Diagnostic Validation of Anti-TOX Antibody for Early-Stage Mycosis Fungoides Through Digital Analysis of Tissue Samples.

ABSTRACT: Mycosis fungoides (MF) has become one of the most difficult diagnostic challenges for both dermatologists and dermatopathologists because its clinical presentation and microscopic findings may mimic benign reactive processes, specifically those displaying histopathological features of interface dermatitis. The goal of our study was to prove with digital scanning and automated sample methodology through algorithmic analysis, combined with the utility of TOX marker a more precise, faster, and objective evaluation of each sample. Moreover, this would offer high levels of reproducibility with the possibility of establishing cut-off points, allowing us to distinguish between inflammatory dermatoses (ID) and MF. A retrospective longitudinal-descriptive and observational study was conducted to compare the diagnostic criteria (immunohistochemical studies of anti-TOX stain) in patients with clinical suspicion of MF by dividing them into 2 groups: samples with a positive biopsy for MF (MF group) and those with a negative biopsy, therefore diagnosed as an ID (control group). The algorithm assessed 5 selected areas with lymphocytic representative cellularity, and based on the intensity, nuclear staining was classified as 0 (negative), 1+ (weak/yellow), 2+ (moderate/orange), and 3+ (strong/scarlet red) nuclei. The results showed statistically significant differences ( P = 0.040) between the mean number of (2+) nuclei in the positive final diagnosis group (MF group) and the negative final diagnosis group (ID group).

Melanocytic Matricoma With Atypical Histopathological Features: A Case Report of an Extremely Rare Entity and Review of the Literature.

ABSTRACT: Melanocytic matricoma with atypical features is a rare, biphasic adnexal neoplasm displaying hair matrix differentiation, with only 3 reported cases worldwide. Generally, the lesion comprised a solid matrical and supramatrical cell proliferation, admixed with intermediate cell aggregates with sparse anucleated "shadow cells" and a prominent pigmented melanocytic hyperplasia. We report the case of a 78-year-old man with a slow-growing crusted lesion on the frontal left scalp, which in a matter of 1-2 months became a 0.6 cm well-defined, black purplish exophytic nodule. Histopathologically, the lesion presented a well-circumscribed border with a nodular dermal growth pattern, presenting different architectural features varying from benign pilomatricoma-like changes to atypical features such as moderate-to-high nuclear pleomorphism in both basaloid (matrical/supramatrical) and epidermal (keratinous) components. Strong nuclear and cytoplasmic positivity for ß-catenin was observed in matrical cells, whereas prominent cytoplasmic membrane positivity for Melan-A in dendritic melanocytes. Owing to the evidence of atypical cytological features, we propose the "atypical/borderline" category of melanocytic matricoma as part of a possible spectrum among matrical neoplasms. Pathologists should be aware of any atypical histopathological features while reporting cases due to their potential malignant transformation.

Pleomorphic lobular carcinoma of the breast with osteoclast-like giant cells: a case report and review of the literature.

BACKGROUND: Breast carcinoma with osteoclast-like giant cells (OGCs) is infrequent, being most reported cased described as ductal invasive carcinomas. Invasive pleomorphic lobular carcinoma (PLC) is a distinct morphological variant of invasive lobular carcinoma characterized by higher nuclear atypia and pleomorphism than the classical type. In the best of our knowledge, a PLC with OGCs has not been previously reported. CASE PRESENTATION: We report the case of a 72-year-old woman presenting with a pleomorphic tumor of the left breast with a dense infiltration by OGCs and T lymphocytes with a 10:1 predominance of CD8+ over CD4+ cells. The diagnosis of a lymphoid or mesenchymal neoplasia was excluded after demonstrating keratin expression by the neoplastic cells. The absence of E-cadherin expression and the morphological features were consistent with the diagnosis PLC with OGCs. In addition, we demonstrated the deleterious mutation C.del866C in CDH1gene, but no mutations in any of the other 33 genes analyzed by next generation sequencing. CONCLUSIONS: Breast carcinoma with stromal osteoclast-like giant cells is a very rare tumor, for that reason, the use of the cytologic features and growth patterns in combination with immunohistochemically studies is mandatory for a correct diagnosis of lobular carcinoma. In addition, further studies are necessary to clarify the influence of OGCs in the prognosis of these patients.

Histological changes secondary to wire coil placement in breast tissue and lymph nodes.

We describe the histological and immunohistochemical features of the changes produced by spiral coil localization wires in the breast parenchyma and lymph nodes of a total of 100 patients undergoing surgery for different breast lesions. Coil wires produced cystic lesions containing a hyaline, mucous-like, PAS-negative fluid. Cavities were lined by cells of variable morphology ranging from synovial-like cells (with a conspicuous epithelial appearance) to mononuclear or multinucleate histiocytic cells that expressed CD68, but were negative for keratins. CD3-positive/CD8-positive T lymphocytes predominated in the inflammatory reaction. Pathologists should be aware of these changes in order to differentiate coil-related lesions from other granulomatous or epithelial lesions, including mucocele-like and ductal carcinoma in situ lesions.

Virilization of a postmenopausal woman by a mucinous cystoadenoma.

OBJECTIVE: To describe the case of the most hyperandrogenaemic ovarian mucinous cystadenoma reported to date. METHODS: We present the clinical, laboratory and radiologic findings in a patient with an unusual diagnosis according to age and the clinical behaviour of the tumour, as well as a review of relevant literature. RESULTS: A 77-year-old women came to our consult because of fronto-parietal alopecia and an augmentation of the abdominal perimeter since 1 year ago. Clitoromegaly was observed during the physical examination. Hormonal analysis showed elevated testosterone and dehydroepiandrostenerone-sulphate levels (659 ng/dL and 1950 ng/ml, respectively), and imaging examination described an andexal cystic mass dependent on the right ovary. Pathological diagnosis was "mucinous cystoadenoma". After surgery, clinical and analytical alterations were normalized. CONCLUSION: Although ovarian mucinous cystadenomas are classically classified as "nonfunctional" tumours, they exceptionally can act as functional, and produce testosterone levels as high as directly secreting hormones or germ cell tumours.

Aortitis With Associated Left Main Coronary Artery Stenosis: Role of Cardiac Computed Tomography.

We report on a 49-year-old man who presented to the emergency department with progressive angina. Echocardiography displayed severe aortic regurgitation and aortic valve thickening. The suspected diagnosis was acute aortic syndrome. Cardiac computed tomography showed circumferential thickening of the aortic wall and left main coronary artery ostial stenosis. Histologic examination showed diffuse aortic inflammation. No damage of any other organ or vascular structure was reported, and the final diagnosis was nonspecific aortitis. Differential diagnosis, prognosis, and therapeutic strategies are discussed.