Well-differentiated hepatocellular lesions (WDHLs) are liver tumors or nonneoplastic lesions in which the cells closely resemble normal hepatocytes. These lesions often include focal nodular hyperplasia, hepatocellular adenoma, macroregenerative nodule, dysplastic nodule, and well-differentiated hepatocellular carcinoma. The diagnosis of these lesions remains challenging because of their morphological similarities, particularly when examined using needle biopsy. The accurate diagnosis of WDHLs is crucial for patient management and prognosis. This review addresses the histopathological characteristics and diagnostic approaches of WDHLs.
Pancreatic metastasis from malignant phyllodes tumor (PT) of the breast is rare, and only a few cases have been reported in the literature. Here, we report a case of pancreatic metastasis from malignant PT of the breast in a 48-year-old woman. She had had three episodes of recurrence of malignant PT in her right breast. She presented with epigastric pain for 2 months. Computed tomography and magnetic resonance imaging revealed a 6 cm-sized, well-defined, heterogeneous mass with peripheral enhancement in the body of the pancreas. Endoscopic ultrasonography-guided fine-needle aspiration was performed, and the pathologic report suggested spindle cell mesenchymal neoplasm. Subsequently, surgical excision was performed, and the mass was confirmed as a metastatic malignant PT. The imaging findings are discussed and the literature is briefly reviewed in this report.
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Integrating single‐cell and spatial transcriptomes reveals COL4A1/2 facilitates the spatial organisation of stromal cells differentiation in breast phyllodes tumours Xia Li, Xuewen Yu, Jiaxin Bi, Xu Jiang, Lu Zhang, Zhixin Li, Mumin Shao Clinical and Translational Medicine.2024;[Epub] CrossRef
Case report: Osteosarcomatous differentiation in the lung metastasis of a malignant phyllodes tumor Ruijing Liu, Jingli Xue, Wen Liu, Beibei Jiang, Fuyun Shi, Zhenzheng Wang, Peifeng Li Frontiers in Medicine.2023;[Epub] CrossRef
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Immunoglobulin G4 (IgG4)-associated autoimmune hepatitis (AIH) is a very rare subtype of autoimmune hepatitis and characterized by marked elevated serum IgG and hepatic infiltration of IgG4-expressing plasma cells. Pathologic confirmation of hepatic IgG4-expressing plasma cells is usually required for the final diagnosis of IgG4-associated AIH. Herein, we report the case of a 47-year-old female diagnosed with autoantibody-negative IgG4-associated AIH mimicking lymphoproliferative disorders.
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Imatinib mesylate is currently used as the first-line treatment for metastatic gastrointestinal stromal tumors (GISTs). Imatinib-induced hepatotoxicity in patients with GIST is very rare. Its features vary from subclinical elevation of serum aminotransferase to clinically apparent acute hepatitis, which is associated with immunologic reactions. Imatinib-induced hepatotoxicity with autoimmune-like features can be treated by the discontinuation of imatinib mesylate and the administration of oral steroids. Here, we report a case of late-onset imatinib-induced hepatitis with autoimmune-like features in a patient with metastatic GIST, which was improved by oral corticosteroids.
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Malignant peripheral nerve sheath tumor (MPNST) is rare, accounting for 5–10% of all soft tissue sarcomas. MPNST is characteristically aggressive and has a poor prognosis. Fifty percent of patients with MPNST have neurofibromatosis type 1 (NF1). NF-associated MPNST (NF-MPNST) occurs more often at younger ages than sporadic MPNST (sMPNST), but the survival difference is controversial. Superficial MPNST from a recurrent neurofibroma is extremely rare and only a limited number of cases have been reported in the literature. Herein, we report an unusual case of superficial MPNST from a recurrent neurofibroma in a patient without NF1.
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Sarcoidosis is a systemic disease of unknown cause involving multiple organs and is characterized by noncaseating granuloma. Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased peripheral platelet destruction due to the presence of an antibody to the platelet and abnormal platelet production. There is no known pathogenesis that occurs concurrently with ITP and sarcoidosis. However, considering together of 2 known pathogenesis, abnormal immune response triggers either ITP or sarcoidosis. The disease that develops first stimulates secondary disease. After development of secondary disease, they stimulate each other. A few cases of ITP associated with sarcoidosis are well documented in English; however, the disease has rarely been reported in Korea. Here, we report on a case of ITP with sarcoidosis in a 29-year-old man. He suffered from easy bruising. The chest X-ray and the contrast-enhanced computed tomography scan showed bihilar lymphadenopathy and reticulonodular infiltrates. Bone marrow study and fluoroscopy-guided percutaneous needle biopsy were performed and the patient was diagnosed with sarcoidosis and ITP. He was put on 400 mg/kg of intravenous immunoglobulin for 5 days and administered oral steroids and further follow-up will be carried out. He has shown a good response without significant bleeding event. However, administration of more oral steroid and additional follow-up is required than for single disease, whether sarcoidosis or ITP.
Acinic cell carcinoma (ACC) is an uncommon malignant tumor of the salivary glands that is difficult to diagnose. It grows slowly and shows distant metastasis rarely. We experienced a case of recurrent ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy. The 29-year-old man had been suffering from severe multiple bones and joints pain for 2 months. Ten years earlier, he underwent superficial parotidectomy due to a right subauricular mass. The mass was diagnosed with ACC. After surgery, the tumor recurred twice. Then the patient was diagnosed with cardiac metastasis via positron emission tomography-computed tomography and trans-thoracic echocardiography. He also had hypertrophic osteoarthropathy with multiple bone metastasis. He was given palliative radiotherapy and conservative treatment. ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy has not yet been reported in literature. From this case, it is recommended to evaluate multiple distant metastasis in the ACC of the parotid gland when joint and bone pain are present.
Type 1 neurofibromatosis (von Recklinghausen's disease, NF-1) is an autosomal-dominant neurocutaneous-disorder characterized by systemic cafe'-au-lait spots, multiple cutaneous neurofibromas, axillary or inguinal freckling, and Lisch nodules (pigmented iris hamartomas). Approximately 10-25% of NF1 patients have gastrointestinal neoplasms. Gastrointestinal stromal tumor (GIST) in patients with neurofibromatosis is most commonly found in the small bowel and the stomach, and approximately 60% of such patients have multiple tumors or multiple tumor sites. Although, the increased incidence of GIST in patients with neurofibromatosis is well documented in pathology literature in English, but has rarely been documented in Korea. Here, we report a case of multiple GISTs in a 48-year-old woman accompanied by NF1. She was admitted to Yeungnam University Hospital with complaints of melena and dyspnea. A contrast-enhanced computed tomography (CT) scan revealed that multiple soft tissue masses were occupying the entire peritoneal cavity. An ultrasonogram- guided biopsy was performed and the tumors were found to have been composed of tumor cells that were positive for c-kit protein. The patient was put on Imatinib mesylate treatment, and further follow-up will be carried out.
Primary liver carcinomas have been classified into hepatocellular carcinoma, cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma (CHC). CHC is a tumor containing unequivocal, intimately mixed elements of both hepatocellular carcinoma and cholangiocarcinoma. It forms a small but significant proportion of primary liver carcinomas. The origin and pathogenesis of CHC have not been well established. According to the 2010 WHO classification, CHCs are categorized into 2 groups: the classical type and a subtype with stem cell features. This review describes recent progress in pathology and classification of CHC.
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Angioleiomyoma of the sinonasal tract is a rare benign tumor. We report a case of angioleiomyoma of the nasal septum in a 51-year-old woman who complained of frequent epistaxis for 3 months. Surgicalexcision was performed. The excised specimen was 0.7 x 0.5 x 0.4 cm in size, well circumscribed, grayish white, rubbery, and soft. Histological examination showed thick-walled blood vessels and smooth muscle cell proliferation. No nuclear atypia or mitoses were present.
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Angiomatoid fibrous histiocytoma is a rare soft tissue tumor that generally affects children and young adults. We report a case of angiomatoid fibrous histiocytoma in an 11-year-old boy who complained of a back mass for 3 years. Surgical excision was performed. The excised specimen showed a 4.0 x 3.6 x 3.0 cm, well circumscribed, grayish white tumor, with multicystic changes. Histological examination showed proliferation of spindle or round shaped tumor cells. There was a dense fibrous pseudocapsule with prominent chronic inflammatory cell infiltrates.
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Hemangioblastoma is a benign tumor that most commonly occurs in the cerebellum and associated with von Hippel-Lindau (VHL) disease. Supratentorial hemanigoblastomas are exceptionally rare. We describe the magnetic resonance imaging (MRI) and histopathologic findings of a supratentorial leptomeningeal hemangioblastoma.
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Cystic dystrophy is an uncommon, benign poorly understood disease. It is characterized by the development of cysts in heterotopic pancreatic tissue. A 57-year-old-man was hospitalized for abdominal pain for a week. He is a heavy alcohol drinker. There was a cyst at second portion of duodenum on CT. Under the impression of peptic ulcer perforation, Whipple’s operation was performed. Grossly, a cystic space, measuring 3.0 cm in diameter, was noted within the thickened duodenal wall. Microscopically, the cyst was lined by columnar epithelium and granulation tissue and embedded in ectopic pancreatic tissue. The adjacent pancreatic tissue showed focal chronic pancreatitis.