Peritoneal carcinomatosis from lung cancer is rare, particularly from lung squamous cell carcinoma (LSCC). Concurrent somatic BRAF and KRAS mutations within the same tumor specimen have not been reported. The present study describes the case of a treatment-naïve LSCC patient with coexisting BRAF V600E and oncogenic KRAS G12A mutations in the primary lung lesion and the peritoneal metastases. The patient presented with prominent peritoneal carcinomatosis and an eosinophilic leukemoid reaction, but no respiratory symptoms. The patient succumbed 8 days after the onset of the condition due to rapid aggravation of the peritoneal carcinomatosis. To the best of our knowledge, this is the first study concerning the coexistence of BRAF and KRAS mutations in LSCC. Intensive activation of ERK was also observed in the primary lung lesion and the peritoneal metastases. Although the exact pathogenesis was unclear, the observations indicated that in the present study, the BRAF V600E and KRAS G12A mutations may have cooperate in inducing the malignant phenotype of LSCC. This case also highlighted the potential aggressive course and unusual pattern of spread of this specific dual-mutated tumor.
To the Editor: Chronic endometritis (CE) is a subtle type of inflammation characterized by the persistent presence of plasma cells in the stroma of the endometrium and is usually asymptomatic, only slight symptoms, such as abnormal uterine bleeding, pelvic pain, dyspareunia, or leucorrhea.There are currently no universally accepted standardized definitions or established diagnostic guidelines for CE. Pathologist agree that the presence of multiple endometrial stromal plasmacytes is the most specific and sensitive finding in pathology.
Cryptococcosis is a systemic and opportunistic fungal infection whichaffects both severely immunosuppressed patients and those with phenotypically "normal" immune systems. In developed countries, the majority cases of cryptococcosis occur among non-human immunodeficiency virus (HIV) patients, such as solid organ transplant recipients.Cryptococcosis is also seen in patients receiving exogenous immunosuppression and patients with innate or acquired immunodeficiency. 1,2 A large population-based US study shows a prevalence of 0.2-0.9 per 100 000 among the HIV-negative immunocompromised patients. 3Although cryptococcosis most often involves the central nervous system, it may also involve the lungs, skin, bones, liver, adrenals, kidneys, prostate, endocardium, and pericardium. 1 The clinical symptoms and radiographic features of pulmonary cryptococcosis are non-specific, so it may easily be misdiagnosed or underdiagnosed. 4 Definitive diagnosis most often relies upon pulmonary specimen culture and the isolation of Cryptococcus in the appropriate clinical and radiological context. 5 We present a case of an asymptomatic 41-year-old male with a past medical history of ulcerative colitis and primary sclerosing cholangitis (PSC)/autoimmune hepatitis overlap syndrome, presenting for a follow-up visit to the gastrointestinal clinic. He had been living in North Carolina for years without a documented history of recent travel or bird contact. His list of medications included immunosuppressants such as prednisone, azathioprine, and mycophenolate. He was on mesalamine for six months but discontinued. A few months later, the patient had a magnetic resonance imaging (MRI) of the abdomen due to the concern for cholangiocarcinoma. The MRI revealed unchanged PSC and an incidental 9 mm left lower lobe lung nodule. A computed tomography (CT) scan of the chest revealed multiple nodules in the lung base (Figure 1). Radiologically, the differential diagnosis included infection, mucoid impaction, or a neoplastic process. The patient underwent a CT-guided percutaneous fine-needle aspiration (FNA) of the largest (15 mm) nodule in the left lung lower lobe. Multiple fine-needle aspirates were obtained and handed to the onsite cytopathology team. Using standard procedures, paired aspirate smears were obtained and stained with Papanicolaou and Diff-Quik stains. Cell block material was acquired and stained by hematoxylin and eosin (H&E).The Diff-Quik stained smears were hypocellular and comprised mainly of histiocytes, lymphocytes, and blood. Many of the cellular groups appeared crushed and poorly visualized. Numerous intra-and extracellular round-spherical structures were noted and believed to represent fungal organisms (Figure 2A,B.) There was no significant acute inflammatory response or well-formed granulomas. The radiology team was advised to obtain sterile material for fungal culture. Microscopic evaluation of all processed material the next day concluded that the material is benign and confirmed the presence of fungal elements using Grocot...
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