A Hemorrhagic Clival Chordoma with a Long Progression-Free Survival.

BACKGROUND: Chordomas and ecchordosis physaliphora may on rare occasions present with intracranial hemorrhage. Their distinction usually relies on the results of the Ki-67 proliferative index, with a result lower than 1% favoring ecchordosis physaliphora. Intracranial hemorrhagic chordomas have been linked to unfavorable prognosis, due to acute neurologic deterioration and death, or progression after treatment. To the best of our knowledge, this is the first report of a patient with an intracranial hemorrhagic chordoma who had a long progression-free survival. CASE DESCRIPTION: A 67-year-old woman presented with a large hemorrhagic clival tumor that was resected through an endonasal endoscopic approach. Physallipharous cells interspersed in a myxoid matrix, positivity for S-100, cytokeratin, and epithelial membrane antigen were found, along with an extremely low Ki-67 index. Imaging findings of bone erosion, a large size, and enhancement favored the diagnosis of chordoma. The patient received adjuvant stereotactic radiotherapy and has remained disease free after 4 years. CONCLUSIONS: Although hemorrhagic intracranial chordomas have been linked to unfavorable outcomes, our case demonstrates that they may have a low proliferative index, and a long progression-free survival may be seen.

Ocorrência sincrônica de carcinoma mucinoso microinvasivo em mama esquerda e linfoma em axila direita / Synchronous ocurrence of microinvasive mucinous carcinoma in left breast and lymphoma in right axilla

Os linfomas correspondem a 3,5% das neoplasias malignas em mulheres. O carcinoma mucinoso invasivo corresponde entre 2 a 4% dos cânceres mamários. No presente artigo, relata-se o diagnóstico, o tratamento e a evolução de um caso raro de ocorrência sincrônica de carcinoma mucinoso microinvasivo em mama esquerda e linfoma de células B em axila direita.

Lymphomas account for 3.5% of all cancers in women. Invasive mucinous carcinoma accounts from 2 to 4% of breast carcinomas. In this paper, we report the diagnosis, treatment and outcome of a rare case of synchronous occurrence of microinvasive mucinous carcinoma in the left breast, and B-cell lymphoma in the right axilla.

Nuclear inclusions and pseudoinclusions: friends or foes of the surgical pathologist?

Abnormal substances in the nuclei that can be observed by light microscopy are often broadly referred to as nuclear inclusions. Although their recognition in the appropriate clinicopathological settings can aid in the diagnosis of some disease entities and tumor types, they can also be a source of error. There are 2 morphologically distinct types of inclusions with different mechanisms of formation and diagnostic significance, including bona fide nuclear inclusions and nuclear pseudoinclusions. Bona fide nuclear inclusions result from accumulation in the nuclei of viral particles, cytoplasmic materials (such as surfactant, immunoglobulin, and glycogen), biotin, nuclear lamins, or polyglutamine. Some of them are diagnostically helpful, such as surfactant inclusion, which can support the pulmonary origin of an adenocarcinoma, whereas others may be misleading, such as biotin inclusion, which can be mistaken for herpes infection. Nuclear pseudoinclusions, which represent invaginations of cytoplasm into the nucleus, are delimited by the nuclear membrane. Although not totally specific, they are particularly common in papillary thyroid carcinoma, meningioma, and usual ductal hyperplasia of the breast and hence may aid in the diagnosis of these entities. Nuclear pseudo-pseudoinclusions, which are artefactual bubbles in the nuclei that mimic nuclear pseudoinclusions or clear nuclei, can lead to misdiagnosis of follicular adenoma or hyperplastic nodule as papillary thyroid carcinoma.

Fibromatose mamária: relato de caso / Mammary fibromatosis: a case report

Fibromatose da mama é tumor não-metastatisante, embora possa infiltrar e recorrer localmente. Trata-se de afecção rara, localmente agressiva, que se caracteriza por alta tendência em recidivar localmente. Os autores relatam caso de fibromatose mamária com infiltração do músculo peitoral maior, sendo abordados aspectos diagnósticos, terapêuticos e prognósticos da patologia.