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Smooth Muscle Tumors True smooth muscle tumors, morphologically identical to those occurring in the esophagus (see previous discussion) do occur rarely in the gastric cardia. Frame R, Head D, Lee R 1987 Granulocytic sarcoma of the prostate: two cases causing urinary obstruction. Other benign soft tissue tumors that occur in the ovary from time to time are hemangioma675 and myxoma. Reichert R A 2007 Primary ovarian adenofibromatous neoplasms with mucin-containing signet-ring cells: a report of 2 cases. For these reasons, cytochemical and immunophenotypic characterization are needed for diagnosis and classification. Pelvic and abdominal lymph node metastases are generally not present at the time of initial surgery, and there does not appear to be any need to dissect them for staging or treatment purposes. Rare ovarian lymphomas are incidental microscopic discoveries in ovaries removed for some other reason. Rarely, the lymphoma presents initially in extraintestinal sites, such as the lung and skin. Hayashi I, Tsuda H, Shimoda T 2000 Reappraisal of orthodox histochemistry for the diagnosis of minimal deviation adenocarci noma of the cervix. Macroscopic Appearances Most lesions have been smaller than 3 cm, and some have not been visible when the renal capsule was stripped. T-Cell Granular Lymphocytic Leukemia this entity is also known as "T-cell large granular lymphocyte leukemia," "T-cell lymphocytosis," or "Tlymphoproliferative disease. Overall, carcinoma of the endometrium is uncommon in women younger than 40 years of age. Br J Surg 73: 278-281 Kakudo K, Carney J A, Sizemore G W 1985 Medullary carcinoma of thyroid. The gross and histologic appearance is similar to that of a leiomyoma of the uterus. The latter two cell types can be recognized by the grooved or contorted nuclei and abundant lightly eosinophilic cytoplasm and are best highlighted by immunostaining for S100 protein. Ages range from early adulthood to old age, with the mean between 50 and 55 years. The well-differentiated tumors show tubular, papillary, and cord-like patterns, and cytologic atypia can be minimal. Lobules of tumor cells with abundant clear cytoplasm are separated by fibrous septa that contain numerous lymphocytes. Multistep endometrial carcinogenesis based on mutation-driven sequential clonal selection during tumor evolution. Tumor cells line glands and cystic spaces, diffusely infiltrate fibrotic stroma, or form solid nests and sheets. Fujimura M, Ostrow R S, Okagaki T 1991 Implication of human papillomavirus in postirradiation dysplasia. A case with prominent cystic change, simulating thymic cyst, has also been reported. Monteagudo C, Ain K, Merino M 1990 Mixed forms of tall cell thyroid carcinoma: a clinicopathologic and immunohistochemical study. The demonstration of monoclonal T-cell populations provides evidence that this condition represents an early phase of enteropathy-associated T-cell lymphoma. Heatley M K 2009 Is female adnexal tumour of probable wolffian origin a benign lesion Young R H, Silva E G, Scully R E 1991 Ovarian and juxtaovarian adenomatoid tumors: a report of six cases. Baergen R N, Rutgers J L 1995 Classification of mural nodules in common epithelial tumors of the ovary. Scattered inflammatory cells and extravasated erythrocytes are common; mitotic activity is commonly brisk. Assessing early invasion is difficult because adenocarci noma in situ may have a complex architecture and some early invasive adenocarcinomas maintain an in situ archi tectural appearance.
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Immunohistochemistry for epithelial markers usually demonstrates epithelial features in cells that appear sarcomatous in sections stained with hematoxylin and eosin (H&E). The lymphoid cells found among the epithelioid histiocytes are mostly small cells showing mild to minimal nuclear atypia. Rhabdomyosarcoma Rhabdomyosarcoma (see Chapter 24) is the most common sarcoma occurring in the prostate in children. They can be very difficult to distinguish from one another on morphologic grounds except when typical areas such as mantle cell lymphoma or follicular lymphoma are found in some foci. The back-to-back glands are lined by columnar cells with stratified hyperchromatic nuclei. It also occurs sporadically in Central and South America, the Middle East, and the southeastern United States. The standard treatment is hysterectomy and bilateral salpingo-oophorectomy, but unilateral salpingooophorectomy is adequate treatment for a young woman. For many lymphoma types, immunophenotyping contributes significantly to the reproducibility of the diagnoses. The neoplastic cells invade and replace the reactive follicles, resulting in vague or discrete nodular structures mimicking follicular lymphoma. Springer, New York pelvis, and extensive histologic sampling is necessary to demonstrate it. Extramedullary hematopoiesis can also occur at sites other than the spleen or liver, particularly late in the course or after palliative splenectomy. Pezzella F, Mason D Y 1990 the bcl-2 gene and 14;18 translocation in lymphoproliferative disorders. Smith L A, Pounder D J 1982 A teratoma-like lesion of the placenta: a case report. When prominent delicate fibrovascular septa are seen, medullary carcinoma should be a serious consideration. Levine G D, Rosai J 1978 Thymic hyperplasia and neoplasia: a review of current concepts. These polyps are more commonly sessile than typical hyperplastic polyps, predominantly located in the antrum, and believed to result from mucosal prolapse. Am J Surg Pathol 29: 1228-1242 detail, (3) cytopathic changes in cancerous glands across the whole spectrum of Gleason grades, and (4) lack of necrosis of normal prostate glands, but often associated with an intense mononuclear infiltrate. Intermediate and poorly differentiated tumors are larger, with an average diameter of 15 cm. This is an important feature of essential thrombocythemia, and careful attention to Differential Diagnosis Underlying causes of reactive thrombocytosis must be ruled out for a diagnosis of essential thrombocythemia to be rendered. Thorgeirsson S S, Grisham J W 2002 Molecular pathogenesis of human hepatocellular carcinoma. Ann Diagn Pathol 3: 331-340 LiVolsi V A, Baloch Z W 1999 Determining the diagnosis and prognosis of thyroid neoplasms: do special studies help Thyroid 21: 505-510 Lo C Y, Lorentz T G, Wan K Y 1995 Follicular carcinoma of the thyroid gland in Hong Kong Chinese. Am J Surg Pathol 2: 401-405 Silverberg S G, DeGiorgi L S 1973 Osteoclastoma-like giant cell tumor of the thyroid. Also included in the differential diagnosis should be pigmented pheochromocytoma (see previous discussion). Macroscopic Appearances Colorectal carcinomas show a range of gross appear ances, including fungating, intraluminal masses; ulcerat ing tumors with heapedup edges. Cells with abundant eosin ophilic cytoplasm are clustered in islands in an edematous stroma. Small cells with inconspicuous pale cytoplasm cover the papillae of type 1 papil lary renal cell carcinoma. The differential diagnosis with polypoid protrusion of prostatic adenocarcinoma into the urethra rarely arises when prostatictype polyps are found in young men, but in older patients this is a possibility, with a similar clinical presentation. The background metaplastic Barrett mucosa, when visible, has a red, finely granular appearance that can be readily distinguished from the paler, smooth esophageal squamous epithelium.
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Bone marrow plasmacytosis <10% of cellularity and low level of plasma cell infiltrate in a core biopsy sample 3. The features that help to distinguish typical squamous cell carcinoma from a condyloma are again useful. The reason for this increase is unknown but does not appear to be entirely explained by greater recognition of the disease. Immunohistochemistry and Molecular Pathology Trisomy 12 is a consistent cytogenetic finding in ovarian fibromas. This histologic appearance is nearly identical to that of acute lymphoblastic leukemia. Features suggesting malignancy include large size (>5 cm diameter), intratumoral necrosis or hemorrhage, and a mitotic rate in excess of 2 per 10 standard highpower fields (hpf). Tavassoli F A, Norris H J 1980 Sertoli tumors of the ovary: a clinicopathologic study of 28 cases with ultrastructural observations. Large cells with abundant eosinophilic cytoplasm infiltrate the squamous epithelium. Most patients are perimenopausal or postmenopausal women who have nonspecific symptoms such as pelvic or abdominal pain, abdominal enlargement, menstrual irregularities, or abnormal vaginal bleeding. Minimal-Deviation Adenocarcinoma (Adenoma Malignum) Clinical Features Minimaldeviation adenocarcinoma7783 is a rare, ex tremely welldifferentiated mucinous tumor that repre sents approximately 1% to 2% of cervical adenocarcinomas. McCluggage W G 2011 Morphological subtypes of ovarian carcinoma: a review with emphasis on new developments and pathogenesis. This may include large eosinophils with nuclear irregularities, vacuolated cytoplasm with sparse or small granules, or eosinophils with small immature granules that stain purple on Wright-Giemsa stain. Many subpopulations exist and, depending on their anatomic position, exhibit subtle differences in immunohistochemical profile and ultrastructural appearances. A historical difficulty for pathologists has been use of the single diagnostic umbrella of hyperplasia to refer to biologically, genetically, and clinically admixed groupings of hormonally altered and premalignant processes. Loss of bcl-2 correlates with lymph node metastasis, vascular invasion, and aberrant p53 expression. The small cell type consists of sheets of tumor cells with scant cytoplasm similar to other small blue cell tumors such as neuroblastoma, Ewing sarcoma, lymphoma, and embryonal rhabdomyosarcoma. Similar exuberant lymphoid reaction can be seen in other viral infections and hypersensitivity reactions. We have reported a series of 12 sarcomatoid carcinomas in which one patient had osteosarcoma as a sarcomatoid component. Another distinctive feature is that both the nuclear and cell membranes of the individual lymphoma cells frequently show molding and "squaring off. Eichhorn J H, Young R H, Scully R E 1993 Nonpulmonary small cell carcinomas of extragenital origin metastatic to the ovary. The idiopathic hypereosinophilic syndrome: clinical, pathophysiologic, and therapeutic considerations. They typically are an exophytic proliferation of squamous epithelium, with acanthotic, hyperkeratotic, verrucous, or reticular subtypes of growth. Because the caudate lobe drains independently, resection of the caudate lobe is also advocated. On microscopic examination, sheets of neoplastic plasma cells diffusely infiltrate the prostatic stroma. Pathol Res Pract 199: 547550 1492 Lymph Node mucosa-associated lymphoid tissue and monocytoid B-cell subcategories): a Southwest Oncology Group study. The presence of goblet cells should strongly raise the possibil ity that the process is neoplastic, because benign goblet cell metaplasia of the cervix is extremely uncommon. Condensation of neoplastic cells underneath the surface epithelium, forming the so-called cambium layer. The 5-year overall survival is 70% to 77%, which ranks second only to extranodal marginal zone lymphoma in terms of best survival among the various lymphoma types. Doussis-Anagnostopoulou I A, Remadi S, Czernobilsky B 1996 Mucinous elements in Sertoli-Leydig and granulosa cell tumours: a revaluation. They have become instrumental in shaping the classification of lymphomas, and their detection (by cytogenetics or other molecular techniques) can aid in diagnosis (Table 21A-3).
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A study of 44 cases followed for a minimum of 10 years, with emphasis on differential diagnosis. The size of the lesions is similarly variable, ranging from a few millimeters in diameter to huge masses that may fill the bladder lumen. Problems in Classification of Thymomas and Histologic Clues the histologic clues for recognition of specific types of thymoma are listed in Table 21C-8. The diagnosis can be confirmed by positive immunostaining for parathyroid hormone. Circulating blast forms and mature lymphocytes comprise the majority of the peripheral blood cellularity; however, it is not uncommon for patients to present without peripheral blasts. Risk of aggressive behavior can be pre dicted by a combination of anatomic site, tumor size, and mitotic rate (Table 92). The tumor cells are polygonal or columnar, and they have abundant amphophilic or clear cytoplasm. Foci of soft graytan tissue resembling brain matter and glistening green or brown thyroid tissue are also commonly seen. Lymphoplasmacytic Lymphoma Definition Lymphoplasmacytic lymphoma is an uncommon lowgrade B-cell lymphoma composed of small lymphoid cells with variable degrees of plasmacytic differentiation. Dhodapkar M V, Lust J A, Phyliky R L 1994 T-cell large granular lymphocytic leukemia and pure red cell aplasia in a patient with Tumors of the Hematopoietic System 1679 309. In patients with a severe phenotype, the entire colorectal mucosa may be carpeted with thousands of small polyps, as well as scattered large polyps. They are lined by epithelium that is Diffuse Leiomyomatosis In this rare condition of unknown etiology, diffuse thickening of the esophageal musculature occurs, sometimes with focal accentuation to form confluent nodules or even overt leiomyomas. They are typically soft, delicate, and friable and may be creamy-white, tan, or pink to red. Solid nests and nests with single or multiple lumina are present in a cellular stroma. Lotan T L, Epstein J I 2009 Gleason grading of prostatic adenocarcinoma with glomeruloid features on needle biopsy. Sessile serrated polyps may show areas of progression to cytologic dysplasia, either conven tional dysplasia with hyperchromatic, elongated nuclei and slightly basophilic cytoplasm, or socalled serrated dysplasia with eosinophilic cytoplasm and more vesicular chromatin. Intra-abdominal metastases are typically present at the time of diagnosis in patients with high-grade serous carcinoma, in the omentum, on peritoneal surfaces, or in abdominal lymph nodes. A more delicate trabecular pattern of blunt cords or a serpentine alignment of cells may also be apparent. The spindle cells, which are in fascicles, are bland-looking and intermingled with neoplastic follicles or papillae in at least some foci. In rare cases, sheets or clusters of atypical T cells can be seen (medium sized, often with irregular nuclei) between the nodules, mimicking peripheral T-cell lymphoma. Generally speaking, diffuse, infiltrating, signet ring cell, and undifferentiated carcinomas have a worse prognosis in advanced gastric cancer but paradoxically not in superficial tumors. This example shows more extensive involvement, with enlargement of many white pulp corpuscles and coalescence. Bishara T, Ramnani D M, Epstein J I 2004 High-grade prostatic intraepithelial neoplasia on needle biopsy: risk of cancer on repeat biopsy related to number of involved cores and morphologic pattern. Histologically, embryonal rhabdomyosarcoma is a polypoid proliferation composed of round, spindled, or strap-shaped cells, some of which have brightly eosinophilic cytoplasm, within a loose myxoid stroma beneath squamous epithelium. It is common for the nuclei to be high in the cytoplasm, away from the basement membrane. It should be seriously considered if the cytologic composition is monotonous or the irregularly folded nuclei have an overall rounded contour. Histologically, the individual nodules have an angiomatoid appearance, comprising slit-like, round, or irregular-shaped vascular spaces lined by plump endothelial cells and interspersed by a population of spindle or ovoid cells. Dehner L P, Hill D A 2009 Adrenal cortical neoplasms in children: why so many carcinomas and yet so many survivors. Architectural score Predominantly glandular Predominantly papillary Predominantly solid 2. Nathaniels E K, Nathaniels A M, Wang C 1970 Mediastinal parathyroid tumours: a clinical and pathological study of 84 cases. The nuclei are enlarged and hyperchromatic, and, similar to adenocarcinoma in situ, which may be present adjacent to the invasive component, apoptotic bodies and mitotic figures are often numerous. These cases can be distinguished by the absence of atypical promyelocytes and the absence of Auer rods.
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- Mendelian susceptibility to atypical mycobacteria
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- Cat eye syndrome
- Fontaine Farriaux Blanckaert syndrome
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Papil lary hidradenoma (hidradenoma papilliferum) rarely arises in the perianal skin. Lage J M, Roberts D J 1993 Choriocarcinoma in a term placenta: pathologic diagnosis of a tumor in an asymptomatic patient with metastatic disease. Rare examples show evidence of an intraepithelial T-cell phenotype, similar to those seen in the intestine (see Chapter 9). However, the rules of the game might be changing with the introduction of extended biopsies, so-called saturation biopsies with sampling from 10 or more sites in contrast to traditional 6-site sextant biopsies. When embryonal rhabdomyosarcoma involves mucosal sites, as it does in the vagina, it tends to grow in a characteristic exophytic, grape-like configuration, garnering the term sarcoma botryoides; therefore, in essence, sarcoma botryoides simply represents a macroscopically distinct subset of embryonal rhabdomyosarcoma with a characteristic clinical appearance, presumably the result of unrestricted growth into a cavitary space. Treatment Effect Radiation treatment for prostate cancers is the most common cause of reactive atypia in the prostate. Ulcerated tumors are most common in the antrum on the lesser curve and classically differ from peptic ulcers by virtue of having more irregular contours with raised, rolled edges. The vast majority of children with vaginal embryonal rhabdomyosarcoma are younger than 5 years old, and most present with vaginal bleeding; in some patients, the first indication may be tumor prolapsing through the vaginal opening. A high mitotic count greater than 20/10 high-power fields or Ki67 index greater than 10% is associated with a worse outcome. Bilaterality is exceptional, although metastases can involve the contralateral ovary in patients with advanced disease. B, the space is much easier to appreciate in a cytokeratin immunostain, because it is totally devoid of cytokeratin-positive thymic epithelial cells. Am J Surg Pathol 31: 889894 Shah R B 2009 Current perspectives on the Gleason grading of prostate cancer. Important differential diagnoses are metastatic adenocarcinoma, mesothelioma, and germ cell tumor. Davidson B, Abeler V M 2005 Primary ovarian angiosarcoma presenting as malignant cells in ascites: case report and review of the literature. Proppe K H, Scully R E, Rosai J 1984 Postoperative spindle cell nodules of genitourinary tract resembling sarcomas: a report of eight cases. In general, a diagnosis of lymphoplasmacytic lymphoma should rarely be made in a mucosal site (for which a diagnosis of extranodal marginal zone lymphoma is more likely). Clement P B, Young R H 1992 Endocervicosis of the urinary bladder: a report of six cases of a benign Mullerian lesion that may mimic adenocarcinoma. Chan R, Tucker M, Russell P 2005 Ovarian gynandroblastoma with juvenile granulosa cell component and raised alpha fetoprotein. Rare Krukenberg tumors have been designated primary Krukenberg tumors because an extraovarian primary could not be identified. One of the patterns, referred to as clear cell (tall columnar) carcinoma83 or pseudohyperplastic pattern of adenocarcinoma,106,107 occurs predominantly in the transition zone. Both the strumal and the carcinoid components of strumal carcinoid appear capable of giving rise to metastases. In such a situation, other immunostains are required to provide the supportive evidence. Some are detected incidentally in asymptomatic women, but when the tumor is large, the symptoms are those of a pelvic mass. Rarely, psammoma bodies are so numerous in a low-grade serous carcinoma that they obscure the epithelial elements of the tumor. Surgery 128: 29-35 Roth S I, Wang C A, Potts J T 1975 the team approach to primary hyperparathyroidism. Morice W G, Kurtin P J, Myers J L 2002 Expression of cytolytic lymphocyte-associated antigens in pulmonary lymphomatoid granulomatosis. Microscopic Pathology Microscopically, much of the tumor is hemorrhagic and necrotic. Patients often have serum elevation of immunoglobulin IgG4, a finding that may help distinguish the lesion clinically from that of pancreatic ductal adenocarcinoma. Shannon R L, Ro J Y, Grignon D J 1992 Sarcomatoid carcinoma of the prostate: a clinicopathologic study of 12 patients. Nests of low-grade transitional cells surrounded by fibrous stroma may be present in the wall of the tumor.
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Histopathology 45: 485-492 Griffiths A P, Rice A, Dixon M F 1998 Anaplastic gastric adenocarcinoma with extensive neutrophilic infiltration. One report has indicated that the inverted pattern of urothelial carcinoma in the upper tract may be a marker for hereditary nonpolyposis colorectal cancer syndrome. A higher incidence is seen in Korea, Central and South America, and some parts of northern and eastern Europe,196 but second-generation immigrants take on the incidence of the host country. The arrow indicates a proliferation center containing mitotic figures and larger nucleolated prolymphocytoid forms. They tend to infiltrate between normal glands and have an ill-defined infiltrative border. Kraus M D, Dehner L P 1999 Benign vascular neoplasms of the spleen with myoid and angioendotheliomatous features. Peripheral Blood and Bone Marrow Findings In well-prepared peripheral blood smears, the neoplastic cells are small to medium-sized cells that demonstrate some of the features of prolymphocytes, but considerable morphologic variation is seen within and between cases. Spread to the spleen is thought to occur after para-aortic and splenic hilar lymph node involvement. D2-40 is a widely used marker for mesothelioma; it is positive in up to 20% of serous carcinomas, but staining tends to be weak and focal compared with the diffuse strong membranous staining seen in mesothelioma. On higher power (right), the malignant character of this lesion is seen, characterized by nuclear anaplasia, prominent nucleoli, and multiple mitoses. Rarely, carcinoma may arise in the remnants of the gallbladder after partial cholescystectomy. Histologically, the germinal centers of preexisting follicles show partial or complete replacement by aggregates of large cells with bizarre or multilobated nuclei and amphophilic cytoplasm. There are small foci of mild to moderate nuclear atypia or branching papillary growth in occasional otherwise benign serous tumors. Am J Clin Pathol 82: 217-224 Hahn H P, Fletcher C D 2007 Primary mediastinal liposarcoma: clinicopathologic analysis of 24 cases. Although t(14;18) was claimed to be much less frequently detected in Asians,668,669 more recent studies have demonstrated a frequency comparable to that in Western populations. Electron Microscopy the neoplastic cells of thymoma possess multiple interdigitating elongated cell processes connected by desmosomes. The Bethesda terminology for reporting of thyroid cytopathology, proposed in 2009, is as follows992,993: 1. The peripheral blood will frequently show increases in myeloblasts and monocytic precursors; however, interestingly, often no increase in peripheral blood eosinophils is found. Murphy W, Grignon D, Perlman E 2004 Atlas of tumor pathology: tumors of the kidney, bladder, and related urinary structures. On gross examination they are typically solitary, polypoid, and variably smooth or lobulated. The cut surfaces are bulging, fleshy, light tan, and often homogeneous, with or without necrosis. Leedham P W, Pollock D J 1970 Intrafollicular amyloid in primary hyperparathyroidism. In the mucinous or colloid variant, the gross appearance is often gelatinous and gray, or the gallbladder may be distended because of the accumulation of mucus. These nodules have been subclassified into a rhabdoid type, in which the tumor cells are polygonal with moderate to abundant eosinophilic cytoplasm and eccentric nuclei with prominent nucleoli; a sarcomatoid type in which the tumor cells are spindled; and a pleomorphic type in which both rhabdoid and spindle cells are present. Konukiewitz B, Enosawa T, Kloppel G 2011 Glucagon expression in cystic pancreatic neuroendocrine neoplasms: an immunohisto chemical analysis. On histologic examination, the tumors usually consist of adenocarcinoma admixed with the stromal (sarcomatous) elements; alternatively, the tumor may comprise two distinct and separate epithelial and mesenchymal components resembling a collision tumor. Lau S K, Spagnolo D V, Weiss L M 2006 Schwannoma of the adrenal gland: report of two cases. In the spectrum of B thymomas, the proportion of lymphocytes decreases from type B1 to B3. This syndrome is associated with (8;13)(p11;q11) chromosomal translocation present in both the lymphoid and myeloid cells. T-prolymphocytic leukemia is characterized by circulating small to medium-sized lymphoid cells with round nuclei, fairly condensed chromatin, distinct nucleoli, and basophilic cytoplasm without azurophilic granules.
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The lesion is hypercellular, with abundance of diagnostic and pleomorphic ReedSternberg cells. Sanders L E, Cady B 1998 Differentiated thyroid cancer: reexamination of risk groups and outcome of treatment. Under high-power magnification the tumor cells show hyperchromatic nuclei and prominent nuclear molding, which are characteristic features of small cell carcinoma in general. This case is of B lineage and expresses terminal deoxynucleotidyl transferase (not shown). In one reported case, the prostate was moderately enlarged and irregular, mimicking a primary prostatic carcinoma. Most tumors measure less than 5 cm; however, occasionally they may be larger, with many such cases having a prominent cystic component. With this system, the grade of a carcinoma is determined by the degree of nuclear atypia, the frequency of mitotic figures, and the extent to which the tumor cells form papillae or glands (Table 13A-5). Hattori T 1985 Morphologic range of hyperplastic polyps and carcinomas arising in hyperplastic polyps of the stomach. Histiocytic sarcoma should be suspected whenever a "large cell lymphoma" shows abundant cytoplasm that is eosinophilic. Nuclear staining, which is more common in endometrioid tumors than in other types of epithelial neoplasms, is the only type of staining that is associated with -catenin mutation. Lennert lymphoma can transform into a large cell lymphoma of T lineage, with loss of the epithelioid histiocyte reaction. Often the cut surface is friable or granular, a reflection of the papillae seen microscopically. Foci of limited stromal invasion are identified occasionally in a borderline serous tumor. The signet ring cells are characterized by nuclear displacement to the edge by clear cytoplasm. Women with ovarian estrogen-secreting tumors have a higher risk of developing endometrial cancer. B, Immunostain for cytokeratin is markedly positive and vividly contrasts the cells of the adenomatoid tumor compared with residual cortex. The most common of these lesions in the appendix is the sessile serrated polyp,124 which was previously often referred to as diffuse hyper plasia. Though frozen section diagnosis may remain problematic in a given case, accuracy rates of up to 98% have been reported. Roth L M, Czernobilsky B 2011 Perspectives on pure ovarian stromal neoplasms and tumor-like proliferations of the ovarian stroma. The uterus is small in 75% of patients, and the fallopian tubes are small or rudimentary in 35% of them. These involve (1) translocations of multiple genes with either the T-cell receptor locus at 7q35, the and T-cell receptor locus at 14q11. J Exp Clin Cancer Res 19: 271-280 Robboy S J, Scully R E, Norris H J 1977 Primary trabecular carcinoid of the ovary. The mucosa is expanded by a lymphoid infiltrate that surrounds the reactive lymphoid follicles. When the tumor location or extent precludes resection, liver transplantation can be performed, but the outcome is less favorable. Young R H, Scully R E 1988 Mucinous ovarian tumors associated with mucinous adenocarcinomas of the cervix: a clinicopathologi cal analysis of 16 cases. The tumor is composed of small nests of cells with abundant intracytoplasmic mucin and eccentric, compressed hyper chromatic nuclei, resembling goblet cells or signet ring cells. The cytoplasmic vacuoles do not contain mucin, and the nature of their content remains uncertain. In some tumors, cords, trabeculae, or areas of diffuse tumor cell growth are present.
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Features in favor of this diagnosis over a large cell lymphoma are occurrence of the activated cells within circumscribed nonexpansile foci in otherwise normal or reactive lymph node tissue, abundance of karyorrhectic debris, numerous distinctive phagocytic cells with crescent-shaped nuclei, and many admixed mediumsized cells with round nuclei consistent with plasmacytoid dendritic cells. One study suggested that finding prostatic ductal adenocarcinoma on needle biopsy implies more advanced cancer with a shortened time to progression. Clinically occult renal cell carcinomas presenting at distant sites with unknown primaries or recurring years after an apparently successful radical nephrectomy may pose special diagnostic problems. Additional useful clues suggesting the pathologic diagnosis of early complete mole include marked atypia of implantation site trophoblast; an unusual primitive villous stroma, with tiny stellate mesenchymal cells, stromal hypercellularity, and prominent karyorrhexis; and unusually shaped villi with complex bulbous protrusions ("cauliflower-like" villi). A clue to the diagnosis is the variation in size and shape of the glands and the cytoplasmic content. In our experience, these tumors are always associated with a high-grade prostatic adenocarcinoma that occurred either previously to , or simultaneously with, the sarcomatoid component. Lesions with increased cellularity and nuclear atypia of the stroma have been referred to as phyllodes-type atypical prostatic hyperplasia or cystosarcoma phyllodes of the prostate, because they are considered analogous to phyllodes tumors of the breast. The glands show a basal cell layer and contain corpora amylacea or orange-brown secretions, and the nuclei lack nucleomegaly or prominent nucleoli. The papillae may be separate from their neighbors or may be adherent to them, particularly near their bases. These are divided into two categories: perilobar nephrogenic rests, which are located at the periphery of the renal lobes (the cortical surfaces, the centers of the columns of Bertin, and the tissue abutting the renal sinus), and intralobar nephrogenic rests, which are located in the cortex or medulla within the renal lobe. Because of the inconspicuous nature of the granules in the microgranular variant, this entity is easily missed. A diagnosis of acellular mucin requires careful study because epithelial cells are usually found if numerous slides are studied. In this diffuse component, large lymphocytic and histiocytic cells are scattered in a background of small lymphocytes (mostly T lineage in the diffuse component) and histiocytes. The tumor cells possess round or oval nuclei with finely dispersed chromatin and inconspicuous nucleoli. A, Plump spindle cells with large irregular-shaped, vesicular nuclei and indistinct cell borders are masked by a heavy lymphoplasmacytic infiltrate. Pattison S, Choong S, Corbishley C M, Bailey M J 2001 Squamous cell carcinoma of the bladder, intermittent self-catheterization and urinary tract infection-is there an association. Franssila K O, Harach H R, Wasenius V M 1984 Mucoepidermoid carcinoma of the thyroid. Aki H, Baslar Z, Uygun N, Ozguroglu M, Tuzuner N 2002 Primary granulocytic sarcoma of the urinary bladder: case report and review of the literature. A, An example composed of bland-looking cells growing in sheets and traversed by a delicate vasculature. Ali T Z, Epstein J I 2007 Basal cell carcinoma of the prostate: a clinicopathologic study of 29 cases. B, the right field shows the preexisting adenoma, with the follicles lined by cells with uniform dark round nuclei. In contrast to grade 1 or 2 follicular lymphoma, grade 3 follicular lymphoma often involves the spleen in the form of large tumor nodules instead of a diffuse miliary pattern. Both 34E12 and p63 are highly specific for basal cells and are negative in areas of adenocarcinoma. Akslen L A, LiVolsi V A 2000 Prognostic significance of histologic grading compared with subclassification of papillary thyroid carcinoma. The average age of the patients, who typically have obstructive symptoms or hematuria, is about 57 years. A sparse amount of granular pigment is present in some cells and is probably lipofuscin. Chronic changes include fibrosis, hyalinization, calcification, hemosiderin deposition, granulomatous inflammation, basal cell hyperplasia, transitional and squamous metaplasia, and, rarely, abscess formation. Most patients are incidentally found to have lymphocytosis, lymphadenopathy, or splenomegaly. Rare gonadal stromal tumors that contain theca cells or luteinized cells are clinically malignant. Cancer 30: 1189-1194 Hainsworth J D, Greco F A 1992 Extragonadal germ cell tumors and unrecognized germ cell tumors.
