Emerging concepts and latest advances regarding the etiopathogenesis, morphology and immunophenotype of basal cell carcinoma.

Basal cell carcinoma (BCC) represents the most common skin malignancy, which has been linked over time to multifactorial causes. It usually occurs on sun-exposed areas in people with fair skin and with predilection for men. BCC usually affects elderly patients and has an extremely wide range of histological subtypes, which can present clinically under different variants, some with really challenging differentials. Although BCC may occur in familial settings, such as nevoid BCC syndrome, Rombo or Bazex-Dupré-Christol syndromes, nonsyndromic multiple BCCs have also been described in the scientific literature. In this review, we discuss in detail the latest scientific concepts regarding BCC, its etiology, pathogenesis, genetic bases of disease, morphology and immunophenotype, as well as the currently known genetic syndromes, which may lead to development of multiple BCCs, especially in young adults.

Cutaneous microcystic/reticular schwannoma: case report and literature review of an exceedingly rare entity with an unusual presentation.

Conventional schwannoma represents a benign peripheral nerve sheath tumor derived from Schwann cells, which usually arises in the fourth or fifth decade of life, in the subcutaneous tissue of the distal extremities, or in the head and neck region of adult patients, with no gender predilection. In addition to the classic type, at least 11 different histopathological subtypes have been described and unawareness of these uncommon histopathological entities may lead to diagnostic pitfalls and risk of mistreatment. Recently described in the scientific literature, microcystic/reticular schwannoma is still relatively unknown to both surgeons and pathologists. The purpose of this paper is to highlight its existence by describing an additional case that occurred in the retroauricular area, and to further characterize its clinical, histopathological and immunohistochemical features. We reviewed the literature and compared the current case with others that have been documented thus far, discussing all possible differential diagnoses.

Keratoacanthoma centrifugum marginatum: an unusual clinical and histopathological diagnostic pitfall.

Keratoacanthoma centrifugum marginatum (KCM) is a very rare variant of keratoacanthoma characterized by progressive peripheral growth accompanied by central healing. The tumor has the peculiar ability to involute spontaneously. A careful differential diagnostic with other skin carcinomas or hyperkeratotic lesions is required in order to ensure appropriate clinical management. We report a case of KCM in a 62-year-old man presenting with a solitary, large exophytic, sessile tumor located on the ventral side of the right lower leg, which developed over the course of one year from an initial erythematous papule. The patient presented history of local trauma. To our knowledge, this is the second report in the scientific literature supporting a possible traumatic etiology. Due to its rarity and lack of distinctive histopathological features, KCM poses a difficult diagnostic challenge. Therefore, the importance of an accurate histopathological examination and extensive use of ancillary studies for differential diagnosis is emphasized.

TB or not TB in HIV infection.

The progression of tuberculosis (TB) is significantly faster in patients with HIV infection. TB is also the main cause of death for HIV-infected individuals, resulting in fatality for 1 of 3 patients. We present the case of a 26-year-old male who arrived at the hospital having previously been diagnosed with HIV in 2014, but was not compliant to the ARV treatment prescribed. The patient presented with acute onset of fever, cough, hemoptysis and malaise. Investigations such as sputum samples and a lymph node biopsy revealed the presence of M. tuberculosis in optic microscopy, which led to a diagnosis of pulmonary and ganglionary TB. As one of the first opportunistic infections that occur in HIV-infected individuals, TB may be one of the earliest clues of an HIV infection. Current guidelines recommend that all individuals diagnosed with HIV should also undertake testing for TB infections.

Surgical and Anatomical Particularities and Difficulties in Histopathological Sampling for Superior Vena Cava Syndrome.

The superior vena cava syndrome is due to the increased venous pressure in the upper torso, neck and head, caused by the obstruction of the superior vena cava. Both external and internal factors cause obstruction (95% are malign causes), and the most severe manifestation is represented by cerebral edema that can even lead to coma. The diagnostic algorithm for the superior vena cava syndrome is widely known. There are many controversies and discussions about the safety of histopathological sampling. The purpose of this paper is to assess such risks, the complication rate and the diagnostic yield of surgical sampling, by analyzing the 26 interventions performed in our clinic. Although the complication rate was higher than that observed in the absence of the superior vena cava syndrome, surgery remains mandatory for a rapid histopathological diagnosis, therefore demanding a protocol that must include a mandatory extemporaneous exam of the biopsy.

Histopathological findings concerning ocular melanomas.

Ocular melanoma is rare in clinical practice. In this study, we present three cases of ocular melanoma surgically removed in the Department of Ophthalmology of the Emergency University Hospital of Bucharest, Romania, and diagnosed in the Department of Pathology of the same hospital using conventional histopathological techniques and immunohistochemical tests.

Trichilemmal carcinoma - a rare cutaneous malignancy: report of two cases.

The trichilemmal carcinoma is a rare low-grade malignant lesion originating from hair follicle cells that usually occurs on sun-exposed skin of older individuals. A differential diagnostic is required with other skin carcinomas. We report two cases of trichilemmal carcinoma admitted at the Emergency University Hospital of Bucharest, Romania, in 2012, one of these cases being localized in the periocular area and the other one resembling a cutaneous horn. These cases present several unusual aspects that are rarely described in the literature namely the site of the tumor which in the eyelid, development of a cutaneous horn, IHC tests which revealed EMA (epithelial membrane antigen) positivity in tumor cells. Considering that this type of tumor seldom develops metastases or local recurrences, and all the cases had free margins, there was no adjuvant therapy.

Acantholytic squamous cell carcinoma: pathological study of nine cases with review of literature.

Squamous cell carcinoma (SCC) is classified in many subtypes or forms; one of them is the acantholytic squamous cell carcinoma, also called pseudoglandular, adenoid, epithelioma dyskeratoticum segregans, or adenoacanthoma. Researching and analyzing nine cases of acantholytic squamous cell carcinoma, we intend to verify if the data provided by the cases studied can be validated by the scientific literature. All the cases presented lesions found on the head and neck skin, with two exceptions - one on the larynx and the other one on the tonsil, all of them ulcerated lesions. In two cases, the tumors developed on the skin, in preneoplasic lesions (actinic keratosis). The tumors had dimensions between 4/3/4 mm and 100/90/36 mm. During one year, two of the cases studied presented multiple recurrences. We also found two cases of metatypical carcinoma accompanied the acantholytic variant of squamous cell carcinoma. None of the analyzed cases presented distant metastasis. The histopathological criteria for selection were: keratinised squamous tumor cell type, adenoid structures with round spaces with a defined wall of at least one cell width, spaces with isolated or grouped dyskeratotic acantholytic cells.

Cutaneous verrucous carcinoma - report of three cases with review of literature.

Verrucous carcinoma is a rare variant of squamous cell carcinoma. It is well differentiated and rarely metastases but can sometimes be very aggressive locally in depth. The paper presents three cases of cutaneous verrucous carcinoma with different localizations. The first patient shows a lesion in the sacrogluteal region, the second one presented a tumor localized on the auricle (external ear), and the third patient showed a tumor on the sole of the foot. All patients underwent tumor excision and the histopathological diagnosis was verrucous carcinoma. In the first two cases, the surgery was completely curative by excision of the tumors. In the last case, the patient had relapsed and due to the aggressive nature of the tumor, which infiltrated the deeper plans, the tumor had reached the bone. None of the patients showed any metastases.

Clinical or postmortem? The importance of the autopsy; a retrospective study.

Medicine is continually evolving; the new technologies of diagnosis and treatment continue to improve the life expectancy and lead to new information concerning various pathologies. The autopsy is viewed more and more as an ultimate branch of medicine and used only in extreme cases or for forensic purposes. Nevertheless, many studies, including this one, prove the utility and indispensability of the autopsies, without which a complete and accurate diagnosis cannot be made. Finally, the autopsy followed by histopathological examination of the tissues remains the ultimate and most important step for the apprehension of the diseases and for further evolution of medicine. This study reveals the correspondence rate between the clinical and the postmortem diagnosis, as well as between macroscopic and histopathological diagnosis.

Metastatic Melanoma in the Femur - Case Report with Review of Literature: a Pathologist's Point of View.

ABSTRACT: The aim of this case report was to evaluate the histopathological characteristics on a patient with metastases in the femur from malignant melanoma. A review from the literature is also mentioned.We present a case of metastatic malignant melanoma in the femur with known primary site in a 44-year-old-female. Diagnosis was confirmed by histopathology.Malignant melanoma is a cancer that may metastasise in the skeleton. However most of bone metastases are found in the axial skeleton and they rarely involve the femur, as in our case. Only a few case reports are published in the literature. Clinicians must be aware of the varied clinical manifestations of disseminated malignant melanoma.The diagnosis for metastatic malignant melanoma is confirmed due to pathological examination. Immunohistochemical study is useful in diagnosis, mainly when malignant melanoma is poorly differen-tiated.

Ciliary body melanoma - a particularly rare type of ocular tumor. Case report and general considerations.

ABSTRACT: Uveal melanoma is the most common primary malignancy of the eye in white adults. Frequently, uveal melanoma arises from choroid or iris. Ciliary body melanoma is a rare if not exceptional subtype of uveal melanoma. Furthermore, ciliary melanoma is often seen in association with the other two subtypes of uveal melanoma. This paper presents a case of primary ciliary melanoma with invasion of the iris. The patient presented with blurred vision, but this symptom could not doubtless be related with the existence of the tumor, because of the small dimension of the malignancy and the lack of medical history of the patient.This tumor was included in the category of "very small ciliary melanoma", a rare diagnosis considering the fast local invasion and the lack of symptoms in such a small tumor. Histopathological and imunohistochemical examinations confirmed the diagnosis of ciliary melanomaThis type of ocular melanoma has a low prognosis due to early metastases.