Cytologic findings of epithelioid trophoblastic tumor of the uterus: a case report.

BACKGROUND: Epithelioid trophoblastic tumor (ETT) is a rare entity within trophoblastic tumors. It is difficult to recognize ETT because of its epithelioid appearance. CASE: A 35-year-old female, 5 years after pregnancy, experienced genital bleeding 2 months prior to consulting us. Preoperative laboratory data showed a slightly elevated serum level of human chorionic gonadotropin (hCG). A cytologic cervical smear revealed large, polygonal, atypical cells. These cells had mononucleate, ovoid, irregularly enlarged and hyperchromatic nuclei with 1 or 2 conspicuous nucleoli. The cytoplasm was thin and abundant, with a distinct cell membrane, and sometimes showed vacuolation. The patient was diagnosed with uterine cancer, and hysterectomy was performed. The tumor was present in the uterine corpus, measuring 3 x 2.5 x 2.5 cm. Histologically, it was composed of mainly mononuclear tumor cell nests resembling intermediate trophoblastic cells with zones of hyaline material. Immunohistochemically, the tumor was positive for cytokeratin and placental alkaline phosphatase but negative for hCG and human placental lactogen. The tumor was subsequently diagnosed as ETT. CONCLUSION: It was difficult to make a definitive diagnosis of ETT using only a cytologic specimen. The diagnosis of ETT is facilitated by a combination of cytologic, histopathologic and clinical findings.

[Histopathological and cytological findings in a case of gastrointestinal stromal tumor presenting in the pelvic cavity].

Gastrointestinal stromal tumor (GIST) usually occurs in the gastrointestinal tract, mainly in the stomach. Recently, GIST arising in extragastrointestinal organs was been reported. This case was a 49-year-old female who was diagnosed as having uterine leiomyoma and pelvic tumor in the rectovaginal septum. The pelvic tumor showed no connection with the uterus and rectum. Grossly, the pelvic tumor was light brown and solid. Cytologically, the tumor cells of the pelvic tumor showed vague interlacing fascicles with spindle/fibrous cytoplasm and elongated nuclei. No necrosis or mitosis was present. Histological findings of the pelvic tumor revealed an interlacing bundle fashioned with one to two mitotic figures per 50 HPE No necrosis was found in the tumor. The tumor cells were positive for CD117 (c-kit protein), CD34, and vimentin by immunohistochemistry, but negative for actin, desmin, and S-100. The tumor was diagnosed as GIST in the pelvic cavity. GIST rarely presents in extragastrointestinal regions such as this case. It is difficult to make a differential diagnosis between GIST and other mesenchymal spindle cell tumors only from a cytologic specimen. A positive reaction for CD117 is useful for the diagnosis of GIST.

Histopathological and immunohistochemical findings in a case of glycogen-rich clear cell carcinoma of the breast.

Glycogen-rich clear cell carcinoma (GRCC) of the breast is a rare variant of primary breast carcinoma that was first described by Hull et al. in 1981, and is characterized by carcinoma cells containing an optically clear cytoplasm and intracytoplasmic glycogen. The present case involved a 33-year-old female. She had noticed a lump in the inner quadrant of the left breast. The tumor obtained by enucleation biopsy had an irregular shape. The tumor cells exhibited sharply defined borders, polygonal contours, a clear or finely granular cytoplasm, and moderate nuclear atypia. The tumor cells showed a positive reaction with periodic acid Schiff, eliminated by diastase digestion. The tumor was diagnosed as GRCC. There was no nodal metastasis. Immunohistochemically, the tumor cells were positive for cytokeratin, epithelial membrane antigen, HER2, and p53, but negative for estrogen receptor (ER) and progesterone receptor (PR). Although the biological behavior of GRCC is difficult to predict in view of the very limited number of case reports, the prognosis of GRCC may be associated with not only histopathological subtype but also other clinicopathological factors, such as size, status of invasion, status of nodal metastasis, nuclear grade, ER, PR, HER-2, p53 and so on. To clarify the pathogenesis of mammary GRCC, the systematic study of additional well-documented cases with long-term follow up will be necessary.

[Two cases of parasitic granuloma found incidentally in surgical specimens].

Occasionally, parasitosis demonstrates no clinical symptoms, and is found incidentally. We report 2 cases of parasitic granuloma found incidentally in surgical specimens in rare sites for parasitosis. Case 1 was a 40-year-old female. She was diagnosed with inguinal hernia, and operation was performed. A white nodule, measured 1.5 x 1 x 1 cm in size, was found in the hernia sac. The nodule was elastic hard and solid. Histologically, eosinophilic granuloma was demonstrated, and the parasite was characterized by renette cell and Y-shaped lateral cord, and suggesting extra-gastrointestinal anisakiasis. Case 2 was a 71-year-old female. She was diagnosed with colonic adenocarcinoma, and colectomy was performed. A white nodule, measured 1 x 1 x 0.8 cm in size was found in the omentum, at first identified as peritoneal dissemination of colonic carcinoma. However, histological findings of the nodule showed eosinophilic granuloma, and parasite was observed in the granuloma. The parasite was characterized by thick cuticle and muscular cells, and suggestive of dilofilariasis. In each case, no clinical symptoms of parasitosis were recognized, and each lesion presented in a rare site as anisakiasis or dirofilariasis. When any lesions as in the present cases is found in a surgical specimen, it is important to make differential diagnosis with consideration for parasitic granuloma.