A case of papillary thyroid carcinoma in struma ovarii and review of the literature.

Malignancy in struma ovarii is a rare form of ovarian germ cell tumour. Because of its rarity, the diagnosis and management of the tumour have not been clearly defined. We present a case of 67- year-old female with papillary carcinoma arising in struma ovarii and review the literature on malignancy in struma ovarii cases, focusing on management of these cases.

An EMA negative, desmin positive malignant mesothelioma: limitations of immunohistochemistry?

Histopathologists in the current environment of medical negligence and litigation are more likely to use immunohistochemical investigations in their day-to-day practice to support their diagnosis and avoid future litigation. The caveat is that relying on immunohistochemistry is a double-edged sword and pathologists should be familiar with its limitations. We present a case of primary malignant peritoneal mesothelioma with an unusual immunohistochemical profile-desmin positive, EMA negative-and wish to highlight the importance of cautiously interpreting immunohistochemistry profiles when they do not fit the clinical history and histological appearance.

Superficial acral fibromyxoma: a clinicopathological study of new 41 cases from the U.K.: should myxoma (NOS) and fibroma (NOS) continue as part of 21st-century reporting?

BACKGROUND: Superficial acral fibromyxoma (SAF) remains poorly recognized by general pathologists and dermatopathologists, partly attributable to its relatively uncommon occurrence and recent documentation. OBJECTIVES: To examine a series of SAF and document the U.K. experience with this new entity. METHODS: We reviewed 771 tumours reported between 1970 and 2006 in seven different U.K. hospitals and coded as myxoma, not otherwise specified (NOS), fibroma (NOS) or dermatofibroma (NOS) presenting at acral sites. Forty-one cases of SAF were studied. RESULTS: The patients comprised 27 men and 14 women, age range 19-91 years (mean 50, median 47), presenting with a solitary mass or nodule with a mean size of 1.92 cm. The common clinical sites were the toes (n=29) and fingers (n=11) as well as the palm (n=1), with more than 75% of cases close to or involving the nail bed. All cases presented with a painless mass except for four cases where pain was the presenting complaint. A history of trauma was reported in only two cases. Histologically, all cases presented as proliferation of spindle-shaped and/or stellate cells with a storiform and fascicular pattern embedded in a fibromyxoid/collagenous stroma with conspicuous mast cells. Multinucleated cells were observed (n=22), increased number of blood vessels in the stroma and extravasation of red blood cells (n=4). The characteristic immunophenotype was CD34+, CD99+/-, epithelial membrane antigen+ focally/-, S100-, desmin-, smooth muscle actin-, HMB45- and cytokeratin-. CONCLUSIONS: We describe a large series of 41 cases of SAF showing that it is a distinct entity with typical clinical, histological and immunohistochemical features. Follow-up was available only in 12 patients, precluding a firm comment on recurrence. However, complete excision and follow-up review is recommended.

Primary smooth muscle tumor of the pleura: a clinicopathological case report with ultrastructural observations and a review of the literature.

Primary smooth muscle tumor of the pleura is exceptionally rare. The authors describe a primary smooth muscle tumor of the pleura that was discovered incidentally on chest X-ray in a 73-year-old man. Magnetic resonance imaging demonstrated a 12 x 18 x 15-cm pleura-based mass arising from the posterior mediastinum. Computerized tomography (CT) guided needle cores from the pleura showed a primary smooth muscle tumor of undetermined malignant potential. Further excision of the whole tumor showed an intimate relation to pleura, and the diagnosis of leiomyosarcoma was made. The clinical, radiological, histopathological, immunohistochemical, and ultrastuctural findings were consistent with a primary smooth muscle tumor of the pleura. This is the seventh case in the literature of a primary smooth muscle tumor of the pleura, which, to the best of the authors' knowledge, is the first such case of the pleura to be diagnosed on CT-guided needle biopsy. In conclusion, this method of investigation is recommended since it is minimally invasive but has a rewarding yield in providing the most likely diagnosis, predicting prognosis, and management planning.

Osseous metaplasia in a tubular adenoma of the colon.

An 85 year old woman presented with a one month history of change in her bowel habits in the form of alternating diarrhoea and constipation. She also noted some rectal bleeding. Flexible sigmoidoscopy revealed a 1.5 cm polyp 30 cm from the anus. The polyp was removed during the sigmoidoscopy by electrocautery and sent for histological examination. The polyp was a tubular adenoma with mild dysplasia. The adenoma contained numerous foci of metaplastic bone. These consisted of irregular islands of mineralised osteoid bone rimmed by a layer of scattered osteoblasts. This is the first case of osseous metaplasia in a tubular adenoma of the colon to be reported.

A study to determine the underlying reason for abnormal glandular cytology and the formulation of a management protocol.

A retrospective review is presented of 89 patients with glandular dyskaryosis in order to formulate a management protocol. Fifteen patients had cervical intraepithelial neoplasia (CIN) without glandular abnormality (17%). One patient had adenocarcinoma in situ of the cervix and one patient had vaginal intraepithelial neoplasia (VAIN) grade III. Twenty-two patients had endometrial carcinoma (24.5%) and 11 patients had cervical carcinoma (12.5%). Of the patients presenting with post-menopausal bleeding as well as having glandular dyskaryosis, 69% had a gynaecological malignancy. In conclusion, colposcopy and out-patient endometrial sampling are recommended in all cases. Patients with abnormal endometrial sampling require hysteroscopy. Cone biopsy is necessary to exclude occult glandular disease if cytology remains abnormal despite negative colposcopy and sampling.

Carney's triad: gastric leiomyosarcoma, pulmonary chondroma and extra-adrenal paraganglioma in young females.

The case of a 13-year-old girl with a gastric leiomyosarcoma and a pulmonary osteochondroma is presented. The association of these two tumours and extra-adrenal paraganglioma has been described as a triad by Carney. The patient is free of recurrence of the gastric tumour with no evidence of paraganglioma 10 months after the operation. To our knowledge this is the first case of the triad reported in the UK.