http://www.diagnosticpathology.org The most accessed research articles published by Diagnostic Pathology 2010-03-01T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: Occult neoplastic cells (ONCs) are the tumor cells floating in the lymph node sinuses, distant from the primary tumor, and supposed to be one of most reliable marker of prognosis. Methods: We report here the case of a 52-year-old woman with a gastric cancer associated by numerous ONCs. Results: Postoperative examination of the stomach disclosed an advanced, poorly differentiated adenocarcinoma with frequent lymph node metastases. In addition to ONCs and occasional micrometastases, focal aggregates of ONCs, one of the possible intermediate lesions between the ONCs and the usual metastases, are also observed. Conclusions: In the present case, at least some of ONCs seem to form the microaggregates of tumor cells in lymph nodes, anchor in the sinuses, and grow up to the large tumorous lesion. Even if most of the ONCs were trapped and disappeared under the influence of tumor immunity, the detection of ONCs could be one of the reliable clues to estimate the prognosis. http://www.diagnosticpathology.org/content/5/1/14 Shinkichi Sato Masaya Mukai Diagnostic Pathology 2010, 5:14 2010-02-24T00:00:00Z doi:10.1186/1746-1596-5-14 Diagnostic Pathology 1746-1596 5 14 2010-02-24T00:00:00Z PDF Background: Mixed epithelial and stromal tumour (MEST) represents a recently described benign composite neoplasm of the kidney, which predominantly affects perimenopausal females. Most tumours are benign, although rare malignant cases have been observed.Case reportA 47-year-old postmenopausal female presented to the urologist with flank pain. A CT scan of the abdomen showed a 30-mm-in-diameter uniform mass adjacent to the pelvis of the left kidney. Surgical exploration showed a tumour arising from the lower anterior hilus of the left kidney. The tumour could be excised by preserving the kidney. By intraoperative frozen section the tumour showed characteristic features of MEST with epithelial-covered cysts embedded in an "ovarian-like" stroma. Additional immunohistochemistry investigations showed expression for hormone receptors by the stromal component of the tumour.DiscussionMEST typically presents in perimenopausal women as a primarily cystic mass. Commonly, the tumour arises from the renal parenchyma or pelvis. The tumour is composed of an admixture of cystic and sometimes more solid areas. The stromal cells typically demonstrate an ovarian-type stroma showing expression for the estrogen and progesterone receptors. Conclusion: MEST represents a distinctive benign tumour entity of the kidney, which affects perimenopausal woman. The tumour should be distinguished from other cystic renal neoplasms. By imaging studies it is difficult to distinguish between a benign or malignant nature of the tumour. Thus, intraoperative frozen section is necessary for conservative surgery, since the overall prognosis is favourable and renal function can be preserved in most cases. http://www.diagnosticpathology.org/content/5/1/16 Michael Richter Werner Meyer Jens Kuster Peter Middel Diagnostic Pathology 2010, 5:16 2010-03-01T00:00:00Z doi:10.1186/1746-1596-5-16 Diagnostic Pathology 1746-1596 5 16 2010-03-01T00:00:00Z XML Background: Endometrial carcinoma (EC) is the most common malignancy of the female genital tract. Gene alterations and overexpression of various oncogenes are important in tumor development. The human HER 2 neu (c-erbB-2) gene product is a transmembrane receptor with an intracellular tyrosine kinase that plays an important role in coordinating the endometrial growth factor receptor signaling network. The aim of this study was to investigate the expression of c-erbB-2 in endometrial cancer, to study its correlation to established prognostic parameters and estrogen receptor (ER) and progesterone receptor (PR) status. Methods: Immunohistochemical (IHC) analyses of ER, PR and c-erbB-2 were performed in 72 EC cases. Results: We detected a positive staining with c erbB 2 in 18.1% of the cases and determined a statistically significant relation between c-erbB-2 and PR. We could not find a statistically significant relation between c-erbB-2 staining and ER. There was not a statistically significant difference between c-erbB-2 and histological grade. The highest level of c-erbB-2 was found in grade 2 cases. There was not any statistically significant relation between c-erbB-2 and menstrual status, myometrial invasion, lymph node status, stage and survival. Conclusions: Although our study provides additional evidence of the potential prognostic role of c-erbB-2, further prospective and controlled studies are required to validate their clinical usefulness. http://www.diagnosticpathology.org/content/5/1/13 Aylin Ege Gul Sevinc Hallac Keser Nagehan Ozdemir Barisik Nilufer Onak Kandemir Caglar Cakir Sibel Sensu Nimet Karadayi Diagnostic Pathology 2010, 5:13 2010-02-18T00:00:00Z doi:10.1186/1746-1596-5-13 Diagnostic Pathology 1746-1596 5 13 2010-02-18T00:00:00Z XML We report a rare case of ostial plication as a potential cause of sudden death. Very few reports and images are available in the specialized literature regarding this anomaly. Ostial plication may be a source of sudden death or cause of death when no other significant autopsy findings are present.Ostial plication is a congenital severe obstruction/occlusion of the right or left ostium. Plication of the aortic wall leads to a "valve-like" ridge that can act as a door blocking inflow during diastolic filling, with consequent ischemia and a potentially life-threatening arrhythmia. The true incidence of this condition and its relationship to sudden death have not been reported in the literature. We believe that this case will be useful to autopsy pathologists in detecting this infrequent anomaly, thus providing a more accurate estimation of its incidence. http://www.diagnosticpathology.org/content/5/1/15 Fabio De-Giorgio Vincenzo Arena Diagnostic Pathology 2010, 5:15 2010-02-25T00:00:00Z doi:10.1186/1746-1596-5-15 Diagnostic Pathology 1746-1596 5 15 2010-02-25T00:00:00Z XML Background: Breast spindle cell tumours (BSCTs), although rare, represent a heterogeneous group with different treatment modalities. This work was undertaken to evaluate the utility of fine needle aspiration cytology (FNAC), histopathology and immunohistochemistry (IHC) in differentiating BSCTs. Methods: FNAC of eight breast masses diagnosed cytologically as BSCTs was followed by wide excision biopsy. IHC using a panel of antibodies against vimentin, pan-cytokeratin, s100, desmin, smooth muscle actin, CD34, and CD10 was evaluated to define their nature. Results: FNAC defined the tumors as benign (n = 4), suspicious (n = 2) and malignant (n = 3), based on the cytopathological criteria of malignancy. Following wide excision biopsy, the tumors were reclassified into benign (n = 5) and malignant (n = 3). In the benign group, the diagnosis was raised histologically and confirmed by IHC for 3 cases (one spindle cell lipoma, one myofibroblastoma and one leiomyoma). For the remaining two cases, the diagnosis was set up after IHC (one fibromatosis and one spindle cell variant of adenomyoepithelioma). In the malignant group, a leiomyosarcoma was diagnosed histologically, while IHC was crucial to set up the diagnosis of one case of spindle cell carcinoma and one malignant myoepithelioma. Conclusion: FNAC in BSCTs is an insufficient tool and should be followed by wide excision biopsy. The latter technique differentiate benign from malignant BSCTs and is able in 50% of the cases to set up the definite diagnosis. IHC is of value to define the nature of different benign lesions and is mandatory in the malignant ones for optimal treatment. Awareness of the different types of BSCTs prevents unnecessary extensive therapeutic regimes. http://www.diagnosticpathology.org/content/1/1/13 Howayda Abd El All Diagnostic Pathology 2006, 1:13 2006-07-22T00:00:00Z doi:10.1186/1746-1596-1-13 Diagnostic Pathology 1746-1596 1 13 2006-07-22T00:00:00Z XML Background: Thyroid nodules are common among adults though only a small percentage is malignant, which can histologically mimic benign nodules. Accurate diagnosis of these thyroid nodules is critical for the proper clinical management. Methods: We investigated immunoexpression in 98 surgically removed benign thyroid nodules including 52 hyperplastic nodules (HN) and 46 follicular/Hurthle cell adenomas (FA), and 54 malignant tumors including 22 follicular carcinoma (FC), 20 classic papillary carcinoma (PTC), and 12 follicular variant papillary carcinoma (FVPC). Results: The staining results showed that malignant tumors express galectin-3, HBME-1, CK19 and Ret oncoprotein significantly more than benign nodules. The sensitivity of these markers for the distinction between benign and malignant lesions ranged from 83.3% to 87%. The sensitivity of two-marker panels was not significantly different. Immunoexpression was usually diffuse and strong in malignant tumors, and focal and weak in the benign lesions. Conclusion: Our findings indicate that these immunomarkers are significantly more expressed in malignant tumors compared to benign lesions and may be of additional diagnostic value when combined with routine histology. http://www.diagnosticpathology.org/content/5/1/9 Husain Saleh Bo Jin John Barnwell Opada Alzohaili Diagnostic Pathology 2010, 5:9 2010-01-26T00:00:00Z doi:10.1186/1746-1596-5-9 Diagnostic Pathology 1746-1596 5 9 2010-01-26T00:00:00Z XML A rare case is presented of a 61-year-old man with a malignant peripheral nerve sheath tumor associated with neurofibromatosis type 1, with metastasis to the heart. The primary tumor originated in the right thigh in 1982. Since then, the patient has had repeated local recurrences in spite of repeated surgical treatment and adjuvant chemotherapy. He has developed previous metastases of the lung and heart. The patient died of cardiac involvement. http://www.diagnosticpathology.org/content/5/1/2 Masanori Kitamura Naoki Wada Shigenori Nagata Norishige Iizuka Yu-Fen Jin Miki Tomoeda Michiko Yuki Norifumi Naka Nobuhito Araki Chikao Yutani Yasuhiko Tomita Diagnostic Pathology 2010, 5:2 2010-01-09T00:00:00Z doi:10.1186/1746-1596-5-2 Diagnostic Pathology 1746-1596 5 2 2010-01-09T00:00:00Z XML Neoplasms of the urinary bladder following augmentation ileocystoplasty are rare. We present the case of a 39-year-old male with a tubular adenoma with high-grade dysplasia in the ileal segment 34 years after augmentation ileocystoplasty to enlarge a post-chemoradiation-induced shrunken bladder. He presented with gross hematuria. Cystoscopy revealed a papillary tumor at the site of ileovesical anastomosis, and transurethral resection was performed. Histologic examination revealed a tubular adenoma with high-grade dysplasia. There are only two previous reports of tubulovillous adenoma in ileal segment after ileocystoplasty, both without high-grade dysplasia. Our observation supports the hypothesis that an ileal neobladder may undergo all the morphologic and molecular changes observed in the development of gastrointestinal adenocarcinoma. Therefore, patients who had an ileal neobladder created should be closely followed. http://www.diagnosticpathology.org/content/2/1/29 Henry Armah Alyssa Krasinskas Anil Parwani Diagnostic Pathology 2007, 2:29 2007-08-13T00:00:00Z doi:10.1186/1746-1596-2-29 Diagnostic Pathology 1746-1596 2 29 2007-08-13T00:00:00Z XML Background: Extrapleural Solitary Fibrous tumors (SFTs) have been increasingly reported. The retroperitoneum, deep soft tissues of proximal extremities, abdominal cavity, trunk, head and neck are the most common extraserosal locations reported. Microscopically they show a wide range of morphological features, and so the differential diagnosis is extensive. Immunohistochemically, they commonly express CD34, vimentin, bcl-2 and CD99. Epithelial membrane antigen (EMA) and smooth muscle actin (SMA) may occasionally be expressed. Epithelioid morphology in extrapleural SFT has only very occasionally been described (five cases reported), some of them with biphasic pattern and others with malignant characteristics.Case presentationA SFT of the thigh with epithelioid areas in a 63 year old woman is reported. Microscopically the tumor showed areas hypo and hipercellular. At the periphery of the hipercellular areas there were nodules composed of epithelioid cells. Immunohistochemically both the spindle and epithelioid cells were positive for CD34, vimentin, bcl-2 and CD99. Epithelial, neural and muscular markers were negative. Molecular study was done and ruled out a synovial sarcoma. Conclusion: Ten cases of SFT of the thigh have been reported but to our knowledge this is the first case with epithelioid morphology affecting the extremities. Identification of this pattern of SFT is of importance, to avoid misdiagnosis with other more aggressive conditions in soft tissue. http://www.diagnosticpathology.org/content/2/1/19 Miguel Martorell Ana Perez Valles Francisco Gozalbo Jose Angel Garcia-Garcia Jair Gutierrez John Gaona Diagnostic Pathology 2007, 2:19 2007-06-18T00:00:00Z doi:10.1186/1746-1596-2-19 Diagnostic Pathology 1746-1596 2 19 2007-06-18T00:00:00Z XML Background: Metastases of malignant melanoma to the bone marrow are very rare. A few case reports are published in the literature with a known primary site.Case presentationHerein we present a case of metastatic malignant melanoma in bone marrow with occult primary site in a 22- year-old-male. Diagnosis was confirmed by morphology and immunohistochemistry. A pertinent review of literature is also presented by using relevant articles indexed in PubMed (National Library of Medicine) database. The search was based on the following terms: metastasis or metastases, malignant melanoma and bone marrow. Conclusion: In this report we discuss a rare case of metastatic malignant melanoma to the bone marrow with an unknown primary. Clinicians must be aware of the varied clinical manifestations of disseminated malignant melanoma even if the primary site is not evident. http://www.diagnosticpathology.org/content/2/1/38 Deepali Jain Tejindar Singh Naresh Kumar Mradul Daga Diagnostic Pathology 2007, 2:38 2007-10-02T00:00:00Z doi:10.1186/1746-1596-2-38 Diagnostic Pathology 1746-1596 2 38 2007-10-02T00:00:00Z XML