Pyloric and foveolar type metaplasia are important diagnostic features in Crohn's disease that are frequently missed in routine pathology.

Pyloric type metaplasia (PYME) as evidence of chronic mucosal damage, is one of the main histopathological findings for diagnosing Crohn's Disease (CD) in terminal ileum biopsies, according to the latest guidelines but still frequently underdiagnosed in routine pathology. Foveolar metaplasia (FOME) changes in mucosa, another aspect of the chronic post -inflammatory Ulcer Associated Cell Lineage (UACL), have only been reported in a few cases. However, their clinical significance has not been investigated in depth except in pouchitis. The aim of this study was to investigate the importance of meticulous study of terminal ileum biopsies for the recognition of PYME/FOME as an adjunct finding helpful for the diagnosis of CD. In the present study, two experienced gastrointestinal pathologists, have reviewed 105 terminal ileum biopsies from 105 patients with CD, using a protocol of 15 sections on average per biopsy. In 21% (22/105) of cases PYME was recognized and in 4% (4/105) FOME was also present. PYME/FOME had not been detected in 83% of these cases in the original reports. FOME was also identified in terminal ileum biopsies, a feature not reported previously in CD. Conclusively, PYME/FOME can be easily missed in terminal ileum biopsies from patients with suspected or known CD unless a meticulous study of the histologic material is carried out combined with awareness of the pathologist about its importance.

Abnormal entrance of the umbilical vein into the liver and fetal thrombotic vasculopathy in a fetus: a rare combined case.

The left umbilical vein is lodged on the fissure of the round ligament of the liver, from umbilicus to portal vein, just on the inferior margin of the falciform ligament. We report an anomalous course of the umbilical vein in a 39-week-old deceased male fetus, also exhibiting fetal thrombotic vasculopathy (FTV). In the present case, the umbilical vein entered the liver through a tunnel on its anterior part of the diaphragmatic surface, close to the lower free edge of the liver and next to the falciform ligament. The entrance of the tunnel was covered by Glisson's capsule. The round ligament's fissure was absent. The quadrate lobe was not well demarcated and the visceral surface of the liver had an abnormal appearance. The coexistence of FTV was confirmed histologically. The possibility of a tunnel present for the umbilical vein, instead of a fissure, is of great significance for surgical approaches or for radiological evaluations, even though it is not likely to cause intrauterine fetal death. However, the anomalous course of umbilical vein might be a predisposing factor for FTV, which often leads to intrauterine fetal death.

Pretibial myxedema in a euthyroid patient.

Pretibial myxedema (PM) is a rare extrathyroidal manifestation of Graves' disease (GD), usually during the hyperthyroid state, coexisting with orbitopathy. We describe a rare case of a biopsy-proven PM in a euthyroid patient, without history of GD or Hashimoto's thyroiditis. Assessment of commonly reported thyroid autoantibodies, such as thyroid peroxidase and thyroglobulin autoantibodies, thyroid stimulating immunoglobulins and thyroid binding inhibitory immunoglobulins, was negative. Resolution of skin pathology was achieved after topical application of corticosteroids and was sustained 1 year later.

Sentinel lymph node metastasis in primary cutaneous basosquamous carcinoma. A cross-sectional study.

BACKGROUND AND OBJECTIVES: Basosquamous carcinoma (BSC) is a rare, biologically aggressive tumor. This cross-sectional study aims to define risk factors for subclinical nodal metastasis in primary BSC, and identify the patients who would benefit from routine sentinel node biopsy (SLNB) as part of the initial management. METHODS: A total of 142 patients, with histologically proven BSC without palpable lymph nodes, underwent SLNB after the initial excision. Clinicopathological features and demographics were analyzed between the patients with detected micrometastasis (SLNM) and those with negative SLN. RESULTS: In 7.7% patients, subcapsular and <0.1 mm SLNM were found. The frequency of SLNM was 0.9%, 11.8%, and 80.0% in patients with maximum lesion diameter ≤ 2 cm, 2.1-3.0 cm and >3.0 cm, respectively (P < 0.001) and was strongly associated with perineural (P < 0.001; OR = 26.46, 95% CI = 5.62-124.52) and lymphatic invasion (P < 0.001; OR = 17.35, 95% CI = 4.44-67.91). Within 18-84 months, no recurrence or metastasis were observed in SLNM positive patients. False negative SLNB rate of 15.4% was recorded. CONCLUSION: Cutaneous BSC is associated with early nodal metastatic potential. Tumor size >2 cm, lymphatic and perineural invasion are significant determinants for SLN micrometastasis. In the absence of palpable lymphadenopathy, wide resection and SLNB with long-term follow-up are highly recommended in these patients.

Initially lymphocytic Sweet's syndrome in male patients with myelodysplasia: a distinguished clinicopathological entity? Case report and systematic review of the literature.

BACKGROUND: Sweet's syndrome (SS) is an acute febrile neutrophilic dermatosis. It can occur as an idiopathic, drug-induced or malignancy-associated entity. SS is also seen in patients with myelodysplastic syndrome (MDS) where it may present atypically, both clinically and histologically. In a few rare cases of MDS, lymphocytic infiltrates are the presenting feature of SS. METHODS: MEDLINE and Scopus were the data sources for our review. RESULTS: A clinicopathological subsetemerged of 12 male SS patients with MDS and a mean age of 67.3 years in which the initial SS lesions were lymphocytic infiltrates. However, from 0.5 to 8 years later, sequential biopsies revealed neutrophilic dermal infiltration typical of SS. CONCLUSION: Initially lymphocytic infiltrates in this subset could be attributed either to an early timing of the biopsy concerning the age of the lesion or to the dysgranulopoiesis syndrome. A possible relationship between the dysfunction of the receptor of the granulocyte-macrophage colony stimulating factor, the gene of which is located on the pseudoautosomal X-Y region, may exist in MDS patients with initially lymphocytic SS. This could explain the male gender of this subset and might establish initially lymphocytic SS as a distinguished clinicopathological entity for predicting the occurrence and even the prognosis of MDS.

Myoepithelioma of the larynx: a case report.

Myoepithelioma of the larynx is a very rare tumor with nonspecific local symptoms. We present the second known case, focusing on the peculiarities of the differential diagnosis for this type of tumor that are crucial for the right histologic diagnosis and furthermore for the therapeutic outcome.We report a 37-year-old male presenting with hoarseness and dyspnea. The indirect laryngoscopy revealed a gross glottic tumor from the right vocal cord who occupied the greater part of the glottis. No apparent cartilage invasion was shown in the CT. He came to us with a previous direct laryngoscopy derived biopsy describing a chondroma. A modified vertical partial laryngectomy, under temporary tracheostomy, with muscle reconstruction for the deficit of the right vocal cord was applied for the removal of the tumor. The final histopathologic diagnosis was myoepithelioma (spindle cell type) of the larynx. A long term follow-up in our case showed no recurrence and a good functional result.The larynx is a very rare localization for this type of tumour. The benign character of the disease in conjunction with its slow progression could delay its detection and diagnosis, leading to a more destructive surgery. A detailed pathology examination is prerequisite for avoidance of misleading diagnosis.

Intraoperative cytological evaluation of Marjolin ulcers.

BACKGROUND: Marjolin ulcers are malignant neoplasia developing in chronic open wounds and pathological scars. A definitive diagnosis is made by histological examination of permanent sections. Frozen section biopsy has been widely used for intraoperative diagnosis and evaluation of surgical excision safety margins. This preliminary study aims to discuss the reliability of a simpler and faster method -- intraoperative cytology -- in the diagnosis of Marjolin ulcers. PATIENTS AND METHODS: Touch or scrape smears of 76 Marjolin ulcers from 22 patients were assessed, and features were compared to the histological appearance of permanent sections. RESULTS: Cytology revealed squamous cell carcinoma (SCC) in 45 ulcers from 11 patients. Histology confirmed SCC in 48 ulcers from 12 patients. No false-positive and one false-negative results were found. Cytology was found to have a 98.7% accuracy, 98% sensitivity and 100% specificity in the intraoperative diagnosis of Marjolin ulcers. CONCLUSIONS: Cytology is a fast and reliable alternative in the intraoperative diagnosis of Marjolin ulcers.

Intranuclear Helioid Inclusions in a Case of Breast Carcinoma.

Helioid inclusions are single membrane-bounded intranuclear bodies of unknown nature which have been described in a case of breast adenoma, in mammary hyperplasia, and in a case of acinic cell carcinoma of the parotid gland. We report the detection of helioid inclusions in a case of breast carcinoma, which involves a 60-year-old woman with infiltrating ductal breast carcinoma of apocrine type. On electron microscopic examination we observed characteristic intranuclear helioid inclusions in some carcinoma cells. Occasionally intranuclear profiles of dense granules were present, some of which showed a just discernible filamentous border. The significance of these rare ultrastructural inclusions remains to be elucidated.