Intranodal palisaded myofibroblastoma (intranodal hemorrhagic spindle cell tumor with amianthoid fibers): a case report and literature review

Intranodal palisaded myofibroblastoma (IPM) is a benign mesenchymal neoplasm originating from smooth muscle cells and myofibroblasts. It is characterized by spindle cells, amianthoid fibers, and by the proliferation of hemosiderin-containing histiocytes in the lymph node. A nodular lesion was excised from the inguinal region of an 80-year-old male patient. Macroscopic examination of a section of the lesion demonstrated a solid appearance with hemorrhagic areas. Microscopic examination revealed spindle cell proliferation, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. Nuclei of the spindle cells displayed a palisaded appearance. Compressed lymphoid tissue was observed around the lesion. With Masson's trichrome, spindle cells stained as smooth muscle, whereas collagen staining was observed in homogeneous eosinophilic accumulations. Neoplastic cells were identified by the presence of vimentin and SMA. The Ki67 index was less than 1%. In light of these results, the case was diagnosed as "intranodal palisaded myofibroblastoma." IPM is an uncommon neoplasm originating from the stromal component of the lymph node. Although IPM is benign, it is frequently confused with metastatic lesions

Histological Subgroups in Classic Kaposi Sarcoma: A Preliminary Study

Background and Design: Kaposi sarcomas (KS) are vascular tumors with a low malignant potential which include overlapping infectious, immunologic, and neoplastic processes. Recently, many histological subtypes have been defined. Material and Method: In the present study, 151 cutaneous classic KS lesions in 56 patients were retrospectively evaluated with regard to histological subtypes. Determination of the subtypes was based on the predominant histopathological component in the lesion. We examined changes in epidermis and dermis along with intratumoral inflammatory response characteristics in the lesions. By defining histopathological variants of the cases, differences regarding subtypes were investigated. Results: Cases that bear the ordinary characteristics of KS and those that can not be classified otherwise, comprised 82..8% of the study group. Twenty-six cases showed consistency with the subtypes outlined in the literature in terms of their histopathological properties. The most common histological subtype was the lymphangiectatic variant in 7.3% of the cases. Bullous (2.6%), lymphangioma like (2.6%), intravascular (2%), and pyogenic granuloma like (2%) variants were less common. The most uncommon histological subtype was micronodular (0.6%) type. Lymphangiectatic, bullous, intravascular, and pyogenic granuloma like variants were frequently observed in the nodular stage of KSs. Lympangioma like changes were seen to be present in the early KS lesions. Lymphangiectatic type was oftenly associated with bullous component, whereas pyogenic granuloma like type demonstrated superficial ulceration and intense inflammatory response. Lymphangioma like and intravascular types exhibited a characteristic appearance, while other variants were accompanied by components belonging to different subtypes. Conclusion: In KS, histopathological subtypes can develop as a result of different pathological processes. The next stage of the current study, which is one of the largest case series in the literature, will be investigation of the clinical and prognostic characteristics of the variants

Cavernous Hemangioma-Like Kaposi Sarcoma: Histomorphologic Features and Differential Diagnosis

Aim. Cavernous hemangioma-like Kaposi sarcoma is a rare morphologic type of Kaposi sarcoma. So far there are no cases in the literature defining the histological features of this morphologic spectrum in detail. In this study we presented two classical-type cutaneous Kaposi sarcoma cases with histologic findings resembling cavernous hemangioma in company with clinical and histopathological data. Cases. One hundred and eighty-five classical-type cutaneous Kaposi sarcoma lesions in 79 patients were assessed retrospectively in terms of histopathological features. Findings of two cases showing features of cavernous hemangioma-like Kaposi sarcoma whose clinical data could be accessed were presented in accompany with the literature data. Both cases were detected to have bluish-purple, protruded, irregularly bordered cutaneous lesions. Histopathological examination revealed a lesion formed by cavernous hemangioma-like vascular structures organized in a lobular pattern that became dilated and filled with blood. Typical histological findings of early-stage KS, consisting of mononuclear inflammation, extravasated erythrocytes, and a few immature vascular structures in superficial dermis, were observed. All cases were serologically HIV-1 negative. A positive reaction with HHV-8, CD31, CD34, and D2-40 monoclonal antibodies was identified at both cavernous hemangioma-like areas and in immature vascular structures. Results. Cavernous hemangioma-like Kaposi sarcoma is a rare Kaposi sarcoma variant presenting with diagnostic challenges, that may be confused with hemangioma. As characteristic morphological features may not be observed in every case, it is important for diagnostic purposes to show immunohistochemical HHV-8 positivity in this variant

Fine-Needle Aspiration Findings in Cases of Thyroid Carcinoma

Amaç: Preoperatif dönemde ince iğne aspirasyon sitolojisi uygulanmış 93 tiroid karsinom olgusuna ait sitopatoloji preparatlarının Bethesda Sistemine göre yeniden değerlendirilmesi ve bulguların klinikopatolojik veriler ile olan ilişkisi incelendi. Gereç ve Yöntem: 93 olgunun sitopatoloji raporlarındaki tanılar gözlemci tarafından Bethesda Sistemi’ne göre kategorize edildi (grup 1) ve önceki tanıları bilinmeksizin sitopatoloji preparatları yeniden tarandı; Bethesda Sistemi’ne göre tanı verildi (grup 2). Her iki tanı grubu arasındaki fark ve/veya uyumsuzluk sorgulandı. Folliküler patern gösteren karsinomların sitopatoloji tanıları arasındaki fark ve/ veya uyumsuzluk da araştırıldı. Yaş, cinsiyet, tümör tipi, tümörün boyutu, tümör odak sayısı, karsinoma eşlik eden komponent ve ilk rezeksiyon tipi olarak değerlendirme kapsamına alınan klinikopatolojik veriler incelendi. Bulgular: Çalışmamızda iki tanı grubu arasındaki fark (p=0.522) anlamlı bulunmazken, gruplar arasında orta derecede uyum saptandı (kappa=0.493). Folliküler patern gösteren karsinom olgularında ise iki grup arasındaki fark istatistiksel olarak anlamlı bulunmazken (p=0.560); orta derecede uyum gözlendi (kappa=0.555). Her iki tanı grubunun tümör tipi, tümör odak sayısı ve eşlik eden komponent ile olan ilişkileri istatistiksel olarak anlamlı bulunmazken, grup 1’in tümör boyutu ile ilişkisi anlamlı bulundu. Sonuçlar: Çalışmamızdaki olguların tamamı histopatolojik olarak karsinom tanısı almış ise de sitopatolojik olarak hepsi ‘Malign’ grupta kategorize edilememiştir. Bethesda Sistemi’ne göre her tanı kategorisinde az da olsa malignite riski olduğundan ince iğne aspirasyon sitolojisine ek olarak klinik ve radyolojik özelliklerin dikkatli olarak değerlendirilmesi tiroid karsinomu olgularının gözden kaçırılmamasını sağlayacaktırObjective: The re-evaluation of 93 cytopathology preparations belonging to thyroid carcinoma cases that underwent fine needle aspiration cytology in the preoperative period according to the Bethesda System and the examination of the relationship between findings and clinicopathological data. Material and Method: Cytopathology reports in 93 cases were categorized by observers that have been diagnosed according to the Bethesda System (group 1) and cytopathology preparations were scanned again without knowing the previous diagnosis; was diagnosed according to the Bethesda System (group 2). The difference and/or non- compliance between the two diagnostic groups have been questioned. The difference and/or non-compliance between carcinomas showing follicular patterns through cytopathology diagnosis were also investigated. Clinicopathological data which included the first resection as age, gender, tumor type, tumor size, number of tumor foci, concomitant carcinoma component and the type of evaluation were analyzed. Results: In our study, the difference between the two diagnostic groups was not significant (p=0.522) but compliance between the groups was moderate (kappa=0.493). There was no statistically significant difference between the two groups showing the pattern of follicular carcinomas (p=0.560); compliance was observed moderate (kappa= 0.555). There was no statistically significant relationship between each of the two diagnostic groups, tumor type, number of tumor foci and accompanying components; on the other hand, the corrrelation between tumor size and group 1 was significant. Conclusion: Even all the patients in our study have a diagnosis of carcinoma histopathologically; cytologically they could not be categorized as ‘malignant’. According to the Bethesda System, in each diagnostic category there is a slight risk of malignancy and in addition to the fine needle aspiration cytology, a careful evaluation of clinical and radiological features will ensure the situation of patients with thyroid carcinoma not being overlooked

Agreement Between Pathologic Diagnosis and Endoscopic Findings on Esophagogastroduodenoscopy Performed by General Surgeons

Aim: The aim of this study is to evaluate cognitive competence of surgeon-endoscopists in esophagogastroduodenoscopy (EGD) by comparison between endoscopic and pathologic diagnosis. Methods: This study is a retrospective chart review of 257 EGDs performed between September 2008 and March 2010 by two attending surgeons (OI, FAG) at the Zonguldak Karaelmas University, Medical Faculty, Department of General Surgery. Cognitive competence was examined by comparison between endoscopic and histopathological diagnosis. Endoscopic and pathologic reports were collected from the hospital database. Results: 217 of 257 EGDs were evaluated. Demographic data of the patients showed that 36% were male and 64% were female. The mean age was 51 years with a range of 24 to 78 years. Endoscopic diagnosis was gastritis in 78% of patients (n=168) and suspicion of malignancy in 11% (n=25). After histopathologic examination, 142 out of 168 patients with endoscopically suspected gastritis were diagnosed as having chronic gastritis or chronic-active gastritis. Surgeons were able to identify an abnormality with a detection rate of 86%. Surgeon-endoscopists had 80% positive predictive and 100% negative predictive value for malignancy according to EGD findings. H. pylori-positive gastric mucosal pattern was accurately identified by surgeons, and the infection was found in 67% (n=112) of patients with chronic gastritis or chronic-active gastritis. Conclusion: Taking into consideration the good agreement observed between endoscopic and pathologic findings in our study, we may conclude that surgeon-endoscopists with high cognitive competence in EGD may establish accurate diagnosis. (The Medical Bulletin of Haseki 2011; 49: 26-9

The comparison of vessels in elective and spontaneous abortion decidua in first trimester pregnancies: Importance of vascular changes in early pregnancy losses

Background. To determine whether adequate trophoblastic migration and maternal placental perfusion occurs in cases of early pregnancy loss, we compared vessels in elective abortion decidua with those in spontaneous abortion decidua. Methods. Elective abortion decidua at 5-11 weeks ( n =40) were compared with spontaneous abortion decidua at 5-12 weeks ( n =25). Also normal late secretory endometrial biopsy specimens ( n =10) were examined. The cross-sections of veins and arteries were counted in 25 elective and 15 spontaneous abortion materials. The number of the veins that contain trophoblastic fragments and the number of the spiral arteries converted by trophoblasts were determined. Statistical significance by Mann-Whitney U and Spearman's correlation test was p <0.05. Results. All sets of decidua had dilated veins, but no secretory endometrium did. The ratio of converted spiral arteries to nonconverted arteries was much more in elective abortion decidua (113/938, 12.04%) than in spontaneous abortion decidua (11/511, 2.15%) ( p <0.001). Conclusions. The presence of converted arteries, dilated veins, and intravenous trophoblastic fragments in decidual specimens were evidence of intervillous circulation and placental perfusion by maternal circulation in the first trimester. Also the insufficient conversion of the arteries in spontaneous abortions might be responsible for many cases of early pregnancy loss. © 2006 Taylor & Francis