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Glandular odontogenic cyst (GOC) is a very rare jaw cyst accounting for 0.2% of all odontogenic cysts. It presents usually in adults with a slight male predominance. It shows radiological, histopathological and even immunohistochemical overlap with low grade intraosseous mucoepidermoid carcinoma (MEC) but their distinction is crucial. A 57-year-old woman with bilocular radiolucency in the anterior mandible crossing the midline is described here. Microscopy features were consistent with glandular odontogenic cyst but multiple MEC-like islands were seen in the capsule, creating a diagnostic head trip with low grade intraosseous MEC. However, the absence of cellular atypia and epidermoid and intermediate cells led to a final diagnosis of GOC, with close follow-up of the patient recommended. This rare finding shows the relation between GOC and MEC or the origin of MEC from GOC.

AimsAn increasing number of small pulmonary nodules are being screened by CT, and an intraoperative diagnosis is necessary for preventing excessive treatment. However, there is limited literature on the frozen diagnosis of small sclerosing pneumocytomas (SPs). In particular, tumours smaller than 1 cm are challenging for pathologists performing intraoperative frozen diagnosis.MethodsIn total, 230 cases of SP were surgically resected between January 2015 and March 2019 at Shanghai Chest Hospital, and of them, 76 cases were smaller than 1 cm. The histology and clinical information of these 76 cases (33.0%, 76/230) were reviewed retrospectively, 54 cases of which were diagnosed intraoperatively, and the pitfalls were summarised. All diagnoses were confirmed on permanent sections and immunohistochemical sections.ResultsHistologically, 78.9% (60/76) of the small SP was dominated by one growth pattern, and solid and papillary growth pattern were the most commonly misdiagnosed circumstances. The rate of intraoperative misdiagnosis of these SP smaller than 1 cm was 11.1% (6/54).ConclusionsThe main reason for misdiagnosis was failure to recognise the dual cell populations and the cellular atypia. Diagnostic clues include the gross morphology, the presence of dual-cell populations and a hypercellular papillary core, foam cell accumulation in glandular spaces and haemorrhage and haemosiderin on the periphery. In spite of awareness of pitfalls some cases may still be essentially impossible to diagnose on frozen section.

El nevo de Spitz es una lesión melanocítica benigna poco común, compuesta de células epitelioides y/o fusiformes grandes, que usualmente se presenta en la infancia. Clínicamente son lesiones pequeñas, generalmente de menos de 6 mm de diámetro, con características histológicas benignas (arquitectura regular, escasas o nulas mitosis y ausencia de atipia celular). El patrón en estallido de estrella y el patrón vascular punteado son los patrones dermatoscópicos más frecuentes. El manejo puede ser expectante o excisional dependiendo de las características clínicas y la edad del paciente.

Introduction: Human papillomavirus (HPV) infection remains the most common cause of cervical intraepithelial neoplasia. The objective of this study is to evaluate the sensitivity and predictive value of the HPV test associated with the cervico-uterine smear in the screening of cervical intraepithelial neoplasia in our environment. Methodology: This is a descriptive cross-sectional study of 625 women who consulted in the department of gynecology for cervical cancer screening, of whom 300 received an HPV test; during the period from January the 1st to December 31st, 2018 at Panzi general reference hospital (South-Kivu, DRC). Data analysis was done using Epi Info version 7 software. Results: For all respondents (n = 625), the cervico-uterine smear was normal in 82.88%, inflammatory in 2.4% of cases and with cellular atypia in 14.72%. The HPV test was positive in 87 respondents against 213 negatives cases, i.e. a prevalence of HPV of 29% [95% CI: 23.9% - 34.5%]. Among women with precancerous lesions, 27.6% had HPV infection; among those with normal smears, 29.3% of them had HPV infection; however, this difference was not statistically significant. Patients with dysplastic lesions, 31.3% had genotypes with very high carcinogenic potential; and for those with a normal Pap smear, 45.1% had genotypes with very high carcinogenic potential; however, this difference was also not statistically significant. Conclusion: The human papillomavirus test remains a very important indication cation in the detection of cervical intraepithelial neoplasia, its sensitivity remaining clearly superior to that of cytology, especially for high grade lesions.

To evaluate the role of toluidine blue (TB) staining patterns in diagnosis of ocular surface squamous neoplasia (OSSN) in comparison to that of impression cytology.TB 1% dye was applied to different ocular surface lesions, followed by impression cytology (IC). Dye distribution, intensity, and pattern of uptake by the lesion were scored and total score ≥5 was considered "positive TB staining". The TB results were then compared with those using IC to determine the presence of cellular atypia.The study enrolled 88 eyes of 82 patients. IC demonstrated cellular atypia in 50 (56.8%) cases. Forty-three of 45 "TB-positive" eyes (95.51%) had cellular atypia on IC (p 0.001). Sensitivity and specificity of TB in identifying OSSN were 86% and 94.74%, respectively, with positive and negative predictive values of 95.56% and 83.72%. TB staining intensity of dark blue and/or mixed types and stippled pattern of TB staining were strongly correlated with dysplastic changes in IC (P ˂ 0.001). TB staining distribution whether in form of diffuse, patchy or scattered eyes with atypia did not significantly differ from those without atypia in IC (P = 0.172).The sensitivity and specificity of TB vital dye in diagnosing OSSN can be increased by focusing on color intensity and a stippled pattern.

Granular cell tumours (GCTs) are generally benign neoplasms, which are believed to be of neural origin. They are uncommon in the gastrointestinal tract. They are rarely found in the colon and even more rarely found to be multiple. We present a case of a man who underwent a right hemicolectomy for a submucosal lesion and polyps and was found to have multiple nodules diagnosed as caecal GCTs with cellular atypia. While uncommon, this case shows it remains an important differential due to implications for patient management, given the often benign nature of disease.

Objective: To highlight the most frequent localization of ovarian endometriosis, the presence of atypical endometriosis, and recurrences. Retrospective review of 259 patients diagnosed with ovarian endometriosis treated at Tîrgu-Mures Emergency County Hospital, Obstetric Gynecology Clinic, between January 2014 and December 2018. Methods: Data were collected and analyzed for demographics, size of ovarian endometriotic cyst, and recurrences. Results: Out of 259 patients, 51 patients presented atypia, 20 on the right, 24 on the left, and seven patients were diagnosed with endometriosis with bilateral atypia. Higher susceptibility for left localization was noted. Thirty-nine patients (15.1%) presented recurrence. A statistically significant correlation (p = 0.006) was noted between patients with recurrence and atypia compared with those without atypia and endometriotic cysts larger than 7 cm. Patients with relapse under the age of 40 were noted to have mainly atypia with localization on the right (p = 0.025, OD = 4.107). Conclusion: The presence of endometrioma was not statistically significant correlated with left or right sided localization, recurrent endometriomas larger than 7 cm represents a risk for atypical endometriosis development. Recurrence and atypia appear more often in patients under the age of 40 and are right-sided. The total removal of the endometriomas can prevent the recurrence and subsequently the appearance of atypia and secondary neoplastic conditions.

Dedifferentiated chondrosarcoma is a well-recognized entity, but its occurrence in the distal extremities is exceedingly rare. We present the case of a 49-year-old woman who experienced local recurrence of an “enchondroma” of the proximal phalanx of the fourth finger of the left hand, which had been initially treated with intralesional curettage at another hospital 4 years before, and 1 year before for a local recurrence. The imaging findings indicated an aggressive behavior, and an incisional biopsy showed a highly cellular proliferation of spindle and pleomorphic elements without evidence of matrix production intermixed with few fragments of a well-differentiated cartilaginous neoplasm with bland cellular atypia, focal nuclear hyperchromatism, and binucleation. An isocitrate dehydrogenase 2 R172S mutation was detected. The final diagnosis was dedifferentiated chondrosarcoma. Despite amputation of the fourth finger, the patient developed lung metastases and further local relapse. Recurrent cartilaginous tumors of the extremities should not be underestimated and should be followed in view of the possible acquisition of aggressive clinical behavior.

Background “Atypical cells” parameter in automated urinalysis has recently been introduced. An instrument capable of measuring quantitative and qualitative features of nuclear and cytoplasmic properties of a cell has the potential to detect cellular atypia. Instruments using flow cytometry have been detecting atypical cells in blood for a long time; yet instruments using the same methodology very lately developed this parameter in urinalysis. Materials and methods Samples with an atypical cells value higher than 1 atypical cell/µL were included in the study. Besides automated urinalysis, every sample was reflexed to modular unit for digital imaging. The remainder of each sample was stained with Sternheimer dye and examined manually under a light microscope. Results 50 samples with higher than1 atypical cell/µL result were included in the study. Patients were composed of 43 females (86 %) and 7 males (14 %). The mean age was 47.12 ± 19.45 years. The median atypical cells value was 1.8/µL (95 % range 1.5–2.4/µL). Manual microscopic evaluation of the 50 samples showed atypical cells in 1 sample. The patient had papillary lesions on cystoscopy and pathology report informed a high grade urothelial carcinoma. Other 49 samples were negative for atypical cells in manual microscopy. They were crowded samples with leucocytes and squamous epithelial cells. Conclusions The positive case provided evidence for Sysmex UN’s capability to detect atypical cells in urine. The negative cases presented clues that probable vulvovaginal contamination and crowded specimens could be deceptive for Sysmex UN in this particular parameter.

Lymphocyte-rich effusions of the body cavities may represent a reactive/benign condition, primary effusion lymphoma, or systemic lymphoma with secondary malignant effusion, either as initial presentation or as a late complication. Cytomorphologic examination is essential and fundamental for diagnosis and may provide important clues to the nature of diseases. However, based on morphology alone, cytologic diagnosis of lymphocyte-rich effusions could be very challenging, particularly when the lymphocytes are small. Cytologists/cytopathologists might be uncertain when a lymphocyte-rich effusion specimen warrants a comprehensive hematopathologic workup. Herein we present a simple and practical algorithmic approach. On the basis of the cytomorphology of lymphocytes (small vs. large cells), presence or absence of cellular atypia, and clinical information (an earlier history or current lymphoma), the lymphocyte-rich effusion samples could be triaged for ancillary studies including immunophenotyping and molecular assays if indicated. Incorporation of cytomorphology, correlation with clinical information, and appropriate application of various ancillary techniques is mandatory for a correct diagnosis of lymphocyte-rich effusion specimens.

Early diagnosis of the rare and life-threatening uterine leiomyosarcoma (LMS) is essential for prompt treatment, to improve survival. Preoperative distinction of LMS from benign leiomyoma remains a challenge, and thus LMS is often diagnosed post-operatively. This retrospective observational study evaluated the predictive diagnostic utility of 32 preoperative variables in 190 women who underwent a hysterectomy, with a postoperative diagnosis of leiomyoma (n = 159) or LMS (n = 31), at the Liverpool Women&rsquo, s National Health Service (NHS) Foundation Trust, between 2010 and 2019. A total of 7 preoperative variables were associated with increased odds of LMS, including postmenopausal status (p &lt, 0.001, OR 3.08), symptoms of pressure (p = 0.002, OR 2.7), postmenopausal bleeding (p = 0.001, OR 5.01), neutrophil count &ge, 7.5 &times, 109/L (p &lt, 0.001, OR 5.72), haemoglobin level &lt, 118 g/L (p = 0.037, OR 2.22), endometrial biopsy results of cellular atypia or neoplasia (p = 0.001, OR 9.6), and a mass size of &ge, 10 cm on radiological imaging (p &lt, 0.0001, OR 8.52). This study has identified readily available and easily identifiable preoperative clinical variables that can be implemented into clinical practice to discern those with high risk of LMS, for further specialist investigations in women presenting with symptoms of leiomyoma.

Pacinian neurofibroma (PN), a rare benign dermal tumor characterized by proliferation of pacinian corpuscles in the dermal myxoid stroma. A 50 year female presented with slow growing, soft, painless swelling over right wrist. No other significant history was found. Histopathology revealed proliferation of fibrous connective tissue along with whorled structures. No cellular atypia was found. Immunohistochemistry examination with antibodies against protein S-100 showed diffuse positivity. A diagnosis of Pacinian neurofibroma was made.

Oral mucosal melanoma (OMM) is notorious for having a poor prognosis. Recognition of the early features of OMM by both clinicians and pathologists can play an important role in improving survival. Therefore, the purpose of this report is to increase awareness of the early features of OMM, by presenting 2 cases with longitudinal clinical and histopathologic documentation showing progression of OMM from a deceptively bland premalignant (noninvasive) oral melanocytic lesion (POML). By analyzing the clinical and histopathologic features of POML in our cases, and those in the literature, we found that the concerning features are (1) clinically, a pigmented lesion violating the ABCDE criteria or showing multiple recurrences; and (2) histologically, a melanocytic proliferation, in either a lentiginous or pagetoid pattern with or without cellular atypia. Making a diagnosis of POML prospectively is often challenging. Increasing awareness of the clinical and histopathologic features and complete surgical excision of POML are emphasized.

Subependymomas are slowly growing glial tumors, corresponding to WHO grade I. Few descriptions of the cytologic features of this neoplasm are available. This study describes the cytologic features of three subependymomas, as well as their differential diagnosis based on cytology. Three men, aged 52, 56, and 63 years, presented with headache. Magnetic resonance imaging revealed a nodular intraventricular mass in all three patients. Intraoperative squash cytology specimens from the three intraventricular tumors showed nodular clusters with microcystic changes. Nuclei were round to oval in shape, but showed no evidence of severe nuclear atypia or mitoses. Histological examination showed features of subependymoma. Squash cytology findings, including nodular clusters, mild cellular atypia, microcystic changes, and mucoid material, are useful in the rapid intraoperative diagnosis of subependymoma.

The use of lasers to treat melanocytic nevi has been subject to debate because of concerns about their possible malignant transformation (Stratigos et al. 2000; Sardana 2013). In the last few years, it has become relatively clear that laser irradiation is unlikely to increase malignant potential. To date, surgical excision is the standard approach in the removal of these lesions since it allows a histopathologic examination and then the exclusion of cellular atypia. However, the presence of some melanocytic nevi in positions sensitive from the aesthetic or functional point of view, in which surgical removal is difficult to obtain or which will probably leave a noticeable scar, may limit this procedure. Therefore, in these cases laser treatment is preferably applied. To date, different types of laser for melanocytic nevi have been proposed with variable clinical outcomes (Bray et al. 2016; Arora et al. 2015; Hammes et al. 2008; Ohmaru et al. 2011; Zeng et al. 2016).

Parosteal osteosarcoma is a rare, slow-growing tumor most commonly arising from the surface of long bones. Tissue or histological sections from 5 dogs and 1 cat with zygomatic arch masses were examined. Clinical presentations varied from chronic sneezing to facial swelling. Imaging consistently demonstrated osseous proliferation in the area of the zygomatic arch. Histologically, the masses were characterized by well-differentiated fibro-osseous and chondroid components that radiated outward from the periosteum of the zygomatic bone. Cellular atypia and mitotic figures were uncommon. Parosteal osteosarcomas have previously been reported in the skulls of dogs and cats, but only 1 has been reported on the zygomatic arch. Initially, these tumors are of low histologic low grade, but with time, they can show more aggressive behavior and invade the underlying bone.

Objective: Cytopathologic interpretation in Graves disease (GD) is considered challenging due to significant cellular atypia. Study Design: We retrospectively identified 55 fine needle aspirations (FNAs) from 43 patients with GD that subsequently underwent thyroidectomy from 1995 to 2016. Results: There were 5 patients with papillary thyroid carcinoma (PTC) and 4 with follicular adenoma (FA). Of the 5 patients with PTC, FNA was interpreted as PTC in 3, atypia of undetermined significance (AUS) in 1, and adenomatoid nodule (AN) in 1 (with a 0.5-cm incidental microcarcinoma). Of the 4 patients with FA, FNA was interpreted as follicular neoplasm (FN) in 2, AUS in 1, and AN in 1. Of the 46 nonneoplastic nodules, FNA was interpreted as nondiagnostic in 2, benign in 26, AUS in 15, FN in 1, and suspicious for PTC in 2. None was diagnosed as malignant. The sensitivity, specificity, positive predictive value, and negative predictive value of PTC diagnosis in FNA were 60, 100, 100, and 96.2%, respectively. Conclusion: FNA is a useful tool for identifying neoplastic nodules arising in GD. However, cytologic atypia often leads to indeterminate diagnoses (18/46, 39.1%). Awareness of clinical information regarding prior treatment for GD may be helpful to avoid overinterpretation.

PurposePhyllodes tumors (PTs) are biphasic tumors accounting for 0.3-1.5% of all breast tumors. Epithelial membrane proteins (EMPs) have been reported in various malignant tumors but their expression in PTs is unclear. In this study, we aimed to evaluate the expression of EMP1, EMP2, and EMP3 in breast phyllodes tumors (PTs), and to investigate their clinical implications.MethodsIn total, 185 PTs were used for constructing a tissue microarray. Immunohistochemical staining for EMP1, EMP2, and EMP3 was performed, and the results were analyzed along with the clinicopathologic parameters.ResultsIn total, 185 PTs were included in this study, and comprised 138 benign, 32 borderline, and 15 malignant PTs. In malignant PTs, the epithelial component showed decreased expression of EMP1 (P = 0.027), EMP2 (P = 0.004), and EMP3 (P = 0.032), compared to the benign and borderline PTs. Conversely, stromal component of borderline and malignant PTs showed higher expression of EMP1 (P = 0.027), EMP2 (P = 0.004), and EMP3 (P = 0.032) compared to benign PTs. Expression of EMP1 and EMP3 correlated positively with stromal cellularity and cellular atypia (P < 0.001). In the univariate analysis, stromal EMP3 was associated with shorter disease-free survival (P < 0.001), and shorter overall survival (P = 0.034).ConclusionThe expression of EMP1, EMP2, and EMP3 is decreased in the epithelial component and is increased in the stromal component of PT with higher histologic grade. Thus, stromal EMP3 expression may serve as an independent prognostic factor in PT.

Highlights • We report a case of MDA arising from clinical LEGH during 5 years of follow-up. • The first sign suggesting MDA was cellular atypia in endocervical cytology, and was followed by an increase in tumor size. • MDA lesion lacked in stromal reaction and MRI failed to detected MDA. • Worsening cytology and lesion enlargement are important signs for malignant change of LEGH during follow-up.

Tzanck smear test is most often used for the diagnosis of erosive–vesiculobullous lesions. When a cytological examination is performed in an erosive–vesiculobullous lesion, firstly, the acantholytic cell should be checked. If acantholytic cell is positive, multinuclear giant cell, dyskeratosis, corps ronds, grains, and cellular atypia should be examined. If there is only acantholytic cell, direct immunofluorescence test on smear should be performed to distinguish Hailey–Hailey’s disease from pemphigus.

Extraventricular neurocytoma (EVN) is an extremely rare tumor of neuroglial origin with a tendency toward ganglionic or glial differentiation. In the 2016 World Health Organization Classification, EVN was classified as a grade II tumor and described as a neoplasm with good outcome. However, the presence of cellular atypia is an important unfavorable prognostic factor. Here, we describe the first case of a patient with a congenital EVN localized in the brainstem. After a sub-total resection, his disease rapidly progressed despite several chemotherapies, including molecular targeting approaches. He died 13 months after diagnosis. In conclusion, we report an atypical case of EVN presenting an extremely aggressive behavior, despite the absence of cellular atypia. The brainstem origin and the age of the patient may have represented two important prognostic factors for our patient.

BACKGROUND Urinary tract (UT) cytology has been used successfully to diagnose high-grade urothelial carcinoma but is reported to have poor sensitivity for low-grade urothelial neoplasms (LGUNs). However, the literature has shown that LGUN may be associated with atypical findings in UT specimens. The authors determined which features were most commonly observed, and whether the method of specimen procurement had an effect. METHODS A total of 326 specimens were identified over an 8-year period. One hundred fifty-three specimens were reviewed and graded for cellularity, number of tissue fragments (TFs), degeneration, inflammation, hyperchromasia, nuclear pleomorphism, nuclear border irregularity, nuclear size, cytoplasmic tails, nuclear eccentricity, and high-grade features. RESULTS Of the 153 specimens, 86 specimens (56.2%) demonstrated cellular atypia; of those, 51.2% were voided urine (VU) and 31.4% were UT washing (UW) specimens. The majority of specimens had many cells (46.5%), many single cells (44.2%), few to moderate TFs (46.5% and 27.9%, respectively), mild hyperchromasia (52.3%), mild nuclear pleomorphism (51.2%), mild nuclear border irregularity (60.5%), cytoplasmic tails (51.2%), and few to moderate eccentric nuclei (37.2% and 36.1%, respectively). The presence of TFs, cytoplasmic tails, and eccentric and enlarged nuclei were significantly more common in UW versus VU specimens (P = .036, .012, .014, and .027, respectively) and in UW versus benign UW controls (P = .001, .002, .002, and .003, respectively). CONCLUSIONS Approximately 50% of UT specimens with LGUN on follow-up demonstrated atypical features. Based on comparison with benign UW controls, TFs, cytoplasmic tails, nuclear eccentricity, and enlarged nuclei were more pronounced in neoplastic UW than VU specimens, suggesting that the method of urine specimen procurement affects the presence of certain low-grade features. Cancer Cytopathol 2016. © 2016 American Cancer Society.

Ameloblastic carcinoma is a rare odontogenic malignancy. Ameloblastic carcinoma is a histopathological presentation, which combines the features of conventional ameloblastoma and cellular atypia. Biological behavior is rather aggressive when compare to conventional ameloblasts and tend to metastasize to the different organs. Diagnosis and treatment of this malignancy is

The article discusses the relationship between etiology and risk factors of fibrocystic disease (FCD) and breast cancer (BC), pathogenesis of FCD in connection with increasing risk of BC, assessment of BC risk in patients with FCD; pathogenetic treatment of FCD aimed for preventing BC; the use of the drug progestogel for the treatment of FCD and prevention of BC. FCD and BC have general etiology and the most risk factors are identical for the both pathologies. Multiple risk factors disturb hormonal balance in the organism of a woman, cause hyperestrogenism and epithelium hyperproliferation in the mammary tissue that results in the development of FCD and at presenceof congenital or acquired gene damage results in the development of BC. Decision value for the estimation of degree of a BC risk in patients with FCD has morphological research of mammary tissue got at a biopsy. The risk of developing BC for non-proliferative FCD does not rise or is minimal. Proliferative FCD without atypia or with atypia was associated with significantly increased BC risk in 2 or 4 times, correspondingly. The risk of developing BC for FCD with ductal or lobular carcinoma in situ is maximal and may be increased in 12 times. Progestogel is hormonal medicinal drug containing progesterone for local application. Results of undertaken studies and supervisions allow to conclude that progestogel is not only effective and safe drug for pathogenetic treatment of FCD and thus could be regarded as indirect factor to decrease BC risk.

Adenoid ameloblastoma (AA) is a very rare subtype of solid/multicystic ameloblastoma. It demonstrates areas of typical or atypical adenomatoid odontogenic tumor along with the ameloblastic content. To date, there are 17 reported cases of AA. This paper reports, however, the first introduced adenoid variant in a peripheral ameloblastoma. It also depicts an unusual appreciation of cellular atypia and nuclear pleomorphism. This find may promote a new pathogenetic scenario to the current nosology of this debatable lesion and to the WHO taxonomy of benign ameloblastomas in 2005.

Teratoma Osteosarcoma is the most common malignancy of mesenchymal cells mostly originating within long bones, but rarely in the jaws. The World Health Organization (WHO) assorts several variants that differ in locale, clinical behavior and cellular atypia. This report illustrates a case of one of the histological variants of osteosarcoma i.e., chondroblastic osteosarcoma in the region of anterior maxilla in a 58 year old male patient previously treated for ossifying fibroma of the same site

The present study was undertaken with an aim of determining the cytological features observed in mucosal smears of oral submucous fibrosis (OSF) patients and comparing them with that of features of normal mucosal cells. The observed features were than analyzed for their reliability in detecting malignant changes in this premalignant condition. Objective of the study was to conduct an oral exfoliative cytology (OEC) study on 30 clinically diagnosed cases of OSF and 30 cases of clinically normal mucosa with no other systemic disease. We observed that all the smears from clinically normal buccal mucosa showed Class I cytology. The exfoliated cells were of normal size and shape with normal staining intensity and normal nuclear characteristics. All the 30 cases of our study group showed features suggestive of benign atypical cytological changes (Class II cytology). In the present study, despite the small number of cases, cytological features consistently observed in all the cases, were indicative of a premalignant change and emphasized a regular follow-up of patients. Early detection of a premalignant oral lesion promises to improve the survival rate of patients suffering from these conditions.

A case of 16 yrs male patient with parosteal lipoma affecting the lower metaphyseal end of the left femur is presented. Clinical suspicion, plain radiographs, CT (Plain and 3 D) as well as MRI suggested a diagnosis of parosteal lipoma. Lipomas may be defined as benign lesions of mature adipose tissue without evidence of cellular atypia [1]. Lipomas are the most common soft tissue lesions and surprisingly are among the rarest bone neoplasias. The most frequent complaints are a tumoral convexity presenting as a visible or palpable mass or a mild-intensity, dull pain. The parosteal type is a rare tumor accounting for 0.3% of all lipomas [2] and is usually asymptomatic. It is seen commonly affecting adults aged over 40 [3]. The present article describes a rare case of parosteal lipoma located in the femur, with extensive hyperostosis visible on plain xray and confirmed by imaging studies (CT and MRI). Unlike the parosteal lipomas reported in adults over 40 yrs in this case it presented in a much younger age group.

Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor characterized by inflammatory cell infiltration and differentiated myofibroblastic spindle cells. IMT was first described in the lung and retroperitoneum. Occurrence in bone has been well described in the maxilla and occasionally in the long bones in the adult population. We present a unique case of IMT arising primarily from the scapula in an 8-year-old patient, not described previously in the pediatric or adult literature. Imaging demonstrated an ill-defined and aggressive osteolytic lesion with cortical bone destruction associated with an important soft tissue component that extended into the adjacent muscles. Histologically, the tumor was composed of spindle and polygonal cells distributed in an inflammatory background with different proportions of plasma cells, lymphocytes, eosinophils and neutrophils. The absence of cellular atypia helped to differentiate this entity from malignant spindle cell tumors, and imaging could differentiate the tumor from the nontumoral inflammatory reaction.

Cellular schwannoma (CS) is a variety of schwannoma with a predominantly cellular growth, normally developing in middle-aged patients. In this report, we describe a 15-month-old infant with primary cutaneous CS on the knee. Because of its histologically malignant features, CS is sometimes overdiagnosed as a malignant nerve tumor. Therefore, awareness of this variant of schwannoma is important for dermatologists to avoid needless treatments for patients with CS.

Recently we described skin tumors driven by skin-specific expression of Zmiz1 and here we define keratoacanthoma pathobiology in this mouse model. Similar to human keratoacanthoma development, we were able to segregate murine keratoacanthomas into three developmental phases: growth, maturation, and regression. These tumors had areas with cellular atypia, high mitotic rate, and minor local invasion in the growth phase, but with development they transitioned to maturation and regression phases with evidence of resolution. The early aggressive appearance could easily be misdiagnosed as a malignant change if the natural pathobiology was not well-defined in the model. To corroborate these findings in the Zmiz1 model, we examined squamous skin tumors from another tumor study in aging mice, and these tumors followed a similar biological progression. Lastly, we were able to evaluate the utility of the model to assess immune cell infiltration (F4/80, B220 Granzyme B, CD3 cells, arginase-1) in the regression phase, however, because inflammation was present at all phases of development, a more comprehensive approach will be needed in future investigations. Our study of keratoacanthomas in selected murine models suggests that these squamous tumors can appear histologically aggressive during early development, but with time will enter a regression phase indicating a benign biology. Importantly, studies of squamous skin tumor models should be cautious in tumor diagnosis as the early growth distinction between malignant versus benign based solely on histopathology may not be easily discerned without longitudinal studies to confirm the tumor pathobiology.

Background: Dysplasia is malignant transformation of stratified squamous epithelium characterized by cellular atypia and loss of stratification and maturation. It can caused by cigarette smoke. Measuring the activity of cell proliferation as the beginning of dysplasia is very useful to know the development of malignancy. One of proliferation marker is Ki67 that expressed in all cell cycle phase except G0.Methods: 30 male wistar rats divided into: control grup (n=10), exposed to cigarette smoke for 4 weeks (n=10), 8 weeks (n=10) as much as 20 cigarettes/group/day/exposure used smoking pump. Specimen were stained HE to see dysplasia and Ki67 expression seen immunohistochemically. Statistical analyzed by Spearman correlation.Result: There was an increase in mean of Ki67 expression and significant differences between groups (p=0,000) and also significant difference of degree of dysplasia between groups (p=0,000). There was a strong correlation between Ki67 score to degree of dysplasia (p=0.001).Conclusion: Increased of Ki67 expression proportional to the Increase in degrees of dysplasia

Background and Aim Endocytoscopy (EC) at ultra-high magnification enables in vivo visualization of cellular atypia of gastrointestinal mucosae. Clear images are essential for precise diagnosis by EC. The aim of the present study was to evaluate the optimal staining method for EC in the colon. Methods Thirty prospectively enrolled patients were allocated 1:1:1 to three distinct staining methods: 0.05% crystal violet (CV) alone, 1% methylene blue (MB) alone, or CV + MB (CM double). Normal rectal mucosae were stained with each dye and videos of EC images were recorded. Visibility of nuclei and gland formation after staining were evaluated as ‘recognizable’ or ‘not recognizable’. Time for each parameter to become ‘recognizable’ was measured, and the average times for the three staining regimens were compared. Results MB alone and CM double staining resulted in ‘recognizable’ (102 ± 27 vs 89 ± 22 s, P = 0.263) nuclei within comparable periods of time, whereas CV alone was unable to identify nuclei. Gland formation became ‘recognizable’ sooner after CM double staining than after MB alone (61 ± 16 vs 108 ± 24 s, P

The dermoscopic island is described as a well-defined area in a melanocytic lesion, with a different dermoscopic pattern from the rest of the lesion. It is predictive of melanoma, particularly when the pattern of the island is atypical. We present the reflectance confocal microscopy (RCM) findings in 3 lesions with dermoscopic islands: nevus-associated melanoma, melanocytic nevus, and in situ melanoma. The nevus-associated melanoma and in situ melanoma presented cellular atypia (atypical cells in isolation or forming nests) and architectural distortion on RCM. The nevus presented a dermoscopic island with a typical globular pattern with dense nests and no atypia on RCM. Dermoscopic island is mainly associated with in situ and nevus-associated melanomas. RCM offers good cellular resolution to the depth of the reticular dermis and is useful for diagnosing of melanomas presenting a dermoscopic island.

The main pillar of cancer diagnosis has been classically represented by the cyto-/histopathological analysis of cells and tissues. The detection of morphological features of cellular atypia (e.g., altered nuclear/cytoplasmic area ratio; nuclear dysmorphism) and disarranged hierarchical architecture of the tissue (i.e., dysplasia) are funding elements in the diagnosis of malignancies, yet the pieces of information conveyed by these features are often insufficient for the precise identification of a specific cancer histotype, and sometimes they prove faulty [1–6].

Solid papillary carcinoma (SPC) is considered a rare malignant breast tumor. Maluf and Koerner first reported this disease entity as a special type of ductal carcinoma in situ with several characteristic histopathological features, including low-grade cellular atypia, intracellular or extracellular mucin deposition, and solid papillary growth pattern, as well as neuroendocrine differentiation. The present paper describes a case of SPC with bcl-2 expression, which is known as a marker for malignancy of neuroendocrine tumors. Interestingly, despite bcl-2 expression being a poor prognostic indicator of neuroendocrine tumors, the patient with this tumor has achieved long-term survival (approximately 6 years) at the time of writing this report. Because previous investigators reported that bcl-2 expression might play a role in the inhibition of the development of breast cancer, we suggest that bcl-2 expression might reflect a good prognosis in patients with SPC, rather than being a poor prognostic indicator, as it is in several types of neuroendocrine tumor. However, to confirm this hypothesis, further investigation is required.

Aims: Metabolite levels can be measured non-invasively using in vivo 1H magnetic resonance spectroscopy (MRS). These tumour metabolite profiles are highly characteristic for tumour type in childhood brain tumours; however, the relationship between metabolite values and conventional histopathological characteristics has not yet been fully established. This study systematically tests the relationship between metabolite levels detected by MRS and specific histological features in a range of paediatric brain tumours. Methods: Single-voxel MRS was performed routinely in children with brain tumours along with the clinical imaging prior to treatment. Metabolites were quantified using LCModel. Histological features were assessed semi-quantitatively for 27 children on H&E and immunostained slides, blind to the metabolite values. Statistical analysis included 2-tailed independent-samples t tests and 2-tailed Spearman rank correlation tests. Results: Ki67, cellular atypia, and mitosis correlated positively with choline metabolites, and phosphocholine in particular. Apoptosis and necrosis were both associated with lipid levels, with the relationship dependent on the use of long or short echo time MRS acquisitions. Neuronal components correlated negatively and glial components positively with N-acetyl-aspartate. Glial components correlated positively with myoinositol. Conclusion: Metabolite levels in children's brain tumours measured by MRS are closely associated with key histological features routinely assessed by histopathologists in the diagnostic process. This further elucidates our understanding of this important non-invasive diagnostic tool and strengthens our understanding of the relationship between metabolites and histological features.

INTRODUCTION: Actinic cheilitis may undergo malignant transformation to squamous cell carcinoma. Furthermore, there is evidence that inflammatory components may be involved in this process, hence the importance of studies involving cellular atypia and chronic inflammation in this lesion. OBJECTIVE: The aim of this study was to evaluate the histological features of actinic cheilitis considering the degree of dysplasia, the intensity of inflammatory infiltrate and the possible correlation between the variables. MATERIAL AND METHODS: We selected 45 paraffin blocks of lesions with clinical and histopathological diagnosis of actinic cheilitis that enabled histopathological evaluation. The histopathological analysis was performed and the dysplasias and inflammatory infiltrates were classified into mild, moderate and severe. Data were analyzed through descriptive statistics, chi-square test and Analysis of variance (ANOVA), considering p < 0.05. RESULTS: 59.5% (27) of cases of actinic cheilitis showed some degree of dysplasia, from which 40% (18) presented mild dysplasia, 11.1% (5) moderate and 8.4% (4) severe. Squamous cell carcinoma occurred in 20% (9) of the specimens. All cases showed some degree of inflammation, from which 48.9% (22) showed mild inflammatory infiltrate, 20% (9) moderate and 31.1% (14) intense. There was a statistically significant association between the degree of dysplasia and the intensity of inflammatory infiltrate, namely ANOVA p = 0.000 and chi-square p = 0.004. CONCLUSIONS: The results indicate that the occurrence of dysplasia and squamous cell carcinoma are common in actinic cheilitis and the inflammatory process was closely related to the progression of epithelial atypia.

Gastric "crawling-type" adenocarcinoma (CTAC) is a neoplasm histologically comprising irregularly fused glands with low-grade cellular atypia that tends to spread laterally in the mucosa. It is necessary to elucidate the clinicopathological characteristics of CTAC.We evaluated 25 CTACs-16 intramucosal (M-) and 9 submucosal invasive (SM-) cancers-clinicopathologically and immunohistochemically.CTAC was most frequently located in the lesser curvature of the middle-third of the stomach. Macroscopically, 21 lesions were superficial-depressed and 4 were superficial-flat type. Histologically, all CTACs had cystic dilated glands and 16 lesions had focal signet-ring cells. All invasive areas of the SM-CTACs were occupied by poorly differentiated adenocarcinoma with an infiltrative growth pattern and abundant stroma. Fifteen CTACs were surrounded by mucosa with partial or no intestinal metaplasia. In the intramucosal area, 24 lesions were mixed phenotype with mucin and brush border immunoexpression. SM-CTAC was frequent in lesions with an intramucosal poorly differentiated component (PDC) greater than 10 mm in size (P = 0.041), and lymph node metastasis (LNM) was frequent in lesions with a PDC greater than 20 mm (P = 0.039). The frequency of an expanded pattern (Ki-67-positive cells occupying50 % of the mucosa) was higher in SM-CTAC than in M-CTAC (P = 0.027). p53 overexpression was not detected in the intramucosal areas of any of the lesions.CTAC is a distinct subgroup of gastric adenocarcinoma in the early phase. A larger PDC and a Ki-67 expanded pattern were predictive of submucosal invasion or LNM.

Verrucous epidermal nevi are congenital, noninflammatory cutaneous hamartomas composed of keratinocytes. They follow the lines of Blaschko and show hyperkeratosis without cellular atypia. The routine histology shows variable amount of hyperkeratosis, acanthosis and papillomatosis and rarely epidermolytic hyperkeratosis. We saw a 3-year-old boy with bilaterally symmetrical, systematized verrucous plaques along the lines of Blaschko extensively involving the trunk and extremities but sparing the face and palmoplantar skin. Histopathology showed features of epidermal nevi with prominent epidermolytic hyperkeratosis. We report here the case for the rarity of this entity.

Verrucous carcinoma (VC) of the skin is relatively rare. The author reports 5 Japanese cases of VC of the skin. The age ranged from 63 to 91 years with a median of 70 years. The locations were hand in 1 case, lip in 1, face in 1, and foot sole in 2. The size ranged from 0.8 cm to 30 mm with a median of 1.5 cm. Grossly, all the cases showed elevated verrucous tumors. Histologically, the tumors were composed of squamous epithelial cells with minimal cellular atypia arranged in a verrucous pattern. One case showed koilocytosis. Neutrophilic abscesses were seen in 3 cases. Microinvasion was recognized in 2 cases. Focus of less differentiated squamous cell carcinoma was seen in the VC in 1 case. Actinic karatosis or squamous cell carcinoma in situ contiguous to VC was seen in 1 case. Definite precedent lesions were not recognized in any of the cases. Immunohistochemically, VCs of the skin were negative for human papilloma virus antigens in the 2 cases examined. p53 protein was expressed in all the VCs and accentuated in the basal and microinvasive parts. The Ki-67 antigen was also expressed in all the VCs, and it was mainly observed in the basal and microinvasive areas. These findings suggest that (1) VC of the skin can occur in any skin sites, (2) VC of the skin can transform into less differentiated squamous cell carcinoma, and (3) VC of the skin may be associated with squamous cell carcinoma in situ.

The authors analyzed 52 cases of female breast angiolipoma (AL). Age distribution was 25 to 80 years of age (56.81 ± 12.78). Most cases showed vascularity below 50%, and 14 cases had vascularity >50%. Cellular and low-vascularity ALs had different clinical and radiological presentations. The mean size was 7.00 ± 3.62 mm for cellular ALs and 19.61 ± 7.58 mm for low-vascularity ALs. In any paucicellular area, the authors could identify a cluster of at least 3 interconnected vessels. The endothelium was mostly flat with uniform, hyperchromatic nuclei, and mitoses and nucleoli were absent. Fibrin thrombi in proliferating capillaries were noted in 96% of cases. Low-vascularity AL can be reliably distinguished on needle core biopsy from other lipomatous and vascular tumors of the breast. Tortuosity and proliferation of capillaries with at least 3 interconnected capillary channels in 1 focus with associated fibrin thrombi constitute a very strong clue for the diagnosis of AL on a breast needle core biopsy. Definite diagnosis of cellular AL is not always feasible because of rare cases with mitotic activity and cellular atypia. Excision is often recommended for cellular AL.

Two cases of spontaneous focal hepatic hyperplasia were observed in young female cynomolgus macaques (Macaca fascicularis). Grossly, a single raised nodule was observed in the left hepatic lobe. Histopathologically, the nodule compressed surrounding normal tissue; however, the hepatic cords within the nodule continued to those in the nor mal area except in part. Extensive fibrosis and absence of a normal hepatic triad were observed in the nodule. Thin fibrous septa radiating from the dense central stellate scarring and distended vessels were apparent in one animal. Hepatocytes in the nodule lacked cellular atypia, showed frequent PAS-positive eosinophilic inclusions in the cytoplasm and showed higher positive ratios for PCNA. The present cases resembled focal nodular hyperplasia reported in humans and a chimpanzee.

目的 : 類内膜腺癌 (以下, G1) および各段階にある子宮内膜増殖症について細胞構築および構成細胞それぞれの観点から従来の報告にある細胞所見と比較検討を行った.方法 : 2000∼2007 年までに生検組織, 細胞診が同時期に実施され, いずれも類内膜腺癌および子宮内膜増殖症と診断された 69 例 (類内膜腺癌 G1 (EA : endometrioid adenocarcinoma) 35 例 ; 複雑型異型増殖症 (AEH : atypical endometrial hyperplasia)10 例 ; 複雑型増殖症 (EH-C : endometrial hyperplasia, complex)11 例 ; 単純型増殖症 (EH-S : endometrial hyperplasia, simple) 13 例) を対象とした. これらを用い細胞集団の出現パターンおよび細胞配列, 扁平上皮化生細胞, 背景と好中球の取込み像, 子宮内膜間質細胞の各因子について検討した.成績 : 1) EH-S, EH-C にみられる過分岐腺管, 拡張腺管の出現率に相違はない, 2) AEH では腺管過密集団の出現, 3) EA は腺管過密集団に加え, 樹枝状集団の出現が特徴としてあげられた. さらに, 各因子の検討からは特に EA, AEH における顕著な変化として, 1) 扁平上皮化生細胞の高い頻度での出現, 2) 背景, 腫瘍細胞およびその周囲にある好中球の出現があげられた.結論 : 子宮内膜細胞診においては各段階にある子宮内膜増殖症や類内膜腺癌に特徴となる異型腺管の出現と重複する異型腺管の頻度を総合的に判定することが必要と考えられた. また, 細胞集団の出現パターン以外の所見として扁平上皮化生細胞, 背景および腫瘍細胞に取り込まれた好中球の出現は EA, AEH を推定するうえで注目すべき所見と考えられた.

Oncocytic carcinoma arising in the submandibular gland is an extremely rare tumor and only 11 cases have been reported previously. We report on a 51-year-old man with a previously benign oncocytoma in the submandibular gland that transformed from a benign morphology to malignant cellular atypia and mitosis. To our knowledge, the current report is the first published case of a malignant transformation from benign oncocytoma to oncocytic carcinoma of the submandibular gland. The proliferative activity of the tumor cells was evaluated immunohistochemically using antibodies against Ki-67.

Background : True papillary lesions of the breast have a significantly high error rate on fine needle aspiration cytology (FNAC), as many other nonpapillary breast lesions exhibit overlapping features on cytosmears. Aim : To evaluate the utility of individual morphological features in offering a more precise cytodiagnosis in papillary lesions of the breast. Materials and Methods : Cytology smears reported as papillary lesions on nipple discharge / FNAC and histopathology over a period of two years were studied and correlated. A subjective assessment of morphological features, namely, the cellular yield, presence of three-dimensional papillary clusters, stromal bare nuclei, presence of cyst macrophages and cellular atypia was carried out on cytosmears. Results : Fourteen cases of papillary lesions were identified. Thirty-six per cent of the cases were found to be true positive, 43% false negative and 21% false positive with a sensitivity of 42% for papillary lesions. Eight of nine papillary lesions showed cyst macrophages. Stromal bare nuclei were seen in three of four malignant papillary lesions. However, the number of stromal bare nuclei was less compared to benign lesions. None of the malignant nonpapillary lesions showed stromal bare nuclei. Conclusions : Cytomorphological features alone are inadequate for the precise diagnosis of papillary lesions of the breast.

The mechanisms for the development of acquired melanocytic nevi remain mostly unclear. Here we report a case of eruptive nevi that developed after localized superficial trauma, and review the currently known cellular and triggering factors for acquired melanocytic nevi. A 66-year-old woman presented a linear arrangement of pigmented macules on her left calf that developed after a bloodless skin erosion on the same spot, resulting from friction with the lining of a ski boot. Dermatopathology identified multiple junctional proliferations of single or small nest-forming melanocytes with bridging, pigment incontinence and moderate cellular atypia. The number of a person’s nevi correlates with age, race and genetics, but blistering diseases, scarring processes, light exposure and immunosuppression can contribute to nevocellular growth as well. Damaged keratinocytes and inflammatory cells can release growth factors inducing nevus cell proliferation, and immunosuppression could end cellular surveillance keeping preexisting nevus cell nests in check. We conclude that in predisposed patients, the trigger for eruptive nevi can be reduced to a simple localized minor trauma.

Objetivou-se verificar a influência das formas de acondicionamento de lâminas de colpocitologia nos resultados dos laudos laboratoriais concernentes a Epitélios Representativos da Amostra, Alterações Celulares Benignas e atipias celulares. Estudo descritivo, quantitativo, realizado entre abril e junho de 2008. Participaram 72 mulheres que realizaram exame preventivo do câncer de colo uterino, em um Centro de Parto Natural de Fortaleza-CE. De cada participante foram coletados dois esfregaços de espécime cérvico-vaginal: um foi acondicionado junto ao de outras usuárias (caso), e outro isoladamente (controle), atendendo aos padrões técnicos. Seguiu-se o critério de "cegagem" da leitura das lâminas. Os resultados das duas lâminas foram comparados verificando discordâncias nos diferentes armazenamentos. Houve discordância de 58,3% em relação aos Epitélios Representativos da Amostra e 48,2% com relação às Alterações Celulares Benignas. Os resultados sugerem novos estudos sobre formas de acondicionamento, controle da intrasubjetividade do técnico responsável pela leitura e ordem de coleta das lâminas caso e controle. The aim of this study was to verify the influence of packing types of cytology slides in laboratory report results pertaining to Sample Epithelia Representatives, Benign Cellular Alterations, and cellular atypia. This is a descriptive and quantitative study conducted between April and June of 2008. The participants were 72 women who underwent cervical cancer preventive examinations in a Center for Natural Childbirth, Fortaleza, Ceará, Brazil. From each participant we collected two cervical smears of vaginal specimen: one was put next to other users (case), and the other alone (control), given the technical standards. This was followed by the criterion of blind control in reading the slides. The results of the two blades were compared by checking inconsistencies in the various packing realities. There was a 58.3% discrepancy compared to epithelia representative samples and 48.2% compared to benign cellular changes. The results suggest further studies are needed regarding packaging, control of the intra-subjectivity of the technician responsible for reading, and the sequence for collecting case and control slides. En este estudio se evaluó la influencia de los tipos de embalaje de hojas de la citología en los resultados de los informes de laboratorio relativos al epitelio de muestra representativa, los cambios celulares benignos y atipia celular. Es un estudio descriptivo, cuantitativo, realizado entre abril y junio de 2008. Las participantes fueron 72 mujeres que se sometieron a exámenes preventivos para el cáncer cervical en un Centro de Parto Natural, en la ciudad de Fortaleza, Ceará, Brasil. De cada participante se recogieron dos muestras de frotis cervical vaginal: uno fue puesto al lado del de otras usuarias (caso), y uno solo (control), teniendo en cuenta las normas técnicas. Se realizó el criterio de "cegagem" de la lectura de las hojas. Los resultados de las dos hojas fueron comparados y fue visto incompatibilidades en los diferentes almacenamientos. Un desacuerdo fue de 58,3% en comparación con el epitelio de muestra representativa, y 48,2% en comparación con cambios celulares benignos. Los resultados sugieren nuevos estudios sobre las formas de almacenamiento, control de la intrasubjetividad del técnico responsable de leer y ordenar la recolección de las hojas de casos y control.