A rare case of primary dermal clear cell sarcoma with focal epidermotropism: An entity difficult to distinguish from melanoma.

Clear cell sarcoma (CCS) is an uncommon soft-tissue sarcoma that only rarely arises within the dermis. It is challenging to distinguish dermal CCS from nodular, primary dermal, or metastatic melanoma, as they share morphologic features and immunoprofiles. We describe a dermal CCS in a 25-year-old man with a cutaneous groin mass. The lesion was initially diagnosed as melanoma, likely metastatic. On consultation, in addition to a melanoma-like tumor in the dermis, we identified focal infiltration of tumor cells into the overlying epidermis (epidermotropism), resembling primary nodular or metastatic melanoma. Given the patient's age and absence of a history of primary melanoma, fluorescence in situ hybridization (FISH) was performed, which revealed separation of the 5' and 3' EWSR1 probe signals on chromosome 22q12, prompting a diagnosis of CCS. Our case highlights the histopathological, immunohistochemical, and ultrastructural similarities between CCS and melanoma, and the consequent potential for major diagnostic confusion. In such cases, FISH analysis remains the key to diagnosis. CCS should be considered in patients with a melanoma-like tumor in the dermis or subcutaneous tissue without epidermal (or with minimal) involvement, or prior to diagnosing metastatic melanoma in the absence of a known history of primary melanoma, especially in young individuals.

Skeletal Radiology: the year in review 2019.

In 2019, Skeletal Radiology published a total of 253 articles including 111 scientific articles, 36 review articles, 51 case reports, 16 Test-Yourself cases, 15 technical reports, as well as multiple browser notes, meeting abstracts, and meeting summaries. As we have done previously, in this review, we will highlight those articles that stimulated the most interest from our readers, as measured by their downloads, and those that stimulated other researchers and authors, as measured by their citations. The manuscripts highlighted herein were chosen from this list.

Glomangiomatosis: a case report.

Glomangiomatosis is a benign vascular variant of a glomus tumor. The lesion represents only 5% of glomus tumors with unusual or atypical features and even fewer glomus tumors with typical features. The lesions are most commonly located in the distal extremities and are multiple, deep, extensive, and often pain producing. They develop from small arteriovenous anastamoses and are most often identified in young adults. The lesions may recur. We present a case of a 33-year-old male who presented clinically with multiple slowly enlarging masses of the leg over a 5-year period, of which one caused significant pain. One of the lesions was reported to be present at birth. Imaging studies were performed and were suggestive of neurofibromatosis. Biopsies from multiple lesions led to an eventual diagnosis of multiple glomangiomatosis.

Giant cell tumor of bone with secondary aneurysmal bone cyst-like change producing ß-human chorionic gonadotropin.

Giant cell tumor of bone is a benign, locally aggressive neoplasm that is composed of sheets of neoplastic mononuclear cells interspersed amongst non-neoplastic, uniformly distributed, osteoclast-like giant cells. They represent approximately 4-5% of primary bone tumors. Rarely, bone tumors have been noted to produce human chorionic gonadotropin, a finding most often reported in osteosarcoma. We present the case of a young woman who presented with a low-level human chorionic gonadotropin level which, after resection of her recurrent giant cell tumor of bone with secondary aneurysmal bone cyst-like change, became undetectable in her blood. Furthermore, cells within the aneurysmal bone cyst component were immunohistochemically positive for ß-human chorionic gonadotropin. This is the first report of such a finding in the literature.

Abdominal wall endometriosis: a rarely anticipated diagnosis: a 16-year experience and brief literature review.

OBJECTIVE: To evaluate cases of endometriosis of the abdominal wall to determine whether the diagnosis was anticipated preoperatively and whether or not the patient had undergone prior surgery. STUDY DESIGN: This was a retrospective review of records of patients undergoing surgical resection of abdominal wall endometriosis from 1996-2011. RESULTS: Nine cases were identified. For the 8 cases with a recorded preoperative diagnosis, the clinical diagnosis of endometriosis was recorded preoperatively in only 25% of cases. The most common preoperative diagnosis was neoplasia. CONCLUSION: Abdominal wall endometriosis remains a difficult diagnosis to make preoperatively. Awareness among gynecologists and consideration of the diagnosis in the differential will potentially decrease the number of cases suspected of malignancy and may alleviate some stress on the patients' part, due to the possibility of a benign diagnosis.

Massive localized lymphedema of the vulva: report of a case and review of the literature.

BACKGROUND: Massive localized lymphedema (MLL) is a recently described entity associated with obesity, most often on the thighs. It rarely occurs on the vulva, and it may pose diagnostic difficulty for both clinician and pathologist in this setting. CASE: An obese 55-year-old woman underwent excision of bilateral polypoid vulvar masses. Histology confirmed the diagnosis of MLL. CONCLUSIONS: Although MLL is not common on the vulva, with the increasing incidence of obesity in the population, more cases can be anticipated, and an awareness of this lesion is important.

Cytopathology fellowship and practice: Are our trainees and cytopathologists diverse?

Over the last several years, there has been increased focus on diversity, equity, and inclusion within all areas of pathology and laboratory medicine. Many of the specialty societies within pathology have taken up the mantle of diversity. While there is little research into the diversity of cytopathologists in practice, the Accreditation Council for Graduate Medical Education (ACGME) has been collecting diversity data on pathology and laboratory medicine trainees since 2011. This data are an opportunity to explore how diverse our trainees in cytopathology are, and by extrapolation, allows us to develop some ideas as to how diverse attending level cytopathologists are. The author will also share personal observations from her own training and career regarding diversity in cytopathology.

Education and diversity in cytopathology: Past, present, and future.

Diversity, equity, and inclusion is a powerful goal which many of us strive toward in medicine, both in patient care and administrative leadership. As the world evolves, the practice of medicine must evolve with it. We are cognizant of the importance of the history of our medical specialties. If we do not acknowledge all parts of our history, we are doomed to repeat it. This special issue is unique and unlike anything that has previously been published in Diagnostic Cytopathology. This issue looks at some of the history of cytopathology. This historical review is followed by some of the present state of cytopathology. There are insights into global cytopathology. The final portion of this issue examines the critical need for cytotechnology schools in the United States. All of these areas are critical to the past, present, and future of cytopathology.

Pseudoangiomatous stromal hyperplasia of the vulva presenting as a polypoid vulvar lesion: a lesion associated with anogenital mammary-like tissue-report of a case and review of the literature.

OBJECTIVE: The study aimed to report the case of a patient with a polypoid vulvar lesion clinically thought to be an aggressive angiomyxoma. MATERIALS AND METHODS: On examination, a 4.0 × 2.0 × 1.5-cm polypoid lesion was seen on the right labium majus. RESULTS: Histopathological findings of the excised mass were consistent with pseudoangiomatous stromal hyperplasia of the vulva CONCLUSIONS: Pseudoangiomatous stromal hyperplasia is a lesion of breast tissue but can occur in anogenital mammary-like glands. It must be distinguished from low-grade angiosarcoma.

Team Approach: Extremity Soft Tissue Sarcoma.

¼ Synovial sarcoma is a soft tissue sarcoma that most commonly presents in the extremity in a periarticular location.¼ As the history and physical examination of patients with synovial sarcoma can overlap considerably with those of patients with non-oncologic orthopedic conditions, it is important that orthopedic surgeons maintain a high level of suspicion when caring for patients with extremity masses.¼ Soft tissue sarcomas are best treated using a team approach. Early recognition and referral to a multidisciplinary sarcoma team are crucial to ensure the best clinical outcome for the patient.

Inflammatory Hibernoma of the Renal Hilum Mimicking a Renal Pelvis Tumor.

We report on an enhancing, heterogenous renal pelvis mass growing over 2 years which was found to be a benign hibernoma with inflammatory and lipomatous features originating from the renal hilum. To our knowledge, this is the first case reported on a hibernoma compressing on the renal pelvis and second case of a hibernoma with the inflammatory variant.

Recognition Awards in Pathology Specialty Societies.

OBJECTIVES: Recognition awards build physician reputation and facilitate career advancement. We hypothesize women physicians are underrepresented as award recipients by pathology medical societies compared with representation in the specialty. METHODS: We analyzed publicly available online information about physician recipients (January 2015 to December 2021) from three general pathology society websites. Recipient gender was determined by pronoun use, first name, and photograph. Representation was compared with Association of American Medical Colleges (AAMC) specialty data from 2015 and 2019, which showed a minimum of 36.7% women pathologists in 2015 and up to 43.4% in 2019. RESULTS: Twenty-six awards and 230 physician recipients were included in the analysis. A total of 159 (69.1%) men physicians and 71 (30.9%) women physicians received awards. Overall, women physicians were underrepresented in recognition awards compared with AAMC benchmarks. Prestigious awards (defined as those that recognize a person's body of work over time) showed a similar disparity with 22 (30.1%) of 73 recipients being women. Men physicians were more likely to receive multiple awards. CONCLUSIONS: Women physicians are underrepresented overall for recognition awards by pathology medical societies. Disparities are greater for prestigious awards. Further research is needed to better understand the reasons for these findings and how they affect women physicians' careers.

Mesenchymal lesions of the vulva.

Mesenchymal lesions of the vulva may be either regionally specific to the vulva or soft tissue neoplasms that can occur in multiple locations on the body. They may have overlapping histological and immunohistochemical features and, in routine practice, are not likely to be encountered, adding to the diagnostic difficulty. A review of mesenchymal vulvar lesions is presented.

Vaginal blue nevus: report of a case and review of the literature.

OBJECTIVE: : Blue nevi are extremely rare in the vaginal canal and are suspicious for melanoma, especially when multiple lesions are present. We describe a woman with multiple blue nevi of the vagina. DESIGN: : We describe 1 case of multiple blue nevi of the vagina. RESULTS: : A 37-year-old woman, status after therapy for serous carcinoma of the ovary, presented with multiple blue to black macular lesions present throughout the vagina. Two of the lesions were examined by biopsy and demonstrated dendritic melanocytes. The patient has been closely followed, and the lesions remain unchanged. CONCLUSIONS: : Multiple vaginal blue nevi are an important differential diagnostic consideration for melanoma of the vagina. These lesions, however, are benign and require only clinical follow-up. Excision is unnecessary.

Chondromyxoid Fibroma of the Sacral Spine.

Background and Importance. Chondromyxoid fibromas are rare tumors of cartilaginous origin typically found in long bones. They usually present during the second and third decades of life. In this case report, we describe the case of a 60-year-old male who presented with back pain and was later found to have a sacral mass. Further immunohistochemical analysis determined that the mass was a chondromyxoid fibroma. Clinical Presentation. A 60-year-old male presented with worsening lower back pain over the course of 2 years. Magnetic resonance imaging demonstrated a destructive mass centered at S4 with heterogeneous enhancement. The patient underwent an S3-to-Co1 laminectomy for gross total resection of the tumor. Histology demonstrated a biphasic, lobulated appearance, characteristic of a chondromyxoid fibroma. The tissue stained faintly positive for multicytokeratin, and it was negative for markers S-100 protein and brachyury, indicating that it was not a chordoma. Conclusion. Only 8 cases have documented sacral chondromyxoid fibroma. As these are exceedingly rare tumors, especially within the sacral spine, the differential diagnosis includes other malignant tumors more likely to be found in the spine, particularly chordomas and chondrosarcomas. Immunohistochemistry and histology are essential in making a definitive diagnosis. This case provides a comprehensive illustration of the clinical presentation, radiographic findings, and immunohistochemistry of sacral chondromyxoid fibroma.

#EBUSTwitter: Novel Use of Social Media for Conception, Coordination, and Completion of an International, Multicenter Pathology Study.

CONTEXT.­: Social media sites are increasingly used for education, networking, and rapid dissemination of medical information, but their utility for facilitating research has remained largely untapped. OBJECTIVE.­: To describe in detail our experience using a social media platform (Twitter) for the successful initiation, coordination, and completion of an international, multi-institution pathology research study. DESIGN.­: Following a tweet describing a hitherto-unreported biopsy-related histologic finding in a mediastinal lymph node following endobronchial ultrasound-guided transbronchial needle aspiration, a tweet was posted to invite pathologists to participate in a validation study. Twitter's direct messaging feature was used to create a group to facilitate communication among participating pathologists. Contributing pathologists reviewed consecutive cases of mediastinal lymph node resection following endobronchial ultrasound-guided transbronchial needle aspiration and examined them specifically for biopsy site changes. Data spreadsheets containing deidentified data and digital photomicrographs of suspected biopsy site changes were submitted via an online file hosting service for central review by 5 pathologists from different institutions. RESULTS.­: A total of 24 pathologists from 14 institutions in 5 countries participated in the study within 143 days of study conception, and a total of 297 cases were collected and analyzed. The time interval between study conception and acceptance of the manuscript for publication was 346 days. CONCLUSIONS.­: To our knowledge, this is the first time that a social media platform has been used to generate a research idea based on a tweet, recruit coinvestigators publicly, communicate with collaborating pathologists, and successfully complete a pathology study.

Primary adrenal leiomyosarcoma with inferior vena cava extension in a 70-year-old man.

Primary adrenal leiomyosarcoma, a malignant soft tissue tumour originating from the smooth muscle of the inferior vena cava and adrenal vein, is rarely described in the literature. Cases are often diagnosed at an advanced stage as the tumour is not hormone-producing. We describe a 70-year-old man who presented with lower extremity swelling and abdominal varices and was subsequently found to have a large adrenal mass on imaging. Our case is among the few reported primary adrenal leiomyosarcomas in which a CT-guided biopsy was used to aid in diagnosis.

Adenomyomatous polyp of the endometrium: a case report.

BACKGROUND: Adenomyomatous polyps of the endometrium are rare, pedunculated lesions that contain smooth muscle in addition to the usual components of an endometrial polyp. Grossly, adenomyomatous polyps have the same appearance as an ordinary endometrial polyp and are characterized histologically by the intertwining of smooth muscle, endometrial glands and endometrial stroma. CASE: A 32-year-old woman underwent a hysterectomy for refractory menometrorrhagia and was found to have a large, sessile, polypoid mass completely filling the endometrial cavity, consisting of multiple, thick-walled vessels; scant smooth muscle; and foci of endometrial glands and stroma. This lesion was diagnosed as an adenomyomatous polyp. No history of tamoxifen use was present in this case. The diagnosis of perivascular epithelioid cell tumor was ruled out. CONCLUSION: We found 1 other report of a similar lesion, which may have represented a hamartoma.

Placental invasion by actinomyces resulting in preterm delivery: a case report.

BACKGROUND: Actinomyces is a gram-positive rod, some of which organisms are anaerobic and others which are facultative anaerobes. Most species of Actinomvces cluster together, forming a structure resembling a fungal colony. The organism is an opportunistic pathogen most commonly seen in the oral cavity but may also infect the gastrointestinal tract, lungs and uterus. Actinomyces is also a part of the normal vaginal flora and can result in infection independent of intrauterine device (IUD) use. Abscesses and swelling are common at the site of the infection. The organisms are grossly apparent by the formation of sulfur granules. Chorioamnionitis due to Actinomyces is exceptionally rare. CASE: A 23-year-old woman delivered a male infant at 28 weeks' gestational age after premature labor. The mother had an unremarkable hospital course. There was no prior IUD history. The infant had an extended stay in the fetal intensive care unit secondary to prematurity. Evaluation of the placenta revealed necrotizing acute chorioamnionitis and organisms with a filamentous growth pattern. The morphology was consistent with Actinomyces spp. CONCLUSION: This case is important because of the rarity of the infection. Clinicians and pathologists alike must be aware of this possibility even in the absence of IUD use.

Preoperative fine needle aspiration cytology diagnosis of microcystic adenoma of the pancreas: fact or fiction? A report of 2 cases.

BACKGROUND: Microcystic adenoma is an uncommon benign neoplasm involving the pancreas that usually affects older populations. These neoplasms often enlarge to significant sizes, causing symptoms of obstruction and discomfort. CASES: We report 2 cases of microcystic adenoma of the pancreas in which an accurate diagnosis could not be rendered on cytology material alone. Bench fine needle aspiration (FNA) biopsy performed on the resection specimen in one of the cases had a higher cellular yield because a different technique was used to prepare the slide. CONCLUSION: A preoperative diagnosis can be helpful in guiding the care of the patient, thereby increasing the importance of a diagnosis to distinguish between a benign vs. malignant process. These case reports demonstrate the difficulty of obtaining diagnostic cells in microcystic adenoma, highlight the use of FNA to increase cellular yield and emphasize the importance of correlating radiologic findings with aspiration of abundant watery fluid from cystic pancreatic masses to make a definitive diagnosis.