Intraosseous inflammatory pseudotumor of the maxilla: A case report.

Inflammatory pseudotumors are benign lesions that are rarely reported in the head and neck. Moreover, intraosseous inflammatory pseudotumors of the maxilla are extremely rare, with less than 10 cases reported. A 52-year-old woman presented with recurrent dental infections; computed tomography scan of the osteolytic maxillary bone lesion and incisional biopsy were performed. Histopathological examination revealed that the lesion was composed of fascicles of fibroblasts and myofibroblasts, in addition to sheets of plasma cells, lymphocytes, and occasional other inflammatory cells. An infiltrative growth pattern was observed. Immunohistochemical staining confirmed an inflammatory pseudotumor. A partial maxillectomy was performed. There was no evidence of recurrence during the 4-month follow-up period. Inflammatory pseudotumors should be considered when treating destructive maxillary lesions. Immunohistochemical staining was performed to confirm polyclonal plasma cell proliferation.

Necrobiotic granulomas of the bowel accompanying 3-year postsurgical recurrence of colon cancer: A case report.

INTRODUCTION: Postsurgical necrobiotic granulomas present a diagnostic challenge and have been described in organs such as the urinary bladder, prostate, and uterus. However, occurrence of these granulomas is rare in the bowel. PRESENTATION OF THE CASE: In this report, we present the case of a 28-year-old woman with recurrent multifocal colonic adenocarcinoma 3 years after sigmoidectomy. Intraoperatively, the ileum was suspicious for tumor deposits. Total colectomy with segmental small bowel resection was performed, and the histopathological findings of the small bowel specimen were consistent with necrobiotic granulomas with no evidence of malignancy. Infectious disease workup was negative. The patient was administered adjuvant chemotherapy and had no negative outcomes at 8 months after the surgery. DISCUSSION: This is a rare and challenging case of postsurgical necrobiotic granulomas of the bowel. CONCLUSION: Granulomas with "active" necrobiosis can occur as late as 3 years after colon cancer surgery and can be a diagnostic pitfall that significantly affects the management.

Metastatic small cell carcinoma of the lung with prominent spindle cell morphology and hemangiopericytoma-like vascular pattern: A sarcoma mimicker.

Small cell carcinoma is a malignant neuroendocrine tumor with aggressive clinical behavior. Histologically, the tumor is characterized by the proliferation of small, round, blue cells. Here, we present the case of a 50-year-old man with a 1-month history of enlarging chest wall mass. Microscopic examination of the lesion revealed a highly cellular neoplasm composed of closely packed, atypical spindle cells with scant cytoplasm, inconspicuous nucleoli, and brisk mitotic activity. The hemangiopericytoma-like vascular pattern was prominent. Areas showing a fibrosarcoma-like fascicular pattern were also observed. The tumor was immunohistochemically positive for TTF1, synaptophysin, and chromogranin, confirming small cell carcinoma. Further investigations revealed a lung origin and widespread metastases. The tumor in this case closely mimicked synovial sarcoma or malignant peripheral nerve sheath tumor. Small cell carcinoma demonstrates a hemangiopericytoma-like pattern that can mimic sarcoma histologically. This is a serious pitfall that can significantly affect the speed of diagnosis and management.

Perinodular hydropic degeneration in uterine leiomyoma causing rapid enlargement and mimicking a myxoid smooth muscle tumor: Case report of a diagnostic challenge.

INTRODUCTION: Hydropic degeneration, sometimes reported as perinodular hydropic degeneration, is one of the various degenerative changes that can be observed in uterine leiomyomas. It can be a clinical and a histopathological diagnostic pitfall. CASE REPORT: Here we present the case of a 40-year-old woman with leiomyoma uteri with perinodular hydropic degeneration. The tumor almost doubled in size over 2 months. Histopathological examination revealed fascicles, cords and nodules of smooth muscle cells separated by excessive amounts of extracellular material. No necrosis or significant atypia was noticed. Average mitotic activity was very low. A myxoid smooth muscle tumor could be excluded only by alcian blue special stain. The presence of floating vessels in the edematous fluid as well as hyalinization inside the tumor nodules were among the reassuring features supporting the diagnosis. CONCLUSION: The pathologist must be aware of this benign entity to avoid overdiagnosis, especially in the view of the alarming histology and the rapid growth. Negative findings with alcian blue special stain help establish the diagnosis.

Poorly Cohesive Cell Carcinoma of the Gallbladder with Signet Rings and Neuroendocrine-Like Morphology: A Rare Incidental Histopathological Diagnosis with Lessons to Learn.

BACKGROUND Poorly cohesive cell carcinoma of the gallbladder is extremely rare. CASE REPORT Here we present a case of a 46-year-old male with the clinical diagnosis of acute cholecystitis. The ultrasound showed gallbladder wall thickening and multiple stones. Cholecystectomy was performed, and the gross examination revealed linitis plastica-like thickening of the gallbladder wall. The microscopic examination revealed diffuse infiltration by a poorly differentiated tumor with signet rings. Another component with insular growth pattern and salt-and-pepper nuclei was present. Immunohistochemical findings were consistent with poorly cohesive cell carcinoma of the gallbladder. Imaging studies revealed regional lymph nodes involvement, in addition to peritoneal and liver metastases. The patient was given chemotherapy, and there was no evidence of disease progression at 4 months post-operation. CONCLUSIONS This case supported that all cholecystectomy specimens must be examined. In addition, although poorly cohesive cell carcinoma was reported to be aggressive, the present case showed a protracted clinical course; this pointed to the need for early clinicoradiological suspicion. This is the first case of poorly cohesive cell carcinoma of the gallbladder with a neuroendocrine-like morphology that mimics mixed adenoneuroendocrine carcinoma. Immunohistochemistry is invaluable in such a scenario.

A rare case of intranodal hemorrhagic spindle cell tumor with amianthoid fibers presenting as a suspicious lump in the groin.

INTRODUCTION: Intranodal hemorrhagic spindle cell tumor with amianthoid fibers is extremely rare. PRESENTATION OF THE CASE: Herein, we present the case of a 58-year-old man with a 2-year history of painless left inguinal swelling. On physical examination, the mass was large, fixed, hard, and non-tender, suggesting a lymph node pathology. The mass had increased slightly in size after a short course of antibiotic treatment. The surgeon decided to perform an excisional biopsy of the left inguinal lymph node. The lesion was intraoperatively hard and suspicious for malignancy. The gross examination revealed a relatively large well-circumscribed mass with a whitish, hard, cut surface. The histomorphological and immunohistochemical findings were consistent with intranodal hemorrhagic spindle cell tumor with amianthoid fibers. There was no evidence of recurrence at 4 years post surgery. DISCUSSION: The present case adds to the very limited data available on this rare entity. CONCLUSION: Intranodal hemorrhagic spindle cell tumor with amianthoid fibers can be a diagnostic pitfall both clinically and histopathologically. It can reach large sizes and be clinically and grossly suspicious for lymphoma. Clinicians must be made aware that such an entity exists.

Mature bony metaplasia in multinodular goiter: A case report.

INTRODUCTION: Various degenerative changes can be seen in multinodular goiter. These include cystic changes, hemorrhage, fibrosis and calcification. However, osseous metaplasia is extremely rare. PRESENTATION OF THE CASE: Here we present a 44-year-old lady with multiple ill-defined thyroid nodules upon physical examination. Thyroid ultrasound showed multiple variably sized nodules with cystic degeneration. The largest left lobe nodule showed macrocalcification. Further evaluation was advised by the radiologist. Total thyroidectomy was performed and it revealed histological osseous metaplasia with lamellar bone formation. The clinical course following resection was unremarkable. DISCUSSION: Osseous metaplasia with ectopic bone formation is extremely rare in benign thyroid disorders. To the best of our knowledge, only thirteen cases of sporadic goiter with heterotopic bone formation are reported. CONCLUSION: Osseous metaplasia can be a pitfall in the diagnosis of multinodular goiter. Ruling out comorbidities is mandatory, and further genetic and follow-up studies are needed.

Extraskeletal myxoid chondrosarcoma of the leg in a child: A case report.

RATIONALE: Extraskeletal myxoid chondrosarcoma is a slow-growing soft tissue tumor of adults with a propensity for local recurrence and eventual metastasis. Only 17 pediatric and adolescent cases have been reported. PATIENT CONCERNS: Here we present an 11-year-old boy with a 3-year history of a slowly growing painless left leg mass. Magnetic resonance imaging of the lesion revealed a subfascial well-circumscribed lesion with intramuscular extension in the medial gastrocnemius muscle of the left leg. DIAGNOSES: He underwent wide local excision of the mass and the histomorphological and immunohistochemical findings were consistent with extraskeletal myxoid chondrosarcoma. INTERVENTIONS: Possible radiotherapy was the further management plan. OUTCOMES: He was in good condition with no evidence of recurrence at 6 months postsurgery. LESSONS: Although pediatric cases of extraskeletal myxoid chondrosarcoma were reported to be aggressive, the tumor in this case demonstrated indolent behavior. Furthermore, the tumor in this case showed primitive round cell foci which adds to a previous study that especially reported this morphology in pediatric cases.