Pleomorphic Cells Research Articles

Proliferating cell nuclear antigen antibody testing – getting them all

Proliferating cell nuclear antigen antibody (PCNA) is associated with systemic lupus erythematosus (SLE) and characterises a cohort of patients at risk of renal or central nervous system involvement. The antibody has also been reported in patients with hepatitis B and C virus infection. It has a pleomorphic nuclear cell cycle dependant pattern on antinuclear antibody (ANA) testing by indirect immunofluorescence (IFA).

Primary Malignant Fibrous Histiocytoma of Proximal Humerus with Pathological Fracture- Case Report

Malignant fibrous histiocytoma (MFH) is a tumor of late adulthood that occurs in men more commonly than women. Proximal humerus involvement in PMFH is comparatively rare. A 45 year old female presented with complain of pain and mild swelling over the left shoulder with restricted range of movement since 15 days. Radiography of the affected part was suggestive of an osteolytic eccentric lesion with a pathological fracture. A trucut needle biopsy showed minimal tumour tissue with abundant necrosis and showed giant cells with pleomorphic mononuclear cells. So intralesional curettage followed by osteosynthesis with PHILLOS plating and bone cementing was done. Intra operative specimen sent for histopathological examination showed presence of fibroblast cells arranged in storiform pattern s/o MFH along with occasional multinucleated giant cells. Postoperatively patient was started with adjuvant chemotherapy. Patient had good results functionally and clinically with no signs of recurrence till follow up of 1.5 years.

Laparoscopic and endoscopic cooperative surgery for leiomyosarcoma of the stomach: a case report with a review of the literature

BackgroundLeiomyosarcoma is a rare tumor that could originate from the gastrointestinal tract, uterus, kidney, retroperitoneum, and the soft tissues of the extremities. It accounts for only 1% of all gastrointestinal mesenchymal tumors and primary leiomyosarcoma of the stomach is extremely rare. Most cases reported as leiomyosarcoma of the stomach before the development of KIT immunohistochemistry might be gastrointestinal stromal tumors (GISTs) of the stomach and only 18 cases of leiomyosarcoma of the stomach have been reported since early 2000s. We report here a patient with leiomyosarcoma of the stomach treated by laparoscopic and endoscopic cooperative surgery (LECS).Case presentationA 59-year-old man was referred to our hospital for an early gastric cancer, which was initially treated by endoscopic submucosal dissection. Six months after his initial treatment, a follow-up esophagogastroduodenoscopy revealed a small polypoid lesion at the lesser curvature of the proximal stomach, which appeared to be a hyperplastic polyp. However, one and a half years later, the lesion grew and showed more irregular surface. Biopsy at the time revealed smooth muscle cell proliferation suggestive of leiomyoma. Three years later, the lesion grew even larger and biopsy showed pleomorphic spindle cells. Immunohistochemical study showed positive staining for alpha-smooth muscle actin and desmin, but negative for c-kit and CD34. Ki-67 labeling index was nearly 60%. Based on these findings, the diagnosis of leiomyosarcoma was established. The patient subsequently underwent a partial gastrectomy by LECS. The patient is currently in good condition without recurrence or metastasis at 12 months after surgery.ConclusionsLeiomyosarcoma of the stomach is extremely rare. This is the first report of leiomyosarcoma of the stomach treated by LECS. We could also follow its appearance change through endoscopic examination for 3 years.

A RARE VARIANT OF SQUAMOUS CELL CARCINOMA: SARCOMATOID CARCINOMA

Background Sarcomatoid carcinoma (SC) is a rare variant of squamous cell carcinoma (SCC). It is a malignant tumor containing an SCC (in situ or invasive) component and a predominantly sarcomatous component with malignant spindle and/or pleomorphic cells. It accounts for less than 1% of all laryngeal tumors. Case Report An 8 × 5 mm polypoid lesion on the right vocal cord of a 72-year-old man with a history of smoking who presented with hoarseness was excised. In microscopic examination of the excision material, a tumoral lesion consisting highly pleomorphic cells with large nuclei and prominent nucleoli that had a spindle cell morphology in some places, an epithelioid cell morphology in some areas, and occasionally a giant cell morphology was observed. The tumor surface had an ulcerous appearance in most areas. There were typical and atypical mitoses in the tumor. Although squamous epithelium in intact benign appearance was in an area on the tumor surface, the presence of squamous epithelium containing atypical cells with disrupted organization standing apart from the tumor was remarkable. Immunohistochemical analysis revealed positive staining with smooth muscle actin and vimentin in the tumor cells. Multifocal positive staining with Pan-CK, EMA, and P40 was observed in the squamous epithelium and lesion. CD34 and desmin were negative. The case was reported to be compatible with SC. Conclusions SC is a rare variant of SCC. In the differential diagnosis, many tumors in spindle cell-like appearance such as nodular fasciitis, spindle cell melanoma, leiomyosarcoma, rhabdomyosarcoma, fibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumors should be kept in mind and examined carefully. Sarcomatoid carcinoma (SC) is a rare variant of squamous cell carcinoma (SCC). It is a malignant tumor containing an SCC (in situ or invasive) component and a predominantly sarcomatous component with malignant spindle and/or pleomorphic cells. It accounts for less than 1% of all laryngeal tumors. An 8 × 5 mm polypoid lesion on the right vocal cord of a 72-year-old man with a history of smoking who presented with hoarseness was excised. In microscopic examination of the excision material, a tumoral lesion consisting highly pleomorphic cells with large nuclei and prominent nucleoli that had a spindle cell morphology in some places, an epithelioid cell morphology in some areas, and occasionally a giant cell morphology was observed. The tumor surface had an ulcerous appearance in most areas. There were typical and atypical mitoses in the tumor. Although squamous epithelium in intact benign appearance was in an area on the tumor surface, the presence of squamous epithelium containing atypical cells with disrupted organization standing apart from the tumor was remarkable. Immunohistochemical analysis revealed positive staining with smooth muscle actin and vimentin in the tumor cells. Multifocal positive staining with Pan-CK, EMA, and P40 was observed in the squamous epithelium and lesion. CD34 and desmin were negative. The case was reported to be compatible with SC. SC is a rare variant of SCC. In the differential diagnosis, many tumors in spindle cell-like appearance such as nodular fasciitis, spindle cell melanoma, leiomyosarcoma, rhabdomyosarcoma, fibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumors should be kept in mind and examined carefully.

Leiomyosarcoma of Inferior Vena Cava involving the Liver– A rare case report

Sarcomas are very rare tumours and 10-30% are located in retro peritoneum. Out of all the sarcoma cases only 1% cases are of Leiomyosarcoma. We reported a case of 60 year female came with chief complaints of pain abdomen and loss of weight. On palpation there was tenderness in the right hypochondrium and was evaluated. MRI abdomen showed a well-defined heterogenous mass of size 8.8 ×7.9×8.2cm noted in the suprarenal location which was compressing inferiorvenacava (IVC) and also showed displacement of IVC with focal intraluminal extension with possibility of Leiomyosarcoma of IVC or retro peritoneum or hepato renal region. Section from trucut biopsy of Liver showed loss of normal liver architecture by pleomorphic spindle tumour cells arranged in bundles. Cells showing marked nuclear pleomorphism with enlarged irregular nucleus with many mononucleate and multi nucleate gaint cells suggestive of malignant spindle cell neoplasm. Immuno Histochemistry (IHC) staining was showed diffuse positivity for smooth muscle Actin, Desmin. Treatment was initiated with adjuvant chemotherapy. Later IVC reconstruction along with resection of supra renal mass was done. Keywords: Leiomyosarcoma of inferiorvenacava (IVC), Malignant spindle cell neoplasm of Liver.

Epithelioid rhabdomyosarcoma: A rare case report mimicking carcinoma breast

Rhabdomyosarcoma (RMS) is an unusual sarcoma in adults. There are four main types of RMS described in the literature, including embryonal, alveolar, pleomorphic, and spindle cell type. Epithelioid RMS is a relatively newer form of RMS described in the literature, with little information regarding the natural course and management. We present a rare case of a young woman with metastatic epithelioid RMS, with an atypical presentation with bilateral large breast lumps, large ovarian mass progressing rapidly to metastasize, involving multiple sites. It has an aggressive clinical course with poor response to therapy.

Cyclin D1 expression in ganglioglioma, pleomorphic xanthoastrocytoma and pilocytic astrocytoma

Ganglioglioma, pleomorphic xanthoastrocytoma (PXA) and pilocytic astrocytoma are rare brain neoplasms with frequent activation of mitogen-activated protein (MAP) kinase pathway. A downstream marker of MAP-kinase pathway activation is cyclin D1. However, the expression of cyclin D1 has not been studied in the differential diagnosis between these brain tumors.The aim of this work is to compare the expression of cyclin D1 in ganglioglioma, PXA, pilocytic astrocytoma. We also compared cyclin D1 expression in giant cell glioblastoma and in IDH wild type glioblastoma.Our work shows that roughly half of gangliogliomas have ganglion cells stained by cyclin D1 while two third of PXA have pleormophic cells stained by cyclin D1 and 15% of giant cell glioblastoma have pleomorphic cells stained by cyclin D1 (p < 0.001). Cyclin D1 never stains normal neurons either in the adjacent cortex of circumscribed tumor, or in entrapped neurons in IDH wild type glioblastomas.The expression of cyclin D1 is correlated to the presence of BRAF V600E mutation in ganglioglioma and PXA (p = 0.002).To conclude, cyclin D1 positivity might be used to confirm the neoplastic nature of ganglion cells. Cyclin D1 is expressed in most cases of BRAF V600E mutated gangliogliomas but also in cases without BRAF mutations suggesting an activation of MAP-kinase pathway through another way. Cyclin D1 immunohistochemistry has currently no or little role in the differential diagnosis of pilocytic astrocytoma. Its role in the differential diagnosis between PXA and giant cell glioblastoma needs to be further investigated on external series.

A requirement for flow to enable the development of Ureaplasma parvum biofilms in vitro.

To use a flow-based method to establish, quantify and visualize biofilms of Ureaplasma parvum. Absorbance readings of a U.parvum HPA5 culture were taken at 550nm every 3h for 30h in order to establish a growth curve, with viability determined by the number of colour changing units (CCUs). Biofilms were established using the DTU flow-cell with a flow rate of 0·01mlmin-1 and compared to the static control. Titres of bacteria were determined by CCU and biofilm biomass was quantified by Syto9 staining and COMSTAT analysis. High-resolution images were obtained by scanning electron microscopy (SEM). Flow resulted in significantly more biofilm and higher cell titre (0·599µm3 /µm2 ±0·152 and 4×108 CCU per ml, respectively) compared with static conditions (0·008µm3 /µm2 ±0·010 and no recoverable cells, respectively). SEM revealed pleomorphic cells, with signs of budding and possible membrane vesicle formation. Flow is an essential requirement for the establishment of U.parvum biofilms. This is the first quantification of biofilm biomass formed by U.parvum. It is now possible to establish viable biofilms of U.parvum which will allow for future testing of antimicrobial agents and understanding of virulence-associated with adhesion.

Basement membrane proteins as a substrate for efficient Trypanosoma brucei differentiation in vitro.

The ability to reproduce the developmental events of trypanosomes that occur in their mammalian host in vitro offers significant potential to assist in understanding of the underlying biology of the process. For example, the transition from bloodstream slender to bloodstream stumpy forms is a quorum-sensing response to the parasite-derived peptidase digestion products of environmental proteins. As an abundant physiological substrate in vivo, we studied the ability of a basement membrane matrix enriched gel (BME) in the culture medium to support differentiation of pleomorphic Trypanosoma brucei to stumpy forms. BME comprises extracellular matrix proteins, which are among the most abundant proteins found in connective tissues in mammals and known substrates of parasite-released peptidases. We previously showed that two of these released peptidases are involved in generating a signal that promotes slender-to-stumpy differentiation. Here, we tested the ability of basement membrane extract to enhance parasite differentiation through its provision of suitable substrates to generate the quorum sensing signal, namely oligopeptides. Our results show that when grown in the presence of BME, T. brucei pleomorphic cells arrest at the G0/1 phase of the cell cycle and express the differentiation marker PAD1, the response being restricted to differentiation-competent parasites. Further, the stumpy forms generated in BME medium are able to efficiently proceed onto the next life cycle stage in vitro, procyclic forms, when incubated with cis-aconitate, further validating the in vitro BME differentiation system. Hence, BME provides a suitable in vitro substrate able to accurately recapitulate physiological parasite differentiation without the use of experimental animals.

Mid-infrared absorption by soft tissue sarcoma and cell ablation utilizing a mid-infrared interband cascade laser.

.Significance: Mid-infrared (MIR) light refers to wavelengths ranging from 3 to and is the most attractive spectral region for ablation of soft and hard tissues. This is because building blocks of biological tissue, such as water, proteins, and lipids, exhibit molecular vibrational modes in the MIR wavelengths that result in strong MIR light absorption. To date, researchers investigating MIR lasers for surgical applications have used bulky light sources, such as free electron lasers, nonlinear light generators, and carbon dioxide lasers. We demonstrate the use of a tiny (a few microns wide, a few millimeters long) MIR interband cascade laser (ICL) for surgical thermal ablation applications.Aim: Our goal is to demonstrate the use of an ICL for surgical thermal ablation and demonstrate its efficacy in ablating normal fibroblasts and primary undifferentiated pleomorphic sarcoma tumor cells (C1619).Approach: We conducted Fourier transform infrared spectroscopy analysis of healthy and cancerous tissue samples, which indicated that the absorption of tumor tissue is higher than healthy tissue around wavelength. These results enabled us to select an ICL emission wavelength, , of to probe normal fibroblast and primary undifferentiated pleomorphic sarcoma cell survival after ICL exposure.Results: We show that the absorption of tumorous tissue is higher than that of healthy tissues around the MIR wavelength. We demonstrate that the ICL is able to ablate cancer cells at very low-power levels that can be clinically implemented but that this effect does not appear to be specific to C1619 when compared to normal fibroblasts.Conclusions: Our study demonstrates that ICLs may represent an exciting new avenue toward precise laser-based thermal ablation.

Aggressive thyroid malignancy presenting with unusual site cutaneous metastasis

Introduction: Anaplastic thyroid carcinoma (ATC) presenting with cutaneous metastasis is rare and only few cases have been reported so far. Commonly involved sites are the cervical region and the thorax. Anaplastic thyroid carcinoma has poor prognosis and no standard treatment has been documented however extensive surgery with curative treatment often with adjuvant radiation and chemotherapy are effective. Most common genetic mutation in ATC is P53 (20-83% cases), RAS mutation (up to 50%), BRAFV600E mutation (25%) p13KCA mutation (12-23%) and copy gain leading to Akt activation (38-61%). Case Presentation: In our study, we have reported a case of a 66 years old male patient who presented with thyroid, back and the ribs (right side) swelling with a radiological diagnosis of malignant thyroid lesion, FNAC was done from all of the above mentioned sites. FNAC smears from all sites showed pleomorphic atypical cells. A diagnosis suggestive of High Grade Epithelial Neoplastic lesion was given with a possibility of Anaplastic thyroid carcinoma with cutaneous metastasis. Conclusion: Anaplastic thyroid carcinomas (ATC) with cutaneous metastasis often present with solitary or multiple swellings as seen in many studies. Very few cases has been reported which has been diagnosed on FNAC. The case reported highlights multiple nodular swelling in neck, right side back and ribs. Cytomorphologically it was suggestive of anaplastic thyroid carcinoma with cutaneous metastasis, which is rare and only few cases documented. Keywords: Anaplastic Thyroid Carcinoma, Bethesda Thyroid cytopathology, Cutaneous metastasis, Squamoid differentiation, Thyroid Fine Needle Aspiration.

Morphologically high‐grade trichoblastic carcinoma: a clinicopathological study with long‐term clinical follow‐up

Trichoblastic carcinomas (malignant trichoblastomas) are rare and poorly documented neoplasms characterized by malignant transformation of a pre-existing benign trichoblastoma and subdivided histologically into low- and high-grade tumours. While morphologically low-grade trichoblastic carcinomas show an indolent behaviour, the morphologically high-grade variant has been associated with poor prognosis, but little is known about their true biologic potential. The present study aims to better define the clinico-pathological features and outcome of morphologically high-grade trichoblastic carcinomas. Four high-grade trichoblastic carcinomas were retrieved from departmental files and the clinical and histopathological features and follow-up were recorded. The tumours presented as nodules on the scalp, neck and shoulder of adults (median age: 40 years, range: 30-55) with a female predominance of 3:1. Three patients had a longstanding history with recent change. Histologically, three tumours were characterized by an expansile cellular nodule composed of sheets of pleomorphic epithelioid cells with brisk mitotic activity and necrosis arising in a background of a benign trichoblastoma. One tumour displayed a more gradual transition from a benign trichoepithelioma to an undifferentiated carcinoma with an infiltrative growth and perineural infiltration. All patients were alive with no evidence of recurrence or metastasis following complete excision after a median follow-up of 96 months (range: 30-180). The correct diagnosis of high-grade trichoblastic carcinoma relies on adequate sampling and recognition of the benign trichoblastic precursor lesion, trichoblastoma or trichoepithelioma. Despite the concerning histologic features of the malignant component, the tumours appear to be less aggressive than previously thought.

Necrotic ulcers on the abdomen

A 50-year-old woman is being evaluated for a 2-month history of painful ulcerations on the lower abdomen associated with loss of appetite, night sweats, weight loss, and fever. Physical examination demonstrates a large painful, necrotic ulcer with elevated erythematous and scalloped borders on the lower abdomen and a few smaller adjacent ulcers in various stages of healing (Fig 1). Bacterial cultures of the ulcer are negative, and the ulcer is unresponsive to broad-spectrum antibiotics. A biopsy specimen is obtained (Fig 2), showing ulceration and a patchy dermal infiltrate of medium pleomorphic lymphoid cells (Fig 2A and 2B).

Atypical Pleomorphic Lipomatous Tumor: Expanding Our Current Understanding in a Clinicopathologic Analysis of 64 Cases.

Atypical pleomorphic lipomatous tumor (APLT) is a recently recognized adipocytic neoplasm that lies on a spectrum with atypical spindle cell lipomatous tumor (ASCLT). APLT/ASCLT are included together in the fifth edition World Health Organization Classification of Soft Tissue and Bone Tumours; however limited data on APLT have emerged since its first description in 2017. This study aims to further define the clinicopathologic features of APLT in a large series of 64 cases. Histologic features and ancillary studies were reviewed, and clinical and follow-up data were obtained from referring institutions. Immunohistochemistry for MDM2, CDK4, CD34, Rb, S100, and desmin was performed in cases with available material. Patients were 24 females and 40 males, and the median age was 61 years (range, 20 to 89 y). Tumors arose in upper limb (33%), lower limb (31%), trunk (23%), head and neck (8%), breast (3%), and inguinal region (2%), with a median size of 5.4 cm (range, 1.5 to 14.5 cm). Tumor depth was mostly subcutaneous or deep/subfascial. Microscopically, APLTs were variably composed of atypical spindle and pleomorphic cells, adipocytes, and lipoblasts, often showing infiltrative growth, myxoid or collagenous stroma, and multinucleate floret cells. Mitoses were infrequent and necrosis was consistently absent. By immunohistochemistry, tumors expressed CD34 (63%), S100 (19%), and desmin (28%). APLT showed frequent loss of Rb (79%; 46/58). Rare cases showed staining for MDM2 (2%) or CDK4 (12%); however, fluorescence in situ hybridization was negative for MDM2 amplification in all cases tested (0/22). Follow-up in 28 patients (median duration: 21 mo) revealed a single patient with local recurrence (4%); no patient developed metastatic disease. Despite its frequently infiltrative growth, nuclear pleomorphism, and hypercellularity which can mimic sarcoma, APLT behaves in an indolent manner and should be distinguished from its more aggressive mimics, including atypical lipomatous tumor/well-differentiated liposarcoma and pleomorphic liposarcoma. Immunohistochemistry for CD34, S100, desmin, and Rb (demonstrating loss), as well as exclusion of MDM2 amplification, can support the diagnosis.

Anaplastic Lymphoma Kinase‐Positive Inflammatory Myofibroblastic Tumor Mimicking Meningioma: A Case Report

A 15-year-old girl presented with intermittent nausea and vomiting, headache, and vision changes. MR imaging of the brain revealed an avidly enhancing infratemporal dural-based mass arising from the tentorium, with hyperintensity on T2WI and transdural extension into the posterior cranial fossa. The well-encapsulated fibrous tumor was resected en bloc after cauterization of its rich tentorial arterial supply. Histologic examination demonstrated pleomorphic myofibroblastic cells admixed with an inflammatory infiltrate. Spindle cells showed strong, diffusely positive immunostaining for anaplastic lymphoma kinase, and genomic sequencing uncovered a tropomyosin 3 gene and anaplastic lymphoma kinase fusion and an activating mutation in the Kirsten rat sarcoma oncogene. A diagnosis of inflammatory myofibroblastic tumor was made. Primary intracranial involvement of inflammatory myofibroblastic tumor is exceptionally rare, and few cases that feature an anaplastic lymphoma kinase translocation have been described. Inflammatory myofibroblastic tumor‐CNS is an important differential diagnosis for dural-based lesions in children and young adults due to its propensity for recurrence and malignant degeneration.

A Rare Presentation of a Large Embryonal Rhabdomyosarcoma at Retroperitoneal Region with Intra-thoracic Extension & Misdiagnosed as Lower Respiratory Tract Infection: A Case Report

Introduction: We are reporting a case of 18 year old boy who presented with features of lower respiratory tract infections and labelled as suffering from left suprarenal gland tumor. However, after complete evaluation, it is diagnosed as left retroperitoneal tumor extending into left thoracic cavity with involvement of left lower lobe lung. He underwent debulking surgery. Rhabdomyosarcoma (RMS ) originates from immature striated muscle and it is considered as the most aggressive malignant mesenchymal tumor. The most common location of RMS is head and neck region. The retroperitoneal presentation of embryonal RMS is extremely rare. The four histological features of RMS, classified by WHO are embryonal, alveolar, pleomorphic and spindle cell or sclerosing. Pleomorphic RMS has worse prognosis. The incidence of embryonal tumors is higher in males with bimodal age distribution, between 2-6 years and second peak between 10-18 years. Their detection is incidental when the size is small and as the size enlarges, symptoms helps in detection. Due to its rarity at retroperitoneal location, there is a lack of literature over the adjuvant treatment. As the size enlarges at retroperitoneal region, enblock resection with clear margins becomes a difficult task and if planned for R0 resection, multiorgan resection escalates surgical morbidity rate. Conclusion: It is a rare location of embryonal rhabdomyosarcoma at retroperitoneal region with rare presentation of intra-thoracic infiltration. R0 resection is the principle goal of surgical excision of retroperitoneal sarcoma.

The Most Common Mistake in Laryngeal Pathology and How to Avoid it

Upper aerodigestive tract (UADT) spindle cell squamous carcinoma (SCSC), also known as sarcomatoid carcinoma, is a high-grade subtype of conventional squamous cell carcinoma (SCC) that is histologically characterized by a combination of differentiated SCC in the form of intraepithelial dysplasia and/or invasive differentiated SCC, and the presence of an invasive (submucosal) undifferentiated malignant spindle-shaped and pleomorphic (epithelioid) cell component. Typically, SCSC presents as a superficial polypoid mass not infrequently with surface ulceration precluding identification of an intraepithelial dysplasia. Further, in many cases an invasive differentiated SCC is not identified. Adding to the complexity in such cases, is that immunohistochemical staining in a significant minority of cases is negative for epithelial-related markers but often the cells express mesenchymal-related markers. In such cases, differentiating SCSC from a reactive (benign) spindle cell proliferation or a mucosal-based sarcoma can be problematic, with treatment implications. Herein, we detail the clinical and pathologic features of laryngeal SCSC and discuss the rationale for diagnosing a carcinoma and avoiding a diagnosis of sarcoma. In our experience, such cases represent one of the more common mistakes made in laryngeal pathology. Yet, virtually all such lesions are SCSCs. The treatment and prognosis relies on the accuracy of this distinction.

Unusual pleomorphic cells in axillary lymph node

A man in his 60s with a history of superficial gastric cancer and stage IIIB intestinal adenocarcinoma since 2 years, untreated due to systemic symptoms of myelofibrosis, on follow-up CT...

CD30-Positive Anaplastic Variant of Diffuse Large B-cell Lymphoma: Frequency and Association With Clinicopathological Parameters.

IntroductionDiffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell lymphoma and is the most common type of non-Hodgkin's lymphoma (NHL) worldwide. The World Health Organization (WHO) classification of hematopoietic tumors has recognized three morphological variants of DLBCL: centroblastic, immunoblastic, and anaplastic. Some studies have shown that the anaplastic variant of DLBCL is associated with aggressive clinicopathological features. Anaplastic DLBCL is rare, and the clinicopathological characteristics of this subtype of DLBCL are not widely studied in our population. Therefore, in this study, we evaluated the frequency of the anaplastic variant of DLBCL and its association with other clinicopathological parameters.MethodsA retrospective study was conducted in the Department of Histopathology at the Liaquat National Hospital and Medical College over a period of six years, from January 2015 to December 2020. All cases diagnosed as DLBCL based on morphology and immunohistochemical (IHC) profile were included in the study. The diagnosis of anaplastic DLBCL was rendered based on morphology (large bizarre pleomorphic cells in a cohesive or sheet-like growth pattern), combined with CD30 IHC expression.ResultsThe mean age of the patients was 52.90 ±16.42 years, and the mean Ki67 index was 73.18 ±16.52%. Of the 220 cases of DLBCL, 47.3% cases were germinal center B-cell (GCB) subtype, and 59.1% cases were nodal. BCL-2, BCL-6, MUM1, c-MYC, and CD10 positivity were noted in 60%, 45.5%, 40.9%, 44.1, and 38.6% cases, respectively. Only 14 cases (6.4%) were recognized as anaplastic variants of DLBCL according to the previously defined criterion. The only significant association of anaplastic-variant DLBCL was noted with a lack of BCL-2 expression. No significant association of anaplastic-variant DLBCL was noted with age, gender, Ki67 index, DLBCL subtype, or any other IHC marker expression.ConclusionWe found a low frequency of the anaplastic variant of DLBCL in our study. No significant association of this DLBCL variant was noted with any of the clinicopathological parameters, except for the lack of BCL-2 expression. Alternatively, from a pathological perspective, it is important to recognize this variant of DLBCL as it often mimics other CD30-positive lymphoma and undifferentiated carcinoma.

Salivary Duct Carcinoma arising from pre-existing Epithelial-Myoepithelial Carcinoma of the parotid gland: Another rare example with Cytological Correlation

An extremely exceptional case of salivary duct carcinoma (SDC) arising from pre-existing epithelial-myoepithelial carcinoma (EMC) of the parotid gland is herein described. The patient was a 50-year-old Japanese female, who presented with an asymptomatic mass of the right parotid gland that had been present for approximately 7 years. A superficial lobectomy of the parotid gland was performed and there have been no symptoms of recurrence or distant metastasis during over 10-year follow-up period. Histologically, the tumor was composed of an EMC component having double-layered ducts and invasive nests of myoepithelial clear cells with an SDC component intermingled throughout the lesion, which consisted of eosinophilic pleomorphic cells. Nests of the SDC component were occasionally accompanied by small luminal structures and minimally focalized comedo necrosis, and were immunoreactive for androgen receptor and GCDFP15. Fine needle aspiration cytology showed moderate cellularity, a few three-dimensional or sheet-like clusters, and single dispersed cells with abundant granular cytoplasm in the background. Furthermore, hyperchromatic small or flattened cells were identified attaching to the periphery of the clusters in retrospective observation. Metachromasia was also seen in May-Grunwald Giemsa stain. Keywords: Salivary duct carcinoma; Epithelial-myoepithelial carcinoma; Parotid gland; Dedifferentiation; High-grade transformation; Fine needle aspiration cytology