Endocrine Mucin-Producing Sweat Gland Carcinoma: Two New Eyelid Cases and Review of the Literature.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare low-grade sweat gland carcinoma. It is clinically often mistaken for basal cell carcinoma and presents a low rate of local recurrence. In this article, we present 2 new cases of EMPSGC arising in a similar location (left lower eyelid) and review the literature on this topic. One patient is a 72-year-old male with complete excision and no evidence of recurrence after 17 months of surveillance. The second patient is a 77-year-old female with incomplete initial excision and local recurrence after 38 months. p63 immunostain was negative in both cases. EMPSGC should be suspected in elderly patients with lesions of eyelids. Histologically, it should be considered and worked up if the lesion is separated from the overlying epidermis and presents a mucinous component. Complete excision is advised to avoid local recurrences.

Eleven-year review of data on Pap smears in Saudi Arabia: We need more focus on glandular abnormalities!

BACKGROUND: We reviewed data from Saudi Arabia on epithelial cell abnormalities (ECA) detected by Pap smear after noticing a slight increase in the incidence of cervical glandular abnormalities in our regional laboratory in recent years. OBJECTIVE: Clarify data on adenocarcinoma (ADCA) on Pap smears in Saudi Arabia. DESIGN: Descriptive, retrospective study. SETTINGS: Regional laboratory, Riyadh. PATIENTS AND METHODS: We reviewed all Pap smears of adult females between 2006 and 2016 and compared our data with previously published results from Saudi Arabia. MAIN OUTCOME MEASURE(S): Descriptive data on ECAs. RESULTS: Among 19759 cases, atypical squamous cell of undetermined significance (ASC-US) was the most prevalent ECA (1.16%). ADCA occurred more than squamous cell carcinoma (SCC). In a comparison of published data before 2014 and after 2014 (including ours), there was a significant rise in ADCA (28 vs 48 cases; P=.004) with a significant drop in SCC, high-grade squamous intraepithelial lesions (HSIL) and low-grade squamous intraepithelial lesions (LSIL) (P < .0001, .004, and < .0001, respectively). CONCLUSION: We recommend that pathologists and cytotechnologists be vigilant in screening Pap smears in our population, particularly for glandular abnormalities. We also recommend use of Pap smears in the initial workup of women with suspected gynecological abnormalities, regardless of evolutions in HPV testing. LIMITATIONS: The pooling of data instead of analyzing by study year.

Human immunodeficiency virus infection and autoimmune hepatitis during highly active anti-retroviral treatment: a case report and review of the literature.

INTRODUCTION: The emergence of hepatic injury in patients with human immunodeficiency virus infection during highly active therapy presents a diagnostic dilemma. It may represent treatment side effects or autoimmune disorders, such as autoimmune hepatitis, emerging during immune restoration. CASE PRESENTATION: We present the case of a 42-year-old African-American woman with human immunodeficiency virus infection who presented to our emergency department with severe abdominal pain and was found to have autoimmune hepatitis. A review of the literature revealed 12 reported cases of autoimmune hepatitis in adults with human immunodeficiency virus infection, only three of whom were diagnosed after highly active anti-retroviral treatment was initiated. All four cases (including our patient) were women, and one had a history of other autoimmune disorders. In our patient (the one patient case we are reporting), a liver biopsy revealed interface hepatitis, necrosis with lymphocytes and plasma cell infiltrates and variable degrees of fibrosis. All four cases required treatment with corticosteroids and/or other immune modulating agents and responded well. CONCLUSION: Our review suggests that autoimmune hepatitis is a rare disorder which usually develops in women about six to eight months after commencing highly active anti-retroviral treatment during the recovery of CD4 lymphocytes. It represents either re-emergence of a pre-existing condition that was unrecognized or a de novo manifestation during immune reconstitution.

Infectious organisms on Papanicolaou smears should not influence the diagnosis of atypical squamous cells of undetermined significance.

BACKGROUND: Atypical squamous cells of undetermined significance (ASCUS) remain the center of diagnostic controversy and patients' stress despite recent advances in cervical cancer screening and the introduction of human papilloma virus (HPV) testing. The role of infectious agents in the induction of such changes is not well understood. AIM: We aim at reviewing the effect of the different infectious organisms in Papanicolaou (PAP) smears on the ASCUS diagnosis. MATERIAL: 133 ASCUS cases associated with variable infectious organisms (ASCUS-infection group) with secondary HPV testing and appropriate follow-up studies were reviewed. A control group of 310 ASCUS cases without any organisms (ASCUS-only group) was selected for comparison. RESULTS: The ASCUS-infection group had a significantly higher proportion of HPV-positive tests than the ASCUS-only group (p = 0.0027). There was no significant difference on follow-up PAPs and biopsies between the two groups (p = 0.4272). They showed an overall mean of 75% negative, 20% low-grade lesions, and 5% high-grade lesions/carcinoma in situ on follow-up. CONCLUSION: Our study demonstrates no significant effect of infections on the cytological changes diagnostic of ASCUS. The cytologist should make this diagnosis neglecting any background infections even when predominant.

Malignant granular cell tumor: a look into the diagnostic criteria.

Fanburg-Smith et al. classified granular cell tumors (GCTs) using six criteria with high Ki-67 and p53 in malignant cases. We aim to refine their classification and reproduce their immunohistochemical findings. We, first, classified our 48 cases according to Fanburg-Smith criteria (37 benign, seven atypical, and four malignant), and performed Ki-67 and p53 on a sample of tumors. Then, we reclassified them into 44 benign and four with uncertain malignant potential (GCT-UMP) using only necrosis and/or mitoses. (1) According to Fanburg-Smith criteria: Malignant cases were significantly younger than benign and atypical ones; occurred predominantly in males; were significantly larger in size; and showed a higher Ki-67 expression but an insignificant difference in p53 staining. (2) Comparative findings: The four malignant cases according to Fanburg-Smith corresponded to our four cases with UMP. The seven atypical cases and our benign group shared similar means, except for age. None of these atypical cases recurred or metastasized. Despite its small number, our preliminary study showed similar selectivity of two more reproducible criteria (vs six) in the classification of cases of GCT with potential aggressive behavior, preserving a role for Ki-67 in difficult cases. However, metastases remain the sole definite criterion for malignancy.

Ovarian malignant mixed mullerian tumor with primitive neuroectodermal differentiation: case report with review of the literature.

Ovarian malignant mixed mullarian tumor (OMMMT) is a rare and aggressive tumor of the female genital tract, occurring mainly in elderly women. Stage of disease is the most important predictor for survival with no prognostic effect, yet, of heterologous elements. Rare case reports described the peculiar presence of primitive neuroectodermal tissue among other heterologous elements in these tumors. Attractive designations, such as teratoid carcinosarcoma, were set by some authors to describe this subset of lesions, where it was considered a primary neuroectodermal tumor capable of multilineage differentiation. We here report a case of OMMMT in an elderly woman with focal primitive neuroectodermal differentiation as the sole heterologous element, and review the controversy on this topic in the literature.

Pancreatic solid-pseudopapillary neoplasm: report of a case in an elderly man with cytologic-histologic correlation.

BACKGROUND: Solid-pseudopapillary neoplasms of the pancreas are rare and unusual tumors, occurring mostly in young women. Their cytologicfeatures are well described in textbooks; however, published reports still show some cytologic findings overlapping with pancreatic endocrine neoplasms and demonstrate the important diagnostic role of endoscopic ultrasound-guided fine needle aspiration. CASE: A case of solid-pseudopapillary neoplasm of the pancreas occurred in a 61-year-old man; on cytology it was initially diagnosed as pancreatic endo crine neoplasm. The resection specimen in addition to immunohistochemical stains gave away the diagnosis. CONCLUSION: Endoscopic ultrasound-guided fine needle aspiration remains a valid, minimally invasive procedure in pancreatic cytology. Tumor cells grouped around fibrovascular cores are the most reproducible cytologic finding in these tumors. Immunostains can play an important role when cell block material is available.

Malignant granular cell tumor: case report with a novel karyotype and review of the literature.

Malignant granular cell tumor is a rare neoplasm reported to occur at various sites in the body. Histogenesis of these tumors is still vaguely understood; however, their metastatic potential and adverse prognosis is well-described in the literature. The histologic criteria of malignancy proposed by Fanburg-Smith et al are still debatable amongst pathologists, with metastasis being the sole criterion of malignancy with unanimous agreement. To our knowledge, no specific karyotype characterizes these tumors. Hence, the importance of detecting characteristic cytogenetic alterations in these tumors which might serve, in the future, as a possible aid in diagnosis or therapy. We report a new case of malignant granular cell tumor of the thigh with metastases to abdominal wall and both lungs causing severe dyspnea. Cytogenetic analysis demonstrated that 60% of cultured tumor cells display the following karyotype 46,XX,+X,dic(5;15).

Periosteal osteoblastoma of the calvaria mimicking a meningioma.

While osteoblastoma of the cranial vault is rare, the periosteal form of the tumor is highly unusual, with only one case reported in the English literature. We report on a 24-year-old woman presenting with headache and tinnitus. Magnetic resonance imaging of the brain showed an extra-axial temporal mass with findings that were suggestive of a meningioma. The mass was excised completely, and histological examination revealed a periosteal osteoblastoma arising from the inner surface of the temporal bone and adhering to the dura. The tumor was strongly positive for epithelial membrane antigen, a feature not previously described in osteoblastoma, and one that could lead to a mistaken diagnosis of metaplastic meningioma in a limited sample. A detailed literature review of 40 other reported cases of calvarial osteoblastoma is presented. Apart from being slightly more common in females, calvarial osteoblastoma is similar in all other respects to that arising at conventional skeletal sites. Accurate histological diagnosis of a calvarial osteoblastoma requires adequate sampling of the tumor, including its interface with adjacent structures. Correlation with the radiological findings is crucial for the diagnosis in most cases; however, it is not helpful in differentiating the rare intracranial periosteal variant from a meningioma.