"Surface epithelial changes" in uterine endometrioid carcinoma mimicking micropapillary serous borderline tumor of ovary: report of two cases and review of the literature

We encountered two cases of endometrioid carcinoma of uterus with extensive surface epithelial changes (SECs) mimicking serous borderline tumor (SBT) of the ovary. The first case was a well-differentiated endometrioid carcinoma arising in a background of complex atypical hyperplasia. The second case was moderately-differentiated endometrioid carcinoma with squamous and mucinous differentiation. The SECs comprised of thin microapapillae without hierarchal branching, lined by cuboidal cells with eosinophilic cytoplasm and mild to moderate nuclear atypia. These areas were reminiscent of SBTs of ovary, micropapillary type. This report expands the existing spectrum of SECs. Serous borderline tumor of ovary like surface epithelial changes could be misleading if present in an endometrial biopsy or curettings. Therefore, knowledge of this morphologic variation is important

Case Report A Rapidly Enlarging Squamous Inclusion Cyst in an Axillary Lymph Node following Core Needle Biopsy

A 73-year-old woman was found to have a 1.7 cm axillary mass, for which a core needle biopsy was performed. The specimen revealed fragmented squamous epithelium surrounded by lymphoid tissue consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. Within one month, the lesion enlarged to 5 cm and was excised. Touch preparation cytology during intraoperative consultation displayed numerous single and sheets of atypical epithelioid cells with enlarged nuclei and occasional mitoses, suggesting a carcinoma. However, multinucleated giant cells and neutrophils in the background indicated reactive changes. We interpreted the touch preparation as atypical and recommended conservative surgical management. Permanent sections revealed a ruptured squamous inclusion cyst in a lymph node with extensive reactive changes. Retrospectively, the atypical epithelioid cells on touch preparation corresponded to reactive histiocytes. This is the first case report of a rapidly enlarging ruptured squamous inclusion cyst in an axillary lymph node following core needle biopsy. Our case demonstrates the diagnostic challenges related to a ruptured squamous inclusion cyst and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations

Clear Cell Lesions of the Mullerian System: Not Always That Clear !

A spectrum of lesions, benign and malignant, of the Mullerian system display clear cells. Interpretation of this finding can be confusing resulting in significant interobserver variability even among gynecologic pathologists.1 It is critical to distinguish bona fide clear cell carcinoma from other endometrial lesions as management is significantly different. We present some key morphologic aspects of endometrial clear cell carcinoma and compare it with 2 other endometrial lesions with clear cells: endometrial surface epithelial changes, clear cell type (SECs),2 and Arias- Stella reaction, posing a major diagnostic pitfall, especially when present in small biopsy material

Simultaneous p53 and KRAS mutation in a high-grade serous carcinoma with deceptive appearance of a low-grade carcinoma. A case report

Summary: Low-grade and high-grade serous carcinomas have unique clinical, morphological, underlying molecular alterations, and vastly different biologic behavior (Prat et al., 2018, Vang et al., 2009). The differentiation into high and low-grade serous carcinoma is important for clinical management and prognosis and is easily recognized by practicing pathologists. High-grade serous carcinoma is characterized by marked nuclear atypia and pleomorphism, frequent, often atypical mitosis with papillary or three-dimensional clusters, p53 mutation, and block-like p16 staining. In contrast, low-grade serous carcinomas have a different morphologic appearance with micropapillary formation, small nests of tumor cells having low to intermediate grade nuclei, and absence of significant mitosis. Low-grade serous carcinoma is often associated with micropapillary variant of ovarian serous borderline tumor. The low-grade serous carcinoma shows wild type p53 expression, patchy p16 staining, and often K-RAS, N-RAS, and/or B-RAF mutation. Here we report a case of mullerian high grade serous with a deceptive morphology resembling low-grade serous carcinoma with micropapillary features and moderate nuclear atypia. However, the tumor is simultaneously p53 and K-RAS mutated. This case illustrates three critical issues; a) potential to be mistaken as a low-grade serous carcinoma because of morphologic appearance and relative uniform cytologic feature. b). raise the question of true progression of low-grade to high-grade serous carcinoma, a rare phenomenon as described in the literature, and c). whether the biologic behavior and/or response to therapy would differ from the classic forms

Frequency of rare and multi viral high-risk HPV types infection in cervical high grade squamous intraepithelial lesions in a non-native dominant middle eastern country: a polymerase chain reaction-based pilot study

Abstract Background The incidence of abnormal cervical smears in the United Arab Emirates (UAE) is 3.6%. Data regarding specific high-risk HPV (hrHPV) genotypes are insufficient. Identification of hrHPV subtypes is essential to allow formulating effective vaccination strategies. Methods A total of 75 archival cervical cone biopsies with HSIL or higher lesions (2012–2016) were retrieved from a tertiary hospital, including HSIL (n = 70), adenocarcinoma in-situ (n = 1) and squamous cell carcinoma (n = 4). Five tissue sections (10-μ-thick each) were cut and DNA extracted using the QIAamp DNA FFPE Tissue Kit. GenomeMeTM’s GeneNavTM HPV One qPCR Kit was used for specific detection of HPV 16 and 18; and non-16/18 samples were typed by GenomeMeTM’s GeneNavTM HPV Genotyping qPCR Kit. Results Median age was 34 years (range 19–58) with 70% UAE Nationals. hrHPV detected were 16, 18, 31, 33, 35, 39, 45, 51, 52, 58, 59, 66 & 68. hrHPV testing was negative in 12% of cases. Most common types were HPV 16 (49%), HPV 31 (20%) and HPV 18 (6.6%). hrHPV 16 and/or 18 represented 56% and rare subtypes 32%. Co-infection was present in 16%. Eight cases had two-viral subtype infections and 4 cases had 3 subtype infections. Multi-viral HPV infection was limited to hrHPV 16, 18, 31 & 33 subtypes. Conclusions Infection by non HPV 16/18 is fairly common. A higher than expected incidence of rare subtype (20% hrHPV31) and multi-viral hrHPV (16%) were detected. This finding stresses the importance of this pilot study as currently only quadravalent vaccine is offered to control the HPV infection in the UAE population

Large Epithelial and Stromal Lesion of Breast: It’s Not Always Phyllodes!

Fibroepithelial lesions (FELs) of breast often pose a diagnostic challenge to pathologists.1 In this article, we share gross and microscopic findings of 3 large breast lesions with epithelial and spindle cell components: (1) a giant fibroadenoma (FA; Figure 1 [1A-C]), (2) a borderline phyllodes tumor (World Health Organization classification2; Figure 1 [2A-C]), and (3) a nodular pseudoangiomatous stromal hyperplasia (NPASH; Figure 1 [3A-C]). This brief report highlights histological overlap between NPASH and FELs, and describes morphological clues that can help pathologists in differentiating NPASH from FELs with PASH-like stroma

Verrucous Carcinoma Arising in Association With Giant Condyloma

Verrucous carcinoma (VC) is a histologic subtype of squamous cell carcinoma characterized by highly differentiated squamous cells with a bulbous invasive pattern of the underlying stroma.1-3 It is a rare entity, often associated and confused with giant condyloma of Buschke-Löwenstein. Some authors consider the 2 entities to be distinct.1,3,4 They should be distinguished from giant condylomas by virtue of their low rate of positivity for high-risk human papilloma virus infection and lack of koilocytic atypia.1,2,4,5 On the other hand, these lesions should be distinguished from conventional squamous cell carcinomas because they pose virtually no risk for nodal metastases.1,3 However, there are published reports showing that VC and conventional squamous cell carcinoma can coexist in the same lesion. Conventional squamous cell carcinoma can also arise form VC.6 These reports suggest that VC is but one of the morphologic transitions of conventional squamous cell carcinoma.

Development of fertilizer recommendation for cabbage production in Low Ganges River Floodplain of Bangladesh

The study was conducted during rabi season of 2013-14 and 2014-15 at the farmers field of Farming System Research and Development (FSRD) site, Hatgobindapur, Faridpur under On-Farm Research Division (OFRD), Bangladesh Agricultural Research Institute (BARI) to evaluate the performance of chemical fertilizers for maximum yield of cabbage and higher economic return. The experiment was laid out in Randomized Complete Block Design (RCBD) with five dispersed replications. The experiment consisted of eight treatments viz. N242P120K33S19Zn1.4B0.6 kg ha-1 (100% NPKSZnB from Soil Test Based (STB) dose, T1), T1+ 25% N (T2), T1+ 25% NP (T3), T1+ 25% NK (T4), T1+ 25% PK (T5), T1+ 25% NPK (T6), 75% of T1 (T7) and Native nutrient (control, T8). The treatment 100 % NPKSZnB (STB) and additional 25% NPK (T6) treatment produced maximum head yield of cabbage (78.89 t ha-1) which was statistically identical with 100 % soil test based NPKSZnB (T1), 100 % NPKSZnB with additional 25% N (T2), 100 % NPKSZnB with additional 25% NP (T3) and 100 % NPKSZnB with additional 25% NK (T4) treatments. The lowest head yield (33.92 t ha-1) was obtained from native nutrient (control). The highest gross margin (Tk.756093.00 ha-1) was obtained from T6 (100% NPKSZnB from STB with additional 25% NPK) followed by T2 (T1 with additional 25% N) and T1 treatments. The results indicated that, the marginal rate of return (MRR) of changing from T7 to T1 was 1818% (for every Tk. 100 of additional investment Tk. 1818 was obtained) and a changing from T1 to T2 gave MRR of 319%. From the experimental results, it was concluded that application of 100% chemical fertilizers of N242P120K33S19Zn1.4B0.6 kg ha-1 from STB (T1) would be suitable for higher yield and economic return of cabbage production in calcareous soil under Low Ganges River Floodplain (Agroecological Zone 12). [Fundam Appl Agric 2018; 3(1.000): 355-362