Malakoplakia, typically involving the urinary tract, is an uncommon form of chronic inflammation caused by chronic infections and characterized by accumulation of macrophages. It has also been found in many other sites such as the gastrointestinal tract, pancreas, liver, lymph nodes, skin, respiratory tract, adrenal gland, vagina and brain. We present a case of a 64-year-old man referred to our hospital with cachexia and radiologic evidence of metastatic tumor of the liver. Colonoscopy revealed a large malignant -appearing polypoid mass of the ascending colon and multiple distinct polyps throughout the rest of the colon. Biopsies of the ascending colon mass confirmed the diagnosis of adenocarcinoma. Histological examination of two of the other polyps revealed malakoplakia which was characterized by aggregates of granular histiocytes with MichaelisGutmann bodies and histochemically confirmed with periodic acid-Schiff and von Kossa stains. This is a rare case diagnosed on endoscopic samples. The majority of reported cases were found in surgical specimens. In addition, the endoscopic appearance of multiple polyps is unusual in malakoplakia.
while the primary location in the lung is rare, accounting for only <0.04-0.2% of lung malignancies. Because of its rarity and submucosal location, patients are usually falsely treated for asthma or chronic obstructive pulmonary disease, resulting in delayed treatment of the carcinoma. The typical morphology consists of small to medium-sized cells, in a tubular, cribiform or solid pattern of growth, rare mitoses and frequent perineural invasion. Cytokeratins and p63 are expressed positively, while there is a lack of TTF-1 expression; findings, which will guide the differential diagnosis from lung adenocarcinoma. It is equally important to rule out metastasis from other organs. Background: To report the case of a male patient, 76, who presented with hoarseness, cough, and hemoptysis. The imaging examinations demonstrated a mass emerging from the trachea wall. A bronchoscopy and tissue biopsy was undertaken. The microscopic examination revealed a case of mucoepidermoid carcinoma of the lung, a rare carcinoma, which belongs to salivary gland-type tumours. Methods: We received 2 pale-white specimens, 0.8-1.5 cm in greatest diameter. Apart from the hematoxylin-eosin stain, we conducted histochemical and immunohistochemical stains. Results: The microscopic examination of the tissue revealed a case of a low-grade mucoepidermoid carcinoma.
Background: The case of a male patient, 25, who presented with pleural effusion. Further imaging examinations demonstrated mediastinal and cervical lymphadenopathy. Methods: The cytologic examination of pleural effusion described an increased number of T-lymphocytes, suggesting further investigation of the patient. A left-sided cervical lymph node was resected, 2 cm in greatest diameter, which was microscopically examinated. Results: The architectural structure of the lymph node was completely destroyed, due to the presence of neoplastic lymphoid cells, mainly medium-sized, in compact growth pattern. They contained little cytoplasm, with a high nucleus-to-cytoplasm ratio, oval nuclei, with distinct nucleoli and condensed chromatin. Mitoses were frequent, while necrosis was absent. The neoplastic cells infiltrated the adjacent fat tissue. Immunochemistry revealed the following immunophenotype:
Background: The case of a male patient, 68, who presented with one week's history of cough, dyspnoe and hemosputum. Chest X-ray showed a shadow near the hilum of the right-sided lung. Furthermore, CT scan of the thorax demonstrated a right middle lobe mass with signs of peripheral obstructive pneumonitis. Bronchoscopy revealed a stenosis of the right middle lobe, of which biopsy material was taken for microscopic examination. Methods: The bioptic material consisted of seven palewhite tissue specimens, 0.2-0.3 cm in greatest diameter. Results: The material contained blood clots, fibrin, and mucin, as well as superficial mucosal specimens. The submucosa of the latter was infiltrated by mainly mediumsized, neoplastic cells with crush artifacts and degenerative changes. These cells showed increased pleomorphy and atypia, with enlarged, abnormal nuclei and distinct nucleoli. Among the immunohistochemical stains, Vimentin, Desmin and Calponin were positively expressed, a fact that implies the mesenchymal origin of the neoplasm. On the other hand, SMA, Caldesmon, MyOD1, CD56, AE1/AE3, CK8/18, CK7, CK5/6, TTF-1, p63, CD45, HMB-45, S-100 and CD34 were negative. The proliferation marker (Ki67) was expressed in 80% of the neoplastic cells. Given the above findings, the diagnosis referred to a mesenchymal neoplasm (sarcoma) of myogenic origin, with high-grade malignancy. The patient received a platinum and taxane chemotherapy. C o n c l u s i o n s : T h e m i c r o s c o p i c e x a m i n a t i o n o f bronchoscopy biopsy material usually leads to the diagnosis of a variety of pulmonary diseases. Immunohistochemistry has significantly expanded the pathologist's diagnostic abilities. However, in some cases, due to the rarity of the disease or the inappropriacy of the biopsy material, there can only be a rough estimation of the origin of the malignant neoplasm. In this case, the differential diagnosis would include, among else, a leiomyosarcoma, a synovial sarcoma, a fibrosarcoma, the spindle-cell variant of squamous cell carcinoma and a metastatic carcinoma.
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