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Background and Aims: Patients with primary gastric lymphoma are at an increased risk of developing gastric cancer. Data on gastric precancerous lesions development in these patients are scanty. We assessed gastric precancerous lesions in a cohort of patients with primary lymphoma. Methods: Data of patients with primary gastric lymphoma [mucosa-associated lymphoid tissue (MALT)- lymphoma or diffuse large B-cell lymphoma (DLBCL)] were analysed. Multiple (>10) biopsies were performed on gastric mucosa at each endoscopic control, beyond macroscopic lesions. Presence and distribution of intestinal metaplasia (IM) at baseline, the onset at follow-up, and progression through the stomach or transformation in the incomplete IM type were assessed. The onset of neoplastic lesions was recorded. Results: Data of 50 patients (mean age of 63.6 ± 10.7 years; M/F: 25/25), including 40 with MALT-lymphoma and 10 with DLBCL, with median follow-up of 30.5 months (range: 9-108) and a median of 6 endoscopic controls (range: 3-14) were evaluated. At entry, IM was present in 12 (24%), and it developed in other 22 (57.9%) patients at a median follow-up of 6 (range: 3-40) months. Overall, progression of IM was observed in 7 (21.2%) cases, including extension in the stomach (n=5) or transformation into the incomplete type (n=2). Low-grade dysplasia was detected in 4, and indefinite dysplasia in other 7 patients. In one patient, low-grade dysplasia had progressed to high-grade and gastric adenocarcinoma of the fundus. Conclusions: Our data found a frequent onset and rapid progression of precancerous lesions on gastric mucosa of lymphoma patients. This observation could explain the increased incidence of metachronous gastric cancer in these patients.

Gastrointestinal involvement in plasma cell neoplasms, either as primary localizations (extramedullary plasmacytomas) or as secondary involvement in systemic multiple myeloma, is a well-known event. Accurate histological examination is crucial in defining the diagnosis. In this report, an uncommon case of duodenal localization of myeloma with plasmablastic features is described, with emphasis on the role of clinical data and findings from ancillary immunostaining techniques to avoid misdiagnosis.

Myxoid liposarcoma exhibits a peculiar clinical behavior, with a tendency to spread to serosal membranes, distant soft tissues, and bones, even in the absence of lung metastases. Therapy-related hematological neoplasms are well-known side effects of cytotoxic chemotherapy. We describe an exceptional case of metastatic myxoid liposarcoma of the spine associated with therapy-related refractory anemia with excess of blasts in a 37-year-old woman who underwent multi-agent chemotherapy for a myxoid liposarcoma of the left thigh. Microscopic examination of the bone marrow biopsy revealed dysplastic features, with abnormal localization of immature precursors and micromegakaryocytes, and islands of undifferentiated oval small/medium-size cells, suggestive of acute myeloid leukemia arising in the setting of a myelodysplastic syndrome. Immunohistochemistry was not discriminant. Cytogenetic analyses of bone marrow aspirate disclosed the presence of 2 different rearrangements, subsequently confirmed by fluorescent in situ hybridization and was crucial in making the correct diagnosis.

In 1998 Tazawa and Tsutsumi described for the first time a case of Helicobacter pylori (HP)-related gastritis characterized by the presence of a conspicuous plasma cell infiltrate with Russell bodies, and coined the term Russell body gastritis (RBG). A 59-year-old HIV-positive man complaining of recurrent epigastric pain underwent an upper gastrointestinal endoscopy revealing in the stomach only hyperemia in the antral portion. Histology showed a moderate glandular atrophy associated with an expansion of the lamina propria due to an infiltration of monomorphous cells with eosinophilic cytoplasm inclusions and eccentric nuclei, somewhat resembling plasma cells. A diagnosis of HP-related RBG was made, after excluding, by means of histochemical, immunohistochemical stainings and molecular studies, a neoplastic process. A review of all cases of RBG previously described in the English literature is reported in order to examine the clinical, endoscopic and microscopic features of this histopathological entity and the possible pathogenetic mechanisms.

The case we describe is, to our knowledge, the first primary epithelioid leiomyosarcoma of the endothoracic fascia reported in the literature. The endothoracic fascia is localized between the costal parietal pleura and the inner face of the thoracic wall and contains connective, adipose, smooth muscular tissues, lymphoid aggregates and vessels. Malignant tumors of the endothoracic fascia are difficult to identify because they quickly infiltrate the lung, the chest wall and the mediastinum. When discovered, these tumors are classified as primary soft tissue sarcomas of these sites. In the present case, early diagnosis of an asymptomatic lesion allowed us to establish its origin in the endothoracic fascia. The CT characteristics suggested a non-aggressive lesion, with clearly defined profiles and without signs of infiltration of the adjacent lung, fat and cartilages. Histological differential diagnosis and role of radiology in the management of the case are discussed. As radiological techniques spread and improve, we expect the diagnosis of endothoracic fascia primary tumors could become more frequent.

Background: The association between lymphomas and Kaposi’s sarcoma has been described since 1920. The simultaneous presence of the 2 pathologic entities within the same lymph node is a rare and interesting occurrence. In the few cases described, the presence of human herpesvirus 8 (HHV8) and Epstein-Barr virus (EBV) in the different neoplastic areas was investigated only by immunohistochemistry and in situ hybridization studies. Methods: Two cases of concurrent non-Hodgkin lymphoma and Kaposi’s sarcoma in the same lymph node are described: a diffuse large B cell lymphoma in an AIDS patient and a T cell-rich large B cell lymphoma in a HIV-negative patient, complete with the clinical, immunohistological and molecular features, the latter ones defined after isolation of the different neoplastic areas by laser capture microdissection. Results: Polymerase chain reaction assays revealed HHV8 DNA sequences only in the microdissected Kaposi’s sarcoma areas and EBV DNA sequences only in the lymphomatous areas in both cases, confirming the HHV8 infection only in the neoplastic sarcomatous cells and evidencing the EBV infection only in the lymphomatous cells. Conclusion: This study represents a further confirmation of the supposed different etiopathogenic mechanisms of the 2 neoplasias, suggesting a coincidental occurrence even when localized in the same lymph node, independently from HIV infection.

Objectives: Lymphangiomas are relatively uncommon lesions of the lymphatic channels that can arise in virtually any part of the body provided by lymphatic vessels. The most common localization is the head/neck region, with only sporadic reports in other sites. The mediastinum is a rare location, with around 20 cases reported in the literature. Methods: We describe one case of mediastinal lymphangioma with a true intrathymic localization, which to our knowledge has never been described. Results: The gross features and microscopic findings are reported with a discussion of the clinicopathologic signatures of this pathologic entity. Conclusions: Intrathymic lymphangioma should always be taken into consideration in the differential diagnosis of cystic mediastinal lesions in children and adult patients.

BACKGROUND Kaposi's sarcoma (KS) is a vascular malignant tumor characterized by human herpesvirus 8 infection of neoplastic cells. Diffuse cutaneous lesions represent the classical clinical presentation. This case report describes the first fine needle aspiration cytology findings of a primary lymph nodal KS, a rather unusual localization of the disease. CASE A 28-year-old, apparently healthy man saw a surgeon for right inguinal node enlargement without other symptoms. The clinician performed fine needle aspiration and made a preliminary diagnosis of a neoplasm of probable mesenchymal origin, not otherwise specified. The lymph node was excised, and the final histologic diagnosis was primary lymphoadenopathic KS. A serologic test revealed antibody positivity for HIV. CONCLUSION The diagnosis of primary KS of the lymph node, in the absence of any other clinical manifestation, was the first sign of HIV infection.

Primary effusion lymphoma (PEL) is a hematolymphoid neoplasia described for the first time in 1995 [1],[2]. It predominantly grows in the body cavities as neoplastic effusion and is associated with...

Low-grade myofibroblastic sarcoma is an uncommon sarcoma with myofibroblastic differentiation. It occurs in a wide variety of sites and has a predilection for the head and neck region. Biologically, low-grade myofibroblastic sarcoma has a propensity for local recurrence and is associated with a low risk of metastatic spread. Histologically, it can mimic a variety of different types of benign and malignant processes and often requires immunohistochemical analysis for its accurate identification. This report describes a case and discusses the differential diagnosis of a low-grade myofibroblastic sarcoma that arose in the larynx of a 69-year-old woman with a history of metastatic skin melanoma. To the best of the authors’ knowledge this is the first description in the English literature of low-grade myofibroblastic sarcoma originating in the larynx.

Granulomatous inflammation with multinucleated giant cells is observed in various infectious and noninfectious diseases. It has been found in association with malignant tumors and designated sarcoid-like reaction. The distinction between a tumor-related granulomatous reaction and a true sarcoidosis can be a problematic issue. A case of renal cell carcinoma with sarcomatoid features (Fuhrman nuclear grade IV) with an extensive peritumoral sarcoid-like reaction and a critical review of the few cases of this association described in the literature have been reported, and the problematic clinical and pathological assessments of such lesions are discussed.

Background Gastrointestinal stromal tumors (GISTs) represent the majority of primary non-epithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by the immunohistochemical staining for the CD117 antigen. Extra-gastrointestinal stromal tumors (EGISTs) are neoplasms with overlapping immunohistological features, occurring in the abdomen outside the gastrointestinal tract with no connection to the gastric or intestinal wall. Case presentation We here report the clinical, macroscopic and immunohistological features of an EGIST arising in the greater omentum of a 74-year-old man, with a discussion on the clinical behavior and the prognostic factors of such lesions and a comparison with the gastrointestinal counterpart. Conclusion The EGISTs in the greater omentum can grow slowly in the abdomen for a long time without clinical appearance. In most cases a preoperative diagnosis is not possible, and the patient undergoes a surgical operation for the generic diagnosis of "abdominal mass". During the intervention it is important to achieve a complete removal of the mass and to examine every possible adhesion with the gastrointestinal wall. Yamamoto's criteria based on the evaluation of the mitotic rate and the MIB-1 labelling index seems to be useful in predicting the risk for recurrence or metastasis. More studies are necessary to establish the prognostic factors related to localization and size of the EGIST and to evaluate the impact of the molecular characterization as an outcome parameter related to the molecular targeted therapy. In absence of these data, an accurate follow-up is recommended.

The incidence of syphilis has increased substantially over the past years, particularly in men who have sex with men. The clinical manifestations of syphilis are variable and liver involvement is uncommon, but may occur at any stage of the disease. We report a case of early syphilitic hepatitis (ESH) in an immunocompetent patient referring multiple bisexual exposures, who presented at admission with jaundice, tiredness, an ulcerated genital lesion and an increase of liver aminotransferases. During his hospital stay, he developed a skin rash, and serology for syphilis was found positive. Our case report strengthens the need to take into consideration the diagnosis of ESH in all patients with unexplained liver enzyme increase and epidemiological data of unsafe sexual exposures. Indeed, an early recognition of the clinical manifestations of syphilis can lead to a prompt treatment, and allows the prevention of the transmission of this disease to other individuals.

The concept of bilineal acute leukemia is defined in the WHO classification, where, along with the undifferentiated acute leukemia and the biphenotypic acute leukemia, it is included in the group o...

Background The purpose of our study was to determine the prevalence and significance of psammoma bodies (PBs) in the cervicovaginal smears of the screening population of Trento district (Italy), with the description of the cytological presentation of an asymptomatic bilateral ovarian psammocarcinoma. Methods From 1993 to 2006, women with PBs detected on consecutively screened cervical smears were identified from the computerized pathology database of Rovereto Hospital. The follow-up period was set from the time of cytological diagnosis to May 31st, 2007. Clinical information was obtained from retrospective review of women's medical records. The source of PBs was identified with adequate diagnostic procedures. Results PBs were found in six of the 201,231 Papanicolaou screening smears (0.0029%). Benign conditions (intrauterine device, inclusion ovarian cysts and ovarian cystoadenofibroma with PBs) were found in four patients. In two cases, PBs were associated with malignant cells; a bilateral ovarian malignancy was diagnosed in both cases, a serous adenocarcinoma and a psammocarcinoma. Conclusion PBs in the cervicovaginal smears are a rare finding, associated more often with benign conditions than with malignancies. Moreover, to our knowledge, our case of primary ovarian psammocarcinoma is the first report in which the presence of malignant cells and PBs in the cervicovaginal and endometrial smears represents the first manifestation of disease.

Myxopapillary ependymoma is a rare variant of ependymoma, almost exclusively occurring in the region of the cauda equina and filum terminale. We describe a myxopapillary ependymoma located in the left cerebellopontine angle of a young man suffering from peripheral vertigo and left sensorineural hearing loss for years. The patient underwent surgical removal of the tumour. Microscopic examination showed histological and immunohistochemical features consistent with a diagnosis of myxopapillary ependymoma. Imaging studies of the spine yielded normal findings, confirming the lesion’s primary nature. To the best of our knowledge, this is the first case of primary intracranial myxopapillary ependymoma described in this location.

BackgroundRhinosporidiosis is a disease affecting primarily the mucosa of nose, conjunctiva and urethra. It is endemic in some Asiatic regions, affecting people of any age and sex. Its manifestation is a polypoid mass growing inside the affected cavity and the only treatment is surgical excision.Rhinosporidium seeberiis the aetiological agent. Many discussions arouse regarding the taxonomic classification of the microorganism, recent studies established it is an aquatic protistan parasite. The lesion may recur and sometimes cause osteolytic bone lesions. In endemic areas it is not easy to establish if recurrent lesions are due to relapse or reinfection.Case presentationA 26-year-old male patient from India, resident in Italy since 2005, presented in March 2006 with a history of nasal obstruction of three months duration. Physical examination showed an erythematous, papillomatous mass, 3 cm in diameter, obstructing the right nasal cavity. A microscopic diagnosis of rhinosporidiosis was made. Few Italian human cases of this disease have been previously reported in the literature.ConclusionRhinosporidiosis is a condition which both clinicians and pathologists should keep in mind when managing patients from endemic countries with nasal masses. Moreover, it is very interesting in such cases to follow the clinical course: an eventual recurrence of the lesion in our patient would mean a true relapse, excluding the possibility of a reinfection, more probable in the endemic areas.

Auteur(s) : Renato Covello1, Stefano Licci2, Angela Ferrari3, Luca Morelli4, Caterina Catricala3 1Department of Pathology, National Cancer Institute “Regina Elena”, Rome, Italy 2Department of Pathology, “Santo Spirito” Hospital, Lungotevere in Sassia, 100193 Rome, Italy 3Department of Dermatologic Oncology, Dermatologic Institute “Santa Maria and San Gallicano”, Rome, Italy 4Department of Pathology, “Santa Chiara” Hospital, Trento, Italy A 69-year-old [...]

Jaundice, a common feature of advanced colon cancer, is usually due to liver parenchyma metastasis, but it can sometimes be caused by extrahepatic biliary obstruction. This rare event is related to metastasis to the lymph nodes placed behind the duodenum, along the choledochus or the vena porta, extrinsically compressing the common duct. Stenosis of the common bile duct secondary to parietal metastatic involvement is extremely rare. We report on a case of colon carcinoma metastasis to the intrapancreatic tract of the common bile duct, with a review of the literature.

Background Primary thyroid gland lymphomas are uncommon tumours that occur in the setting of lymphocytic thyroiditis or Hashimoto's disease in almost all cases. In this condition a distinction between an inflammatory lymphoid infiltrate and a low grade lymphoma may be extremely difficult and precise criteria are necessary for a correct diagnosis. Patient and methods We report a case of a minute focus of primary extranodal marginal zone B-cell lymphoma (EMZBCL), incidentally discovered in a 63-year-old man with Hashimoto thyroiditis (HT) and diagnosed by means of polymerase chain reaction (PCR) after laser capture microdissection. The histological examination of surgical specimen confirmed the diagnosis of HT and showed a minute focus of dense lymphoid infiltrate (less than 4 mm in diameter), composed by centrocyte-like cells forming MALT balls. Immunoistochemistry was not useful. A microscopic focus of EMZBCL was suspected on the basis of morphological features. PCR assays revealed the rearrangement of the heavy chain of immunoglobulins only in the microdissected suspicious area, confirming the diagnosis of EMZBCL. Conclusion Our finding suggests that in cases of autoimmune thyroiditis a careful examination of the thyroid specimen is warranted, in order to disclose areas or small foci of lymphomatous transformation. Furthermore, in difficult cases with doubtful immunohistological findings, ancillary techniques, such as molecular studies, are necessary for a conclusive diagnosis.

Background Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are widely used in the clinical diagnosis of parotid gland tumors and their efficacy in identifying benign lesions is well documented. However, problems arise when facing some malignant lesions. Only few cases of salivary gland low grade malignant tumors have been previously reported in the literature complete with the radiological features. Case presentation We here describe a case of epithelial-myoepithelial carcinoma (EMC) of the parotid gland, a low grade malignant tumor, with spread to an intraparotid lymph node and with CT and MRI findings mimicking a benign lesion. Conclusion All the images revealed sharply outlined profiles and a homogeneous enhancement of the nodule, suggesting a benign tumor and demonstrating that a radiological evaluation of the lesion alone may be unsatisfactory and misleading in the diagnosis of salivary gland tumours, especially in the case of low grade malignant tumors, such as EMC.