The Impact of DTYMK as a Prognostic Marker in Colorectal Cancer.

Background: Overexpression of deoxythymidylate kinase (DTYMK) has been associated with more aggressiveness and pathological behaviors in hepatocellular carcinoma (HCC) and non-small cell lung cancer (NSCLC). However, the expression of DTYMK and its prognostic significance in colorectal cancer (CRC) patients are yet unknown. The goal of this study was to investigate the DTYMK immunohistochemistry reactivity in CRC tissues and to see how it correlated with various histological and clinical features as well as survival. Methods: Several bioinformatics databases and two tissue microarrays (TMAs) of 227 cases were used in this study. Immunohistochemistry assay was used to study the protein expression of DTYMK. Results: Based on the GEPIA, UALCAN, and Oncomine databases, DTYMK expression has increased in tumor tissues at both RNA and protein levels in colorectal adenocarcinoma (COAD) compared to normal tissues. A high DTYMK H-score was found in 122/227 (53%) of the cases, whereas a low DTYMK H-score was found in 105/227. The age at diagnosis (P = 0.036), stage of the disease (P = 0.038), and site of origin (P = 0.032) were all linked to a high DTYMK H-score. Patients with high level of DTYMK had bad overall survival. Interestingly, high DTYMK protein level was associated with PSM2 (P = 0.002) and MSH2 (P = 0.003), but not with MLH2 or MSH6. Conclusion: This is the first study to cover the expression and prognostic significance of DTYMK in CRC. DTYMK was upregulated in CRC and could be considered as a prognostic biomarker.

The effect of vagotomy on c-fos expression in the reticular formation areas following cystometry in cyclophosphamide-induced cystitis in rats.

BACKGROUND: The involvement of the vagus nerve in the supraspinal neural circuits that control the urinary bladder function, especially during pathological conditions, became increasingly evident. However, the role of brainstem areas in these circuits is not studied yet. METHODS: In the present study, using c-fos immunohistochemistry, the roles of the vagus nerve to the responses of the reticular formation to cystometry in cyclophosphamide-treated rats were investigated. RESULTS: Cyclophosphamide treatment significantly increased the c-fos expression in the lateral reticular nucleus (LRt), lateral paragigantocellular nucleus (LPGi), caudal part of the ventrolateral reticular nucleus (CVL), and gigantocellular reticular nucleus (Gi) following cystometry. However, cyclophosphamide treatment didn't have significant effect on c-fos expression in ventrolateral reticular nucleus (VL), rostral part of VL (RVL), raphe pallidus nucleus (RPa), and raphe obscurus nucleus (Rob). Vagotomy significantly demolished the effect of cyclophosphamide in the LRt and LPGi areas without having any significant effect on other reticular formation areas. Whereas, in comparison to normal animals, the vagotomised animals didn't show any significant changes in c-fos expression. CONCLUSION: The results of this study demonstrate the involvement of the reticular formation areas, particularly the ventral part, in processing urinary bladder function under cystitis condition. It also demonstrates the contribution of the vagus nerve in these processes.

Myositis ossificans of the chest wall in an 8-year-old boy: a case report of a diagnostic pitfall.

Myositis ossificans of the chest wall is extremely unusual with fewer than a dozen reported cases. In addition, the occurrence in children younger than 10 years is extremely rare. We report a case of an 8-year-old male who presented with painful and progressively enlarging left-sided chest wall mass. The tumor showed close histo-morphological mimicry with osteosarcoma. Moreover, the characteristic radiographic findings of myositis ossificans were absent. The age of the patient and the absence of attachment to the rib helped exclude extra-skeletal and parosteal osteosarcomas, respectively. The patient was doing well 4 months after surgery.

The Diagnostic and Prognostic Significance of EFEMP1 in Breast Cancer: An Immunohistochemistry Study.

EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP1) has been associated to a variety of malignancies. Because EFEMP1 can act as both a tumor suppressor and an oncogene, this study aimed to evaluate the expression of EFEMP1 at mRNA and protein in breast cancer and to ascertain the diagnostic and prognostic value of EFEMP1 in relation to clinical features of breast cancer. Several bioinformatics websites such as GEPIA and Oncomine databases were used to analyze the mRNA level of EFEMP1. Immunohistochemistry assay was used to detect EFEMP1 immunoexpression using tissue microarray (TMA) and clinical breast cancer samples. EFEMP1 was shown to be overexpressed in breast cancer in some study cohorts while being low expressed in others. In TMA, 86 patients (39.1%) with a high H-score and 134 patients (60.9%) with a low H-score had EFEMP1 positive for breast cancer. While HER2 breast cancer and normal breast tissues had the lowest expression of EFEMP1, it was shown to be highly expressed in Luminal B, A, and TNBC. EFEMP1 H-score is associated with tumor stage and indicates poor overall survival in breast cancer. EFEMP1 H-score was high in the clinical tumor tissues compared with adjacent normal tissue (n = 20), therefore, it would to be a sensitive biomarker for breast cancer. EFEMP1 is a key indicator for assessing the clinical prognosis and diagnosis of patients with breast cancer, as evidenced by the higher expression of EFEMP1 in tumor tissue compared to normal tissue and its association with poor overall survival.

Intraosseous inflammatory pseudotumor of the maxilla: A case report.

Inflammatory pseudotumors are benign lesions that are rarely reported in the head and neck. Moreover, intraosseous inflammatory pseudotumors of the maxilla are extremely rare, with less than 10 cases reported. A 52-year-old woman presented with recurrent dental infections; computed tomography scan of the osteolytic maxillary bone lesion and incisional biopsy were performed. Histopathological examination revealed that the lesion was composed of fascicles of fibroblasts and myofibroblasts, in addition to sheets of plasma cells, lymphocytes, and occasional other inflammatory cells. An infiltrative growth pattern was observed. Immunohistochemical staining confirmed an inflammatory pseudotumor. A partial maxillectomy was performed. There was no evidence of recurrence during the 4-month follow-up period. Inflammatory pseudotumors should be considered when treating destructive maxillary lesions. Immunohistochemical staining was performed to confirm polyclonal plasma cell proliferation.

Significance of fibulin-3 expression in bladder cancer: a tissue microarray-based immunohistochemical study.

BACKGROUND: Predicting the behavior of bladder cancer by easy noninvasive methods and with less cost is needed. Fibulin-3 (EFEMP1), a glycoprotein of the extracellular matrix that is encoded by the gene EFEMP1, has been nominated as one of the potential mediators of muscle invasion in bladder cancer. METHODS: In this tissue microarray-based immunohistochemical study, fibulin-3 level of expression was evaluated using a semiquantitative scoring system and was correlated with patient's age and sex and tumor grade and stage. RESULTS: A total of 160 urothelial carcinoma cases were analyzed. The age of the patients ranged from 25 to 91 years (mean, 60.15; SD, 11.60). Fibulin-3 was significantly associated with muscle invasion and overall tumor stage (p = 0.033 and 0.02, respectively). Fibulin-3 expression was nonsignificantly associated with tumor grade (p = 0.092) CONCLUSIONS: We found that the expression of fibulin-3 is significantly associated with muscle invasion in urinary bladder urothelial carcinoma. However, the prognostic role of fibulin-3 needs further investigations.

Live in Front of Students Teaching Sessions (LISTS): a Novel Learning Experience from Jordan During the COVID-19 Pandemic.

Objective: The COVID-19 pandemic uncovered innovative approaches in medical education. Modifications are needed to overcome the drawbacks of pure online teaching. Our study aimed at testing a hybrid method of live online practical anatomy sessions in which an element of face-to-face teacher-student interaction is maintained. Methods: We performed an experiment with a one-group design in which medical and medical laboratory sciences students were taught different practical anatomy topics using either purely online or live in front of students teaching sessions (LISTS). Students' performance and perceptions were quantitatively assessed. Results: For 108 medical laboratory sciences students, the mean quiz scores were significantly higher for the topics taught by the LISTS approach (p = 0.025). For two groups of 13 and 17 medical students, the performance in exams was significantly higher for the topics taught using the LISTS method (p = 0.000 and 0.011, respectively) with large effect sizes. Students' perceptions of preference, enjoyment, and satisfaction were all in favor of LISTS. Conclusions: Our results confirmed that keeping at least a minimum of interaction between the teacher and students can have a significant improvement in the performance and engagement in practical anatomy sessions for health professionals. The results indicate that the extra effort of LISTS was worth it.

Interactive online practical histology using the poll everywhere audience response system: an experience during the COVID-19 lockdown / Histología práctica interactiva en línea usando poll everywhere audience response system: una experiencia durante el confinamiento de COVID-19

SUMMARY: The shift to online learning due to the COVID-19 pandemic sheds light on the need for innovative approaches to medical education, making it more interactive and effective. Histology is a challenging subject because it is known to be image intensive. In this study, we compared two methods of online teaching of practical histology: an interactive method using the Poll Everywhere Audience Response System and a traditional method without the use of Poll Everywhere. We performed a randomized controlled crossover trial. One hundred and forty students were divided into two groups. The first group was taught using the interactive method and the second group was taught using the traditional method. Each group was then taught using the other method for a second subject. Students' performance and preferences were assessed using tests and questionnaires. The examination scores were significantly higher for Poll Everywhere group. All students' responses were overwhelmingly in favor of the use of Poll Everywhere, with regard to their engagement, enjoyment, and morphology understanding, in addition to the applicability of the interactive approach. Interactive sessions of practical histology using applications such as Poll Everywhere can be an effective way to increase students' engagement, enjoyment, and knowledge retention during distance learning.

RESUMEN: El cambio al aprendizaje en línea debido a la pandemia de COVID-19 determinó la necesidad de enfoques innovadores para lograr que este método de educación médica sea más interactivo y efectivo. La histología es un tema desafiante debido a que se considera intensivo en imágenes. En este estudio, comparamos dos métodos de enseñanza en línea, en clases de laboratorio de histología: un método interactivo con el uso de Poll Everywhere Audience Response System y un método tradicional sin el uso de Poll Everywhere. Realizamos un ensayo cruzado (crossover) controlado aleatorio. Se dividieron cientocuarenta estudiantes en clases de laboratorio de histología en línea interactivas o tradicionales. Luego, a cada grupo se le asignó el segundo método para un segundo tema. El rendimiento y las preferencias de los estudiantes se evaluaron mediante pruebas y cuestionarios. Los puntajes de las pruebas fueron significativamente más altos para los grupos de Poll Everywhere, y las respuestas de los estudiantes fueron a favor de usar Poll Everywhere en lo que respecta a su participación, agrado y comprensión de la morfología como también del enfoque interactivo. Las clases de laboratorio de histología interactivas que utilizan aplicaciones como Poll Everywhere pueden ser una forma eficaz de impulsar la interacción de los estudiantes durante el aprendizaje a distancia.

The significance of StAR-related lipid transfer protein-3 expression in breast cancer.

StAR-related lipid transfer domain containing proteins (STARD3) are a group of proteins that contain a steroidogenic acute regulatory protein-related lipid transfer domain. Breast cancer (BC) has been linked to the STARD3 gene. In this study, we sought to confirm the relationship of STARD3 protein expression with clinicopathological characteristics and BC molecular subtypes. Using tissue microarray, we examined the STARD3 protein expression in 200 BC tissues and 20 normal breast tissues. Higher protein expression of STARD3 was found in tumor tissues than normal tissues. One hundred and fifty-two (69.1%) of the 200 cases tested positive for STARD3 (high H-score), while seventy (30.9%) had a low STARD3 H-score. When STARD3 is present, its expression ranges from mild to strong. STARD3 H-score was strongly linked to human epidermal growth factor receptor 2 (HER2)-positive (p < 0.001) and estrogen receptor (ER)-positive (p < 0.009) patients, but not to triple-negative BC patients. STARD3 high H-score was associated with histological grade and tumor size. No significant associations were found with stage of the disease, pathological stage or node status. Our research revealed that STARD3 levels were higher in tissues from malignant BC, and it was associated with HER2 and ER, suggesting that it might be utilized as a marker for BC.

Self-Reported Obsession Toward COVID-19 Preventive Measures Among Undergraduate Medical Students During the Early Phase of Pandemic in Jordan.

Background: Coronavirus disease 2019 (COVID-19) pandemic and its associated precautionary measures have substantial impacts not only on the medical, economic, and social context but also on psychological health. This study aimed to assess the obsession toward COVID-19 preventive measures among undergraduate medical students during the early phase of the pandemic in Jordan. Methods: Online questionnaires were distributed between March 16, 2020 and March 19, 2020. Socio-demographic characteristics were collected, and self-reported obsession toward COVID-19 preventive measures was assessed using a single question.COVID-19 knowledge, risk perception, and precautionary measures were evaluated using scales. Using the chi-square test, Student t-test, and one-way ANOVA, we assessed the differences in the obsession of students with socio-demographic characteristics and scores of the scales. Results: A total of 1,404 participants (60% were female participants) completed the survey with a participation rate of 15.6%. Obsession with preventive measures was reported by 6.8%. Obsession was significantly more common among women (9.2%) than men (3.3%) and students who attended COVID-19 lectures (9.5%) than those who did not attend such lectures (5.8%) (p < 0.001 and p = 0.015, respectively). Obsessed participants reported significantly higher levels of COVID-19 knowledge (p = 0.012) and precautionary measures (p < 0.001). COVID-19 risk perception had a mild effect size difference but with no statistical significance (p = 0.075). There were no significant differences in the academic levels of participants (p = 0.791) and universities (p = 0.807) between students who were obsessed and those who were not. Conclusions: Obsession is one of the significant but unspoken psychological effects of COVID-19 precautionary measures among undergraduate medical students. Medical schools should be equipped with means to handle pandemic psychological effects.

The usefulness of histopathology examples in teaching practical histology for medical students: A CONSORT-compliant randomized crossover trial.

BACKGROUND: Teaching histology as an image-intensive discipline is a major challenge to medical teachers. We compared knowledge retention and student preference after performing comparison-based and traditional methods of teaching practical histology. METHODS: We performed a crossover randomized controlled trial. Eighty nine first-year and 37 second-year medical students were randomly assigned to comparison-based or traditional classes in which PowerPoint slides were used. Each teaching approach was then switched to another group for a second tissue set. Quantitative assessment was performed using multiple-choice questions and a questionnaire. RESULTS: The first-year students' overall examination scores were significantly higher in the comparison-based approach compared to the traditional approach for both tissue sets, with a large effect size. Interestingly, even for the second-year students, a significantly higher overall score for one set of tissue samples was observed in the comparison-based approach compared to the traditional approach. The students' responses to all the elements in the questionnaire were significantly in favor of the comparison-based approach. CONCLUSION: Our findings indicate that the simple implementation of a few histopathology examples can yield a tremendous improvement in first-year medical students' understanding, enjoyment, and engagement in practical histology classes.

Differential Expression and Prognostic Significance of STARD3 Gene in Breast Carcinoma.

StAR related lipid transfer domain containing 3 (STARD3) gene has been reported to be co-amplified with human epidermal growth factor receptor 2 (HER2) in breast carcinoma. STARD3 is necessary for cholesterol transfer and metabolism in tumor cells. The possible role played by STARD3 as a diagnostic and prognostic biomarker was investigated in breast cancer (BC). Data mining was performed using several bioinformatics websites to investigate the correlation of STARD3 with BC and its molecular subtypes, and conventional PCR was used to detect the STARD3 mRNA levels in a panel of BC cell lines. STARD3 was overexpressed in BC more than the other types of cancer. The results also showed that STARD3 expression was significantly associated with HER2+ BC tumors and BC cell lines, and low STARD3 mRNA and protein expression levels were observed in estrogen receptor-positive (ER+) and triple-negative BC (TNBC) patients. Moreover, high STARD3 expression levels predicted worse overall survival (OS), relapse-free survival (RFS) and disease metastasis-free survival (DMFS) in BC, and HER2+ BC. Notably, low expression of STARD3 was associated with poor OS in ER+ BC. Our findings suggest that STARD3 may have strong diagnostic and prognostic value for HER2+ breast carcinoma.

Differential Expression of Androgen Receptor in Type I and Type II Endometrial Carcinomas: A Clinicopathological Analysis and Correlation with Outcome.

OBJECTIVES: Endometrial carcinomas (EC) are the most common gynecological malignancies and are conventionally divided into type I and type II due to diagnostic and prognostic considerations. Female hormone expression in EC is extensively studied; however, data about androgen receptor (AR) expression in EC are sparse. We aimed to study AR expression in different types of EC at our institute and whether it had an impact on patient outcomes. METHODS: A retrospective analysis of EC cases diagnosed and treated from 2010-2019. AR immunohistochemical expression was tested in 52 EC cases (type I = 40; type II = 12). Histological typing was verified according to conventional diagnostic criteria. Only primary EC were included without neoadjuvant therapy. Histologic score was calculated as: stain intensity (graded 0-3) × positive cells percentage (graded 0-4). Level of expression was scored from 0 to 12. RESULTS: The mean age of the selected patients was 60.3 years (range = 31-88 ± 12.6). Recurrence was detected in 11 (21.2%) patients. The outcome was 40 patients were alive without disease, eight alive with disease, three dead of disease, and one dead of other causes. About 62.5% of type I-EC and 25.0% of type II-EC were AR positive. AR expression was analyzed against different clinicopathological parameters including: type (p = 0.005), histotype (p = 0.044); grade (p = 0.035); age group (p = 0.207); menopause (p = 0.086); estrogen receptor (ER) expression (p = 0.284); atypical complex hyperplasia (p = 0.594); tumor stage (p = 0.994); tumor recurrence (p = 0.530); node status (p = 0.110); and outcome (p = 0.202). CONCLUSION: AR expression was higher in type I EC, endometrial endometrioid carcinoma histotype, and with a lower grade. AR expression was not significantly correlated with age, stage, ER, atypical hyperplasia, recurrence, node status, or outcome. Results agree with recent literature that AR expression is associated with better-differentiated EC and may be a potential hormonal therapeutic tool.

The Prognostic Significance of Proteasome 26S Subunit, Non-ATPase (PSMD) Genes for Bladder Urothelial Carcinoma Patients.

Proteasome a highly sophisticated systems that alter protein structure and function. Proteasome 26S Subunit, Non-ATPase (PSMD) genes have been implicated in several types of malignancies. This is the first study to look at how proteasomal subunits are expressed in patients with bladder urothelial carcinoma (BLCA). BLCA was used to evaluate the predictive value of PSMD genes (PSMD1 to PSMD12) in relation to clinicopathological characteristics. PSMD genes' expression patterns at the mRNA level were analyzed using a variety of bioinformatics methods, including gene expression profile integrative analysis (GEPIA), Oncomine, TCGA, and Gene expression Omnibus (GEO) databases. The GEPIA and TCGA dataset survival plot functions were used to assess the prognostic significance of PSMD genes. PSMD2, PSMD3, PSMD4, PSMD8, and PSMD11 genes were significantly overexpressed in BLCA compared with normal bladder tissues. PSMD2 and PSMD8 were significantly overexpressed in BLCA more than other types of cancer. High level of PSMD2 and PSMD8 predicted shorter overall (OS) and progression free survival (PFS) in BLCA patients. High level of PSMD2 was significantly associated with elder age (P < .001), female gender (P = .014), tumor grade (P < .001), and metastasis (P = .003). PSMD2 has been shown to be an independent predictor for OS in BLCA patients based on univariate and multivariate analysis (P < .001). Overall, according to this study, PSMD2 and PSMD8 could be served as a prognostic biomarker for BLCA patients.

Necrobiotic granulomas of the bowel accompanying 3-year postsurgical recurrence of colon cancer: A case report.

INTRODUCTION: Postsurgical necrobiotic granulomas present a diagnostic challenge and have been described in organs such as the urinary bladder, prostate, and uterus. However, occurrence of these granulomas is rare in the bowel. PRESENTATION OF THE CASE: In this report, we present the case of a 28-year-old woman with recurrent multifocal colonic adenocarcinoma 3 years after sigmoidectomy. Intraoperatively, the ileum was suspicious for tumor deposits. Total colectomy with segmental small bowel resection was performed, and the histopathological findings of the small bowel specimen were consistent with necrobiotic granulomas with no evidence of malignancy. Infectious disease workup was negative. The patient was administered adjuvant chemotherapy and had no negative outcomes at 8 months after the surgery. DISCUSSION: This is a rare and challenging case of postsurgical necrobiotic granulomas of the bowel. CONCLUSION: Granulomas with "active" necrobiosis can occur as late as 3 years after colon cancer surgery and can be a diagnostic pitfall that significantly affects the management.

Medical students' perceptions of pathology and a proposed curricular integration with histology: a future vision of curricular change / Percepciones de los estudiantes de medicina sobre patología y una propuesta de integración curricular con histología: una visión futura de cambio curricular

Students' perceptions and feedback have a significant impact on academic progress. The aim of this study was to determine the perceptions of medical students regarding the cumulative effects of the first year general histology course and the sophomore pathology introductory course, in addition to their perceptions regarding the curricular integration of histology and pathology. In this cross-sectional study, a questionnaire was given to second-year and third-year medical students in the middle of second semester. The questionnaire comprised several items on students' attitudes toward anatomic pathology, their feedback on the first year general histology and the sophomore pathology courses, and their perceptions regarding the integration of histology and pathology courses. A five-point Likert scale was used. Data were analyzed using Statistical Package for the Social Science (SPSS) v 20 software. Two hundreds and fourteen of the 236 questionnaires distributed were analyzed (response rate = 90.7 %). More than 51 % of the respondents reported that they couldn't identify the normal tissue counterpart of most practical pathology cases. Only 31.3 % thought their practical histology knowledge was beneficial for them in practical pathology. More than 87 % agreed or strongly agreed that pathology cases need to be copresented with normal tissue examples. A significant proportion of the respondents (60.7 %) were with merging histology and pathology in integrated courses. Pathology was of career choices for only 15.4 % of the participants. The curricular integration of histology and pathology in the first year needs to be tested, and much effort is needed to increase students' affinity for anatomic pathology.

Las percepciones y comentarios de los estudiantes tienen un impacto significativo en el progreso académico. El objetivo de este estudio fue determinar las percepciones de los estudiantes de medicina con respecto a los efectos acumulativos del curso de Histología general de primer año y del curso introductorio de Patología de segundo año, además de sus percepciones con respecto a la integración curricular de Histología y Patología. En este estudio transversal, se entregó un cuestionario a estudiantes de medicina de segundo y tercer año, a mediados del segundo semestre. Asimismo, el cuestionario comprendió varios aspectos referente a la actitud de los estudiantes hacia Patología Anatómica, sus comentarios sobre la Histología general en el primer año y los cursos de Patología de segundo año. Además se incorporaron las percepciones de los estudiantes con respecto a la integración de los cursos de Histología y Patología. Se utilizó una escala de Likert de cinco puntos. Los datos se analizaron utilizando el paquete Statistical Package for Social Science (SPSS) v 20. Se analizaron 214 de los 236 cuestionarios distribuidos (tasa de respuesta = 90,7 %). Más del 51 % de los encuestados indicaron estar de acuerdo o totalmente de acuerdo, en que no lograron identificar el tejido normal, en la mayoría de los casos de Patología práctica. Solo el 31,3 % observó que su conocimiento de Histología práctica era beneficioso para ellos durante la Patología práctica. Más del 87 % estuvo de acuerdo o muy de acuerdo en que los casos de Patología deben ser analizados con muestras de tejido normal. Un grupo importante de los encuestados (60,7 %) consideraba incorporar la Histología y la Patología en cursos integrados. Patología fue de elección en la carrera para el 15,4 % de los participantes. La integración curricular de Histología y Patología en el primer año, debe ser evaluada con el propósito de incrementar la afinidad de los estudiantes con la Patología Anatómica.

Metastatic small cell carcinoma of the lung with prominent spindle cell morphology and hemangiopericytoma-like vascular pattern: A sarcoma mimicker.

Small cell carcinoma is a malignant neuroendocrine tumor with aggressive clinical behavior. Histologically, the tumor is characterized by the proliferation of small, round, blue cells. Here, we present the case of a 50-year-old man with a 1-month history of enlarging chest wall mass. Microscopic examination of the lesion revealed a highly cellular neoplasm composed of closely packed, atypical spindle cells with scant cytoplasm, inconspicuous nucleoli, and brisk mitotic activity. The hemangiopericytoma-like vascular pattern was prominent. Areas showing a fibrosarcoma-like fascicular pattern were also observed. The tumor was immunohistochemically positive for TTF1, synaptophysin, and chromogranin, confirming small cell carcinoma. Further investigations revealed a lung origin and widespread metastases. The tumor in this case closely mimicked synovial sarcoma or malignant peripheral nerve sheath tumor. Small cell carcinoma demonstrates a hemangiopericytoma-like pattern that can mimic sarcoma histologically. This is a serious pitfall that can significantly affect the speed of diagnosis and management.

Perinodular hydropic degeneration in uterine leiomyoma causing rapid enlargement and mimicking a myxoid smooth muscle tumor: Case report of a diagnostic challenge.

INTRODUCTION: Hydropic degeneration, sometimes reported as perinodular hydropic degeneration, is one of the various degenerative changes that can be observed in uterine leiomyomas. It can be a clinical and a histopathological diagnostic pitfall. CASE REPORT: Here we present the case of a 40-year-old woman with leiomyoma uteri with perinodular hydropic degeneration. The tumor almost doubled in size over 2 months. Histopathological examination revealed fascicles, cords and nodules of smooth muscle cells separated by excessive amounts of extracellular material. No necrosis or significant atypia was noticed. Average mitotic activity was very low. A myxoid smooth muscle tumor could be excluded only by alcian blue special stain. The presence of floating vessels in the edematous fluid as well as hyalinization inside the tumor nodules were among the reassuring features supporting the diagnosis. CONCLUSION: The pathologist must be aware of this benign entity to avoid overdiagnosis, especially in the view of the alarming histology and the rapid growth. Negative findings with alcian blue special stain help establish the diagnosis.

Poorly Cohesive Cell Carcinoma of the Gallbladder with Signet Rings and Neuroendocrine-Like Morphology: A Rare Incidental Histopathological Diagnosis with Lessons to Learn.

BACKGROUND Poorly cohesive cell carcinoma of the gallbladder is extremely rare. CASE REPORT Here we present a case of a 46-year-old male with the clinical diagnosis of acute cholecystitis. The ultrasound showed gallbladder wall thickening and multiple stones. Cholecystectomy was performed, and the gross examination revealed linitis plastica-like thickening of the gallbladder wall. The microscopic examination revealed diffuse infiltration by a poorly differentiated tumor with signet rings. Another component with insular growth pattern and salt-and-pepper nuclei was present. Immunohistochemical findings were consistent with poorly cohesive cell carcinoma of the gallbladder. Imaging studies revealed regional lymph nodes involvement, in addition to peritoneal and liver metastases. The patient was given chemotherapy, and there was no evidence of disease progression at 4 months post-operation. CONCLUSIONS This case supported that all cholecystectomy specimens must be examined. In addition, although poorly cohesive cell carcinoma was reported to be aggressive, the present case showed a protracted clinical course; this pointed to the need for early clinicoradiological suspicion. This is the first case of poorly cohesive cell carcinoma of the gallbladder with a neuroendocrine-like morphology that mimics mixed adenoneuroendocrine carcinoma. Immunohistochemistry is invaluable in such a scenario.