Showing papers in "Československá patologie in 2012"

[Pleomorphic adenoma of salivary glands: diagnostic pitfalls and mimickers of malignancy].

Abstract: Pleomorphic adenoma is the most common salivary gland tumor, characterized by a complex biphasic proliferation of epithelial and myoepithelial cells intermingled with a mezenchymal component with frequent metaplastic changes and protean histomorphology of the cells. This review describes several unusual histological findings in pleomorphic adenoma that may mimic malignancy, and therefore they represent a diagnostic pitfall. Intravascular invasion of tumor cells is generally suspicious of malignancy; however, intravascular tumor deposits may be rarely found within the capsule of clinically benign salivary pleomorphic adenomas. It is important not to render a malignant diagnosis in such neoplasms, in the absence of other evidence of malignancy. Pleomorphic adenomas, particularly of minor glands of palate, may contain large areas of squamous and mucinous metaplasia suspicious of mucoepidermoid carcinoma (MEC). In contrast to MEC, metaplastic pleomorphic adenomas do not harbour the distinctive translocations t(11;19) and t(11;15), they are not invasive, in contrast they reveal at least focally myxochondroid stroma. Cribriform structures in pleomorphic adenoma may mimic adenoid cystic carcinoma. Oncocytic metaplasia in cellular rich pleomorphic adenoma/myoepithelioma may be associated with significant nuclear polymorphism and hyperchromasia suspicious of malignancy. The most common pitfall in diagnosis of pleomorphic adenoma is so called "atypical PA" that must be distinguished from early malignant transformation to in situ-carcinoma ex pleomorphic adenoma.

Immunoexpression of type-1 adiponectin receptor in the human intestine.

Abstract: SUMMARY Adiponectin is an important biomarker of metabolic syndrome that was recently identified in human breast milk. We demonstrate the presence of type-1 adiponectin receptor (adipoR1) by immunoperoxidase method in 21 bioptic specimens – duodenum (n = 6), terminal ileum (n = 7) and colon (n = 8) from 14 human subjects (6 females and 8 males aged 9 months-47 years). In all the samples, adipoR1 was detected. The positivity was observed in enterocytes and colonocytes as well as in lymphocytes in the submucosa and in the smooth muscle of the intestinal wall. Thus, adiponectin may influence intestinal physiology through its type-1 receptor.

Pseudotumors and mimickers of malignancy of the head and neck pathology.

Abstract: We are summarizing some of the difficult pitfalls in tumors of the head and neck, which we have encountered in our biopsies referred for consultation as well as from our routine praxis in the last 20 years. Shortly we are presenting the following lesions of head and neck: multifocal sclerosing thyroiditis, mucoepidermoid carcinoma of the thyroid, solid cell nests, Chievitz organ, rhomboid glossitis, ectopic parathyroid, signet ring cell change of salivary glands, mucocele, epithelial misplacement of the vocal cord squamous cell epithelium, and angiomatoid nasal polyps.

[Histiocytic necrotizing lymphadenitis / Kikuchi-Fujimoto disease (HNL/K-F) and its differential diagnosis: analysis of 19 patients].

Abstract: Histiocytic necrotizing lymphadenitis / Kikuchi-Fujimoto disease (HNL/K-F) is being recognized with an increasing frequency not only in the East Asia but also on the American continents and in the Europe. Still the diagnostics of HNL/K-F is not easy and difficulties with its proper classification persist. In a group of 19 patients diagnosed primarily or as consults at our department there were 12 woman and 7 men. An average age at diagnosis was 28 years, median 25 years. Cervical lymph nodes were involved in 18 patients. Bilateral lymphadenopathy was present in one patient, the remaining 17 were unilateral. Inguinal lymph node was affected in one patient. In one other patient there were enlarged retroperitoneal lymph nodes simultaneously with a cervical lymphadenopathy. The size of the lymph nodes varied between 5 mm to 32 mm. The subclassification showed the necrotizing type in 14 patients, in one there was a predominant xanthomatous tissue reaction around the necrotic areas (xanthomatous type), and in 4 patients the disease was recognized as the proliferative type without necrosis (in two with a variously intense apoptosis of the proliferating lymphocytes). Of 10 consult cases the tumor was primarily evaluated as B cell lymphoma not otherwise specified (1x), peripheral T cell lymphoma (1x), classical Hodgkin lymphoma of mixed cellularity (1x); two patients were submitted with a differential diagnosis between peripheral T cell lymphoma and HNL/K-F; in one diagnosis of probable EBV lymphadenitis and in one diagnosis HNL/K-F was made. There were no data submitted in the remaining three cases. The authors stress diagnostic features which should lead to the diagnosis of the disease and should prevent unnecessary oncological staging investigations and potential chemotherapy for a lymphoma. Among diagnostic features of HNL/K-F identification of the proliferating cells - CD8 activated lymphocytes with apoptotic decay prevail, there are frequent plasmacytoid monocytes and a striking reaction of macrophages which are CD68/myeloperoxidase positive. There are virtually no neutrophil granulocytes and there is a miminal participation of plasma cells. In case of necrotizing and xanthomatous type infectious causes are to be ruled out as well. In case we still need to distinguish HNL/K-F from a lymphoma PCR analysis of a rearrangement of the immunoreceptor gene in T cell population should be investigated.

Histopathological autoptic findings in 8 patients with pandemic influenza A (H1N1) pneumonia.

Abstract: UNLABELLED In the years 2009 and 2010 a novel influenza A (H1N1) caused the first influenza pandemic after 41 years. In the Czech Republic it culminated in November and December 2009 and there were 101 laboratory-confirmed deaths. Another few cases occurred later in the year 2010 and at the beginning of 2011. Here we report 8 autoptic cases of patients who died between 2009 and 2011 with confirmed H1N1 influenza and underwent a post mortem examination at the Institute of Pathology, General University Hospital in Prague, Czech Republic. This group differs from the others reported in literature by having a higher age as well as a higher percentage of patients with pre-existing severe comorbidities including malignant diseases. All 8 patients developed atypical pneumonia with subsequent respiratory failure. In this article we present these cases with related clinical data and findings in other organs, but we focus primarily on the findings in the respiratory tract which were shown to be approximately similar to those in the other studies and case reports. Nevertheless there were also some noteworthy variations. The most prominent feature observed was diffuse alveolar damage accompanied by intraalveolar haemorrhage and inflammatory infiltrate of variable extent. Less frequent features included cytopathic changes of pneumocytes and their desquamation, reactive changes of bronchial epithelium, intraalveolar fibrinous exudate, minor necroses, residual necrotizing bronchitis, focal granulation tissue and incipient fibrosis. In one case we found an extraordinary vascular change of uncertain origin. In conclusion, this group of patients is slightly atypical and differ in some features from those in other published studies and case reports concerning novel pandemic influenza. By reporting them we wish to extend the number of described cases, which may contribute to a better understanding of the pathogenesis of novel influenza infection. KEYWORDS influenza A virus, subtype H1N1 - viral pneumonia - diffuse alveolar damage.

Myxoid mixed low-grade endometrial stromal sarcoma and smooth muscle tumor of the uterus. Case report.

Abstract: We report the case of a 73-year-old female with myxoid mixed low-grade endometrial stromal sarcoma and smooth muscle tumor of the uterus. Grossly, the tumor sized 130 x 130 x 100 mm involved the uterine corpus almost in its entirety. Histologically, the tumor consisted of two cell types. In some areas, the tumor cells showed typical features of endometrial stromal tumors and resembled stromal cells of proliferative endometrium. In other areas, however, the tumor showed smooth muscle features and consisted of larger mostly epitheloid cells with a moderate amount of cytoplasm. In all areas, myxoid changes and multiple hyalinizing giant rosettes were present. The tumor infiltrated the myometrium in a pattern typical of low-grade endometrial stromal sarcoma. Immunohistochemically, the tumor cells showed expression of vimentin, estrogen and progesterone receptors and variable expression of CD10, α-smooth muscle actin, desmin, h-caldesmon, and cytokeratin AE1/AE3. Other markers examined including CD99, α-inhibin, cytokeratin CAM5.2, S-100 protein, and HMB45 were negative. To the best of our knowledge, mixed low-grade endometrial stromal and smooth muscle tumor with myxoid changes has not been described to date.

Review of precancerous vulvar lesions

Abstract: Classification of squamous vulvar precancerous lesions is based on the concept of vulvar intraepithelial neoplasia (VIN) and incorporates a three grade evaluation of the intensity of dysplastic changes (VIN I, II and III). On the basis of histological features, VIN has been subdivided into the usual VIN (u-VIN) and differentiated VIN (d-VIN), which represent the two basic pathways of the pathogenesis of vulvar squamous cell carcinoma. Although u-VIN is etiologically associated with the human papillomavirus (HPV) infection and histologically corresponds to cervical intraepithelial neoplasia, d-VIN represents the HPV-negative sequence of vulvar carcinogenesis, which is linked to lichen sclerosus (LS) and lichen simplex chronicus (LSC). u-VIN preferentially occurs in relatively young women with a history of cervical, vaginal or vulvar premalignant lesions. On the other hand, d-VIN usually affects postmenopausal women without anamnestic data of other dysplastic lesions of the lower female genital tract. d-VIN is characterized by a higher tendency of stromal invasion than u-VIN and its malignant potential is analogous to carcinoma in situ (VIN III). The histological appearance of d-VIN is subtle with basal atypia and a well-preserved differentiation of the superficial parts of the squamous epithelium, therefore it is frequently misdiagnosed for u-VIN I, LS or LSC in vulvar biopsies. Primarily because of the low diagnostic reproducibility of the u-VIN I category and the doubts about its precancerous potential as well as due to the questionable differentiation between u-VIN II and III, a revised VIN classification was proposed in 2004. The grading of vulvar precancerous lesions was abandoned, the u-VIN I category was discontinued and u-VIN II and III were merged. In the revised terminology, the term u-VIN represents HPV-associated high grade precancerous vulvar lesions (formerly u-VIN II and III) and d-VIN encompasses HPV-negative high grade dysplasias.

Gliosarcoma with alveolar rhabdomyosarcoma-like component: report of a case with a hitherto undescribed sarcomatous component.

Abstract: UNLABELLED Gliosarcoma (GS) is a relatively rare glioblastoma variant characterized by biphasic glial and mesenchymal differentiation patterns. The sarcomatous part most commonly resembles fibrosarcoma or so-called malignant fibrous histiocytoma. Rarely, GS shows heterologous lines of differentiation in the form of osteosarcoma, chondrosarcoma, liposarcoma, leiomyosarcoma, squamous or glandular malignant epithelial differentiation, or primitive neuroectodermal tumor (PNET)-like foci. When rhabdomyoblastic differentiation occurs, it is in the form of malignant spindle cells, with cross-striated strap cells or rounded rhabdomyoblasts reminiscent of the embryonal type of rhabdomyosarcoma. We are reporting a case of GS with an alveolar rhabdomyosarcoma-like component. The tumor consisted of poorly differentiated primitive small round cells growing in a solid and alveolar pattern, with minimal cytoplasm, markedly elevated mitotic activity and numerous apoptotic nuclei. Rhabdomyosarcomatous differentiation was confirmed by desmin and myogenin immunopositivity. To the best of our knowledge, this histologic pattern has not been previously reported in GS. Differential diagnostic considerations are discussed. KEYWORDS gliosarcoma - alveolar rhabdomyosarcoma - myogenin - desmin.

Peripheral neuropathy in Whipples disease: a case report.

Abstract: Whipples disease is a chronic multisystem inflammatory disease with predominantly gastrointestinal manifestations due to Tropheryma whipplei infection. Typical neurological abnormalities include dementia, eye movement abnormalities, hypothalamic dysfunction and oculomasticatory myorhythmias. The literature on peripheral neuropathy in Whipples disease is sparse and the involvement of peripheral nerves in Whipples disease has not been documented convincingly so far. We present a case of Whipples disease presenting by axonal peripheral neuropathy without gastrointestinal involvement. The diagnosis was confirmed by a sural nerve biopsy and consequent PCR of the sample. All clinical signs disappeared progressively during the antibiotic therapy. Two years after the T. whipplei infection, the patient developed dopa-sensitive Parkinson's disease, although these two events seem to be unrelated. This case illustrates the value of peripheral nerve biopsy in cases of axonal neuropathy of unexplained origin and extends the clinical spectrum of Whipples disease to a new modality.

Recurring multifocal leiomyosarcoma of the urinary bladder 22 years after therapy for bilateral (hereditary) retinoblastoma: a case report and review of the literature.

Abstract: SUMMARY We report on a case of urinary bladder leiomyosarcoma in a 23-year-old woman, 22 years after therapy for bilateral retinoblastoma. The tumor presented with dysuria and macroscopic haematuria. Cystoscopy revealed a tumor localized in the trigonum covered by an ulcerated urothelium. The patient underwent a transvesical tumor resection. Eight months later, a second leiomyosarcoma developed in the vertex, at a site different from the previous one. A cystoscopic trans-urethral tumor resection was performed, followed by combined chemotherapy. One year later another recurrence occurred at the site of the primary resection. Open laparotomic resection of the involved bladder wall was performed. The patient remains both recurrence and metastases free after twenty months of follow-up. Molecular analysis of the peripheral blood showed rare germline point mutation in the intron 24 of the RB1 gene. FISH analysis of the tumor tissue revealed polyploid cells with relative loss of normal RB1 gene locus, indicating deletion and second hit loss of the second RB1 allele function. Along with the ten previously reported cases, this report suggests a non-random association between the hereditary retinoblastoma and urinary bladder leiomyosarcoma. Therapy with cyclophosphamide seems to be an important risk factor. Life-long surveillance for second malignancies, including bladder leiomyosarcoma is therefore mandatory in these patients.

Neuroendocrine adenoma of the middle ear with extension into the external auditory canal.

Abstract: We report a case of middle ear adenoma (neuroendocrine adenoma of the middle ear) protruding into the external ear canal The patient was a 65-year-old man with hearing alterations and a headache in whom an otoscopy disclosed a sessile, pea-sized, brown-reddish, focally bleeding mass located in the posterior-superior aspect of the right external auditory canal Histopathologically, there was a neoplasm composed of closely packed, sometimes back-to-back glandular structures formed by small uniform cuboidal or cylindrical cells Small solid islands were also present Following the histopathologic examination, a high resolution computed tomography was performed showing an extensive osteolytic defect mostly involving the mastoid air cells of the mastoid process with a partial destruction of the middle ear cavity This defect was filled with a mass-like lesion with the density of soft tissue which bulged to the external auditory canal Histopathologic examination of the mass in the middle ear cavity revealed findings identical to those seen in the original biopsy, confirming diagnosis of middle ear adenoma extending into the external ear canal

[Neurodegenerative disorders: review of current classification and diagnostic neuropathological criteria].

Abstract: Neurodegenerative disorders are progressive diseases characterized by loss of specific neuronal populations followed by a clinical picture of a different neurodegenerative entity. Current classification of these diseases respects the names of the main pathophysiological processes involved in the groups of disorders. This is the reason why key proteins which represent neuropathological and biochemical hallmarks of diseases are found in their names. Neuropathological diagnosis is a synthesis of neurohistological changes in the brain and spinal cord and identification of pathological proteinaceous aggregates in neurons and/or glial cells. These inclusions are predominant diagnostic micromorphological and biochemical markers of disease. In the text, there is a brief summary of current knowledge about pathophysiology of neurodegenerations and diagnostic criteria for the most frequent entities.

[José Juan Verocay, "el patólogo de Praga" (on occasion of the 100th anniversary of his habilitation in Prague)].

Abstract: Jose Juan Verocay was born on June 16, 1876 in Paysandu, Uruguay to Italian immigrants; in 1887 they sent him to Cortina d'Ampezzo to learn languages first; he then graduated from the high school in Trento (1897) and from the German Medical Faculty in Prague (1904) where he, a disciple of Hanns Chiari, became the 1st demonstrator (1902), 3rd (1904) to 1st assistant (1905), and volunteer (from 1908) at the Department of Pathological Anatomy. He repeatedly substituted the professors Chiari (until 1906), Kretz (1907-1910), and Ghon (from 1910) during their absence. Anomalies and neoplasms prevailed among his research subjects. In the paper "Zur Kenntnis der »Neurofibrome«" (1910) he introduced the term "neurinoma" for a tumor with characteristic structures later named "Verocay bodies". On the basis of the paper he was habilitated for pathological anatomy as private docent at the German Medical Faculty in Prague (1911). During World War I he served for the Austro-Hungarian army at military hospitals in Chrudim (Bohemia) and Vienna. After the war he returned to Uruguay to work as a general practitioner in his native region (1919-1921), thereafter in Montevideo as head of pathological laboratories at the military hospital (1921-1925), at the Dental School (1925-1927), and at the Medical Faculty Department of Neurology (from March 19, 1927). As early as on May 3, 1927, however, he had to retire due to rapid worsening of his pulmonary tuberculosis. The renowned scientist remained a stranger in his own country ("el patologo de Praga"); he never gained professorship except for a symbolic proclamation by devoted students on August 24, 1927, two days before he left for Europe to undergo treatment. On December 26, 1927 he died in Dubi (a spa near Teplice in Bohemia, Czechoslovakia, now Czech Republic).

[Giant-cell lesions of bone and their differential diagnosis].

Abstract: UNLABELLED Giant-cell lesions of bone-neoplastic and reactive growths form a group of clinicopathological entities that differ in their behaviour and may present substantial problems in differential diagnosis. The presence of multinucleated giant cells of the osteoclast type, reactive osteoplasia and the formation of secondary aneurysmal cysts in many unrelated lesions of bone further complicates their classification. Clinicopathologic correlation of all findings, including the radiologic features and laboratory tests, is of paramount importance in reaching a correct diagnosis in this group of histologically overlapping entities. Malignant features can be identified in the primary and secondary conventional malignant giant cell tumours and in some types of osteosarcoma with a giant cell component. KEYWORDS giant-cell lesions of bone - giant-cell tumor - osteoclast - osteosarcoma.

Neuropathological diagnostics in pediatric oncology from the clinical point of view

Abstract: Treatment of pediatric brain tumors in children and adolescents is a tremendous challenge for the treating physicians, requiring a multidisciplinary approach and co-operation of multiple sub-specialities. Considerable progress in diagnostics and treatment of brain tumors has been made in recent years. In many brain tumors, especially embryonal brain tumors important, clinically relevant bio markers, were identified and are increasingly used in patient stratification into risk groups. Collaboration between clinicians, pathologists and molecular biologists is essential for successful therapy. This article gives some examples of collaboration in pediatric neuro-oncology.

Vaginal myofibroblastoma with glands expressing mammary and prostatic antigens.

Abstract: A case of unusual vaginal myofibroblastoma containing glands which expressed mammary and prostatic markers is described. The tumor occurred in 70-year-old woman in the proximal third of the vagina. It showed morphology and immunophenotype typical of so-called cervicovaginal myofibroblastoma. The peripheral zone of the lesion contained a few groups of glands suggesting vaginal adenosis or prostatic-type glands on initial examination. The glands showed a surprising simultaneous expression of mammary markers mammaglobin and GCDFP-15 and prostatic markers prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP). Immunostains for alpha-smooth muscle actin, p63 and CD10 highlighted the myoepithelial cell layer of the glands. The finding indicates that simultaneous use of both mammary and prostatic markers for examination of unusual glandular lesions in the vulvovaginal location can be helpful for an exact diagnosis, and can contribute to better understanding of prostatic and mammary differentiations in the female lower genital tract.

Primary vaginal squamous cell carcinoma arising in a squamous inclusion cyst: Case report

Abstract: SUMMARY We report the case of a 39-year-old female with primary vaginal squamous cell carcinoma arising from a squamous inclusion cyst of the posterior wall. The tumor was located in the vaginal wall and extended into the rectovaginal septum. The overlying mucosa was intact. Histologically, there was invagination of the surface squamous vaginal epithelium forming a cystic lesion. In some areas of this invagination, the squamous epithelium showed dysplastic changes (VAIN3) transitioning into invasive squamous cell carcinoma. To the best of our knowledge, we have documented the first case of primary squamous cell carcinoma arising in a vaginal cyst in a patient without having undergone a previous hysterectomy.

[Precanceroses of the endometrium, fallopian tube and ovary: a review of current conception].

Abstract: Recently, there has been a significant increase of knowledge regarding the pathogenesis and genetic changes occurring in carcinomas of the female genital tract and also regarding the definition of their precursors. A dualistic model of endometrial carcinogenesis has been accepted for a long period of time. Recently, a similar concept has been proposed for ovarian carcinomas. A correct definition of cancer precursors is important for the understanding of tumor pathogenesis. Moreover, it has an impact on the prevention and therapy of these tumors. In this review we summarize the precancers of the endometrium, fallopian tube and ovary according to the most recent advances in this research.

Pseudotumors of the testis and testicular adnexa

Abstract: A review article dealing with the most common pseudotumors of the testicular region. Nodules of immature tubules, pseudotumors in adrenogenital syndrome, fibromatous periorchitis, pseudosarcomatous myofibroblastic proliferation, posstraumatic mesothelial glandular inclusions and vasitis nodosa are described in detail, including morphologic and immunohistochemical features, altogether with a differential diagnostic approach. Key words: testis - testicular adnexa - nodules of immature tubules - pseudotumors in adrenogenital syndrome - fibromatous periorchitis - pseudosarcomatous myofibroblastic proliferation - posstraumatic mesothelial glandular inclusions - vasitis nodosa.

[Sarcomatoid (metaplastic) spindle cell carcinoma arising in a phylloid tumor with massive squamous metaplasia - a case report and review of the literature].

Abstract: UNLABELLED A 76-years-old woman underwent a partial mastectomy and a low-grade malignant homologous phyllodes tumor measuring 45 mm in maximum diameter was diagnosed. Beyond its typical dual composition the tumor displayed extensive intraductal squamous metaplasia. Approximately in one third of the lesion the original mesenchymal component cytologically and structurally changed which ultimately led to seeming stromal overgrowth. The loose storiform background contained isolated larger atypical elements with ample eosinophilic cytoplasm and obvious mitotic activity. This final fibromatosis-like arrangement was completed either by multiple dispersed abrupt squamous morules or just by pearl-like abortive form of squamous differentiation. Conventional in situ or invasive ductal carcinoma was not present. A combined expression of both low and high molecular weight cytoketatins, S100 protein, p63, CD10 and GFAP confirmed the incomplete basal/myoepithelial phenotype and ultimately led to the diagnosis of a spindle cell metaplastic carcinoma arising in a phyllodes tumor - a neoplasm unpublished so far. A review of the literature concerning epithelial malignancies originating from a milieu of phyllodes tumor guides discussion/speculation over the possible histopathogenesis of this vanishingly rare lesion. KEYWORDS breast - phylloid tumor - phyllodes tumor - spindle cell sarcomatoid/metaplastic carcinoma - squamous metaplasia.

Primary hepatic neuroendocrine carcinoma

Abstract: UNLABELLED Primary neuroendocrine carcinoma of the liver is a rare tumour, probably arising from scattered neuroendocrine cells of the bile duct. We present the case of a 72-year-old male who experienced gradual weight loss and diarrhoea. Given the fact that he had stayed in the Dominican Republic, a parasitic disease was initially suspected. However, this was not confirmed. Further examination showed tumour infiltration of the liver. Fine needle aspiration cytology of the tumour site was performed. The diagnostic procedure revealed neuroendocrine carcinoma. The tumour cells expressed the following neuroendocrine markers (chromogranin, synaptophysin, CD56 and NSE) as well as the epithelial marker AE1-AE3. The tumour was considered metastasis of the primary tumour located in the gastrointestinal tract. A thorough clinical examination was performed including gastroscopy, colonoscopy, In-111 Octreoscan scintigraphy, computed tomography and magnetic resonance imaging. These methods revealed metastases in the vertebrae, pelvis, long bones and skull. No other tumour sites were found in the lungs, gastrointestinal tract or pancreas. The patient became increasingly cachexic and later died. An autopsy showed massive multicentric tumour infiltration of the liver. Histological examination revealed well differentiated neuroendocrine carcinoma which transformed into intermediate and small cells. The autopsy found no tumour sites in the gastrointestinal tract, lungs or pancreas. The results were suggestive of primary neuroendocrine carcinoma of the liver. KEYWORDS neuroendocrine carcinoma - liver - primary tumour.

Mediastinal ganglioneuroma with perineural cell differentiation. Report of a case.

Abstract: An unusual case of ganglioneuroma with perineural cell differentiation is presented. The tumor was removed from the mediastinum in a 34-year-old male patient. Histologically, it contained neuroid bundles of bland spindle cells, scattered ganglion cells, and some foci of adipocytic metaplasia. Immunohistochemically, the tumor showed expected expressions of S100 protein, neurofilament protein and calretinin. In addition, many spindle cells were positive for perineural cell markers EMA, claudin-1, and GLUT-1. These cells were often arranged in an organoid fashion around the schwannoid bundles. This case indicates that the cells of ganglioneuroma can mature simultaneously towards both Schwann cell and perineural cell phenotypes.

Differential diagnosis of the chronic pancreatitis and the pancreatic ductal adenocarcinoma

Abstract: UNLABELLED The histopathological distinction of pancreatic ductal adenocarcinoma (PDA) and chronic pancreatitis represents one of the most difficult differential diagnosis in surgical pathology, especially in small biopsy specimens and frozen sections. Practically usable morphological criteria, which allow an efficient differential diagnosis of these lesions have been determined by a number of authors. The perineural and vascular invasion represent findings, which are entirely diagnostic for PDA; however, they are rarely detectable in small biopsy specimens as well as in the presence of solitary naked ducts in fat without surrounding pancreatic elements or fibrous tissue, which also supports the diagnosis of PDA. The features that are suggestive of PDA include random haphazard distribution of ductal structures, irregular ductal contours, ruptured ducts, nuclear enlargement, pleomorphism, hyperchromatism, and mitoses. Uniterrupted proliferation of numerous ducts (>50), ducts lying adjacent to arterioles, intraluminal cellular debris, and hyperchromatic raisinoid nuclei represent less frequently displayed features that also support the diagnosis of PDA. On the contrary, the preserved lobular arrangement, clusters of uniform ductal units, smooth ductal contours, ducts related to the remaining acini and islets, and finding of intraluminnal mucoprotein plugs favor a benign process over PDA. The combination of presented criteria and features should enable a reliable differential diagnosis of invasive pancreatic cancer and chronic pancreatitis. KEYWORDS chronic pancreatitis - pancreatic ductal adenocarcinoma - pseudotumor - differential diagnosis.

[Expression of p57 marker in differential diagnosis of complete and partial mole - correlation with DNA analysis].

Abstract: Nowadays valid classification of gestational trophoblastic disease, according to the World Health Organisation from the year 2003, divides gestational trophoblastic disease into three groups - molar pregnancies, non-neoplastic non-molar changes of trophoblast and tumours of trophoblast. To the molar pregnancies belong complete, partial, invasive and metastatic hydatidiform mole. In the differential diagnosis it is important to distinguish the complete hydatidiform mole from other forms of gestational trophoblastic disease, because there is an increased risk of malignant transformation of trophoblast cells in complete hydatidiform mole. 10 cases of genetically confirmed diploid complete mole and 10 cases of genetically confirmed triploid partial mole were included into our retrospective study. All cases were examined microscopically in the basic haematoxillin and eosin staining and immunohistochemically with the use of antibodies against human choriogonadotropin hormone, placental alkaline phosfatase and protein p57. Villous cytotrophoblast, stromal villous cells, extravillous trophoblast and decidual cells were p57 positive in all cases of partial hydatidiform mole. All 10 cases of complete hydatidiform mole were p57 negative in stromal villous cells and villous cytotrophoblast. P57 protein is a marker distinguishing complete hydatidiform moles from partial moles.

Perineural cell differentiation in ganglioneuromas. Report of 8 cases with immunohistochemical expression of perineural cell markers.

Abstract: Eight cases of ganglioneuroma were examined for a presence of perineural cell differentiation, using the immunohistochemical markers epithelial membrane antigen (EMA), claudin-1 and GLUT-1. The mean age of the patients was 42.3 years (range 26-68 years), six patients were females and two were males. Five tumors were located in the adrenal gland and 3 tumors in the retroperitoneum. Morphology of the tumors was typical, i.e., they were composed of neuroid spindle cell population and scattered mature appearing ganglion cells. Spindle cells positive for perineural cell markers claudin-1 and GLUT-1 were found in all lesions, at least focally. EMA+ cells were seen in 2 of 8 tumors. These perineural-type cells were often arranged in organoid fashion around the schwannoid bundles or around the vessels. Our findings indicate that perineural cell differentiation is commonly present in ganglioneuromas.

Micropapillary urothelial carcinoma of the ureter

Abstract: Micropapillary urothelial carcinoma (MPUC) is a rare aggressive variant of urothelial carcinoma, associated with advanced tumor stage, high tendency to invade lymphovascular spaces, and metastasize to lymph nodes and other organs. Therefore, it has a poor prognosis. One of the most prominent histological features is the presence of small, round empty spaces surrounding infiltrating tumor nests. If detected, even a small focus of micropapillary pattern may be therapeutically significant; the higher proportion of micropapillary component, the worse the prognosis. Radical nephroureterectomy is the treatment of choice even in the setting of superficially invasive disease. Although, MPUC has been well studied in urinary bladder, only a few cases of MPUC in upper urinary tract have been described. We are describing a case of a 79-year old woman with micropapillary urothelial carcinoma involving ureter and review the literature of this rare entity.