Pilomatrix carcinoma. A case report with immunohistochemical findings, flow cytometric comparison with benign pilomatrixoma and review of the literature

We report a case of pilomatrix carcinoma in a 42 year old woman. The patient presented a rapidly growing 4-cm subcutaneous mass in the right preauricular area. She was free of recurrence 24 months after surgery. Immunoreactivity was studied for cytokeratins, epithelial membrane antigen, S-100 protein, blood group antigens, Leu-M1, beta-2-microglobulin, vimentin, neuron-specific-enolase and cellular binding for peanut agglutinin. Squamous cells were reactive for cytokeratin AE1/3, epithelial membrane antigen, blood group antigens B and H, and peanut agglutinin. Basaloid cells were focally reactive for cytokeratin AE1/3 and epithelial membrane antigen. Flow cytometry revealed a euploid DNA content and a high proliferative rate of the pilomatrix carcinoma and in benign pilomatrixoma studied for comparison. The pathological diagnosis must be based on histomorphological criteria

Angiomatoid malignant fibrous histiocytoma: cytologic, immunohistochemical, ultrastructural, and flow cytometric study of 20 cases.

Twenty examples of angiomatoid malignant fibrous histiocytoma (AMFH) were studied. Patients ranged in age from 3 mo to 42 yr, with a mean of 13.4 yr (median 10.5 yr). There were 12 males and eight females. Tumors occurred in the upper extremities in eight cases, lower extremities in 10 cases, and one case each in the buttock and neck. Five patients had local recurrence from 5 to 18 mo after initial surgery, and one patient developed regional lymph node metastases and eventually died of disease. Eight of nine patients with follow-up information were alive from 11 to 31 mo after the diagnosis. Preoperative fine needle aspiration cytology performed in two patients showed features that suggested the correct diagnosis. Ultrastructural and immunohistochemical studies demonstrated findings consistent with a fibroblastic-histiocytic nature of the neoplasm and failed to detect endothelial differentiation of the tumor cells. Flow cytometric analysis performed in six cases, including three recurrent tumors, revealed a DNA diploid pattern in all instances. AMFH appears to be a distinctive low grade sarcoma in the spectrum of malignant fibrous histiocytoma

Inflammatory myofibroblastic tumor (plasma cell granuloma). Clinicopathologic study of 20 cases with immunohistochemical and ultrastructural observations.

Twenty cases of inflammatory myofibroblastic tumor (IMT) were studied; 19 involved the lung and 1 the esophagus only. The patients' ages ranged from 3 to 72 years. There were 9 males and 11 females. Involvement of a bronchus was seen in one case and of mediastinal structures in four. Chest pain and dyspnea were common symptoms; eight patients were asymptomatic. Seven patients underwent lobectomy, 12 local excision, and 1 biopsy alone. The lesions were nonencapsulated and ranged from 1.2 to 15 cm. Various proportions of plasma cells, histiocytes, and spindle cells were observed; the latter corresponded ultrastructurally to fibroblasts and myofibroblasts, were immunoreactive for vimentin and actin and focally for desmin, and were negative for epithelial markers. Plasma cells were polyclonal for light chains. One patient had two recurrences, and in one case a large pleural IMT was found eight years after the excision of a similar lesion in the lung. All patients with follow-up (ten) were well as long as ten years after the diagnosis (average, 3.7 years)

Is there a relationship between zinc and the peculiar comorbidities of Down syndrome

Zinc plays a central role in the immune system and has been found to be significantly reduced in people with Down syndrome. The effectiveness of zinc supplementation in people with Down syndrome has been reported with discordant results. A comparison was made between a range of clinical and biochemical variables and zinc levels in 120 individuals with Down syndrome. Two groups of participants, one with normal zinc levels and the second with low zinc levels, were compared on the following measures: growth hormone secretion, IgA and IgG antigliadin antibodies, presence of coeliac disease, T3, T4, fT3, fT4, TSH, hypothyroidism, hyperthyroidism, CD4/CD8 ratio, total immunoglobulins G and subclasses. No significant difference was found between the two groups, except for IgG4 which was, unexpectedly, significantly decreased in the group with normal zinc levels. In conclusion, an impairment of zinc blood level in individuals with Down syndrome does not necessarily impact on the organs and systems evaluated here

[Benign lesions of the breast].

Benign lesions represent the most frequent lesions of the breast. Such lesions often onset with nodules or palpable masses simulating a breast cancer. In uncertain cases, an excisional biopsy may be at the same time a diagnostic and a therapeutic solution. A high percentage (40\%) of the diagnosed lesions belongs to fibrocystic disease. A remaining 50\% can be shared among tumor-like lesions, inflammatory lesions or benign tumors like fibroadenomas. Only in the 10\% of palpable breast masses, biopsy reveals a breast cancer. The role of the pathologist is strictly related to the surgeon's one. Clinically benign lesions may be excised throughout a biopsy performed under local anesthesia. Clinically uncertain lesion must be evaluated by a fine needle aspiration biopsy (FNAB), nevertheless in some cases the doubt may persist. In such cases an excisional biopsy performed while the patient is under general anesthesia may finally solve the question. In case of breast malignancies the intervention can be enlarged as described for cancer

Surgical pathology of benign breast diseases

Benign lesions represent the most frequent lesions of the breast. Such lesions often onset with nodules or palpable masses simulating a breast cancer. In uncertain cases, an excisional biopsy may be at the same time a diagnostic and a therapeutic solution. A high percentage (40%) of the diagnosed lesions belongs to fibrocystic disease. A remaining 50% can be shared among tumor-like lesions, inflammatory lesions or benign tumors like fibroadenomas. Only in the 10% of palpable breast masses, biopsy reveals a breast cancer. The role of the pathologist is strictly related to the surgeon's one. Clinically benign lesions may be excised throughout a biopsy performed under local anesthesia. Clinically uncertain lesion must be evaluated by a fine needle aspiration biopsy (FNAB), nevertheless in some cases the doubt may persist. In such cases an excisional biopsy peformed while the patient is under general anesthesia may finally solve the question. In case of breast malignancies the intervention can be enlarged as described for cancer