Malignant solitary fibrous tumor of the pleura with liposarcomatous differentiation.

Pleural solitary fibrous tumors (SFTs) are uncommon tumors. Although these tumors have been well characterized, malignant pleural SFTs with liposarcomatous differentiation have not been reported. We report an unusual malignant pleural SFT intermixed with foci of well-differentiated liposarcoma. The patient was a 66-year-old, white man with a large, solid right pleural mass that measured 13.5 x 10.3 x 8.5 cm. The tumor was composed of spindle-shaped and plump cells embedded in dense collagenous stroma. The tumor cells were arranged in interlacing fascicles or in a patternless pattern. Marked nuclear atypia, a high mitotic rate (21 mitoses per 10 high-power fields), and areas of prominent necrosis were evident. In addition, numerous adipocytes mixed with typical lipoblasts were seen scattered throughout portions of the tumor. Immunohistochemistry revealed the tumor cells were strongly positive for CD34 and vimentin and negative for cytokeratin, desmin, smooth muscle actin (IA4), and S100. To the best of our knowledge, this case represents the first example of a malignant SFT with liposarcomatous differentiation.

Inflammatory pseudotumor of the ileum. A report of a multifocal, transmural lesion with regional lymph node involvement.

Inflammatory pseudotumor (inflammatory fibroid polyp) of the ileum is a rare, usually solitary and polypoid lesion that frequently presents clinically as small-intestinal intussusception and obstruction. Regional lymph nodes are usually not involved. We describe an inflammatory pseudotumor of the ileum that was multifocal, not polypoid, and involved one regional lymph node. Grossly, two circumferential transmural nodules were separated by 8.5 cm of normal ileum. Microscopically, the lesion extended through the muscularis propria into peri-intestinal adipose tissue and involved one noncontiguous regional lymph node. The pseudotumor was composed of highly vascularized stroma with a mixture of spindle cells and chronic inflammatory cells including numerous eosinophils, lymphocytes, plasma cells, histiocytes, neutrophils, and multinucleated giant cells forming small granulomas. Immunohistochemically, the majority of spindle cells reacted with vimentin but not smooth-muscle, endothelial, or lymphoid markers. Ultrastructurally, the spindle cells had abundant rough endoplasmic reticulum, cytoplasmic filaments, and dense bodies consistent with myofibroblasts, plump endothelial cells (some with Weibel-Palade bodies), and chronic inflammatory cells. We prefer the term inflammatory pseudotumor to inflammatory fibroid polyp for the lesion in this case, since it was not polypoid and shared many histologic features with inflammatory pseudotumors arising at sites other than the gastrointestinal tract.

Slipped capital femoral epiphysis in a 35-year-old man (a case report).

This is a case report of a 35-year-old man with multiple open epiphyses and a slipping of the right capital femoral epiphysis. An endocrine evaluation revealed primary hypothyroidism. The patient was placed on hormonal therapy and an in situ hip pinning was performed to prevent further slip. The operation was successful. The symptoms disappeared and all of the epiphyses were closed within one year. In an adult patient presenting with slipped capital femoral epiphysis, endocrine dysfunction such as hypothyroidism should be suspected.