Novel BRAF N581S mutation in mantle cell lymphoma.

BRAF mutations are associated with a small number of hematologic malignancies, including hairy cell leukemia and histiocytic disorders. In addition, BRAF mutations have also been detected in low frequency in other B-cell lymphomas, such as chronic lymphocytic leukemia and diffuse large B-cell lymphoma, but never in mantle cell lymphoma (MCL). We present a case of a 69-year-old female with classic MCL harboring a BRAFN581S mutation. To our knowledge, this is the first reported case of any BRAF mutation in MCL.

Prognostic Significance of Three-Tiered World Health Organization Classification of Phyllodes Tumor and Correlation to Singapore General Hospital Nomogram.

OBJECTIVES: Phyllodes tumors (PTs) are categorized by the World Health Organization (WHO) as benign, borderline, and malignant. Singapore General Hospital (SGH) nomogram is a recurrence risk assessment tool for PT, which uses cytologic atypia, mitosis, stromal overgrowth, and the surgical margin status. We studied the prognostic significance of WHO classification and its correlation to the SGH nomogram. METHODS: We identified 270 consecutive cases of PT (195 benign, 49 borderline, 26 malignant). Follow-up was available on 246 cases (mean follow-up of 51 months). RESULTS: The recurrence rates were 2% (4 of 176) for benign, 4% (2 of 46) for borderline, and 25% (6 of 24) for malignant (log-rank test P < .0001 for recurrence-free survival). Only five patients with malignant PT experienced distant recurrence. Stromal overgrowth was an independent predictor of recurrence-free survival on multivariable analysis. The mean nomogram scores for benign, borderline, and malignant PT were 20, 20.3, and 32, respectively. The higher than expected score for benign PT was due to positive margins in 39% of cases. CONCLUSIONS: The WHO three-tiered classification of PT is prognostic. Despite positive margin status, most benign PTs do not recur. Other features of the nomogram help in determining recurrence but are also used for WHO classification.

Multiorganism HIV-associated diarrhea and telescoping bowel.

Diarrhea in individuals with human immunodeficiency virus (HIV) remains a diagnostic challenge. We treated a 53-year-old woman from Africa who presented with acute diarrhea, which yielded a diagnosis of HIV and severe immune deficiency. The patient's diarrhea resulted in hypovolemic shock and acute abdominal pain. Evaluation revealed an intestinal intussusception. Pathology findings were consistent with Cryptosporidium, Entamoeba, Giardia, and cytomegalovirus infections. The actual prevalence of multiple microorganisms causing HIV-associated diarrhea is unknown. A nonmalignant-related adult intussusception in this context is exceedingly rare and of noteworthy significance.

Primary Extra-Gonadal Retroperitoneal Seminoma, Clinically Mimicking Sarcoma.

Extra-gonadal Germ cell tumours (EGCTs) are germ cell tumours that are found in locations other than the gonads. These tumours are seen in young males in the midline, mostly in the mediastinum followed by retroperitoneum, pineal gland, and sacrococcygeal area. While most of these are non-seminomatous, few are seminomatous. We present here a case report of a 25-year-old, mentally retarded male patient, with bilaterally normal testes, who presented with a huge mass in abdomen. The ultrasound and CECT (Contrast Enhanced Computerized Tomography) scan done showed two large retroperitoneal masses, which on FNAC (Fine Needle Aspiration Cytology) suggested germ cell tumour. Surgical resection was done and the subsequent histopathological examination provided the diagnosis of seminoma, which was further confirmed by PAS (Periodic Acid Schiff) staining and Immunohistochemistry for PLAP (Placental Alkaline Phosphatase). Retroperitoneum is a common site for sarcomas, which also present as huge, bulky masses. Thus, EGCTs should be considered in the differential diagnosis of a soft-tissue mass in abdomen, especially arising in the retroperitoneum.