Hepatocellular Carcinoma with Prominent Intracytoplasmic Inclusions: A Report of Two Cases.

Hepatocellular carcinoma (HCC) is the commonest primary malignant neoplasm of the liver in most countries with a notoriously poor prognosis. Variation in global incidence is well-recognized and the occurrence of HCC is linked to several established environmental, dietary, and lifestyle factors. HCC demonstrates morphological heterogeneity both within the same tumor and from patient to patient. Differing architectural patterns and cytological variants may be seen. Inclusion bodies are believed to represent organized structures of proteins which contribute to their pathogenesis and share several constituents like chaperones, p62, ubiquitin, and Valosin containing protein. The various hepatocyte cytoplasmic inclusions described in HCC include Mallory-Denk bodies (MDBs), hyaline bodies (HBs), glycogen, fat, fibrinogen, alpha 1 antitrypsin (AAT), and ground glass. MDBs are the most common inclusions seen in hepatocellular carcinomas. The two cases shared intracytoplasmic inclusions which are characterized by larger sizes and present in every section examined. These exhibited features of MDBs and HBs present in most tumor cells, further supporting close relationship.

Chronic abdominal pain secondary to mesenteric panniculitis treated successfully with endoscopic ultrasonography-guided celiac plexus block: A case report.

Mesenteric panniculitis is a chronic illness that is characterized by fibrosing inflammation of the mesenteries that can lead to intractable abdominal pain. Pain control is a crucial component of the management plan. Most patients will improve with oral corticosteroids treatment, however, some patients will require a trial of other immunosuppressive agents, and a minority of patients will continue to have refractory disease. Endoscopic ultrasound guided celiac plexus block is used frequently to control abdominal pain in patients with pancreatic pathology. To our knowledge there are no case reports describing its use in mesenteric panniculitis patients with refractory abdominal pain.

Diverticular disease of the right colon.

BACKGROUND: The incidence of colonic diverticular disease varies with national origin, cultural background and diet. The frequency of this disease increases with advancing age. Right-sided diverticular disease is uncommon and reported to occur in 1-2% of surgical specimens in European and American series. In contrast the disease is more prevalent and reported in 43-50% of specimens in Asian series. Various lines of evidence suggest this variation may represent hereditary differences. The aim of the study is to report all cases of right sided diverticular disease underwent surgical resection or identified during pathological examination of right hemicoloectomy specimens METHODS: A retrospective review of all surgical specimens with right sided colonic diverticular disease selected from a larger database of all colonic diverticulosis and diverticulitis surgical specimen reported between January 1993 and December 2010 at the Pathology Department McMaster University Medical Centre Canada. The clinical and pathological features of these cases were reviewed RESULTS: The review identified 15 cases of right colon diverticulosis. The clinical diagnoses of these cases were appendicitis, diverticulitis or adenocarcinoma. Eight cases of single congenital perforated diverticuli were identified and seven cases were incidental multiple acquired diverticuli found in specimen resected for right side colonic carcinomas/large adenomas. Laparotomy or laparoscopic assisted haemicolectomies were done for all cases. Pathological examination showed caecal wall thickening with inflammation associated with perforated diverticuli. Histology confirmed true solitary diverticuli that exhibited in two cases thick walled vessels in the submucosa and muscular layer indicating vascular malformation/angiodysplasia. Acquired diverticuli tend to be multiple and are mostly seen in specimens resected for neoplastic right colon diseases. CONCLUSION: Single true diverticular disease of the right colon is usually of congenital type and affects younger age group and may be associated with angiodysplasia in some cases. Multiple false diverticuli are more seen in association with caecal carcinoma or large adenomas. These are usually asymptomatic and are more seen in older patients. However this study dose not reflects the true incidence of the disease in the general population.

Xanthogranulomatous salpingitis associated with a large uterine leiomyoma.

A case of xanthogranulomatous salpingitis (XGS) associated with a large uterine leiomyoma in a 50-year-old woman is presented. Xanthogranulomatous inflammation is an uncommon form of chronic inflammation that is destructive to affected organs. It is characterized by the presence of lipid-filled macrophages with admixed lymphocytes, plasma cells, and neutrophils. A review of the literature revealed that most patients with XGS have a clinical history of long-standing pelvic inflammatory disease (PID) or, less often, endometriosis. We report a case lacking a history of either PID or endometriosis but with a concurrent large uterine leiomyoma. Although the exact etiology in this case was not clear, the leiomyoma may have played a contributory role in pathogenesis.

Cutaneous angiomyxoma and pilomatricoma: a new combination.

Superficial angiomyxomas are rare benign tumors that typically present as a solitary lesion or as a component of Carney complex and rarely have been associated with other lesions. In this article, we report 3 cases of an unusual association of superficial angiomyxoma with pilomatricoma. This combination has never been described in the literature. The 3 patients presented with variable-sized pedunculated, asymptomatic skin papules overlying firm deeply situated nodules. Histopathologic examination demonstrated that the superficial pedunculated lesion is a superficial angimyxoma with underlying pilomatricoma. Thorough clinical examination failed to reveal any further lesions. We present a rare and unique combination of angiomyxoma and pilomatricoma. This combination may be incidental, representing collision tumors or etiologically related.

Ovarian splenosis: a case report.

Splenosis is auto transplantation of splenic tissue following traumatic rupture of the spleen. In females it can mimic endometriosis when symptomatic. Asymptomatic splenosis is common than previously suspected and it can also involve ovary. In a patient with a history of splenectomy, splenosis can act and provide the function of the spleen and thus should not be routinely excised. We report a case of an asymptomatic, incidental ovarian splenosis of left ovary accompanying multiple pelvic and serosal splenotic nodules. To our best knowledge, total three cases of ovarian splenosis have been reported previously including two cases of ovarian splenosis accompanying pelvic and serosal splenotic nodules and one case of solitary ovarian splenosis.

Papillocystic variant of acinar cell pancreatic carcinoma.

Acinar cell pancreatic carcinoma is a rare solid malignant neoplasm. Recent review of the literature showed occasional cases with papillary or papillocystic growth patterns, ranging from 2 to 5 cm in diameter. We report a large 10 cm pancreatic tumor with papillocystic pathology features involving the pancreatic head. The growth pattern of these tumors could be mistaken for intraductal papillary mucinous tumors or other pancreatic cystic neoplasms.

Hepatic Epithelioid Angiomyolipoma: Case Series.

Hepatic epithelioid angiomyolipoma (AML) is a rare, benign, mesenchymal neoplasm found in both males and females, and most commonly encountered in adult females. These lesions are difficult to diagnose by imaging, especially when fatty component is scant or absent. Histomorphologically, they resemble hepatocellular carcinoma. The tumor cells are strongly positive for homatropine methylbromide-45 (HMB-45) and smooth muscle actin by immunohistochemistry, which are the key markers for accurate pathological diagnosis. Hepatic AML should be considered in the differential diagnosis of a well circumscribed hepatic mass, even in the absence of an adipose tissue component.

Insulin-like growth factor-binding protein-3 in osteosarcomas and normal bone tissues.

BACKGROUND: To better understand the significance of local insulin-like growth factor-binding protein 3 (IGFBP-3) in the development of osteosarcoma, IGFBP-3 levels and subcellular localization were compared in biopsies from osteosarcomas and unaffected normal bone tissues. PATIENTS AND METHODS: IGFBP-3 levels were analyzed by immunohistochemistry in 21 osteosarcomas and 5 unaffected bone tissues. IGFBP-3 levels were compared for patient outcome. RESULTS: Mature osteocytes of normal bone tissues contained high levels of predominantly nuclear IGFBP-3, whereas only 50% of osteosarcomas contained IGFBP-3-positive tumor cells, with predominantly cytoplasmic IGFBP-3 staining. Comparison of IGFBP-3 levels for patient outcome resulted in two groups. Patients with a low level of IGFBP-3 in osteosarcoma experienced a trend for a shorter survival time than did patients with a high level of IGFBP-3. CONCLUSION: Our results suggest that the levels and subcellular localization of local IGFBP-3 play a role in osteosarcoma development. Further prospective evaluation with higher clinical sample numbers might reveal a prognostic role for IGFBP-3 level in local tumors in patients with osteosarcoma.

Primary gastric lymphoma with florid granulomatous reaction.

Epithelioid cell granulomas are more commonly seen in Hodgkin's disease and T cell lymphomas. Rarely florid granulomatous reaction with necrosis may be a prominent feature in lymphoma. To the best of our knowledge, a total of 11 cases of Burkitt's lymphoma with florid necrotizing granulomas have been reported in the English literature. None of these cases have previously had the stomach involved. Here we report a gastric Burkitt's lymphoma with florid granulomatous reaction diagnosed following a partial gastrectomy. The initial gastric biopsy showed granulomatous gastritis but the radiological and endoscopic appearance was that of a gastric stromal tumour. We conclude that in the presence of a mass lesion, the finding of epithelioid granulomas should warrant re-biopsy to establish an accurate diagnosis and exclude a concurrent malignant process. Hence, major surgery and postoperative complications can be avoided and appropriate treatment regimen can be initiated.

Basaloid squamous cell carcinoma: two case reports.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma (SCC) that occurs preferentially in the upper aerodigestive tract. We present two cases of BSCC, one arising in the conjunctiva and the other arising in a paranasal sinus. Clinical and pathological findings in these two cases, including immunohistochemistry is presented along with brief discussion of literature. To the best of our knowledge, this is the first report of BSCC of the conjunctiva. BSCC of the head and neck should be distinguished from adenoid cystic carcinoma, small cell neuroendocrine carcinoma, basal cell adenocarcinoma, adenosquamous carcinoma, squamous cell carcinoma, spindle cell squamous carcinoma, mucoepidermoid carcinoma, and adenoid cystic carcinoma.

Visualization of Mycobacterium avium in Crohn's tissue by oil-immersion microscopy.

Studies seeking Mycobacterium avium subsp. paratuberculosis in Crohn's disease by PCR have generated inconsistent findings. As an alternative, microscopy offers a number of advantages, including direct visualization of organisms in tissue. Experimental infections have demonstrated that M. avium organisms can be seen by both acid-fast staining and species-specific in situ hybridization, but because they are smaller than M. tuberculosis, oil-immersion microscopy (x 1,000 magnification) is needed. We performed a blinded search for M. avium in paraffin-embedded surgical resections from Crohn's and control subjects at two centres. Specimens were coded and subjected to acid-fast staining and ribosomal RNA in situ hybridization for M. avium rRNA. Agreement between these two methods was good (42/52 patients, kappa=0.60) and similar results were observed for patients from two centers. Together, both methods provided positive results in 10 of 17 Crohn's subjects (59%, 95% CI: 36-78), contrasting with only 5 of 35 control subjects (Odds ratio for Crohn's vs. controls=8.6, p=0.002). M. avium organisms had an intracellular localization within inflammatory lesions, but were often observed as lone organisms outside of granulomas. Using two assays in two settings, presence of M. avium organisms was strongly associated with Crohn's disease.

Nuclear expression of E-cadherin in solid pseudopapillary tumors of the pancreas.

CONTEXT: Solid pseudopapillary tumors of the pancreas are rare and have recently been shown to harbor mutations of the beta-catenin gene with resultant nuclear localization of beta-catenin protein to the nucleus. Moreover, there is a close relationship between beta-catenin and E-cadherin. OBJECTIVE: To explore the protein expression of E-cadherin in a series of solid pseudopapillary tumors of the pancreas. PARTICIPANTS: Eighteen cases of solid pseudopapillary tumors of the pancreas. DESIGN: The cases were studied using a tissue microarray that was constructed as follows: for each case, 4 to 14 cores measuring 1.0 mm each were drilled from the blocks. Tissue cores from normal pancreas were used as controls and for orientation purposes. MAIN OUTCOME MEASURES: The slides were stained with the following commercially available antibodies: CD10, CD56, vimentin, alpha-1-antitrypsin, alpha-1-antichymotrypsin, neuron-specific enolase, chromogranin, synaptophysin, beta-catenin and E-cadherin. RESULTS: All the tumors were CD10, vimentin, alpha-1-antitrypsin and alpha-1-antichymotrypsin diffusely positive (50% or more of the tumor cells staining) and CD56 showed focal positivity in all cases with 5-10% of tumor cells displaying immunolabeling. All cases were negative for chromogranin and synaptophysin. All 18 cases displayed cytoplasmic and nuclear localization of beta-catenin protein. Similarly, E-cadherin protein was localized to the nucleus in all 18 cases, with loss of the characteristic membranous decoration of cells. CONCLUSION: This study is the first demonstration of aberrant nuclear localization of E-cadherin protein in solid pseudopapillary tumors of the pancreas. Whilst the exact mechanism is not know and nuclear E-cadherin is not related to tumor aggression, this staining pattern may be of diagnostic value in concert with beta-catenin staining.

Synchronous epithelioid stromal tumour and lipoma in the stomach.

An 82-year-old man presented with upper gastrointestinal bleeding. A polypoid lesion of the distal stomach with focal ulceration was seen at endoscopy. This was treated by a partial gastrectomy. The resected stomach contained two separate tumours near the pylorus: a gastrointestinal stromal tumour (GIST) and an adjacent lipoma. The literature includes case reports of synchronously occurring GIST and adenocarcinoma, GIST and mucosa-associated lymphoid tissue lymphoma and GIST and carcinoid tumour. Herein is the first case report of two distinct mesenchymal tumors coexisting in the stomach.