Focal nodular hyperplasia with calcification and ossification

We describe a 33-year-old woman with Crohn's disease, who presented with recurrent episodes of small bowel obstruction. A solitary liver lesion was discovered incidentally by abdominal ultrasound. Pathological examination of the resected specimen revealed features typical of focal nodular hyperplasia together with uncommon findings including calcification, ossification and fibrous obliteration of blood-filled "cysts", changes more commonly associated with regression in hepatic haemangiomas. This report strengthens the favoured hypothesis that a vascular malformation underlies the pathogenesis of focal nodular hyperplasia.     

Concomitant hepatocellular carcinoma and non-Hodgkin's lymphoma in a patient with nodular regenerative hyperplasia

Hepatocellular carcinoma (HCC) is the most common primary cancer in the liver. Liver invasion of non-Hodgkin's lymphoma (NHL) is also often observed. But simultaneous existence of HCC and NHL in a liver is extremely rare. Such patients reported previously had cirrhotic livers. Herein is reported a patient who simultaneously had HCC and NHL in a liver without cirrhosis, but with nodular regenerative hyperplasia (NRH). NHL was of the diffuse large B-cell type. Lymphoma cells invaded the portal vein, and formed thrombi. These thrombi would contribute to the development of NRH by decreasing portal vein blood flow. HCC was of the well-differentiated type and there was a 2 cm-sized nodule at the lateral segment. There is the possibility that NRH was associated with the HCC because NRH is reported as a premalignant lesion. HCC and NHL were colocalized in the liver without hepatic virus infection or cirrhosis, although common cause(s) of development of these malignancies remain unclear in the present case.     

Fibrolamellar hepatocellular carcinoma: a case report

A 6-year-old Malay boy presented with fever and abdominal pain for 2 months. Computerised tomography showed a nodular mass in the left lobe of the liver. There was also portal vein thrombosis on the left side. Serum alpha-fetoprotein was not elevated and Hepatitis B antigen was negative. Biopsy of the liver mass led to a histological diagnosis of fibrolamellar hepatocellular carcinoma. In view of extensive tumour involvement, he could not be operated on but was treated with chemotherapy. However, the tumour did not respond. While this is expected for fibrolamellar hepatocellular carcinoma, the possibility of the tumour having a component of ordinary hepatocellular carcinoma could not be excluded as the tumour was not resected. Fibrolamellar hepatocellular carcinoma is a rare histological subtype of hepatocellular carcinoma, associated with a better prognosis. It affects the younger age group and has no association with cirrhosis, hepatitis B virus infection or exposure to oral contraceptives, all of which are implicated in ordinary hepatocellular carcinoma. Serum alpha-fetoprotein level is usually within normal limits and other laboratory values are not contributory to the diagnosis. The diagnosis is usually suggested by radiographic studies viz. CT scan of the abdomen, which would show an irregular non-homogenous mass in the liver, and confirmed by histological examination. The most characteristic microscopical feature is fibrosis arranged in a lamellar fashion around polygonal and deeply eosinophilic neoplastic hepatocytes.     

肝上皮样血管平滑肌脂肪瘤并发局灶性结节性增生1例

肝上皮样血管平滑肌脂肪瘤(hepatic epithelioid angiomyolipoma,HEAML)是非常罕见的一种血管平滑肌脂肪瘤,由于其缺乏典型的临床及影像学表现极易误诊为肝细胞肝癌.局灶性结节性增生(focal nodular hyperplasia,FNH)亦为少发病例.本文通过分享1例并发HEAML和...     

Multifocal nodular oncocytic hyperplasia of the parotid: case report

Multifocal nodular oncocytic hyperplasia of salivary glands is a tumor-like lesion that occurs predominantly in the parotid gland. The differential diagnosis of the clear cell variant includes many malignant salivary gland tumors. We report the case of a 66-year-old woman who was referred for a left total parotidectomy allowing the final diagnosis of clear cell multifocal nodular oncocytic hyperplasia. The differential diagnoses and histopathogenesis of this rare entity are discussed.     

Rapidly-growing nodular pseudoangiomatous stromal hyperplasia of the breast: case report

Pseudoangiomatous stromal hyperplasia is a benign proliferative lesion of the mammary stroma that rarely presents as a localized mass. Pseudoangiomatous stromal hyperplasia is characterized by a dense, collagenous proliferation of the mammary stroma, associated with capillary-like spaces. Pseudoangiomatous stromal hyperplasia can be mistaken with fibroadenoma on radiological examination or with low-grade angiosarcoma on histological examination. Its main importance is its distinction from angiosarcoma. The presented case was a 40-year-old woman who was admitted with a rapidly growing breast tumor. Physical examination revealed an elastic-firm, well-defined, mobile and painless mass in her right breast. Mammograms revealed a 6.7 x 3.7 cm, lobulated, well-circumscribed mass in her right breast but no calcification. Sonographic examination showed a well-defined and homogenous mass, not including any cyst. Based on these findings, a provisional diagnosis of fibroadenoma was made. Considering the rapid growth history of the mass, tumor excision was performed. The excised tumor was well demarcated and had a smooth external surface. Histological examination revealed the tumor to be composed of markedly increased fibrous stroma and scattered epithelial components (cystic dilatation of the ducts, blunt duct adenosis). The fibrous stroma contained numerous anastomosing slit-like spaces. Isolated spindle cells appeared intermittently at the margins of the spaces resembled endothelial cells. Immunohistochemical staining showed that the spindle cells were positive for CD34 and negative for Factor VIII-related antigen. The lesion was diagnosed as nodular pseudoangiomatous stromal hyperplasia.     

p53 immunoreactivity in hepatocellular adenoma, focal nodular hyperplasia, cirrhosis and hepatocellular carcinoma

The prolonged half-life of mutant p53 makes feasible its immunocytochemical detection. In order to assess the pathogenetic role of mutant p53 in regenerative and neoplastc liver disease we studied its immunohistochemical expression in cases of hepatic cirrhosis, hepatocellular carcinoma (HCC), cirrhosis with areas of HCC, hepatocellular adenoma and focal nodular hyperplasia. The study included needle and wedge biopsies of 50 cirrhotic livers, 59 HCCs (36 of them with associated cirrhosis), six adenomas and two focal nodular hyperplasias. Sixty-five HCC fineneedle cytology specimens were also included in the study. There was no immunohistochemical evidence of mutant p53 expression in any of the cases of cirrhotic liver (except for one instance associated with HCC) adenoma or focal nodular hyperplasia. In contrast p53 was detected in 8.5% of HCC cases in the biopsy series and 24% of HCC cases in the fine needle aspiration series. In addition, mutant p53 expression in HCC was positively correlated with tumour grade. According to grade, the distribution of p53 positive immunoreactivity among HCCs was as follows: Grade I-II, 0% of cases in the biopsy series and 9% in the fine needle aspirates; Grade III, 18% in the biopsy series and 55% in the fine needle aspirates; and Grade IV, 40% in the biopsy series. Therefore, mutant p53 expression does not seem to be associated with benign liver lesions but seems to correlate with the progression of HCC through various grades of increasing malignancy.     

肝脏局灶结节性增生238例临床病理分析

目的 分析肝脏局灶结节性增生(FNH)的临床病理特点.方法 回顾性分析238例FNH患者的临床及影像资料,复习大体标本及光镜下组织学特点,按照现有的分类标准对FNH行组织学分类,并对所有患者随访.结果 238例FNH患者中男性145例,女性93例,年龄11～77岁,平均年龄39.1岁.有完整临床资料的233例中,188例无相关症状,216例无乙型和(或)丙型病毒性肝炎史,232例患者血清甲胎蛋白为阴性.有影像结果的185例中123例(66.5%)经影像诊断为FNH.大体观察上238例FNH标本包含284枚病灶,平均直径3.7cm,215例(90.3%)单发,172枚发生于肝右叶,115枚(40.5%)切面可见星状瘢痕或呈结节状.光镜下观察238枚FNH病灶,229枚(96.2%)为经典型FNH,6枚为毛细血管扩张型FNH,3枚为混合性增生与腺瘤样型FNH,未见到细胞不典型FNH.173例患者获得随访结果,无FNH相关性死亡,2例患者于术后2年和4年复发.结论 FNH是对肝脏内局部异常血流的反应性肝细胞增生性疾病,无女性好发倾向;毛细血管扩张型FNH应归类为肝细胞腺瘤,该组无细胞不典型FNH;超过66%的病例可经影像诊断.

Abstract：

Objective To study the clinicopathologic features of focal nodular hyperplasia (FNH)of liver. Methods The clinical, radiologic, pathologic findings and follow-up data of 238 cases of FNH were retrospectively analyzed. Results The patients included 93 females and 145 males. The age of the patients ranged from 11 to 77 years(median=39.1 years). Amongst the 233 patients who had clinical information available, 188 were asymptomatic, 216 had no history of hepatitis B and/or C infection and 232had negative serum alpha-fetoprotein level. Amongst the 185 patients who had undergone radiologic examination, 123(66.5%) were accurately diagnosed as such. Macroscopically, of the 284 lesions from 238 patients, the average diameter was 3.7cm. Two hundred and fifteen cases (90.3%) were solitary, 172cases were located in the right lobe and 115(40.5%) had central stellate fibrotic scars or lobulated cut surface. Histologically, 229 lesions belonged to classic type and 9 lesions were of non-classic type. The latter was further classified as the telangiectatic form (6 lesions ) and the mixed hyperplastic and adenomatous form(3 lesions). There was no evidence of significant cytologic atypia. Follow-up data were available in 173 patients (72.7%).None of them died of the disease and 2 patients suffered from relapses after 2 and 4 years, respectively. Conclusions FNH is a hyperplastic response of normal liver cells to local blood flow anomalies. It has no obvious sex predilection and more than 66% can be diagnosed accurately with radiologic examination. The lesions in the current study show no cytologic atypia.     

Hepatocellular carcinoma associated with focal nodular hyperplasia

We describe a hepatocellular carcinoma partially surrounded by focal nodular hyperplasia in a 65-year-old female patient. In order to clarify the relationship of the hepatocellular carcinoma and the adjacent focal nodular hyperplasia, clonal analysis was conducted. The clonal analysis was based on the methylation pattern of the polymorphic X-chromosome-linked androgen receptor gene (HUMARA). The allelic bands from the amplification of the focal nodular hyperplasia and of the hepatocellular carcinoma showed a significant reduction in the intensity of one of the two alleles as compared with two alleles of equal intensity in the buff coat after HhaI digestion, which indicated that these two parts were monoclonal. However, the inactivated allele in the focal nodular hyperplasia and that in the hepatocellular carcinoma were not identical. Therefore, the focal nodular hyperplasia and hepatocellular carcinoma probably derived from the clonal expansion of two different clones.     

Papillary carcinoma with nodular fasciitis-like stroma--a case report in pregnancy

We report a case of Papillary carcinoma with nodular fasciitis-like stroma that is a rare variant of Papillary carcinoma characterized by a prominent stromal cell proliferation that causes difficulties in cytologic and histologic diagnosis. The patient was a 34-year-old woman, pregnant, presented with a 1-year history of a growing mass in neck, dysphagia, and hoarseness. Physical examination revealed a firm nodular mass in thyroid gland. The fine needle aspiration biopsy specimen contained, besides diagnostic epithelial features of Papillary thyroid carcinoma, discohesive arrangement of bland spindle cells. Macroscopically, the specimen consisted of nodular tumor measuring 10 x 6 x 6 cm. Histologically the tumor was composed of small foci of neoplastic epithelial component distributed in abundant stroma. In immunohistochemistry, spindle cells in the stroma were positive for alpha-smooth muscle actin and the neoplastic cells showed positive staining for TTF-1 and progesterone receptor.     

乳腺囊性高分泌性癌伴微小浸润癌及囊性高分泌性增生一例

患者女,44岁.发现左侧乳腺肿物,行肿物切除术,原单位冷冻切片病理报告导管原位癌伴浸润,遂行乳腺改良根治术.于2009年4月7日来本院会诊.具体病史不详.病理检查:镜下观察:肿瘤主要由含有大量均质嗜酸性分泌物的大小不等扩张的腺腔构成,形态酷似甲状腺滤泡.病变广泛,部分腺腔被覆单层扁平上皮,形态温和.     

Fibrolamellar hepatocellular carcinoma: a case report with cytological features in a sixteen-year-old girl

We report a case of a 16-yr-old girl with a liver tumor revealed by thrombophlebitis of the left leg. On physical examination the patient was found to have painless hepatomegaly. Ultrasound and CAT scan showed a large tumor of the left portion of the liver, measuring 14 cm in diameter. Cytological preparations were touch imprints of the biopsy fragments obtained under ultrasound guidance. Cytological examination using May-Grünwald Giemsa stain revealed highly cellular smears containing large tumor cells with a round nucleus, prominent nucleoli, and abundant granular basophilic cytoplasm. Cytological features were those of fibrolamellar hepatocellular carcinoma, confirmed by histological examination of the biopsy sample as well as the surgical specimen obtained after wide excision of the lesion following ineffective neoadjuvant chemotherapy.     

胃EB病毒阳性淋巴上皮瘤样癌伴B淋巴细胞单克隆性增生一例

报道1例罕见胃EB病毒阳性淋巴上皮瘤样癌合并B淋巴细胞单克隆性增生,并复习相关文献。患者为男性75岁,胃底贲门见一溃疡型肿块。镜下观察:肿瘤以推挤性生长为主,侵及胃壁深肌层。肿瘤组织中淋巴上皮间质明显多于肿瘤细胞,肿瘤细胞间质淋巴细胞背景中部分为B淋巴细胞构成,周围可见淋巴上皮病变。EB病毒原位杂交显示:癌细胞阳性。分子病理显示B细胞IgH-DH克隆性基因重排。最终诊断为:胃EB病毒阳性淋巴上皮瘤样癌伴淋巴样间质内B细胞单克隆性增生。     

原发性子宫内膜鳞状细胞癌伴子宫内膜不典型增生1例

原发性子宫内膜鳞状细胞癌(primary endometrial squamous cell carcinomas, PESCC)是一种罕见的子宫内膜癌。本文报道1例55岁患者, 刮宫标本及经腹腔镜筋膜外全子宫切除标本组织学形态均显示不同分化程度的鳞状上皮呈浸润性生长, 并见短梭形细胞, 胞质丰富、透亮。刮宫标本中未见正常子宫内膜腺体及异常腺性结构;全子宫切除标本中短梭形与鳞状上皮穿插生长, 侵犯浅肌层, 周围子宫内膜可见慢性子宫内膜炎, 局灶符合子宫内膜不典型增生;免疫表型:明确的鳞状上皮成分及短梭形细胞广谱细胞角蛋白、细胞角蛋白(CK)5/6、p63、β-catenin、CD10均阳性, CK7、CDX2阴性。患者随访8个月, 身体状况良好。PESCC需要严格掌握诊断标准, 除外子宫颈来源的鳞状细胞癌及子宫内膜样癌伴广泛鳞化。该文描述PESCC组织学特点、刮宫及全子宫标本诊断难点、阐述其诊断要点, 并复习和总结相关文献。     

Malignant nodular hidradenoma with angiolymphatic invasion: a case report

Malignant nodular hidradenomas are rare variants of sweat gland carcinomas characterized by aggressive clinical behaviour. We report a case of 42-year-old female with 3 x 2 x 1 cm nodule on her foot followed by cutaneous and regional lymph node metastasis. Flow cytometry showed S-phase fraction of 72.6% and 15.8% of aneuploid cells corroborating with its aggressive nature.