Clinical examination revealed a massive swelling, which was bilateral, symmetric, and located ventral and 1/3 cranial part of the neck and suspected to be the cause of the respiratory sounds. Routine haematology of the camel was normal but thyroid function tests had low TSH, high level T3 and T4. Radiology revealed peritracheal soft tissue opacity and tracheal deviation. Ultrasonographic examination revealed the heterogenic mass and numerous different echogenities (anechoic, hyperechoic) in the parenchyma (multinodular appearance). Ultrasound guided fine needle aspiration and then cytology was performed. Cytology pointed to thyroid hyperplasia. Iodine therapy was planned. After two months, the swelling regressed to about 30% rate and abnormal respiratory sounds also disappeared.

Nadir Görülen Üst Dudak Kitlesi: Schwannoma

Schwannomas are benign lesions of the peripheral nerve sheath. There are only a few cases of upper lip schwannomas in the literature. A male patient 23 years old, admitted to our clinic with mobile, non-tender, and 2x2 cm sized lip swelling. The mass was excised and the histological diagnosis was consistent with a schwannoma. Multinodular appearance was detected on microscopic evaluation. Most of the lip swellings are treated like a mucocele in outpatient clinics but the specimen should be examined carefully to differentiate the possible diagnosis.

Matrix-producing metaplastic carcinoma: a clinicopathologic and prognostic analysis of 16 cases with review of literature

To study the clinicopathologic features, immunophenotype and prognosis of matrix-producing metaplastic carcinoma (MPC). Sixteen cases of MPC diagnosed between 2002 and 2012 in West China Hospital were identified. The clinicopathologic features were analyzed. Immunohistochemistry for E-cadherin, S-100 protein, CK5/6, HCK, PCK, CK7, CK8, p63, SMA, EMA, CD99, MSA, CK14, EGFR, ER, PR, HER2 and Ki-67 was performed with EnVision method. The clinical outcome was evaluated and compared to matched controls of invasive ductal carcinoma. All patients were women and ranged in age from 29 to 69 years (median age 48 years). The median size of primary tumor was 4 cm. Most of the tumors were well-circumscribed with expansile and multinodular appearance. Histology showed invasive carcinoma with a direct transition from carcinoma to cartilaginous/chondromyxoid matrix without an intervening spindle cell component. Tumor distribution was either nodular or diffuse. The matrix component accounted for 10%-80% of the tumor volume. All the tumors were strongly positive for S-100 protein and basal-like cytokeratin with triple negative phenotype (ER, PR and HER2 negative). Alcian blue stain was positive for the cartilaginous/chondromyxoid matrix. Compared with invasive ductal carcinoma, patients with MPC had increased locoregional recurrence (P = 0.010), increased distant recurrence (P = 0.011) and shorter disease-free survival (P = 0.017). MPC is a rare variant of mammary metaplastic carcinoma with unique characteristics of morphology and immunohistochemical staining pattern. This subtype seems to have aggressive biologic behavior.

Low-grade myxofibrosarcoma following a metal implantation in femur: a case report

Myxofibrosarcoma is a myxoid variant of malignant fibrous histiocytoma that most commonly involves the extremities of elderly people. However, a primary myxofibrosarcoma with bone invasion in young adults is extremely rare. Herein, we report the case of a 31-year-old male with a gradually enlarging left thigh mass, who had a history of left femur fracture and received an open reduction and internal fixation with titanium alloy plates and screws 33 months previously. Imaging investigations revealed an irregularly shaped soft tissue mass around the left femur shaft and a partial bone defect in the middle one-third of the left femur. Pathological examination of the resected specimen showed a multi-nodular appearance, abundant myxoid matrix and elongated curvilinear capillaries. Immunohistochemical studies revealed that the tumor cells was positive for VIM and MDM2, and was negative for CK, MSA, SMA, DES, S-100 and CD34. Labeling index of Ki-67 was 25%. Based on the morphological finding and immunostaining, it was diagnosed as a low-grade myxofibrosarcoma. The clinical and imaging examinations did not reveal the evidence of a primary cancer elsewhere, and the patient had no personal or family history of malignancy. To our knowledge, this is the first case of a primary myxofibrosarcoma developed following a fracture and metal implantation in young adults.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1745984882113605

Cotyledonoid Dissecting Leiomyoma of the Uterus with Intravascular Luminal Growth: A Case Study

Here, we report the case of a 43-year-old female who was diagnosed with a cotyledonoid dissecting leiomyoma (CDL) of the uterus. CDL is a recently described and extremely rare variant of a benign leiomyoma that can grossly masquerade as a malignancy. The 13-cm sized tumor was located primarily on the extrauterine surface as an intrauterine continuity, which showed dark red, congested, bulbous protuberances. It was multinodular appearance, encasing the bilateral adnexae and the left iliac vein. Microscopically, the nodules were separated by extensive hydropic degeneration. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. They also showed an intravascular luminal growth pattern. CDL with intravascular growth was diagnosed after excluding intravascular leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. The present case is the second reported case of CDL in Korea. Recognition of this rare and bizarre, malignancy-mimicking leiomyoma is crucial to prevent inappropriate treatment.

Multinodular Reticular Schwannoma in the Head and Neck Region

Reticular/microcystic schwannoma is a recently described morphologic variant of schwannoma that occurs predominantly in visceral organs, most commonly the gastrointestinal tract. This report describes a case occurring in the masticator space, accompanied by focal erosion of the orbital floor, clinically and radiologically worrisome for malignancy. The 26-year-old man presented with facial swelling for 3 month. The tumor shows a multinodular appearance, with dense lymphoplasmacytic infiltrates in the fibrous septa. The tumor nodules are composed of plump spindle cells disposed in a reticular pattern. The diagnosis is confirmed by strong positive staining for S100 protein. The differential diagnoses of reticular schwannoma in the soft tissues of head and neck region are different from those in the gastrointestinal tract.

Carney's complex: a successful pregnancy after bilateral adrenalectomy.

Carney's complex: a successful pregnancy after bilateral adrenalectomy.