Primary peritoneal low-grade serous carcinoma detected in cervical smear: Pitfalls mitigated by clinicocytopathologic clues and cellblock immunocytochemistry.

Pap smears play a role in detecting extrauterine serous tumours in asymptomatic women. Certain cytopathologic and histopathologic findings combined with relevant clinical and radiologic findings indicate the possibility of primary peritoneal serous tumours. Cellblock immunohistochemistry is a valuable confirmatory diagnostic tool.

Unusual benign polypoid and papular neoplasms and tumor-like lesions of the vulva.

We aimed to investigate the prevalence and spectrum of unusual benign neoplasms and tumor-like lesions presenting as vulvar polyps and papules, to study their clinical, pathologic, hormonal, and developmental features and whether they have important associations with other pathologic lesions or clinical diseases. We conducted a retrospective review study of 115 vulvar specimens over 7 years. Common lesions, for example, fibroepithelial polyps, skin tags, papillomas, abscesses, viral warts and common cysts, were excluded. We found 21 cases (18%) with uncommon benign vulvar lesions. They included 7 epithelial cysts, 3 vascular lesions, 3 glandular neoplasms, 3 endometrioses, 1 caruncle, 1 pilonidal sinus, 1 prolapsed urethra, 1 seborrheic keratosis, and 1 granular cell tumor. The age range was between 1 and 64 years with a mean age of 33 years. Most (86%) were 2.5 cm or less. Many were asymptomatic incidental pathologic findings that can be missed clinically. Nine cases have important clinical associations or coexisting incidental pathologic lesions. Some lesions demonstrated hormone receptors. Some were clinically confused with fibroepithelial polyps, abscesses, warts, melanocytic lesions, and tumors. In conclusion, although the vulva is a small compartment, its developmental and histologic complexity can result in a variety of unusual and rare benign polypoid and papular lesions, some unique to the vulva, which might present diagnostic challenges to the clinicians and pathologists. In addition, many bear controversy regarding their histogenesis and origin of development in the vulva.

Isotretinoin as a Possible Cause for Eosinophilic Esophagitis and Eosinophilic Gastroenteritis: A Case Report.

A 39-year-old female patient who took isotretinoin for severe acne for around six months presented with severe upper abdominal pain, as well as abdominal distention. Initially, she was diagnosed with acute cholecystitis due to the presence of gallstones on ultrasound. However, additional imaging showed mural thickening of the bowel, for which she underwent further work-up. Laboratory investigations showed raised inflammatory markers along with eosinophilia. Concurrently, bedside paracentesis showed raised levels of eosinophils. The patient underwent an endoscopic assessment, which revealed eosinophilic esophagitis and gastroenteritis likely to be induced by isotretinoin. Following the discontinuation of isotretinoin and the initiation of corticosteroid therapy, the patient's clinical condition improved significantly. The diagnosis of eosinophilic gastrointestinal disorders, though rare, must be kept in mind when patients on long-term isotretinoin treatment or with other risk factors present with symptoms such as dysphagia, abdominal pain, odynophagia, nausea, and vomiting.

Challenging Diagnostic Dilemma: Mesenteric Desmoid Tumor Masquerading as Perforated Peritonitis.

Desmoid fibromatosis is a rare benign neoplasm of the soft tissue. Primary desmoid neoplasms rarely occur in the small bowel and are primarily found in patients with a previous abdominal surgery or irradiation history. They are challenging to diagnose at the time of presentation due to a lower incidence and their non-specific presentation making it difficult to distinguish from other intra-abdominal neoplasms, such as gastrointestinal stromal tumors (GISTs), which may present with similar symptoms. We like to present a case of a 34-year-old male with a four-day history of abdominal pain with worsening severity and one episode of non-bloody vomiting. Physical examination was significant for generalized abdominal tenderness with positive rebound and board-like rigidity. A computed tomography (CT) scan of the abdomen showed the presence of a lower abdominal mass of unknown etiology with free air foci and free intraperitoneal fluid either due to rupture of the suspicious mass or secondary to infection by an air-producing organism. The patient was immediately taken for emergency surgery, the tumor was resected successfully, and a specimen collected was sent for histopathology, which came out to be a desmoid tumor. We aim to highlight the importance of keeping a broad differential diagnosis in a patient with acute abdomen and symptoms of peritonitis.

Collagenous Spherulosis in Well-Differentiated Papillary Mesothelioma in a Female With Multilocular Peritoneal Inclusion Cysts.

Multilocular peritoneal inclusion cysts are mesothelial tumor-like lesions with or without small foci of florid papillary mesothelial hyperplasia that might simulate serous epithelial papillary lesions or well-differentiated papillary mesothelioma (WDPM) of the peritoneum. The papillary cores in papillary mesothelial hyperplasia and in WDPM display a variety of different histomorphologic features. To our knowledge, collagenous spherulosis in WDPM was not previously described or illustrated in the literature. Collagen spherules have been described in several miscellaneous benign and malignant lesions of the breast, prostate, salivary gland, and cutaneous adnexal tumors. They sometimes impose a diagnostically challenging cribriform growth pattern. We report a case of a young adult woman who presented with a large painful palpable multicystic mass in the right iliac fossa and pelvis. Histologically, it showed features of multilocular peritoneal inclusion cysts with an incidental finding of a small nodule demonstrating morphologic and immunohistochemical features of WDPM. The papillary cores revealed uniform homogenous eosinophilic round collagenous spheres with a cribriform pattern. The unusual finding of collagen spherules may expand the morphologic spectrum of mesothelial papillary lesions, the differential diagnosis of female pelvic peritoneal and omental epithelial and nonepithelial lesions and might cause some diagnostic confusion on small specimens. It may also shed some light on the pathophysiology and role of mesothelial and submesothelial stromal cells in the variable morphologic patterns of the stroma of papillary cores in different mesothelial lesions.

Cutaneous cytomegalovirus infection in a patient with acquired immunodeficiency syndrome.

Abstract Cytomegalovirus (CMV) infection in immunocompromised patients is a common opportunistic systemic infection which can lead to death, and usually presents with visceral manifestations, especially of the lung, brain, eye, and gastrointestinal tract. Cutaneous CMV infection is, however, relatively rare in immunocompromised patients. Cutaneous CMV infection can have variable clinical and histologic manifestations, and thus can be easily missed. We report a case of cutaneous CMV infection in a patient with acquired immunodeficiency syndrome, presenting as a generalized, pruritic, erythematous, maculopapular eruption.