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American Journal of Surgical Pathology

Eric A Swanson, Jordon K March, Frederic Clayton, Marc R Couturier, Ramir Arcega, Richard Smith, Kimberley J Evason
Recent publications have described epithelial cytoplasmic vacuoles and inclusions incidentally noted within gallbladder epithelium and concluded that they represent coccidian parasite infection, in particular, Cystoisospora belli. We identified 8 gallbladder specimens from our institution in the past 3 years in which this diagnosis was suggested or in which similar epithelial alterations were prominent. Molecular analysis was performed on the 8 gallbladder specimens and on 3 positive control specimens: small bowel biopsies from acquired immunodeficiency syndrome patients with diarrhea...
July 16, 2018: American Journal of Surgical Pathology
Nissreen Mohammad, Josh D Haimes, Skyler Mishkin, Brian A Kudlow, May Ying Leong, Sung Hock Chew, Eleanor Koay, Ann Whitehouse, Nichola Cope, Rola H Ali, Martin Köbel, Colin J R Stewart, W Glenn McCluggage, Cheng-Han Lee
Inflammatory myofibroblastic tumor (IMT) is a myofibroblastic/fibroblastic neoplasm of intermediate malignant potential. It is frequently characterized by genetic fusion of ALK with a variety of partner genes, which results in the activated ALK signaling pathway that can be targeted with kinase inhibitors. IMTs can occur in the gynecologic tract, with the uterus (corpus and cervix) being the most frequent site. Recent studies suggest that IMTs in the gynecologic tract are underrecognized, and a low-threshold for performing ALK immunohistochemistry has been proposed...
July 13, 2018: American Journal of Surgical Pathology
Michael Michal, Abbas Agaimy, Alejandro Luiña Contreras, Marian Svajdler, Dmitry V Kazakov, Petr Steiner, Petr Grossmann, Petr Martinek, Ladislav Hadravsky, Kvetoslava Michalova, Peter Svajdler, Zoltan Szep, Michal Michal, John F Fetsch
In our routine and consultative pathology practices, we have repeatedly encountered an unusual subcutaneous fatty tumor with notable anisocytosis, single-cell fat necrosis, and patchy, often mild, adipocytic nuclear atypia. Because of the focal atypia, consultative cases have most often been received with concern for a diagnosis of atypical lipomatous tumor. Similar tumors have been described in small series under the designations "subcutaneous minimally atypical lipomatous tumors" and "anisometric cell lipoma...
July 11, 2018: American Journal of Surgical Pathology
Annikka Weissferdt
Amphicrine carcinoma is a distinct type of carcinoma characterized by synchronous exocrine and endocrine differentiation within the same tumor cell. Such tumors are exceedingly rare and most commonly recognized in the gastrointestinal tract. In the lung, sporadic descriptions of such lesions exist. This report presents 3 more such tumors, expanding the spectrum of amphicrine carcinomas in this organ. The patients were 3 men, 53 to 78 years of age (mean: 63 y) and all were current or former smokers. In one patient the tumor was an incidental finding, the others presented with lower respiratory symptoms...
July 11, 2018: American Journal of Surgical Pathology
Xin He, Zongguo Pang, Xianliang Zhang, Ting Lan, Huijiao Chen, Min Chen, Hong Yang, Juan Huang, Yihua Chen, Zhang Zhang, Wenyi Jing, Ran Peng, Hongying Zhang
Low-grade osteosarcoma (LGOS) encompasses low-grade central osteosarcoma (LGCOS) and parosteal osteosarcoma (POS). LGOSs are characterized by a supernumerary ring and giant rod chromosomes containing the 12q13-15 amplicon. The fibroblast growth factor receptor substrate 2 (FRS2) gene is located close to MDM2 and CDK4. Recent studies identified consistent amplification of FRS2 gene in atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma. The aim of this study was to evaluate the frequency of FRS2 amplification and its relationship with the clinicopathologic features of LGOSs...
July 11, 2018: American Journal of Surgical Pathology
Stefano La Rosa, Silvia Uccella, Francesca Molinari, Antonella Savio, Ozgur Mete, Alessandro Vanoli, Roberta Maragliano, Milo Frattini, Luca Mazzucchelli, Fausto Sessa, Massimo Bongiovanni
Mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN) consisting of adenoma and well-differentiated neuroendocrine tumor (NET) has been recently defined as "MANET." However, the clinico-pathologic and pathogenetic features of this entity are not thoroughly studied. We examined the clinico-pathologic features of 12 MANETs by expanding their p53 and β-catenin expression profiles as well as the presence of microsatellite instability and KRAS, BRAF, and PIK3CA mutations in the 2 tumor components. In all cases, the adenomatous component represented the larger part of the lesions and the NET was localized in the deep central portion of polyps...
July 11, 2018: American Journal of Surgical Pathology
Changqing Ma, Dane C Olevian, Brett M Lowenthal, Priya Jayachandran, Margaret M Kozak, Daniel T Chang, Reetesh K Pai
The special AT-rich sequence binding protein (SATB2) has been reported to be a specific immunohistochemical marker for colorectal carcinoma; however, correlation of SATB2 expression with molecular alterations commonly assessed in colorectal carcinoma has not been performed. We examined the immunohistochemical expression of SATB2 in 586 adenocarcinomas of the gastrointestinal (GI) tract and pancreas to assess its utility in diagnosis and analyze the clinicopathologic and molecular characteristics of colorectal carcinoma stratified by SATB2 expression...
July 11, 2018: American Journal of Surgical Pathology
Jennifer A Bennett, Ana C Braga, Andre Pinto, Koen Van de Vijver, Kristine Cornejo, Anna Pesci, Lei Zhang, Vicente Morales-Oyarvide, Takako Kiyokawa, Gian Franco Zannoni, Joseph Carlson, Tomas Slavik, Carmen Tornos, Cristina R Antonescu, Esther Oliva
Uterine perivascular epithelioid cell tumors (PEComas) are rare neoplasms that may show overlapping morphology and immunohistochemistry with uterine smooth muscle tumors. In this study, we evaluated the morphologic, immunohistochemical, and molecular features of 32 PEComas, including 11 with aggressive behavior. Two distinct morphologies were observed: classic (n=30) and those with a lymphangioleiomyomatosis appearance (n=2). In the former, patients ranged from 32 to 77 (mean: 51) years and 13% had tuberous sclerosis...
July 11, 2018: American Journal of Surgical Pathology
Yue Sun, Pedram Argani, Satish K Tickoo, Jonathan I Epstein
Acquired cystic disease-associated renal cell carcinoma (ACKD-RCC), originally described by Tickoo and colleagues, is found exclusively in patients with end-stage renal disease. Tickoo and colleagues noted: "Many of the tumors (16 of 24 dominant tumors) appeared to arise in a cyst, most often completely filling the cystic space. The cells lining such cysts were morphologically similar to those in the rest of the tumor." Subsequent literature lacks analysis of cysts lined by cells identical to ACKD-RCC, yet lacking areas of solid growth...
July 11, 2018: American Journal of Surgical Pathology
Melanie Johncilla, Jose Jessurun, Ian Brown, Jason L Hornick, Andrew M Bellizzi, Jinru Shia, Rhonda K Yantiss
The World Health Organization considers enterocolic mast cell aggregates with atypical morphologic and/or immunohistochemical features diagnostic of systemic mastocytosis mostly because published data are heavily influenced by inclusion of symptomatic patients with systemic disease. We occasionally encounter atypical mast cells in gastrointestinal biopsy samples from patients in whom systemic mastocytosis is not suspected. The aim of this study was to describe the clinicopathologic features and implications of atypical enterocolic mast cell aggregates in 16 patients without suspected or established systemic mastocytosis...
July 11, 2018: American Journal of Surgical Pathology
Carlie S Sigel, Esther Drill, Yi Zhou, Olca Basturk, Gokce Askan, Linda M Pak, Efsevia Vakiani, Tao Wang, Thomas Boerner, Richard K G Do, Amber L Simpson, William Jarnagin, David S Klimstra
Intrahepatic cholangiocarcinomas are histologically heterogenous. Using a cohort of 184 clinically defined, resected intrahepatic cholangiocarcinomas, we retrospectively classified the histology into 4 subtypes: large duct (LD), small duct (SD) (predominantly tubular [SD1] or predominantly anastomosing/cholangiolar, [SD2]), or indeterminate. Then, we tested the 4 subtypes for associations with risk factors, patient outcomes, histology, and immunophenotypic characteristics. SD was the most common (84%; 24% SD1 and 60% SD2) with lower proportions of LD (8%), and indeterminate (8%)...
July 11, 2018: American Journal of Surgical Pathology
Jarish N Cohen, Iwei Yeh, Richard C Jordan, Rebecca J Wolsky, Andrew E Horvai, Timothy H McCalmont, Philip E LeBoit
Non-neural granular cell tumor (NNGCT; also known as primitive polypoid granular cell tumor) is a rare neoplasm composed of large ovoid cells with abundant granular cytoplasm, variable nuclear pleomorphism, and the potential for regional lymph node spread. In contrast to conventional granular cell tumor (GCT), NNGCT lacks S100 expression and can exhibit greater nuclear atypia and mitotic activity. Therefore, we investigated clinicopathologic features of 12 NNGCT, and also used next-generation sequencing to identify potential driver events in a subset of NNGCT and 6 GCT...
July 11, 2018: American Journal of Surgical Pathology
Shoko Vos, Sjoerd G Elias, Petra van der Groep, Yvonne H Smolders, Carla H van Gils, Paul J van Diest
Heredity, mostly due to BRCA germline mutations, is involved in 5% to 10% of all breast cancer cases. Potential BRCA germline mutation carriers may be missed following the current eligibility criteria for BRCA genetic testing. The purpose of this study was to, therefore, develop an immunohistochemistry-based model to predict likelihood of underlying BRCA1 and BRCA2 germline mutations in unselected female breast cancer patients. The study group consisted of 100 BRCA1-related, 46 BRCA2-related, and 94 sporadic breast carcinomas...
July 3, 2018: American Journal of Surgical Pathology
Jayalakshmi P Balakrishna, Tapan Bhavsar, Alina Nicolae, Mark Raffeld, Elaine S Jaffe, Stefania Pittaluga
Human herpes virus 6 (HHV-6) is a member of the β-herpesvirinae subfamily. Most people acquire HHV-6 primary infection early in life and reactivation may occur, most often in immunocompromised individuals, leading to various clinical manifestations. HHV-6 infected cells may be identified in lymph nodes in both reactive and neoplastic conditions. Cases were retrieved from the hematopathology consultation service archives at National Institutes of Health from 2003 to 2017 in which infection by HHV-6 had been documented by immunohistochemical stains to HHV-6 gp60/110 envelope glycoprotein...
July 3, 2018: American Journal of Surgical Pathology
Erin Chapman, Alena Skalova, Nikola Ptakova, Petr Martinek, Angela Goytain, Tracy Tucker, Wei Xiong, Mary Leader, Brian A Kudlow, Josh D Haimes, Malcolm M Hayes, Peter Bohus, Marketa Miesbauerova, Cheng-Han Lee, Tony L Ng
We describe a novel gene fusion, EWSR1-CREM, identified in 3 cases of clear cell carcinoma (CCC) using anchored multiplex polymerase chain reaction, a next-generation sequencing-based technique. CCC is a low-grade salivary tumor recently characterized to have EWSR1-ATF1 fusions in the majority of cases. Three cases of malignant tumor presenting in the base of tongue, lung, and nasopharynx were studied. All cases shared a clear cell morphology with hyalinized stroma, presence of mucin and p63 positivity and were initially diagnosed as mucoepidermoid carcinoma but were negative for evidence of any of the expected gene fusions...
July 3, 2018: American Journal of Surgical Pathology
Doreen N Palsgrove, Yunjie Li, Christine Pratilas, Ming-Tseh Lin, Aparna Pallavajjalla, Christopher Gocke, Angelo M De Marzo, Andres Matoso, George J Netto, Jonathan I Epstein, Pedram Argani
Eosinophilic solid and cystic (ESC) renal cell carcinoma (RCC) has recently been described as a potentially new subtype of RCC based upon morphologic and immunohistochemical features. These neoplasms typically demonstrate solid and cystic architecture, and the neoplastic cells contain voluminous eosinophilic cytoplasm with granular cytoplasmic stippling. There is frequently focal immunoreactivity for cytokeratin 20. Although the initial cases all occurred in adult females and had benign outcome, we recently expanded the proposed spectrum of this neoplasm to include pediatric cases, multifocal neoplasms, and a case with hematogenous metastasis...
July 3, 2018: American Journal of Surgical Pathology
Nancy M Joseph, Elizabeth M Brunt, Celia Marginean, ILKe Nalbantoglu, Dale C Snover, Swan N Thung, Matthew M Yeh, Sarah E Umetsu, Linda D Ferrell, Ryan M Gill
Hepatic small vessel neoplasm (HSVN) is a recently described infiltrative vascular neoplasm of the liver, composed of small vessels. Although the infiltrative nature can mimic angiosarcoma, HSVN are thought to be benign or low-grade neoplasms because they lack cytologic atypia and increased proliferation. To characterize the molecular pathogenesis of HSVN, we performed both targeted panel sequencing and exome sequencing on 18 benign or low-grade vascular neoplasms in the liver including 8 HSVN, 6 classic cavernous hemangioma (CH), and 4 variant lesions (VL) with overlapping features between HSVN and CH...
July 3, 2018: American Journal of Surgical Pathology
Cong He, Yuki Fukumura, Akane Toriyama, Kanako Ogura, Noriko Sasahara, Keiko Mitani, Takashi Yao
Twenty-four surgically resected, gallbladder pyloric gland adenomas (GB-PGAs) were examined and their features were compared with the reported features of stomach, duodenum, and pancreatic PGAs to better understand GB-PGAs. Clinical information on background gallbladder lesions and histologic data, including tumor grade, existence of squamoid morules, intratumoral cholesterosis, and intracytoplasmic mucins were collected. Immunohistochemical staining for MUC2, MUC5AC, MUC6, CDX2, pepsinogen I, p53, and MIB-1/nuclear β-catenin were evaluated...
July 3, 2018: American Journal of Surgical Pathology
Caterina Marchiò, Patrizia Dell'Orto, Laura Annaratone, Felipe C Geyer, Tiziana Venesio, Enrico Berrino, Ludovica Verdun di Cantogno, Andrea Garofoli, Nelson Rangel, Laura Casorzo, Carmine dell'Aglio, Patrizia Gugliotta, Elena Trisolini, Alessandra Beano, Francesca Pietribiasi, Renzo Orlassino, Paola Cassoni, Achille Pich, Filippo Montemurro, Marcella Mottolese, Anne Vincent-Salomon, Frédérique Penault-Llorca, Enzo Medico, Charlotte K Y Ng, Giuseppe Viale, Anna Sapino
The American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 2013 guidelines for HER2 assessment have increased the number of HER2 equivocal breast carcinomas following in situ hybridization reflex testing, that is, HER2 "double equivocal" (equivocal protein expression and equivocal gene copy number). Forty-five double-equivocal carcinomas were subjected to Prosigna analysis. Twenty-seven cases were investigated for the expression of genes found to be differentially expressed between estrogen receptor (ER)-positive/HER2-positive (N=22) and ER-positive/HER2-negative (N=22) control cases...
July 3, 2018: American Journal of Surgical Pathology
David Suster, German Pihan, Alexander C Mackinnon, Saul Suster
Thymic carcinoma represents a rare and poorly understood type of thymic epithelial neoplasm that has been the subject of much controversy. Poorly differentiated nonkeratinizing squamous cell carcinoma, also known as lymphoepithelioma-like thymic carcinoma, is a rare variant of thymic carcinoma that has not been adequately characterized in the literature. The clinicopathologic, immunohistochemical, ultrastructural, and molecular features of 25 cases are reported. The patients were 19 men and 6 women, ranging in age from 20 to 85 years (mean: 60 y)...
July 3, 2018: American Journal of Surgical Pathology
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