Case Reports in Pathology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Massive Localized Lymphedema Arising from Abdominal Wall: A Case Report and Review of the Literature Mon, 31 Aug 2015 13:34:05 +0000 Massive localized lymphedema (MLL) is a rare pseudosarcomatous lesion due to localized lymphatic obstruction from variable causes. It is most common on medial aspect of thigh and inguinal region. Abdominal localization is rare and may cause clinical diagnostic confusion with other malignant tumors due to its large size. We report a case of abdominal wall MLL of a 56-year-old male patient under clinical suspicion of well differentiated liposarcoma. The literature search and differential diagnosis will be addressed. In doubt cases, immunohistochemical stain or fluorescent in situ hybridization can help to separate this entity from the other mimickers. Teodóra Tóth, Yi-Che Chang Chien, Sándor Kollár, and Ilona Kovács Copyright © 2015 Teodóra Tóth et al. All rights reserved. Leishmaniasis Panamensis Masquerading as Myiasis and Sporotrichosis: A Clinical Pitfall Sun, 30 Aug 2015 12:02:47 +0000 We report a case of cutaneous leishmaniasis panamensis in nonendemic Costa Rica. A 19-year-old female presented with nonhealing, unilateral eruption of erythematous papules with superficial central ulceration in a sporotrichoid pattern on right upper arm and back. Given the clinical picture and geographic locale, the patient was initially diagnosed with myiasis or human botfly infestation; however, the sporotrichoid pattern of the bites is an unlikely finding in myiasis. Peripheral blood smear, Giemsa stain, and polymerase chain reaction (PCR) were consistent for Leishmania spp. Ulceration resolved with 20-day course of IV sodium stibogluconate. Peter G. Pavlidakey, Thy Huynh, Kristopher Michael McKay, and Naveed Sami Copyright © 2015 Peter G. Pavlidakey et al. All rights reserved. Desmoplastic Small Round Cell Tumor, a “Floating Island” Pattern in Pleural Fluid Cytology: A Case Report and Review of the Literature Thu, 27 Aug 2015 12:42:36 +0000 Desmoplastic small round cell tumor (DSRCT) is a rare aggressive sarcoma with characteristic clinical and pathologic features. It typically involves pelvic and abdominal organs of young male patients, and patients usually present at advanced stage with poor prognosis. A few reports are available describing the cytopathologic features of DSRCT in serous effusions, with the majority of published cases depicting undifferentiated small blue cells that need to be distinguished from other small blue cell tumors. We report an interesting case of DSRCT involving a pleural effusion with a “floating island” pattern that has been described in hepatocellular carcinoma, renal cell carcinoma, and adrenal cortical carcinoma. In our case, the epithelioid tumor cells form cohesive aggregates surrounded by a single layer of spindle cells, mimicking the “endothelial wrapping” in other tumors with “floating island” patterns. We demonstrate, by ancillary testing, that these peripheral spindle cells are tapered/flattened DSRCT cells, in contrast to endothelial wrapping cells, as seen in other tumors with this unique cytomorphology. To our knowledge, this is the first case report describing DSRCT showing a “floating island” pattern that needs to be differentiated from metastatic hepatocellular carcinoma, renal cell carcinoma, and adrenal cortical carcinoma in effusion cytology. Hui Zhu, Emily Marie McMeekin, and Charles D. Sturgis Copyright © 2015 Hui Zhu et al. All rights reserved. Anaplastic Transformation of Papillary Thyroid Cancer in the Retroperitoneum Sun, 16 Aug 2015 09:18:51 +0000 Anaplastic thyroid carcinoma is an aggressive variant of thyroid cancer that in most cases arises from anaplastic transformation of terminally differentiated thyroid carcinomas. This process usually occurs in the thyroid or cervical lymph nodes. Anaplastic transformation in distant metastatic sites is exceedingly rare, only previously documented in a few case reports. We report a rare case of anaplastic transformation of papillary thyroid carcinoma within a large retroperitoneal metastasis in a 64-year-old male 30 years after the initial diagnosis. James P. Solomon, Fang Wen, and Lily J. Jih Copyright © 2015 James P. Solomon et al. All rights reserved. Metachronous Bilateral Testicular Leydig-Like Tumors Leading to the Diagnosis of Congenital Adrenal Hyperplasia (Adrenogenital Syndrome) Sun, 16 Aug 2015 07:32:24 +0000 A 33-year-old male with a history of left testis Leydig cell tumor (LCT), 3-month status after left radical orchiectomy, presented with a rapidly enlarging (0.6 cm to 3.7 cm) right testicular mass. He underwent a right radical orchiectomy, sections interpreted as showing a similar Leydig cell-like oncocytic proliferation, with a differential diagnosis including metachronous bilateral LCT and metachronous bilateral testicular tumors associated with congenital adrenal hyperplasia (a.k.a. “testicular adrenal rest tumors” (TARTs) and “testicular tumors of the adrenogenital syndrome” (TTAGS)). Additional workup demonstrated a markedly elevated serum adrenocorticotropic hormone (ACTH) and elevated adrenal precursor steroid levels. He was diagnosed with congenital adrenal hyperplasia, 3β-hydroxysteroid dehydrogenase deficiency (3BHSD) type, and started on treatment. Metachronous bilateral testicular masses in adults should prompt consideration of adult presentation of CAH. Since all untreated CAH patients are expected to have elevated serum ACTH, formal exclusion of CAH prior to surgical resection of a testicular Leydig-like proliferation could be accomplished by screening for elevated serum ACTH. Josip Vukina, David D. Chism, Julie L. Sharpless, Mathew C. Raynor, Matthew I. Milowsky, and William K. Funkhouser Copyright © 2015 Josip Vukina et al. All rights reserved. Nodular Elastosis of the Pancreas Sun, 09 Aug 2015 08:08:55 +0000 Elastofibromatous change is a benign process that has been increasingly recognized in the tubular gastrointestinal tract. These changes can present as a colonic polyp or be seen in conjunction with inflammatory changes. Similar lesions have been noted in the liver, apparently associated with vascular injury. We describe a case in which multiple circumscribed nodules of elastofibromatous change within the pancreas had a similar morphology to nodular elastosis of the liver. To our knowledge, this is the first description of such a finding occurring within the pancreas. Whitney Wedel, Geoffrey Talmon, and Aaron Sasson Copyright © 2015 Whitney Wedel et al. All rights reserved. A Dilemma in Staging of Esophageal Cancer: How Should We Stage ypT0 N2 M0 Esophageal Cancer after Neoadjuvant Therapy? Thu, 06 Aug 2015 09:34:16 +0000 Background. Since neoadjuvant treatment in esophageal cancer began to become popular, a complete pathological response at the primary tumour site has been commonly reported. An issue of conflict is whether complete response in the esophageal lumen means that the esophagus is completely tumour-free. Another important issue is whether lymph nodes that are retrieved from pathologically complete response cases are also tumour-free or not. There is a gap in the esophageal cancer staging system for ypT0 N2 M0 tumours that have received neoadjuvant therapy. Here, we will discuss the problem about staging of esophageal cancer associated with neoadjuvant therapy. Case. A female aged 40 years complaining of dysphagia was diagnosed as having locally advanced thoracic esophageal cancer. Neoadjuvant therapy decision was taken by oncology committee. Six weeks after neoadjuvant therapy, with a curative intention, minimal invasive surgery was performed. The pathology report was as follows. “There were no neoplastic cells in the suspected area of the esophageal mucosa upon examination with all staining. There was no cancer at resection margins. Four metastatic lymph nodes were infiltrated with squamous cell cancer.” Conclusion. Despite the growing use of neoadjuvant treatment in locally advanced esophageal cancer in world, we do not have a protocol for the evaluation of these patients’ pathology reports. We believe that new studies and new ideas are needed to resolve this dilemma associated with neoadjuvant therapy. Sebahattin Celik, Remzi Erten, Abdulsamed Batur, and Burak Suvak Copyright © 2015 Sebahattin Celik et al. All rights reserved. Two Rare Cases of Hepatocellular Carcinoma after Kasai Procedure for Biliary Atresia: A Recommendation for Close Follow-Up Mon, 03 Aug 2015 11:56:59 +0000 The instigation of the Kasai procedure in infants who are born with biliary atresia has led to increased survival in this population for over half a century. The many complications that arise as a result of biliary atresia led to an early death for most patients. However, the Kasai procedure is not without its own impediments. Among them is the development of hepatocellular carcinoma. We present two cases of hepatocellular carcinoma, after Kasai procedure, from two different age groups, as a recommendation that these patients should be even more closely monitored. Furthermore, if they are in need of transplant, we recommend that the explanted livers be carefully examined, as the tumor may not have been diagnosed preoperatively. Alicia C. Hirzel, Beatrice Madrazo, and Claudia P. Rojas Copyright © 2015 Alicia C. Hirzel et al. All rights reserved. Pediatric Papillary Renal Cell Carcinoma in a Horseshoe Kidney: A Case Report with Review of the Literature Sun, 02 Aug 2015 11:46:32 +0000 Renal cell carcinoma is the most common malignancy of the kidney in adults. In children, however, it only accounts for an estimated 1.8 to 6.3% of all pediatric malignant renal tumors. Papillary renal cell carcinoma is the second most common type of renal cell carcinoma in children. We present the case of a 12-year-old boy with a 2-month history of abdominal pain, unexplained weight loss, and gross hematuria. Computed tomography revealed a horseshoe kidney and a well-defined mass of 4 cm arising from the lower pole of the right kidney. Microscopically the tumor was composed of papillae covered with cells with abundant eosinophilic cytoplasm and high-grade nuclei with prominent nucleoli. Immunohistochemistry was performed; EMA, Vimentin, and AMACR were strongly positive while CK7, CD10, RCC antigen, TFE3, HMB-45, and WT-1 were negative. Currently, 10 months after the surgical procedure, the patient remains clinically and radiologically disease-free. Abelardo Loya-Solis, Lucía Alemán-Meza, Luis Carlos Canales-Martínez, Rodolfo Franco-Márquez, Alim Adriana Rincón-Bahena, Karla María Nuñez-Barragán, Raquel Garza-Guajardo, and Marco Antonio Ponce-Camacho Copyright © 2015 Abelardo Loya-Solis et al. All rights reserved. Tracheal Diverticulum: A Unique Case with Intraoperative Morphologic Assessment Tue, 28 Jul 2015 09:39:08 +0000 There are rare case reports of tracheal diverticula or paratracheal air cysts. These cases, however, were reported mostly as incidental sonographic or radiologic findings without histologic confirmation. Furthermore, the handful of studies that describe this entity histopathologically report only cases in patients with prior respiratory symptoms. Here, we report a rare case of an asymptomatic 60-year-old female with no significant past medical history who presented with primary hyperparathyroidism. She was found to have an incidental right paraesophageal air-filled diverticulum with multiple thin septations on her imaging studies. She was taken to surgery and the histologic examination of the specimen revealed multiloculated cystic cavity lined by respiratory-type columnar epithelium with lymphocytic infiltrate and minor salivary glands within the surrounding stroma, rendering the diagnosis of tracheal diverticula. Rohini Chennuri, Pavithra Dissanayake, Urjeet A. Patel, and Gabor Tarjan Copyright © 2015 Rohini Chennuri et al. All rights reserved. An Isolated Phlebolith on the Lip: An Unusual Case and Review of the Literature Wed, 22 Jul 2015 11:47:52 +0000 Background. Calcified thrombi are a common finding, especially in the pelvic veins. There are generally multiple thrombi, and they are generally associated with vascular malformations. Design. Herein we report a rare case of a single labial phlebolith, not associated with any other vascular lesion. We aim to alert clinicians to the possibility of the occurrence of vascular thrombi in the mouth and to describe the clinical and histological characteristics of such lesions in order to simplify the diagnosis and treatment. Furthermore, we have reviewed the English-language literature published since 1970 reporting oral (including masticatory muscles) phleboliths. Results. Twenty-nine cases of phleboliths have been reported in the literature since 1970. Only three of the reported phleboliths were solitary and not associated with other vascular lesions, as in the case presented here. Conclusion. Although phleboliths not associated with other vascular lesions are not common, clinicians should be aware of the existence of this pathology and include it as differential diagnosis of oral lesions. Gabriela de Morais Gouvêa Lima, Renata Mendonça Moraes, Ana Sueli Rodrigues Cavalcante, Yasmin Rodarte Carvalho, and Ana Lia Anbinder Copyright © 2015 Gabriela de Morais Gouvêa Lima et al. All rights reserved. Oral Myiasis Caused by Cochliomyia hominivorax in a Disabled Person Tue, 21 Jul 2015 08:29:33 +0000 Myiasis is a parasitic disease caused by developing maggots of fly species, which can infect humans. Patients with special needs, especially those with severe neuropsychomotor limitations, may have oral manifestations of this disease. Here, we present a clinical case in which a disabled person was affected by oral myiasis caused by Cochliomyia hominivorax. Maggots were found in two ulcerated lesions, a 2 cm diameter lesion in the maxilla and a 6 cm diameter lesion in the mandible. Forty-five maggots were removed during inspection, whereas 75 maggots were surgically removed under general anesthesia with nasotracheal intubation. Dipyrone, ivermectin, and clindamycin were prescribed, and the patient remained hospitalized for 3 days. Seven days after surgical intervention, no maggots were observed. Our study emphasizes that dentists must recognize the symptoms and behaviors of parasitic diseases that affect the oral cavity. José Pereira Novo-Neto, Fabiano de Sant’Ana dos Santos, Ana Emília Farias Pontes, Fernando Salimon Ribeiro, Fábio Luiz Ferreira Scannavino, and Alex Tadeu Martins Copyright © 2015 José Pereira Novo-Neto et al. All rights reserved. Eccrine Spiradenoma Arising from the Breast Skin Tue, 07 Jul 2015 10:35:14 +0000 Eccrine spiradenomas are uncommon, benign lesions, which are thought to originate from the eccrine sweat glands. They are common in young adults and are without a sex predilection. Here we report a case of eccrine spiradenoma of the breast skin in a 39-year-old woman who presented with a breast nodule for 10 years. It is crucial to take eccrine spiradenoma into consideration in superficial, well-circumscribed, breast skin/subcutaneous lesions. It is useful to recognize the two-cell populations constituting this tumor: small, dark, basaloid cells with hyperchromatic nuclei, which are immunoreactive for P63 and calponin, and larger cells with a pale nucleus, often near the center of the cluster (inner cells), which are immunoreactive for CK7 and CD117 (C-kit). Mark A. Benedict and Ugur Ozerdem Copyright © 2015 Mark A. Benedict and Ugur Ozerdem. All rights reserved. Primary Squamous Cell Carcinoma of Thyroid: A Rare Entity Mon, 29 Jun 2015 10:50:22 +0000 Primary squamous cell carcinoma (PSCC) of thyroid is an extremely rare malignancy of thyroid. Herewith, we describe a case report of female patient who presented with neck swelling; FNAC misdiagnosed it as papillary carcinoma of thyroid but, after resection, biopsy revealed it to be a case of squamous cell carcinoma of thyroid. After extensive investigations no possible primary focus of squamous cell carcinoma was found elsewhere, so diagnosis of primary squamous cell carcinoma of thyroid was made. Patient underwent chemoradiation but still patient succumbed to death within a year. Rahulkumar N. Chavan, Bhargav Chikkala, Cinjini Biswas, Somak Biswas, and Diptendra Kumar Sarkar Copyright © 2015 Rahulkumar N. Chavan et al. All rights reserved. Occult Breast Lobular Carcinoma with Numerous Circulating Tumor Cells in Peripheral Blood Thu, 25 Jun 2015 05:57:01 +0000 We experienced a very rare case of occult breast lobular carcinoma with numerous circulating tumor cells in peripheral blood. The diagnosis was very difficult because there were no symptoms of breast cancer and the preceding chief complaints such as general fatigue and weight loss or abnormality of peripheral blood findings were suggestive of a hematological disease. We could make a correct diagnosis of this case by checking the findings of complete blood count and bone marrow biopsy at the same time using immunohistochemistry. Kanako Ogura, Maki Amano, Toshiharu Matsumoto, Asumi Sakaguchi, Taijiro Kosaka, Toshiaki Kitabatake, and Kuniaki Kojima Copyright © 2015 Kanako Ogura et al. All rights reserved. Poorly Differentiated Thyroid Carcinoma Arising in Struma Ovarii Sun, 21 Jun 2015 11:35:22 +0000 Struma ovarii is an uncommon type of ovarian mature teratoma with a predominant thyroid component. The morphological spectrum of the thyroid tissue ranges from that of normal thyroid to proliferative adenoma-like lesions and thyroid-type carcinomas (malignant transformation). The histologic features of ovarian strumal lesions sometimes cause diagnostic problems due to the confusion with other types of ovarian neoplasms and the difficulty in the prediction of their clinical behavior. We report an extremely rare case of poorly differentiated thyroid carcinoma arising in struma ovarii. A 22-year-old woman presented with a 15 cm right ovarian mass. The tumor showed a predominantly tubular pattern which raised a differential diagnosis between endometrioid adenocarcinoma and Sertoli cell tumor. A review of the gross specimen with additional tissue sampling helped identify the teratomatous and strumal nature, with a support by immunohistochemical staining. Despite FIGO stage IA by optimal staging procedure and the absence of identifiable lymphovascular invasion, the patient developed pulmonary metastasis 15 months after surgery and died from the progression of the disease 7 years after the diagnosis. This case emphasizes the importance of macroscopic examination of the specimen and the awareness of this uncommon tumor in the differential diagnosis of ovarian neoplasms. Surapan Khunamornpong, Jongkolnee Settakorn, Kornkanok Sukpan, Prapaporn Suprasert, and Sumalee Siriaunkgul Copyright © 2015 Surapan Khunamornpong et al. All rights reserved. Small Bowel Obstruction due to Intestinal Xanthomatosis Wed, 17 Jun 2015 07:25:22 +0000 Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders. L. E. Barrera-Herrera, F. Arias, P. A. Rodríguez-Urrego, and M. A. Palau-Lázaro Copyright © 2015 L. E. Barrera-Herrera et al. All rights reserved. Metastasis of Malignant Melanoma to Urinary Bladder: A Case Report and Review of the Literature Thu, 28 May 2015 12:31:36 +0000 Aims. Metastatic malignant melanoma of the urinary bladder is a rare clinical entity, with only twenty-three published cases to date. We present a case of this rare entity, a thorough review of the literature, and differential diagnosis of melanoma in the bladder. Methods and Results. A 55-year-old woman with a history of malignant melanoma of the right thigh, excised eight years ago, presented with back pain, fatigue, and hematuria. She underwent computed tomography (CT) scan and was found to have metastases within the liver, spleen, lungs, and urinary bladder. She underwent cystoscopy and transurethral resection of three polypoid lesions. Histologic and immunohistochemical examination revealed metastatic malignant melanoma involving bladder mucosa. Conclusions. This case illustrates the importance of including malignant melanoma in the differential diagnosis of high grade neoplasms of bladder, especially in cases where the relevant clinical history is not available. Rashna Meunier, Gyan Pareek, and Ali Amin Copyright © 2015 Rashna Meunier et al. All rights reserved. Malakoplakia of the Pancreas with Simultaneous Colon Involvement: Case Report and Review of the Literature Thu, 21 May 2015 11:37:56 +0000 Although malakoplakia has been reported to occur at various body sites, pancreatic malakoplakia with simultaneous colonic involvement is very rare. Lesions of malakoplakia can masquerade as tumor masses leading to unwanted resections. Nevertheless, malakoplakia can occur in association with frank carcinomas, especially in the colon. By reporting a case of pancreatic malakoplakia diagnosed by fine needle aspiration cytology, this paper aims to describe cytologic features of malakoplakia and to further review findings from previous reported cases of pancreatic malakoplakia in the literature. With advances in minimally invasive, image-guided aspiration technologies, cytomorphological analyses can diagnose lesions of malakoplakia. This may help avoid surgeries that would have otherwise been carried out due to a misleading impression of tumor. However challenges remain as to the further management of patients diagnosed with this condition. More studies are necessary to determine the probability of malignancies arising in association with malakoplakia, in order to devise appropriate treatment protocols. Surya Guha and Haiyan Liu Copyright © 2015 Surya Guha and Haiyan Liu. All rights reserved. Invasive Aspergillosis Associated with a Foreign Body Sun, 10 May 2015 14:34:35 +0000 Invasive aspergillosis is a serious complication in immunocompromised individuals. It is associated with a high mortality rate, which demands a combined approach involving radical surgery and antifungal therapy. Here, we describe a patient who presented with nonspecific fever, refractory to antimicrobial agents. Though it primarily involved the nasal cavity and sinuses, it perforated into the oral cavity causing palatal changes. Surprisingly, a foreign body was found in the involved tissues that might have acted as a nidus of infection. A sufficient dose (3 mg/kg/day) of liposomal amphotericin B was initiated soon after a thorough debridement procedure and the patient survived. Akifuddin Syed, Prashanth Panta, Imran Shahid, and David H. Felix Copyright © 2015 Akifuddin Syed et al. All rights reserved. High Grade (Large Cell) Neuroendocrine Carcinoma of the Nasopharynx: Novel Case Report with Touch Preparation Cytology and Positive EBV Encoded Early RNA Sun, 10 May 2015 11:42:59 +0000 Fewer than five case reports of primary large cell neuroendocrine carcinoma of the nasopharynx are known to the authors. No previous reports have included examples of cytomorphology or have proven association with Epstein-Barr virus. We herein illustrate MRI findings, histopathologic features, immunohistochemical characterization, cytologic details, and in situ hybridization studies from a unique case of primary large cell neuroendocrine carcinoma of the nasopharynx in a 38-year-old Caucasian male patient. Recognition of rare tumor types of the nasopharynx allows for refinements in disease management and prognostication. Charles D. Sturgis, Brian B. Burkey, Suhael Momin, and Aaron P. Hoschar Copyright © 2015 Charles D. Sturgis et al. All rights reserved. An Unusual Location of Neuroendocrine Tumour: Primary Hepatic Origin Thu, 07 May 2015 16:02:11 +0000 Although neuroendocrine tumours (NETs) of primary hepatic origin are extremely rare, most of NETs present with liver metastasis. When a NET is found in the liver, it must be treated to exclude metastasis from extrahepatic primary sites. The patient was a 38-year-old female. Abdominal ultrasound showed an 8 cm tumour in liver during a routine examination. Liver biopsy was done. The tumour was first considered a metastatic hepatic tumour on histopathological examination. No clues to the origin of a primary tumour were found. Upper and lower endoscopy of the GI tract and chest CT were performed to search for a primary tumour and were negative for any tumour. One month later, more extensive areas of the tumour were seen on histopathological examination of second liver biopsy with the same morphologic characteristics as the first biopsy. Immunohistochemically, there was positive staining for synaptophysin, CD 56, and S-100 in the tumour cells. These findings suggested the diagnosis of NET. The diagnosis of primary liver NET was considered in a multidisciplinary meeting. Then, left hepatectomy was performed. The final pathologic diagnosis of the tumour in the resected liver specimen was Grade II NET. The patient was doing well at postoperative 28-month follow-up. A. Bahar Ceyran, A. Tarık Artış, Serkan Şenol, and Bengü Çobanoğlu Şimşek Copyright © 2015 A. Bahar Ceyran et al. All rights reserved. Mature Cystic Teratoma in Douglas’ Pouch Tue, 28 Apr 2015 06:33:32 +0000 Mature cystic teratoma is one of the most common ovarian neoplasms, but extragonadal teratoma is rare. Teratoma in Douglas’ pouch is extremely rare, and only 12 cases have been reported since the first case was described in 1978. We report a 20-year-old woman with a multicystic mass in Douglas’ pouch that was treated via laparoscopic resection. The tumor consisted of cysts lined by stratified squamous epithelium with an accumulation of keratin debris and various mature tissues. No immature elements or malignancy was found in the tumor, confirming the pathologic diagnosis of a mature cystic teratoma. The teratoma contained no ovarian tissues and both of the ovaries were intact on laparoscopy. These findings suggest that the teratoma originated primarily in Douglas’ pouch rather than being caused by autoamputation of a previously existing ovarian teratoma. This is the first case that simultaneously showed normal ovaries and a teratoma in Douglas’ pouch on laparoscopy. Kenji Ohshima, Anna Umeda, Ayako Hosoi, Toshiya Yamamoto, and Satoru Munakata Copyright © 2015 Kenji Ohshima et al. All rights reserved. Lipoleiomyoma of the Uterus and Primary Ovarian Leiomyoma in a Postmenopausal Woman: Two Rare Entities in the Same Individual Mon, 27 Apr 2015 09:31:45 +0000 Uterine lipoleiomyomas are rare benign tumours that are composed of various mixtures of smooth muscle and mature fat tissue. Leiomyomas, which arise primarily in the ovary, are extremely rare tumours that account for 0.5–1% of all benign ovarian tumours. To the best of our knowledge, we present the first case of an ovarian leiomyoma coexisting with a uterine lipoleiomyoma in the postmenopausal period. A 59-year-old, gravida 4, para 3, postmenopausal woman exhibited pelvic discomfort and increased frequency of micturition. A pelvic examination revealed a solid, tender mass on the left side that could not be clearly separated from the uterus. She underwent a laparotomy with an initial diagnosis of a left ovarian mass. She had previously undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy. A histopathological examination revealed a uterine lipoleiomyoma, composed of variable amounts of smooth muscle cells and mature adipocytes and a right ovarian leiomyoma composed of interlacing bundles and fascicles of spindle cells. The coexistence of these two rare entities in the same individual may represent a common pathway as a stimulating agent. This case may help to clarify the pathogenesis of these lesions. Sefa Kelekci, Serenat Eris, Emine Demirel, Serpil Aydogmus, and Nese Ekinci Copyright © 2015 Sefa Kelekci et al. All rights reserved. Extramedullary Hematopoiesis in a Sentinel Lymph Node as an Early Sign of Chronic Myelomonocytic Leukemia Thu, 16 Apr 2015 09:35:14 +0000 Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy with features of both a myeloproliferative neoplasm and a myelodysplastic syndrome. Even though extramedullary leukemic infiltration is common in CMML patients, lymph node involvement has rarely been reported in the literature. We present an unusual case of a 72-year-old female who was found to have extramedullary hematopoiesis (EMH) in a sentinel lymph node that was excised during mastectomy for lobular breast carcinoma. One year later bone marrow biopsy was performed due to persistent anemia, thrombocytopenia, and monocytosis and the patient was diagnosed with CMML. Our case illustrates the importance of recognizing EMH in a lymph node during routine histological examination, especially in adults. Proliferation of bone marrow elements in a lymph node, in a patient with no known hematologic disorder, should trigger immediate bone marrow evaluation, as this could be the first clue in diagnosing underlying bone marrow disorder. Joslin M. Bowen, Anamarija M. Perry, Erin Quist, and Mojtaba Akhtari Copyright © 2015 Joslin M. Bowen et al. All rights reserved. Microsatellite Genotyping to Distinguish Somatic β-HCG Secreting Carcinoma from Epithelioid Trophoblastic Tumor Wed, 15 Apr 2015 13:20:36 +0000 Objective. Morphologically, β-HCG secreting somatic carcinoma can be difficult to distinguish from epithelioid trophoblastic tumors (ETT). However, their distinction is critical due to their potentially differing prognoses and choice of chemotherapy. Presence of biparental alleles in ETT can be identified with molecular testing. We describe a patient who presented with metastatic carcinoma and elevated serum β-HCG and contrast this to an ETT in another patient. Data and Results. A 32-year-old female with recent possible miscarriage presented with pulmonary emboli and was found to have an increased serum β-HCG, a retroduodenal mass, and multiple nodules in her lungs, liver, and para-aortic lymph nodes. Biopsy showed a β-HCG and p63 positive epithelioid neoplasm with otherwise noncontributory immunohistochemistry. Molecular testing for biparental alleles in repeated length polymorphisms was negative, consistent with somatic origin. The second patient was a 35-year-old pregnant female with increased serum β-HCG and a uterine epithelioid tumor positive for β-HCG. Clinical and pathologic findings were characteristic of ETT and molecular testing was not required. These 2 cases illustrate that β-HCG secreting tumors of different etiologies may have similar appearances, and when clinical and/or IHC findings are inconclusive, molecular testing may be useful. Mary Anne Brett, Monalisa Sur, Dean Daya, Jefferson Terry, and Alice Lytwyn Copyright © 2015 Mary Anne Brett et al. All rights reserved. Colorectal Microcarcinoids in Association with Long-Term Exposure to Urinary Content: A Case Report and Review of the Literature Thu, 02 Apr 2015 09:42:59 +0000 Long-term exposure of colonic mucosa to urinary content and its association with increased risk of infection, mechanical and biochemical irritation, and malignancy have been described in the literature. Existing case reports and studies depict the low but distinct risk of malignancy in gastrointestinal segments which come in contact with urinary content as a result of surgical correction of urinary tract abnormalities. However, these reports are largely limited to colonic adenocarcinoma and urothelial cell carcinoma. Late urointestinal carcinoma in patients with ileal incorporation into the urinary tract has also been reported. To the best of our knowledge, however, there is only one case report documenting neuroendocrine (NE) cell hyperplasia in colonic mucosa after long-term cystoplasty. Our case is the first to describe microcarcinoids and diffuse NE hyperplasia occurring in a patient with congenital anorectal anomalies, resulting in long-term exposure of colonic mucosa to fecal stream and urinary content. This case, in conjunction with the reported cases in the literature, raises the distinct possibility of an association between exposure of colonic mucosa to urine and long-term development of malignancy, including NE neoplasms. Grace W. Weyant, Dipti M. Karamchandani, and Negar Rassaei Copyright © 2015 Grace W. Weyant et al. All rights reserved. Ameloblastic Fibrosarcoma of the Mandible: A Case Report and Brief Review of the Literature Tue, 10 Mar 2015 06:56:31 +0000 Ameloblastic fibrosarcoma is an uncommon odontogenic tumor composed of a benign epithelial component and a malignant ectomesenchymal component most frequently seen in the third and fourth decades of life. It mainly presents as a painful maxillary or mandibular swelling. Radiographs show a radiolucent mass with ill-defined borders. Radical surgical excision and long-term follow-up are the suggested treatment. We report the case of a 22-year-old female with a 2-month history of an asymptomatic swelling in her left mandible. Examination revealed an exophytic growth measuring  cm extending from the mandibular left first premolar to the second molar. The patient underwent a left hemimandibular resection. Histopathological examination revealed a biphasic tumor composed of inconspicuous islands of benign odontogenic epithelium and an abundant malignant mesenchymal component with marked cellularity, nuclear pleomorphism, hyperchromatism, and moderate mitotic figures with clear margins; one year after the surgical procedure, the patient is clinically and radiologically disease-free. Abelardo Loya-Solis, Karla Judith González-Colunga, Cynthia M. Pérez-Rodríguez, Natalie Sofía Ramírez-Ochoa, Luis Ceceñas-Falcón, and Oralia Barboza-Quintana Copyright © 2015 Abelardo Loya-Solis et al. All rights reserved. Cytological Features of Mammary Analogue Secretory Carcinoma of the Parotid Gland in a 15-Year-Old Girl: A Case Report with Review of the Literature Sun, 01 Mar 2015 12:03:11 +0000 Mammary analogue secretory carcinoma (MASC) is a recently recognized tumor of salivary glands characterized by the ETV6-NTRK3 fusion gene. This tumor is very rare in children and adolescents. We report a case of MASC in a 15-year-old girl, the fifth youngest case so far reported. The patient complained of a left infra-auricular mass that gradually enlarged for a year. Fine-needle aspiration cytology/imprint cytology showed individual tumor cells that had faintly eosinophilic granular cytoplasm with secretion granules sometimes seen adjacent to the tumor cells. These cytological features overlapped between those of zymogen granule-poor acinic cell carcinoma (AciCC) and MASC. In addition to the case report, we present a review of the related literature with a focus on the cytological features of MASC. The differential diagnostic clues are also discussed. Takako Inaba, Yuki Fukumura, Tsuyoshi Saito, Junkichi Yokoyama, Shinichi Ohba, Atsushi Arakawa, and Takashi Yao Copyright © 2015 Takako Inaba et al. All rights reserved. Hepatocellular Carcinoma with Both Fibrolamellar and Classical Components: An Unusual Morphological Pattern Thu, 26 Feb 2015 07:09:07 +0000 Fibrolamellar carcinoma (FLC) is an uncommon form of primary liver malignancy with unique clinical, histological, and biological characteristics. It is usually seen in young adults without underlying liver disease. Histologically, it shows large cells with abundant eosinophilic cytoplasm, large vesicular nuclei, prominent nucleoli, and lamellar type fibrosis. In contrast, classical hepatocellular carcinoma (HCC) is typically present in elderly male patients with cirrhosis. It is the most common histological subtype, and it is characterized by its resemblance to the normal liver, both in its growth pattern and its cytology. The unusual case of a liver carcinoma that presented with histological features of both FLC and classical HCC is herein reported. This was the case of a 37-year-old female complaining of diffuse abdominal discomfort and epigastric pain for two months. She was referred to us for further management after she was diagnosed with HCC in a noncirrhotic liver. She underwent a left-sided hepatectomy. A yellow nodular mass with well-defined borders and a necrotic center was present in the resection specimen. The morphological features and immunohistochemical studies were consistent with a diagnosis of FLC mixed with classical HCC. The patient was followed up for five months, and no signs of recurrence were evident. Diana Castro-Villabón, Luis E. Barrera-Herrera, Paula A. Rodríguez-Urrego, Rachel Hudacko, Alonso Vera, Johanna Álvarez, Rafael Andrade, and Rocío López Copyright © 2015 Diana Castro-Villabón et al. All rights reserved.