Sarcomatoid squamous cell carcinoma: a long-standing case.

Sarcomatoid, or spindle cell squamous cell carcinoma (SCSC), is relatively uncommon, but may be encountered. It poses a challenge in differential diagnosis that includes other spindle cell neoplasms. We present a case where the lesion existed for 20 years and raised the potential of chronicity as a factor in inducing spindle cell morphology. Detailed immunohistochemical features are demonstrated, and discussion of the differential diagnosis is offered. The patient was an 89-year-old African-American female with an exophytic and polypoid mass of the right upper arm measuring 5.5 x 5.5 x 3.0 cm. The mass had been present for the last 20 years, and was gradually and very slowly increasing in size. After refusing surgery several times, she finally agreed to have an excision. The tumor proved to be SCSC.

Blastomyces dermatitidis with large yeast forms.

Yeast forms of Blastomyces dermatitidis typically range from 8 to 20 microm in largest diameter. We report a rare case of primary pulmonary blastomycosis with an unusual morphology, in which we found significant numbers of large yeast forms ranging from 30 to 35 microm in diameter. To our knowledge, this is only the second reported case of giant forms of B dermatitidis. We also review the literature and discuss the possible association of this unusual morphology with immunosuppression in general and glucocorticoid use in particular.

Colo-cholecystic fistula: an unusual complication of colonic diverticular disease.

Colonic diverticular disease can lead to various complications. We describe a case of an 81-yr-old man who was found to have intrabiliary air on computed tomography of the abdomen. Endoscopic retrograde cholangiopancreatography and subsequent surgical exploration of the abdomen revealed an ascending colonic diverticulum penetrating into the gall bladder. Colocholecystic fistula is an unusual cause of intrabiliary air and, to our knowledge, this has not been reported in the literature.

High grade dysplasia/esophageal adenocarcinoma in short segment Barrett's esophagus.

Short segment Barrett's esophagus (SSBE) is a frequent finding in patients having endoscopy, but its clinical significance is not fully understood. With the rising incidence of esophageal adenocarcinoma, a potential role of SSBE has been suggested. Biopsy of such lesions may have to be done when seen on endoscopy.

Atypical mitotic figures in basal cell carcinoma. A review of 208 cases.

A retrospective review of 208 cases of basal cell carcinoma (BCC) from the Johnson City Veterans Affairs Medical Center (VAMC) and University Physician's Practice Group Clinic was made to ascertain the percentage of BCCs having mitoses and to evaluate the possible occurrence of abnormal mitotic figures. One of the authors had observed in a limited cytologic sample that the detection of atypical mitotic figures in a lesion suspected of being a BCC could be a helpful indicator pointing toward a nonbasal cell carcinoma diagnosis. The present study demonstrated abnormal-appearing mitotic figures in 121 of 208 cases. However, definite tripolar or tetrapolar forms were present in only a small number of cases. Thus, the presence of these forms in an "equivocal" basal cell carcinoma may suggest an alternate diagnosis but does not totally exclude a diagnosis of BCC.

Seborrheic inclusion cyst.

Epidermoid cysts with seborrheic keratosis-like linings are a recently described rare variant of epidermoid cysts. We report a case in which such a cyst developed following the excision of a typical seborrheic keratosis.

Metastatic epidermotropic squamous carcinoma histologically simulating primary carcinoma.

We present a case of a patient with penile squamous carcinoma and unilateral inguinal nodal involvement. Histological sections of the inguinal tumor demonstrated a basaloid (small-cell) squamous carcinoma of the type that arises from modified skin or mucosa. Multiple cutaneous lesions subsequently developed in the ipsilateral lower extremity. Biopsies revealed tumor that had the same histologic appearance as the nodal metastasis but that also showed a smooth and continuous connection with the overlying epidermis. We discuss the significance of this finding and review the pertinent literature.

False-positive diagnosis in fine-needle aspiration of an atypical Warthin's tumor: histochemical differential stains for cytodiagnosis.

Cytologic smears of a Warthin's tumor (WT) typically consist of sheets of oncocytic (oxyphilic) cells and scattered lymphocytes. Reparative foci within this neoplasm can occur, which may give rise to exfoliated, malignant-appearing, squamous-like cells. A false-positive diagnosis of squamous carcinoma can occur when these atypical cells dominate the cytologic aspirate. Histochemical and immunoperoxidase stains may aid in diagnosing an atypical WT when the usual cytologic features are absent.

Frequency of occurrence of diagnostic cytologic parameters in basal cell carcinoma. A retrospective review of 25 cases.

Twenty-five cases of cytologic preparations from basal cell carcinomas documented by subsequent tissue material were obtained. The cases were retrospectively analyzed to evaluate the frequency of occurrence of various features that could either be helpful or misleading in the diagnosis. These features included peripheral palisading, Bowenoid nuclei, and keratinized cells. Results from the study include the fact that a major criterion for the histologic diagnosis of basal cell carcinoma (peripheral palisading) could seldom be appreciated in the cytology preparations. Large clusters of cells with crowded nuclei were found in every case and thus represent a useful cytologic parameter. However, because of the frequent absence of peripheral palisading, the study suggests there could be diagnostic confusion with lesions of small cell squamous carcinoma.

Cutaneous larva migrans.

Cutaneous larva migrans, or creeping eruption, is an infection caused by certain nematode larvae and, occasionally, fly maggots. After penetrating human skin, the larvae remain in the epidermis and wander aimlessly. The burrows may be intensely pruritic. Systemic reactions may include profound eosinophilia. Oral or topical thiabendazole is effective therapy.

Bizarre blue nevus: a case report with deoxyribonucleic acid content analysis.

A case report of an unusual variant of blue nevus is presented. The lesion demonstrated striking cytologic atypia but lacked clinical and certain histologic features of malignancy. Similarities and differences between this lesion and atypical blue nevus and Spitz nevus are discussed. An analysis of the deoxyribonucleic acid levels in lesional cells was consistent with polyploidy. This supports the interpretation of the lesion as atypical but is not inconsistent with a benign diagnosis.

A misleading flow cytometric analysis of DNA in an adenocarcinoma: a comparative flow cytometric and cytogenetic study.

A case is presented in which flow cytometric and cytogenetic analysis was done on a biopsy from a highly anaplastic metastatic adenocarcinoma. Flow cytometric analysis of DNA content failed to show a significant population of aneuploid cells. However, histologic examination revealed a substantial number of tumor cells, and cytogenetic analysis produced chromosome counts ranging from 20 to 144.

Metastasis of bronchogenic carcinoma to the skin involved by melanoma.

In a 52-year-old man, a cutaneous malignant melanoma developed concurrently with an adenocarcinoma of the right lung. The latter disseminated widely, and autopsy disclosed that it had also metastasized to the dermal tissue involved with the melanoma. Because it was not a metastasis into the substance of the melanoma, it was classified as an unusual type of "collision tumor" rather than a "cancer-to-cancer" metastasis.