B-Cell Lymphoma Presenting as Acute Pancreatitis Federico, Edda; Falconi, Massimo; Zuodar, Gianni ...
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... et al.,
12/2011, Letnik:
11, Številka:
6
Journal Article
Recenzirano
Abstract Background: Pancreatic lymphoma is uncommon, representing less than 0.5% of pancreatic tumors, with diffuse large B-cell lymphoma being the predominant histotype. Acute pancreatitis ...associated with pancreatic lymphoma is rare. Case Report: We describe a case of synchronous pancreatic and pulmonary localizations of non-Hodgkin's lymphoma in a 42-year-old man who presented with acute pancreatitis. Acute pancreatitis resolved after standard treatment with a fasting regimen, gabexate mesilate and parenteral nutrition. However, ultrasound scan and abdominal computed tomography revealed two hypoechogenic areas within the pancreas, and chest X-ray film showed a pulmonary infiltrate in the right basal field. A percutaneous fine-needle aspiration biopsy of the pulmonary infiltrate under computed tomography guidance demonstrated a diffuse infiltration by atypical lymphoid cells positive for leukocyte common antigen, CD20 and CD30. Percutaneous fineneedle aspiration biopsy under ultrasound guidance of the pancreatic mass confirmed the diagnosis of diffuse large B cell lymphoma. The patient was classified as stage IV-A, low-intermediate risk and received 6 cycles of chemotherapy. Conclusion: This is the first case of large B-cell lymphoma presenting with concomitant primary pancreatic and pulmonary involvement. Pancreatic lymphoma is uncommon and represents a rare cause of acute pancreatitis. The discovery of a pancreatic mass needs pathologic diagnosis to distinguish lymphoma from carcinoma or autoimmune pancreatitis.
We have reviewed the effusion cytology of 51 cases of histologically proven malignant mesothelioma of the pleura (49 cases) and the peritoneum (2 cases). The patient group included 45 males and 6 ...females, aged 45-83 yr. A cytological diagnosis of malignancy had been rendered on 43 cases, and in 30 of them it was consistent with, or at least suggestive of, a mesothelioma. Diagnostic clues, especially evident in epithelial and biphasic tumors were hypercellularity and/or morular aggregates of malignant cells showing scalloped borders and nuclei with dense chromatin and evident nucleoli. Cytomegaly with multinucleation was also frequently observed. Reactive mesothelial cells were often present along with other non specific features such as red blood cells, fibrin, necrotic debris. In 13 cases, a diagnosis of malignancy was entertained but mesothelioma, although considered, was not reported out because of scantiness of material. In four cases, adenocarcinoma was erroneously diagnosed for the presence of deceptive cell vacuoles. In eight cases, no diagnostic cells were recovered in repeated effusions. The first diagnosis was a cytologic one in 37 patients, Tissue study was performed on autopsy (35 patients) and surgical material. The latter was the only source of histology in six cases. Immunocytochemical investigation was negative for carcinoembryonic antigen in all but one tested cases (1/21) and positive for human milk fat globulin in about one-half of the epithelial and biphasic tumors. In 18 of 21 cases, positivity for combined high- and low-molecular-weight keratins was detected.
The authors report 2 cases of cutaneous pseudolymphoma that occurred in 2 young adult patients who referred for relentlessly growing nodules that appeared within 4 to 5 months after the application ...of a mercury-based tattoo. Systemic symptoms were not present and there was no evidence of lymph node enlargement. Clinically, both lesions were limited to the red, mercury-based areas of the tattoo. Microscopic examination featured a dense cellular infiltrate composed of polytypic T cells in the upper to mid-dermis, coupled with focal interface tissue reaction. Scattered macrophages contained finely granular particles in their cytoplasm. In addition, extracellular pigment particles were also recognized. Collections of epithelioid macrophages were present in both cases and were reminiscent of epithelioid granulomas. This study confirms evidence that, among skin diseases featuring a dense lymphoid infiltrate, cutaneous pseudolymphoma secondary to tattooing is a rare but not exceptional source of diagnostic challenges.
Elderly patients are a potential source of additional organ supply for transplantation. Unfortunately, with increasing age, the chance is greater that an apparently healthy aged man will be carrying ...a silent prostatic carcinoma. Therefore, in order to maximize safety, intraoperatory evaluation of the prostatic gland may be required to rule out adenocarcinoma. We evaluated 14 prostatic tissue specimens obtained from “marginal” donors and examined by intraoperatory frozen sections. These were positive for carcinoma in three cases and negative in 11. Examination of permanent sections from snap-frozen tissue revealed three additional cases that were unrecognized on the initial frozen sections. The inaccuracy of the method could be explained by the difficulty, caused by freezing, of discriminating benign from malignant gland and by technical artifacts. Snap-freezing artifacts also compromised the evaluation of tumor invasion into the extraprostatic fat in 2 cases. Because of the architectural distortion, frozen sections were also ineffective in the recognition of Gleason pattern in all cases. Examination of prostatic frozen sections may be useful if the pathologist is asked to recognize only larger tumors. The estimation of small volume tumors, extracapsular extension, as well as Gleason pattern assessment suffers from an irreducible bias.
A number of studies on the putative relation between Polycomb-Group (PcG) proteins overexpression and carcinogenesis have been published recently. BMI1, the prototype PcG gene, is critically involved ...in cell cycle control and differentiation, and despite the regulatory role demonstrated in central nervous system (CNS) development, its implication in brain tumorigenesis is scarcely known. Moreover, to the best of our knowledge, large studies on human brain tumors tissue are lacking. To gain a new insight, we tested 80 primary brain astrocytomas for BMI1 expression using immunohistochemistry and established a correlation with the expression of p16, a negatively regulated target of BMI1 function. Fifty-four cases (72.5%) were BMI1 + /p16-, and 22 cases (27.5%) were BMI1 + /p16+. Slight non-significant differences were noted in the expression profile between grades II, III, and IV astrocytomas. However, when the 22 BMI1 + /p16+ tumors were examined cytologically, a substantial proportion contained a significant gemistocytic component, which is thought to be an adverse prognostic factor or to display a high degree of anaplasia, suggesting a common molecular mechanism of BMI1/p16 pathway disruption, which may have prognostic implications.
The authors report a case of an incidentally discovered myxoid stromal tumor occurring in the outer wall of the stomach of a 65-year-old woman. The tumor was phenotypically consistent with ...parachordoma (or myoepithelioma), showing a chordoid microscopic appearance of tumor cells loosely arranged within a myxoid or hyaline background. Immunoreactivity for high-molecular-weight keratins, S100 protein, and vimentin was detected. In this report, the authors address the differential diagnosis of parachordoma and the unusual location of this neoplasm.
We report three cases of solitary fibrous tumor of the breast. The patients were adult to elderly women and complained of a slowly but relentless growing lump. The tumors were fairly circumscribed ...and cured by means of lumpectomy or, in one case, simple mastectomy. Histologically, they featured the customary “patternless pattern” of short spindle cells haphazardly arranged in fascicles within a collagenized or myxoid ground substance. In two cases, a prominent hemangiopericytic arrangement of tumor cells around a rich vascular framework could be noticed. Cellular areas were often present and showed nuclear overlapping, clumping of chromatin, and a brisk mitotic activity. No atypical mitosis was recognized. Tumor cells were immunoreactive for CD34, bcl2, and vimentin only. On follow-up there was no evidence of either local recurrence or distant metastases. Solitary fibrous tumors of the breast may represent a significant diagnostic problem because of the close mimicry to numerous benign and malignant mammary lesions composed of spindle cells; diagnostic clues may be further obscured in cellular and actively proliferating tumors. A brief overview of mammary solitary fibrous tumor taxonomy along with the principal differential diagnoses within the breast is presented.
Images in Pathology Pizzolitto, Stefano; Falconieri, Giovanni
International journal of surgical pathology,
10/2003, Letnik:
11, Številka:
4
Journal Article
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