Hodgkin's lymphoma with unusual pulmonary presentations: Reporting two cases.

Classical Hodgkin's lymphoma (CHL) presenting with exclusively pulmonary symptoms is very unusual. We report two cases of CHL with atypical clinical presentations mimicking pulmonary infections. The first case represents a stage IV CHL with secondary lung involvement, and the second case demonstrates a very rare case of CHL with isolated lung involvement, also known as primary pulmonary Hodgkin's lymphoma. The second patient was initially misdiagnosed and treated with six months of antibiotics before the correct diagnosis was made by a lung biopsy. Both patients received chemotherapy; one patient achieved complete remission and the other achieved near-complete remission.

Adenocarcinoma Ex-Goblet Cell Carcinoid of the Appendix With Metastatic Peritoneal Spread to Meckel's Diverticulum and Endometriosis.

Adenocarcinoma ex-goblet cell carcinoid is a very rare and histologically unique appendiceal malignancy with dual glandular and neuroendocrine differentiation. There is a high incidence of this tumor among middle-aged women with metastasis to the gynecologic tract with the mode of metastasis following peritoneal spread rather than hematogenous distribution. Adenocarcinoma ex-goblet cell carcinoid can spread to any peritoneal site including ovaries or omentum. We report a 37-year-old healthy woman who initially presented with right lower quadrant abdominal pain and pseudomyxoma peritonei. Histopathology of the appendectomy specimen revealed an adenocarcinoma ex-goblet cell carcinoid, signet ring cell type. Follow-up right hemicolectomy, omentectomy, bilateral salpingo-oophorectomy, and regional peritoneal resections revealed metastatic involvement by adenocarcinoma ex-goblet cell carcinoid, signet ring cell type. In this report, we describe a case of appendiceal adenocarcinoma ex goblet cell carcinoid with metastases to Meckel's diverticulum and areas of pelvic endometriosis, which have not been previously reported.

Newly Diagnosed Colonic Adenocarcinoma: The Presenting Sign in a Young Woman with Undiagnosed Crohn's Disease in the Absence of Primary Sclerosing Cholangitis and a Normal Microsatellite Instability Profile.

Ulcerative colitis has long been linked with an increased risk for colonic adenocarcinoma, whereas Crohn's disease (CD) has recently been reported to pose a similar increased risk. We report a 33-year-old healthy female with no family history who presented with abdominal pain and a colon mass. Histopathology revealed a moderately differentiated adenocarcinoma extending through the muscularis propria with metastatic lymph nodes and intact mismatch repair proteins by immunohistochemical expression and gene sequencing. The nonneoplastic grossly uninvolved background mucosa showed marked crypt distortion, crypt abscesses, CD-like lymphoid hyperplasia, transmural inflammation, and reactive epithelial atypia. Additional patient questioning revealed frequent loose stools since she was a teenager leading to diagnosis of a previously undiagnosed CD without primary sclerosing cholangitis (PSC). The adenocarcinoma is suspected to be related to the underlying CD. Newly diagnosed adenocarcinoma in a young female as the presenting sign for CD in the absence of PSC is extremely rare.

Metastatic Gastrointestinal Adenocarcinoma with Osteoblastic Activity: A Case Report of Esophageal and Colonic Primaries.

Adenocarcinoma with osteoblastic metastases is classically seen in prostate, breast, and lung primaries. Less common primary sites include thyroid, kidney, and stomach. We present two cases of primary gastrointestinal adenocarcinoma with metastatic osteoblastic activity from two previously unreported sites. The first case represents an esophageal adenocarcinoma arising in a background of intestinal metaplasia that metastasized with osteoblastic activity to the deltoid muscle. The second case demonstrates a Stage IV sigmoid colon adenocarcinoma with osteoblastic metastases to the liver and lymph nodes. The findings indicate that metastases from various gastrointestinal primary adenocarcinomas can have prominent bone formation.

Discontinuous unilateral involvement of 12 part core biopsies by adenocarcinoma predicts bilateral involvement of subsequent radical prostatectomy.

At our institution, percent tumor burden in prostate core biopsies is quantified using variations of one of two methods. Measurement by the Aggregate method reports only adenocarcinoma and omits intervening stroma and benign prostatic glands while the Discontinuous method includes the intervening stroma and benign glands between distinct foci of adenocarcinoma. In this study, we selected cases with 12-part core biopsies that were followed by a radical prostatectomy within two years. Interestingly, we found that when adenocarcinoma involved prostate 12-part core biopsies and subsequent resection unilaterally, there is no significant difference in absolute percentage of tumor using either measuring method (P = 0.4). In contrast, when adenocarcinoma involved the biopsies unilaterally and subsequent prostatectomy bilaterally, the two measurement methods had a statistically significant difference in percentage scores (P = 0.002). In the study cohort, other factors including Gleason score (P = 0.88) and total number of adenocarcinoma-involved cores (P = 0.27) did not introduce any significant correlation with bilateral involvement. In this study, we found that biopsies that discontinuously and unilaterally involve half of a prostate are much more likely to involve both lobes than those that are unilateral and present in nodular aggregates.

EBUS-FNA of a station seven lymph node: an unusual presentation of a young nonsmoker male with hemoptysis and subcarinal lymphadenopathy.

Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) is a safe and minimally invasive bronchoscopic technique that allows both visualization and cytologic sampling with a high diagnostic yield in a patient with mediastinal lymphadenopathy. Besides the most common indication of staging for a patient with a primary lung carcinoma, EBUS-FNA can be used to identify benign infectious and noninfectious processes as well as lymphoma and malignancy of unknown primary. Triaging of procured specimen for diagnostic, prognostic, and therapeutic ancillary studies requires appropriate clinical information at the time of rapid on site evaluation (ROSE) of smears. This case report demonstrates a young, previously healthy nonsmoker presenting clinically with cough, hemoptysis, and a 1.7 cm enlarged subcarinal lymph node by imaging. EBUS-FNA obtained smears from the lymph node revealed a pleomorphic population of smaller cells with a low nuclear to cytoplasmic ratio and prominent nucleoli, and larger cells had nuclei with bizarre shapes, mitoses, multinucleation, enlarged nucleoli, and pigmentation in a background of lymphocytes. The cytomorphologic and immunohistochemical workup of this case confirmed the unexpected diagnosis of metastatic melanoma. This result was a complete surprise to the clinical team managing the patient and prompted a thorough clinical workup. Subcarinal lymphadenopathy with metastatic malignant melanoma as the cause is rare. This case report highlights how ROSE and appropriate triaging of specimen were crucial in appropriately working up this case. We also survey the literature to review the reported unusual presentations of metastatic melanoma.