Pseudocarcinomatous Hyperplasia Research Articles

Simultaneous distinct cutaneous fungal infections with chromoblastomycosis due to Exophiala xenobiotica and hyalohyphomycosis due to Scedosporium apiospermum in a patient with severe cellular immunodeficiency.

Deep-seated dermatomycosis is a rare disease that is often caused by trauma and/or systemic immunodeficiency. We describe a case of chromoblastomycosis complicated by hyalohyphomycosis that occurred simultaneously at different sites. A 92-year-old Japanese man who had been taking oral prednisolone for an IgG4-related respiratory disease visited our clinic. He developed brownish plaques with grayish-white scales with pseudo-carcinomatous hyperplasia and numerous brownish muriform cells developing in the dermis of his right hand, and multiple painful abscesses with pustules and papules and numerous hyphae within and around the histiocytes in the dermis of his right lower leg. Upon skin tissue culture and DNA sequencing, Exophiala xenobiotica and Scedosporium apiospermum were detected separately. He had severe cellular immunodeficiency indicated by low levels in the phytohemagglutinin (PHA)-stimulated lymphocyte transformation test (LTT) and serum interferon-gamma (IFN-γ), although his humoral immunity was normal. The patient died of bacterial pneumonia, despite antifungal drug treatment for 2 months. IFN-γ producing type 1 T helper (Th1) cells play an important role in the defense against fungal infections, however, corticosteroids specifically suppress Th1 cell responses and promote the induction of fungal infection. Measurement of PHA-stimulated LTT and serum IFN-γ may be useful in determining the severity and prognosis of deep-seated dermatomycosis in patients undergoing corticosteroid treatment.

Pseudocarcinomatous hyperplasia of the fallopian tube: a clinicopathological analysis of sixteen cases

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of pseudocarcinomatous hyperplasia of the fallopian tubes. Methods: Sixteen cases of pseudocarcinomatous hyperplasia of the fallopian tubes diagnosed at Obstetrics and Gynecology Hospital of Fudan University from January 2011 to January 2024 were collected.The pathological sections were reviewed, the clinical and pathological data were consulted, and immunohistochemical examination was conducted along with follow-up. Results: The patients were aged from 19 to 57 years, with an average age of 41 and a median age of 38. Among the 16 cases, 4 were located in the right fallopian tubes, 6 in the left fallopian tubes, while the remaining cases presented bilaterally. The general manifestations were tubal edema, crispness and purulent secretion in the lumen. Morphologically, the fallopian tube mucosa exhibited a significant infiltration of neutrophils, lymphocytes and plasma cells. The epithelial cells of the fallopian tube displayed evident proliferation, stratification and disorganized arrangement leading to formation of small glandular cavity with back-to-back, fissure-like and sieve-like structures. Immunohistochemical analysis revealed positivity for CK7 and WT1, along with wild-type p53 expression, Ki-67 index ranged from 5% to 20%. During the follow-up period ranging from 1 to 156 months, all the patients remained free of disease. Conclusions: Pseudocarcinomatous hyperplasia of the fallopian tube is a rare non-neoplastic lesion, which can lead to epithelial hyperplasia and atypical hyperplasia. The most important significance of recognizing this lesion lies in avoiding misdiagnosis of fallopian tube cancer during intraoperative and postoperative pathological examination. This ensures that clinicians can administer correct clinical interventions.

Малигнизация при хроническом остеомиелите бедра: клинический случай

of malignant transformation 34 years after the diagnosis of chronic osteomyelitis of the hip. Materials and methods The medical case history was studied and pathomorphological examination of the surgical material of patient D. with chronic osteomyelitis of the femur was conducted. Results Patient D., after a comminuted fracture of the left femur as a result of an accident, at the age of 25 years, developed chronic osteomyelitis, the surgical interventions did not lead to a long-term remission of the process. The course of the disease was complicated by malignancy and pathological fracture. The treatment ended with the amputation of the limb. The pathohistological examination revealed structural changes in bone tissue: necrosis, bone marrow fibrosis, bone microsequestration, inflammatory infiltrate with a high content of neutrophils that corresponded to the morphological signs of chronic osteomyelitis in the acute stage. Signs of pseudocarcinomatous hyperplasia, mass appearance of "horny pearls", invasion of the squamous epithelium of the bone tissue, squamous epithelial cells seemed to be highly differentiated. Discussion The pathomorphological picture of the surgical material was characterized as pseudocarcinomatous hyperplasia, the prolonged existence of which could cause the occurrence of squamous cell carcinoma of the femur. It is not clinically and histologically possible to establish when the reactive proliferation of the epidermis acquires fundamentally different biological properties of a malignant tumor. It is a serious problem in the timely diagnosis. Conclusion A thorough pathoanatomical assessment of the material from the affected areas (ulcers, fistulous tracts, bone marrow space) is necessary for the early detection of malignant neoplasms that may occur in osteomyelitis. The presence of long-term dynamics of pseudocarcinomatous hyperplasia requires vigilance in relation to the process of malignancy.

Mucocutaneous infections in a patient who is immunocompromised.

We report the case of a 74-year-old man who was immunosuppressed and presented with multiple skin lesions on the right upper limb. Histological examination revealed epidermal pseudocarcinomatous hyperplasia and dermal granulomatous suppurative infiltrate with aggregates of Gram-positive microorganisms compatible with a grain-forming infection.

Progressive Premalignant and Malignant Development (Metachronous Appearance) in Multiple Burn Sears (Marjolm’s Ulcers) Report of a Rare Case and Review of the Literature

The eponym Marjolin’s ulcer is used to describe the malignant transformation of any skin ulcer or scar. A 35-year-old white woman sustained a thermal bum injury over her lower half of the body when she was 8 years old. After 16 years of the event and over 9 years, metaehronous skin ulcers, pseudocarcinomatous hyperplasia and well differentiated squamous cell carcinomas occured, mainly on both lower limbs. The clinical history, histologic aspects, histogenesis, follow-up data and therapeutic considerations are discussed along with a review of the relevant literature.

Giant peripheral ossifying fibroma with coincidental squamous cell carcinoma: a case report

BackgroundPeripheral ossifying fibroma is an inflammatory or reactive hyperplasia of the gingiva that is usually small. It is formed by hard tissue in fibrous tissue, and the name “neoplastic lesion” has tended to be used frequently in Europe and America. Clinically, peripheral ossifying fibromas are painless, solitary, exophytic, sessile, or pedunculated and more frequently found in females than in males. To the best of our knowledge, there have been no reports of malignant cases. We herein report the case of giant peripheral ossifying fibroma with squamous cell carcinoma.Case presentationThe patient was an 83-year-old Japanese woman who visited our hospital with a gingival massive mass. She was referred to us for an examination and treatment because it was difficult to perform tracheal intubation for surgery of sigmoid colon cancer at another hospital. The mass measured 83 × 58 × 35 mm, and it protruded to the extra-oral region from the right maxillary premolar alveolar region. Panoramic X-ray revealed the shadow of the mass in the right maxillary premolar region, which included some hard tissue. Computed tomography showed scattering calcified images in the mass. Magnetic resonance imaging was not performed because she had vertebral artery clips and screws in her forehead. Given the above findings, we performed a biopsy under local anesthesia. However, we were unable to diagnose absolutely whether the dysplastic squamous epithelia were pseudocarcinomatous hyperplasia of the gingiva or well-differentiated squamous cell carcinoma. Therefore, tumor resection was performed under general anesthesia. The histopathological diagnosis was peripheral ossifying fibroma with coincidental squamous cell carcinoma. There have been no signs of recurrence during follow-up as of 2 years after surgery.ConclusionsThe etiology of giant peripheral ossifying fibroma with squamous cell carcinoma is still not definite. Therefore, careful observation is necessary. It needs to be examined by accumulation of more cases in the future. We herein report the case of giant peripheral ossifying fibroma coincidental squamous cell carcinoma.

PSEUDOCARCINOMATOUS HYPERPLASIA IN A PATIENT WITH PERI-IMPLANT DISEASE: A CASE REPORT

Pseudocarcinomatous hyperplasia (PCH) consists of a non-neoplastic epithelial hyperplasia that can mimic squamous cell carcinoma (SCC) both clinically and histopathologically. Some inciting factors have been associated with PCH, including trauma, infection, chronic inflammation, and neoplasia. A 57-year-old female patient, heavy smoker, was referred with complaint of pain at level of the tooth #16, where there was an implant. Clinical examination revealed discharge of pus and swelling of the peri-implant mucosa. Radiographic examination showed progressive bone loss around the dental implant. Therefore, the implant was removed, and the surrounding soft tissue was sent for histopathologic analysis, which revealed foci of the hyperplastic epithelium in the connective tissue that projected from the surface epithelium, surrounding isolated bone trabeculae, and admixed with chronic inflammation. In this case, a relationship between peri-implantitis and PCH is probable, which should be included within the histopathologic spectrum of this peri-implant disease, to avoid misdiagnosis with SCC.

Hiperplasia endometrial cística em ouriço-pigmeu-africano (Atelerix albiventris) – relato de caso

A 2 year old female african pygmy hedgehog (Atelerix albiventris) was presented at a private clinic with persistent hematuria. Abdominal ultrasound identified suggestive changes of uterus enlargement, indicating its surgical removal. Anesthesia was accomplished with isoflurane via chamber induction and was maintained via mask. Ovariohysterectomy was performed and tissue fragments were submitted to histopathologic evaluation. For postoperative treatment, meloxicam, enrofloxacin and dipyrone were used. Microscopy revealed moderate uterine squamous metaplasia, cystic endometrial pseudocarcinomatous hyperplasia (CEH), and moderate uterine adenomyosis. The knowledge of these animals’ reproduction morphophysiology is essential, not only by the demand as pets in the clinical routine, as well as in the advances of comparative pathology.

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Introduction Carcinomatous degeneration is a severe complication of chronic osteomyelitis. The exact mechanism of the malignant transformation remains unknown. This degeneration most often results from squamous cell carcinoma arising in chronic osteomyelitis. Early diagnosis and appropriate treatment are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis. Definitive treatment of chronic osteomyelitis and antimicrobial therapy are thought to be effective in prevention of malignant changes. Objective To identify diagnostic criteria for neoplastic disease in chronic osteomyelitis. Methods We reviewed 7 (2.75 %) patients aged 39 to 65 years who were treated for relapse of bone infection at the Clinic of Osteology Infection between 2017 and 2018. The average duration of the disease was 36 ± 6.42 years. A comprehensive examination performed for the patients on admission included radiographs of the involved limb segment, microbiological analysis of wound discharge, complete blood count, serum biochemistry panels, Doppler ultrasonography of the lower limb arteries and an excisional biopsy. Results Squamous cell carcinoma was diagnosed in the feet of all patients. Discussion The examinations performed were useful for identifying several diagnostic criteria for neoplastic process associated with pseudocarcinomatous hyperplasia in chronic osteomyelitis.

Chronic Lichenoid Inflammatory Process with Hyperplasia: a Case Report

A woman with melanoderma, with a previous histopathological diagnosis of squamous cell carcinoma in the hard palate central region, reported to not smoking or consuming alcohol during anamnesis. The intrabuccal examination revealed an exophytic lesion, 1 cm in its largest diameter, irregular, showing purplish coloration, painless, and unmodified since the beginning of the diagnostic process. Laboratory tests were negative for HIV, HPV, tuberculosis, and syphilis. Before proceeding for definitive oncological treatment, the histological slides from the initial biopsy were reviewed by an oral pathologist. The result of this histopathological analysis indicated pseudocarcinomatous hyperplasia with associated lymphocytic infiltrate. Thus, another partial biopsy was performed, aimed at a definitive diagnosis with the immunohistochemical analysis; the results were negative for CD10 and Cyclin D1, and positive for CD20, CD3, Ki-67, and anti-apoptotic protein Bcl-2. The result, chronic lichenoid inflammatory process with hyperplasia was established. Periodic clinical follow-up was the proposed therapeutics.

Syndecan 1: A Useful Marker for Differential Diagnosis in Pseudocarcinomatous Hyperplasia and Squamous Cell Carcinoma

Some proteins have been used as immunohistochemical markers for tumor diagnosis. Such is the case of syndecan-1, one of the four transmembrane heparin sulfate proteoglycans which are mainly present on the cellular surface. Syndecan-1 is the principal syndecan on the epithelial cells of adult tissue, involved in numerous processes such as cellular growth, differentiation, adhesion, and migration among others.

Giant tuberculous pseudocarcinomatous hyperplasia of fallopian tube mimicking ovarian neoplasm - A challenging diagnosis

Pseudocarcinomatous hyperplasia of the fallopian tubes is an incidental histopathological finding or it causes slight enlargement of tubes. We are reporting a case where 38 years old woman reported with lump abdomen (corresponding to 28 weeks gravid uterus) and hypomenorrhea, was diagnosed as ovarian neoplasm after extensive work up that included tumor markers and CT scan. Staging laprotomy was undertaken, but intraoperatively it revealed massive enlargement of both the tubes. Frozen section and histopathological examination showed tuberculous pseudocarcinomatous hyperplasia of fallopian tubes. Bilateral salpingectomy was done. We are reporting this case because of its rarity, where massive enlargement of both the tubes was due to tuberculous Pseudocarcinomatous hyperplasia that mimicked ovarian neoplasm on clinical examination and on radioimaging techniques.

Mandibular intraosseous pseudocarcinomatous hyperplasia: a case report.

BackgroundMandibular pseudocarcinomatous hyperplasia is a rare and generally benign pathology. We report on one of these rare cases.Case presentationThe case history of a 73-year-old white man stated that he had a carcinoma of the oropharynx, which was primarily treated with radiotherapy and chemotherapy 4 years prior. As a result of radiotherapy he developed an osteoradionecrosis of his mandible and a consecutive pathological fracture of his left mandibular angle. Subsequent osteosynthesis was performed with a reconstruction plate. When we first saw him, his reconstruction plate was partially exposed with intraoral and extraoral fistulation. The resected bone of his defect-bordering jaw showed the typical pathohistological findings of an intraosseous mandibular pseudocarcinomatous hyperplasia. After a first reconstruction attempt with an iliac crest graft failed, definitive reconstruction of his mandible with a microvascular anastomosed fibula graft was achieved.ConclusionsIntraosseous pseudocarcinomatous hyperplasia of the mandible is a rare differential diagnosis in maxillofacial surgery. Besides other benign epithelial neoplasms, such as calcifying epithelial odontogenic tumor, squamous odontogenic tumor, or different forms of ameloblastoma, the far more frequent invasive squamous cell carcinoma needs to be excluded. A misinterpretation of pseudocarcinomatous hyperplasia as squamous cell carcinoma must be avoided because it can lead to a massive overtreatment.

Lack of Utility of Cytokeratins in Differentiating Pseudocarcinomatous Hyperplasia of Granular Cell Tumors from Oral Squamous Cell Carcinoma.

Granular cell tumor (GCT) of the oral cavity is a benign lesion. Half of oral GCTs demonstrate pseudocarcinomatous hyperplasia (PCH) of the mucosa which can mimic invasive islands of oral squamous cell carcinoma (SCC). Such similarity can be confusing when diagnosing or evaluating the two conditions, potentially leading to misdiagnosis or misclassification. Indeed, several misdiagnosed cases of oral GCT have been reported in the literature as OSCC or malignant oral GCT that resulted in unnecessary aggressive treatment for the affected patients. The aim of this study was to investigate if the cytokeratin pattern of the PCH can help in differentiating GCT from oral SCC. To distinguish between these two entities, we examined 12 patient specimens of oral GCT-PCH and oral SCC histologically and via immunohistochemistry (IHC) for CK13, CK17 and P75. The results suggest that the cytokeratin profile of PCH is similar to that of oral SCC. Therefore, consideration of IHC findings for epithelial markers alone may lead to erroneous diagnosis; thus, the presence of the granular tumor underneath the PCH and its immunopositivity for P75 or other neural definition markers can be essential to identify the underlying tumor and exclude oral SCC. Finally we recommend more studies on the molecular biology of PCH to understand how it can mimic oral SCC histologically without harboring its malignant phenotype clinically, which could have significant translational potential for understanding invasive oral SCC.

The pathology of urinary bladder lesions with an inverted growth pattern.

Inverted lesions in the urinary bladder have been the source of some difficulty in urological pathology. The two common ones are von Brunn's nests and cystitis cystic/cystitis glandularis, which are considered normal variants of urothelium. Apart from them, a number of other rare urothelial lesions with inverted growth pattern occur in the urinary bladder. Some of them are only reactive conditions, just as pseudocarcinomatous hyperplasia. Some are benign tumors, namely inverted papilloma. Whereas others are malignant neoplasms, including inverted papillary urothelial neoplasm of low malignant potential (PUNLMP), non-invasive inverted papillary urothelial carcinoma (low-grade and high-grade), and invasive urothelial carcinoma (inverted, nested and big nested variants). Because of the overlapping morphological features of all the inverted lesions mentioned above, even between high-grade invasive carcinoma and pseudocarcinomatous hyperplasia which are only a kind of reactive conditions, it is very important for the surgical pathologist to recognize and be familiar with these inverted lesions in urinary bladder. In this article, we review these spectrums of inverted lesions of the urinary bladder. Emphasis is placed on histogenesis, morphology, differential diagnosis of these lesions, and the pathologic grading of the non-invasive inverted neoplasms, such as inverted papilloma, inverted PUNLMP, non-invasive inverted papillary urothelial carcinoma with low-grade, and non-invasive inverted papillary urothelial carcinoma with high-grade.

Immunohistochemical findings and differential diagnosis of papillary-type cutaneous verrucous carcinoma of the neck: A case report.

Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma, with the majority of cases occurring in the oral cavity and genital area. The present study describes a rare case of cutaneous VC of the neck manifesting as a semi-pedunculated multinodular protrusion. Histological analysis revealed thickening of the epidermis and papillary growth. Although cellular atypia was generally mild, a large number of mitoses were observed, of which a small number were abnormal. Additionally, bulbous subepidermal invasion was observed. The lesion was differentiated from papillary squamous cell carcinoma, another rare subtype of squamous cell carcinoma, based on the presence of epidermal verrucous growth and the lack of remarkable nuclear atypia. Benign disorders, including seborrheic keratosis, fibroepithelial polyp, verruca vulgaris and pseudocarcinomatous hyperplasia, were also differentiated from the lesion. Immunohistochemical analysis of cytokeratin (CK)10 expression revealed attenuated staining of the lesion, therefore, anti-CK10 immunohistochemistry may be valuable in the diagnosis of VC.

Pseudocarcinomatous hyperplasia in anaplastic large cell lymphoma, a mimicker of poorly differentiated squamous cell carcinoma: report of a case and review of the literature

Pseudocarcinomatous hyperplasia can occasionally be observed in biopsies of CD30-positive lymphoproliferative disorders. It is important to be cognizant of this association, because epithelial hyperproliferation can overshadow large atypical lymphoid cells, leading to an erroneous diagnosis of squamous cell carcinoma (SCC) or keratoacanthoma. Herein, we present a case of anaplastic large cell lymphoma (ALCL) with pseudocarcinomatous hyperplasia simulating a poorly differentiated carcinoma and review the literature on this subject. Immunohistochemical staining with p63 helped delineate the infiltrating tongues of pseudocarcinomatous hyperplasia from the malignant infiltrate. We present this case to raise awareness of the potential for pseudocarcinomatous hyperplasia to occur in the setting of CD30+ lymphoproliferative disorders. Clinicians and dermatopathologists should consider the possibility of ALCL or lymphomatoid papulosis when examining lesions with features of inflamed SCC, especially if the tumor presents on a site or in a patient that is not typical of SCC.

Pseudocarcinomatous hyperplasia associated with primary lymphoma in the urinary bladder: a case report

A case of pseudocarcinomatous hyperplasia of the urothelium associated with primary extranodal marginal-type lymphoma of the urinary bladder in an 81-year-old man is described. To the best of our knowledge, this is the first report in the literature of a primary lymphoma of the bladder associated with pseudocarcinomatous hyperplasia of the urothelium, closely mimicking the nested variant of urothelial carcinoma. The lesion enters in the differential diagnosis with a collision tumor, which has been described rarely in the bladder.

CD30+ cutaneous lymphoproliferative disorders with pseudocarcinomatous hyperplasia are associated with a T-helper-17 cytokine profile and infiltrating granulocytes

The pathogenetic mechanism of CD30(+) cutaneous lymphoproliferative disorders (CLPD) associated with pseudocarcinomatous hyperplasia (PCH) and granulocytic inflammation surrounding atypical CD30(+) lymphocytes remains unclear. We sought to characterize clinical and pathological findings of a cohort of patients with PCH associated with CD30(+) CLPD and to analyze the cytokine profile of the atypical lymphocytes. We retrospectively reviewed medical records and pathological material of CD30(+) CLPD with PCH. Immunohistochemistry for T-helper (Th)17 cytokine profile was performed. In all, 25 patients with a median age of 52 years were included. The median follow-up was 3.7 years. Histologically, an infiltrating pattern of PCH was observed in 14 cases with a neutrophilic-rich infiltrate (P = .21), and epidermal pattern in 11 cases with eosinophil-rich infiltrate (P = .03). Th17 or Th22 cytokines were detected in tumor cells in 81% cases tested. Tumor cells expressed Th17 transcription factor retinoic acid receptor (ROR)-related orphan receptor gamma-2 in 2 of 7 samples tested and 1 was positive for aryl hydrocarbon receptor. This is a retrospective study of a small sample. PCH in CD30(+) CLPD is associated with Th17/Th22 cytokine expression in the atypical lymphocytes. Although these lesions commonly regress spontaneously and are associated with an indolent course, some cases develop a generalized process and tumor progression.

Keeping pace with New Frontiers in Pathology.

Keeping pace with New Frontiers in Pathology.