Case Reports in Pathology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Metastatic Melanoma to the Urinary Bladder of Ocular Origin Accompanied with Primary Cutaneous Melanoma: Diagnostic Challenge—A Report of a Case Mon, 11 Sep 2017 00:00:00 +0000 Metastases of melanoma to the urinary bladder are infrequent. Even rarer are metastases to the urinary bladder from uveal melanoma, with only 3 cases published in the literature so far. Herein we present a case of a 77-year-old male patient who presented with metastatic melanoma to the urinary bladder. The patient’s history included the diagnoses of uveal melanoma treated with radiation 25 years ago, as well as that of cutaneous melanoma diagnosed 7 years ago. The molecular study of the urinary bladder tumor specimen identified mutation of the GNAQ gene, which has been suggested to be an early molecular event in the pathogenetic course of over 80% of uveal melanomas. Therefore, the diagnosis of uveal melanoma metastatic to the urinary bladder was made. Constantine Theocharides, Kyriakos Chatzopoulos, Dimitrios Papanikolaou, Vasileios Siokas, Ioannis Amplianitis, and Athanasios Papanikolaou Copyright © 2017 Constantine Theocharides et al. All rights reserved. Malignant Peripheral Nerve Sheath Tumor of the Inguinum and Angiosarcoma of the Scalp in a Child with Neurofibromatosis Type 1 Thu, 24 Aug 2017 07:23:17 +0000 Benign and malignant tumors are common in the setting of neurofibromatosis type 1 (NF1). Malignant peripheral nerve sheath tumor (MPNST) and angiosarcoma are rare tumors in children and adolescents and mostly occur in young patients in relation to NF1. Both histological types can be present in the same tumor mass in patients with NF1. We present a case of 12.5-year-old girl with NF1 who first presented with MPNST of the right inguinal region and 1.5 years later with unrelated angiosarcoma of the scalp. Marija Milković Periša, Tihana Džombeta, Jasminka Stepan Giljević, and Božo Krušlin Copyright © 2017 Marija Milković Periša et al. All rights reserved. Bilateral Mesenchymal Hamartoma of the Chest Wall in a 3-Month-Old Boy: A Case Report and Review of the Literature Wed, 16 Aug 2017 00:00:00 +0000 Mesenchymal hamartoma of the chest wall is a well-recognized but extremely rare entity. This entity is believed to be benign with no propensity for invasion or metastasis. Although the lesion manifests with alarming aggressive clinical, radiological, and histological features, it is considered benign and carries an excellent outcome. Therefore it is important to recognize this benign entity to avoid the possible misdiagnosis of malignancy and the unnecessary use of chemotherapy. We present a case of bilateral multifocal mesenchymal hamartomas of the chest wall in a male infant and a literature review of this entity. Our aim is to improve the awareness of this condition and highlight its benign behavior and satisfactory outcome following complete surgical resection. Mona Alfaraidi, Hossam Alaradati, Irfan Mamoun, and Shamayel Mohammed Copyright © 2017 Mona Alfaraidi et al. All rights reserved. Esophageal Squamous Cell Carcinoma Presenting with Streptococcus intermedius Cerebral Abscess Tue, 15 Aug 2017 08:33:11 +0000 Background. Cerebral abscess is caused by inoculation of an organism into the brain parenchyma from a site distant from the central nervous system. Streptococcus intermedius (S. intermedius) is a commensal organism that is normally present in the aerodigestive tract and was reported to be the cause of brain abscesses after esophageal dilatation or upper endoscopy. Case Presentation. We report the case of a 53-year-old female who presented with hematemesis and melena followed by left-sided weakness. Initially, her hemiplegia was found to be secondary to a right thalamic brain abscess caused by S. intermedius. Investigations led to the diagnosis of a mid-esophageal squamous cell carcinoma. We hypothesize that the cause of the abscess with this bacterium that naturally resides in the digestive tract and oral cavity is secondary to hematogenous spread from breach in the mucosal integrity from ulceration due to the cancer. Conclusion. To our knowledge, our case is the first in the literature to describe a brain abscess caused by S. intermedius in association with a previously undiagnosed esophageal squamous cell carcinoma without any prior esophageal intervention. Rabih Nayfe, Mustafa S. Ascha, and Esther H. Rehmus Copyright © 2017 Rabih Nayfe et al. All rights reserved. Idiopathic Myointimal Hyperplasia of Mesenteric Veins of the Ileum and Colon in a Patient with Crohn’s Disease: A Case Report and Brief Review of the Literature Tue, 15 Aug 2017 06:30:54 +0000 Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare disease characterized by intimal smooth muscle proliferation, leading to the thickening of small to medium-sized mesenteric veins. This vascular disease mimics inflammatory bowel disease (IBD) clinically and endoscopically, while showing ischemic mucosal changes without the classic features of IBD on biopsy. Given the mixed picture, this entity is frequently misdiagnosed. Surgical resection of the diseased bowel segment reveals the true etiology of the pathology and is curative. We describe a case of a 59-year-old man with a long-standing history of Crohn’s disease refractory to medical therapy and status after multiple small bowel resections. The patient underwent a subtotal abdominal colectomy with pathology showing dense, indurated mesenteric adipose tissue, significant muscularis propria hypertrophy, and myointimal hyperplasia of the mesenteric veins in a peri-ileal and pericolic distribution, as confirmed by elastin stain. No evidence of mucosal ischemic changes or findings of chronicity or acuity were seen. IMHMV, a rare disease with a mixed presentation, poses a significant diagnostic challenge to clinicians and pathologists. Sharon J. Song and Stuti G. Shroff Copyright © 2017 Sharon J. Song and Stuti G. Shroff. All rights reserved. Adenocarcinoma Ex Goblet Cell Carcinoid of Appendix: Two Case Reports Mon, 14 Aug 2017 09:54:16 +0000 Adenocarcinoma ex goblet cell carcinoid is a rare tumor incidentally found in specimens of appendicitis. Most patients present with acute abdomen, similar to acute appendicitis. Here we present two cases, which were found incidentally after operation. We give a brief summary about clinical and biological behavior of this entity. Yu-Ting Wang, Yi-Ru Li, and Tuan-Ying Ke Copyright © 2017 Yu-Ting Wang et al. All rights reserved. Calciphylaxis of the Postmenopausal Female Breast: An Uncommonly Encountered Mimic of Carcinoma Wed, 09 Aug 2017 00:00:00 +0000 Calciphylaxis is a serious medical condition that is typically associated with end-stage renal disease and presents as the sequelae of calcifications in arterioles with subsequent ischemia of affected tissues. Classically, calciphylaxis produces ulcerated and necrotic skin lesions. These may be biopsied to aid in confirmation of the diagnosis. Herein we report a case of a large necrotic breast lesion in the clinical setting of calciphylaxis, and we emphasize that a multidisciplinary approach to diagnosis and management is important to avoid unnecessary oncological resection. Aaron G. Novotny, Ashley B. Simpson, Melinda A. Kral, Benjamin C. Calhoun, Amy E. Cocco, Steven D. Billings, Susan K. Miller, Paulette L. Lebda, and Charles D. Sturgis Copyright © 2017 Aaron G. Novotny et al. All rights reserved. Intraocular Plasmablastic Lymphoma in a HIV Patient Tue, 08 Aug 2017 07:43:07 +0000 Plasmablastic lymphoma (PBL) is a rare B-cell lymphoma occurring mainly in HIV patients. The tumor frequently involves extranodal sites such as the oral cavity, nasal cavity, gastrointestinal tract, skin, and lungs. The neoplastic cells are characterized by a plasmablastic appearance and typical immunophenotype that indicates plasma cell differentiation. Herein, we report a case of intraocular involvement by plasmablastic lymphoma in a HIV patient with a long history of cytomegalovirus retinitis and loss of vision. After an evisceration performed to control the blind, painful eye a diagnosis of PBL was made by examining the eye contents. Two months later, a biopsy of cervical lymph node revealed nodal lymphoma of the same type. To the best of our knowledge, this is the second case of intraocular PBL reported in English literature. Carolline Fontes Alves Mariano, Glauce Lunardelli Trevisan, Antonio Augusto Velasco e Cruz, and Fernando Chahud Copyright © 2017 Carolline Fontes Alves Mariano et al. All rights reserved. A Rare Case of Cutaneous Plasmacytosis in a Korean Male Mon, 07 Aug 2017 00:00:00 +0000 Cutaneous and systemic plasmacytosis are reactive disease processes that occur in middle-aged Japanese and Chinese men. Systemic plasmacytosis, defined by plasmacytic infiltration of two organ systems, might rarely progress to lymphoma. Cutaneous plasmacytosis, however, is chronic and benign and is characterized by the development of multiple plasma cell-rich infiltrates in the skin. We present a case of cutaneous plasmacytosis in a 46-year-old Korean male. The patient demonstrated classic features of the disease entity, including disseminated red-brown plaques, differentiated plasmacytoid infiltrates on biopsy, hypergammaglobulinemia, and the absence of systemic disease. Corey Georgesen, Meenal Kheterpal, and Melissa Pulitzer Copyright © 2017 Corey Georgesen et al. All rights reserved. Gastric Medullary Carcinoma with Sporadic Mismatch Repair Deficiency and a TP53 R273C Mutation: An Unusual Case with Wild-Type BRAF Thu, 03 Aug 2017 00:00:00 +0000 Medullary carcinoma has long been recognized as a subtype of colorectal cancer associated with microsatellite instability and Lynch syndrome. Gastric medullary carcinoma is a very rare neoplasm. We report a 67-year-old male who presented with a solitary gastric mass. Total gastrectomy revealed a well-demarcated, poorly differentiated carcinoma with an organoid growth pattern, pushing borders, and abundant peritumoral lymphocytic response. The prior cytology was cellular with immunohistochemical panel consistent with upper gastrointestinal/pancreaticobiliary origin. Overall, the histopathologic findings were consistent with gastric medullary carcinoma. A mismatch repair panel revealed a mismatch repair protein deficient tumor with loss of MLH1 and PMS2 expression. BRAF V600E immunostain (VE1) and BRAF molecular testing were negative, indicating a wild-type gene. Tumor sequencing of MLH1 demonstrated a wild-type gene, while our molecular panel identified TP53 c.817C>T (p.R273C) mutation. These findings were compatible with a sporadic tumor. Given that morphologically identical medullary tumors often occur in Lynch syndrome, it is possible that mismatch repair loss is an early event in sporadic tumors with p53 mutation being a late event. Despite having wild-type BRAF, this tumor is sporadic and unrelated to Lynch syndrome. This case report demonstrates that coordinate ancillary studies are needed to resolve sporadic versus hereditary rare tumors. Brett M. Lowenthal, Theresa W. Chan, John A. Thorson, Kaitlyn J. Kelly, Thomas J. Savides, and Mark A. Valasek Copyright © 2017 Brett M. Lowenthal et al. All rights reserved. Pulse Granulomas of the Gastrointestinal Tract and Gallbladder: Report of Five Cases Thu, 13 Jul 2017 00:00:00 +0000 Hyaline rings with admixed multinucleated giant cells characterize pulse granulomas; the term pulse refers to edible seeds of legume vegetables. The etiology has been controversial, with theories including vascular degenerative changes or a reaction to vegetable material; ultrastructural studies and experimentally induced lesions in animals favor the latter. This lesion is typically seen in the oral cavity, with only rare reports in the gastrointestinal tract and gallbladder. We herein describe five cases of pulse granulomas identified in these sites. All cases contained foreign-body giant cells and vegetable debris within or near hyaline rings. Pulse granulomas may form mass lesions but are usually an incidental finding on microscopic examination. In incidentally detected cases, recognition of pulse granulomas can suggest a mural abscess, fistula, or perforation of the gut, findings which may not be grossly apparent. The presence of vegetable material in all five cases further supports an exogenous pathogenesis. Tom C. DeRoche, Gregory A. Gates, and Aaron R. Huber Copyright © 2017 Tom C. DeRoche et al. All rights reserved. Leiomyosarcoma and Squamous Cell Carcinoma Arising in Mature Cystic Teratoma of the Ovary Sun, 02 Jul 2017 08:05:42 +0000 The occurrence of malignant transformation in mature cystic teratoma of the ovary is rare, with squamous cell carcinoma being the most common histologic type. Sarcomatous transformation has been rarely described in the literature. We present a case of leiomyosarcoma with a minor component of squamous cell carcinoma arising in mature cystic teratoma of ovary in a 65-year-old woman. The malignant tumor showed two distinct components of sarcomatous and invasive epithelial elements, which were confirmed by immunostaining. To our knowledge, only four cases of leiomyosarcoma in ovarian mature cystic teratoma have been reported and this is a unique case report of leiomyosarcoma and squamous cell carcinoma arising in a mature cystic teratoma of ovary. Tip Pongsuvareeyakul, Kornkanok Sukpan, Somjet Chaicharoen, and Surapan Khunamornpong Copyright © 2017 Tip Pongsuvareeyakul et al. All rights reserved. Glomangioma of the Kidney: A Rare Case of Glomus Tumor and Review of the Literature Sun, 18 Jun 2017 09:50:59 +0000 Background. Glomus tumors are rare mesenchymal tumors originating from glomus bodies in the skin. Glomus tumors of the kidney are rare tumors and only a few cases have been reported in the medical literature. An extensive search revealed a very limited number of primary renal glomus tumors. Although most of these cases were benign in nature, including a case with uncertain diagnosis of malignant potential, two were malignant. Case Report. We present a unique case of a 57-year-old male patient with an incidentally discovered 2 cm left renal mass. Histopathology examination and immunohistochemical studies confirm the diagnosis of glomangioma (a form of glomus tumor). The patient was followed for one year after partial nephrectomy and showed a benign course without any evidence of local recurrence or metastasis. Conclusion. To the best of our knowledge, this is the 16th case of primary benign renal glomus tumors. Primary renal glomus tumors are rare and may mimic other mesenchymal renal neoplasms radiologically. Proper investigation (including histopathological analysis and immunohistochemical staining) of kidney tumors is essential to make the diagnosis of glomus tumors, which usually show a benign clinical course following resection. Ammar Almaghrabi, Nizar Almaghrabi, and Haneen Al-Maghrabi Copyright © 2017 Ammar Almaghrabi et al. All rights reserved. PAX8 Distinguishes Diffuse Large B-Cell Lymphoma Mimicking Sarcoma Sun, 28 May 2017 00:00:00 +0000 PAX8 is important for embryogenesis of the thyroid, Müllerian system, and upper urinary/renal tract, and expression of PAX8 has been described in carcinomas from each of these sites. The sensitivity and specificity of the polyclonal PAX8 antibody in a large cohort of epithelial tumors as well as lymphomas have been previously determined, the latter because polyclonal PAX8 is known to be immunoreactive in nonneoplastic B-cell lymphocytes which are often used as the positive internal control for immunohistochemistry. In this case report, PAX8 was a diagnostic clue for revising a previous diagnosis of unclassified high grade sarcoma to diffuse large B-cell lymphoma. This case report demonstrates a pitfall for PAX8 immunoreactivity and acts as a reminder that lymphoma should be included in the differential diagnosis of a PAX8 positive, epithelial cell marker negative tumor of unknown primary origin. Michelle S. Hirsch and Alessandra F. Nascimento Copyright © 2017 Michelle S. Hirsch and Alessandra F. Nascimento. All rights reserved. A Case Report: Gastric Mixed Neuroendocrine-Nonneuroendocrine Neoplasm with Aggressive Neuroendocrine Component Wed, 24 May 2017 06:40:05 +0000 Mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN) is defined as mixed epithelial neoplasms composed of both neuroendocrine and nonneuroendocrine components with variable proportions for each component. Neuroendocrine component can show morphological features including well- or poorly differentiated neuroendocrine neoplasms and nonneuroendocrine component can present different tumor types depending on the site of origin. Recently, studies of tumors have shown that MiNENs are not as rare as our traditional belief, due to the wide application for immunohistochemistry. However, our knowledge of MiNENs is still limited. There is no universal consensus about nomenclature, classification, and guideline of treatment. Hereby, we would like to present a case report of gastric MiNEN with aggressive neuroendocrine component to contribute a small part towards common understanding of gastric MiNENs. Quang Duy Pham, Ichiro Mori, and Robert Y. Osamura Copyright © 2017 Quang Duy Pham et al. All rights reserved. Langerhans Cell Sarcoma: A Case Report Demonstrating Morphological and Immunophenotypical Variability within a Single Lesion Wed, 24 May 2017 06:37:24 +0000 Langerhans cells are antigen presenting dendritic cells and tumours arising from these are rare. The tumours arising from these dendritic cells are divided into two categories according to a WHO classification: Langerhans cell histiocytosis and Langerhans cell sarcoma. It is the degree of atypia and clinical aggressiveness that distinguishes the two subtypes. Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells which can occur in skin, bone marrow, lymph nodes, spleen, liver, and lung. LCS can present with multiple cutaneous and systemic lesions. We present a case of Langerhans cell sarcoma with a unique morphological appearance and variable immunohistochemical profile within a single cutaneous lesion. LCS is a rare malignancy and its diagnosis is based on morphology, immunophenotypical examination, and ultrastructural analysis by electron microscopy. Our case highlights a unique morphological description of LCS wherein the pleomorphic neoplastic cells show epidermotropism and are surrounded by a variable amount of inflammatory infiltrate within a single cutaneous lesion. A single cutaneous lesion of Langerhans cell sarcoma with variable immunohistochemical profile has not been described so far. Rasika Singh, Charles Edward Keen, Christopher Stone, and Patrick Sarsfield Copyright © 2017 Rasika Singh et al. All rights reserved. Primary Renal Carcinoid with Bilateral Multiple Clear Cell Papillary Renal Cell Carcinomas Tue, 23 May 2017 07:48:51 +0000 Clear cell papillary renal cell carcinoma (CCPRCC) is a newly recognized entity in the 2016 WHO classification and usually presents as a small, circumscribed, solitary mass of indolent nature. CCPRCCs could seldom occur in conjunction with other synchronous or metachronous kidney tumors and even less frequently as bilateral masses. To our knowledge, multiple bilateral CCPRCCs have never been described with the existence of a synchronous well-differentiated neuroendocrine tumor of the kidney and hence reported here as a unique case. This case report highlights the importance in considering this entity and its unusual presentation in the differential diagnosis as a possible mimicker of Von Hippel-Lindau syndrome. Daniel A. Anderson and Maria S. Tretiakova Copyright © 2017 Daniel A. Anderson and Maria S. Tretiakova. All rights reserved. Benign Multicystic Peritoneal Mesothelioma: A Rare Condition in an Uncommon Gender Thu, 18 May 2017 00:00:00 +0000 Benign Multicystic Peritoneal Mesothelioma (BMPM) is a rare condition that arises from the abdominal peritoneum. Fewer than 200 cases have been reported worldwide. BMPM usually affects premenopausal women and is extremely rare in men. Many factors are suspected to contribute to its development, such as previous surgery, endometriosis, and familial Mediterranean fever. The main management is surgical resection; however, it is estimated that the recurrence rate is up to 50%. Malignant transformation is rare. We report a case series of three male patients who were diagnosed with BMPM and were treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Muhammad S. Khurram, Hamadullah Shaikh, Uqba Khan, Jacob Edens, Warda Ibrar, Ameer Hamza, Awais Zaka, Roohi Bano, and Tarik Hadid Copyright © 2017 Muhammad S. Khurram et al. All rights reserved. Sporadic Retroperitoneal Hemangioblastoma: Report of a Case and Review of the Literature Thu, 18 May 2017 00:00:00 +0000 We report a case of sporadic isolated hemangioblastoma arising from the retroperitoneum and provide a review of the scarce literature regarding this very rare tumor. Furthermore, we thoroughly describe the pathologic features and the broad differential diagnosis that should always be included in the study of any retroperitoneal soft tissue mass to arrive at the final diagnosis. F. G. Jalikis, B. L. Hoch, R. Bakthavatsalam, and M. I. Montenovo Copyright © 2017 F. G. Jalikis et al. All rights reserved. Keratoacanthoma of the Nasal Septum Secondary to Ranibizumab Use Thu, 11 May 2017 06:24:18 +0000 Keratoacanthoma (KA) is a benign epithelial tumor that typically presents as a firm, cone-shaped, flesh-colored nodule with a central horn-filled crater. KA is considered to be a low-grade variant of squamous cell carcinoma (SCC). We report a rare case of a 72-year-old male who presented with a KA involving the nasal septum, possibly related to ranibizumab use. A flesh-colored lesion on the right anterior nasal septum lesion was visualized on examination. Histologic examination revealed a well-circumscribed, dome-shaped central crater filled with keratin, well-differentiated squamous epithelium with ground-glass cytoplasm with pushing margins, and intraepithelial microabscesses establishing the diagnosis of KA. KA of the nasal septum has only been reported once in the literature. This case is unusual because it normally presents on sun-exposed areas. Additionally, this patient was taking ranibizumab, a vascular endothelial growth factor (VEGF) inhibitor for macular degeneration. Despite ranibizumab not being directly linked to precancerous and cancerous skin lesions, agents in this medication class have been. Although it is difficult to prove associations in this isolated case, the role of ranibizumab causing cutaneous lesions should be further investigated. Jason E. Cohn, Hilary M. Caruso Sales, Giang Huong Nguyen, Harvey Spector, and Kenneth Briskin Copyright © 2017 Jason E. Cohn et al. All rights reserved. Hybrid Desmoplastic/Follicular Ameloblastoma of the Mandible: A Case Report and Review of the Literature Thu, 11 May 2017 00:00:00 +0000 Desmoplastic ameloblastoma (DA) is one of the 6 histopathological subtypes of ameloblastoma. Hybrid lesions in which histopathologically conventional ameloblastoma coexists with areas of DA are rare. A 40-year-old male was referred to our hospital complaining of a swelling in the right premolar region of the mandible. A panoramic radiograph showed an area of radiolucency with a well-defined corticated border, whereas computed tomography revealed a unilocular radiolucent lesion and buccal expansion together with cortical perforation. The lesion was treated via enucleation and curettage of the marginal bone and fenestration. A histopathological examination showed a hybrid ameloblastoma with a pronounced desmoplastic pattern and follicular changes. The patient’s postoperative course has been favorable up to now, and no marked changes have been observed. We presented a case of hybrid ameloblastoma and reviewed the 36 reported cases of hybrid ameloblastoma that have been reported in the English literature. Masayasu Iwase, Airi Fukuoka, Yoko Tanaka, Naoyuki Saida, Eriko Onaka, Sanae Bando, and Gen Kondo Copyright © 2017 Masayasu Iwase et al. All rights reserved. Strongyloides Colitis as a Harmful Mimicker of Inflammatory Bowel Disease Sun, 07 May 2017 07:05:51 +0000 Autoinfection caused by Strongyloides stercoralis frequently becomes a life-long disease unless it is effectively treated. There is overlapping histomorphology between Strongyloides colitis and inflammatory bowel disease; a low index of suspicion can lead to misdiagnosis and fatal consequences. We present a case of Strongyloides colitis mimicking the clinical and pathologic features of inflammatory bowel disease. A 64-year-old female presented to the emergency department with a four-day history of abdominal pain, diarrhea, and hematochezia. Colonoscopy revealed diffuse inflammation suggestive of inflammatory bowel disease, which led to initiation of 5-aminosalicylic acid and intravenous methylprednisolone. Biopsies of the colon revealed increased lymphoplasmacytic infiltrate of the lamina propria with eosinophilic microabscesses and presence of larvae, consistent with Strongyloides stercoralis. Immunosuppressive medication was halted. The patient ultimately died a few days later. This case emphasizes the importance of identifying the overlapping clinical and pathologic features of Strongyloides colitis and inflammatory bowel disease. A high index of suspicion and recognition of particular histological findings, including eosinophilic microabscesses, aid in the correct diagnosis. Definitive diagnosis is crucial as each disease carries distinct therapeutic implications and outcome. Julio Poveda, Farah El-Sharkawy, Leopoldo R. Arosemena, Monica T. Garcia-Buitrago, and Claudia P. Rojas Copyright © 2017 Julio Poveda et al. All rights reserved. Diffuse Alveolar Hemorrhage in Systemic Lupus Erythematosus: Histopathologic Features and Clinical Correlations Thu, 27 Apr 2017 07:56:18 +0000 The case of a 16-year-old African-American girl with systemic lupus erythematosus, who developed diffuse alveolar hemorrhage with fatal consequences, is described. Diffuse alveolar hemorrhage is a rare but serious complication of systemic lupus. It occurs in three distinct but overlapping phenotypes, acute capillaritis, bland pulmonary hemorrhage, and diffuse alveolar damage, each of which is associated with a different group of underlying conditions. Diffuse alveolar hemorrhage is a medical emergency: choice of treatment depends on early diagnosis and determination of the underlying etiology. Acute infection, superimposed on diffuse alveolar hemorrhage in the setting of immune compromise, is often a terminal event, as in this case. Robert Ta, Romulo Celli, and A. Brian West Copyright © 2017 Robert Ta et al. All rights reserved. Primary Villoglandular Mucinous Adenocarcinoma of the Vulva Wed, 19 Apr 2017 00:00:00 +0000 Primary villoglandular mucinous adenocarcinoma of the vulva is rare tumor. We report a case of 68-year-old woman who developed this very uncommon malignant tumor. Immunohistochemical examination of this tumor revealed positive staining for Cytokeratin 20, Mucin 2, and CDX2, although Cytokeratin 7 and Mucin 6 were negative. This positive staining indicated the tumor enteric type characters. In order to exclude the possibility of the metastasis from another site, we thoroughly evaluated clinical data and extensively investigated the whole body. However, we could not detect any other tumors. The patient was treated by tumor resection. The patient remains free of disease 5 years after surgery. Akiko Matsuzaki, Masanao Saio, Noritake Kosuge, Hajime Aoyama, Tomoko Tamaki, Hirofumi Matsumoto, and Naoki Yoshimi Copyright © 2017 Akiko Matsuzaki et al. All rights reserved. Plasmacytoma as a Mimicker of Colonic Carcinoma in an Elderly Man Wed, 19 Apr 2017 00:00:00 +0000 Multiple myeloma is a neoplastic proliferation of monoclonal plasma cells. Although it is usually restricted to the bone marrow, extraskeletal spread in the form of localised extramedullary collections of malignant plasma cells (plasmacytomas) can occur. However, gastrointestinal tract involvement in multiple myeloma is rare and overt gastrointestinal bleeding from plasmacytoma is uncommon. We report a case of colonic plasmacytoma which presented with bleeding per rectum and was initially misdiagnosed as colonic neuroendocrine carcinoma. Later the patient presented with recurrence of the colonic mass along with multiple lytic bone lesions. The diagnosis of colonic plasmacytoma with progression into multiple myeloma was given. We also discuss here the diagnostic difficulty of plasma cell neoplasms in small biopsies of the colon. Sara Mathew George, Eman Ali Aljufairi, Nisha Chandran, and Sayed Ali Isa Almahari Copyright © 2017 Sara Mathew George et al. All rights reserved. Prostate Cancer Presenting as Huge Mediastinal and Retroperitoneal Masses: Case Report and Review of the Literature Thu, 30 Mar 2017 08:11:59 +0000 Mediastinum and retroperitoneum are exceedingly rare sites for metastatic prostate cancer to occur. Here, we present the case of a 67-year-old male patient with incidental findings of mediastinal and retroperitoneal masses which were found to be due to metastatic prostate adenocarcinoma based on histopathology and immunohistochemical studies and later on supported by the significantly elevated Prostate Specific Antigen (PSA) levels. Prostate cancer should always be considered in the differential diagnosis of elderly men presenting with metastatic epithelial tumors even in unusual sites. Safa Alshaikh and Zainab Harb Copyright © 2017 Safa Alshaikh and Zainab Harb. All rights reserved. Borderline Clear Cell Adenofibroma of the Ovary Thu, 30 Mar 2017 07:56:01 +0000 Borderline clear cell tumors are extremely rare, and few cases have been reported in the literature. Herein, we present a case of borderline clear cell adenofibroma of the ovary in a 58-year-old woman who presented with a pelvic mass and constipation. Physical examination revealed a 10 cm solid midline pelvic mass. Computed tomography showed an 8 cm heterogeneous enhancing mass attached to the left posterolateral wall of the uterus. The patient’s serum CA 125 levels were slightly elevated (80.9 U/ml). The patient was given a total abdominal hysterectomy with bilateral salpingooophorectomy. On gross examination, it was found that the left ovarian tumor was an 8.0 7.5 8.0 cm solid multilobulated mass containing tiny cysts. Histologically, the tumor was composed of small glands in dense fibrous and myxoid stroma. The glands were lined with cuboidal cells with clear cytoplasm and mild to moderate nuclear atypia. No stromal invasion was observed. The pathological diagnosis was borderline clear cell adenofibroma of the left ovary. There was no reoccurrence 36 months post operation. Pilaiwan Kleebkaow, Apiwat Aue-aungkul, Amornrat Temtanakitpaisan, and Chumnan Kietpeerakool Copyright © 2017 Pilaiwan Kleebkaow et al. All rights reserved. Microcystic/Reticular Schwannoma of the Frontal Lobe: An Unusual Occurrence Mon, 27 Mar 2017 00:00:00 +0000 Schwannoma is a benign peripheral nerve sheath tumor that typically involves cranial nerves of the head and neck region. Intraparenchymal occurrence of this tumor is uncommon. Even rarer in this site is the microcystic/reticular pattern of schwannoma. This histologic variant, first described in 2008, has a predilection for visceral organs. Herein, we report the first case of microcystic/reticular schwannoma of the frontal lobe. Lauren Pearson, Erinc Akture, Julien Wonderlick, Gregory Fuller, and Maryam Zenali Copyright © 2017 Lauren Pearson et al. All rights reserved. Odontogenic Cyst with Verrucous Proliferation Exhibiting Melanin Pigmentation Mon, 20 Mar 2017 07:36:35 +0000 Verrucous proliferation arising from odontogenic cysts is a rare entity. We report an unusual case of an infected odontogenic cyst with verrucous proliferation and melanin pigmentation in a 13-year-old male patient who presented with an intraoral swelling in relation to impacted teeth 26 and 27. The enucleated lesion was diagnosed as an odontogenic keratocyst and the patient died within two years of presentation due to multiple recurrences. The clinical, radiological, and microscopic features of the lesion are presented with an attempt to discuss the etiopathogenesis. The case hereby reported is uncommon with only eight cases reported in the literature. Nidhi Manaktala, Karen Boaz, Krupa Mehta Soni, Srikant Natarajan, Junaid Ahmed, Keshava Bhat, Nandita Kottieth Pallam, and Amitha Juanita Lewis Copyright © 2017 Nidhi Manaktala et al. All rights reserved. On a Rare Cutaneous Metastasis from a Sacrococcygeal Chordoma Sun, 19 Mar 2017 06:46:19 +0000 Chordomas are rare malignant tumors of notochordal origin and are rare locally aggressive ones with a metastatic potential. The skin rarely is seen as metastatic site. We describe a case of an adult woman with cutaneous metastasis of a primary sacral chordoma excised ten years before, which appeared as a painless cutaneous mass located in the dorsal region. Once removed, the surgical specimen was formalin fixed and in paraffin embedded. Sections were stained with haematoxylin-eosin, and histochemical and immunohistochemical investigations were performed. Histologically, the neoplasia was characterized by cords or single tumor cells with an abundant myxoid stroma, conspicuous pale vacuolated cytoplasm (the classic “physaliphorous cells”), and mild nuclear atypia. Mitotic activity was scanty. At immunohistochemistry, the tumor cells were diffusely positive for S-100 protein, pan-keratins, EMA, and vimentin. A diagnosis of cutaneous metastasis of chordoma was performed. This case illustrates a diagnostic challenge because of the unusual presentation of an already rare tumor. Alessandro D’Amuri, Matteo Brunelli, Federica Floccari, Francesco De Caro, Giuliana Crisman, Francesca Sanguedolce, and Marcello Filotico Copyright © 2017 Alessandro D’Amuri et al. All rights reserved.