Cortical ependymoma or monomorphous angiocentric glioma?

Ependymoma is the third most common childhood intracranial tumor after medulloblastoma and pilocytic astrocytoma. Most ependymomas occur in the posterior fossa and spinal cord but only five cases confined to the cerebral cortex have been reported. The current case is a 5-year-old boy with a somewhat ill-defined cortical tumor diagnosed as pilocytic astrocytoma on biopsy, and treated with radiotherapy. Nine years later, resection of the essentially unaltered tumor was performed for treatment of intractable seizures. Histologically, the tumor had some areas with the typical appearance of ependymoma as well other areas which contained piloid cells. There was also evidence of focal infiltrative growth. These findings bore resemblance to a recently described entity monomorphous angiocentric glioma/angiocentric neuroepithelial tumor, which combines features of ependymoma with pilocytic and diffuse astrocytomas. Both cortical ependymomas and angiocentric monomorphous glioma/angiocentric neuroepithelial tumor appear to be low-grade tumors although their rarity makes accurate prognosis problematic. The current case has features of both entities, suggesting they may be closely related.

Surgical approach, histopathology, and pathogenesis in cataract associated with true lens exfoliation.

We report a case of true exfoliation of the crystalline lens in a 53-year-old baker who presented with reduced vision due to cataract. Phacoemulsification cataract surgery with intraocular lens implantation was performed, and the anterior capsule was analyzed histologically. Preoperative clinical and anterior segment optical coherence tomography observations are presented, with a description of the modified phacoemulsification technique and histopathology. A possible mechanism of pathogenesis is proposed in the context of the histopathology.

Peritoneal metastases from an atypical fibroxanthoma.

Atypical fibroxanthoma (AFX) is a mesenchymal neoplasm usually occurring in sun-exposed skin of elderly patients. The majority have an excellent prognosis, as recurrences are uncommon and metastases are rare. We present a case of an 81-year-old man who developed widespread peritoneal metastases from an AFX on his scalp, which was completely excised 3 years earlier. Histology of the scalp lesion showed a markedly pleomorphic neoplasm characteristic of AFX. Features associated with increased risk of metastasis, namely lymphovascular space invasion, deep invasion, and substantial necrosis, were not present. An extensive immunohistochemical panel was performed. The tumor cells were negative for melanocytic, epithelial, and smooth muscle immunohistochemical stains, and positive for vimentin, CD10, CD99, and focally for CD68. Histologically, the peritoneal tumor was virtually identical to the original scalp lesion and had an identical immunohistochemical profile. Electron microscopy of the peritoneal tumor revealed pleomorphic undifferentiated cells with abundant lipid vacuoles. This is the first reported case of AFX with peritoneal metastases. Although AFXs generally have an excellent outcome, pathologists must remain cognizant of the small but real potential for metastasis and this needs to be conveyed in all reports.