Intraocular metastases of lung origin: Case reports and cytology correlates.

Intraocular metastases from the lung are a common occurrence and an important differential for cytopathologists reading fine needle aspiration biopsies (FNAB). It is a particularly challenging diagnosis when the patient has had no previous diagnosis of lung cancer. We present two cases of intraocular metastases from lung primaries, and we discuss the clinical, radiological, and cytopathological features that help differentiate intraocular metastases of lung primary from other intraocular tumours, in the setting of FNAB. We also discuss the importance of recognising the spectrum of FNAB cases that can be seen specific to an institution, which may vary according to different patient populations. A thorough metastatic workup and ancillary testing, such as IHC or molecular genetics, ensures an accurate diagnosis.

Biphasic chest wall synovial sarcoma with epithelial pleural effusion: a diagnostic challenge.

Synovial sarcoma (SS) is a rare malignancy that most commonly involves the extremities and large joints. We describe a 67-year-old woman who presented with shortness of breath and flu-like symptoms, and a chest wall mass. On resection of the mass biphasic morphology of SS was noted, as well as confirmatory immunostains including TLE1 and bcl2. An SS18/SSX2 fusion transcript was detected by reverse transcriptase-DNA amplification. A year later, following chemotherapy, the patient developed a right-sided pleural effusion. Cytological examination of the fluid showed an epithelial population forming clusters and groups. TLE1 was positive, as well as fluorescent in situ hybridization analysis for the SS18/SSX2 fusion transcript. SS can be a challenging diagnosis in fluid-filled cavities, when the epithelial component predominates and its original biphasic quality is not seen. We discuss the diagnostic challenges of monophasic and biphasic SS, and updates to ancillary testing.

Metachronous aneurysmal bone cyst in a 9-year-old boy: case report and review of the literature.

Aneurysmal bone cyst (ABC) is a locally aggressive, benign bone tumor that commonly affects children. Metachronous ABCs are rare, and have been described only three times in the literature. Here we present a fourth case in a 9-year-old boy who presented with an ABC of the scapula; 2½ years later he presented with a tibial ABC. We also review the literature and discuss the pathological and clinical characteristics of this lesion.

Chorangioma and related vascular lesions of the placenta--a review.

Chorangioma has been referred to as a hamartoma-like, or a hyperplastic capillary lesion, rather than a true neoplasm. Its incidence is 1 in 100 placentas. In chorangiomas larger than 4 cm, there can be significant effects on the hemodynamic and circulatory processes of the fetus, leading to grave clinical consequences, such as polyhydramnios and fetal heart failure. Chorangiomas can show various histopathologic pictures, ranging from vascular to cellular, and can undergo degenerative changes. They can be diagnosed prenatally by ultrasound, color Doppler imaging, and magnetic resonance imaging (MRI). Chorangioma must be differentiated from other villous capillary lesions, namely, chorangiomatosis and chorangiosis. They have overlapping similarities with chorangioma, and have clinical implications. Chorangiomatosis has been associated with negative fetal outcomes such as intrauterine growth retardation (IUGR) and preeclampsia. Chorangiosis is associated with maternal diabetes mellitus. Another rarer differential is chorangioma with trophoblast proliferation ("chorangiocarcinoma," a probable misnomer), a rare proliferation of trophoblastic tissue seen in the vicinity of otherwise benign chorangioma. Treatment modalities of chorangioma include endoscopic devascularization, alcoholic ablation, and interstitial laser coagulation. In this article, we will review the clinical and pathologic picture of chorangioma as well as treatment, and discuss its main differentials.

Intraosseous benign notochordal cell tumor.

Intraosseous benign notochordal cell tumor is a presumably benign, intravertebral lesion of notochord origin, which can be found incidentally on removal of the vertebra for unrelated lesions or during an autopsy. The notion of a larger benign notochordal cell tumor that is macroscopic, occasionally symptomatic, and seen radiologically was recently introduced, and described as giant vertebral notochordal rest, giant notochordal hamartoma of intraosseous origin, and benign chordoma . Because of the location, size, and similar histologic and immunohistochemical characteristics, larger benign notochordal cell tumors are easily misdiagnosed as the malignant notochord-type of tumor/chordoma, with critical implications. In this review, we attempt to shed light on the major differences between benign notochordal cell tumors and chordoma and other related notochord lesions, such as notochordal vestiges of the intervertebral disk and ecchordosis physaliphora.

Infarcted ectopic spleen presenting as retroperitoneal mass.

Wandering or ectopic spleen is an exceptionally rare condition. Because of the abnormally long pedicle, an ectopic spleen is prone to torsion and infarction. Patients can present with abdominal pain or an acute abdomen. The incidence is over a wide age range, but it occurs with a female predominance in the third to fifth decades. We present a case in a 26-year-old female of an infarcted ectopic spleen, initially thought to be a retroperitoneal mass on computed tomography scan, but found at surgery in the lower abdomen. The minimally invasive gynecologic surgeon needs to be aware of this entity, which may rarely be encountered.

Cellular angiofibroma is genetically similar to spindle cell lipoma: a case report.

Cellular angiofibroma is a benign mesenchymal neoplasm of female and male genital tract composed of prominent vasculature and stromal spindle cells, often with admixture of adipose tissue. The tumor has histomorphologic similarities to angiomyofibroblastoma and spindle cell lipoma. Herein we describe a tumor arising in the perineal region of a 60-year-old man with morphological and immunohistochemical features of cellular angiofibroma and showing cytogenetic characteristics similar to spindle cell lipoma. To our knowledge, this is the first report of cytogenetic changes in cellular angiofibroma. The genetic overlap of these entities supports their origin from the same mesenchymal stem cell.