ABSTRACT
Histopathologists in the current environment of medical negligence and litigation are more likely to use immunohistochemical investigations in their day-to-day practice to support their diagnosis and avoid future litigation. The caveat is that relying on immunohistochemistry is a double-edged sword and pathologists should be familiar with its limitations. We present a case of primary malignant peritoneal mesothelioma with an unusual immunohistochemical profile-desmin positive, EMA negative-and wish to highlight the importance of cautiously interpreting immunohistochemistry profiles when they do not fit the clinical history and histological appearance.
Subject(s)
Biomarkers, Tumor/metabolism , Desmin/metabolism , Mesothelioma/metabolism , Mucin-1/metabolism , Peritoneal Neoplasms/metabolism , Fatal Outcome , Humans , Male , Mesothelioma/pathology , Middle Aged , Peritoneal Neoplasms/pathologyABSTRACT
A 75-year-old woman presented to her general practitioner with a keratotic skin lesion on her abdomen. Microscopic examination showed an irritated seborrheic keratosis. However, further inspection revealed a well-defined dome-shaped area in the dermis showing a number of small nerve fibres admixed with relatively few mature ganglion cells. Both the spindle cell component and the ganglion cells stained positively for S-100 protein, neurofilament protein and CD56 (Leu-19, NCAM) by routine immunohistochemistry. Primary cutaneous ganglioneuroma is an exceedingly rare benign tumour of the skin with only 13 cases having been reported in English literature. We describe the second case of primary cutaneous ganglioneuroma associated with seborrheic keratosis.
Subject(s)
Ganglioneuroma/complications , Keratosis, Seborrheic/complications , Skin Neoplasms/complications , Aged , Female , Ganglioneuroma/pathology , Humans , Keratosis, Seborrheic/pathology , Skin Neoplasms/pathologySubject(s)
Cellulitis/pathology , Eosinophilia/pathology , Skin Diseases, Vesiculobullous/pathology , Adult , Diagnosis, Differential , Female , Humans , Male , Middle AgedSubject(s)
Leg Dermatoses/complications , Lichenoid Eruptions/complications , Primary Myelofibrosis/complications , Vasculitis/complications , Aged , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Chronic Disease , Dapsone/therapeutic use , Humans , Leg Dermatoses/drug therapy , Lichenoid Eruptions/drug therapy , Male , Treatment Outcome , Vasculitis/drug therapyABSTRACT
A 21-year-old man presenting with jaundice and hypertension was found to have an extraadrenal pheochromocytoma. Cholangiography demonstrated a cavity in the head of the pancreas that was in communication with both the pancreatic and common bile ducts. Hemorrhage from the cavity led to the patient's death and postmortem examination revealed focal infarction of the pancreatic head. This case adds hemobilia, obstructive jaundice, and focal pancreatic infarction to the list of bizarre remote manifestations of pheochromocytoma.
Subject(s)
Adrenal Gland Neoplasms/pathology , Infarction/pathology , Pancreas/blood supply , Pheochromocytoma/pathology , Adrenal Gland Neoplasms/complications , Adult , Cholestasis/etiology , Cholestasis/pathology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Humans , Hypertension, Malignant/etiology , Hypertension, Malignant/pathology , Infarction/etiology , Male , Pancreas/pathology , Pheochromocytoma/complicationsABSTRACT
The role of gamma-interferon in the pathogenesis of enteropathies with an immunological basis such as coeliac disease, is unclear. Gamma-interferon immunoreactive lymphocytes were quantified in jejunal biopsies from patients with coeliac disease and from normal controls. In coeliac disease, there was an apparent decrease in the percentage of both intraepithelial (3.5% v 13.5%) and lamina propria (10.3% v 47.2%) lymphocytes expressing gamma-interferon compared with controls. In patients successfully treated with a gluten free diet, the percentage of gamma-interferon immunoreactive intra-epithelial lymphocytes was 10.3%. Intraepithelial lymphocytes were immunonegative for class II major histocompatibility complex, while epithelial cells showed increased expression of this product in coeliac disease. The results show that a relatively large proportion of lymphocytes in normal small bowel express gamma-interferon. They also indicate that in coeliac disease the major increase in the numbers of mucosal lymphocytes is the result of infiltration by lymphocytes not expressing gamma-interferon.
Subject(s)
Celiac Disease/immunology , Interferon-gamma/analysis , Intestinal Mucosa/immunology , Jejunum/immunology , Lymphocytes/immunology , Adolescent , Adult , Aged , Celiac Disease/diet therapy , Epithelium/immunology , Female , HLA-D Antigens/immunology , Histocompatibility Antigens Class II/analysis , Humans , Immunohistochemistry , Interferon-gamma/physiology , Leukocyte Count , Lymphocytes/cytology , Lymphocytes/metabolism , Male , Middle AgedABSTRACT
Small cell carcinoma has been reported to arise in many extrathoracic sites. However, such tumours arising from bone have not been previously described. We report what we believe is the first reported case of extrapulmonary small cell carcinoma of bone. The tumour arose from the fifth dorsal vertebra in a 60 year old woman. The patient was treated with local radiotherapy and combination chemotherapy and remains in remission, 18 months after diagnosis. As such extrathoracic small cell tumours are rare, there seem to be no clear-cut guidelines for treating them, but combination chemotherapy is recommended.
Subject(s)
Carcinoma, Small Cell/pathology , Spinal Neoplasms/pathology , Thoracic Vertebrae , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Small Cell/drug therapy , Carcinoma, Small Cell/radiotherapy , Combined Modality Therapy , Female , Humans , Middle Aged , Spinal Neoplasms/drug therapy , Spinal Neoplasms/radiotherapyABSTRACT
We describe a case of metastatic basal cell carcinoma, an extremely rare tumour, which caused cord compression. This is the first case presenting in this fashion.
