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We performed next generation sequencing of DNA extracted from the neoplastic tissues obtained from a patient who underwent surgery for a large right ovarian carcinoma (OC) of endometrioid type associated with endometrial cancer (EC). This was done in order to ascertain whether the tumors were synchronous endometrial/ovarian cancers or an advanced metastatic stage from either the ovary or the uterus. Pathologic criteria favoured synchronous EC/OC. We identified a PTEN c.959 T > G (p.L320X) truncating mutation occurring with similar allele frequency in both neoplastic tissues (ovary: 88 %, endometrium 89 %) and a CTNNB1 c.100C > G (p.S37C) activating mutation, with a comparable allelic frequency in both tumor tissues (ovary 51 %, endometrium 52 %). The shared genetic mutations, and the presence of PTEN c.959 T > G (p.L320X) truncating mutation, albeit at low allelic frequency (6 %), in the healthy peritumoral endometrial tissue, appear to confirm the recent literature on a primary endometrial origin for synchronous EC/OC. A third mutation was CTNNB1 c.92 T > C (p.L31 P), a missense mutation occurring with a low allele frequency (3.7 %) only in the ovarian cancer tissue. This mutation is only occasionally described in hepatocellular carcinomas.

Studies to define the optimal upper limits of tumor size and number as predictors of outcome after orthotopic liver transplantation (OLT) have yielded conflicting results. We analyzed 72 patients with cirrhosis and hepatocellular carcinoma (HCC) who underwent OLT over a 12-year period in a single center. Predictive factors for survival and tumor recurrence, according to the Milan criteria, were also examined. Our cohort included 60 men and 12 women of mean age 54 +/- 8 years and mean follow-up of 40 +/- 39 months. Origin of cirrhosis was postviral in 70% and Child class B or C in two thirds of patients. HCC was multifocal in 61%; about one fifth of patients had micro- or macrovascular involvement or positive nodes upon histologic examination. The cumulative size of the lesions was3 cm in 17 patients;3 toor =5 cm in 28 patients;5 toor =8 cm in 14 patients; and8 cm in 13 patients. According to the number and size of tumor nodules, 49 patients met the Milan criteria. During follow-up 25 patients died, 13 due to tumor recurrence. The 1- and 2-year survivals were 90% and 85% for patients who met the Milan criteria versus 57% and 51% for patients exceeding those limits (P = .006). A cumulative tumor size8 cm was predictive of survival and tumor recurrence upon multivariate analysis. The adoption of Milan criteria for selection of cirrhotic patients has improved survival and reduced the rate of tumor recurrence. The evaluation of cumulative tumor size might further improve patient selection.

Microphthalmos with cyst is a rare condition characterized by a small globe and an inferior uveoretinal coloboma. There is also a defect in the posterior aspect of the eye through which a cyst lined by neuroectodermically derived tissue protrudes into the orbit. A case of isolated bilateral colobomatous and cystic microphthalmos is reported in an otherwise healthy child, showing no evidence of chromosomal abnormalities. Microscopic findings in the enucleated eye consisted of iris and retinal dysgenesis, ectopia lentis, persistent anterior tunica vasculosa lentis and pupillary membrane, intrachoroidal smooth muscle, and optic nerve hypoplasia. In the orbital cyst, a thick membrane reminiscent of the retinal inner limiting membrane lay between the fibroadipose and vascularised outer wall and the inner neuroectodermal lining.

Forty allograft nephrectomies (28 males and 12 females, mean age of 33.2 years), performed between 1986 and 1999, were selected. Twenty patients had been grafted from cadaveric donors; of the remaining cases, 15 had received a kidney from a living related donor. Except for six patients who received steroid-azathioprine immunosuppression, all recipients were treated with cyclosporine A and low doses of steroids. None had primary or acquired hyperoxaluria as the cause of original end-stage renal disease, and none had a history of kidney stones or urinary infection. Kidney failure occurred after a time period ranging from 2 days to 11 years posttransplant and was secondary to acute rejection in 17 cases, chronic rejection in 15, ischemic necrosis in five, acute or chronic pielonephritis in two, and allergic microangiopathy in one. No blood chemistry evaluations for oxalemia were performed. Clinical data are summarized in Table 1. Multiple sections cut from formalin-fixed, paraffin-embedded blocks and stained with haematoxylin-eosin (H&E) were examined using partially crossed polarizing screens. The presence of calcium oxalate crystals in different segments of the nephron or in the interstitium was recorded. Birefringent deposits with characteristic green iridescence, presenting as large plate-like or diamondshaped crystals, or any shape, provided that the crystals displaced tissue structures, were studied. Confirmation of the crystal nature was obtained using Yasue’s method, a histochemical stain considered to be specific for calcium oxalate, while usual stains for calcium (alizarin red and von Kossa’s method) were negative. Silver nitrate–rubeanic acid with 5% acetic acid pretreatment (Yasue’s method) stains only calcium oxalate, since calcium phosphate and calcium carbonate are dissolved with the acetic acid. A thyroid with multiple deposits of calcium oxalate and hydroxyapatite crystals was used as a positive control for the histochemical stains.

A large mass in the right orbit, causing proptosis, ptosis of the right upper eyelid, and limitation to eye movements, was surgically removed from a 51-year-old woman suffering from Paget's bone disease (PBD). Histologically, a giant cell tumor of the bone (osteoclastoma) was diagnosed. No bony involvement was apparent either operatively, microscopically, or on preoperative computed tomographic scans. The neoplasm has not recurred in a 3-year follow-up. In addition to the fact that osteoclastoma complicating PBD is rare, the extraskeletal origin of the tumor is a matter of interest and can be tentatively explained by an unusually powerful systemic stimulus acting on circulating osteoclast precursors. HUM PATHOL 31:1527-1531.

Summary A case of inflammatory pseudotumour of the liver is reported, and evidence is presented for its subsequent evolution into malignant non-Hodgkin's lymphoma. Such postulated malignant transformation challenges the assumption that hepatic inflammatory tumours are entirely benign lesions.