ABSTRACT
Pulmonary complications associated with Sjögren syndrome (SS) have attracted attention in recent years. Sjögren syndrome has been associated with small cyst formation in salivary glands, thymus, and lungs and has been recently brought to the forefront by radiologists due to high-resolution techniques. However, pathologists are less aware of this finding unless clinico-radiologic-pathologic correlation is sought. Formation of large bullae in SS is a rare complication with potential for confusion with other diseases. Here, we present the clinical, radiologic, and pathologic findings in 3 patients with SS associated with multiple pulmonary cystic lesions. All 3 patients had a variable mixed restrictive and obstructive component of the disease. There was good correlation with the pulmonary function tests (PFTs), high-resolution computed tomographic scan, and morphology with regard to the restrictive component. The small cysts appear to correlate with the extent of obstructive changes on the PFTs. However, the large bullae do not, implying noncommunication with the conducting airways. This noncorrelation between the PFTs and extent of bullous disease with predominant involvement of lower lobes in SS enables distinction from bullous emphysema. The mechanism of bulla formation in SS appears to be different from bullous emphysema. A check valve mechanism has been proposed previously in SS, which does not explain cyst formation in the thymus. Alternately, inflammation may play a role with the key suspects being CD4 T-helper cells and perhaps NK cells. This is the first report of a clinico-radiologic-pathologic correlation with analysis of lymphocyte subsets.
Subject(s)
Lung Diseases/etiology , Lung Diseases/pathology , Lymphocyte Subsets/pathology , Sjogren's Syndrome/complications , Adult , Biopsy , Female , Humans , Lung/pathology , Lung Diseases/diagnostic imaging , Middle Aged , Radiography , Tomography Scanners, X-Ray ComputedABSTRACT
Tattoo pigment in the sentinel lymph nodes of melanoma patients represents a clinical challenge. If a tattoo is present in the area of the primary melanoma, the draining lymph nodes are likely to contain tattoo pigment, as well as being the site for metastatic deposits of melanoma. We describe a case report involving an elderly Caucasian male diagnosed with a Clark level-4 nodular malignant melanoma, wherein intraoperatively we encounter a darkly pigmented lymph node highly suspicious for metastatic disease. The patient had a tattoo in the vicinity of the malignant melanoma The specimen is sent for histological examination and is found to contain pigmented macrophages, but metastatic malignant melanoma is not identified. Histological confirmation of an enlarged pigmented node is essential before radical surgery is performed.
Subject(s)
Coloring Agents/analysis , Foreign-Body Migration/diagnosis , Lymph Nodes/chemistry , Melanoma/diagnosis , Skin Neoplasms/diagnosis , Tattooing/adverse effects , Aged , Humans , Lymph Nodes/pathology , Male , Sentinel Lymph Node BiopsySubject(s)
Bronchial Neoplasms/diagnosis , Lymphangioma/diagnosis , Adenoma/diagnosis , Bronchial Neoplasms/diagnostic imaging , Bronchial Neoplasms/pathology , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Lymphangioma/diagnostic imaging , Lymphangioma/pathology , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Exanthema/diagnosis , Leprosy, Tuberculoid/diagnosis , Aged , Dapsone/therapeutic use , Diagnosis, Differential , Endemic Diseases , Exanthema/etiology , Humans , Leprosy, Tuberculoid/drug therapy , Leprosy, Tuberculoid/physiopathology , Leukemia, Lymphoid/complications , Male , Rifampin/therapeutic use , TexasABSTRACT
Pilonidal sinus is a well-recognized condition that occurs most commonly in the sacrococcygeal area of younger men. It is hypothesized to be an acquired chronic inflammation condition due mainly to hair trapped beneath the surface. A pilonidal sinus in the sacrococcygeal region is associated with recurrent infection, abscess formation, cellulitis, fistulae, and rarely, squamous cell carcinoma. A pilonidal sinus of the penis is a rare entity. The association of a penile pilonidal cyst and Actinomyces is even more uncommon with only three cases reported previously. Two cases of pilonidal sinus are reported in this paper. One of the cases was associated with actinomycosis. Pilonidal sinus of the penis should be considered in the clinical and pathological differential diagnosis and has to be distinguished from balanoposthitis, epidermal cyst, and carcinoma. The knowledge about possible association with actinomycosis is important to ensure early treatment.
Subject(s)
Actinomycosis , Penile Diseases/pathology , Pilonidal Sinus/pathology , Actinomyces/isolation & purification , Actinomycosis/complications , Actinomycosis/pathology , Actinomycosis/surgery , Adult , Hair/pathology , Humans , Male , Penile Diseases/microbiology , Penile Diseases/surgery , Pilonidal Sinus/microbiology , Pilonidal Sinus/surgeryABSTRACT
Streptococcal-toxic-shock syndrome is caused by virulent strains of exotoxin-producing streptococcus, almost always group-A organisms such as Streptococcus pyogenes. It has often been described in the setting of surgical wounds, burns, childbirth, diabetics, elderly, neonates, and immunocompromised hosts, where the portal of entry is the skin. Our patient was on steroids and nonsteroidal anti-inflammatory drugs for chronic rheumatoid arthritis and developed this deadly infection after a fall.
Subject(s)
Arthritis, Rheumatoid/complications , Elbow Injuries , Fasciitis, Necrotizing/etiology , Shock, Septic/etiology , Accidental Falls , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Aged , Amputation, Surgical , Anti-Bacterial Agents , Antirheumatic Agents/adverse effects , Antirheumatic Agents/therapeutic use , Arm/surgery , Arthritis, Rheumatoid/drug therapy , Cellulitis/diagnosis , Combined Modality Therapy , Debridement , Diagnosis, Differential , Drug Therapy, Combination/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Immunocompromised Host , Isoxazoles/therapeutic use , Leflunomide , Male , Shock, Septic/diagnosis , Shock, Septic/drug therapy , Shock, Septic/microbiology , Shock, Septic/surgery , Staphylococcal Scalded Skin Syndrome/diagnosis , Streptococcus pyogenes/isolation & purificationABSTRACT
The coexistence of basal cell carcinoma with a cutaneous metastasis is rare; it is most frequently associated with lung cancer. We report an unusual case of contralateral metachronous metastasis of small-cell carcinoma of the lung to a site of basal cell carcinoma.
Subject(s)
Carcinoma, Basal Cell/pathology , Carcinoma, Small Cell/secondary , Lung Neoplasms/pathology , Neoplasms, Multiple Primary/pathology , Skin Neoplasms/pathology , Skin Neoplasms/secondary , Biomarkers, Tumor/analysis , Carcinoma, Small Cell/chemistry , Carcinoma, Small Cell/diagnosis , Carcinoma, Small Cell/diagnostic imaging , Carcinoma, Small Cell/pathology , Chromogranins/analysis , Diagnosis, Differential , Humans , Lung Neoplasms/chemistry , Male , Middle Aged , Neoplasms, Multiple Primary/chemistry , Nuclear Proteins/analysis , Phosphopyruvate Hydratase/analysis , Radiography , Shoulder , Skin Neoplasms/chemistry , Skin Neoplasms/diagnosis , Thyroid Nuclear Factor 1 , Transcription Factors/analysisSubject(s)
HIV Infections/complications , Lymphoma, T-Cell, Cutaneous/pathology , Lymphomatoid Papulosis/pathology , Skin Neoplasms/pathology , Adult , Diagnosis, Differential , Humans , Lymphoma, T-Cell, Cutaneous/etiology , Lymphomatoid Papulosis/etiology , Male , Skin Neoplasms/etiology , Staining and LabelingABSTRACT
We present five cases of nodular histiocytic/mesothelial hyperplasia (two peritoneal, two pulmonary, and one pericardial) with identical microscopic features. All the lesions were biphasic and composed of cohesive monotonous epithelioid clusters of polygonal or oval cells with round or deeply grooved nuclei in association with darker cuboidal cells. Because of the increased cellularity and monotonous histologic pattern with some degree of cytologic atypia, neoplastic processes were seriously considered in the differential diagnoses. The majority of the cells marked as histiocytes by immunostain. A few scattered individual cells or small epithelial cell clusters were confirmed by calretinin stain to be mesothelial cells. The histologic patterns of the current lesions, irrespective of the location, were identical to nodular histiocytic/mesothelial hyperplasia. Histiocytic proliferations can be erroneously confused with primary mesothelial lesions or neoplasms such as granulosa cell tumor, eosinophilic granuloma, chronic myelogenous leukemia, and carcinoma. The purpose of this article is to describe the clinicopathologic features of nodular histiocytic/mesothelial hyperplasia and help familiarize pathologists with this lesion to prevent an erroneous diagnosis, particularly when it occurs in locations where mesothelial cells are not normally present.
Subject(s)
Epithelium/pathology , Histiocytes/pathology , Histiocytosis/pathology , Neoplasms, Mesothelial/pathology , Adult , Aged , Antibodies, Monoclonal/metabolism , Antigens, CD/metabolism , Biomarkers/analysis , Diagnosis, Differential , Epithelium/metabolism , Histiocytes/metabolism , Histiocytosis/metabolism , Humans , Hyperplasia/metabolism , Hyperplasia/pathology , Immunohistochemistry , Male , Middle Aged , Neoplasms, Mesothelial/metabolismABSTRACT
We describe a rare variant of papillary thyroid carcinoma (PTC), the Cribriform-Morular Variant (C-MV). A handful of cases have been described in the literature of this entity. They exhibit the morphologic features of a distinctive papillary neoplasm along with solid, cribriform, and squamoid-morular areas. The cribriform and morular features make this a separate entity which could be mistaken for a high grade aggressive thyroid neoplasm. These lesions are usually associated with familial adenomatosis polyposis (FAP) but rarely may be sporadic. We report three cases that we have encountered.