Case Reports in Pathology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Small Cell Carcinoma of the Uterine Cervix in a Pregnant Patient Diagnosed with Liquid Based Cytology and Cell Block Immunocytochemistry Thu, 28 Aug 2014 12:36:26 +0000 http://www.hindawi.com/journals/cripa/2014/971464/ Definitive cytomorphologic diagnosis of small cell carcinoma of the uterine cervix is possible but can be challenging in routine cervicovaginal cancer screening specimens. Several small series of reported cases of cervical small cell carcinoma have shown this uncommon malignancy to represent fewer than 2% of all invasive cervical cancers. This tumor type is associated with poor prognosis and rapid disease progression and can develop to an advanced stage in the interval between screening visits. Only rare case reports of small cell carcinoma arising in gravid cervices are known. In the current case a 29-year-old, gravida 6, para 2, pregnant (10-week gestation) female presented with postcoital bleeding. A definitive diagnosis of small cell carcinoma of the cervix was made possible by liquid based Pap testing with ancillary cell block preparation allowing for immunocytochemical characterization of the lesional cell population. Mawuli F. Attipoe and Charles D. Sturgis Copyright © 2014 Mawuli F. Attipoe and Charles D. Sturgis. All rights reserved. Pleuropulmonary Blastoma: A Case Report and Review of the Literature Thu, 07 Aug 2014 10:34:26 +0000 http://www.hindawi.com/journals/cripa/2014/509086/ The case of 38-month-old boy is being reported who was brought to the pediatrics clinic with fever, cough, hemoptysis, and breathing difficulty. Imaging studies revealed a right lower chest mass. Lobectomy and histopathological examination revealed it to be predominantly solid pleuropulmonary blastoma type II. It is a rare pediatric pleuropulmonary tumor with aggressive behavior and tendency to spread to the brain. The case is being presented to make the general histopathologist aware of this rare entity and to highlight to the pediatric physicians/surgeons, radiologists, and histopathologists the fact that lung cysts in infants and young children should be evaluated seriously and sampled thoroughly to diagnose cases of type I pleuropulmonary blastoma which will progress over time to type II or type III tumors. Also the siblings and first degree relatives of the patient should be screened for associated pulmonary and extrapulmonary benign and malignant conditions. Amjad Ali Khan, Ahmed Kamal El-Borai, and Mohammad Alnoaiji Copyright © 2014 Amjad Ali Khan et al. All rights reserved. Thyroid-Like Follicular Carcinoma of the Kidney in a Young Patient with History of Pediatric Acute Lymphoblastic Leukemia Tue, 15 Jul 2014 12:42:01 +0000 http://www.hindawi.com/journals/cripa/2014/313974/ Thyroid-like follicular carcinoma of the kidney (TLFCK) is a rare histological variant of renal cell carcinoma not currently included in the World Health Organization classification of renal tumors. Only 24 previous cases of TLFCK have been reported to date. We report a case of TLFCK in a 19-year-old woman with history of pediatric acute lymphoblastic leukemia. This patient is the youngest with TLFCK to be reported to date and the first with history of lymphoblastic leukemia. The development of TLFCK in a young patient with history of lymphoblastic leukemia is interesting and suggests that genes involved in leukemogenesis may also be important for TLFCK pathogenesis. Recognition of TLFCK is important to distinguish it from other conditions that show thyroid-like features, as a misdiagnosis can result in adverse patient care. William W. Wu, Julia T. Chu, Ali Nael, Sherif A. Rezk, Stephen G. Romansky, and Lisa Shane Copyright © 2014 William W. Wu et al. All rights reserved. Primary Hairy Cell Leukemia/Lymphoma of the Breast: A Case Report and Review of the Literature Tue, 15 Jul 2014 09:56:06 +0000 http://www.hindawi.com/journals/cripa/2014/497027/ Hairy cell leukemia/lymphoma (HCL) is a rare B-cell neoplasm primarily involving spleen, bone marrow, and blood. However, other sites of primary involvement do occur and can present a diagnostic and therapeutic challenge. We present an unusual case of HCL involving predominantly the breast that was diagnosed as an incidental finding during an elective reduction mammoplasty in an otherwise healthy asymptomatic woman. Bone marrow performed for staging revealed limited involvement by HCL. Notably, there was no splenomegaly and/or involvement of other extramedullary sites. The peripheral blood revealed minimal involvement detected by flow cytometry. Extensive immunohistochemical studies supported by positive BRAF V600E mutational status confirmed the diagnosis of HCL. The patient remains asymptomatic without treatment one year following the diagnosis. This is the first case of a well-documented HCL presenting primarily in the breast in an asymptomatic patient. We review the literature on extramedullary, extrasplenic involvement by HCL and discuss the diagnostic challenges as well as the utility of immunohistochemistry and molecular studies in the diagnosis of atypical presentations of HCL. Monika Pilichowska, Ahmad Shariftabrizi, Ian Mukand-Cerro, and Kenneth Miller Copyright © 2014 Monika Pilichowska et al. All rights reserved. Primary Renal Angiosarcoma with Extensive Necrosis: A Difficult Diagnosis Tue, 15 Jul 2014 08:56:41 +0000 http://www.hindawi.com/journals/cripa/2014/416170/ Angiosarcoma of the kidney is an exceedingly rare and aggressive neoplasm. Very few cases have been reported in the English literature to date. We report a case of primary renal angiosarcoma with extensive necrosis and discuss its diagnostic difficulties. An 86-year-old male presented with a 12 cm necrotic renal mass and multiple pulmonary and hepatic nodules. A CT guided renal biopsy revealed extensive necrosis and few vascular channels lined by malignant endothelial cells. Diagnosis was given on a morphologic base and proven by an immunohistochemical study. Primary renal angiosarcoma should be included among the differential diagnosis of necrotic renal lesions. Sohail Qayyum, Jignesh G. Parikh, and Nadeem Zafar Copyright © 2014 Sohail Qayyum et al. All rights reserved. Intracranial Gliofibroma: A Case Report and Review of the Literature Sun, 13 Jul 2014 11:56:16 +0000 http://www.hindawi.com/journals/cripa/2014/165025/ Gliofibroma is a rare tumor with biphasic morphology, commonly occurring in the first two decades of life. Currently, the tumor is not listed as a distinct entity in the current World Health Organization (WHO) classification of central nervous system tumors. As its biological behavior, histogenesis, and prognostic factors are still debated, the aim of this paper was to describe a case of a gliofibroma and to update the data about these lesions. Hence, we present here clinical symptoms, pathological findings, and evolution observed in a child with gliofibroma. A 10-year-old girl with seizures was referred for study. Neuroimaging showed a hemispheric hyperdense tumor with little peritumoral edema and no mass effect. The tumor was totally removed. Histologically, the tumor consisted of a mixture of glial cells and collagen-rich stroma. Immunohistochemical examination revealed positive staining for GFAP, CD 99, S100, and vimentin. EMA staining showed a paranuclear dot pattern in only few cells in isolated areas. These findings of a glial component with collagenous stroma were consistent with a desmoplastic glioma. Because of the rarity of this entity, we believe it is important to report every case in order to adequately analyze and categorize the tumor in the next WHO classification. Patricia Gargano, Graciela Zuccaro, and Fabiana Lubieniecki Copyright © 2014 Patricia Gargano et al. All rights reserved. Invasive Mucinous Adenocarcinoma Associated with Adjacent Sessile Serrated Lesion of the Appendix Vermiform: A Case Report Wed, 09 Jul 2014 10:25:29 +0000 http://www.hindawi.com/journals/cripa/2014/979674/ Although the definition of sessile serrated lesion (SSL) of colon is controversial and the risk of progression to malignancy is also under investigation at present, SSL is generally described as a polyp characterized by a serrated architecture. It is estimated to represent a feature of a new cancerization pathway, coined “serrated neoplasia pathway,” particularly in right-sided colon adenocarcinomas. On the other hand, in appendix, the role of this pathway remains uncertain, probably because very few cases of appendiceal adenocarcinoma associated with SSL were reported, and furthermore, immunohistochemical examination was rarely carried out. We herein report an interesting case of invasive appendiceal mucinous adenocarcinoma exhibiting SSL, which was pathologically estimated as a potential precursor lesion, and performed representative immunohistochemistry for both the mucinous adenocarcinoma and SSL in the same specimen. To further elucidate the progression of the appendiceal carcinoma from SSL, both an adequate sectioning of the lesion and systematic immunohistochemical examination of a large number of appendiceal carcinoma cases containing adjacent SSL would be required. Osamu Kinoshita, Yasutoshi Murayama, Yoshiaki Kuriu, Masayoshi Nakanishi, Chohei Sakakura, and Eigo Otsuji Copyright © 2014 Osamu Kinoshita et al. All rights reserved. Axillary Metastasis from an Occult Tubal Serous Carcinoma in a Patient with Ipsilateral Breast Carcinoma: A Potential Diagnostic Pitfall Wed, 09 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/cripa/2014/534034/ Axillary nodal metastasis from a nonmammary neoplasia is much rarer than diseases associated with a primary breast carcinoma. However, this has to be considered in the differential diagnosis of nodal disease in patients with a history of breast cancer. Here, we report the case of a 73-year-old female with a past medical history of breast cancer, presenting with an ipsilateral axillary metastatic carcinoma. The immunohistochemical profile of the metastatic lesion was consistent with a high grade serous carcinoma. After undergoing a total abdominal hysterectomy and salpingo-oophorectomy, thorough pathological examination revealed two microscopic foci of serous carcinoma in the right fallopian tube, not detectable by preoperative magnetic resonance imaging. In this context, the poorly differentiated appearance of the metastatic tumor and positive staining for estrogen receptor, might lead to a misdiagnosis of metastatic breast carcinoma. As the therapeutic implications differ, it is important for the pathologist to critically assess axillary lymph node metastases, even in patients with a past history of ipsilateral breast carcinoma and no other known primary tumors. Chantal Atallah, Gulbeyaz Altinel, Lili Fu, Jocelyne Arseneau, and Atilla Omeroglu Copyright © 2014 Chantal Atallah et al. All rights reserved. Nodular Lymphocyte Predominant Hodgkin Lymphoma versus T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Diagnostic Challenge Mon, 07 Jul 2014 14:04:42 +0000 http://www.hindawi.com/journals/cripa/2014/956217/ Lymphomas with overlapping histological features of two distinct entities cause difficulty in classification. Their classification is of particular significance when the two alternatives require different treatment modalities. We present a diagnostically challenging case of a nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with features of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL). Our patient is a 39-year-old woman who presented with painless subclavicular and axillary lymphadenopathy. The biopsied lymph node showed diffuse architectural effacement and scattered large neoplastic cells with large irregular nuclei and prominent nucleoli. These cells were positive for CD20 and Bcl-6 and negative for CD15, CD30, IgD, and Bcl-2. The background cells were predominantly T lymphocytes, whereas B cells were markedly depleted. The lymph node was interpreted as NLPHL, consistent with THRLBCL-like variant. NLPHL, especially THRLBC-like variant, and de novo THRLBCL are characterized by significant morphologic and immunophenotypic overlap. Our case demonstrates a rare predominance of background T-cells in NLPHL and emphasizes the importance of thorough evaluation of multiple morphologic and immunophenotypic features as an essential approach for arriving at the correct diagnosis. Anton V. Rets and Susan R. S. Gottesman Copyright © 2014 Anton V. Rets and Susan R. S. Gottesman. All rights reserved. Polypoid Adenomyoma of Endocervical Type Tue, 01 Jul 2014 11:46:20 +0000 http://www.hindawi.com/journals/cripa/2014/275421/ We report herein a 53-year-old Japanese female case of polypoid adenomyoma of endocervical type. A sessile 16 mm sized cervical polyp, hard in consistency, was surgically removed. Histologically, the polypoid lesion was composed of smooth muscle bundles and scattered benign-looking endocervical glands. The mucin was diffusely alcianophilic. Immunohistochemically, some mucous glands were positive for MUC1 (CA15-3) and MUC5AC, and the other small glands were immunoreactive for MUC6. MUC2 and mucin characteristic of gastric gland mucous cells (M-GGMC-1 or HIK1083) were negative. Carcinoembryonic antigen was consistently expressed along the apical surface. Estrogen receptor was positive, while progesterone receptor was negative. Ki-67 labeling index was low. These findings were consistent with the endocervical nature of the mucin-producing columnar cells. This is the 18th case of adenomyoma of endocervical type reported in the English literature. Yuka Takeda, Daiju Araki, Toru Arase, and Yutaka Tsutsumi Copyright © 2014 Yuka Takeda et al. All rights reserved. Cellular Angiofibroma of the Prostate: A Rare Tumor in an Unusual Location Tue, 01 Jul 2014 09:17:44 +0000 http://www.hindawi.com/journals/cripa/2014/871530/ We report the unusual occurrence of a cellular angiofibroma in prostatic tissue. In this case, a 84-year-old man presented in the emergency room with urinary retention. Ultrasound revealed an enlarged prostate, which was suggestive for benign prostatic hyperplasia. The patient was treated with a Millin retropubic prostatectomy. Macroscopically the prostate contained multiple circumscribed nodules. Microscopic examination of the tumor showed the appearance of cellular angiofibroma, consisting of bland spindle cells and prominent, hyalinized vessels. The diagnosis was supported by FISH, which revealed monoallelic loss of RB1/13q14 region, as seen in spindle cell lipoma, (extra-) mammary myofibroblastoma, and cellular angiofibroma. Cellular angiofibromas are rare, benign soft tissue tumours and were never reported in the prostatic gland. Inez Wyn, Maria Debiec-Rychter, Ben Van Cleynenbreugel, and Raf Sciot Copyright © 2014 Inez Wyn et al. All rights reserved. An Unusual Case of Systemic Inflammatory Myofibroblastic Tumor with Successful Treatment with ALK-Inhibitor Wed, 18 Jun 2014 07:40:05 +0000 http://www.hindawi.com/journals/cripa/2014/470340/ Systemic inflammatory myofibroblastic tumor is an exceedingly rare entity. A 45-year-old Hispanic female presented with a 6-month history of left-sided thigh pain, low back pain, and generalized weakness. PET/CT scan revealed abnormal activity in the liver, adrenal gland, and pancreas. MRI of the abdomen demonstrated two 6-7 cm masses in the liver. MRI of the lumbar spine demonstrated lesions in the L2 to L4 spinous processes, paraspinal muscles, and subcutaneous tissues, as well as an 8 mm enhancing intradural lesion at T11, all thought to be metastatic disease. A biopsy of the liver showed portal tract expansion by a spindle cell proliferation rich in inflammation. Tumor cells showed immunoreactivity for smooth muscle actin and anaplastic lymphoma kinase 1 (ALK1). Tissue from the L5 vertebra showed a process histologically identical to that seen in the liver. FISH analysis of these lesions demonstrated an ALK (2p23) gene rearrangement. The patient was successfully treated with an ALK-inhibitor, Crizotinib, and is now in complete remission. We present the first reported case, to our knowledge, of inflammatory myofibroblastic tumor with systemic manifestations and ALK translocation. This case is a prime example of how personalized medicine has vastly improved patient care through the use of molecular-targeted therapy. Sanjivini V. Jacob, John D. Reith, Angerika Y. Kojima, William D. Williams, Chen Liu, and Lizette Vila Duckworth Copyright © 2014 Sanjivini V. Jacob et al. All rights reserved. Small Intestinal Amyloidosis: A Rare Cause of Diverticular Disease Thu, 05 Jun 2014 11:57:12 +0000 http://www.hindawi.com/journals/cripa/2014/362835/ Systemic amyloidosis frequently involves the small intestine. However, its association with diverticular disease has been seldom reported to date. To draw attention to this rare but potentially harmful association, we herein present an additional case of small bowel diverticular disease associated with amyloidosis. Gabriel M. Groisman and Hector I. Cohen Copyright © 2014 Gabriel M. Groisman and Hector I. Cohen. All rights reserved. A Case of Unsuspected Peritoneal Mesothelioma Occurring with Colonic Adenocarcinoma Masquerading as Peritoneal Metastases Tue, 20 May 2014 11:45:42 +0000 http://www.hindawi.com/journals/cripa/2014/838506/ We report a case of synchronous primary colonic adenocarcinoma and malignant mesothelioma. A 61-year-old male presented with a six-month history of fatigue and weight loss. An abdominal computed tomography (CT) scan showed a 5.8 cm partially obstructing mass in the cecum with ascites and peritoneal thickening. A biopsy of the large mass showed an adenocarcinoma. Because the patient was clinically thought to be a T4 colon carcinoma with peritoneal metastatic lesions (M1), prior to initiating chemotherapy, a debulking right hemicolectomy was performed. Resection of the colon and ileum revealed a T3N0 colonic mucinous adenocarcinoma and concurrent diffuse malignant peritoneal mesothelioma. Presenting synchronous colonic and peritoneal mesothelial primary malignancies are exceedingly rare but must be considered to prevent incorrect clinical staging. Wei Xie, Linda K. Green, Rishi A. Patel, and Syeling Lai Copyright © 2014 Wei Xie et al. All rights reserved. Cytopathologic, Histopathologic, and Immunohistochemical Features of Intrahepatic Clear Cell Bile Duct Adenoma: A Case Report and Review of the Literature Mon, 19 May 2014 00:00:00 +0000 http://www.hindawi.com/journals/cripa/2014/874826/ Intrahepatic clear cell bile duct adenoma is extremely rare, with only 3 previous cases reported in the literature. The cause of cytoplasmic clearing in clear cell bile duct adenoma has not been previously investigated. Distinguishing clear cell bile duct adenoma from other clear cell tumors, particularly clear cell cholangiocarcinoma, can be challenging. Previous studies have shown loss of CD10 expression and focal CD56 expression in cholangiocarcinoma. Expressions of CD10 and CD56 have not been previously studied in clear cell bile duct adenoma. A 37-year-old morbidly obese woman was diagnosed with a 2.8 cm intrahepatic clear cell bile duct adenoma following segmental hepatic resection. Histochemical analysis of the tumor suggested the cause of cytoplasmic clearing in the neoplastic cells to be mucin and not glycogen or lipid. On immunohistochemical staining, the neoplastic cells demonstrated staining for CK7, CA 19-9, polyclonal CEA, CD10 (apical), CD56 (focal), and vimentin. Ki-67 highlighted less than 2% of tumor cell nuclei. This is the first report to study the etiology of cell clearing in clear cell bile duct adenoma. Expression of CD10 in clear cell bile duct adenoma may help distinguish clear cell bile duct adenoma from clear cell cholangiocarcinoma. William W. Wu, Mai Gu, and Di Lu Copyright © 2014 William W. Wu et al. All rights reserved. Intravascular Large B-Cell Lymphoma Presenting as Interstitial Lung Disease Thu, 15 May 2014 06:50:17 +0000 http://www.hindawi.com/journals/cripa/2014/928065/ Intravascular large B-cell lymphoma (IVLBL) is a rare subtype of diffuse large B-cell lymphoma that resides in the lumen of blood vessels. Patients typically present with nonspecific findings, particularly bizarre neurologic symptoms, fever, and skin lesions. A woman presented with shortness of breath and a chest CT scan showed diffuse interstitial thickening and ground glass opacities suggestive of an interstitial lung disease. On physical exam she was noted to have splenomegaly. The patient died and at autopsy was found to have an IVLBL in her lungs as well as nearly all her organs that were sampled. Although rare, IVLBL should be included in the differential diagnosis of interstitial lung disease and this case underscores the importance of the continuation of autopsies. Elham Vali Khojeini and Joo Young Song Copyright © 2014 Elham Vali Khojeini and Joo Young Song. All rights reserved. Oral Floor and Gingival Metastasis of Cholangiocarcinoma: A Case Report and Review of the Literature Wed, 07 May 2014 13:05:18 +0000 http://www.hindawi.com/journals/cripa/2014/712912/ The oral cavity is very unusual site of metastases even though wide spread metastatic disease may be present. The most common primary sites that metastasize to the oral cavity are lung, kidney, breast, and hepatocellular carcinoma. We present a rare case of a 77-year-old Caucasian female with metastasis from a cholangiocarcinoma to the oral floor contiguous with lingual gingival mucosa. The patient presented with left sided rib pain. A CT scan of the chest, abdomen, and pelvis showed multiple pulmonary nodules and a single dominant mass in the right lobe of the liver. This tumor was 6.5 cm with multiple satellite lesions surrounding it. The liver biopsy was diagnostic of a moderately to poorly differentiated adenocarcinoma, consistent with a primary cholangiocarcinoma. After undergoing one cycle of gemcitabine chemotherapy, the patient noticed an extremely rapidly growing mass involving her right lower gingiva and the entire right floor of her mouth. The biopsy of that mass also showed a moderately to poorly differentiated adenocarcinoma. The gingival tumor had a similar cytomorphology and immunophenotype as her cholangiocarcinoma. Therefore, an unusual site for metastatic cholangiocarcinoma was confirmed. Yukihiro Nakanishi, Bo Xu, and Charles LeVea Copyright © 2014 Yukihiro Nakanishi et al. All rights reserved. Clinical History and Colliquative Myocytolysis Are Keys to the Diagnosis of Shoshin Beriberi Wed, 07 May 2014 13:04:41 +0000 http://www.hindawi.com/journals/cripa/2014/506072/ Cardiovascular beriberi presents as either the fulminant (Shoshin beriberi) or chronic form. Shoshin beriberi is a rare disease that may lead to a fatal outcome if the patient does not receive appropriate treatment. In the present report, we describe the case of a 66-year-old man presenting with leg edema and dyspnea at rest. Clinical presentations were nonalcoholic Shoshin beriberi and lactate accumulation; however, clinical improvement was observed after the administration of thiamine. His pretherapy thiamine level (2.1 μg/dL) was consistent with a diagnosis of beriberi. Based on the findings of the present case, we believe that a diagnosis can be made in patients with a clinical history that is consistent with that of Shoshin beriberi, combined with low thiamine levels, lactate accumulation, and colliquative myocytolysis. Learning Objective. Shoshin beriberi is often misdiagnosed because of its rarity; a detailed clinical history and characteristic myocardial histopathology changes may be useful for making a definite diagnosis. Toshiki Kuno, Hiroshi Nakamura, Yutaka Endo, Kohei Saito, Hiroyuki Yamazaki, Hiroyuki Motoda, Yohei Numasawa, Kazuhiko Shimizu, and Toshiyuki Takahashi Copyright © 2014 Toshiki Kuno et al. All rights reserved. A Pitfall in Transrectal Prostate Biopsy: Malakoplakia Evaluation of Two Cases Based on the Literature Review Tue, 29 Apr 2014 07:24:31 +0000 http://www.hindawi.com/journals/cripa/2014/150972/ Malakoplakia is a rarely seen inflammatory condition that is considered to develop secondary to a chronic Escherichia coli infection. Although malakoplakia usually affects the genitourinary tract, it may also be observed in the colon, stomach, lungs, liver, bones, uterus, and skin. Malakoplakia of the genitourinary system usually involves the bladder, whereas it may also affect the prostate along with the bladder. Malakoplakia of the prostate is very rare, and it may be clinically mistaken for prostatic malignancies. Definitive diagnosis is only possible through histopathological examination. This study elaborates on two patients who presented to our hospital in 2013 with high PSA levels. The primary clinical consideration was prostate carcinoma. However, these two cases were diagnosed as malakoplakia based on the results of histopathological analysis of the transrectal prostate biopsy specimen. Dudu Solakoglu Kahraman, Sevil Sayhan, Gulden Diniz, Duygu Ayaz, Tugba Karadeniz, and Ertan Can Copyright © 2014 Dudu Solakoglu Kahraman et al. All rights reserved. A Rare Collision Tumor Composed of Follicular Lymphoma and Adenocarcinoma in the Ampulla of Vater: A Case Report Mon, 28 Apr 2014 06:44:10 +0000 http://www.hindawi.com/journals/cripa/2014/530727/ The duodenum is infrequently affected by malignant lymphoma, and follicular lymphomas of the duodenum are rare histological subtypes. There are no reported cases of collision of follicular lymphoma and other tumors in the ampulla of Vater. A 57-year-old Japanese man presented with jaundice, and abdominal computed tomography revealed a tumor of the ampulla of Vater invading the pancreatic head with biliary dilatation and a thickened duodenal wall. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Histopathology of the resected specimen revealed lymphoid follicular formations with small-to-medium-sized centrocyte-like cells and some centroblast-like cells. The atypical lymphoid cells were immunohistochemically positive for CD10, CD20, and CD79a but negative for CD5 and cyclin D1. BCL2 protein was highly expressed in the follicle centers. The diagnosis was duodenal follicular lymphoma, Grade 1. The follicular lymphoma, 40 mm in diameter, involved duodenal submucosa and regional lymph nodes without distant metastasis. This duodenal follicular lymphoma was partially overlapped by adenocarcinoma of the ampulla of Vater, measuring  mm, which involved the lower common bile duct, pancreas, and duodenum. We report the first case of a surgically treated collision tumor composed of a rare mass-forming follicular lymphoma and adenocarcinoma of the ampulla of Vater. Shioto Suzuki, Fumihiko Tanioka, Keisuke Inaba, Shingo Takatori, Hideto Ochiai, and Shohachi Suzuki Copyright © 2014 Shioto Suzuki et al. All rights reserved. Extranodal Marginal Zone Lymphoma Presenting within the Meckel Diverticulum as Diverticulitis: A Case Report Mon, 28 Apr 2014 06:43:17 +0000 http://www.hindawi.com/journals/cripa/2014/374814/ Meckel diverticulum is the most common congenital defect of the gastrointestinal tract. It can be asymptomatic or mimic appendicitis and may be complicated by bleeding, diverticulitis, obstruction, and, rarely, neoplasia. We report the first case of extranodal marginal zone lymphoma occupying a Meckel diverticulum. A 44-year-old man with history of colonic diverticulitis presented to the emergency department for evaluation of acute abdominal pain. Radiography showed enteric obstruction, prompting diagnostic laparoscopy. Above the level of mid-ileum an intact Meckel diverticulum was identified. Microscopy showed extensive infiltration of sheets of small lymphocytes with abundant cytoplasm (monocytoid B-cells) prominently in submucosa and focally transmural involving serosal adipose tissue with multiple reactive germinal centers. The immunostains showed positivity for CD20, BCL-2, and CD43 (weak) and negativity for CD3, CD5, BCL-1, CD10, and BCL-6 in monocytoid B-cells. Fluorescence in situ hybridization studies revealed API2-MALT1 fusion signals consistent with t(11;18)(q21;q21), which confirmed the diagnosis of extranodal marginal zone lymphoma, also known as mucosa associated lymphoid tissue lymphoma. A. Nael, M. L. Wu, P. Nagesh Rao, S. Rezk, and X. Zhao Copyright © 2014 A. Nael et al. All rights reserved. Unusual Dermoid Cyst in Oral Cavity Thu, 10 Apr 2014 12:08:38 +0000 http://www.hindawi.com/journals/cripa/2014/389752/ Dermoid cysts in oral cavity are unusual lesions. Their etiology is not yet clear and can be associated with trapped cells as a result of the inclusion error resulting in the development into the ectoderm, mesoderm, and endoderm tissues. The aim of this case report is to evidence the presence of a dermoid cyst in the floor of mouth surgically removed. In the present case, the lesion showed soft consistency, floating, regular borders, smooth surface, and the same color as the adjacent mucosa, asymptomatic and measuring 4.5 × 5.5 cm in its greatest diameter. The initial diagnostic was ranula in consequence of the similarity with clinical characteristics and localization. After surgical removal lesion, a fibrotic capsule was identified with a friable material with intensive yellow color. The microscopic exam showed cystic lesion with cavity lined by squamous stratified epithelium hyperorthokeratinized. Cutaneous attachments, such as sebaceous glands and hair follicles, were present in connective adjacent tissue. Surgical intervention is elective in these situations. All dentists must have a thorough knowledge of this unusual lesion. Evanice Menezes Marçal Vieira, Alvaro Henrique Borges, Luis Evaristo Ricci Volpato, Alessandra Nogueira Porto, Artur Aburad Carvalhosa, Gilberto de Almeida Botelho, and Matheus Coelho Bandeca Copyright © 2014 Evanice Menezes Marçal Vieira et al. All rights reserved. HPV11 Positive Endometrioid Carcinoma of the Endometrium with Signet-Ring Cells: Diagnostic Criteria and Review of the Literature Mon, 07 Apr 2014 15:40:27 +0000 http://www.hindawi.com/journals/cripa/2014/380571/ The presence of signet-ring cells in an endometrial adenocarcinoma is extremely uncommon and it is always necessary to rule out a metastatic neoplasm. We report a FIGO grade 2 endometrial carcinoma with a signet-ring cell component found in the curettage performed to a 53-year-old woman. The neoplastic proliferation was also found in the endometrium of the radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy. The uterine neoplasm invaded less than one-half of the myometrium (FIGO stage I B). Alcian blue showed the presence of mucin in the signet-ring cells. The patient was alive and without evidence of recurrence 14 months after surgery. Polymerase chain reaction method from paraffin-embedded tissue revealed the presence of human papilloma virus type 11. We have discussed the differential diagnosis of this kind of neoplasm and we have reviewed the literature on signet-ring cell carcinoma of the endometrium. Teresa Pusiol Copyright © 2014 Teresa Pusiol. All rights reserved. Mixed Large Cell Neuroendocrine Carcinoma and Adenocarcinoma with Spindle Cell and Clear Cell Features in the Extrahepatic Bile Duct Tue, 01 Apr 2014 09:05:51 +0000 http://www.hindawi.com/journals/cripa/2014/347949/ Mixed adenoneuroendocrine carcinomas, spindle cell carcinomas, and clear cell carcinomas are all rare tumors in the biliary tract. We present the first case, to our knowledge, of an extrahepatic bile duct carcinoma composed of all three types. A 65-year-old man with prior cholecystectomy presented with painless jaundice, vomiting, and weight loss. CA19-9 and alpha-fetoprotein (AFP) were elevated. Cholangioscopy revealed a friable mass extending from the middle of the common bile duct to the common hepatic duct. A bile duct excision was performed. Gross examination revealed a 3.6 cm intraluminal polypoid tumor. Microscopically, the tumor had foci of conventional adenocarcinoma (CK7-positive and CA19-9-postive) surrounded by malignant-appearing spindle cells that were positive for cytokeratins and vimentin. Additionally, there were separate areas of large cell neuroendocrine carcinoma (LCNEC). Foci of clear cell carcinoma merged into both the LCNEC and the adenocarcinoma. Tumor invaded through the bile duct wall with extensive perineural and vascular invasion. Circumferential margins were positive. The patient’s poor performance status precluded adjuvant therapy and he died with recurrent and metastatic disease 5 months after surgery. This is consistent with the reported poor survival rates of biliary mixed adenoneuroendocrine carcinomas. John Wysocki, Rishi Agarwal, Laura Bratton, Jeremy Nguyen, Mandy Crause Weidenhaft, Nathan Shores, and Hillary Z. Kimbrell Copyright © 2014 John Wysocki et al. All rights reserved. Solitary Mastocytoma of the Vulva Sun, 30 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/cripa/2014/412656/ Solitary mastocytoma of the skin is a rare tumor. Its occurrence in the vulva is extremely rare with only few case reports in the literature. We report a solitary mastocytoma of the vulva in a 10-year-old girl. Her systemic examination was unremarkable. The clinical and histopathological features were consistent with the diagnosis of solitary mastocytoma of the vulva. The follow-up after surgical excision was uneventful. The purpose of this communication is (i) to report a case of solitary mastocytoma occurring in an unusual site, the vulva and to show that (ii) in this case age at presentation is 10 years with infancy as common age of presentation of solitary mastocytoma, and to show that (iii) in appropriate setting this should be included in the differential diagnosis of vulval swelling. Shasi Velusamy, Jayasree Karuthedath Areeppurath Mana, and Chalissery Francis Mathew Copyright © 2014 Shasi Velusamy et al. All rights reserved. Spontaneous Splenic Rupture in Melanoma Wed, 26 Mar 2014 08:27:37 +0000 http://www.hindawi.com/journals/cripa/2014/865453/ Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin) confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic) rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen. Hadi Mirfazaelian, Ahmad Oryan, Aida Davari, Khosrow Daneshbod, and Yahya Daneshbod Copyright © 2014 Hadi Mirfazaelian et al. All rights reserved. Cylindroma with Stromal Adipose Tissue Metaplasia versus Arising in a Background of Nevus Lipomatosus Sun, 16 Mar 2014 11:44:41 +0000 http://www.hindawi.com/journals/cripa/2014/203298/ Nevus lipomatosus superficialis is a rare type of connective tissue nevus. Cylindroma is a benign skin appendage tumor with a predilection for the scalp of older females. We describe the case of a 56-year-old woman with a scalp lesion demonstrating histopathologic features consistent with benign cylindroma arising within a nevus lipomatosus superficialis. To our knowledge, this lesion has not been raised in the literature in the differential for cylindroma with what is presumed to be stromal adipose metaplasia. Ryan Yu and Salem Alowami Copyright © 2014 Ryan Yu and Salem Alowami. All rights reserved. Bilateral Spontaneous Pneumothorax in Chronic Silicosis: A Case Report Sun, 16 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/cripa/2014/561861/ Silicosis is an occupational lung disease caused by inhalation of crystalline silica. People working in occupations like sandblasting, surface drilling, tunneling, silica flour milling, ceramic making, and so forth are predisposed to develop silicosis. Crystalline forms of silica are more fibrogenic than the amorphous forms, highlighting the importance of the physical form in pathogenesis. Lung biopsy is rarely performed for the diagnosis of silicosis as it can easily be detected by occupational history and radiological features. Patients with silicosis can develop complications like tuberculosis, lung cancer, progressive massive fibrosis, cor pulmonale, broncholithiasis, or tracheobronchial compression by lymph nodes. Pleural involvement in silicosis is rare. Spontaneous pneumothorax is a pleural complication that can develop in such patients. Usually in silicosis pneumothorax is unilateral. We hereby report the lung biopsy findings and discuss the mechanism of pneumothorax development in a case of chronic silicosis who, later on died during the course of the disease. Pritinanda Mishra, Sajini Elizabeth Jacob, Debdatta Basu, Manoj Kumar Panigrahi, and Vishnukanth Govindaraj Copyright © 2014 Pritinanda Mishra et al. All rights reserved. Extramedullary Hematopoiesis in Uterine Leiomyoma Associated with Numerous Intravascular Thrombi Thu, 06 Mar 2014 14:09:31 +0000 http://www.hindawi.com/journals/cripa/2014/957395/ We report a case of extramedullary hematopoiesis (EMH) in uterine leiomyoma and associated numerous intravascular thrombi. A 29-year-old nulliparous female presented with heavy vaginal bleeding and a hematocrit of 22%. No bone marrow biopsy has been performed. She had a history of uterine leiomyomata and menorrhagia for a year. A transvaginal ultrasound confirmed the presence of a uterine leiomyoma. The patient was treated conservatively with oral contraceptive pills due to desire for fertility. However, she continued to have heavy vaginal bleeding and developed bilateral upper extremity deep vein thrombosis and multiple superficial vein thromboses after two months. An exploratory laparotomy with uterine myomectomy was performed. Gross examination of the specimen revealed a single nodular mass measuring  cm with a white-tan swirling cut surface. Microscopic examination revealed benign smooth muscle consistent with leiomyoma and numerous intravascular thrombi both with areas of EMH. Immunohistochemical stains confirmed the presence of all three benign lineages of hematopoietic cells. Occurrence of EMH in uterine leiomyoma and intravascular thrombi is very rare. It may be related to systemic hematopoietic stimulation due to severe chronic anemia and local presence of hematopoietic growth factors and/or cytokines. Xiaoyan Cui, Deniz Peker, Heather O. Greer, Michael G. Conner, and Lea Novak Copyright © 2014 Xiaoyan Cui et al. All rights reserved. Granulomatous Pancreatitis in a Patient with Acute Manifested Insulin-Dependent Diabetes Mellitus Wed, 05 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/cripa/2014/615426/ Isolated granulomatous noncaseating pancreatitis is a rare condition exceptionally described in human population. We demonstrate a case of the a 71-years-old female patient suffering from recent diabetes mellitus, generalized atherosclerosis and hypertension who died due to pulmonary embolism and terminal bronchopneumonia. Lipomatosis of pancreatic tissue was observed during the postmortem examination. Histological examination of pancreatic tissue discovered multiple small noncaseating epithelioid cell and giant cell granulomas, partly replacing the islets of Langerhans. To our knowledge, our case represents the first description of noninfectious granulomatous pancreatitis associated with acute manifested insulin-dependent diabetes mellitus. Václav Mandys, Michal Kheck, and Michal Anděl Copyright © 2014 Václav Mandys et al. All rights reserved.