A case report of infantile cystic nephroblastoma

Abstract Background Nephroblastoma (NB) is a malignant embryonal neoplasm derived from nephrogenic blastemal cells. NB usually forms a solid mass, but in extremely rare cases, it may show cystic changes. Case presentation A six-month-old girl with persistent high fevers was found to have pyuria and bacteriuria. Ultrasonography revealed multilocular cysts in the right kidney. Right nephrectomy was performed with cyst wall rupture during surgery. An intraoperative rapid diagnosis, based on peritoneal fluid cytology, confirmed three components of blastemal, stromal, and epithelial cells. The blastemal cells were dyshesive, with scant to no cytoplasm and were the predominant cell type. The spindle-shaped stromal cells were arranged in fascicles. The epithelial cells demonstrated tubular structures. Macroscopically, the resected cystic tumor measured 80 mm in maximum diameter with a prominently thin cyst wall, but solid areas were also apparent. Histologically, the tumor was diagnosed as cystic NB (blastemal-predominant) displaying a triphasic pattern. Hyperchromatic nuclei and apoptotic bodies were found. The clinical stage classification of Japan Wilms Tumor Study group was 3. The patient was treated with chemotherapy and radiotherapy. Tumor recurrence and metastasis have not been observed in the 8 months since surgery. Conclusion This is an extremely rare case of infantile cystic NB. We diagnosed the NB cells that appeared in the peritoneal fluid by intraoperative rapid cytology. Cytological examination proved to be a very useful technique for determining the clinical stage of NB. Additionally, we propose that massive tumor degeneration and necrosis be considered as a pathogenic mechanism of cyst formation in NB

Uterine cervical mesonephric hyperplasia with focal cystic change masquerading clinicopathologically as lobular endocervical glandular hyperplasia to malignancy

Introduction: Although uterine cervical mesonephric hyperplasia (MH) arising from mesonephric remnants is a well-known but uncommon entity, it might pose a clinicopathological diagnostic challenge to distinguish from lobular endocervical glandular hyperplasia (LEGH) or adenocarcinoma, if MH rarely presents as a lobular and/or cystic mass with expansion of the cervical wall. However, few papers have described the detailed clinicopathological characteristics of MH compared to those benign to malignant lesions. Case presentation: An early forties Japanese female presented with a history of increased vaginal watery discharge. Multiple cystic lesions measuring less than 3 mm in diameter generated a high signal intensity on T2-weighted MRI, in the bilateral aspects of the variably enlarged uterine cervix. A gross examination of a hysterectomy specimen revealed bilateral small multicystic lesions, filled partly with secreted fluids, measuring approximately 25 × 7 × 5 mm, respectively, located in the superficial to relatively deep cervical wall. A microscopic examination showed that these lesions predominantly consisted of a lobular proliferation of small to medium-sized tubules and cysts containing occasionally periodic acid-Schiff-positive eosinophilic/pink secreted materials, lined by bland-looking cuboidal to flattened epithelium. Immunohistochemically, these lining cells were specifically positive for CD10 in a characteristic luminal staining pattern, whereas negative for MUC6, and had a low MIB-1 labeling index. We ultimately made a diagnosis of cervical MH, lobular type, with focal cystic change. Conclusion: We should be aware that, since gynecologists/pathologists might misinterpret MH as LEGH to malignancy, including the malignant counterpart of MH, a wide panel of immunohistochemical antibodies can be helpful supplemental tools

An autopsy case of peripheral T cell lymphoma occurring in a postpartum woman: a unique case suggesting changes in the immunocharacteristics of lymphoma cells before and after delivery

Abstract Background The occurrence of malignant lymphoma after delivery is an extremely rare event. Although several cases of Hodgkin lymphoma and B cell lymphoma and a few cases of peripheral T cell lymphoma (PTCL) after delivery have been reported, there are no report of autopsy cases of PTCL in the puerperal period. Case presentation A 32-year-old Japanese woman with a past medical history of atopic dermatitis and bronchial asthma presented with generalized eruptions four days after the delivery of her first child; generalized skin induration and lymphadenopathy subsequently emerged. A skin biopsy specimen showed the diffuse proliferation of atypical lymphoid cells that were immunohistochemically-positive for CD4 but negative for CD8. She was diagnosed as PTCL, not otherwise specified (PTCL, NOS). She died one year and three months after the onset of symptoms. At autopsy, the systemic infiltration of lymphoma cells into the whole body was observed. Unexpectedly, these lymphoma cells were immuno-reactive with CD8 but not with CD4. Conclusion The occurrence and development of PTCL after delivery with the shift from CD4 positivity to CD8 positivity may be associated with not only the selection of resistant subclone as a result of chemotherapy but also the changes of immune status before and after delivery