Epithelioid variant of pleomorphic liposarcoma as potential mimic of metastatic carcinoma

We report a case of epithelioid variant of pleomorphic liposarcoma (EPL) found in the the infrapatellar fat pad of Hoffa of a 31-year old male. Histologically, the predominant population was formed by epithelioid cells with eosinophilic or clear cytoplasm admixed with rare pleomorphic lipoblasts. The immunohistochemical panel was not helpful in the diagnosis. FISH analysis using the locus-specific indicator CHOP (12q13) dual color break apart was applied to representative formalin-fixed, paraffin-embedded tissue sections. The result of FISH indicated a rearranged CHOP (DDIT3) gene and confirmed the diagnosis of EPL. The EPL should be differentiated from a metastatic carcinoma or other type of sarcoma. In these cases a clinicopathological correlation and an exhaustive sampling of the specimen for demonstration of lipogenic areas or pleomorphic lipoblasts is always necessary. FISH with demonstration of CHOP gene rearrangement is useful in providing specific ancillary information for the difficult differential diagnosis of this case

Cellular neurothekeoma with neuroendocrine differentiation

We report a case of cellular neurothekeoma with unusual clinicopathological features in which neuroendocrine markers, determined by immunohistochemistry were observed. Histologically, the tumor showed a micronodular architecture with hypercellular lobules composed of slightly spindled to epithelioid cells, with nuclear atypia or pleomorphism and extension into fat, skeletal muscle. Neoplastic cells were immunoreactive for NKI/C3, CD68, CD10, and smooth-muscle actin, whereas S100 and HMB-45 staining was negative. An intriguing feature was the strong expression by tumor cells of different neuroendocrine markers. Clinical follow up showed no local recurrences after five months despite the presence of positive margins. The presence of atypical histopathological features may cause diagnostic problems with malignant mesenchymal tumors, nevo-melanocytic lesions, and fibrohistiocytic tumors. The immunohistochemical profile including the positive staining for neuroendocrine markers may suggest divergent differentiation or an origin from myofibroblast and neuroendocrine cells

“Black Ink” Sonographic Pattern as a Predictor for Invasive Papillary Thyroid Micro Carcinoma: A Case Report

Background: This study investigated the utility of the Sonographic pattern "Black Ink" with BRAF mutation testing of thyroid fine-needle aspiration cytology specimens for the risk papillary thyroid microcarcinoma (PTMC).&#x0D; Case Presentation: We describe a case of a 41-year-old Caucasian woman affected by a ultrasonography “Black Ink” papillary thyroid microcarcinoma (PTMC) of the left lobe of the thyroid gland with very tiny size (Ø 0.4 cm). The characteristics, with the Diagnostic Imaging using Ultrasonography (US), Superb Micro-Vascular Imaging (SMI), fine-needle-aspiration cytology (FNAC) and mutation analysis are here discussed. There are more rare subtypes of thyroid cancer as papillary microcarcinoma "Black Ink" that even if small, are invasive and there is why the need to early diagnosis to avoid their aggressive behavior is needed. Nowadays, focusing on the size, the cut-off for non-occult tiny tumors has dropped to 0.3 cm. This value is of great relevance.&#x0D; Conclusion: Ultrasonography, FNAC and BRAF molecular study have proven to be the most sensitive diagnostic combination for the early detection of thyroid cancer. Despite the size of this micro-lesion, the Black Ink ultrasonographic pattern associated with malignant cytology at FNAC represents an important biological risk factor and could still be a predictor of the PTMC and risk for neck lymph node metastases.</jats:p

Fatal ischemic acute pancreatitis complicating trans-catheter arterial embolization of small hepatocellular carcinoma: Do the risks outweigh the benefits?

Hepatocellular carcinoma (HCC) is an accepted indication for liver transplantation (LT). Pre-LT adjuvant ablation treatments to prevent tumour progression and drop out from the waiting list have been increasingly adopted at most transplant centers. Trans-catheter arterial chemo-embolization (TACE) is frequently used, but the procedure can be difficult and severe complications may arise. Among them, acute ischemic pancreatitis occasionally occurs and may clinically mimic a post-embolization syndrome. Fatal outcomes of this complication have been reported exceptionally but never in patients awaiting LT. The present case raises concern about the widespread application of TACE and highlights the need for a critical evaluation of the risks and benefits to patients with monofocal small HCC who are scheduled for LT. Superselective embolization of the tumour-feeding artery and systematic monitoring of serum pancreatic enzymes after this radiological procedure are recommended