Psammoma Research Articles

Juvenile ossifying fibroma: an analysis of clinico-pathological features in a case series with a literature review

Juvenile Aggressive Ossifying Fibroma (JAOF) is divided into two entities namely Juvenile Psammomatoid Ossifying Fibroma (JPOF) and Juvenile Trabecular Ossifying Fibroma (JTOF). JAOFs are aggressive but benign tumours that require clinico-pathological correlation to arrive at the definitive diagnosis. We report nine new cases of JPOF and 6 cases of JTOF with a brief review of the literature to aid correct diagnosis of these two different entities. According to the clinico-pathological analysis both JPOF and JTOF had occurred in children and adults, with a mean age of 28.6 years and 21 years at presentation respectively. JPOF showed a male predilection while equal gender distribution was observed in JTOF. Both tumours occurred most often in the mandible. Regarding the histopathological features all tumours were unencapsulated. All cases of JPOF showed presence of psammoma bodies which can be considered as a main diagnostic feature. JTOF showed osteoid and immature woven bone trabeculae. Osteoblastic rimming was commonly observed among JTOF but absent in JPOF. Other histopathological features did not show any striking difference between the two lesions. In conclusion, the term “Juvenile aggressive ossifying fibroma” is a misnomer as it can occur in adults as well. Therefore, the word “Juvenile” should be excluded when renaming the tumour which is a “need of the hour”. Further, the study demonstrates the use of demographic, radiological and histopathological features with clinico-pathological correlation to diagnose and exclude mimics of JPOF and JTOF.

Psammoma Bodies in Cervical Cytology of Nigerian Woman

Psammoma Bodies in Cervical Cytology of Nigerian Woman

Cytological features of solid variants of papillary thyroid carcinoma: a fine needle aspiration cytology study of 18 cases.

Solid variants of papillary thyroid carcinoma (SV-PTC) are rare, and there have been few reports describing the cytological findings of such variants. The cytological features of cellular specimens aspirated from 18 histologically confirmed SV-PTC cases were evaluated, retrospectively. Solid and small papillary clusters were observed in 14 (77.8%) and 13 (72.2%) cases, respectively. The incidences of large papillary clusters (11.1%) and sheet-like arrangements (11.1%) were low. Nuclear features were consistent with conventional PTC. The background was clean, and there were no colloid materials, foamy histiocytes, multinucleated giant cells, psammoma bodies, or necrotic materials. Solid clusters and small papillary clusters in conjunction with a clean background are diagnostic clues that indicate SV-PTC cytologically. It is thought that small papillary clusters reflect the micropapillary growth pattern seen within the lumen of middle-sized follicular structures. The presence of nuclear findings typical of conventional PTC and the absence of mitotic figures and necrotic materials are important for distinguishing SV-PTC from poorly differentiated carcinoma.

Diagnostic assessment of intraoperative cytology for papillary thyroid carcinoma: using a decision tree analysis.

The aim of this study was to elucidate the cytological characteristics and the diagnostic usefulness of intraoperative cytology (IOC) for papillary thyroid carcinoma (PTC). In addition, using decision tree analysis, effective features for accurate cytological diagnosis were sought. We investigated cellularity, cytological features and diagnosis based on the Bethesda System for Reporting Thyroid Cytopathology in IOC of 240 conventional PTCs. The cytological features were evaluated in terms of nuclear score with nuclear features, and additional figures such as presence of swirling sheets, psammoma bodies, and multinucleated giant cells. The nuclear score (range 0-7) was made via seven nuclear features, including (1) enlarged, (2) oval or irregularly shaped nuclei, (3) longitudinal nuclear grooves, (4) intranuclear cytoplasmic pseudoinclusion, (5) pale nuclei with powdery chromatin, (6) nuclear membrane thickening, and (7) marginally placed micronucleoli. Nuclear scores in PTC, suspicious for malignancy, and atypia of undetermined significance cases were 6.18±0.80, 4.48±0.82, and 3.15±0.67, respectively. Additional figures more frequent in PTC than in other diagnostic categories were identified. Cellularity of IOC significantly correlated with tumor size, nuclear score, and presence of additional figures. Also, IOCs with higher nuclear scores (4-7) significantly correlated with larger tumor size and presence of additional figures. In decision tree analysis, IOCs with nuclear score >5 and swirling sheets could be considered diagnostic for PTCs. Our study suggests that IOCs using nuclear features and additional figures could be useful with decreasing the likelihood of inconclusive results.

Risk factors analyses for lateral lymph node metastases in papillary thyroid carcinomas: a retrospective study of 356 patients.

The aim of this study was to investigate the incidence and risk factors for lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). 356 patients diagnosed with PTC who underwent total thyroidectomy and central lymph node dissection and lateral lymph node dissection between January 2005 and December 2011 were enrolled. The relation between LLNM and clinicopathological features such as gender, age, tumor size, tumor spread, psammoma bodies, tumor multifocality, extrathyroidal extension (ETE), unilateral or bilateral disease, tumor primary location and central lymph node metastases (CLNM) was analyzed. The rate of LLNM was 75.0%. In the univariate analysis, it was significantly associated with age, tumor size, tumor spread, extrathyroidal extension, primary tumor location and central lymph node metastasis (p < 0.05). In contrast, in the multivariate analysis, it was significantly associated with primary tumor location, central lymph node metastasis (p < 0.05) and tumor size > 1.5 cm with p = 0.05 but was unrelated to the other factors. Patients with PTC, with the primary tumor located in the upper part of the lobe and positive central compartment lymph node metastasis with a tumor size > 1.5 cm diameter are more likely to have LLNM. Therefore, more meticulous evaluations including the lateral lymph nodes should be performed before surgery.

A Prediction Model for ROS1-Rearranged Lung Adenocarcinomas based on Histologic Features.

AimsTo identify the clinical and histological characteristics of ROS1-rearranged non-small-cell lung carcinomas (NSCLCs) and build a prediction model to prescreen suitable patients for molecular testing.Methods and ResultsWe identified 27 cases of ROS1-rearranged lung adenocarcinomas in 1165 patients with NSCLCs confirmed by real-time PCR and FISH and performed univariate and multivariate analyses to identify predictive factors associated with ROS1 rearrangement and finally developed prediction model. Detected with ROS1 immunochemistry, 59 cases of 1165 patients had a certain degree of ROS1 expression. Among these cases, 19 cases (68%, 19/28) with 3+ and 8 cases (47%, 8/17) with 2+ staining were ROS1 rearrangement verified by real-time PCR and FISH. In the resected group, the acinar-predominant growth pattern was the most commonly observed (57%, 8/14), while in the biopsy group, solid patterns were the most frequently observed (78%, 7/13). Based on multiple logistic regression analysis, we determined that female sex, cribriform structure and the presence of psammoma body were the three most powerful indicators of ROS1 rearrangement, and we have developed a predictive model for the presence of ROS1 rearrangements in lung adenocarcinomas.ConclusionsFemale, cribriform structure and presence of psammoma body were the three most powerful indicator of ROS1 rearrangement status, and predictive formula was helpful in screening ROS1-rearranged NSCLC, especially for ROS1 immunochemistry equivocal cases.

Efficiency of Embosphere in the Pre-Operative Embolization of Meningioma:Clinical Experience

Embosphere^® was approved in Japan for embolizing intracranial arteries for the reduction of intraoperative bleeding in January 2014. Until August 2015, we performed embolization for four meningiomas using Embosphere^®. We performed an initial evaluation of all the cases, including evaluation of the clinical courses, change in the maximum tumor diameters and volumes, alteration in the appearance on magnetic resonance imaging(MRI), amount of intraoperative bleeding, complications, and histopathological findings. After embolization, the maximum tumor diameters and volumes slightly decreased on MRI, whereas the signal change on diffusion-weighted imaging(DWI)or fluid-attenuated inversion recovery(FLAIR)varied in each case. One case demonstrated a partial signal change on DWI one day after the initial procedure, and another case demonstrated a decrease in perifocal edema on FLAIR. Among our patients, least bleeding was recorded at 6 days after the embolization. Histopathological analysis revealed coagulative necrotic lesions in two cases. The von Kossa stain was used to distinguish Embosphere^® from the psammoma body. One case involved a thromboembolic complication of the retinocentral artery caused by an Embosphere^® of 100-300 μm. Our early-stage experience suggests that an Embosphere^® of 300-500 μm should be used for safe embolization before resection to avoid thromboembolic complications because an Embosphere^® of 100-300 μm can pass through the dangerous anastomosis. Our present strategy was to resect the tumor approximately seven days after the embolization using Embosphere^®. However, further studies and discussion on the size of Embosphere^®, and the interval between pre-operative embolization and surgical removal are needed.

Sonographic-Pathologic Correlation for Punctate Echogenic Reflectors in Papillary Thyroid Carcinoma: What Are They?

It is commonly held that punctate nonshadowing echogenic foci on sonography, often termed microcalcifications, represent psammoma bodies. We aimed to determine the validity of this supposition by correlating the presence of punctate echogenic foci on sonography with their presence at histopathologic examination. We examined 51 nodules (surgically proven papillary thyroid carcinoma) by sonography and histopathologic examination. On the latter, nodules were examined for evidence of psammomatous calcifications, dystrophic calcifications, and colloid. Two subspecialty-trained radiologists with 2 and 25 years of experience in sonography, respectively, reviewed the sonograms for the presence and distribution of punctate echogenic foci. All nodules contained colloid at histologic examination. Twenty of the papillary carcinomas lacked any calcification at pathologic examination. In the remaining 31 nodules with calcifications, 13 had psammomatous calcifications only; 6 had both coarse and psammomatous calcifications; and 12 had only coarse calcifications. The presence of punctate echogenic foci on sonography was 74% sensitive, was 46% to 53% specific, and had a positive predictive value of only 45% to 48% for the presence of psammomatous calcifications. The computed 2-tailed P value indicated that the punctate echogenic foci-to-psammoma body correlation was not statistically significant. The sonographic signature commonly referred to as "microcalcifications" may represent a variety of entities, including psammomatous calcifications, dystrophic calcifications, and eosinophilic colloid; for this reason, "punctate echogenic foci" would be a more accurate term.

Hypermetabolic Calcified Lymph Nodes on 18Fludeoxyglucose-Positron Emission Tomography/Computed Tomography in a Case of Treated Ovarian Cancer Recurrence: Residual Disease or Benign Formation?

The contribution of positron emission tomography/computed tomography (PET/CT) with 18F-fludeoxyglucose (FDG) in evaluating ovarian cancer recurrence even after a prolonged disease-free interval, and in therapy response is well-described. Calcifications observed in CT, although usually attributed to benign conditions, may actually represent active disease. Such an example of calcified formations is psammoma bodies. We present a case of 56-y. o. patient with ovarian cancer relapse at the supraclavicular area 18 years after complete response and disease-free interval. The patient received chemotherapy and underwent 18F-FDG-PET/CT for the evaluation of treatment response. Both CT corrected and uncorrected PET images showed hypermetabolism in the massively calcified lymph nodes in the neck, mediastinum, axilla and abdomen, indicative of active residual disease.

Immunohistochemical study of ovarian psammocarcinoma: Report of a rare case

Psammocarcinoma is a rare variant of serous carcinoma of the ovaries and has a favourable prognosis resembling that of serous borderline tumors [1]. A 60-year-old woman had a pelvic mass 20weeks size. Magnetic resonance imaging (MRI) showed bilateral ovarian cysts with suspicious peritoneal deposits (Figure. 1A). Carbohydrate antigen 125 level was 1300 U/mL. Peritoneal fluid cytology showed large cell groups with high nucleocytoplasmic ratio, irregular nuclear borders, and indistinct nucleoli. A single psammoma body (PB) was detected (Figure 1B). A diagnosis of ovarian carcinoma was offered. Intraoperatively, bilateral large cystic ovarian masses were seen with thickened omentum and multiple subdiaphragmatic deposits. A biopsy of the omental deposits showed tumor composed of small cuboidal to round cells arranged in a papillary, cribriform pattern. The cells showed minimal pleomorphism and scant mitotic figures. Abundant PBs were scattered throughout the fibrous stroma and in the tips of the papillae (Figure 1C). A diagnosis of metastatic deposits of ovarian psammocarcinoma, International Federation of Gynecology and Obstetrics (FIGO) Stage IIIc was given. Cytokeratin 7 and epithelial membrane antigen showed strong immunoreactivity in tumor cells (Figure 1D and 1E) and none for cytokeratin 20, calretinin, and desmin. Immunoreactivity for estrogen receptors was seen in 75% of tumor cells (Figure 1F). The patient was given tamoxifen and chemotherapy. Patients with psammocarcinoma range in age from 36 years to 76 years (mean age 57 years) [1]. Psammocarcinoma shows: (1)

A Rare Case of Primary Peritoneal Psammocarcinoma Presenting as Acute Intestinal Obstruction and Ascites

We report a rare case of primary peritoneal psammocarcinoma (PPP) in a 60year old female patient who presented to surgical emergency with complaints of inability to pass feces and flatus for last 3 days along with pain and distension of abdomen. On clinical examination there were features of acute intestinal obstruction. Contrast CT of abdomen was suggestive of intestinal obstruction along with a stricture at the recto-sigmoid junction. On exploration there was a growth compressing the recto-sigmoid junction from the serosal surface. Anterior resection of the recto-sigmoid was done with negative gross margins. Histopathological examination of the resected specimen led to a diagnosis of primary peritoneal psammocarcinoma because of a solitary peritoneal lesion having abundant psammoma body formation and normal ovaries visualized on radiology and per-operatively. The diagnosis was further confirmed by histochemical tests and immunohistochemistry along with normal CA-125 levels in the patient.

Distinct Morphological Features Predictive for Aggressiveness of Papillary Thyroid Microcarcinoma: a Study of 72 Cases and 80 Tumor Foci

Abstract Introduction: In this study, we aimed to investigate the importance of some distinctive morphological parameters in predicting the extrathyroidal extension, as marker of aggressiveness, in a series of papillary thyroid microcarcinoma (PTMC) cases. Material and methods: All consecutive PTMC cases, sized ≥ 5mm, registered at the Department of Pathology, Tîrgu-Mureș Emergency County Hospital from January 2002 to December 2013 were re-evaluated. The following histological features were noted: the multifocality, the extrathyroidal extension, the histologic variant, the tumor’s border (well circumscribed versus infiltrative), the PTC nuclear features (well developed versus subtle), the tumor associated stromal reaction (fibrosis/desmoplasia/sclerosis versus none of these changes), the presence of “plump pink” cells, psammoma bodies, intratumoral lymphocytic infiltrate, cystic change, back-to-back arrangement, intratumoral multinucleated giant cells and lymph node involvement. Results: Our study included 72 PTMC cases, summing up to a total of 80 PTMC foci. We have shown that extrathyroidal extension is significantly associated with the presence of “plump pink”cells (p=0.0019), well developed nuclear features of PTC (p=0.018) and tumor associated stromal reaction (fibrosis/dezmoplazia/sclerosis) (p&lt;0.0001). Other parameters were more prevalent among PTMC foci with extrathyroidal extension, but did not reach statistical significance. Conclusion: Our results pointed out the importance of a distinct set of morphological microscopical parameters, predictive for extrathyroidal extension in PTMC cases (“plump pink” cells, well developed PTC nuclear features, tumor associated stromal reaction, infiltrative tumor borders and conventional PTC histology). All these parameters are important to be mentioned in the histopathological reports, as they might be associated with a more aggressive biological behaviour.

Cryopreserved human umbilical cord patch for in-utero spina bifida repair.

To identify a patch system to repair surgically created spina bifida in a sheep model for its efficacy in healing the skin defect, protecting the underlying spinal cord and reducing the Chiari II malformation. Spina bifida was created surgically in 16 fetuses from eight timed-pregnant sheep at gestational age of 75 days. Two fetuses did not survive the procedure. Repeat hysterotomy was performed at 95 days' gestation to cover the defect with either biocellulose film with underwater adhesive (BCF-adhesive) (n = 7) or human umbilical cord with suture (HUC-suture) (n = 7). Three fetuses without formation of the defect served as reference controls. The skin healing was examined by direct visualization after a planned Cesarean section at term, followed by histological analysis using hematoxylin and eosin and Masson's trichrome stains. Mid-sagittal sections of the fetal cranium and upper cervical spine were analyzed by a pediatric neuroradiologist who was blinded to the type of patch received. Three fetuses that received the BCF-adhesive and six fetuses that received the HUC-suture survived to term for final analysis. As a result of dislodgment of the BCF-adhesive, all spina bifida defects repaired using BCF-adhesive were not healed and showed exposed spinal cord with leakage of cerebrospinal fluid. In contrast, all spinal defects repaired by HUC-suture were healed with complete regrowth of epidermal, dermal and subdermal tissue components, with no exposed spinal cord. The maximal skin wound width was 21 ± 3.6 mm in the BCF-adhesive group but 3 ± 0.8 mm in the HUC-suture group (P < 0.001). The spinal cord area (P = 0.001) and the number of anterior horn cells (P = 0.03) was preserved to a greater degree in the HUC-suture group than in the BCF-adhesive group, whilst psammoma bodies, signifying neuronal degeneration, were only observed in the BCF-adhesive group. Anatomic changes, indicative of Chiari II malformation, were seen in all three fetuses of the BCF-adhesive group but in none of the HUC-suture group (P < 0.01). Cryopreserved umbilical cord graft is a promising regenerative patch for intrauterine repair of spina bifida.

Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance.

Papillary thyroid microcarcinoma (PTMC) is generally an indolent disease and active surveillance is conducted for low-risk cases. This study was carried out to clarify the pathological characteristics of PTMC cases that exhibited enlarged nodules or nodal metastasis during the surveillance period. A total of 188 PTMC cases that underwent surgery after active surveillance for ≥ 1 year were examined. Ki-67 labeling indices of > 5% and > 10% were detected in 50.0% and 22.2% of enlarged cases, respectively, values that were significantly higher than those in non-enlarged cases. Intraglandular dissemination and psammoma bodies in normal thyroid tissue were associated with new occurrence of nodal metastasis. Ultrasonographic macrocalcification and follicular variants were observed in 13.8% and 10.6% of non-enlarged cases, respectively, but not in enlarged or nodal metastatic cases. Intraglandular dissemination and psammoma bodies were ultrasonographically detected in 50.0% and 40.0% of cases, which was confirmed by microscopy. Thus, high Ki-67 labeling index, intraglandular metastasis, and psammoma bodies in normal thyroid tissue are indicators of progressive PTMC, and may be identified cytologically or ultrasonographically. In PTMC cases with ultrasonographic macrocalcification, active surveillance can be proactively implemented.

Analysis of 258 Different Lesions of the Central Nervous System for Real Time Histopathological Diagnosis Using Confocal Laser Endomicroscopy

Abstract Objective: The safe removal of central nervous system tumors in or near eloquent tissue remains extremely challenging due to its complex anatomy. The injury of eloquent tissue can have serious consequences for both mental and physical health while an insufficiently resected tumor bears a high risk of tumor recurrence decreasing the patient’s life quality and quantity. The novel method, confocal laser endomicroscopy (CLE), promises safe tumor resection as it permits intraoperative histological imaging of tissues in real-time. Thus, aim of the current study was to evaluate CLE for a fast diagnosis of brain and spinal cord lesions in neurosurgery. Methods: CLE was used for an ex vivo assessment of tumor samples from 258 diverse central nervous system lesions. Additionally, traditional histology was performed on the same examined tissue as the gold standard. Nonneoplastic brain tissue served as a control. Results: The examination of brain and spinal biopsies using CLE allowed the identification of healthy tissue, primary brain and spinal tumors, metastases, abscesses and vascular malformations with a high accuracy of 88.64%. Confocal imaging provided precise cellular and sub-cellular details such as psammoma bodies in meningiomas, perivascular pseudorosettes in ependymomas, microvascular proliferation in glioblastomas and mitotic activity in highgrade tumors. Conclusion: CLE is a promising method for distinguishing tumor from the surrounding healthy tissue, as well as for the immediate diagnosis of biopsies. Our studies have the potential to establish a faster preliminary diagnosis in an ongoing surgery as compared to current available methods. Moreover, the presented characteristic cellular and subcellular confocal features of examined tumors and non-neoplastic tissues could be used to guide future tumor surgeries to enable a more precise and safe resection.

Fine-needle aspiration study of cystic papillary thyroid carcinoma: Rare cytological findings.

Background:Cystic papillary thyroid carcinoma (CPTC) is a variant of papillary carcinoma that has many mimickers in cytological grounds.Aim:To study the cytomorphologic features of CPTC and compare them to those of other cystic thyroid lesions using fine-needle aspiration cytology (FNAC). We also aimed to identify the cytomorphologic features that distinguish CPTC from other cystic thyroid lesions.Materials and Methods:Seventy-three cases of CPTC were included in the study. The cytomorphologic features of these cases were analyzed. The FNA smears of other thyroid lesions with cystic changes (300 colloid goiters, 290 adenomatoid nodules, 11 follicular neoplasms, and 9 hurtle cell neoplasm) were also studied.Results:The smears in CPTC revealed isolated follicular cells, small groups of cells with scalloped margins, cell swirls, small clusters with a cartwheel pattern, papillary clusters, intranuclear inclusions, nuclear grooves, sticky colloid, intracellular colloids, psammoma bodies, multinucleated giant cells, and foamy and hemosiderin laden macrophages. Small groups of cells with scalloped borders, cellular swirls, and small clusters with a cartwheel pattern were seen in CPTC, but not in other cystic lesions. Interestingly, mesothelial-like cells and hemophagocytic cells were seen in five and three cases of CPTC, respectively, but not in other cystic lesions.Conclusion:Mesothelial-like cells and hemophagocytic cells were observed in five and three cases of CPTC, respectively. Similar finding have not been previously reported in the literature.

Case report of a rare case of primary sinonasal meningioma

The aim of this study was to report a case of sinonasal meningioma in Sudan. Meningiomas account for nearly 20% of all intracranial neoplasms and are the second most common tumor of the central nervous system. Primary meningiomas of the nose and paranasal sinuses are extremely rare. The clinical and radiological features of these tumors are nonspecific, and consequently an accurate diagnosis requires histologic evaluation. A 62-year-old woman from North Sudan presented to our hospital in May of 2016 complaining of right nasal obstruction associated with bloody nasal secretion and proptosis. Endoscopic endonasal examination revealed a soft mass in the right nasal cavity between the septum and the middle and superior turbinates posteriorly. MRI revealed the presence of a lobulated mass with soft-part density in the right nasal cavity (middle meatus) and the right ethmoid sinus invading the orbital contents and extending intracranially. The biopsy of the lesion revealed nodular neoplasm composed of regular cells arranged in whorled pattern. One psammoma body was noted and there was no evidence of pleomorphism or necrosis. The features are consistent with sinonasal meningioma. The patient was referred to the oncological department because it was an unresectable malignant meningioma and surgery was not feasible and would create more complications. Meningiomas involving the nasal cavity and paranasal sinuses are rare. The mortality is low, and its lethality is due to the complications of the surgery and injury of vital structures. Complete surgical extirpation of sinonasal tract meningiomas has an overall good prognosis. Hence, endoscopic nasal approach is an excellent surgical option in these cases, due to its low morbidity and satisfactory lesion resection.

Serous Cystadenocarcinoma Arising in Presumed Vitelline Duct Remnant: A Case Report and Implications in the Management of Cancer of Unknown Primary

Background. Malignant neoplasms arising in Meckel's diverticulum, a vitelline duct remnant, are rare yet well-documented. Case Presentation. A 53-year-old previously healthy female presented with an enlarging midline abdominal wall mass. A computed tomography scan revealed a mass involving the linea alba, bilateral rectus abdominis, and subcutaneous fat. Extensive clinical workup failed to demonstrate other lesions, except local and paratracheal/hilar lymphadenopathy. Histopathologic examination of the resected tumor demonstrated a spectrum of serous neoplasia including serous cystadenoma, papillary serous carcinoma with numerous Psammoma bodies, and a poorly differentiated component. Immunophenotypically, the tumor cells were strongly positive for CK7, CK19, CA19.9, and MUC1 but negative for other lineage markers, findings suggestive of pancreatobiliary type differentiation. The patient died of the disease one year after the initial presentation despite chemotherapy, radiation, and surgery. Conclusion. We present a case of adenocarcinoma arising from the anterior midline abdominal wall, from presumed vitelline duct remnant, with histologic and immunophenotypic features of serous cystadenocarcinoma of pancreatobiliary origin. Though the origin from vitelline duct remnant is difficult to prove in this single case, understanding tumorigenesis of embryonic remnant origin is potentially important to improve the management of cancer of unknown primary.

Renal cell carcinoma with t(6;11)(p21.2;q13)/MALAT1-TFEB fusion: a clinical and pathological analysis

To study the clinicopathologic features, immunophenotype, differential diagnosis and prognosis of renal cell carcinoma (RCC) associated with t(6;11)(p21.2;q13)/MALAT1-TFEB gene fusion. A total of 9 cases of such rare tumor were selected for clinicopathologic, immunohistochemical and molecular analysis, with review of literature. The age of the patients ranged from 21 to 42 years (mean=31.3 years). The patients included four men and five women. Histologically, 4 of the 9 cases studied showed classic morphologic features of TFEB RCC, with hyaline material, pigments and psammoma bodies frequently identified. The remaining 5 cases demonstrated uncommon morphology, mimicking perivascular epithelioid cell neoplasm, clear cell RCC, chromophobe RCC or papillary RCC. Immunohistochemical study showed that TFEB and vimentin were positive in all cases. Most of the tumors studied also expressed Ksp-cadherin, E-cadherin, CD117, HMB45, Melan A and Cathepsin K. CKpan showed immunostaining in only 1 case. The staining for TFE3, CD10 and CK7 were all negative. TFEB gene rearrangement was detected in all the 9 cases studied using fluorescence in-situ hybridization. MALAT1-TFEB fusion gene was identified in 2 cases by polymerase chain reaction and direct sequencing. TFEB RCC seemed to be an indolent tumor. During a mean follow-up of 31 months, none developed tumor recurrence, progression, or metastasis. TFEB fusion-associated RCC is a rare neoplasm, tends to occur in young age group and carries an indolent behavior. Diagnosis relies on clinicopathologic findings and immunohistochemical analysis. TFEB break-apart FISH assay is a reliable tool in confirming the diagnosis.

The Clinical Relevance of Psammoma Body and Hashimoto Thyroiditis in Papillary Thyroid Carcinoma: A Large Case-control Study.

This study aims to investigate the impact of psammoma body (PB) on papillary thyroid carcinoma (PTC), and evaluate the association among PB, Hashimoto thyroiditis (HT), and other clinicopathologic characteristics in PTC patients.We conducted a retrospective case-control study involving 1052 PTC patients who underwent total thyroidectomy or lobectomy with lymph node dissection.Psammoma body was observed in 324 out of 1052 PTC (30.8%) patients. Ultrasonographic (US) calcification (P < 0.001), multifocality of the tumor (P = 0.047), lymph node metastasis (LNM) (P < 0.001), HT (P < 0.001), and Primary tumor (T), Regional lymph nodes (N), Distant metastasis (M) staging (P = 0.001) were significantly related to the presence of PB. The presence of PB was significantly associated with US microcalcification (P < 0.001). In the subgroup with HT, compared with the patients without PB, the patients with PB exhibited a higher frequency of central LNM (54.7% vs 32.1%; P < 0.001) and US microcalcification (94.7% vs 38.8%; P < 0.001), as well as smaller tumors (0.9 ± 0.6 vs 1.3 ± 0.9 cm; P < 0.001). In the subgroup without HT, the patients with PB displayed a higher incidence of lateral LNM (25.8% vs 14.6%; P < 0.001), US microcalcification (87.3% vs 52.5%; P < 0.001), and extrathyroidal extension (47.2% vs 34.8%; P = 0.001), as well as larger tumors (1.3 ± 0.9 vs 1.0 ± 0.8 cm; P < 0.001) than without PB. Moreover, in the subgroup with PB, the PTC patients with HT showed a higher LNM (77.9% vs 57.2%; P < 0.001) and a lower frequency of extrathyroidal extension (20.0% vs 47.2%; P < 0.001) than without HT.Psammoma body is a useful predictor of aggressive tumor behavior in PTC patients. HT with PB shows more aggressive behaviors than non-HT with PB in PTC patients.