Morphologic Subtypes of Hepatocellular Carcinoma

A retrospective study of 118 cases of granulosa cell tumor of the ovary with a follow-up from 5 to more than 30 years was made Abnormal bleeding before, during, or after the menopause was the most common presenting symptom Of the 64 examined endometria, 84% showed signs of estrogen stimulation, while atypical adenomatous hyperplasia was seen in 16%, and adenocarcinoma in 31% Histologically, the diffuse growth pattern was found in one-half of the tumors, but it had no significant influence on prognosis There was a positive correlation between cellular atypia and a high number of mitoses and increased mortality The clinical stage had important prognostic significance No patient younger than 40 years died from her tumor The overall relative survival at 10 years was 80 versus 86% in Stage I Surgery is the primary treatment of choice Irradiation should be added in Stage II or higher In Stage I patients, radiotherapy did not improve the prognosis Recurrences developed as late as 22 years following primary treatment, and occurred in 21% of the patients The prognosis in such instances is poor, and aggressive treatment is recommended Patients with granulosa cell tumors should be followed for the rest of their lives

Granulosa Cell Tumors of the Ovary. A Clinicopathological Study of 118 Cases with Long-Term Follow-Up

Actinomycosis is a rare subacute or chronic, endogenous infection mainly by Actinomyces species, showing low virulence through fimbriae and biofilms. Cervicofacial, thoracic, abdominal, pelvic and sometimes cerebral, laryngeal, urinary and other regions can be affected. Actinomycosis mimics other diseases, often malignancy. Disease risk in immunocompromised subjects needs clarification. Diagnosis is often delayed and ‘sulfur granules’ are helpful but nonspecific. Culture requires immediate specimen transport and prolonged anaerobic incubation. Imaging, histology, cytology, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and molecular methods improve the diagnosis. Actinomycetes are β-lactam susceptible, occasionally resistant. Treatment includes surgery and/or long-term parenteral then oral antibiotics, but some 1–4-week regimens or oral therapy alone were curative. For prophylaxis, oral hygiene and regular intrauterine device replacement are important.

Actinomycosis: a frequently forgotten disease

Background Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast with unknown aetiology. Its treatment is controversial and the recurrence rate is high. The objectives of this study were to examine the demographic, sociocultural and clinical characteristics observed among a large cohort of IGM patients from Turkey and to identify factors related to the recurrence of IGM. Methods The study was designed as a multicentre retrospective study including 22 breast centres in Turkey. A total of 720 IGM patients are included in the study. Patient data were obtained from the patient's files and electronic records based on the study protocol. Patients' demographic, clinical, radiological, treatment and recurrence of IGM related characteristics were recorded. Results Our results revealed a statistically significant association between IGM recurrence and history of pregnancy, breastfeeding, breast infection and smoking (P 0.05). Conclusion Our findings show that history of pregnancy, breastfeeding, breast infection and smoking were the risk factors for IGM recurrence. As current treatment methods did not affect IGM recurrence, recurrence-related factors, such as breast infection and smoking, should be considered to eliminate while focusing on less invasive local treatment research.

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Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study?

Adenosarcomas are rare malignancies of the female genital tract, accounting for approximately 5 % of uterine sarcomas. Occasionally, adenosarcoma occurs in the ovaries or in extra-uterine tissue, which may be related to endometriosis. These tumors are characterized by benign epithelial elements and a malignant mesenchymal component. Pathologic diagnosis is dependent on the identification of the characteristic morphologic features. The most common immunohistochemical markers for adenosarcoma are CD10 and WT1, but these are not specific. The most frequent presenting symptom is abnormal uterine bleeding. The majority of patients present with stage I disease, with a 5-year overall survival of 60 to 80 %. Survival is influenced by the presence of myometrial invasion, sarcomatous overgrowth, lymphovascular invasion, necrosis, and the presence of heterologous elements including rhabdomyoblastic differentiation. Patients with sarcomatous overgrowth have significantly increased risk of recurrence 23 versus 77 % and decreased 5-year overall survival 50 to 60 %. Standard of care treatment is total hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy, as the incidence of lymph node metastasis is rare. Retrospective data does not support the use of adjuvant pelvic radiotherapy in uterine adenosarcomas as no survival benefit is seen. Insufficient data exists to recommend routinely neoadjuvant or adjuvant chemotherapy for uterine adenosarcomas. Limited evidence exists for the role of hormonal therapy in uterine adenosarcomas. The PIK3/AKT/PTEN pathway is mutated in ∼70 % of adenosarcomas, and this may represent a possible therapeutic target. This article reviews the current state of knowledge concerning uterine adenosarcoma and discusses the management of this rare tumor.

Uterine Adenosarcoma: a Review

Pathologic evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings The aim of the present study was to determine the incidence and type of pathologic diagnoses found in appendectomy specimens at our institution The clinicopathological data of 1627 patients who underwent appendectomies for presumed acute appendicitis from January 2008 to October 2014 were reviewed retrospectively There were 986 men and 641 women (sex ratio M/F = 15) aged between 16 months and 90 years (mean = 30 years) All patients underwent appendectomy (either open or laparoscopic) Histological examination of the surgical specimen showed acute inflammation of the appendix in 1455 cases (8942 %), fibrosed appendix in 37 cases (227 %), and Enterobius vermicularis (n = 23) In 101 cases (62 %), the appendix was histologically normal Incidental unexpected pathological diagnoses were noted in 57 appendectomy specimens They included pinworm (n = 23), mucinous neoplasms (n = 12), neuroendocrine tumors (NET) (n = 8), adenocarcinoma (n = 2), granulomatous inflammation (n = 5), tuberculosis (n = 2), hyperplastic polyp (n = 1), tubular adenoma (n = 1), diverticulitis (n = 1), endometriosis (n = 1), and actinomycosis (n = 1) The routine histopathological examination of the appendix is of value for identifying unsuspected conditions requiring further postoperative management Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic exam It is recommended that in order to avoid misdiagnoses, all appendices should be histopathologically examined

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Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases.

Background: Miliary osteoma cutis (OC) of the face is a rare benign extra skeletal bone formation. For our knowledge, only 23 cases have been reported in the English literature. These lesions may be primary or secondary. They cause diagnostic, therapeutic and cosmetic concern especially in women who are usually concerned. Our purpose is to present a case which is completely documented with the clinical, histological and radiological findings. We also report a possible pathogenic theory according to our histologic findings. Main observation: We report a case of a multiple miliary OC of the face in a 45-year-old woman which suffered from gravidarum acne. These lesions were treated by focal surgical treatment. Conclusions: Based on our histological findings, an osteoblastic metaplasia seems to be a possible pathogenic theory. This metaplasia seems to be secondary to a chronic inflammation. Concerning therapeutic procedures, they are non consensual and debated and are based on surgical or medical treatment. More reports are needed in order to assess the therapeutic management of this disease and its inducing factors. ( J Dermatol Case Rep. 2011; 5(4): 77-81)

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Miliary osteoma cutis of the face

Background: Cystic neoplasms of the pancreas are rare and constitute approximately 0.5% of all pancreatic neoplasms. Aims: The study was to describe clinicopathological features of pancreatic cystic tumors. Patients and Methods: In our retrospective study, we reviewed 10 cases of pancreatic cystic neoplasms that were diagnosed at the pathology department of Mongi Slim hospital over a 14-year period (2000-2013). We adopted the latest World Health Organization (WHO) classification (2010) in grouping all tumors. Results: There were one male and nine female patients (sex ratio M/F = 1:9) aged between 21 and 68 years (mean = 37.5 years). The most common clinical presentation was epigastric and abdominal pain ( n = 6) followed by vomiting ( n = 3). Abdominal computed tomography (CT) scan disclosed a cystic lesion of the pancreas ranging in size between 2 and 10 cm (mean = 6.75 cm). All patients underwent surgical treatment. Histopathological examination of the surgical specimen established the diagnosis of solid pseudopapillary neoplasm ( n = 2), serous cystic neoplasm ( n = 2), mucinous cystadenoma ( n = 4), mucinous cystadenocarcinoma ( n = 1), and intraductal papillary mucinous neoplasm with invasive carcinoma ( n = 1). Conclusion: Better understanding of pancreatic cystic neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.

Pancreatic cystic neoplasms.

Pancreaticobiliary maljunction is a congenital anomaly in which the junction between the pancreatic duct and the common bile duct is located outside the sphincter of Oddi. It is well known that pancreaticobiliary maljunction is frequently associated with carcinoma of the

biliary tract. We report a case of metachronous cancer of the gallbladder and pancreas associated with pancreaticobiliary maljunction and cystic dilatation of common bile duct in a 68-year-old Tunisian woman who underwent a cholecystectomy for acute cholecystitis. The pancreatic tumor was an adenosquamous carcinoma. Pancreaticobiliary maljunction allows for pancreatobiliary or biliopancreatic reflux which may induce biliary tract carcinoma. Few cases of multifocal cancer associated with this anomaly have been reported. The association with pancreatic carcinoma remains rare. Close attention should be given to both the biliary tract system and pancreas during the long-term follow-up of patients with pancreaticobiliary maljunction, especially after they have undergone a choledochojejunostomy.

Metachronous cancer of gallbladder and pancreas with pancreatobiliary maljunction

A 77-year-old female patient with a medical history significant for hypertension and epilepsy presented with right breast pain of 6-months duration. Examination revealed a hard sub-areola tender mass with irregular borders associated with mild right nipple retraction. Mammography showed a 2.2 x 2.4 cm stellate mass of the right breast. Ultrasound-guided core biopsies of the tumour were performed. Pathological examination revealed a grade II infiltrating ductal carcinoma. The patient underwent right radical mastectomy with homolateral axillary lymphadenectomy. Histological examination of the surgical specimen revealed grade II infiltrating ductal carcinoma concomitant with granulomatous lobular mastitis. To the best of our knowledge, the coexistence of granulomatous lobular mastitis and ductal carcinoma has been described only twice in the English language literature. The theory that chronic inflammation leads to cancer is well documented. Whether our patient had developed cancer from granulomatous lobular mastitis or otherwise is a matter of debate until more cases are encountered and more research is done in the area of breast cancer pathogenesis with regards to it arising from granulomatous lobular mastitis.

Ahlem Lahmar

Papers

Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases.

Miliary osteoma cutis of the face

Pancreatic cystic neoplasms.

Metachronous cancer of gallbladder and pancreas with pancreatobiliary maljunction

Coexistence of lobular granulomatous mastitis and ductal carcinoma: a fortuitous association?