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Alvogyl dressing is used to help control hemostasis, foster healing, and prevent complications after certain oral procedures. It is a paste composed of different antiseptic and analgesic substances, and fern-derived Penghawar djambi fibers that have styptic properties. It is claimed to be a resorbable and self-eliminating paste with little complications. However, some studies have demonstrated detrimental effects. We report 3 cases of postextraction nonhealing sockets after Alvogyl dressing. Histologically, they demonstrated residual Alvogyl fibers with foreign body giant cell stromal reaction and complications that were clinically confused with abscess, cysts, infections, and neoplastic lesions. Being unaware of their histopathologic appearances, the foreign bodies in 2 cases were initially confused with fungal hyphae, parasitic ova, vegetable material, and other surgical and nonsurgical materials. To add to our confusion, they were periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) positive, septated, spiked, and calcified. A history of Alvogyl dressing was retrospectively found. Learning from our mistakes and being aware of the histologic manifestations of Alvogyl fibers, the third case was correctly spotted. Because Alvogyl fibers are undissolvable and are not spontaneously eliminated, they may, if left for a long period, elicit tumefactive foreign body giant cell stromal and epithelial reactions that can be confused with inflammatory, infectious, and neoplastic lesions. Histologically, they can mimic infectious agents and noninfectious materials. Because history of dressing is not always provided, pathologists should be familiar with their histomorphologic features to avoid pitfalls and guide clinicians to correct diagnosis and management. In absence of history, certain histologic features are helpful hints.

Intravascular papillary endothelial hyperplasia (IPEH) or so-called Masson hemangioma is a benign nonneoplastic thrombus-associated organizing proliferation. De novo or secondary IPEHs are not uncommon oral lesions. An associated oral phlebolith is uncommon. Oral IPEHs and phleboliths can be diagnostically challenging. Certain histomorphologic features are helpful clues. Immunohistochemistry is a useful confirmatory tool. We present a case of an IPEH with phlebolith in a 37-year-old healthy lady who presented with a nodular lesion of the tongue. Histology showed a calcific nodule associated with an endothelial-lined vascular lesion with histomorphologic and immunohistochemical features of IPEH. The presence of a solitary extruded phlebolith could be challenging for pathologists and could be confused with other oral calculi, particularly sialoliths. The presence of papillary fronds, endothelial-lined minute vascular channels, fibrin thrombi, and hemosiderin pigment on the surface of the calculus points to a calcified thrombus. The lamellated concentric onion ring layers corresponding to Zahn lines around a central calcific nidus is another hint. Phleboliths should be considered by pathologists in their differential diagnosis of oral calculi. Distinction from sialolith is clinically important because the etiology and management are different.

Pilar cysts are common cutaneous cysts of follicular origin. They are easy to diagnose clinically and pathologically. Histologic diagnostic difficulties might arise in certain situations, however. Acute inflammation with total destruction of the cyst wall due to rupture with replacement by an abscess formation, foreign body giant cell reaction, and fibrosis could obscure their recognition. Cysts with hybrid lining epithelium could be confused with other cutaneous cysts. Epithelial remnants of the basal layer with loss of the squamous epithelium and shelled out cyst contents might mimic other epithelial cysts and vascular lesions. Few studies focused on the phenomenon of epithelial remnants or epithelial separation of pilar cysts. We report a case of a scalp cyst composed of a single layer of pigmented cuboidal lining epithelium. The initial differential diagnosis was hidrocystoma, solid-cystic hidradenoma, arteriovenous malformation, and lymphangioma. The intraepithelial pigment was melanin. The lining epithelium was positive for cytokeratin cocktail, CK5/6, CK8, CK19, p63, and D2-40 with scattered S-100 protein and melan-A positive melanocytes. Being unaware of the phenomenon of epithelial split in pilar cysts, it was mislabeled as a melanin-pigmented eccrine hidrocystoma. Surgical pathologists should be aware of pilar cysts' epithelial remnants to avoid potential diagnostic pitfalls. An attention to certain histologic hints and knowledge of the immunoprofile of the basal layer should help pathologists avoid this pitfall.

Primary soft tissue tumors of the head and neck region are relatively uncommon. Most are not distinctive to this region. Benign mesenchymal tumors of the external ear are rare. Some are common tumors but unusual in this location. All of the reported cases were single case reports or small series. Our aim was to study the prevalence and spectrum of different types of benign mesenchymal tumors that involve the external ear in our institution, to find out whether any lesion is distinctive to this site, their potential clinical associations and to highlight their potential diagnostic challenges. We performed a retrospective review study over 13 years. We retrieved 14 cases of external ear tumors. They included two cases of leiomyomas, two hemangiomas, three neurofibromas, two xanthogranulomas, three osteomas, a lipoma and a sclerotic fibroma. The age range was between 8 and 61 years with an average age of 34.2 years. The male to female ratio was 1.3 to 1. The average size was 8 mm. They were miscellaneous uncommon lesions and most were not unique to the external ear. Meatal osteomas and auricular angioleiomyomas are not infrequent with some predilection to the ear. With the exception of neurofibromatosis type-1, they were solitary nonsyndromic lesions. Multiplicity can be a hint to a syndrome. Clinically, benign external ear mesenchymal tumors can be confused with neoplastic and nonneoplastic lesions. Histopathologic examination is needed for proper classification. Benign soft tissue tumors of the external ear are generally easy histologic diagnosis. Immunohistochemistry is needed to confirm the diagnosis in certain tumors showing overlapping features., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Multilocular peritoneal inclusion cysts are mesothelial tumor-like lesions with or without small foci of florid papillary mesothelial hyperplasia that might simulate serous epithelial papillary lesions or well-differentiated papillary mesothelioma (WDPM) of the peritoneum. The papillary cores in papillary mesothelial hyperplasia and in WDPM display a variety of different histomorphologic features. To our knowledge, collagenous spherulosis in WDPM was not previously described or illustrated in the literature. Collagen spherules have been described in several miscellaneous benign and malignant lesions of the breast, prostate, salivary gland, and cutaneous adnexal tumors. They sometimes impose a diagnostically challenging cribriform growth pattern. We report a case of a young adult woman who presented with a large painful palpable multicystic mass in the right iliac fossa and pelvis. Histologically, it showed features of multilocular peritoneal inclusion cysts with an incidental finding of a small nodule demonstrating morphologic and immunohistochemical features of WDPM. The papillary cores revealed uniform homogenous eosinophilic round collagenous spheres with a cribriform pattern. The unusual finding of collagen spherules may expand the morphologic spectrum of mesothelial papillary lesions, the differential diagnosis of female pelvic peritoneal and omental epithelial and nonepithelial lesions and might cause some diagnostic confusion on small specimens. It may also shed some light on the pathophysiology and role of mesothelial and submesothelial stromal cells in the variable morphologic patterns of the stroma of papillary cores in different mesothelial lesions.

Testicular T-cell lymphomas are rare and heterogeneous. Their rarity, nonspecific clinical and radiologic features, histomorphologic heterogeneity, and aberrant immunohistochemical expression may impose diagnostic difficulties for clinicians and pathologists. They may mimic germ cell neoplasms, infectious orchitis, and scrotal abscess. We report a case of a high-grade T-cell lymphoma of the testes in an elderly man with uncontrolled diabetes mellitus. It was clinically and radiologically unexpected and was confused with viral or tuberculous orchitis with abscess formation and systemic sepsis., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Intestinal metaplasia of the urinary bladder can occur within the surface urothelium due to chronic irritation in repaired exstrophic urinary bladder. Colonic villous adenomas and tubulovillous adenomas with high-grade dysplasia and associated adenocarcinoma have been reported in adult patients with a history of augmented exstrophic bladder. To our knowledge, we report the first example of a nonadenomatous serrated hyperplastic colonic polyp in an elderly patient with a history of exstrophic bladder., (Copyright © 2018. Published by Elsevier Inc.)

Primary sarcomas of the larynx are rare and miscellaneous. The most common is chondrosarcoma. Other sarcomas are very rare. Sarcomas can have heterogeneous morphologic features of spindle, small round, epithelioid, pleomorphic and giant cells. Laryngeal sarcomas may mimic carcinomas, lymphomas, small cell carcinoma, mesothelioma and melanoma. This imposes diagnostic challenges for unfamiliar pathologists particularly in small laryngeal biopsies. Our aim was to study the different types of sarcomas that can involve the larynx in our institution, to investigate their diagnostic challenges and potential pitfalls and to find helpful histologic clues to avoid misinterpretation and missed diagnosis. We performed a retrospective review study over 13 years. We retrieved 5 cases of laryngeal sarcomas. They included Kaposi sarcoma, low-grade chondrosarcoma, epithelioid angiosarcoma, polypoid leiomyosarcoma and small cell osteosarcoma. The age range was between 32 and 74 years with an average age of 52 years. The male to female ratio was 3:2. The Kaposi sarcoma and chondrosarcoma were correctly diagnosed. The angiosarcoma was initially missed as recurrent carcinoma. The leiomyosarcoma was initially inferred as polypoid sarcomatoid squamous cell carcinoma. The small cell osteosarcoma initiated the differential diagnosis of high-grade lymphoma, small cell carcinoma, undifferentiated carcinoma, Ewing sarcoma and rhabdomyosarcoma. An implementation of a panel of immunohistochemical markers guided by certain histomorphologic clues was helpful to make the correct diagnosis. Pathologists should be aware of the morphologic spectrum and different growth patterns of laryngeal sarcomas. Immunohistochemistry studies are essential. Correct diagnosis, classification and grading of laryngeal sarcomas are clinically important for the prognosis and appropriate management of patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: Our aim is to study the prevalence of eosinophilic effusions (EEs) in our institution, to highlight their cytologic patterns, potential interpretation pitfalls, diagnostic importance, and to investigate their possible causes and clinical associations., Materials and Methods: We conducted a retrospective review study for over 13 years. We retrieved all of the cytology reports of pleural, pericardial, and peritoneal effusions with eosinophils. We reviewed and screened the cytology slides looking for eosinophils that constitute >10% of the cells. We extracted the clinical, radiologic, and laboratory findings and follow-up data for each patient., Results: We found 12 patients (0.7%) with EEs. They included five pleural, five peritoneal, and two pericardial fluids. The age range was between 16 and 75 with a mean age of 36.5 years. The male to female ratio was 3:1. We have recognized three cytomorphologic patterns; purely eosinophilic, dominantly eosinophilic, and mixed inflammatory infiltrate that correlated with peripheral blood eosinophilia. Two cases demonstrated extracellular and intracellular Charcot-Leyden crystals. Certain cellular and crystal features are potential cytologic pitfalls. EEs were associated with miscellaneous specific and non-specific medical conditions. None was associated with tuberculosis, malignancy, drugs, or parasites., Conclusions: EEs are uncommon. They mostly occur in young adult males. There are three cytomorphologic patterns that correlate with peripheral eosinophilia. Etiologies are diverse or obscure. EEs with a very high eosinophilia are less likely malignant, tuberculous, parasitic, and seldom associated with drugs. Cytopathologists should be aware of certain potential diagnostic pitfalls. Correct cytologic recognition is clinically important since some causes are treatable., (© 2018 Wiley Periodicals, Inc.)

Emboli are common clinicopathologic findings. Recognition of the type of arterial emboli could be the first clue to the original source. Emboli with myxomatous changes are rare. Myxoma-like features in mural organizing thrombi have been reported. The most challenging differential diagnosis is between embolic cardiac myxomas and myxomatous thromboemboli. Emboli from sarcomas and arteriosclerotic plaques with myxoid features are also potential pitfalls. There is scarcity of studies focusing on myxoid emboli and their clinical and pathologic importance. We performed a retrospective study over 12 years. We retrieved all of the embolectomy specimens. We histologically screened the emboli for myxoid stroma, myxomatous changes, and mucinous degeneration. We retrieved 12 cases (3%) of myxoid emboli out of 391 embolectomy specimens. We found 4 cases of thromboemboli, 5 cases of atrial myxomas, 2 cases of atheromatous plaques, and a myxoid liposarcoma. The age range was between 35 and 71 years, with a mean age of 51 years. The male-to-female ratio was 3:2. Myxoid thromboemboli and myxomas were large, while atheromatous plaque emboli were small. Myxoid emboli arising from organizing mural thrombi can be histologically confused with cardiac myxomas and vice versa. Myxoid emboli from atheromatous plaque and myxoid sarcomas can mimic embolizing myxomas. Certain histologic features are helpful hints to differentiate between myxoid emboli. In doubtful cases, immunohistochemistry is helpful. Correct histologic recognition of the different types of myxoid emboli helps guide the clinicians to the most likely etiology and appropriate management in occlusive peripheral vascular diseases with clinically unrecognized lesions.

CD20-negative diffuse large B-cell lymphomas (DLBCLs) constitute a rare and heterogeneous group of aggressive lymphomas. Known well-documented variants include plasmablastic lymphomas, primary effusion lymphomas, anaplastic kinase-positive large B-cell lymphomas, and large B-cell lymphomas arising in human herpesvirus 8 (HHV8)-associated multicentric Castleman disease. They impose diagnostic challenges for pathologists and therapeutic confrontations for clinicians. CD20 loss in B-cell lymphomas is a well-known phenomenon after rituximab therapy. De novo loss of CD20 has been reported in human immunodeficiency virus (HIV)-positive patients. Rare cases of primary CD20-negative DLBCLs that did not meet the criteria of the well-established subtypes of CD20-negative DLBCLs have been reported. This might expand the spectrum of unclassifiable CD20-negative DLBCLs with aberrant genetic and immunophenotypes. This imposes further diagnostic and therapeutic challenges. We report a case of a primary CD20-negative DLBCL in an HIV-infected female patient with an Epstein Barr virus (EBV) coinfection, who presented with generalized lymphadenopathy and fever. The nodal neoplastic immunoblasts were positive for LCA, PAX5, CD30, OCT2, BOB1, MUM1, CD79a, and CD19. Ki67 proliferation index was 100%. They were negative for CD20, CD3, ALK, EMA, CD138, CD38, EBV, and HHV8. Our case did not meet the criteria of the known variants of CD20-negative DLBCLs. The aim of this study is to highlight the diagnostic challenges associated with CD20-negative DLBCLs. De novo unclassifiable CD20-negative DLBCLs might raise an insight into the complex genetic mechanisms of CD20 concealment with variable immunoprofiles and resistance to conventional chemotherapies.

Classic Hodgkin lymphoma (CHL) has four subtypes. Different morphologic variations can be seen in lymph nodes involved by CHL. Primary interfollicular (IF) involvement is not considered a separate subtype but an unusual diagnostically challenging morphologic variant. Our aim was to study the prevalence of IF growth pattern and coexistence of other morphologic variants in lymph nodes involved by CHL, to investigate the diagnostic challenges and clinical importance of this growth pattern, and to find helpful histologic clues in cases with subtle morphologic features to help avoid misinterpretation and missed diagnosis. We performed a retrospective review study over 10years. We searched for diagnosed cases of nodal CHL. We retrieved and reviewed cases of CHL with IF involvement. The clinical and pathologic features of each case were collected and compared. We found 103 cases of CHLs. Eight cases (7.8%) demonstrated IF growth patterns. The age range was between 3 and 48years with an average age of 26years. The male to female ratio was 7:1. Six cases were mixed cellularity HLs. Three cases had associated epithelioid granulomas, one had follicular involvement and one had an associated. HHV-8 negative plasma cell rich Castleman disease. One case was initially missed as benign follicular hyperplasia, one case was referred as CD and three cases were initially suspected as HL. IF growth pattern in nodal CHLs can be missed because it can be mild and focal with subtle morphologic features. The presence of epithelioid histiocytes, eosinophils and other coexistent morphologic variants are helpful histologic clues. In doubtful cases, immunohistochemistry study is essential. The majority were early stage cervical node MCHLs in young adults and children. Pathologists should be aware of this possibility when examining reactive lymph nodes. The clinical significance is limited and needs further validation by larger studies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma which has been recognized to have a variable clinical presentation and a broad spectrum of histomorphologic features. Its variable histomorphologic appearances are sometimes diagnostically challenging for the pathologists since they can mimic sarcomas, melanomas and undifferentiated carcinomas. To our knowledge, a previous case of axillary soft-tissue mass of ALK-positive ALCL with an alveolar growth pattern has been so far reported in the literature. This alveolar appearance is unusual for ALCL. It can impose a diagnostic pitfall, particularly in extranodal soft-tissue masses. We report a case of ALK-negative ALCL that presented as an extranodal soft-tissue neck mass in an adult man. Histologically, it showed a characteristic alveolar growth pattern composed of well-defined nests of dyscohesive highly pleomorphic large neoplastic cells separated by thin fibrovascular septae. Morphologically, it mimicked sarcomas, carcinomas, melanoma and germ cell neoplasms. Initially, a histologic diagnosis of ALCL was not considered. However, the negative immunomarkers for the above mimickers and the strong CD30 positivity have raised the suspicion of anaplastic lymphomas. Further immunohistochemistry studies showed the neoplastic cells to be positive for CD4 and CD43. This case report emphasizes the potential diagnostic pitfalls associated with an ALK-negative ALCL when manifests as a soft-tissue mass with an alveolar growth pattern. Pathologists should be aware of this uncommon growth pattern in ALCLs. They should implement a broad panel of immunomarkers in soft-tissue masses of anaplastic pleomorphic cells with an alveolar morphology.

Glandular odontogenic cyst (GOC) is a relatively rare but well-described clinicopathologic entity. Its rarity and unpredictable clinical behavior are challenging to managing clinicians. Its variable and overlapping histomorphologic features are also diagnostically challenging for pathologists. Other odontogenic cysts and oral cystic neoplasms can simulate GOC. There are specific histologic criteria that help distinguish GOC from other mimickers. To our knowledge, the phenomenon of hemosiderin pigments deposition within the lining glandular epithelium of GOC has not been covered in detail or specifically reported so far in the literature. We report a case of nontraumatized anterior mandibular GOC in a middle-aged male, which histologically showed hemosiderin pigments within the lining epithelium without stromal siderophages. This finding might reflect a nonspecific spontaneous intraluminal hemorrhage. However, intraepithelial hemosiderin in GOC may be an additional helpful diagnostic clue of GOC in challenging cases since this phenomenon has not been reported in other mimicker cystic lesions.

Epithelioid granulomas, epithelioid histiocytes, and occasional multinucleated giant cells are recognizable pathologic findings in lymphomas, particularly in Hodgkin lymphomas. The giant cells could be neoplastic and nonneoplastic. The nonneoplastic giant cells are of different histogenesis. They include, in the majority of cases, histiocytes. Usually, they are minor easily recognizable components of the nodal lymphomas. To our knowledge, low-grade B-cell non-Hodgkin lymphomas with numerous multinucleated histiocytic giant cells without epithelioid granulomas or crystals formation have not been previously reported. This might present a diagnostic challenge for the unwary pathologists since the diagnostic workout will be focused on the giant cells that might mask the apparently mixed bland-looking neoplastic lymphocytic background. We report a case of a 24-year-old woman who presented with generalized lymphadenopathy, organomegaly, and B-symptoms. The lymph nodes were enlarged and diffusely effaced with a striking feature of numerous multinucleated giant cells with a background of apparently mixed population of small lymphocytes and plasma cells. Initially, the diagnosis of a small low-grade lymphoma was histologically missed and the focus was on the differential diagnoses of the giant cells. Immunohistochemistry and flow cytometry raised the suspicion of masked small lymphocytic lymphoma that was subsequently confirmed by molecular studies. The rarity of small lymphocytic lymphoma and the unusual histologic features in this case confounded the clinical and pathologic diagnosis.

Background: Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure to reduce weight in morbidly obese patients, with an overall low rate of complications and thus gaining a worldwide popularity. It provides an opportunity to study the pathology of the stomach in obese patients. Most studies, however, focused on clinical aspects, surgical techniques, and postoperative complications. Few authors studied the histopathologic findings. Whether routine histopathologic examination is warranted in patients with grossly unremarkable LSG specimens and nonsignificant clinical history was not previously studied., Methods: We conducted a prospective study over 8 years to compare the prevalence, the morphologic spectrum and importance of histopathologic findings, and the frequency of incidental neoplasms in LSG specimens with other studies. We also proposed a protocol for the gross handling and sectioning of LSG specimens., Results: We found 546 LSG specimens. Five patients developed iatrogenic postoperative complications, two of which pursued a medicolegal case. There was no association between the histopathologic findings and the complications. Less than 1 % of incidental benign lesions were found. No malignancies were identified. All of the patients without postoperative complications had uneventful outcome after 5 months to 6 years follow-up., Conclusions: Routine microscopic examination of all LSG specimens is not necessary. Selective microscopic examination guided by relevant clinical history and macroscopic examination is a better option. This protocol will save money, time, and workload without compromising patient's safety and future management. However, a careful gross description is still necessary in certain cases for potential future medicolegal implications.

The practice of self-injection of anabolic steroids (AS) in bodybuilders is common. AS are not the only materials used by bodybuilders for muscle augmentation or image enhancement. Other materials, for example, plant oils, silicon, Vaseline, and paraffin are also injected either in a pure form or mixed with AS. Muscle bulking is the main aim. However, bodybuilders undergo illicit injections for cosmetic, therapeutic, and sexual purposes. Even though the practice of unsupervised injection is probably common in the sports community, site-specific complications are underreported in the medical literature and mostly limited to case reports. Complications can be clinically and pathologically challenging because some can be confused with nonneoplastic and, more important, with neoplastic lesions. Bodybuilders are reluctant to disclose information because of stigma and legal issues. This study attempts to correlate the clinical manifestations and histomorphological features of different injected materials used for different purposes by bodybuilders in our region. A series of 11 cases out of 9 male bodybuilders was studied. A variety of clinical presentations and histological tissue reactions was identified, with some overlapping features between some cases. We identified 5 basic tissue reaction patterns depending on the injected materials, site, and duration of injection. Certain histological features provide useful hints in the absence of prior knowledge of injection history. However, in other cases, a retrospective enquiry by clinicians is warranted to avoid pitfalls. The medical and sports community should be aware of these injection-site complications. Bodybuilders should be discouraged from this practice by implementing appropriate educational and legislative measures., (© The Author(s) 2014.)

Even though actinomyces are common oral commensals, actinomycosis is an uncommon oral infection. Cheek dimple creation is a common surgical procedure with rare complications. Bacterial infection with abscess formation and foreign body reaction were reported. We report a rare example-and, to our knowledge, the first-of oral actinomycosis after cheek dimple creation. A young woman complained of a chronic tender nodule of the right buccal mucosa with pus discharge after surgery for cheek dimple creation. Histologic examination showed a sinus tract with actinomyces microorganisms. This complication can be mimicked by other oral or dental sinus-forming lesions, can be chronic and insidious, and could therefore clinically be missed or mistreated. This might delay the diagnosis and cause scarring and disfigurement. The treatment of choice is early recognition and complete surgical excision to avoid irreversible complications and prevent recurrence. Awareness of this potential complication by aesthetic surgeons, oral clinicians, and dentists is important. Patients' adherence to preventive measures and plastic surgeons' application of inclusion criteria and contraindications, as well as their choice of best technique per patient, should help minimize such a problem in a simple and safe aesthetic procedure. LEVEL OF EVIDENCE 5:, (© 2014 The American Society for Aesthetic Plastic Surgery, Inc.)

Langerhans cell histiocytosis (LCH) involvement of the gastrointestinal tract (GIT) is rare. The infiltrate in a colonic biopsy can be dissimilar to classic cytomorphologic features. It could be patchy, restricted to the subepithelial lamina propria and the lesional cells might have prominent nucleoli with lymphocytes-dominant background. The GIT manifestations could be confused with infectious, allergic, immunodeficiency and inflammatory bowel diseases. The rarity of GIT lesions, unawareness of some atypical endoscopic and histologic features might lead to false negative results. We report a case of LCH in an 11-month-old baby that was clinically unsuspected and histologically overlooked.

We aimed to investigate the prevalence and spectrum of unusual benign neoplasms and tumor-like lesions presenting as vulvar polyps and papules, to study their clinical, pathologic, hormonal, and developmental features and whether they have important associations with other pathologic lesions or clinical diseases. We conducted a retrospective review study of 115 vulvar specimens over 7 years. Common lesions, for example, fibroepithelial polyps, skin tags, papillomas, abscesses, viral warts and common cysts, were excluded. We found 21 cases (18%) with uncommon benign vulvar lesions. They included 7 epithelial cysts, 3 vascular lesions, 3 glandular neoplasms, 3 endometrioses, 1 caruncle, 1 pilonidal sinus, 1 prolapsed urethra, 1 seborrheic keratosis, and 1 granular cell tumor. The age range was between 1 and 64 years with a mean age of 33 years. Most (86%) were 2.5 cm or less. Many were asymptomatic incidental pathologic findings that can be missed clinically. Nine cases have important clinical associations or coexisting incidental pathologic lesions. Some lesions demonstrated hormone receptors. Some were clinically confused with fibroepithelial polyps, abscesses, warts, melanocytic lesions, and tumors. In conclusion, although the vulva is a small compartment, its developmental and histologic complexity can result in a variety of unusual and rare benign polypoid and papular lesions, some unique to the vulva, which might present diagnostic challenges to the clinicians and pathologists. In addition, many bear controversy regarding their histogenesis and origin of development in the vulva., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Nonepithelial and nonmelanocytic anal neoplasms are uncommon. The majority are mesenchymal tumors, most of which are malignant sarcomas, particularly leiomyosarcomas and gastrointestinal stromal tumors. Benign mesenchymal anal neoplasms are even rarer. The most common reported cases were anal leiomyomas, granular cell tumors, fibroadenomas, and xanthogranulomas. Benign fibrous histiocytomas (BFHs) or dermatofibromas are common mesenchymal cutaneous tumors that occur in different sites and at any age. Review of the literature did not show previous reports of BFH arising in the anal canal region. We report the first case of a solitary BFH, an unexpected occurrence of a common tumor type presenting as a polyp in an unusual site such as the anus. This rare occurrence can present diagnostic challenges for the surgeons and pathologists. Clinically, it can be confused with the usual anal tags, fibroepithelial polyps, or hemorrhoids. Benign fibrous histiocytoma is a neoplasm with a potential of local recurrence and, therefore, carries certain clinical implications for the patients' management and follow-up when compared with the common nonneoplastic causes of anal polyps such as the anal tags of anal fissures, hemorrhoids, or fibroepithelial papilla. Histologically, it should be differentiated from other histiocytic lesions. This can be resolved by the application of certain histologic features with the appropriate immunohistochemical markers taken within the correct clinical context., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Epithelial cystic neoplasms of the epididymis are rare, the commonest is papillary serous cystadenoma. Recently, few cases of epididymal nonpapillary serous cystadenoma (NPSC) were reported. They have unique histomorphologic and immunohistochemical features that help distinguish them from other cystic lesions of the paratestis. All the reported cases presented as a single unilateral epididymal cyst. We report a unique example and, to our knowledge, the first case of multiple bilateral NPSC of the epididymis. Moreover, it showed a pigmented epithelium., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Even though apoptotic bodies (ABs) are frequent in colorectal adenomas, their relevance has been covered only in a few studies. Focal active cryptitis (FAC) is a well-known manifestation of several etiologies; however, its prevalence and significance in colonic adenomas were not scrutinized. Likewise, whether the neutrophilic infiltrate of the lamina propria (LP) in colonic adenomas has a clinical or pathologic significance was not previously studied. We attempted to investigate the prevalence and importance of ABs in the cryptal epithelium and of neutrophils in the form of FAC and in the form of LP infiltrates in conventional colorectal adenomas. We conducted a retrospective review study over a 6-year period. We collected 223 conventional adenomas from 156 patients. We studied the interrelationship between these 3 histologic parameters and their potential association with other clinical and pathologic variables. Comparison controls included normal colonic mucosa, hyperplastic polyps, serrated adenomas, and flat adenomas. We found 91 (41%) adenomas to have crypt apoptosis, 40 (18%) to have FAC, and 69 (31%) to have neutrophilic infiltrate of the LP. We found ABs to be more frequent in high-grade adenomas. LP neutrophilic infiltrate was significantly associated with high-grade adenomas and in high-grade adenomas with invasive foci. In contrast, FAC was not associated with high-grade adenomas and was secondary to bowel preparations and drugs. Crypt apoptosis and LP neutrophils might have a potential prognostic value in predicting the biologic behavior of colonic adenomas. FAC in adenomas is a nonspecific finding of no prognostic significance and is related to external stimuli.

Mesenchymal anal and perianal tumors are relatively uncommon. The majority are malignant. Benign mesenchymal anal tumors are rare. Some are common stromal neoplasms, but with the rare presentation as anal polyps. Other lesions are rare, but unique to the anal/perianal region. Common keratinous cysts might uncommonly present as anal polyps, while other rare cysts are unique to the anogenital region. A retrospective review study of 493 anal and perianal specimens conducted over seven years showed twenty cases (4.0%) of benign anal polypoid lesions. We excluded the usual fibroepithelial polyps, anal tags, papilla, hemorrhoids and warts. We found six cysts, three lipomas, two papillary hidradenomas, two melanocytic nevi, one hamartoma, one xanthogranuloma, one seborrheic keratosis, one hematoma, one fibrous histiocytoma, one granular cell tumor and one lymphangioma. The male to female ratio was 1.5:1. They were found in adults (mean age 37.8 years) and in infants (mean age 2.4 years). In general, they were smaller than 2 cm. They were either asymptomatic or presented with anal pain, bleeding or lumps. Some were clinically confused with the more common non-neoplastic anal tags, hemorrhoids and fibroepithelial polyps/papilla. A variety of common and rare benign lesions might present as anal polyps with important surgical and pathologic challenges and implications., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

Intramammary lymph nodes (IntraMLNs) are frequent mostly benign incidental findings. However, they are clinically important because they can be the primary sites of metastasis and sentinel lymph nodes. Literature data regarding the clinical significance of IntraMLNs metastasis, however, remains controversial. This study aimed to perform a systematic review and meta-analysis to better define the prognostic value of positive IntraMLNs in patients with breast cancer. A systematic review of the literature without date restrictions was conducted. Five electronic medical databases were searched, and a hand-search of the reference lists of the collected articles was also performed. Studies with sufficient and relevant pathologic and clinical survival data were included. Other studies with insufficient data or normal findings were excluded. This study found 18 studies eligible for systematic review, 3 of which were eligible for outcome meta-analysis. IntraMLNs metastases were strongly correlated with axillary lymph nodes involvement. Positive IntraMLNs are reliable predictors of axillary lymph node involvement and therefore a guide for further surgical management of the axillary nodes. Even though it could be concluded that IntraMLNs metastasis is an independent predictor of outcome, this meta-analysis was limited because of the scarcity of data and the inconsistencies and heterogeneity of the outcome studies.

To compare the frequency of abnormal cervical cytology in women with systemic lupus erythematosus (SLE) with that of healthy women without connective tissue diseases by using ThinPrep® liquid based Pap Tests(TM) . A retrospective case-control study over 2 years was conducted. The cases included all women with SLE who had Pap tests during their treatment period. The control group included all women without SLE or other connective tissue diseases (CTDs) that had routine Pap tests in the same period. The age and demographic features were adjusted and matched for both groups. Statistical analysis included Chi-Square test and Fischer exact test. The SLE group (n= 55) showed significantly (P < 0.05) more abnormal cervical squamous epithelial abnormalities [14 positive cases (25.4%) than the controls (n = 8,175, with 285 positive cases (3.5%)]. Women with SLE had statistically significant higher frequency and prevalence of squamous intraepithelial lesions than women without SLE of similar age and demographic background. The data suggested that women with SLE might benefit from more frequent cervical cytology screening., (Copyright © 2010 Wiley-Liss, Inc.)

Small round cell mesenchymal component in breast metaplastic carcinoma is very rare and could be confused with other small round cell neoplasms of the breast. Synovial sarcoma exceptionally involves the breast and rarely may show a poorly differentiated small round cell component. These unusual small round cell components in biphasic metaplastic carcinoma and synovial sarcoma as well as collision tumor of ductal carcinoma and Ewing sarcoma might have overlapping clinical, histologic and immunohistochemical features which make distinction between these neoplasms difficult for the pathologists. Separation between these neoplasms is important for the treating oncologists because each tumor type has different prognostic implications and treatment modalities. Certain immunohistochemical markers might help, but cytogenetics study is the final confirmatory test. We report a unique example of a biphasic breast neoplasm in a 43-year-old woman that showed a combination of a minor central component of adenocarcinoma distinct from the bulky surrounding component of small round cell tumor. The histologic and immunohistochemical features were overlapping between metaplastic carcinoma, poorly differentiated synovial sarcoma and a composite collision tumor of invasive ductal carcinoma and Ewing sarcoma.

Objectives: Evidence-based medicine (EBM) relies on systematic review (SR), meta-analysis (MA) and randomized controlled trials (RCTs). These EBM tools are more commonly used in clinical medicine than in laboratory medicine. The extent of their use in cytopathology is not clear. The purpose of this study was to investigate the frequency of SR, MA and RCTs in cytopathology compared to other laboratory and clinical medicine specialties., Study Design: A literature-based search for SRs, MAs and RCTs in cytopathology was performed. Several electronic databases were searched without date restrictions. Four journals in cytopathology, pathology and clinical medicine were also searched over 6 years., Results: Gynecology cytology utilized SRs, MAs and RCTs more frequently (83%) than nongynecology and fine needle aspiration cytology. Cytopathology, histopathology and laboratory medicine journals showed comparable rates of 0.5-1.1% in papers reporting SRs, MAs and RCTs. Specialty medical journals showed a higher rate of 5.6% and general medical journals showed a much higher rate of 30%., Conclusions: SR, MA and RCTs are less frequently utilized in pathology than in clinical medicine. Cytopathologists should be more aware of the benefits of SR and MA in resolving uncertainties and improving the clinical applicability of level III diagnostic studies., (Copyright © 2012 S. Karger AG, Basel.)