Kaposiform hemangioendothelioma in an adult with rheumatoid arthritis.

This report describes a case of kaposiform hemangioendothelioma arising in an adult man during the course of rheumatoid arthritis treated with steroids and methotrexate. The vascular proliferation began in the terminal phase of the disease, which culminated in acute renal failure and death. We discuss the possible relationship between rheumatoid arthritis, its treatment, and the onset of vascular proliferation, as well as the role of kaposiform hemangioendothelioma in aggravating the autoimmune disease and leading to its fatal outcome.

Lane's type pseudosarcoma of glans penis.

We herein present a rare case of polypoid "pseudosarcomatous lesion" of the glans penis, associated with in situ or mini-invasive squamous carcinoma. These lesions, described by Lane, in the upper aerodigestive tract, can rarely occur elsewhere. Immunohistochemistry is crucial for a correct diagnostic interpretation, confirming that the aytpical cells are components (fibroblasts, myofibroblasts, endothelial) of granulation tissue.

A peculiar fibroma-like lesion of superficial soft tissue: morphologic and immunophenotypic evaluation.

Apeculiar lesion of superficial soft tissue characterised by fibroma-like morphology and an immunohistochemical profile consisting of CK+, VIM+, CD34+, CD31+/-, FLI1+ and INI-1 retained is described. The lesion entered into differential diagnosis with the so-called fibroma-like variant of epithelioid sarcoma, with the entities defined as ES-like/pseudomyogenic haemangioendothelioma and the recently identified entity defined as superficial CD34+ fibroblastic tumour. All of these entities share a common morphological structure, but differ in their immunophenotypic profile.

A complex association between derivatives from the neural crest. A case report.

We report the case of a very complex proliferation arose in the context of the soft tissues of the axilla, composed of elements derived from the neural crest: several of hamartomatous significance: ("cafe au lait spots without neurofibroma, groups of nevoids cells), others clearly neoplastic with the characters of the melanoma and the MPNST. The melanoma cells express, furthermore, neuroendocrine markers. Differential diagnostic characters are discussed and emphasizes the importance of this kaleidoscopic, transient, structure in determining the phylogeny and ontogeny of living beings.

Histogenetic and taxonomic considerations on a case of post-traumatic bizarre parosteal osteochondromatous proliferation (BPOP).

A case of bizarre parosteal osteochondromatous proliferation (BPOP) arising in the head of the fibula of a young man following injury on the lateral aspect of the knee is reported. Microscopically, four zones could be recognized proceeding from the periphery to the deep portion: 1) an outer thick fibrous cap showing an abundant cellular component, composed of thin spindled elements of fibroblastic appearance, haphazardly arranged and exhibiting intense and diffuse immunohistochemical expression of S100 protein (a previously unreported observation); 2) an irregular and atypical cartilaginous cap beneath the fibrous cap; 3) a layer of blue bone in which islands of atypical chondrocytes are still present but gradually decreasing, moving towards the deeper areas; 4) a layer of mature bone, pink bone, which is implanted in the skeletal segment (the deep margin is devoid of periosteum). The intratrabecular spaces of blue or pink bone did not contain haematopoietic marrow, but rather a loose myxoid stroma. This case confirms the fact that BPOP can occur in skeletal segments other than those indicated in the original report of Nora, and that trauma, even if minor, is an important factor in the development of the lesion. The latter begins at the periosteal level, where fibroblasts may acquire a chondroformative function (becoming chondrofibroblasts), as witnessed by the strong and widespread expression of P S100, first documented in this report.

Morphologic and immunohistochemical observations on the mammary and extramammary Paget's disease: implications for the histogenesis.

Using a panel of three anti-CK MoAbs, belonging to Gown's Classes II, III and IV, the Paget's cells shown a variable reactivity to such antibodies indicating a more frequent immunocytochemical similarity to the cells of the epidermal basal-ductal system than to the cells of the glandular secreting section of the epidermal derivatives. According these findings the P.C. not necessarily is the result of a cellular migration from ductal section toward the epidermis, but may arise from a epidermal basal-stem cell, from a ductal or more rarely from glandular secreting cell. This assumption is enforced also by the expression of the CEA from morphologically bonafide basal epidermal cells in proximity of the pagetic lesion.

Carcinoma of the thyroid showing thymoma-like features.

A new case of thyroid carcinoma with thymoma-like features, occurring in a 45-year-old lady, is reported. In order to establish the incidence of residual thymic tissue, 2575 consecutive surgically removed thyroid glands were also examined. Thymic tissue was found to be present in up to 1.4% of the cases. The clinicopathological and immunohistochemical features of the case together with its possible relationship with the persistence of aberrant nodules of thymic tissue in the neck are discussed.

Postoperative spindle cell nodules (PSCN) resembling sarcomas: an atypical granulation tissue or atypical pyogenic granuloma with exuberant myofibroblastic component?

Three cases of PSCN that developed 6-8 weeks after operations to the lower genital tract in two women, and after tooth removal in a 9-year-old boy are described. The lesions averaged 2 cm. in diameter and simulated spindle cell sarcomas because of their high mitotic rate, and marked cellularity. On follow-up (2-6 years) all patients were found to be free of disease. Immunohistochemical testing of the spindle cells showed a strong positivity for vimentin, and muscle actin and a weak, focal and inconstant positivity for F. VIII R.A., and Ulex E. The was total negativity for desmin, smooth muscle actin, S 100 Protein and Cytokeratins. We believe that these lesions represent an atypical form of granulation tissue in which the exuberant myofibroblastic component obscure the vascular elements of the lesion.

[Atypical lipoma, floret-like pleomorphic variant. A lipomatous lesion simulating a liposarcoma]. / Lipoma atipico, variante pleomorfa floret-like. Una lesione lipomatosa simulante il liposarcoma.

A case of submucous lump of the majus labium of a 56 year old female has reported. This is a composite lesion which shows a loose connectival texture and a high cellularity with spindle cells, multivacuolated cells of irregular shape and hyperchromatic nuclei; moreover, there are characteristic multinucleated floret-like cells. This is a particular variant of Atypical Lipoma defined as Pleomorphic Lipoma by Enzinger. Despite this ominous cellularity, the lesion is perfectly benign. The small size and the superficial site are the majors elements of good prognosis. In retroperitoneal localization lesions with similar histologic presentation and of major size show more severe prognosis and are classified as Low Grade Well Differentiated Liposarcoma.

Histological typing and nuclear evaluation of endometrial adenocarcinoma.

On the basis of the nuclear pattern "homologous adenocarcinoma" of the endometrium, arising in women under 40, may be divided into three cytologically distinguishable entities: 1) atypical adenomatous hyperplasia Grade 1; 2) atypical adenomatous hyperplasia Grade 2; 3) adenocarcinoma; probably different also at biological level.

[Diagnostic problems in adenocarcinoma of the endometrium in women less than 40 years of age]. / Problemi diagnostici in tema di adenocarcinoma dell'endometrio in donne al di sotto dei quaranta anni

Endometrial adenocarcinoma in women under the age of forty presents a different course according to its histology. Adenocarcinomas of the endometrium may be classified into 4 main types: type 1, homologous or endometrioid; type 2, fallopian-like; type 3, cervical-like; type 4, unclassifiable. The majority of homologous adenocarcinomas have a relatively benign course, whereas the other types are definitely malignant. There is no room for doubt between adenocarcinoma and atypical endometrial hyperplasia in women under forty unless the histological pattern is of the homologous or endometrioid type, because the other patterns are definitely malignant.