Malignant gastric glomus tumor: a case report and literature review of a rare entity

A glomus tumor is a mesenchymal neoplasm that usually develops in the peripheral soft tissue, especially in the distal part of the extremities. The subungual zones of the fingers and toes are the most frequent sites of observation. The majority of glomus tumors are entirely benign, and the malignant counterparts are very rare, especially those arising in the visceral organs. We report a case of an extremely rare malignant glomus tumor arising in the stomach of a 53-year-old female admitted to the King Khalid University Hospital, Saudi Arabia. The patient reported a four-month history of pain and fullness in the left hypochondrium. She underwent laparotomy and resection of the gastric mass. The mass was analysed by histopathology. Based on the pathological findings of large tumor size, nuclear atypia, increased mitotic rate, atypical mitosis, the presence of necrosis, and characteristic immunohistochemistry the diagnosis of malignant glomus tumor was rendered. Ultrastructural study confirmed the diagnosis. The patient is well and continues regular follow-up

histological spectrum of early mycosis fungoides: a study of 58 Saudi Arab patients

The histopathological diagnosis of Mycosis Fungoides [MF] is challenging in its early stages and can easily be confused with inflammatory dermatoses. This study aims to; [i] assess the frequency and significance of different histopathological parameters in early MF, seen in Saudi patients, and [ii] to study the utility of these parameters in differentiating between early MF and inflammatory dermatoses. This is a five years study of 66 skin biopsies generated from 58 patients with clinically suspicious MF lesions or early patch stage MF. These cases were retrieved from the archives of the Department of Pathology, King Khalid University Hospital, Riyadh from the year 2002 to 2006. Histological criteria were assessed and graded semi-quantitatively on a four-point scale by a dermatopathologist and two pathologists independently. The histological parameters suggesting the diagnosis in early stages MF include epidermotropism, dermal fibrosis, Pautrier's micro abscesses, Basal alignment of neoplastic lymphocytes, hyperconvoluted dermal and epidermal lymphocytes and grandiosity sign [size of lymphocytes becoming larger as they migrate towards granular layer of epidermis]. These parameters on univariate analysis achieved statistical significance [p<0.05] in differentiating MF from non-MF cases. In addition, hyperconvoluted dermal and epidermal lymphocytes proved to be highly reliable with high specificity and sensitivity. The histopathological diagnosis of early MF lesions and their discrimination from inflammatory simulators can be achieved by carefully observing the hyperconvoluted dermal and epidermal lymphocytes along with the constellation of the other parameters

HER2/neu immunostaining in invasive breast cancer: analysis of false positive factors

HER2/neu gene amplification by Fluorescent in situ hybridization and protein expression by immunohistochemistry have been used for prognosis and guidance for the treatment of invasive ductal carcinoma of the breast with Trastuzumab. False positive results are a significant problem where immunohistochemistry is exclusively used to test HER2/neu protein over expression. A minority of cases of breast cancer scoring HER2 [3+] by immunohistochemistry using Hercep test may not be associated with amplification of the HER2/neu gene by FISH, a test which is a more specific and sensitive than immunohistochemistry. This study aims to examine the factors contributing to false positive results by immunohistochemistry and subsequently not showing HER2/neu gene amplification by FISH analysis. A retrospective analysis of 18 cases [3+] by immunohistochemistry in the pathology laboratory not associated with HER2/neu gene amplification was performed. The histological review of these cases was done, the technical error [i.e staining of blood vessels or benign ducts] and the interpretation errors were evaluated. Polysomy 17 was absent in all the cases studied by FISH analysis. By immunohistochemistry, five of the 18 cases were purely interpretation errors and the remaining were a combination of technical and interpretational errors. False positive results related to technical and interpretational errors can be prevented by properly educating the technologist and pathologist to perform high quality immunostains and to render an accurate diagnosis respectively. This issue is of utmost importance as it may have deleterious effects on the selection of therapeutic arsenal in invasive ductal carcinoma of the breast