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Case Presentation: A 72-year-old man underwent endoscopic resection of a 10-mm polypoid sessile lesion of the rectum. Histologic examination found a well-differentiated, low-grade (G1), neuroendocrine tumor. A thoracoabdominal CT scan was performed for staging purposes. The chest CT scan revealed a so-called cannonball-like distribution of multiple rounded nodules, with well-defined margins, ranging from 0.5 to 5 cm, scattered in both lungs (Figs 1A, 1B). The abdominal CT scan showed no abnormalities. A recent colonoscopy showed no evidence of malignancy. No prior chest imaging was available and the patient had never complained of respiratory symptoms. The patient was a former smoker, with a smoking history of 20 pack-years. He had a history of hypertension, mild stenosis of both carotid arteries, and benign prostatic hypertrophy. He reported the presence of long-standing multiple cutaneous hemangiomas on the trunk and face and a larger hemangiomatous lesion on his left lower limb, which was previously investigated by color Doppler ultrasound imaging. All these lesions were reported as unaltered and unchanged since early infancy. [ABSTRACT FROM AUTHOR]

Background: Intravascular lymphoma is a rare type of non-Hodgkin lymphoma mostly of B-cell lineage. A few cases of intravascular lymphoma have been found to be of NK/T-cell origin, mainly affecting the skin and central nervous system.Case Presentation: A 54-year-old Caucasian man sought care because of a 2 weeks history of jaundice and intermittent fever, not responsive to antibiotics and antipyretics. Laboratory tests showed low blood oxygen concentration and pancytopenia. Serum microbiological tests were negative. Computerized tomography (CT) scan revealed hepatosplenomegaly and diffuse ground-glass opacities in both lungs without interlobular septal thickening. Despite oxygen therapy, the clinical conditions rapidly deteriorated leading to death 3 days after admission. Autopsy revealed a multiorgan involvement by an Epstein-Barr virus positive NK/T-cell lymphoma, strikingly growing within the blood vessel lumina, in absence of skin lesions.Conclusions: The current case highlights the pathological features of this rare entity, the protean clinical presentation of which is often misleading, resulting in delayed diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The paradigm of mutually exclusive alterations among oncogenic drivers in non-small-cell lung cancer (NSCLC) is challenged by the increasing evidence of detection of two or more driver alterations in the same tumor using highly-sensitive molecular assays. We report here two cases of ALK -rearranged adenocarcinomas harboring concomitant exon 2 K-RAS mutations (G13D and Q61H). The patients, a 49-year-old smoker man and a 59-year-old non-smoking woman, experienced a rapid disease progression and primary resistance to crizotinib. Search for similar cases in the literature reveals that concomitant K-RAS mutations and ALK rearrangement occur in a subset of NSCLC and seems to lead to resistance to crizotinib. Among 8 similar cases receiving crizotinib previously reported (4 in first line and 4 in second line), 1 had a partial response, 1 stable disease and 6 disease progression. One patient still had progression disease when switching to ceritinib. At the end, K-RAS mutations seem to represent a negative predictive marker in ALK -rearranged adenocarcinomas treated with ALK inhibitor. [ABSTRACT FROM AUTHOR]

The occurrence of secondary EGFR mutation T790 M in exon 20 and histologic “transformation” are common mechanisms underlying resistance to EGFR first- or second-generation tyrosine kinase inhibitors (TKI). We describe here on a hitherto unreported mechanism of EGFR TKI resistance synchronously combining squamous-cell carcinoma change and occurrence of the EGFR exon 20 S768I secondary mutation in a 43 year-old woman with stage IV adenocarcinoma harbouring EGFR exon 21 L858R mutation. After 8 months of response to gefitinib, the patient experienced EGFR TKI resistance and died of leptomeningeal neoplastic dissemination. [ABSTRACT FROM AUTHOR]

Oncogenic drivers in lung non-small-cell lung cancer (NSCLC) are considered mutually exclusive, but a review of the literature reveals that concomitant EGFR mutations and ALK rearrangement may occur in a subset of NSCLC. We report here a case of pulmonary adenocarcinoma with concomitant EGFR mutation in exon 21 (L858R) and ALK rearrangement in naive and relapsed tumors. Tumor cells seem to harbor both gene alterations and the patient had a long-lasting response both to EGFR inhibitor in second line and ALK inhibitor once tumor progressed. A speculative discussion on molecular mechanisms underlying this uncommon phenomenon and practical points about epidemiologic, clinicopathologic features and therapeutic options in this intriguing subset of double-positive tumor are reported. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15-year-old female African with the diffuse large B cell lymphoma and schistosomiasis. It discusses its recommendation of chlorambucil with first-line treatment of chronic lymphocytic leukemia (CLL), her medical history having tuberculosis of left tibia in childhood.

The article presents a case study of 27-year-old, Moroccan, woman was admitted to hospital for cesarean delivery prescribed for umbilical cord prolapse and membrane rupture at 40 weeks. Her abdominal computed tomography (CT) and magnetic resonance imaging (MRI) evidenced partially cystic mass of the liver, considered to be suspicious for hydatic cyst. It mentions amniotic fluid embolism (AFE) is a well-known and feared complication of pregnancy leading to intrapartum.

The article presents a case study of a 61-year-old woman with progressive worsening dyspnea and dry cough without fever. Topics discussed include results of various medical examinations; complications due to dyspnea and dry cough; and the usage of computed tomography scan, pulmonary resection and histology in the treatment.

The article presents a case study of a 70-year-old man who was diagnosed with multiple myeloma with multilobated/multinucleated plasma cells after experiencing severe back pain and fatigue. Particular focus is given on the diagnosis of the patient's disease after undergoing serum electrophoresis, magnetic resonance imaging, bone marrow biopsy, whole body radiographic scan and immunohistochemistry.

The article presents a case study of a 75-year-old male with mild pancytopenia, clinical history included a cutaneous lesion. It discusses the trephine biopsy showed a hypercellular marrow with a diffuse proliferation of medium-/large-sized cells with a high nuclear-cytoplasmic ratio. It discusses the Rosai-Dorfman disease Involving bone marrow in association with acute myeloid leukemia. It also mentions the identification of sinus histiocytosis with massive lymphadenopathy.

Context.-- Diffuse parenchymal lung disease (DPLD) is a well-recognized complication of systemic connective tissue disease (CTD) but rarely arises in patients with psoriasis or psoriatic arthritis, a poorly understood phenomenon. Objective.-- To characterize DPLD associated with psoriasis or psoriatic arthritis, with or without prior immunomodulation. Design.-- Pathology consultation files were searched for patients having psoriasis or psoriatic arthritis and DPLD. After excluding cases with active infection or smoking-related DPLD only, 44 patients (22 women; median age, 60 years; range, 23-81 years) were enrolled. Clinical history and pathology slides were reviewed. Results.-- Twenty-seven of 44 patients (61%) had psoriatic arthritis; the remainder had psoriasis alone. Most presented many years later with nonspecific respiratory symptoms. Nearly one-third had no prior immunosuppression, and most had no concomitant CTD. Radiographically, ground-glass opacities, consolidation, and/or reticulation were typical. Histologically, nonspecific interstitial pneumonia and unclassifiable fibrosis were seen in 24 patients (55%) and 8 patients (18%), respectively; usual interstitial pneumonia and airway-centered fibrosis were rare. Superimposed acute lung injury was common, usually manifesting as organizing pneumonia. Lymphoplasmacytic infiltrates, lymphoid aggregates, and chronic pleuritis were frequent. Interstitial granulomas were seen in 17 patients (39%) but were usually rare, poorly formed, and nonnecrotizing. No histologic differences were apparent among patients with or without concomitant CTDs or prior therapy. Conclusions.-- Some patients with psoriasis or psoriatic arthritis develop clinically significant DPLD, even without prior therapy. Histopathologic findings mirror changes seen with other CTDs. Additional studies are warranted to clarify the association between psoriasis or psoriatic arthritis and DPLD. [ABSTRACT FROM AUTHOR]

Pulmonary minute meningothelial-like nodules (MMNs) are common incidental findings in surgical specimens, consisting of tiny proliferation (usually no larger than 5–6 mm) of bland-looking meningothelial cells showing a perivenular and interstitial distribution, sharing morphologic, ultrastructural, and immunohistochemical profiles with meningiomas. The identification of multiple bilateral MMNs leading to an interstitial lung disease characterized by diffuse and micronodular/miliariform patterns radiologically allows the diagnosis of diffuse pulmonary meningotheliomatosis (DPM). Nevertheless, the lung is the most common site of metastatic primary intracranial meningioma, and differential diagnosis with DPM may be impossible without clinic–radiologic integration. Herein, we report four cases (three females; mean age, 57.5 years) fitting the criteria of DPM, all incidentally discovered and histologically evidenced on transbronchial biopsy (2) and surgical resection (2). All cases showed immunohistochemical expression of epithelial membrane antigen (EMA), progesterone receptor, and CD56. Notably, three of these patients had a proven or radiologically suspected intracranial meningioma; in two cases, it was discovered before, and in one case, after the diagnosis of DPM. An extensive literature review (44 patients with DPM) revealed similar cases with imaging studies excluding intracranial meningioma in only 9% (4 of 44 cases studied). The diagnosis of DPM requires close correlation with the clinic–radiologic data since a subset of cases coexist with or follow a previously diagnosed intracranial meningioma and, thus, may represent incidental and indolent metastatic deposits of meningioma. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the expression of napsin A in pulmunary sclerosing haemangioma (SH).

Inflammatory myofibroblastic tumors (IMT) in the head and neck region are rare neoplasms that generally mimic benign/low-grade neoplasms. Overexpression of anaplastic lymphoma kinase (ALK) has been reported in 50% of IMT cases, secondary to ALK activation by structural rearrangements in the ALK gene, which results in a fusion protein with echinoderm microtubule associated protein like 4 (EML4) in ~20% of cases. The present study describes a case of a 74-year-old woman with a malignant IMT in the right posterior hypopharynx harboring a previously unreported chromosomal rearrangement resulting in EML4 and ALK gene fusion. Strong ALK immunoreactivity was observed in neoplastic cells, while fluorescent in situ hybridization combined with fluorescent fragment analysis and direct sequencing identified the first case of the 3a/b variants of the EML4-ALK fusion gene in IMT. The results of the current study highlight the uncommon occurrence of ALK-positive IMT in the head/neck region and demonstrate the importance of integrating different molecular methodologies to identify unequivocal gene fusion characterization. [ABSTRACT FROM AUTHOR]

Background and Aims Bronchial fibroepithelial polyp is an uncommon, poorly recognised lesion, lacking clear diagnostic criteria at histology, but possibly mimicking neoplastic growth on clinico-radiologic and histopathological grounds. The aim of this study was to define the clinico-pathological features, bronchoscopic appearance and treatment of bronchial fibroepithelial polyp. Methods We collected the largest series of bronchial fibroepithelial polyps (15 consecutive cases), including clinico-pathological, bronchoscopic, radiologic and histological features. Results Overall, there were 13 males and 2 females, with a mean age of 68 years at diagnosis. Eight patients were asymptomatic, whereas four presented with haemoptysis, two with fever, cough and pneumonia-like opacity, and one with dry recurrent cough. Mean size of the lesion was 6.5 mm (range, 2-20 mm) without any prevalence for segmental bronchi. Lesions larger than 10 mm were always symptomatic and visible at computed tomography scans. At bronchoscopy, the lesion appeared as a firm endobronchial nodule with hard consistency and glistening, whitish, smooth surface. A multilobulated and sepimentated surface was observed in the largest polyps. Whatever the size, histological features were quite similar in all cases, consisting in a polypoid lesion with a dense, collagenous, hypocellular stroma with some thin-walled, ectatic vessels and a regular respiratory mucosa on surface. In-situ hybridisation with human papillomavirus probe was negative in all the eight tested cases. Conclusion Despite the benign behaviour of bronchial fibroepithelial polyps, it is important to fix some robust diagnostic criteria in order to avoid misdiagnoses leading to unnecessary aggressive treatment. Differential diagnosis mainly includes inflammatory polyps, hamartomas and papillomas. [ABSTRACT FROM AUTHOR]

Rossi G, Gasser B, Sartori G, Migaldi M, Costantini M, Mengoli M C, Piccioli S, Cavazza A & Rivasi F (2012) Histopathology 60, 1133-1143 MUC5AC, cytokeratin 20 and HER2 expression and K-RAS mutations within mucinogenic growth in congenital pulmonary airway malformations Aims: To analyse the expression of several mucins (MUC1, MUC2, MUC3, MUC5AC and MUC6), epidermal growth factor receptor (EGFR), v-erb-b2 erythroblastic leukaemia viral oncogene homologue 2 (HER2), thyroid transcription factor-1 (TTF-1), caudal type homeobox 2 (CDX2) and cytokeratin 20 (CK20), and the presence of mutations of EGFR, KRAS and HER2 in congenital pulmonary airway malformations (CPAM). Methods and results: Forty-one cases of CPAM and six pulmonary sequestrations were included. TTF-1 expression was observed in all cases but was not seen in mucinogenic growths in CPAM. CDX2 expression was completely negative. MUC1 expression was noted in 12 (29%) CPAM and in 33% sequestrations. MUC5AC was noted in only five cases (26%) by immunohistochemistry and was found in the mucinogenic proliferations of type 1 CPAM. No immunolabelling was noted for the other mucins. EGFR was expressed variably in almost all cases, while HER2 and CK20 was seen exclusively in the mucinogenic proliferations. All mucinous growths were characterized by KRAS mutations. No EGFR and HER2 gene alterations were identified. Conclusions: KRAS mutations and MUC5AC, CK20 and HER2 expression was seen in all mucinogenic proliferations, supporting the neoplastic nature of these cytologically bland growths. These findings emphasize the importance of complete surgical resection of such lesions. [ABSTRACT FROM AUTHOR]