The American journal of surgical pathology
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Am. J. Surg. Pathol. · Apr 2009
Comparative StudyTransitional cell tumors of the ovary: a comparative clinicopathologic, immunohistochemical, and molecular genetic analysis of Brenner tumors and transitional cell carcinomas.
Transitional cell tumors of the ovary include 2 distinct clinicopathologic categories: Brenner tumors and transitional cell carcinomas (TCCs). Their molecular genetic alterations have not been fully investigated. We have performed a clinicopathologic, immunohistochemical, and molecular genetic analysis of 19 transitional cell tumors including 13 Brenner tumors (5 benign, 7 borderline, and 1 malignant) and 6 TCCs. ⋯ The malignant Brenner tumor was also negative for p16, Rb, and p53, and strongly positive for Cyclin D1, Ras, and EGFR. In contrast, TCCs had p53 mutations with p53 and p16 protein overexpression and showed a negative immunoreaction for EGFR, Cyclin D1, and Ras. Our results suggest that Brenner tumors and TCCs follow different tumorigenic pathways, whereas borderline and malignant Brenner tumors are low-grade neoplasms with activation of the PI3K/AKT pathway through EGFR, TCCs are high-grade tumors that have p53 mutations and p16 and p53 protein overexpression.
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Am. J. Surg. Pathol. · Feb 2009
Case ReportsRhabdomyosarcomatous differentiation in gastrointestinal stromal tumors after tyrosine kinase inhibitor therapy: a novel form of tumor progression.
Approximately 80% of advanced metastatic gastrointestinal stromal tumors (GISTs) respond to treatment with the tyrosine kinase inhibitor (TKI) imatinib mesylate. However, the majority of patients suffer disease progression at a median of 2 years due to drug resistance. In general, progressing GISTs retain their typical morphology. ⋯ It is associated with loss of KIT expression, but retention of the receptor tyrosine kinase mutation of the precursor GIST. The rhabdomyoblastic differentiation can represent a diagnostic pitfall. The molecular mechanisms for this form of TKI-resistant clonal evolution remain to be determined.
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Am. J. Surg. Pathol. · Oct 2008
Subcutaneous panniculitis-like T-cell lymphoma: a clinicopathologic, immunophenotypic, and molecular study of 22 Asian cases according to WHO-EORTC classification.
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is defined as a rare cytotoxic alpha/beta T-cell lymphoma characterized by primary involvement of subcutaneous tissue mimicking panniculitis and a predominant CD3+/CD4-/CD8+ phenotype in 2005 World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) classification for cutaneous lymphomas. We presented a detailed study of SPTL, describing clinicopathologic, immunophenotypic, and molecular features of 22 cases in China. Strict diagnostic criteria according to the WHO-EORTC definition were applied to the diagnosis of all SPTL cases. ⋯ Owing to its indolent clinical course and relatively high survival rate, SPTL should be differentiated from cutaneous gamma/delta T-cell lymphoma. EBV is generally absent in SPTL but can rarely be detected especially in Asian population. Angioinvasion is a poor prognostic factor in SPTL.
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Am. J. Surg. Pathol. · Sep 2008
Case ReportsComplications of endovascular polymers associated with vascular introducer sheaths and metallic coils in 3 patients, with literature review.
Hydrophilic coatings on arterial introducer sheaths reduce the frequency of spasm during cardiac catheterization. Moreover, during treatment of cerebral artery aneurysms, hydrophilic coatings on microcatheters ease their maneuverability, and polymers within embolization coils enhance neointimal fibrosis at the aneurysm neck. Foreign-body giant cell reactions can result when a polymer is stripped from its source. CASES 1 AND 2: A 51-year-old man and a 66-year-old woman underwent coronary angiography via the radial artery, using hydrophilic-coated sheaths. They both developed tender lesions at the access site 2 weeks later. Microscopy of resected lesions showed pieces of hydrophilic coating and granulomatous inflammation, as has been reported by others. CASE 3: A 58-year-old woman underwent embolization of a ruptured distal right internal carotid artery aneurysm using polymer-containing coils. Nine months later, she began developing multiple right-sided cerebral ring-enhancing lesions. Biopsy revealed granulomas and microabscesses, in which polymer filaments were later identified. To our knowledge, this complication has not been described previously. ⋯ Hydrophilic coating may dislodge and induce a prominent foreign-body granulomatous response or microabscesses. Although the culprit radial artery sheath is now rarely used, embolization coils containing polymers are commonly deployed in clinical practice and may be a source of recurrent inflammatory lesions.
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Am. J. Surg. Pathol. · Aug 2008
Case ReportsThe surgical pathology of notochordal remnants in adult intervertebral disks: a report of 3 cases.
The notochord plays a critical role in organizing and directing vertebral development. In humans, most notochordal cells are eventually sequestered into the nucleus pulposus and disappear within the first decade of life. Although notochordal remnants and related lesions have been described in the axial skeleton of adults, their presence in intervertebral disks is rare. ⋯ Their histologic features were reminiscent of notochordal vestiges in the fetus. However, they raised the differential diagnosis of benign notochordal cell tumor and chordoma. Notochordal rests can be a source of diagnostic confusion and should be distinguished from notochordal neoplasms because they do not necessitate resection or other forms of therapy.