Rare Histological Finding Research Articles

#2557 Clinical and histological findings in cancer patients—a single center study

Abstract Background and Aims During the last years, there has been an outstanding improvement in cancer treatment. As patients’ survival has been elongated, the prevalence of kidney injury is increasing. However, clinicopathological data are limited in these patients. We aimed to assess the spectrum of kidney biopsy findings in cancer patients and their relation to treatment. Method Single center retrospective study of all patients with solid and hematologic malignancies, who underwent kidney biopsy due to renal impairment, from September 2015 to July 2023. Clinical, laboratory, histopathological and therapeutic data were evaluated Results Fifty-four patients were biopsied, 35 men and 21 women, of median age 66 (42-84) years and follow up 15 (3-84) months. Median serum creatinine was 3 (0.5-22) mg/dl and proteinuria 3 (0.1-23) gr per day at the time of biopsy. Among the solid malignancies (38/54), lung cancer was the commonest (11), followed by gastrointestinal (5), breast (4), sarcoma (5) and melanoma (3); the rest 10 included other solid malignant tumors. Hematologic malignancies (16/54) were mainly multiple myeloma (6) and lymphomas (5), followed by lymphoblastic leukemia (3) and AL amyloidosis (2). The most frequent indication of biopsy was acute kidney injury (AKI) (29/54), followed by both AKI and proteinuria (15/54) and proteinuria with preserved kidney function (9/54); out of 24 patients with proteinuria, 12 exhibited nephrotic range proteinuria (median 10, 3.5-23 gr/day). At the time of biopsy, more than half of patients (30/54) were on cancer treatment; 5 on immunotherapy, 11 on immunotherapy combined to chemotherapy, 10 on chemotherapy solely and four of them received other kind of treatment. Glomerulonephritis (GN) was shown on 24/54 patients. Among GN, focal segmental glomerulosclerosis (FSGS) was the most common lesion (7), followed by light chain deposit disease (LCDD, 3) and membranous nephropathy (MN, 2); among the last, a rare case of MN with a full-house immunoflorescence pattern was reported. Notably, four patients showed amyloidosis (three AL-amyloidosis linked to multiple myeloma and one AA-amyloidosis possibly related to immunotherapy). A rare case of bevacizumab-induced hyaline occlusive glomerular microangiopathy is also reported. The rest 7/24 cases included glomerulosclerosis (1), minimal change disease (MCD, 1), IgA nephropathy (1), diabetic nephropathy (2) and membranoproliferative glomerulonephritis (2). Tubulointerstitial lesions were found on 30 patients. Acute interstitial nephritis (AIN), acute tubular necrosis (ATN) and combination of two (AIN+ATN) were found on 7, 4 and 12 patients respectively (23 in total). Of note, four out of five patients receiving ifosfamide for sarcomas, presented karyomegalic tubulointerstitial nephritis. Four patients, (three with B-cell lymphoma and one with urothelial carcinoma) exhibited renal infiltration by tumor cells. In addition, two patients were shown with oxalate nephropathy and one with nephrocalcinosis. Kidney disease was secondary to treatment in 23 patients, predominantly attributed to immunotherapy (13). Based on histological findings, cancer treatment was withheld in all patients (23/23).Sixteen of all patients received specific treatment for kidney injury, including corticosteroids, cyclosporine or colchicine. In most of them (14), kidney injury was evaluated as secondary to treatment; Two patients, who presented FSGS and MCD, exhibited renal damage attributed to cancer itself. All treated patients (16/16) recovered renal injury. A small proportion of patients (6/54) underwent dialysis—two due to oxalate nephropathy, two with ifosfamide toxicity, one with LCDD and the last due to sepsis. Half of patients (27/54), including 5/6 who were on dialysis, died during observation period. Conclusion Diagnosing and managing kidney injury in cancer patients may be a challenging task. In our single center study, kidney biopsy revealed diverse and rare histological findings, which necessitated tailored therapeutic interventions.

Small Bowel Neuroendocrine Neoplasms-A Review.

Neuroendocrine neoplasms (NENs) are rapidly evolving small bowel tumors, and the patients are asymptomatic at the initial stages. Metastases are commonly observed at the time of presentation and diagnosis. This review addresses the small bowel NEN (SB-NEN) and its molecular, histological, and imaging features, which aid diagnosis and therapy guidance. Somatic cell number alterations and epigenetic mutations are studied to be responsible for sporadic and familial SB-NEN. The review also describes the grading of SB-NEN in addition to rare histological findings such as mixed neuroendocrine-non-NENs. Anatomic and nuclear imaging with conventional computed tomography, magnetic resonance imaging, computed tomographic enterography, and positron emission tomography are adopted in clinical practice for diagnosing, staging, and follow-up of NEN. Along with the characteristic imaging features of SB-NEN, the therapeutic aspects of imaging, such as peptide receptor radionuclide therapy, are discussed in this review.

Bone marrow necrosis in paediatric patients: a diagnostic dilemma

Bone marrow necrosis (BMN) is regarded as an infrequent and rare pathological finding in the aspirates and the trephine biopsies. It is a rare histological finding which may be associated with infections, sickle cell disease, leukemia and other diseases. Its postmortem prevalence ranges from 0.3% to 2.2%., BMN might also be seen prior to, or following a diagnosis of neoplasia, ordering subsequent treatments with chemotherapy or radiotherapy. Cellular elements can be masked by the extensive necrosis, leading to a non-diagnosis and can also precede the disease pathology before its presentation, which can lead to delay in accurate diagnosis. This study was done to highlight the rare findings of BMN and to scrutinize the underlying disease producing BMN after evaluating medical history, clinical presentation, laboratory findings and morphological analysis of bone marrow aspirations and biopsy. A cross-sectional observational study was done for a period of 3 years and this rare finding was observed only in five cases. This study indicates that the conditions associated with BMN are varied and malignancy remains common. BMN may precede or obscure the diagnosis, and repeat biopsies are indicated to secure a diagnosis. Pyrexia, bone pain, pancytopenia, elevated LDH and alkaline phosphatase levels are common associates of BMN.

Hyaline protoplasmic astrocytopathy in epilepsy.

Hyaline protoplasmic astrocytopathy (HPA) describes a rare histologic finding of eosinophilic, hyaline cytoplasmic inclusions in astrocytes, predominantly in the cerebral cortex. It has mainly been observed in children and adults with a history of developmental delay and epilepsy, frequently with focal cortical dysplasia (FCD), but the nature and significance of these inclusions are unclear. In this study, we review the clinical and pathologic features of HPA and characterize the inclusions and brain tissue in which they are seen in surgical resection specimens from five patients with intractable epilepsy and HPA compared to five patients with intractable epilepsy without HPA using immunohistochemistry for filamin A, previously shown to label these inclusions, and a variety of astrocytic markers including aldehyde dehydrogenase 1 family member L1 (ALDH1L1), SRY-Box Transcription Factor 9 (SOX9), and glutamate transporter 1/excitatory amino acid transporter 2 (GLT-1/EAAT2) proteins. The inclusions were positive for ALDH1L1 with increased ALDH1L1 expression in areas of gliosis. SOX9 was also positive in the inclusions, although to a lesser intensity than the astrocyte nuclei. Filamin A labeled the inclusions but also labeled reactive astrocytes in a subset of patients. The immunoreactivity of the inclusions for various astrocytic markers and filamin A as well as the positivity of filamin A in reactive astrocytes raise the possibility that these astrocytic inclusions may be the result of an uncommon reactive or degenerative phenomenon.

Sinonasal IgG4-related sclerosing disease: A rare entity and challenging diagnosis.

To describe the rare presentation, imaging and histological findings, and treatments in patients with IgG4-related disease (IgG4-RD) and diagnostic pitfalls and difficulties. Cases of sinonasal IgG4-RD were retrieved, and clinicopathological features were reviewed. Seven cases of sinonasal IgG4-RD were identified over an 11-year period, including four males and three females, with an age range of 19-66 years (median 58 years). Patients presented with symptoms related to the mass effect of the lesions or the destructive nature of the disease including fullness, swelling, obstruction, and pain. Serum IgG and IgG4 levels, IgG/IgG4 ratios, storiform fibrosis, obliterative phlebitis, and plasma cell infiltration were seen in varying proportions. Bony erosion and tissue inflammation were present in some cases. Sinonasal IgG4-RD is exceedingly rare among other IgG4-RD and varied in its clinical presentation thus posing as a clinically difficult disease to diagnosis. Proper clinical, pathological, and immunohistopathological analysis is required for accurate diagnosis. Such disease should be considered in all cases of similar presentation to those in this study.Level of Evidence: 4.

Spectrum of histopathological findings in pediatric renal biopsies; a five-year single center experience in Egypt

Introduction: Medical renal diseases stand as one of the major health problems in pediatric age group considering its morbidity/mortality and the subsequent management plans. Objectives: In this manuscript, the spectrum of histopathological patterns of medical nephropathic lesions in Egyptian pediatric patients over duration of five years is reported with clinical indications. Patients and Methods: We conducted a retrospective study for analysis of our pathological reports of renal needle biopsies during the period from January 2014 until January 2019. One hundred and sixteen cases were included. Results: The most commonly encountered pediatric renal pathology was minimal change disease (27.59%), followed by congenital glomerular diseases (22.41%), focal segmental glomerulosclerosis (12.93%), and thrombotic microangiopathy (7.76%). The most common clinical indication for biopsy was nephrotic syndrome (37.07%) followed by impaired renal functions with elevated serum creatinine (21.55%). In addition, we report very rare histological findings in few cases including infantile nephropathic cystinosis, Barakat syndrome and C3 glomerulopathy. Conclusion: Minimal change disease and congenital glomerular diseases accounted for half of pediatric renal pathologies in the study population. The most common clinical indication for renal biopsy was nephrotic syndrome. Electron microscopic examination and genetic studies are mandatory for proper evaluation of pediatric nephropathies.

Intraocular osseous metaplasia presenting as a solid mass in chronic retinal detachment: a case report

BackgroundIntraocular osseous metaplasia is a rare histological finding associated with benign cellular transformation. Its development requires inflammatory cytokines and the process takes many years. Previous case reports of intraocular ossification manifested as linear calcification or white plaques. In contrast, our case presented with a tumor-like solid mass, in which a long-standing chronic inflammatory stimulation may contribute to the stunning appearance.Case presentationThis is a 48-year-old woman with past history of advanced Coat’s-like retinopathy and chronic retinal detachment in the left eye for 12 years. She underwent vitreoretinal surgery to prevent phthisis bulbi. During the operation, a 9 mm solid mass was found embedded within the proliferative tissue above the retina and was removed. Pathological findings revealed bone formation in the center of the mass surrounded by fibrous metaplasia and focal gliotic changes. Layers of cohesive cells were found lining on the external side of the mass, and further immuno-histochemical study suggested them retinal pigment epithelial cells. Postoperatively, the retina was attached with stable visual acuity and normal intraocular pressure.ConclusionTo our knowledge, the appearance of a tumor-like mass representing intraocular osseous metaplasia in eyes with chronic inflammation or retinal detachment has not been reported in previous case reports. This case emphasizes the importance of considering osseous metaplasia as one of the differential diagnoses of an unknown intraocular mass, especially in eyes with great severity of chronic inflammation. Also, our immuno-histochemical study provided more evidence on the pathological role of retinal pigment epithelial cells in developing ossification.

Chondro-Osseous Metaplasia in Ependymoma: A Rare Histopathological Finding

Ependymoma is a circumscribed glioma composed of uniform glial cells with bland nuclei in a fibrillary matrix. It is characterized by the presence of perivascular pseudorosettes. Unusual histopathological findings have rarely been reported in ependymomas, 0.5% of all diagnosed cases. Such unusual and exceedingly rare histological findings include osseous or chondroid metaplasia. To the best of our knowledge, only 15 cases of osseocartilaginous ependymomas have been reported in English literature. We report a 3-year-old boy who presented with ataxia, vomiting, and headache for three months. Radiological imaging revealed a posterior fossa lesion. Histopathological examination of the lesion confirmed a posterior fossa ependymoma with chondro-osseous metaplasia. The present case outlines the clinical presentation, histopathological findings, and outcome of chondro-osseous metaplasia in ependymomas. To date, the etiology of chondro-osseous metaplasia in ependymomas remains uncertain. Further research exploring such phenomenon is of paramount importance to explain how these tumors develop.

Intracardiac germ cell tumour in neonate with patent ductus arteriosus: An unusal case

Primary cardiac tumors are rare in pediatrics age group. Germ cell tumor although relatively common in mediastenum, but intracardiac mature teratoma with PDA are extremely rare histological finding reported in our department of pathology in 9 days old full term neonate.

Isolated eosinophilic myometritis –A rare histological finding

Isolated eosinophilic myometritis –A rare histological finding - JDPO- Print ISSN No: - 2581-3714 Online ISSN No:- 2581-3706 Article DOI No:- 10.18231/j.jdpo.2019.047, IP Journal of Diagnostic Pathology and Oncology-IP J Diagn Pathol Oncol

Multiple Myeloma with Intracytoplasmic Azurophilic Granules

Bone marrow examination plays an important role in the diagnosis of multiple myeloma. In some cases with multiple myeloma, marrow plasma cells with cytoplasmic inclusions are seen. In this study, a 46-year- old man was evaluated for multiple myeloma. In bone marrow aspiration, large intracytoplasmic azurophilic granules, resembling intracellular microorganisms were seen. IHC study demonstrated that these cells are CD138 positive. This is a rare histologic finding that usually results from the deposition of excess immunoglobulin.

SMARCB1- and vimentin-positive esophageal carcinoma with undifferentiated components, rhabdoid features, and a good prognosis: a case report

BackgroundUndifferentiated carcinoma of the esophagus with rhabdoid features is a very rare histologic finding that is occasionally associated with the loss of SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1 (SMARCB1); however, until now, few survey reports of this type of tumor have been published. In this study, we describe a case of esophageal carcinoma with undifferentiated components and rhabdoid features that was exclusively positive for vimentin and SMARCB1 in a patient with prolonged survival.Case presentationA 67-year-old man complained of a stomachache and loss of appetite persisting for 1 month. He was then admitted to the hospital. Diagnostic imaging studies revealed a transdiaphragmatic circular ulcerative tumor of the esophagogastric region. Biopsy specimens showed undifferentiated round cell carcinoma. The patient underwent lower esophageal resection and total gastrectomy with lymph node dissection. Microscopic analysis revealed that most of the primary tumor consisted of large undifferentiated round cells and scattered rhabdoid cells. The tumor invaded the muscular layer in the esophagus and the subserosal layer in the stomach, and metastasis was noted in only one lymph node. Immunohistochemical analysis revealed that the round and rhabdoid cells found in the primary tumor were diffusely positive for SMARCB1 and vimentin. The tumor displayed focal positivity for the anti-pan-cytokeratin antibody AE1/AE3. In the positive lymph node, round undifferentiated carcinoma cells were admixed with squamous carcinoma cells that were positive for cytokeratin 5/6 and 34βE12. The MIB-1 index was 19.7% and 0.5% for the round cells from the primary tumor and epithelial cells from the metastatic lymph node lesion, respectively, and 70.1% for the round cells from the metastatic lymph node lesion. The patient has been alive for 10 years after surgery without tumor recurrence.ConclusionsWe reported a rare case of esophageal carcinoma with undifferentiated components, rhabdoid features, and a good prognosis.

Noninvasive Encapsulated Anaplastic Thyroid Carcinoma Promising an Excellent Clinical Course: A Case Report and Review of the Literature

Noninvasive encapsulated anaplastic thyroid carcinomas (NE-ATCs) have been described in few case reports, and consistently associated with favorable outcome compared to the classical ATCs. Our aim is to remark a rare histological finding in ATCs, encapsulation, which has been associated with a favorable outcome. We have documented a rare case of an NE-ATC with its clinical, pathological, and molecular features. We also provided a thorough discussion of all the encapsulated ATCs reported in the literature. A 50-year-old woman with an unremarkable medical history, who presented with a thyroid nodule, and diagnosed as "follicular lesion of undetermined significance" by fine needle aspiration biopsy. The patient was lost to follow-up for six years and revisited upon her neck disturbances and underwent total thyroidectomy. Sections of the right lobe revealed a grossly encapsulated nodular lesion, measuring 75x55x55 mm. Histologically, the tumor consisted of both carcinomatous and sarcomatous components supported by immunohistochemical stains. Necrosis and atypical mitotic figures were evident. Capsular and/or vascular invasion was not identified. There were no BRAF codon 600, KRAS, NRAS mutations and RET/PTC rearrangement. During three-month follow-up, the patient was free of disease without adjuvant therapy. Encapsulated ATCs tend to follow a favorable clinical course and may deserve conservative treatment approaches.

Purely Cystic Desmoplastic Ganglioglioma: An Incidental Finding in a Giant Cyst

AbstractDesmoplastic infantile ganglioglioma (DIG) is a rare supratentorial brain tumor occurring mostly before the age of 2 years. It has a good prognosis and total excision of the tumor is curative, necessitating no further treatment. An accurate pathologic diagnosis is crucial. Until now, approximately 70 cases of this tumor type have been reported. Solid-cystic variety is mostly described with occasional purely solid type lesion also. We are presenting a 12-month-old male infant with developmental delay and a giant cyst on the right side of supratentorial compartment, which showed histological features of desmoplastic ganglioglioma. Hence, the current case is reporting the rare histologic finding of cystic change in desmoplastic ganglioglioma. Cystic form of desmoplastic ganglioglioma should be considered in differential diagnosis of supratentorial cystic lesion in an infant. Prognosis is excellent after complete excision.

Oral Leiomyoma With Intracytoplasmic Inclusion Bodies: A Rare Histological Finding

Oral Leiomyoma With Intracytoplasmic Inclusion Bodies: A Rare Histological Finding

Extensively Ossifying Oral Leiomyoma: A Rare Histologic Finding

Oral leiomyoma are rare neoplasms of the oral cavity. Ossification within leiomyoma is not unusual but is mostly reported in leiomyoma of the deep soft tissue. Ossifying leiomyoma is extremely rare in the head and neck. We identified a total of three cases of extensively ossified leiomyoma in the head and neck in the literature including lesions in the lateral pterygoid muscle and orbit. To the best of our knowledge, only one case of extensively calcified leiomyoma has been reported in the oral cavity. We present two such rare cases of oral leiomyoma with extensive intratumoral calcifications and ossification. Ossified leiomyoma should be considered in the differential diagnosis of calcified or hard/firm soft tissue masses in the oral cavity.

English

UNUSUAL VARIANTS OF FIBROADENOMA BREAST DIAGNOSED ON CYTOLOGY Fibroadenomas are common benign breast tumours that display a characteristic morphology, although several epithelial and stromal variations exist which may pose a diagnostic difficulty. We are discussing a case series of four cases of benign fibroadenoma with morphological variations as observed on cytology smears in the department of Pathology, KGMU, Lucknow, UP. Juvenile fibroadenoma constitutes only 4% of the total fibroadenomas with incidence of 0.5% per year. Another very rare histological finding is the presence of multinucleated giant cells throughout the stroma of a benign fibroadenoma, more commonly found incidentally within the interlobular stroma of breast tissue. Similarly apocrine metaplasia has been found to be 28% in a case series (Arno Kuijper et.al) of 396 cases of fibroadenoma. It is important to identify these variants as they may be misinterpreted as malignancy.

Metaplastic Ossification in a Juvenile Rectal Polyp: A Rare Histological Finding

An osseous metaplasia is a phenomenon which has been described in a wide variety of tissue types with respect to both neoplastic and non-neoplastic conditions. However, an osseous metaplasia is exceedingly rare in colonic polyps. We are herein representing a case of osseous metaplasia in a juvenile rectal polyp in a six year old boy, with review of the literature on the suggested mechanisms of its aetiology.

Prostatic Stromal Hyperplasia with Atypia

Prostatic stromal hyperplasia with atypia (PSHA) is a rare histologic finding diagnosed incidentally on prostate biopsies, transurethral resection specimens, and radical prostatectomy specimens. PSHA has a bizarre histologic appearance and these lesions often raise concern for sarcoma; however, their clinical course is indolent and does not include extraprostatic progression. We discuss a case of PHSA discovered on prostate biopsy performed for an abnormal digital rectal examination and review the literature on this rare pathologic finding.

Signet ring carcinoma of the esophagogastric junction in a Nigerian man

Globally, the majority of cancers of the esophagogastric junction are adenocarcinomas. Of the four histological subtypes, the signet ring carcinomas are rare. There is a dearth of reports of this relatively rare histological finding from patients in sub-Saharan Africa. We present such a case in 69 year old Nigerian with advanced malignant disease. Key word: Signet ring carcinoma, esophagogastric junction, endoscopy, Nigeria