CPs reproduce the immunophenotype of HYS and early endoderm with variable expression of both AFP and markers of early gut or hepatic differentiation. SGPs with intestinal differentiation often have incomplete immunophenotypes. A differential diagnosis panel, including both markers of pluripotentiality (SALL4 and/or LIN28) and endoderm (AFP, GPC3 and villin), is proposed. It identifies overlapping multidifferentiation of primitive and somatic immunophenotypes, supporting the recently proposed term of primitive endodermal tumours.
We report for the first time a case of ovarian strumal carcinoid containing both trabecular carcinoid and mucinous glands lined by both goblet and neuroendocrine cells and a low-grade mucinous neoplasm that presented clinically as pseudomyxoma peritonei in the absence of appendiceal lesion in a 58-yr-old woman. Histologically, there were both a tall columnar cell epithelial component lacking neuroendocrine cells, showing the scalloped contours and subepithelial clefts of low-grade appendiceal-type neoplasms and a mixed goblet cell neuroendocrine element. Characteristically, both reproduced appendiceal neoplastic phenotypes in a teratoid fashion. In addition, we present previously unreported oncocytic and mucinous changes in the thyroideal components of strumal carcinoid. This case represents a rare instance of pseudomyxoma peritonei of primary ovarian origin and is an example of multiple somatic teratoid endodermal differentiations of the different sections of the embryonal gut: foregut represented by thyroid, midgut by both mucinous appendiceal components, and hindgut by trabecular carcinoid.
A 34-year-old female, with a history of continued asbestos exposure, presented with a papillary peritoneal mesothelioma with a diffuse, prominent clear foamy cell change, with microvacuolation in its papillary lining, that expressed cytokeratins 7, 5/6 and calretinin as well as nuclear WT-1 and apical membrane staining for thrombomodulin, podoplanin D2-40 and HBME-1. In contrast, lining cells were CD68 negative. Foamy cell change has been reported in isolated cases as solid cords but not as a diffuse change in the mesothelial papillary lining. This phenomenon prompts differential diagnoses with abdominal and renal papillary clear cell tumours, which were discarded after a characteristic mesothelial immunophenotype was demonstrated.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4679576081031834.
An 88-year-old male, with a history of diffuse abdominal discomfort and weight loss that presented a composite gastric lymphoma (CGL) expressing CD20, BCL-6 and a high cell proliferation index in diffuse large B-cell lymphoma and positive to CD30 and C15 in typical Reed-Stemberg cells forming a Classical Hodgkin´s lymphoma. Composite lymphoma represents <5% of the occurrence of lymphoma with a poor prognosis, which were corroborated and demonstrated with a characteristic immunophenotype.
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