A complex case of a granulosa cell tumour

This is a case of a 73-year-old woman who first presented in 2020 with a fullness in her abdomen. After several thorough investigations and unforeseen complications, the fullness was diagnosed as a granulosa cell tumour. In 2003, she had been diagnosed with a granulosa cell tumour of the ovary. Complete excision was performed, however she was not given a follow-up appointment after the procedure. This case highlights the importance of frequent follow-up of these tumours, the high recurrence rate, the severe complications which may result and the awareness of possible variations in this tumour’s histologic appearance.

Should we be concerned about histologic changes caused by novel submucosal injection agents used for EMR and ESD?

Normal saline mixed with dyes is a widely used submucosal lifting agent for endoscopic resection of small gastrointestinal (GI) lesions. For larger GI lesions, novel agents are used to achieve optimal results. ORISE gel is a novel, premixed submucosal lifting solution for endoscopic resection procedures. The initial histologic appearance of endoscopic specimens with injection of ORISE gel is characterized by a pale, basophilic amorphous appearance which has the potential to be misinterpreted as a pathologic finding. The histologic appearance changes overtime to an eosinophilic appearance that is reflected by an inflammatory, foreign body reaction. We summarize the @GIJournal discussion held on May 12, 2021, about the article by Olivas et al “Histologic changes caused injection of a novel submucosal lifting agent for endoscopic resection in GI lesions” 1. The guest experts to discuss pathology included Drs. Emma Furth (EF), and Pallavi Patil (PP), the discussion was moderated by Dr. Dmitriy Kedrin (DK).

A Case of a 4-Year-Old Carbon Baby: Acquired Universal Melanosis and Literature Review

Disorders of color variation can be localized or generalized, congenital or acquired, acute or chronic. Among the various causes of generalized skin darkening encountered in the pediatric age group, acquired universal melanosis aka Carbon Baby Syndrome is an uncommon hypermelanotic condition, with a histologic appearance of extensive epidermal melanization. The authors report one such case of a 4-year old boy with progressive darkening of skin starting at the age of 1 year and involving the entire body surface in the absence of any other systemic alterations. The disease prevalence, etiology, mechanism and prognosis are still unknown.

Lifting Agent Granuloma

Objectives Histologic findings after endoscopic resection using submucosal lifting agents Eleview and ORISE gel are described. Methods Four cases were identified based on the histologic presence of ORISE gel. Cases were selected to illustrate the histologic appearance of the lifting agent immediately after injection (day 0) and after an interval of approximately 2 months. Results Immediately after injection, the gel had an appearance similar to acellular mucin on H&E stain and showed mucicarmine positivity but was negative for periodic acid-Schiff stain and Alcian blue. At 2 months, the appearance changed drastically and was characterized by a hard, homogenous eosinophilic quality and elicited a robust foreign body-type giant cell reaction; we have proposed the name lifting agent granuloma for this histologic appearance. The aged material may be mistaken for amyloid or a pulse (legume) granuloma; however, the material was negative on Congo red stain and had a different clinical history and distribution in the tissue from those of a pulse granuloma. Conclusions It is important to take note of the histologic appearance of these new submucosal lifting agents over a varying time interval, as outlined here, so that they are readily recognized and not mistaken for other entities.

Odontoameloblastoma with extensive chondroid matrix deposition in a guinea pig

Odontoameloblastomas (previously incorporated within ameloblastic odontomas) are matrix-producing odontogenic mixed tumors and are closely related in histologic appearance to the 2 other types of matrix-producing odontogenic mixed tumors: odontomas and ameloblastic fibro-odontomas. The presence or absence of intralesional, induced non-neoplastic tissue must be accounted for in the diagnosis. Herein we describe a naturally occurring odontoameloblastoma with extensive chondroid cementum deposition in a guinea pig ( Cavia porcellus). Microscopically, the mass featured palisading neoplastic odontogenic epithelium closely apposed to ribbons and rings of a pink dental matrix (dentinoid), alongside extensive sheets and aggregates of chondroid cementum. The final diagnosis was an odontoameloblastoma given the abundance of odontogenic epithelium in association with dentinoid but a paucity of pulp ectomesenchyme. Chondroid cementum is an expected anatomical feature of cavies, and its presence within the odontoameloblastoma was interpreted as a response of the ectomesenchyme of the dental follicle to the described neoplasm. Our case illustrates the inductive capabilities of odontoameloblastomas while highlighting species-specific anatomy that has resulted in a histologic appearance unique to cavies and provides imaging and histologic data to aid diagnosis of these challenging lesions.