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Pre-Bullous changes in bullous lupus erythematosus
ABSTRACTS
S83
PINEAL PARENCHYMAL TUMOUR OF INTERMEDIATE DIFFERENTIATION
cord. Multiple tissue fragments were sent to our department for frozen tissue assessment which microscopically showed a tumour with features resembling carcinoma ex-pleomorphic carcinoma with a malignant component suggestive of myoepithelial carcinoma. This was confirmed with immunohistochemistry done on further samples of the tumour. The patient was discovered in our databases to have had a previous left parotidectomy in 2008 for a carcinoma ex pleomorphic adenoma with features similar to the frozen section tissue. The clinicians involved with this case had no knowledge of this. This case, whilst rare, highlights the importance of the pathologist’s role in diagnosis and patient management.
Julie A. Teague1, Jeremy Russell2 and Jessica Ng1 1Anatomical Pathology, and 2Neurosurgery, The Royal Children’s Hospital, Melbourne, Vic, Australia
PRE-BULLOUS CHANGES IN BULLOUS LUPUS ERYTHEMATOSUS
prognosis as compared to a low grade B-cell lymphoma such as MALT lymphoma, awareness of its ability to aberrantly express B cell phenotype such as CD19, CD20 and CD79a is pivotal in preventing a misdiagnosis. In such an instance, a judicious application of a panel of immunohistochemistry stains in conjunction with molecular studies will assist in establishing the correct diagnosis.
Background: Pineal parenchymal tumours of intermediate differentiation (PPTID) were first described 20 years ago. We present a case of grade III PPTID. Clinical presentation: An 8-year-old boy presented with 5 weeks of bifrontal headache, dipolopia, torticollis and gross bilateral papilloedema. MRI showed a 161012 mm pineal mass with a cystic and solid component, causing obstructive hydrocephalus. Clinical management consisted of posterior fossa craniotomy and resection. Results: The tumour comprised diffuse sheets of undifferentiated small cells with hyperchromatic nuclei, small nucleoli and fine chromatin. Mitotic figures were inconspicuous, there was no necrosis or vascular endothelial proliferation and no markedly enlarged or atypical cells. Immunohistochemical staining showed expression of synaptophysin and retention of INI-1 staining. Neurofilament protein, GFAP, desmin, SMA, CD45, cytokeratin AE1/AE3 and EMA were negative. Ki-67 index was approximately 15–20%. The tumour was cellular, had relatively uniform nuclei, only one mitosis /10 HPF and a Ki-67 labelling index of approximately 15–20%. On this basis a diagnosis of PPTID (WHO grade III) was favoured over pineoblastoma (WHO grade IV). Conclusions: Distinction between PPTID and pineoblastoma is difficult as it relies on arbitrary cut-off points in assessment of cellularity, mitotic activity and nuclear atypia. However, attempts should be made at a distinction, as this does seem to provide useful prognostic information.
CARCINOMA EX-PLEOMORPHIC ADENOMA METASTASISING TO VERTEBRA DIAGNOSED ON FROZEN SECTION – A CASE REPORT Valli Thanni, Anita Achan and Hedley G. Coleman Anatomical Pathology Department, ICPMR, Westmead Hospital, Sydney, NSW, Australia Carcinoma ex-Pleomorphic adenoma is defined as a carcinoma that arises in the epithelial and/or myoepithelial component of a pleomorphic adenoma. Prognosis and management is highly dependent on the type of carcinoma and extent of invasion. The malignant component is classified as non-invasive (intracapsular), minimally invasive, and widely invasive. Non-invasive and minimally invasive tumours have an excellent prognosis and very low metastatic potential. This case study is of a 59-year-old man with a tumour in the Thoracic 9 vertebra that was compressing the spinal
Mathumathi Vythianathan, Christopher Henderson and Sarvjit Virdi Sydney Southwest Pathology Services, Liverpool Hospital and University of Western Sydney, The University of New South Wales, NSW, Australia We are presenting here an interesting case of pre-bullous biopsy in a patient going on to develop bullous lupus erythematosus. This is a 45-year-old female patient who is a known case of lupus nephritis on treatment since 2007, who presented with a 4-month history of persistent erythematous plaques in the body and limbs. The biopsy of the lesion in the forearm showed an unusual neutrophilic dermatosis with both interstitial dermal component and prominent neutrophilic interface reaction to epidermis, suspected to be systemic lupus erythematosus (SLE) associated. The immunofluorescence was consistent with known diagnosis of SLE. The patient presented with a blister on the ankle 2 months later, the histology of which was consistent with bullous SLE. The pre-bullous appearances have not been described in detail in the literature. This is to compare the histology at the pre-bullous stage of the disease with other non-connective tissue associated rashes. The histological features combined with the immunofluorescence might help to attribute the rash to the patient’s lupus even before clinical blistering, so that the treatment can be streamlined.
UTILITY OF NEW IMMUNOHISTOCHEMICAL STAINS IN UROLOGICAL PATHOLOGY S. Wang1, M. Patel2 and F. Maclean3 1Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, 2Urological Cancer Outcomes Centre, Discipline of Surgery, The University of Sydney, Sydney, and 3Douglass Hanly Moir Pathology, Sydney, NSW, Australia Background/aims: A number of new immunohistochemical stains has recently become available for use in urogenital pathology. By way of illustration, we present a case of multifocal nephrogenic metaplasia of the bladder mimicking invasive urothelial carcinoma, and discuss the use of immunohistochemistry in distinguishing this entity from its malignant mimics. Case report: A 76-year-old lady underwent a radical cystectomy for BCG-resistant invasive urothelial carcinoma. Although invasive high-grade urothelial carcinoma was confirmed histologically, additionally present were apparent nests of glandular cells arising subjacent to urothelial carcinoma in situ. The cells were positive
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
S83
PINEAL PARENCHYMAL TUMOUR OF INTERMEDIATE DIFFERENTIATION
cord. Multiple tissue fragments were sent to our department for frozen tissue assessment which microscopically showed a tumour with features resembling carcinoma ex-pleomorphic carcinoma with a malignant component suggestive of myoepithelial carcinoma. This was confirmed with immunohistochemistry done on further samples of the tumour. The patient was discovered in our databases to have had a previous left parotidectomy in 2008 for a carcinoma ex pleomorphic adenoma with features similar to the frozen section tissue. The clinicians involved with this case had no knowledge of this. This case, whilst rare, highlights the importance of the pathologist’s role in diagnosis and patient management.
Julie A. Teague1, Jeremy Russell2 and Jessica Ng1 1Anatomical Pathology, and 2Neurosurgery, The Royal Children’s Hospital, Melbourne, Vic, Australia
PRE-BULLOUS CHANGES IN BULLOUS LUPUS ERYTHEMATOSUS
prognosis as compared to a low grade B-cell lymphoma such as MALT lymphoma, awareness of its ability to aberrantly express B cell phenotype such as CD19, CD20 and CD79a is pivotal in preventing a misdiagnosis. In such an instance, a judicious application of a panel of immunohistochemistry stains in conjunction with molecular studies will assist in establishing the correct diagnosis.
Background: Pineal parenchymal tumours of intermediate differentiation (PPTID) were first described 20 years ago. We present a case of grade III PPTID. Clinical presentation: An 8-year-old boy presented with 5 weeks of bifrontal headache, dipolopia, torticollis and gross bilateral papilloedema. MRI showed a 161012 mm pineal mass with a cystic and solid component, causing obstructive hydrocephalus. Clinical management consisted of posterior fossa craniotomy and resection. Results: The tumour comprised diffuse sheets of undifferentiated small cells with hyperchromatic nuclei, small nucleoli and fine chromatin. Mitotic figures were inconspicuous, there was no necrosis or vascular endothelial proliferation and no markedly enlarged or atypical cells. Immunohistochemical staining showed expression of synaptophysin and retention of INI-1 staining. Neurofilament protein, GFAP, desmin, SMA, CD45, cytokeratin AE1/AE3 and EMA were negative. Ki-67 index was approximately 15–20%. The tumour was cellular, had relatively uniform nuclei, only one mitosis /10 HPF and a Ki-67 labelling index of approximately 15–20%. On this basis a diagnosis of PPTID (WHO grade III) was favoured over pineoblastoma (WHO grade IV). Conclusions: Distinction between PPTID and pineoblastoma is difficult as it relies on arbitrary cut-off points in assessment of cellularity, mitotic activity and nuclear atypia. However, attempts should be made at a distinction, as this does seem to provide useful prognostic information.
CARCINOMA EX-PLEOMORPHIC ADENOMA METASTASISING TO VERTEBRA DIAGNOSED ON FROZEN SECTION – A CASE REPORT Valli Thanni, Anita Achan and Hedley G. Coleman Anatomical Pathology Department, ICPMR, Westmead Hospital, Sydney, NSW, Australia Carcinoma ex-Pleomorphic adenoma is defined as a carcinoma that arises in the epithelial and/or myoepithelial component of a pleomorphic adenoma. Prognosis and management is highly dependent on the type of carcinoma and extent of invasion. The malignant component is classified as non-invasive (intracapsular), minimally invasive, and widely invasive. Non-invasive and minimally invasive tumours have an excellent prognosis and very low metastatic potential. This case study is of a 59-year-old man with a tumour in the Thoracic 9 vertebra that was compressing the spinal
Mathumathi Vythianathan, Christopher Henderson and Sarvjit Virdi Sydney Southwest Pathology Services, Liverpool Hospital and University of Western Sydney, The University of New South Wales, NSW, Australia We are presenting here an interesting case of pre-bullous biopsy in a patient going on to develop bullous lupus erythematosus. This is a 45-year-old female patient who is a known case of lupus nephritis on treatment since 2007, who presented with a 4-month history of persistent erythematous plaques in the body and limbs. The biopsy of the lesion in the forearm showed an unusual neutrophilic dermatosis with both interstitial dermal component and prominent neutrophilic interface reaction to epidermis, suspected to be systemic lupus erythematosus (SLE) associated. The immunofluorescence was consistent with known diagnosis of SLE. The patient presented with a blister on the ankle 2 months later, the histology of which was consistent with bullous SLE. The pre-bullous appearances have not been described in detail in the literature. This is to compare the histology at the pre-bullous stage of the disease with other non-connective tissue associated rashes. The histological features combined with the immunofluorescence might help to attribute the rash to the patient’s lupus even before clinical blistering, so that the treatment can be streamlined.
UTILITY OF NEW IMMUNOHISTOCHEMICAL STAINS IN UROLOGICAL PATHOLOGY S. Wang1, M. Patel2 and F. Maclean3 1Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, 2Urological Cancer Outcomes Centre, Discipline of Surgery, The University of Sydney, Sydney, and 3Douglass Hanly Moir Pathology, Sydney, NSW, Australia Background/aims: A number of new immunohistochemical stains has recently become available for use in urogenital pathology. By way of illustration, we present a case of multifocal nephrogenic metaplasia of the bladder mimicking invasive urothelial carcinoma, and discuss the use of immunohistochemistry in distinguishing this entity from its malignant mimics. Case report: A 76-year-old lady underwent a radical cystectomy for BCG-resistant invasive urothelial carcinoma. Although invasive high-grade urothelial carcinoma was confirmed histologically, additionally present were apparent nests of glandular cells arising subjacent to urothelial carcinoma in situ. The cells were positive
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.