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Objectives Our aim was to explore the performance of TRPS1 as an immunohistochemical diagnostic marker; find the optimal conditions for its use in breast carcinomas, especially triple-negative breast cancers (TNBCs); and compare its results in carcinomas of a select few organ sites, with an emphasis on gynecologic tumors. Methods Tissue microarrays from breast carcinomas (n = 197), endometrial adenocarcinomas (n = 69), ovarian tumors (n = 250), vulvar squamous cell carcinomas (n = 97), pancreatic ductal adenocarcinomas (n = 20), and gastric adenocarcinomas (n = 12) were stained with TRPS1 using 2 different conditions (protocol 1: high pH; protocol 2: low pH). Breast carcinomas consisted of hormone receptor (HR)–positive/ERBB2 (formerly HER2 or HER2/neu)–negative (n = 53) samples, HR-positive/ERBB2-positive (n = 6) samples, and TNBCs (n = 138). Results Comparing TRPS1 results in breast carcinomas vs tumors from other organ sites, the sensitivity of TRPS1 was 91% and 87%, respectively, while the specificity was 66% and 74% for protocol 1 and 2, respectively. For TNBCs vs gynecologic tumors, the sensitivity of TRPS1 was 89% and 85%, respectively, while the specificity was 65% and 73%, respectively. Conclusions TRPS1 stains approximately 90% of breast carcinomas but also up to 71% of endometrial carcinomas, albeit with a weaker median expression. Our data show that although TRPS1 is a highly sensitive marker for TNBCs, it is not as highly specific as previously reported. [ABSTRACT FROM AUTHOR]

Objectives: SOX10 expression helps identify melanocytic lesions. Over time, novel uses have been identified, such as expression in triple-negative breast cancer (TNBC). We evaluated the usefulness of SOX10 in breast pathology-specifically, identification and subtyping of TNBC and distinction from gynecologic carcinomas, use as a myoepithelial marker, and in the distinction of usual ductal hyperplasia (UDH) from atypical ductal hyperplasia (ADH).Methods: Several breast and gynecologic carcinoma tissue microarrays containing a total of 492 cases were stained with SOX10. Whole sections of 34 ADH, 50 UDH, and 29 ductal carcinoma in situ (DCIS) samples were also stained with SOX10.Results: SOX10 expression was identified in 67% of consecutive TNBC cases. Expression was mostly seen in nonapocrine, androgen receptor (AR)-negative TNBCs. All gynecologic carcinomas (n = 157) were negative. All UDH cases showed mosaic SOX10 expression, while all ADH cases lacked expression. All estrogen receptor (ER)-positive DCIS (n = 19) specimens were negative for SOX10, while 2 of 10 ER-negative DCIS specimens were positive for SOX10. The latter 2 cases showed SOX10-positive invasive carcinomas.Conclusions: SOX10 identifies nonluminal AR-type TNBC and is useful in distinguishing TNBC from gynecologic carcinomas. SOX10 can distinguish UDH from ADH. SOX10 is not useful in distinguishing ADH from DCIS. [ABSTRACT FROM AUTHOR]

Cardiac lipomatous hypertrophy is a rare benign condition that usually involves the interatrial septum. Due to its benign nature it rarely requires intervention. Its presence outside the interatrial septum is reported infrequently. We present a case of lipomatous hypertrophy in the intraventricular septum that was complicated by a severe, symptomatic, and disabling dynamic left ventricular outflow tract obstruction. The symptoms significantly improved following the excision of the mass. In our case transthoracic echocardiogram was used to visualize the mass and measure the severity of the obstruction; Cardiac Magnetic Resonance Imaging was used to characterize the mass and histopathology confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

Paratesticular liposarcomas are rare neoplasms that comprise 3%-7% of all testicular sarcomas and usually arise in the adipose tissue of the spermatic cord or by malignant transformation of a pre-existing lipoma. These entities can be challenging to diagnose since oftentimes, they mimic benign conditions such as hernia, cystic lesions, and subcutaneous lipomas. We present the case of a 70-year-old man with a one-year history of inguinal discomfort and a slow-growing, painless mass of the left testis. A testicular ultrasound was performed, which revealed a vascular lesion initially thought to be an omental hernia, which was followed with a CT scan that showed a mass less likely to be a hernia but suspicious for testicular malignancy. The patient underwent a left orchiectomy and was diagnosed as having dedifferentiated liposarcoma in a background of well-differentiated liposarcoma of the sclerosing type. The mass measured 30.2 cm in maximum dimension and revealed both low- as well as high-grade dedifferentiation. Dedifferentiation has been described very rarely in the genitourinary region and occurs in approximately 10 % of well-differentiated liposarcomas, confers a poorer prognosis, and increases the rates of local disease recurrence and metastasis. Although traditionally, tumors with both high- and low-grade dedifferentiation were considered to be equally aggressive, current literature suggests that high-grade dedifferentiation has a worse prognosis as compared to low-grade dedifferentiation. Thorough evaluation of scrotal masses, a high level of suspicion aided by imaging studies and documentation of the type of dedifferentiation in histopathology reports are essential in the diagnosis and appropriate management of these uncommon lesions. [ABSTRACT FROM AUTHOR]

Plasma cell neoplasms (PCNs) are lymphoproliferative disorders arising from post germinal center B cells with somatic hypermutations that exhibit varied manifestations and can be a challenging diagnosis for clinicians and pathologists. A subset of PCN reveals translocations of chromosome 14 involving the immunoglobulin heavy chain locus (IgH) with specific clinicopathological features with prognostic implications that have not been well characterized. We present to you the case of a 69-year-old man with mid back pain that radiated to his chest. Imaging of the thoracic spine revealed heterogeneous enhancement of both T6 and T11 vertebrae, after which he underwent a CT-guided biopsy of the T6 vertebra. The touch preparation and core biopsy revealed extensive infiltration by small-sized plasmacytic cells in a paratrabecular pattern. Immunohistochemistry revealed these cells to be positive for CD138, CD20, Bcl-2, MUM1, and cyclin D1, and negative for CD45, CD3, CD5, CD10, and Bcl-6. In situ hybridization (ISH) for kappa and lambda demonstrated lambda light chain restriction leading to a diagnosis of plasmacytic neoplasm with features most consistent with a CD20-positive plasmacytoma/myeloma. Fluorescence ISH revealed polysomy of odd-numbered chromosomes, chromosome 17 abnormalities, and the CCND1/IGH fusion gene in 71% of the examined cells. Although CD20 positivity in PCN with t(11,14) is well documented and has considerable therapeutic implications, it becomes very difficult to distinguish the present case from a B-cell lymphoma with plasmacytic features. Some studies show a worse prognosis for translocation-associated PCN, while other studies do not support this finding. Since PCNs present with heterogeneous morphology, clinical features, and immunohistochemical and molecular profiles, extensive work-up and clinicopathologic correlation is essential for appropriate classification and management. [ABSTRACT FROM AUTHOR]