Multiple venous and arterial thromboses of the gallbladder causing acute cholecystitis. A previously undescribed complication of essential thrombocythemia.

Well established complications of essential thrombocythemia are multiple thrombohemorrhagic phenomena in various abdominal organs. We describe the case of a 22 year old man with essential thrombocythemia and thrombosis of the mesenteric and splenic veins as well as cavernomatous transformation of the portal vein. The patient also had a splenic infarction and a subphrenic hematoma. Additionally, he developed signs and symptoms of acute cholecystitis which in turn led to an open cholecystectomy. The gallbladder had a markedly thickened wall due to multiple recent and recanalized thrombi predominantly in subserosal veins. Only a few arteries were occluded by thrombi. A marked vascular proliferation in the subserosal connective tissue mimicking a hemangioma was most likely the result of collateral circulation. There was also a mild acute and chronic inflammatory infiltrate and edema in the lamina propria of the gallbladder. Hyperplasia of interstitial cells of Cajal in the lamina propria and between smooth muscle cells and proliferation of nerve trunks in the subserosal connective tissue adjacent to the thrombosed veins and arteries was also noted. To our knowledge this unique gallbladder thrombotic complication of essential thrombocythemia has not been previously reported.

Florid lobular intraepithelial neoplasia with signet ring cells, central necrosis and calcifications: a clinicopathological and immunohistochemical analysis of ten cases associated with invasive lobular carcinoma.

BACKGROUND AND AIMS: In its most florid form, classic lobular intraepithelial neoplasia (LIN) proliferates to form a solid mass of tumor cells that fill and expand the duct within the terminal duct lobular unit lumen. Foci such as these can develop central necrosis and calcifications, detectable on mammograms. The immunohistochemical expression of E-cadherin has been found to be absent in all reported examples of LIN with necrosis. The occurrence of LIN composed entirely of signet ring cells with central necrosis is extraordinarily rare. METHODS: We described 10 of these cases to illustrate this uncommon morphologic pattern of LIN. The cases were encountered during routine clinical practice of the authors over a 5-year period at the Oncology Hospital of the Mexican Social Security Institute in Mexico City. Cases were comprised of several (>6) foci of LIN with signet ring cells as well as with comedo-type necrosis. RESULTS: Age of patients ranged from 45-75 years (mean age: 51.2 years). The indications for biopsy were calcifications (n = 7) and mass (n = 3) on mammograms. Luminal necrosis was seen in all ten cases and calcifications in seven cases. Eight cases had associated invasive carcinoma, including six lobular carcinomas and one composite carcinoma (lobular and ductal). All cases showed a lack of E-cadherin membrane staining and a diffuse cytoplasmic immunoreactivity for high molecular weight keratin, positivity for estrogen receptors and progesterone receptors was present in 9/10 and 8/10 of cases, respectively. CONCLUSIONS: LIN composed entirely of signet ring cells can develop macro-acini, central necrosis and calcifications. These cases are frequently associated with invasive lobular carcinoma at the time of initial presentation.

[Mammary gland Rosai Dorfman disease. A case report and literature review]. / Enfermedad de Rosai-Dorfman en glándula mamaria. Informe de un caso y revisión de la literatura.

Rosai-Dorfman disease (RDD) is an uncommon idiopathic, benign histiocytic lesion. It generally involves the cervical lymph nodes and, less often the extranodal sites. Involvement of the breast is rare, with about 18 cases reported in the English literature to date. We describe a case of breast involvement by extranodal RDD. The patient was a 67 year old woman with a solid breast lesion that was detected during mammography screening. Microscopically, the lesion was well-circumscribed, and made of sheets of S-100 protein-positive large histiocytes displaying lymphocytophagocytosis. Because the clinical presentation and imaging characteristics of RDD frequently mimics invasive breast carcinoma, awareness and appropriate diagnosis of this entity is essential for proper treatment.