Search

The diagnosis of bland-looking spindle cell lesions of the breast is often challenging because there is a close morphological and immunohistochemical overlap among the different entities. The present review will discuss reactive spindle cell nodule/exuberant scar, nodular fasciitis, inflammatory pseudotumor, myofibroblastoma (classic type), lipomatous myofibroblastoma, palisaded myofibroblastoma, benign fibroblastic spindle cell tumor, spindle cell lipoma, fibroma, leiomyoma, solitary fibrous tumor, myxoma, schwannoma/neurofibroma, desmoid-type fibromatosis, dermatofibrosarcoma protuberans, low-grade fibromatosis-like spindle cell carcinoma, inflammatory myofibroblastic tumor and low-grade myofibroblastic sarcoma arising in the breast parenchyma. The pathologist should be aware of each single lesion to achieve a correct diagnosis to ensure patient a correct prognostic information and therapy. Accordingly representative illustrations and morphological/immunohistochemical diagnostic clues will be provided., (Copyright © 2019 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Umbilical cord hemangioma is an uncommon benign vascular neoplasm arising from the free segment of the umbilical cord, distinct from placental and fetal insertion, and is thought to originate from endothelial cells of the umbilical vessels. Cystic changes in the umbilical cord rarely occur as a consequence of the damage to the amnionic surface of the cord caused by the presence of the hemangioma. Until now, a total of 8 cases of umbilical cord hemangioma associated with cystic changes in the umbilical cord have been reported in the literature, however, among these cases, only one showed an associated cyst derived from inclusion of the amniotic epithelium, and the remaining seven cases consisted of hemangiomas with associated pseudocyst of the umbilical cord. We herein report a case of umbilical cord hemangioma with an associated amnionic epithelial inclusion cyst. Clinicopathological features and differential diagnostic considerations are also discussed., (Copyright © 2019 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Intestinal-type adenocarcinoma is a rare primary vaginal carcinoma and considerably more uncommon than metastatic lesions which represent the most frequent malignancy at this anatomic site. Among all malignant tumors, colorectal, breast and female genital tract carcinomas have the tendency to metastasize to the vagina., As morphologic and immunohistochemical features of intestinal-type adenocarcinoma occurring primarily in the vagina are not specific, clinical and radiologic information is crucial to exclude a metastatic lesion., Herein we present a rare case of intestinal-type adenocarcinoma from a villous adenoma, presenting as a polypoid mass in the posterior wall of vaginal introitus of 51-year-old menopausal woman. To the best of our knowledge, only 19 cases of intestinal-type adenocarcinoma of the vagina have been reported in the English literature so far. Notably the origin from a previous villous adenoma has been well documented only in a few cases., (Copyright © 2018 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Perineurioma is a relatively rare benign peripheral nerve sheath tumor composed of cells resembling to normal perineurium. Although this tumor may arise in the context of a nerve (intraneural perineurioma), extraneural perineurioma does occur, frequently involving the soft tissues of the lower and upper extremities, trunk and head and neck. Rarely it has also been reported in visceral organs, including gastrointestinal tract. We herein describe the clinicopathologic features of a rare case of a perineurioma presenting as a polypoid lesion of the sigmoid colon, emphasizing the pathologic diagnostic clues., (Copyright © 2018 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Renal cell carcinoma is one of the most common tumours to spread by extranodal metastases to the head and neck. Metastatic renal cell carcinoma to the head and neck area has been demonstrated mostly in the paranasal sinuses, parotid gland, the mandible, larynx and hypopharinx. Renal cell carcinoma should be excluded whenever a metastatic lesion is encountered in the head and neck area, even if the metastatic lesion is the first clinical presentation. The diagnosis of metastatic RCC should be suspected in any patient with even a remote history of renal cell carcinoma. We report a case of 79 year old woman with recurrent episodes of rhinorrhea, headache, hyposmia and monolateral right epistaxis, with a history of RCC. We describe RCC nasal metastases in a metachronous bilateral neoplasm, in which a second occult lesion debuted with a homolateral nasal metastases, ten years after left nephrectomy., (© Copyright Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Sarcoidosis is a multisystemic granulomatous disease characterized by the presence of noncaseating granulomas, the exact etiology of which is yet to be determined. Most of patients show granulomas located in the lungs or in the related lymph nodes. However, lesions can affect any organ. Noncaseating granulomas are not a pathognomonic sign of sarcoidosis, being observed also in other diseases, therefore the diagnosis is often of exclusion. We report a case of sarcoidosis with parotid gland involvement in the context of a Heerfordt syndrome, discussing about its clinical presentation, pathogenesis, pathology and differential diagnosis with other granulomatous diseases., (© Copyright Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Kikuchi-Fujmoto disease (KFD), also known as "histiocytic necrotizing lymphadenitis", is a rare lymphadenitis of unknown origin, but with an excellent prognosis. It is more common in Asia, but isolated cases are also reported in America, Africa and Europe. The disease can have an acute or subacute course, usually develops in 1 to 3 weeks, with spontaneous resolution in 1-4 months. The main clinical sign is cervical lymphadenopathy, especially in the posterior cervical triangle with bulky and painful lymph nodes, usually affecting only one side; rare cases of generalized lymphadenopathy can be seen. This common clinical presentation can also be accompanied by nausea, vomiting, weight loss, weakness, headache and arthralgia. An extranodal extension of the disease, including involvement of skin, eye, and bone marrow localizations, has been rarely described. Most patients have leukopenia or neutropenia with a relative leukocytosis. At an ultrasound exploration of the affected lymph nodes, a hypoechoic aspect can be seen, with an external, thick and irregular hyperechoic ring. As there are no specific tests for KFD, the final diagnosis is histologically-based from lymph node excisional biopsy. Histological examination shows paracortical foci of coagulative necrosis containing karyorrhectic debris, which are surrounded by numerous CD68+/myeloperoxidase (MPO)+ histiocytes, CD68+/CD123+ plasmacytoid dendritic cells, and a minority of small- to large-sized CD8+lymphocytes and immunoblasts. Differential diagnosis mainly includes systemic lupus erithematous (SLE)-related lymphadenopathy and large cell lymphoma. The histological absence of neutrophils, plasmacells, as well as hematoxylin bodies, is a feature which argues against the diagnosis of SLE. In addition, the absence of auto-antibodies and anti-nuclear antibodies is useful in ruling out an autoimmune disorder. Early diagnosis of KFD is crucial to prevent the patients undergo extensive investigations related to suspected malignant lymphomas or other diseases., (© Copyright Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Sclerosing angiomatoid nodular transformation of the spleen is a rare benign vascular lesion with extensive sclerosis and unknown aetiology. Although its pathogenesis is not clear, it has been postulated that it may represent a peculiar hamartomatous transformation of red pulp in response to an exaggerated non-neoplastic stromal proliferation. However, it is unclear whether SANT is the end stage of a variety of benign splenic conditions including inflammatory pseudotumour, hamartoma or hematoma. Considering that the lesion is benign, splenectomy is curative. We report a new case of SANT, discussing differential diagnosis, immunohistochemical profile and pathogenesis.

Benign peripheral nerve sheath tumours, including neurofibroma, may occasionally contain a heterologous mature fatty component. Additional lipoblast-like cells can be occasionally identified among mature adipocytes. We report the first case of a plexiform neurofibroma from a NF1 patient containing exclusively lipoblast-like cells exhibiting morphological and immunohistochemical features identical to univaculoted lipoblasts typically seen in myxoid liposarcoma. Awareness of the possibility that an otherwise typical neurofibroma may contain lipoblast-like cells is crucial for the pathologist to avoid a misdiagnosis of malignancy. Differential diagnostic problems and histogenetic considerations are provided.

Osteocartilaginous metaplasia in lipomas is rare and mainly encountered in large-sized, long-standing lipomas. This entity can be found at almost any site of the body, particularly in the soft tissues of the skeletal system, breast, pharynx, and nasopharynx. We describe a case of lipoma with osteochondroid metaplasia in a 65-year-old woman with an indolent lesion, and discuss differential diagnoses.

We report a case of a 66-year-old man with a simultaneous leiomyoma and contralateral smooth muscle hyperplasia of the epididymis. The left nodule showed characteristics of a benign leiomyoma consisting in the homogeneous proliferation of smooth muscle with a typical pattern of interlacing fascicles of spindled smooth muscle cells showing no mitotic activity. The right nodule was made up of bundles of smooth muscle, growing in a perivascular and interstitial pattern, without the homogeneous aspect of contralateral leiomyomatous tumours. The latter finding suggested non-neoplastic hyperplasia of the smooth muscle fibres of the epididymis. At 6 months after surgery, ultrasound of the scrotum showed no evidence of recurrent lesions.

We describe the case of an 18-year-old girl with an oligodendroglioma arising in an immature ovarian teratoma. The oligodendroglioma, which closely involved the cystic teratoma, was moderately cellular, composed of monomorphic cells with uniform round nuclei and perinuclear halos with a characteristic "fried-egg" appearance. Rare microcalcifications and a dense network of branching capillaries with a chicken-wire appearance were also observed. By immunohistochemistry, tumour cells showed positivity for S-100, but were negative for GFAP, synaptophysin and neuro-specific enolase. The patient is free of disease on follow-up examination at 24 months.

We report a case of a 29-year-old male patient with a respiratory epithelial adenomatoid hamartoma (REAH) of the nasal cavity. REAH is a polypoid proliferation of glandular spaces lined by ciliated epithelium and goblet cells in the upper aerodigestive tract. Although REAHs are benign lesions, they may be confused with a variety of other pathologies such as inflammatory polyps, inverted Schneiderian papillomas and low-grade sinonasal adenocarcinomas. The recognition of this entity is important as complete excision is curative.