“Towards Curing Incurable Cancer” Amazing lecture by Prof. James Watson, co-discoverer of the structure of DNA, at King Faisal Specialist Hospital and Research Centre.
This is a fine needle aspiration from 50 years old female patient presented with bilateral ovarian masses. She is also known case of breast carcinoma for which she had mastectomy.
Different architectural patterns including trabecular and follicular grouping.
Many nuclear grooves.
The following features strongly support the diagnosis of Granulosa Cell Tumor of the ovary. The diagnosis can be confirmed with inhibin immunostain.
Other features not present in this case:
Call-Exner bodies, noncellular material that is brightly magenta in color on Diff quick stain surrounded by granulosa cells.
Falling in the trap of assuming this tumor as a metastatic breast adenocarcinoma is easy. follicular grouping might be interpreted as glandular differentiation.
Male patient in his second decade presents with huge thigh mass.
Touch preparations stained with Diff Quick showed :
- Fibrillary to myxoid metachromatic stroma.
- The cells show plumpy hyperchromatic nuclei with moderate pleomorphism some intranuclear pseudoinclusions are also noted.
- Nerve sheath differentiation in the form of elongated, slender wavy nuclei.
- Scanty cytoplasm.
On Histopathology the case was diagnosed as Malignant Peripheral Nerve Sheath Tumor.
The morphological features of MPNST are very variable. The 2 most common patterns are the spindle cell and epithelioid cell patterns. Cases showing fibromyxoid like morphology and Hemangiopericytoma like features are reported.
“The majority of MPNST are diagnosed as spindle cell sarcoma or pleomorphic sarcoma with FNA. The cellular features may suggest MPNST but a diagnosis may be difficult, even with the help of adjunctive methods. IC may be of diagnostic help if S-100 protein is positive. The positivity in MPNST is typically focal, extensive staining favours a cellular schwannoma. negative staining with desmin, SMA and muscle-specific actin excludes smooth muscle tumours and negative staining with cytokeratin, EMA and CD99 excludes synovial sarcoma”. The Cytology of Soft Tissue Tumours Dr. Mi1ns Akerman Dr. I-Ienryk A. Domanski
Helpful features include sharp radiating pain in FNA aspiration, Relation with major nerve trunk and history of Neurofibromatosis type 1 .
(By courtesy of Dr. Hatim Khoja)
Benign melanocytic nevi in certain anatomical sites may show unusual histopathological features, Conjunctival nevi are another example of nevi at special sites that may present with worrisome features. it is safe to ‘downgrade’ the atypia that is often seen in conjunctival nevi. The lesion is often accompanied with cystic inclusions of epithelium.
Arteriovenous malformations (AVMs) are type of vascular malformation most relevant to the surgical pathologist. Because their vessels tend to leak and induce gliosis. AVMs can present with seizure disorder and also cause spontaneous hemorrhage. Best seen by trichrome or elastic stains, AVMs manifest artery-vein connections with associated arterialization of veins. Arterialization is thickening of a venous wall to the point where it resembles an artery, possibly due to fibrotic reaction to shunted arterial blood. Arteries show irregular duplication or loss of elastin . Thrombi are common. (Sternberg’s 5th ed)
Adenomatoid tumors are composed of two major elements the epithelial component and the fibrous stroma. the epithelial component is arranged in tubules, cords and nests withe cells that are flat, cuboidal to low columnar with round or oval nuclei and abundant dense cytoplasm however the cells might contain cytoplasmic vacuols and sometimes it’s so extensive that it results in signet ring like morphology as in the case of this gentle man how presents with painless small 2 cm mass in the epididymis. one should not confuse this with metastasizing signet ring carcinoma as adenomatoid tumors are very common only second to cord lipomas in such locations. Negative CEA immunostain will rule out adenocarcinoma.