Coccidioidomycosis [Pathology Infographic]

Coccidioidomycosis was first described in 1892 by Alejandro Posadas (a medical student from Argentina), when he evaluated Domingo Ezcurra, a soldier who presented with a verrucous papule on the right cheek. A diagnosis of mycosis fungoides with psorospermia was considered. After having observed spherical organisms with a double-refractile outer wall, that appeared similar to the protozoan Coccidia, Posadas and his mentor, Robert Wernicke, believed that these organisms had a parasitic origin. Ezcurra died in 1898 despite many topical treatments. His head is now conserved in a museum in Buenos Aires.

Ref:Garcia SCG, Alanis JCS, Flores MG, Gonzalez SEG, Cabrera LV, Candiani JO. Coccidioidomycosis and the skin: a comprehensive review. Anais Brasileiros de Dermatologia. 2015;90(5):610-619. doi:10.1590/abd1806-4841.20153805.

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Educational Gif – Pathology of Respiratory Epithelial Adenomatoid Hamartoma

 

REAH is an expansile mass that causes upper respiratory symptoms and discomfort mainly in adults .

Symptoms at presentation vary and are similar to those that accompany chronic sinusitis, eg, nasal congestion, nasal obstruction, headaches, facial pain, epistaxis, and hyposmia.

Endoscopy does not reveal any distinguishing features to suggest a diagnosis of REAH, and neither CT nor magnetic resonance imaging produces a specific signal intensity that can help the clinician distinguish REAH from other sinus lesions.

Distinctive histologic features of REAH include a glandular component that originates in the overlying surface respiratory epithelium and polypoid growths that represent a proliferation of respiratory epithelial adenomatoid tissue.

It is important to recognize this lesion, however, because it can be confused histopathologically with other disease processes that require a significantly different treatment approach.

Included in the microscopic differential diagnosis of REAH are inflammatory polyps , inverted Schneiderian papillomas , and well-differentiated adenocarcinoma .

Pathologists must be aware of this entity to avoid overdiagnosis and overly aggressive surgical procedures.

Hua X, Huang X, Liao Z, Xian Q, Yu L. Clinicopathological and EBV analysis of respiratory epithelial adenomatoid hamartoma. Diagnostic Pathology. 2014;9:70.
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September2017

Educational Gif – Pathology of Goblet Cell Carcinoid of the Appendix

 

 

Goblet cell carcinoid tumors accounts for 6% of appendiceal carcinoid tumors.

Histologically, GCC has features of both epithelial and carcinoid tumors and is considered intermediate between classic appendiceal carcinoid tumors and adenocarcinomas.

Although some authors believe that this tumor is of low-grade malignancy , it has a more aggressive natural history than the classic carcinoid tumors with variable malignant potential .

At diagnosis the tumor most commonly has transmural extension with diffuse infiltration into the periappendiceal fat and perineural invasion.

Although simple appendectomy may be adequate for most patients, some patients may require a more radical procedure including right hemicolectomy, particularly if there is involvement at the base of the appendix with cecal wall inflammation, lymph node metastasis, tumor size greater than 2 cm, or high-grade tumor histology.

Dang D, DeRenne LA. Goblet Cell Carcinoid Presenting as Appendicitis 1.5 Years After a Normal CT Scan. Radiology Case Reports. 2007;2(2):69-71.

 

 

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September2017

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Educational Gif – Pathology of Pseudoangiomatous Stromal Hyperplasia of the Breast (PASH)

 

PASH is a benign proliferation of the mammary stromal tissue. On histologic analysis, it shows complex interanastomosing slit-like spaces which appear to be lined by spindle cells in the breast parenchyma.

It is important to differentiate the lesion from angiosarcoma. It can be confused histologically with PASH. Angiosarcoma often shows a more aggressive infiltrative pattern into surrounding fibroadipose breast tissue and is highly vascular, lined by endothelial cells. It does not show a collagenous stroma. Angiosarcoma displays positive immunoreactivity for CD31 and, although less frequently and with less sensitivity, for the factor VIII–related or von Willebrand factor antigens.

PASH is associated with several benign entities including proliferative and nonproliferative fibrocystic changes, such as fibroadenomas, gynecomastia, normal breast tissue, and sclerosing lobular hyperplasias. The etiology and pathogenesis remain unknown.

Local excision is curative in most cases. Although recurrence may occur, the overall rate is low. Follow-up after excision is recommended as local recurrence has been reported.

Almohawes E, Khoumais N, Arafah M. Pseudoangiomatous stromal hyperplasia of the breast: a case report of a 12-year-old girl. Radiology Case Reports. 2015;10(3):1-4.
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September2017

Educational Gif – Pathology of Hyalinizing Trabecular Tumour

 

Hyalinizing trabecular tumor (HTT) of the thyroid gland is a rare neoplasm of follicular cell origin that was initially described by Carney et al. This rare form of tumor is commonly circumscribed or encapsulated, consisting of polygonal and spindle cells arranged in a trabecular pattern and separated by hyalinized stroma .Microscopically, this neoplasm shows hyaline contents and nuclei with frequent grooves and intranuclear inclusions, mimicking the presence of amyloid in medullary thyroid carcinoma or the nuclear features of papillary thyroid carcinoma , potentially leading to misdiagnosis of this benign tumor as malignant based on preoperative fine needle aspiration (FNA) cytology. HTT is generally accepted to be a benign tumor , in which the majority of tumors do not present with aggressive behavior such as capsular/vascular invasion, local recurrences, or distant metastases.

Jang H, Park CK, Son EJ, et al. Hyalinizing trabecular tumor of the thyroid: diagnosis of a rare tumor using ultrasonography, cytology, and intraoperative frozen sections. Ultrasonography. 2016;35(2):131-139.

 

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September2017

Visit: Pathology Magazine – September 2017 Issue