Search

Background: Charcot neuropathic arthropathy is a debilitating, rapidly destructive degenerative joint disease that occurs in diabetic, neuropathic midfoot. Clinicoradiologic assessment for Charcot neuropathic arthropathy previously relied on Eichenholtz stage. There is limited histopathologic data on this entity. We wanted to independently develop a histopathologic scoring system for Charcot neuropathic arthropathy., Design: Retrieval of surgical pathology midfoot specimens from Charcot patients (2012-2019) were analyzed to evaluate joint soft tissue and bone. Considering progression from large (≥half 40× hpf) to small (

We report a case of a 72 year old male with hyperparathyroidism secondary to end stage diabetic renal disease and coexisting bilateral chromophobe renal cell carcinomas. The patient presented with back and groin pain, right pelvic hemorrhage, and multiple lytic bone lesions concerning for metastatic renal cell carcinoma. Fine needle aspiration cytology demonstrated benign appearing osteoclasts and spindled cells. A concurrent core biopsy showed foci of spindled cell proliferation populated by osteoclast-like giant cells with stromal hemorrhage without evidence of metastatic carcinoma. The cytologic and histologic findings, in correlation with the clinical history, radiographic features, markedly increased parathyroid hormone levels and other serologic studies, were diagnostic of the reactive lesion seen in brown tumor of hyperparathyroidism secondary to chronic renal failure., (© 2017 Wiley Periodicals, Inc.)

Imaging findings of breast silicone implant rupture are well described in the literature. On MRI, the linguine sign indicates intracapsular rupture, while the presence of silicone particles outside the fibrous capsule indicates extracapsular rupture. The linguine sign is described as the thin, wavy hypodense wall of the implant within the hyperintense silicone on T2-weighted images indicative of rupture of the implant within the naturally formed fibrous capsule. Hyperintense T2 signal outside of the fibrous capsule is indicative of an extracapsular rupture with silicone granuloma formation. We present a rare case of a patient with a silicone calf implant rupture and discuss the MRI findings associated with this condition.

Endometrial adenocarcinoma is the most common gynecologic cancer in the United States. The prognosis is generally favorable, however, a significant number of patients do develop local or distant recurrence. The most common site of recurrence is vaginal. Our aim was to better characterize patients with vaginal recurrence of low-grade endometrioid adenocarcinoma with respect to associated tumor parameters and clinical outcome. We compiled 255 cases of low-grade (FIGO Grade I or II) endometrioid adenocarcinoma on hysterectomy specimens with lymph node dissection. A total of 113 cases with positive lymph nodes or recurrent disease were included in our study group. Seventy-three cases (13 Grade 1, 60 Grade 2) developed extravaginal recurrence and 40 cases (7 Grade 1, 33 Grade 2) developed vaginal recurrence. We evaluated numerous tumor parameters including: percentage myoinvasion, presence of microcystic, elongated, and fragmented pattern of myoinvasion, lymphovascular space invasion, and cervical involvement. Clinical follow-up showed that 30% (34/113) of all patients with recurrent disease died as a result of their disease during our follow-up period, including 31 (42.5%) with extravaginal recurrence and 3 (7.5%) with primary vaginal recurrence (P=0.001). The 3 patients with vaginal recurrence developed subsequent extravaginal recurrence before death. Vaginal recurrence patients show increased cervical involvement by tumor, but lack other risk factors associated with recurrent disease at other sites. There were no deaths among patients with isolated vaginal recurrence, suggesting that vaginal recurrence is not a marker of aggressive tumor biology.

This article discusses the most common diagnostic dilemmas when trying to distinguish between tumor and sports injury or other trauma. Bone tumors frequently occur in the same young active patients who experience sports injuries. If the pain persists longer than expected, imaging studies should be obtained to prevent a delay in diagnosis or an inappropriate arthroscopy. A history of spontaneous fracture or a fracture after minor trauma should raise suspicion for underlying lesion as the cause. Occasionally necrosis and/or hemorrhage within a soft tissue sarcoma is so extensive that only a small cuff of viable tumor tissue is present., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This case report presents a teenage patient who initially was thought to have a sports-related injury but ultimately was diagnosed with a primary soft tissue tumor. A previously healthy 16-year-old softball player presented with a history of left knee joint line pain, clicking, and swelling. The patient was presumed to have a lateral meniscus tear. However, magnetic resonance imaging demonstrated an intra-articular mass. Arthroscopy revealed a 2.5- × 1.5-cm firm pedicular mass in the lateral joint. Histological exam demonstrated localized pigmented villonodular synovitis. The patient healed uneventfully and returned to sporting activities. This report re-emphasizes the possibility that "sports tumors" can mimic symptoms of a meniscal tear in young athletes.

Unlabelled: Pro-inflammatory cytokines like TNF-α activate sphingosine kinase (SK). Therefore, inhibition of SK is a potential molecular target for the treatment of rheumatoid arthritis., Aims: The primary goal of this study was to assess the efficacy of ABC249640 (a selective SK-2 inhibitor) in two models of rodent arthritis. A secondary goal was to evaluate the pharmacological profile of ABC294640, when given in combination with methotrexate., Methods: The efficacy of ABC294640 was determined by paw diameter/volume measurements, histological evaluations, and micro-CT analyses., Results: ABC294640 attenuated both collagen-induced arthritis in mice, as well as adjuvant-induced arthritis in rats. With the adjuvant arthritis model, the prophylactic efficacy profile of ABC294640 was similar to indomethacin. Of note, ABC294640 reduced the bone and cartilage degradation, associated with adjuvant-induced arthritis. Rats treated with a suboptimal dose of MTX (50 μg/kg/day) in combination with ABC249640 (100 mg/kg/day) had better anti-arthritis effects in the adjuvant model, than treatment with either agent alone., Conclusion: Our results suggest that ABC249640 is an orally available drug candidate with a good pre-clinical efficacy profile for the prevention and/or treatment of RA.

Crystal-storing histiocytosis (CSH) is a rare process most often occurring in conjunction with an underlying hematopoietic neoplasm, usually multiple myeloma or low-grade B-cell lymphoma. We report the first case of pulmonary CSH diagnosed by fine-needle aspiration biopsy. A patient with a history of urothelial carcinoma developed a lung nodule, which was evaluated by fine-needle aspiration biopsy. Cytologic examination revealed macrophages with abundant cytoplasmic crystals diagnostic of CSH. Based on this cytologic interpretation, additional clinical laboratory evaluation was pursued and revealed a previously unknown monoclonal serum protein. CSH must be differentiated from other non-neoplastic and neoplastic lesions and when diagnosed, should trigger a search for an underlying lymphoproliferative disorder., (Copyright 2009 Wiley-Liss, Inc.)

Purpose: Well-differentiated thyroid cancer typically presents as a thyroid mass. Common sites of metastases upon presentation include cervical lymph nodes, lung, and bone. Well-differentiated thyroid cancer with clinically apparent kidney metastases is rare, with fewer than 20 cases reported in the literature. In the vast majority of these cases, the patients had known thyroid neoplasms at the time the renal metastases were identified. We report a case of papillary thyroid carcinoma that presented with abdominal pain in a 25-year-old woman with no previous history of thyroid disease., Study Design: This study is a case report., Results: The patient underwent radical nephrectomy for a right renal mass, which was diagnosed as papillary thyroid carcinoma follicular variant. During subsequent evaluation, metastatic disease was also identified in the patient's lungs. The patient was treated with total thyroidectomy and iodine 131., Conclusions: Papillary cancer, which ordinarily behaves in an indolent manner, can have unusual presentation, including disseminated metastasis on presentation. Renal metastases are extremely rare.

Altered expression of epidermal growth factor receptor (EGFR) is common in a variety of epithelial malignancies, including cervical cancer. However, the prognostic significance of EGFR expression is controversial for cervical cancer. Platelet-derived growth factor receptor (PDGFR) expression status is unknown in cervical cancer. Our results demonstrated that expression of EGFR and PDGFR was greatly enhanced in vivo and in organotypic cultures of low-grade cervical dysplastic tissues, but levels were decreased in high-grade lesions. To our knowledge, this is the first report identifying the expression of PDGFR in human epithelium. When low-grade dysplastic organotypic culture tissues were induced to differentiate more completely, EGFR expression, but not PDGFR expression, was relocalized to the basal layer as seen in normal tissues. Differentiation also induced phosphorylation of EGFR but not PDGFR. Our results suggest a role for EGFR and PDGFR during the early stages of cervical carcinogenesis, and demonstrate the facility of organotypic cultures to study the role of these growth factors in the development of cervical cancer.

We sought to determine whether the variability in dysplasia rates in cases of atypical squamous cells of undetermined significance (ASCUS) reflects variability in interpretation of cervical biopsy specimens. In phase 1, 124 biopsy specimens obtained because of a cytologic diagnosis of ASCUS were reviewed independently by 5 experienced pathologists. Diagnostic choices were normal, squamous metaplasia, reactive, indeterminate, low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). The rate of dysplasia ranged from 23% to 51%. All pathologists agreed in 28% of cases. In 52% of cases, the diagnoses ranged from benign to dysplasia. The overall interobserver agreement was poor. In phase 2, 60 cervical biopsy specimens (21 obtained for ASCUS, 22 for LSIL, and 17 for HSIL) were evaluated using the same diagnostic choices. Agreement was better in biopsies performed for HSIL and LSIL compared to those for ASCUS. Intraobserver reproducibility in the interpretation of biopsies performed for ASCUS ranged from poor to excellent. We conclude that variability in the interpretation of biopsy specimens plays an important role in the differences in rates of dysplasia reported for the follow-up of ASCUS.

The presence of the ossific nucleus and its role in reducing the risk of ischemic necrosis in developmental dysplasia of the hip remains a matter of controversy. Ischemic necrosis of the pre-osseous capital femoral epiphysis, defined as chondronecrosis, was evaluated in a rabbit model. Histologic evidence of chondronecrosis after casting in maximum abduction was greater in 1-day-old New Zealand White rabbits before the radiographic appearance of the ossific nucleus, compared with 16-day-old New Zealand White rabbits with an ossific nucleus already present. This preliminary study supports the hypothesis that the ossific nucleus may decrease the risk of intracapsular compressive ischemic injury to the developing capital femoral epiphysis in a rabbit model.

Osteonecrosis (ON) is rare while arthropathy is common in persons with haemophilia. A recent case of bilateral ON of the femoral head prompted us to review our experience with hip arthroplasty. We identified nine patients with presumed end-stage haemophilic arthropathy. Four of the nine individuals had radiographic findings suggestive of ON, but without unequivocal microscopic evidence of ON. It is important to recognize ON at an early stage because there are surgical interventions which may prolong the life of the joint and improve quality of life. We suggest that ON should be included in the differential diagnosis of hip pathology in persons with haemophilia presenting with hip pain or dysfunction., (Blackwell Science Ltd.)

Motor vehicle accidents account for most cases of blunt chest trauma; seat belts have been implicated as the cause of a few of these injuries. We report a case of a seat-belt-induced fatal isolated left atrial appendage rupture in a 40-year-old female.

Renal metastases from solid tumors to both kidneys rarely result in acute renal failure (ARF). We present a case of squamous cell pulmonary carcinoma responsible for ARF due to (1) extensive (50% to 75%) bilateral parenchymal infiltration and replacement accompanied by tissue destruction, (2) widespread vascular invasion and thrombosis resulting in ischemia, and (3) histological evidence for foci of distal intratubular obstruction and pyelonephritis. Five additional cases, including one pulmonary cancer, causing ARF from extensive tissue replacement and destruction are reviewed. In a separate case, ARF resulted from lymphatic metastases rather than from parenchymal destruction or obstruction. Common findings in all six reported cases include bilaterally enlarged kidneys and progressive oligoanuria despite correction of prerenal or postrenal conditions. In our patient and in one other prior reported case, extrarenal obstruction was not considered important because invasive therapeutic procedures were unsuccessful in reversing ARF. In one case, irradiation of kidney tumor resulted in reversal of ARF. These cases emphasize the rare potential for solid tumors to metastasize to both kidneys and result in irreversible oligoanuric ARF. A high level of suspicion is required, and an early diagnosis may result in reversible ARF if the tumor is amenable to chemotherapy or irradiation.

The acquired immunodeficiency syndrome and other causes of immunosuppression have ushered in a variety of opportunistic infections. One of these is bacillary angiomatosis, a vasoproliferative lesion whose principal causative agent is Rochalimaea henselae. Bacillary angiomatosis, while preponderantly a cutaneous affliction, can be systemic, including involvement of the head and neck mucous membranes. Molecular technology and epidemiologic studies used to identify the bacterial agent of bacillary angiomatosis have also uncovered R henselae as the organism responsible for most cases of cat-scratch disease. Why the same organism promotes two different histopathologic lesions, as seen in bacillary angiomatosis and cat-scratch disease, is unknown.

Contemporary management of laryngeal carcinoma often incorporates multiple modalities of therapy. We report a case of osteoradionecrosis of the hyoid bone in a patient treated with surgery, chemotherapy, and radiation therapy for a supraglottic squamous cell carcinoma. A discussion regarding pathophysiology, radiation dosimetry and treatment options is also presented.

The histomorphology of nodular fasciitis (NF), a benign proliferation of myofibroblasts, is well described in the surgical pathology literature. The cytomorphology, however, has been reported infrequently. Cytologic interpretation of this pseudosarcomatous lesion is subject to the same pitfalls so frequently reported for histologic material. NF arises most commonly in the extremities or trunk; occurrence in the parotid gland is relatively uncommon. We describe a case of NF arising in association with the parotid gland; review the clinical, cytologic, histologic and immunohistochemical features of NF; and offer a differential diagnosis, based on cytologic features, of other benign and malignant lesions likely to be encountered at this location.

An atlas of 32 captioned color photomicrographs of typical musculoskeletal tumors is presented to demonstrate the need for close radiologic and pathologic correlation of these tumors. Diagnostic and key microscopic features of these soft tissue and bone lesions are highlighted.

We present a case of primary lymphoma of bone arising in the proximal tibial epiphysis of a 16-year-old boy. To the best of our knowledge, primary lymphoma of bone has not been described previously as a mimicker of chondroblastoma. This case report is intended to increase awareness among clinicians and radiologists that primary lymphoma of bone can present with a long clinical prodrome and initially benign radiographic appearance. Early recognition of this unusual presentation will (hopefully) increase the likelihood of cure. However, it is recognized that in children, primary lymphoma of bone is a rare diagnosis and associated with a poor prognosis unless aggressive treatment is utilized [8].

Clear cell cribriform hyperplasia (CCCH) of the prostate is an unusual form of benign prostatic hyperplasia characterized by a nodular proliferation of clear cells with small, uniform nuclei. The authors studied 15 cases of CCCH by immunohistochemistry and 13 of them by DNA flow cytometry to establish the immunohistochemical and DNA profile of this lesion. Patients ranged in age from 58 to 88 years (mean, 68 years). Follow-up of a mean of 22 months showed all patients alive with no evidence of malignant prostatic disease. All 13 CCCHs showed diploid DNA content; in contrast, among 4 papillary/cribriform carcinomas of the prostate used for comparison, 3 were aneuploid and 1 was diploid. A basal cell layer was demonstrated in all 15 CCCHs by the use of the 34 beta E12 anti-high-molecular-weight keratin antibody (EAB-903) that reacts with the basal cells but not with the acinar cells of the prostate. A continuous basal cell layer was not evident in the carcinomas. The blandness of the epithelium, the well-defined nodular configuration, the presence of a basal cell layer demonstrable by immunocytochemistry, and the lack of aneuploidy as determined by DNA flow cytometry together lend support to the concept that CCCH is a benign lesion.

Ovarian carcinoma metastatic to the breast is uncommon. We report a rare occurrence of ovarian carcinoma that initially presented as a breast mass. Complete examination revealed bilateral ovarian tumors with widespread peritoneal and abdominal disease. One of the ovarian tumors was a papillary serous tumor of low malignant potential, and the other was a well-differentiated papillary serous carcinoma. Although the neoplasm within the breast resembled serous ovarian carcinoma with psammoma bodies, the initial presentation and the presence of an apparent intraductal component created a potential for its misdiagnosis as a primary breast carcinoma. Using DNA flow cytometry, we demonstrated the relationship between the breast, lymph node, and peritoneal metastases and the serous carcinoma, thereby supporting the histologic diagnoses.

A case of extraskeletal osteosarcoma occurring in its most common location, the thigh, is reported. Particular emphasis is given to demonstrating the spectrum of radiological findings, including CT, MRI, and scintigraphy and to illustrate that this entity can metastasize to bone.

A 3-month-old female infant with oral-facial-digital syndrome (OFD-I) was found to have extensive malformations of the brain and spinal cord. Our review of other case reports indicated that the most common central nervous system malformations found in OFD-I include cerebral epithelial (ependymal) cysts, agenesis of the corpus callosum, cerebral micropolygyria, and hypoplasia or dysplasia of the cerebellum, pons, and medulla. It is suggested that the individuals with OFD-I syndrome should be carefully studied clinically and pathologically for complex nervous system anomalies.

The RapID STR system (Innovative Diagnostic Systems, Inc., Atlanta, Ga.) was evaluated in the identification of 266 streptococci. Organisms included 60 beta-hemolytic streptococci, 71 group D strains (48 enterococci and 23 nonenterococci), 26 Streptococcus pneumoniae, and 109 viridans group strains. With concomitant optochin testing, as is currently recommended by the manufacturer for all alpha-hemolytic strains, the RapID STR system correctly identified 100% of beta-hemolytic strains, 87.3% of group D strains (93.7% of enterococci, 73.9% of nonenterococci), 88.5% of S. pneumoniae, and 72.5% of viridans strains. Without the use of optochin, the correct identification of S. pneumoniae and the viridans group was 26.9 and 52.3%, respectively. The RapID STR system incorrectly identified 3.0% of strains, including four group D streptococci, three pneumococci, and one viridans isolate. Reproducibility was excellent, with 95% of strains tested in triplicate yielding identical results on each of the three occasions. The RapID STR system represents a worthwhile advance in streptococcal species identification, especially for group D and viridans strains.

The prognosis for women with endometrial cancer correlates with stage of disease. Spread to the cervix distinguishes Stage II from Stage I disease. To assess the accuracy of endocervical curettage (ECC) in predicting cervical involvement by endometrial adenocarcinoma, we examined and assigned to one of four groups the ECC from 147 women treated between 1980 and 1985. Ultimate determination of spread to the cervix was based on examination of subsequent hysterectomy specimens. In the hysterectomy specimen 19 of 147 women (13%) had cervical involvement demonstrated. Five women had tumor clearly within the endocervical tissue of the ECC (Group I), and three of these five (60%) had spread of tumor to the cervix in the hysterectomy specimen. At hysterectomy, 13 of 41 women (32%) with tumor present but not contiguous with endocervical tissue within the ECC (Group II) had cervical involvement. Of the 80 women without tumor in the curettage (Group III), one (1.2%) had cervical involvement by tumor at hysterectomy. Two of the 21 women (9.5%) with curettings considered insufficient for diagnosis (Group IV) had spread of adenocarcinoma to the cervix within the hysterectomy specimen. We also compared the results of ECC performed at our institution with those performed at referring hospitals and found a significant difference between them in ability to obtain definitive results. We conclude that (a) the absence of carcinoma in ECC is highly predictive of absence of cervical involvement by endometrial carcinoma; (b) ECC having tumor within endocervical tissue is a good predictor of cervical involvement by tumor.(ABSTRACT TRUNCATED AT 250 WORDS)