Angioinvasion as a factor for predicting aggressive outcome in primary thyroid angiosarcoma: three case reports and literature review.

We report three primary thyroid angiosarcoma (PTA) cases revealing distinctive morphological features. A systematic literature review completed our analysis to evaluate the most important morphological factors for predicting prognosis in PTAs. Three rare PTA cases were analysed. In addition, we identified 46 previously reported PTAs with available follow-up data to compare morphological features related to prognosis between patients with a favourable versus aggressive outcome. The three PTAs displayed considerable architectural heterogeneity: case 1 presented a well circumscribed tumour, extensively necrotic, with only a few highly pleomorphic vascular proliferation; cases 2 and 3 both exhibited plump epithelioid cells forming rudimentary vascular spaces or solid sheets. Case 3 also presented angioinvasion. Cases 1 and 2 were alive and disease-free at 40 and 73 months following diagnosis, respectively, whereas case 3 died within 14 months. Other significant prognostic factors were highlighted by our review and literature data analysis: increased tumour size (p = 0.042), extrathyroidal extension (p = 0.009), and distant metastases at diagnosis (p = 0.001). Although regarded as highly aggressive, PTA can also be characterised by an unusual favourable outcome. For the first time we highlight the importance of reporting angioinvasion, in cases of PTA, as a possible adverse prognostic factor.

Morphologic and molecular subtype status of individual tumor foci in multiple breast carcinoma. A study of 155 cases with analysis of 463 tumor foci.

The aim of this study is to evaluate biomarker immunophenotypic heterogeneity between separate tumor foci of multiple breast carcinoma, its correlation with morphologic features and tumor grade, and its influence on the treatment. One hundred fifty-five invasive multiple breast carcinomas were retrospectively analyzed over a 6-year period (2007-2012), and the expression of estrogen (ER) and progesterone (PR) receptors, Ki-67 proliferative index, human epidermal growth factor receptor 2 expression, morphologic subtype, and tumor grading were analyzed in each tumor focus. We found mismatches in immunohistochemical features in 71 (53.78%) of 132 patients with similar histology and in 13 (56.52%) of 23 cases with different histology. When analyzing mismatches in ER and PR statuses together, in 4 (23.52%) of 17 cases, one of the tumor foci was ER or PR positive, whereas the index tumor did not express either marker. The most numerous mismatches (45 cases; 29.03%) concerned the proliferative index; in 14 cases (9.03%), the additional focus had a higher index than did the main focus, and in 9 of these cases, the additional focus displayed a histologic grade of 3. Mismatches in human epidermal growth factor receptor 2 status appeared in 25 (16.12%) cases. The histologic type of the additional foci was different from the index tumor in 23 (14.83%) cases. Assessment of all tumor foci would have determined 19 (12.25%) cases to receive different adjuvant treatments compared with what would have been indicated if only the biological status of the largest primary tumor was assessed. We strongly recommend assessing and reporting each tumor focus independently.

Ectopic Complete Hydatidiform Mole Presenting as an Adnexal Tumor in a Postmenopausal Patient.

Hydatidiform mole (HM) is rare in postmenopause, with only 7 cases reported. The occurrence of ectopic HM is also rare, with 26 fully documented tubal cases. We are not aware of any reported cases of ectopic HM in a postmenopausal patient. In a 51-year-old patient with 3 years amenorrhea, surgery revealed a necrotic, hemorrhagic mass involving the right peritubal space. Microscopically, chorionic villi were seen within the hemorrhagic mass accompanied by circumferential trophoblast hyperplasia. Immunohistochemically, p57(kip2) positive nuclei were prominent in the extravillous (intermediate) trophoblast. The HER2 FISH expression was diploid, consistent with the diagnosis of an early complete HM.