Sebaceous Adenocarcinoma in Parotid Gland of a 65-Year-Old.

Sebaceous adenocarcinoma of the parotid gland is a rare, malignant epithelial neoplasm with focal areas of sebaceous differentiation. A literature search revealed only 34 cases as of December 2020. Our case brings this total to 35. It is characterized as a partially encapsulated neoplasm with predominant areas of basaloid or squamous cells, and variable degrees of sebaceous differentiation. The sebocytes display an immunohistochemical staining pattern of EMA (cytoplasmic vesicles), CD15, lactoferrin, GCDFP-2, and androgen receptor positivity in the sebocytes. Bimodal peaks occur in the third and seventh decades of life. We present a case of sebaceous adenocarcinoma in a 65-year-old male who initially presented in the emergency department with hypertensive urgency and vertigo. MRI and CT scans showed a heterogeneous mass with a solid component and cystic areas, including calcifications that measured approximately 2.7 x 2.1 x 4.1 cm, predominantly in the deep part of the left parotid gland and extending upward to the adjacent sternocleidomastoid muscle and possibly infiltrating or abutting the muscle. Further questioning of the patient revealed a seven month history of a painless, slow-growing mass and increased sensation of fullness on the left side of his neck. Patient underwent a left total parotidectomy with flap reconstruction and left neck dissection, revealing a 6.0 x 4.4 x 2.2 cm left parotid gland with a 2.4 x 2.2 x 1.6 cm, well-circumscribed, multiloculated cystic mass that released red-brown serous fluid and thick yellow material and appeared to abut multiple resection margins. Microscopic examination showed nests of basaloid cells at the periphery and areas of distinct sebaceous differentiation, separated by bands of extensive hyalinization. The tumor also displayed an average of 2 mitotic figures per 10 high power fields, and less nuclear atypia and less invasiveness into the surrounding glandular tissue than what has been described in sebaceous adenocarcinomas. This is an unusual case because of the rarity of the tumor as well as the lack of nuclear atypia and invasiveness compared to what is described of sebaceous adenocarcinoma in the literature.

Gone fishing: a unique histologic pattern in cutaneous angiosarcoma.

Cutaneous angiosarcoma is a rare but aggressive vascular malignancy that can present a diagnostic challenge due to a wide variety of clinical appearances and histologic features. Final diagnosis traditionally is yielded by corroborating the histologic and immunohistochemical findings with the clinical presentation; however, a histologic feature known as "fish in the creek," which consists of free-floating or tufted pleomorphic spindle cells within the vascular lumen, may be an additional diagnostic clue. In this study, we aimed to determine the diagnostic utility of this finding in cutaneous angiosarcoma. Our results suggest that "fish in the creek" has the potential to be an additional useful diagnostic tool for an otherwise challenging and deceptive malignancy.

A Rare Case of Lymphadenopathy: Kikuchi-Fujimoto Disease.

A relatively unknown cause of cervical lymphadenopathy is Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis. This is a rare and benign condition that presents with painful cervical lymphadenopathy, fevers, night sweats, and weight loss. This disease is most prevalent in Asian women between the age of 20-35 years. The diagnosis of Kikuchi Disease is made histologically and is characterized by paracortical areas of necrosis and a notable complete absence of neutrophils. The painful lymphadenopathy can be simply treated with antipyretics, but due to its presenting symptoms of Kikuchi disease, it is often mistaken for malignant lymphoma. As such, accurate diagnosis is required to avoid unnecessary testing. The evaluation of lymphadenopathy without an obvious cause can be quite challenging. When patients present with relapsing remitting lymphadenopathy, Kikuchi disease may warrant consideration.

Adequacy of powered vs manual bone marrow biopsy specimens: a retrospective review of sequential marrow aspirates and biopsies in 68 patients.

OBJECTIVES: To evaluate the quality and quantity of the bone marrow aspirates and biopsy specimens obtained with a powered system in comparison with the standard manual method. METHODS: The Pathology Laboratory Information System was reviewed for patients who had previously undergone bone marrow biopsies performed by both the OnControl Bone Marrow System and the manual method. A total of 136 cases (68 patients) were reviewed for adequacy and compared using an unpaired t test. RESULTS: The core biopsy specimens obtained by the OnControl system were significantly longer compared with those obtained by the manual system (16.9 vs 14.4 mm, P = .0036). However, the core biopsy specimens obtained by the manual method had on average more evaluable marrow elements (66% vs 40%, P < .0001), and the manual method was superior in 46 of the 68 cases when the length of evaluable marrow was calculated (9.7 vs 7 mm, P = .0049). CONCLUSIONS: Our findings show that longer core biopsy specimens are obtained by the OnControl Bone Marrow system but that the manual method is still superior when the percentage and length of evaluable bone marrow are analyzed.

Aggressive variant of a solid pseudopapillary neoplasm: a case report and literature review.

Solid pseudopapillary neoplasm, a lesion of uncertain cellular differentiation, is an unusual tumor of the pancreas with an indolent clinical course that typically arises in young females. We report a case of solid pseudopapillary neoplasm arising in a 17-year-old adolescent girl who presented with progressive abdominal pain. The patient underwent surgical resection of an 18 × 14 × 8-cm pancreatic mass that displayed the usual histologic features of a solid pseudopapillary neoplasm in addition to prominent nuclear atypia, increased proliferative index, and extensive necrosis. These unusual histologic findings are rare and are of particular interest owing to the dramatically decreased survival time displayed in this case. Although precise pathologic criteria suggesting a high risk for aggressive behavior of solid pseudopapillary neoplasms are uncertain, recognition of the unusual pathologic features displayed in this case may be useful in the prediction of potentially more aggressive neoplasms that portend a poorer prognosis.

Usual clinical presentation of bizarre parosteal osteochondromatous proliferation (BPOP) with unusual histology.

Bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion is a unique, bony lesion that most often arises in the small bones of the hands and feet. The lesion was first described by Nora et al. in 1983, and documented cases have now shown the lesion to arise in the long bones, skull, maxilla and mandible. Radiographically, the bony lesion typically lacks a connection with the adjacent medullary cavity which is commonly seen with osteochondroma, the main differential diagnosis for Nora's lesion. Reported is the case of a 35-year-old male who presented to the orthopedic clinic after a non-painful mass arising on the right index finger was identified on routine physical examination. The lesion was surgically removed and sent for pathologic evaluation. Microscopic examination of the lesion revealed a disordered spindle cell proliferation and trabecular bone with no cartilaginous cap. The findings were believed to represent an osteocartilaginous neoplasm with radiographs and magnetic resonance imaging (MRI) suggestive of Nora's lesion. Thus, it was felt that the lesion fell within the overall spectrum of BPOP. The lesion is a unique entity that requires a complete history and physical exam along with radiographic and histologic analysis for proper identification. The lesion is benign but may be locally aggressive. Complete excision is the treatment of choice, and recurrence is common.

Sani-cloth wipe mimics rare enzyme deficiency malonic aciduria on newborn screen.

Within a 7-month period at our institution, newborn screening by tandem mass spectrometry revealed 10 cases with elevated levels of malonylcarnitine, which suggested malonic aciduria. Malonic aciduria is a rare autosomal recessive inborn error of metabolism. Confirmatory testing yielded normal results in all the newborns involved. The application of quality improvement practices dictated investigating the dried blood spot collection process, which revealed the use of multiple blood-collection techniques by newborn nursery staff, improper handling of the dried blood spot specimens, and sanitary wipe contamination as the causes of the aberrant false-positive results at our institution. This systematic evaluation identified the cause of the aberrant false-positive results and a strategy was implemented to avoid aberrant results in the future. Thus far, no false-positive results have occurred since the investigative process. False-positive results on a newborn screen can cause unnecessary emotional and economic stress on families, a finding that was identified at our institution. Historically, false-positive newborn screening results have been identified in infants born by cesarean delivery in which iodine antiseptic was used and in newborns who receive total parenteral nutrition, such as premature infants in the NICU. Therefore, if an unusually high number of false-positive results are found during the newborn screening process, contamination should be considered as a contributing factor.

Increased expression and aberrant localization of mucin 13 in metastatic colon cancer.

MUC13 is a newly identified transmembrane mucin. Although MUC13 is known to be overexpressed in ovarian and gastric cancers, limited information is available regarding the expression of MUC13 in metastatic colon cancer. Herein, we investigated the expression profile of MUC13 in colon cancer using a novel anti-MUC13 monoclonal antibody (MAb, clone ppz0020) by immunohistochemical (IHC) analysis. A cohort of colon cancer samples and tissue microarrays containing adjacent normal, non-metastatic colon cancer, metastatic colon cancer, and liver metastasis tissues was used in this study to investigate the expression pattern of MUC13. IHC analysis revealed significantly higher (p<0.001) MUC13 expression in non-metastatic colon cancer samples compared with faint or very low expression in adjacent normal tissues. Interestingly, metastatic colon cancer and liver metastasis tissue samples demonstrated significantly (p<0.05) higher cytoplasmic and nuclear MUC13 expression compared with non-metastatic colon cancer and adjacent normal colon samples. Moreover, cytoplasmic and nuclear MUC13 expression correlated with larger and poorly differentiated tumors. Four of six tested colon cancer cell lines also expressed MUC13 at RNA and protein levels. These studies demonstrate a significant increase in MUC13 expression in metastatic colon cancer and suggest a correlation between aberrant MUC13 localization (cytoplasmic and nuclear expression) and metastatic colon cancer.

Primary cutaneous mantle cell lymphoma with blastic features: report of a rare case with special reference to staging and effectiveness of chemotherapy.

We describe a case of blastic primary cutaneous mantle cell lymphoma (MCL) in an 83-year-old male with a complex medical history. The patient presented to his primary care physician with a nodular erythematous skin eruption on his thighs. Histopathologic examination showed a diffuse lymphoid infiltrate of intermediate to large cells that involved the dermis and subcutis but spared the epidermis. Immunohistochemical staining showed expression of CD20, CD5 and cyclin-D1. The lymphoma cells were negative for CD10 and CD23. Fluorescence in situ hybridization (FISH) analysis revealed a characteristic translocation [t(11;14)(q13;q32)], which is diagnostic of MCL. Cutaneous involvement by MCL is typically secondary because of widespread disease, and primary cutaneous MCL can only be diagnosed in the absence of extracutaneous involvement. Primary cutaneous MCL is extremely rare and requires proper clinical staging. In this case, clinical staging revealed no evidence of bone marrow or peripheral blood involvement, and positron emission tomography (PET) scan revealed weak, abnormal uptake only in a few cervical lymph nodes. Because of the lack of disseminated involvement, we favor the lesion to be a primary cutaneous MCL.

Opting for Christian Science vs. surgical removal: a case report of a giant basal cell carcinoma arising on the back of a 66-year-old man.

Basal cell carcinoma is the most common form of skin cancer, with giant basal cell carcinoma comprising only 0.5 percent of all basal cell carcinomas. When a basal cell carcinoma is larger than 5 cm, it is designated as a giant basal cell carcinoma. Neglect is often a contributing factor to these lesions, and local recurrence and metastasis is not uncommon. Presented is a case of a 66-year-old man who presented with a chief complaint of increasing shortness of breath and fatigue. The patient was found to have a large 15 cm x 12 cm pedunculated tumor on his back that had been present for 10 years. The patient had forgone medical attention until presenting with a symptomatic anemia due to his belief in Christian Science, which relies on prayer and divine healing for the treatment of illness. Christian Scientists are allowed to see physicians, but they may present with advanced symptoms or disease presentations due to their beliefs. Fortunately, a computed tomography (CT) scan revealed that the tumor was confined to the skin, and biopsy revealed a basal cell carcinoma. Thus, the patient was able to undergo a wide local excision and split thickness skin graft with clear surgical margins.