1
|
Nobee A, Taraif S, Arriola A, Mollaee M. A Large High-Grade Endometrial Serous Carcinoma with Yolk Sac Tumor Differentiation in a Post- Menopausal Woman: Case Report. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction/Objective
Yolk sac tumors are germ cell tumors mostly arising in the ovary or vagina, with cases reported throughout the gynecological tract. Only few cases were reported to arise in the endometrium and even fewer admixed with a conventional carcinoma especially in postmenopausal women. Yolk sac tumor-like areas are considered a form of retro-differentiation. Here we report a case of high-grade serous carcinoma of the endometrium with yolk sac differentiation in a postmenopausal woman.
Methods/Case Report
An 82-year-old Caucasian female presented with postmenopausal bleeding and a 17.6 cm endometrial mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. A large markedly necrotic friable mass occupied the entire endometrial cavity. Microscopic examination revealed a noninvasive carcinoma arising within a polyp. Tumor cells showed two different distinct morphologic patterns, including a predominantly high-grade serous carcinoma with scant foci of clear cell component, admixed with areas of squamous/eosinophilic-like morphological pattern. The latter was diffusely positive for p53, p16, AE1/AE3 and CK7, focally positive for CK5/6, GATA3, HepPar1 , AFP , PLAP , PAX8, CD30 and SALL4 , while negative for desmin, ER, PR, Napsin A, HCG, p40, p63, C-Kit, HMB45, S100, and Melan A. Mismatch repair proteins expression was intact throughout the entire tumor. Serum AFP level measured three weeks after surgery was within normal range.
Results (if a Case Study enter NA)
NA
Conclusion
Highlighting the yolk sac tumor differentiation in endometrial carcinoma is very challenging and requires a thorough immunohistochemical evaluation combined with morphologic assessment.
Collapse
Affiliation(s)
- A Nobee
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - S Taraif
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - A Arriola
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - M Mollaee
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| |
Collapse
|
2
|
Nobee A, Yin J, Hassler J, Rong Y. Sudden Cardiac Death due to Giant Cell Myocarditis in a 37-Year-Old Female: Case Report. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction/Objective
Giant cell myocarditis (GCM) is a rare and aggressive inflammatory process that targets the myocardium and is often rapidly fatal. Most cases have been reported in young to middle aged adults with a slight male predominance. The etiology of this disease is largely unknown, however there is an association with multiple autoimmune disorders. Most patients present with rapidly progressive or fulminant heart failure, arrhythmias, heart block or sudden cardiac death. The incidence of GCM ranges from 0.007% to 0.051% and most cases are confirmed on autopsy examination. Here we present a case of GCM in a young female diagnosed on autopsy.
Methods/Case Report
A 37-year-old female presented with shortness of breath and chest pain for a 5-day duration. She had no past medical history and was otherwise well before the onset of symptoms. On admission, she was noted to have clinical findings consistent with heart failure and progressed to cardiogenic shock with ventricular arrhythmias within hours. Despite high dose corticosteroids and other supportive therapy, the patient remained in refractory, vasodilatory shock, in cardiac standstill and eventually died. Findings on autopsy included mild ventricular hypertrophy, petechial hemorrhages through out the atria and ventricles, as well as pulmonary edema and congestion. Microscopic examination showed a diffuse infiltrating pattern of inflammation within the heart, that was composed predominantly of lymphocytes, giant cells, scattered neutrophils, and eosinophils. The lymphocytes were CD3, CD4, CD8 positive and CD20 negative, consistent with a T-cell infiltrate. Gram and GMS stains were negative for bacterial and fungal microorganisms. Focal areas of necrosis without granuloma formation are also noted ruling out sarcoidosis.
Results (if a Case Study enter NA)
NA.
Conclusion
This case demonstrates a rapid manifestation of GCM in a previously healthy individual. GCM must be considered in the differential diagnosis when a young patient presents with cardiac symptoms. Early diagnosis and initiation of targeted therapy is critical for GCM patients' survival.
Collapse
Affiliation(s)
- A Nobee
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - J Yin
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - J Hassler
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - Y Rong
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| |
Collapse
|
3
|
Amer S, Nobee A, Kuklani R, Proca D. Aneurysmal Bone Cyst (ABC), A Rare Diagnosis in Oral Pathology Based on Our 15-Year Institutional Experience. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Aneurysmal bone cyst (ABC) is a rare, benign bone lesion that was first described by Jaffe and Lichtenstein in 1942. Primary ABC usually affects vertebrae and metaphyseal regions of long bones, particularly femur and tibia. Only 2-3% of ABCs occur in the head and neck region, with the mandible and maxilla being the most common. It arises mostly in children and young adults, mean age 20 yo, with no gender predilection. ABC can manifest with pain, swelling, and pathological fractures. Radiographically, it appears as a metaphyseal expansile lesion that thins the cortex and has a sclerotic rim. Lesions containing “fluid-fluid” levels are best appreciated on MRI. Approximately 70% of primary ABCs have rearrangements of the USP6 gene. The most common translocation seen in primary ABCs is t(16;17) (q22;p13) leading to the fusion of the cadherin 11 gene with USP6 gene. The USP6 gene product inhibits the differentiation of osteoblasts and dysregulates bone morphogenetic protein signaling pathway.
Methods/Case Report
A retrospective chart review of all oral pathology cases referred to our institution between 1996 and 2022 was performed; three patients diagnosed with primary ABC were identified. Patient demographic data, clinical presentation, treatment, slides, and pathologic features were reviewed.
Results (if a Case Study Enter NA)
We report of three primary ABCs of the mandible and maxilla. The mean age was 39 yo (range, 26-59 years). The mandible was affected in two cases, and the maxilla involved in one. Female: Male ratio was 2:1. All lesions were primary ABC, with no other associated lesion - they showed pseudocystic structures with fibrous stroma and a variable numbers of multinucleated giant cells in relation to sinusoidal blood spaces, as well as irregular trabeculae of osteoid and reactive woven bone.
Conclusion
Primary ABC is a rare tumor in oral pathology. The importance of this study is to increase awareness of this neoplasm in the head and neck region, as well as delineate features that help differentiate ABCs from other fibro- osseous lesions of the mandible and maxilla.
Collapse
Affiliation(s)
- S Amer
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - A Nobee
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - R Kuklani
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| | - D Proca
- Pathology, Temple University Hospital , Philadelphia, Pennsylvania , United States
| |
Collapse
|