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Endothelial cyst of the adrenal gland: an uncommon retroperitoneal cyst
S72
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Methods: Retrospective study looking at data of biopsies by GPs from 2009 to 2011. Variables included demographic data, methods and sites of biopsy, size and margins of tumours. Data collected was compared to the NICE guidelines. Results: Out of 35,494 skin specimens processed at St. Georges Hospital, 3893 were from GPs; 137 skin specimens were found to be malignant, of which 113 were BCCs. Discussion: This audit has highlighted issues regarding the management of low-risk BCCs by GPs. Forty percent (40%) of BCCs were biopsied from the head and neck region, reflecting poor adherence to guidelines regarding sites of biopsy. There was also poor adherence to guidelines regarding the size and margins of tumours biopsied by GPs. Knowledge of the NICE guidelines is crucial to ensure the best possible outcome for patients.
Dermatopathology: Poster#99
Intrathyroid parathyroid tumors are not common lesions and are difficult to diagnose, both clinically and histologically; especially when the patient has no hyperparathyroid symptoms. A 45-yearold Thai woman was treated as having non-toxic goiter for 20 years. She was diagnosed with papillary carcinoma of the thyroid gland with lung metastases. During investigations of her hemoptysis and right lung atelectasis, incidental bilateral lobe enlargement was detected of her substernal thyroid gland, with multiple hypodense nodules on both lobes. Total thyroidectomy was performed after cytological studies failed to give a definite diagnosis. She did not have hyperparathyroid symptoms and her serum calcium level prior to surgery was normal (8.4 mg/dL, normal 8.4–10.2 mg/dL). The surgical specimen revealed concurrent follicular adenoma with degenerative changes (left lobe, 5.5 7.0 cm), multiple ectopic parathyroid (right lobe, 0.5 0.7 cm) and atypical parathyroid adenoma (right lobe, 2.5 3.5 cm). The occurrence of ectopic lesions is explainable on an embryologic basis. Non-functioning parathyroid adenoma is uncommon and coexisting thyroid tumors are rare.
SPECTRUM OF HISTOPATHOLOGICAL FINDINGS OF SKIN IN DIABETES MELLITUS Endocrine Pathology: Poster#101
Suniti Shrestha and Om Prakash Talwar Kathmandu University, Nepal Background: The accessibility of skin capillaries makes cutaneous diabetic microangiopathy ideal for research on the progression of microvascular disease in diabetic patients. The recognition of microangiopathy can facilitate early prediction of microvascular complications in other organs. Methods: Skin biopsy samples for microvasculature study were stained with hematoxylin and eosin, periodic acid-Schiff (PAS) and Masson trichrome. The slides were screened for features of diabetic microangiopathy. Results: Out of 60 patients, 53 (88.3%) showed evidence of diabetic microangiopathy, of which 41 (77.35%) were males and 12 (22.64%) females. PAS positive capillary basement membrane thickening was seen in all 53, endothelial proliferation in 42 (70%), perivascular lymphocytic infiltration in 23 (38.3%) and thickened collagen bundles in 15 (25%) patients. All four microscopic features were seen in 7 patients. Microangiopathy was most prevalent in the age group 50–59 years. Diabetic complications were present in 46 (76.6%) patients, of which 42 had microangiopathy. Conclusion: The study provides a tissue measure of integrated glycemia and an estimate of the consequent risk of developing complications.
CYSTIC LYMPHANGIOMA-LIKE ADENOMATOID TUMOR OF THE ADRENAL GLAND: REPORT A RARE CASE FROM LAO PDR Thitsamay Luangxay1, Bounleuang Kousonh1, Phetsamone Arounlangsy1, Phaengvilay Xaysomphet1, Prawat Nitiyanant2 and Hallgrimur Benediktsson3 1Department of Pathology, University of Health Sciences, Lao PDR, 2Department of Pathology, Ramathibodi Hospital, Mahidol University, Thailand, and 3Department of Pathology and Laboratory Medicine, University of Calgary, Canada Adenomatoid tumors (AT) are rare benign tumor of mesothelial deriviation. The adrenal gland is a rare site for AT and frequently mistaken for adrenocortical tumors or pheochromocytoma, clinically and radiologically. AT of adrenal glands majority occur in males. Among 34 cases reported, grossly solid tumors were more common. Solid with cystic areas were rare. Only 5 cases were almost entirely cystic. Only six cases of cystic lymphangiomalike AT of adrenal gland were reported. We report a 27-year-old male, who had a 6.5 cm cystic focally solid adrenal mass found in routine medical examination. Laparotomic adrenalectomy was done and showed features of cystic lymphangioma-like AT. (Scanning and transmission electronmicroscopy and immunohistochemical study were done in Ramthibodi Hospital, Mahidol University.)
Endocrine Pathology: Poster#100 CONCERRENT FOLLICULAR ADENOMA AND MULTIPLE ECTOPIC PARATHYROID GLANDS WITH AN ATYPICAL PARATHYROID ADENOMA 1
2
Endocrine Pathology: Poster#102 ENDOTHELIAL CYST OF THE ADRENAL GLAND: AN UNCOMMON RETROPERITONEAL CYST
Chaiwat Aphivatanasiri , Prerapat Kongmalai , Nittaya Chamadol3 and Sarithorn Siritunyaporn1 1Department of Pathology, 2Department of Surgery, and 3Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Hunaina Al-Kindi1, Mina George1 and Rashid Al-Ruzaiqi2 1Histopathology Department, Directorate General of Khoula Hospital, and 2Department of General Surgery, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
Ectopic intrathyroid parathyroid glands may be the cause of primary hyperparathyroidism, parathyroid adenoma or carcinoma.
Adrenal cysts are uncommon. Most are asymptomatic and diagnosed incidentally during a work up for abdominal pain or
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
IAP 2014 ABSTRACTS
incidentally during imaging studies for an unrelated cause. Adrenal cysts show a spectrum of histological changes. Traditionally, adrenal gland cysts have been classified as pseudocysts, endothelial cysts, epithelial cysts, and parasitic cysts. We report a case of a 29-year-old man who presented to our hospital with history of back pain radiating to both lower limbs. During the workup of the back pain, an incidental finding of a mass displacing the left kidney was seen on MRI. Ultrasound abdomen was done and revealed a large well defined cyst in the left upper quadrant. Contrast enhanced CT was recommended and revealed a 14 13 13 cm, thin walled cystic lesion in the left quadrant. Surgical resection of the cyst was undertaken and the specimen sent for histological examination. Histopathologic examination and immunohistochemical findings were consistent with vascular (endothelial) cyst of the adrenal.
Endocrine Pathology: Poster#103 EXPRESSION OF PHOX2B IN PHEOCHROMOCYTOMA OF ADULTS AND CHILDREN Decaussin Myriam1 and Sartelet Herve´2 1Department of Pathology, Lyon Sud Hospital Centre, Pierre Be´nite, Hospices Civils de Lyon, University Lyon I, France, and 2Department of pathology, Centre hospitalier universitaire Robert Debre, Paris, France Background: Phox2b gene encodes a transcription factor with an expression pattern restricted to the autonomic nervous system during growth, development and adulthood. Phox2b has recently been reported as a useful diagnostic marker for neuroblastic tumors but its expression is controversial in pheochromocytoma. The aim of the study is to determine pattern of expression of Phox2b in a large number of pheochromocytomas of adults or children. Methods: An immunohistochemical study was performed on sixteen adult and pediatric pheochromocytomas with antibodies against Phox2b and neurofilament protein. Two classical neuroblastomas were used as positive control. Results: Every tumor had a non-specific and heterogeneous cytoplasmic expression of Phox2b but only 3 pediatric (18.7%) and 1 adult (6%) pheochromocytomas have demonstrated a specific focal nuclear expression of Phox2b. The tumors with nuclear positivity showed background of neuropil which expressed neurofilament. Conclusion: In the present study, the nuclear expression of Phox2b was focal and associated with neuropil which is only found with neuroblasts but not with chromaffin cells. Also, we can conclude that pheochromocytoma have infrequently foci of neuroblastic tumor areas, particularly in children, while true composite associating large areas of the two types of these tumors are rare.
Endocrine Pathology: Poster#104 HISTOPATHOLOGICAL EVALUATION OF ADRENOCORTICAL CARCINOMAS – A 15 YEAR CASE SERIES Kerollos N. Wanis1 and Rani Kanthan2 1College of Medicine, and 2Department of Pathology & Lab Medicine, University of Saskatchewan, Canada
S73
Adrenocortical carcinoma is a rare cancer, with a reported incidence of 0.5–2.0 cases per million/population/year. Adult adrenocortical carcinoma has a poor prognosis, underscoring the importance of identifying diagnostic and prognostic markers. A 15-year search of our laboratory database for all cases with a diagnosis of adrenocortical carcinoma was undertaken. A total of 8 cases were identified, including one adrenal sarcomatoid carcinoma. We examined the histopathological features of the tumors, specifically assessing for the presence of cellular necrosis, mitotic activity, pleomorphism and vascular invasion. The integrity of the reticulin framework was also examined. Immunohistochemical evaluation of the expression of p53, b-catenin, and Ki67 as a marker of proliferative activity was undertaken. p53 was positive if greater than 10% of cells showed nuclear staining. Necrosis was noted in six of the eight tumors, while vascular invasion was observed in five. Seven tumors had an altered reticulin fiber network. The number of tumors with a high proliferative activity, defined as a Ki67 level of greater than 40%, was six. Five of the tumors were p53 positive, while four stained positive for b-catenin. In summary, we present eight cases of adrenocortical carcinoma with an examination of histological and immunohistochemical features of diagnostic and prognostic value.
Endocrine Pathology: Poster#105 HISTOPATHOLOGICAL PATTERN OF THYROID LESIONS IN KANO: A TEN YEAR RETROSPECTIVE STUDY (2002–2011) Solomon Raphael1, Aminu Zakari Mohammed1 and Iliyasu Yawale1 1Department of Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria, 2Department of Pathology, Ahmadu Bello University, Shika-Zaria, Kaduna, Nigeria Objective: To describe the histopathological pattern of 522 thyroidectomy specimens received at the Pathology department of Aminu Kano Teaching Hospital, Kano, Nigeria, analyse the sex and age variations and compare with findings from previous studies done in Nigeria and elsewhere. Materials and methods: We reviewed slides from paraffin embedded blocks of all thyroidectomy specimens to confirm type of lesion and extracted data such as age and sex from the request forms. Results: The female (86.4%) to male (13.6%) ratio is 6.4:1. The ages ranged from 5 months to 86 years with a mean age of 36.3 years and the relative peak age incidence was seen in the 30–39 years age group. The most common entity was multinodular goitre (57.2%) with a mean age at presentation of 37.5 years. It was followed by thyroid adenomas (15.7%) and thyroid carcinomas (12.6%). Histologically, papillary carcinoma predominated (53%), followed by follicular carcinoma (33.3%) and medullary carcinoma (9.1%). Thyroglossal duct cysts and toxic hyperplasia accounted for 6.9% and 5.4% respectively while thyroiditis was uncommon with only 2 cases (0.4%). Conclusion: Goitre is the most common thyroid lesion in Kano while papillary carcinoma is the most common thyroid cancer, a finding at variance with most reports from Nigeria.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Methods: Retrospective study looking at data of biopsies by GPs from 2009 to 2011. Variables included demographic data, methods and sites of biopsy, size and margins of tumours. Data collected was compared to the NICE guidelines. Results: Out of 35,494 skin specimens processed at St. Georges Hospital, 3893 were from GPs; 137 skin specimens were found to be malignant, of which 113 were BCCs. Discussion: This audit has highlighted issues regarding the management of low-risk BCCs by GPs. Forty percent (40%) of BCCs were biopsied from the head and neck region, reflecting poor adherence to guidelines regarding sites of biopsy. There was also poor adherence to guidelines regarding the size and margins of tumours biopsied by GPs. Knowledge of the NICE guidelines is crucial to ensure the best possible outcome for patients.
Dermatopathology: Poster#99
Intrathyroid parathyroid tumors are not common lesions and are difficult to diagnose, both clinically and histologically; especially when the patient has no hyperparathyroid symptoms. A 45-yearold Thai woman was treated as having non-toxic goiter for 20 years. She was diagnosed with papillary carcinoma of the thyroid gland with lung metastases. During investigations of her hemoptysis and right lung atelectasis, incidental bilateral lobe enlargement was detected of her substernal thyroid gland, with multiple hypodense nodules on both lobes. Total thyroidectomy was performed after cytological studies failed to give a definite diagnosis. She did not have hyperparathyroid symptoms and her serum calcium level prior to surgery was normal (8.4 mg/dL, normal 8.4–10.2 mg/dL). The surgical specimen revealed concurrent follicular adenoma with degenerative changes (left lobe, 5.5 7.0 cm), multiple ectopic parathyroid (right lobe, 0.5 0.7 cm) and atypical parathyroid adenoma (right lobe, 2.5 3.5 cm). The occurrence of ectopic lesions is explainable on an embryologic basis. Non-functioning parathyroid adenoma is uncommon and coexisting thyroid tumors are rare.
SPECTRUM OF HISTOPATHOLOGICAL FINDINGS OF SKIN IN DIABETES MELLITUS Endocrine Pathology: Poster#101
Suniti Shrestha and Om Prakash Talwar Kathmandu University, Nepal Background: The accessibility of skin capillaries makes cutaneous diabetic microangiopathy ideal for research on the progression of microvascular disease in diabetic patients. The recognition of microangiopathy can facilitate early prediction of microvascular complications in other organs. Methods: Skin biopsy samples for microvasculature study were stained with hematoxylin and eosin, periodic acid-Schiff (PAS) and Masson trichrome. The slides were screened for features of diabetic microangiopathy. Results: Out of 60 patients, 53 (88.3%) showed evidence of diabetic microangiopathy, of which 41 (77.35%) were males and 12 (22.64%) females. PAS positive capillary basement membrane thickening was seen in all 53, endothelial proliferation in 42 (70%), perivascular lymphocytic infiltration in 23 (38.3%) and thickened collagen bundles in 15 (25%) patients. All four microscopic features were seen in 7 patients. Microangiopathy was most prevalent in the age group 50–59 years. Diabetic complications were present in 46 (76.6%) patients, of which 42 had microangiopathy. Conclusion: The study provides a tissue measure of integrated glycemia and an estimate of the consequent risk of developing complications.
CYSTIC LYMPHANGIOMA-LIKE ADENOMATOID TUMOR OF THE ADRENAL GLAND: REPORT A RARE CASE FROM LAO PDR Thitsamay Luangxay1, Bounleuang Kousonh1, Phetsamone Arounlangsy1, Phaengvilay Xaysomphet1, Prawat Nitiyanant2 and Hallgrimur Benediktsson3 1Department of Pathology, University of Health Sciences, Lao PDR, 2Department of Pathology, Ramathibodi Hospital, Mahidol University, Thailand, and 3Department of Pathology and Laboratory Medicine, University of Calgary, Canada Adenomatoid tumors (AT) are rare benign tumor of mesothelial deriviation. The adrenal gland is a rare site for AT and frequently mistaken for adrenocortical tumors or pheochromocytoma, clinically and radiologically. AT of adrenal glands majority occur in males. Among 34 cases reported, grossly solid tumors were more common. Solid with cystic areas were rare. Only 5 cases were almost entirely cystic. Only six cases of cystic lymphangiomalike AT of adrenal gland were reported. We report a 27-year-old male, who had a 6.5 cm cystic focally solid adrenal mass found in routine medical examination. Laparotomic adrenalectomy was done and showed features of cystic lymphangioma-like AT. (Scanning and transmission electronmicroscopy and immunohistochemical study were done in Ramthibodi Hospital, Mahidol University.)
Endocrine Pathology: Poster#100 CONCERRENT FOLLICULAR ADENOMA AND MULTIPLE ECTOPIC PARATHYROID GLANDS WITH AN ATYPICAL PARATHYROID ADENOMA 1
2
Endocrine Pathology: Poster#102 ENDOTHELIAL CYST OF THE ADRENAL GLAND: AN UNCOMMON RETROPERITONEAL CYST
Chaiwat Aphivatanasiri , Prerapat Kongmalai , Nittaya Chamadol3 and Sarithorn Siritunyaporn1 1Department of Pathology, 2Department of Surgery, and 3Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Hunaina Al-Kindi1, Mina George1 and Rashid Al-Ruzaiqi2 1Histopathology Department, Directorate General of Khoula Hospital, and 2Department of General Surgery, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
Ectopic intrathyroid parathyroid glands may be the cause of primary hyperparathyroidism, parathyroid adenoma or carcinoma.
Adrenal cysts are uncommon. Most are asymptomatic and diagnosed incidentally during a work up for abdominal pain or
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
IAP 2014 ABSTRACTS
incidentally during imaging studies for an unrelated cause. Adrenal cysts show a spectrum of histological changes. Traditionally, adrenal gland cysts have been classified as pseudocysts, endothelial cysts, epithelial cysts, and parasitic cysts. We report a case of a 29-year-old man who presented to our hospital with history of back pain radiating to both lower limbs. During the workup of the back pain, an incidental finding of a mass displacing the left kidney was seen on MRI. Ultrasound abdomen was done and revealed a large well defined cyst in the left upper quadrant. Contrast enhanced CT was recommended and revealed a 14 13 13 cm, thin walled cystic lesion in the left quadrant. Surgical resection of the cyst was undertaken and the specimen sent for histological examination. Histopathologic examination and immunohistochemical findings were consistent with vascular (endothelial) cyst of the adrenal.
Endocrine Pathology: Poster#103 EXPRESSION OF PHOX2B IN PHEOCHROMOCYTOMA OF ADULTS AND CHILDREN Decaussin Myriam1 and Sartelet Herve´2 1Department of Pathology, Lyon Sud Hospital Centre, Pierre Be´nite, Hospices Civils de Lyon, University Lyon I, France, and 2Department of pathology, Centre hospitalier universitaire Robert Debre, Paris, France Background: Phox2b gene encodes a transcription factor with an expression pattern restricted to the autonomic nervous system during growth, development and adulthood. Phox2b has recently been reported as a useful diagnostic marker for neuroblastic tumors but its expression is controversial in pheochromocytoma. The aim of the study is to determine pattern of expression of Phox2b in a large number of pheochromocytomas of adults or children. Methods: An immunohistochemical study was performed on sixteen adult and pediatric pheochromocytomas with antibodies against Phox2b and neurofilament protein. Two classical neuroblastomas were used as positive control. Results: Every tumor had a non-specific and heterogeneous cytoplasmic expression of Phox2b but only 3 pediatric (18.7%) and 1 adult (6%) pheochromocytomas have demonstrated a specific focal nuclear expression of Phox2b. The tumors with nuclear positivity showed background of neuropil which expressed neurofilament. Conclusion: In the present study, the nuclear expression of Phox2b was focal and associated with neuropil which is only found with neuroblasts but not with chromaffin cells. Also, we can conclude that pheochromocytoma have infrequently foci of neuroblastic tumor areas, particularly in children, while true composite associating large areas of the two types of these tumors are rare.
Endocrine Pathology: Poster#104 HISTOPATHOLOGICAL EVALUATION OF ADRENOCORTICAL CARCINOMAS – A 15 YEAR CASE SERIES Kerollos N. Wanis1 and Rani Kanthan2 1College of Medicine, and 2Department of Pathology & Lab Medicine, University of Saskatchewan, Canada
S73
Adrenocortical carcinoma is a rare cancer, with a reported incidence of 0.5–2.0 cases per million/population/year. Adult adrenocortical carcinoma has a poor prognosis, underscoring the importance of identifying diagnostic and prognostic markers. A 15-year search of our laboratory database for all cases with a diagnosis of adrenocortical carcinoma was undertaken. A total of 8 cases were identified, including one adrenal sarcomatoid carcinoma. We examined the histopathological features of the tumors, specifically assessing for the presence of cellular necrosis, mitotic activity, pleomorphism and vascular invasion. The integrity of the reticulin framework was also examined. Immunohistochemical evaluation of the expression of p53, b-catenin, and Ki67 as a marker of proliferative activity was undertaken. p53 was positive if greater than 10% of cells showed nuclear staining. Necrosis was noted in six of the eight tumors, while vascular invasion was observed in five. Seven tumors had an altered reticulin fiber network. The number of tumors with a high proliferative activity, defined as a Ki67 level of greater than 40%, was six. Five of the tumors were p53 positive, while four stained positive for b-catenin. In summary, we present eight cases of adrenocortical carcinoma with an examination of histological and immunohistochemical features of diagnostic and prognostic value.
Endocrine Pathology: Poster#105 HISTOPATHOLOGICAL PATTERN OF THYROID LESIONS IN KANO: A TEN YEAR RETROSPECTIVE STUDY (2002–2011) Solomon Raphael1, Aminu Zakari Mohammed1 and Iliyasu Yawale1 1Department of Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria, 2Department of Pathology, Ahmadu Bello University, Shika-Zaria, Kaduna, Nigeria Objective: To describe the histopathological pattern of 522 thyroidectomy specimens received at the Pathology department of Aminu Kano Teaching Hospital, Kano, Nigeria, analyse the sex and age variations and compare with findings from previous studies done in Nigeria and elsewhere. Materials and methods: We reviewed slides from paraffin embedded blocks of all thyroidectomy specimens to confirm type of lesion and extracted data such as age and sex from the request forms. Results: The female (86.4%) to male (13.6%) ratio is 6.4:1. The ages ranged from 5 months to 86 years with a mean age of 36.3 years and the relative peak age incidence was seen in the 30–39 years age group. The most common entity was multinodular goitre (57.2%) with a mean age at presentation of 37.5 years. It was followed by thyroid adenomas (15.7%) and thyroid carcinomas (12.6%). Histologically, papillary carcinoma predominated (53%), followed by follicular carcinoma (33.3%) and medullary carcinoma (9.1%). Thyroglossal duct cysts and toxic hyperplasia accounted for 6.9% and 5.4% respectively while thyroiditis was uncommon with only 2 cases (0.4%). Conclusion: Goitre is the most common thyroid lesion in Kano while papillary carcinoma is the most common thyroid cancer, a finding at variance with most reports from Nigeria.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.