Recognizing the distinct cytomorphologic features of solid pseudopapillary neoplasm of the pancreas.

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare low-grade malignant tumor with an indolent clinical course and a favorable prognosis that is most commonly seen in young women of reproductive age. We present a case of SPN in a middle-aged man, diagnosed on a limited cytology specimen. Interestingly, this tumor has unique cytomorphologic findings in fine needle aspiration cytology smears, which help distinguish it from other pancreatic lesions. The presence of fibrovascular cores lined by loosely cohesive monomorphic neoplastic cells is a reliable cytomorphologic feature on aspiration cytology. Recognition of this characteristic finding is crucial for the diagnosis of this entity, especially when it presents in unexpected patient populations or when faced with scant cytology specimens. This report focuses on the distinguishing characteristics of SPN and how they compare and contrast with other pancreatic lesions that are in the differential diagnosis of SPN.

Diffuse hepatic epithelioid hemangioendothelioma developed in a patient with hepatitis C cirrhosis.

Hepatic epithelioid hemangioendothelioma (HEHE) is an infrequent vascular tumor of endothelial origin that primarily occurs in women in the mid-fifth decade of life without underlying chronic liver disease or cirrhosis. Liver transplant should be the first-line of therapy in patients with large or diffuse unresectable tumors even in the presence of metastatic disease due to the favorable long-term outcome. We report the case of a 48-year-old female who complained of abdominal pain and weight loss. She has a history of cirrhosis secondary to chronic hepatitis C (HCV) and was treated with interferon and ribavirin with sustained virological response. Her work-up revealed multiple confluent infiltrating bilobar liver masses diagnosed as HEHE. She underwent a successful liver transplant without evidence of recurrent HCV infection. She developed cervical spine (C4-C6) HEHE metastases 4 years after transplant. She underwent surgical resection and local radiotherapy after resection with good clinical response. To the best of our knowledge, this is the first report of HEHE that developed in a patient with HCV cirrhosis successfully treated with antiviral therapy before transplant and liver transplant with good allograft function without evidence of recurrent liver tumor or HCV infection but developed metastases to the cervical spine 4 years after transplant.

Congenital granular cell epulis.

Congenital granular cell epulis is a rarely reported lesion of unknown histogenesis with a strong predilection for the maxillary alveolar ridge of newborn girls. Microscopically, it demonstrates nests of polygonal cells with granular cytoplasm, a prominent capillary network, and attenuated overlying squamous epithelium. The lesion lacks immunoreactivity for S-100, laminin, chromogranin, and most other markers except neuron-specific enolase and vimentin. Through careful observation of its unique clinical, histopathologic, and immunohistochemical features, this lesion can be distinguished from the more common adult granular cell tumor as well as other differential diagnoses.