Atypical Carcinoid Neuroendocrine Tumor of the Ureter: A Case Report and Literature Review.

Neuroendocrine tumors (NETs) of the ureter are rare, with less than 40 cases described in the literature. A majority of tumors described are poorly differentiated tumors with a poor prognosis. We present the case of a moderately differentiated atypical carcinoid NET of the ureter with a good postoperative outcome. A literature review was also performed to identify similar cases to compare their management and postoperative outcomes.

Efficacy of an incident-reporting system in cellular pathology: a practical experience.

BACKGROUND AND AIMS: Incident reporting (IR) refers to systematic documentation of adverse incidents to facilitate their appropriate investigation and institution of corrective or remedial actions, and provide data to identify risk trends for recurrent problems. Minimisation of errors and reduction in process variation is recognised as an important goal of quality management and is an essential part of continuous quality improvement. Published data on the role IR plays in cellular pathology remains scanty. METHODS: In this study, the authors collected and analysed all incidents and adverse events reported in their department over a 2-year period. RESULTS: 584 incidents were reported (0.5% of all cases processed). The majority (59%) occurred in the pre-analytical phase of the laboratory process with 23% in the analytical and 18% in the post-analytical phases. Booking-in and specimen labelling-related incidents were the largest single group (56% of all incidents), prompting further root cause analysis, but no other obvious patterns or trends were identified, and most incidents were followed by corrective actions on an individual basis. Most incidents (79%) posed potential harm, as opposed to causing actual harm to the service or patients. Only 78 cases (14%) posed a major risk to patients, such as specimen loss or mix-up, whereas 27% were associated with moderate risk and 59% with minor or insignificant risk. CONCLUSION: Major risk incidents are relatively rare in the cellular pathology laboratory. IR should be included as an important component of a risk management strategy and clinical governance framework.

Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia.

AIMS: To provide updated evidence of the outcome of breast lesions of uncertain malignant potential (B3) and suspicious of malignancy (B4) diagnosed on needle core biopsy (NCB) and analyse the outcome of the different types of intraductal epithelial atypia. METHODS AND RESULTS: One-hundred and forty-nine B3 and 26 B4 NCBs diagnosed over a 2-year period (2007-2008) were compared with those diagnosed over a previous 2-year period (1998-2000). The proportion of B3 diagnoses increased from 3.1% to 4.5%, and the positive predictive value (PPV) of malignancy of a B3 core decreased from 25% to 10%. Increased diagnosis of radial scar and reductions in the PPV of lobular neoplasia and of atypical intraductal proliferation may explain the reduction in the PPV of the B3 group as a whole. There were no significant changes in the proportion of B4 diagnosis (1.1% and 0.8%) or the PPV of B4 (83% and 88%). Review of cores with intraductal atypia showed a wide range of PPVs, from 100% for suspicious of ductal carcinoma in situ, to 40% for atypical ductal hyperplasia categorized as B3, and 14% for isolated flat epithelial atypia. CONCLUSION: The study has found a decrease in the PPV for a B3 diagnosis and suggests possible explanations.

Trichilemmal cyst with carcinoma in situ within an atypical fibroxanthoma.

A 91-year-old lady presented with an 8-month history of a slow growing keratotic nodule on the forehead, which was excised. Histological examination showed a well-defined lesion with marked cellular pleomorphism. Numerous mitoses were present. The cells stained positively with CD10 and CD68 and weakly with smooth muscle actin. However, the tumor was negative for cytokeratins (AE1/AE3), epithelial membrane antigen (EMA), S100, Melan A, HMB45, leukocyte common antigen (LCA), desmin, and CD31. Therefore, the lesion was designated as atypical fibroxanthoma (AFX) by exclusion. Within the AFX, there was also a cyst lined by squamous epithelium showing pilar keratinization. The epithelium showed full-thickness dysplasia with increased mitotic activity and was stained positively with AE1/AE3, thus supporting our view of carcinoma in situ within the wall of the cyst. To the best of our knowledge, this article describes the first case of trichilemmal cyst with carcinoma in situ arising within an AFX.

Angiomatosis: a case with metaplastic ossification.

Angiomatosis is defined as a hemangioma that affects a large segment of the body in a contiguous fashion, either by vertical extension to involve multiple tissue planes (eg, skin, subcutis, muscle, bone) or by crossing muscle compartments to involve similar tissue types (eg, multiple muscles). Such lesions usually present in the first 2 decades of life and have a highly characteristic but not totally specific histological pattern. Histology usually shows a haphazard mixture of small and medium-sized vessels, fat, connective tissue, and lymphatics. Large amounts of mature fat frequently accompany the vascular elements, suggesting that the lesion may possibly be a more generalized mesenchymal proliferation rather than an exclusively vascular lesion. Here we present what we believe to be the first case of angiomatosis showing osseous metaplasia.