Nodular Fasciitis of the breast – An uncommon benign reactive proliferative lesion

Nodular fasciitis is rarely reported in breast. It is benign reactive proliferative lesion of fibroblast. A 65 year old female presented to surgical department for left breast mass since 2 months duration, rapidly enlarging without any regional lymphadenopathy. Mammography showed hyperdensity masses with irregular margin. On FNAC reported as benign spindle cell lesion. Left sided two breast masses measuring 4 x 3.3 x 2.5cm and 2.0 x 1.6 x 0.5cm were excised and on histopathology reported as Nodular Fasciitis of left breast. We are presenting this extremely rare case of nodular fasciitis of breast for its clinical, radiological and histopathological findings.

Teat sinus and duct adenomatous hyperplasia in dogs

Seventeen lesions diagnosed as teat sinus and duct adenomatous hyperplasia were identified in 10 dogs. All of the dogs were small breeds. Six were spayed female and 4 were male, 3 castrated and 1 intact. In 5 cases, the lesions involved multiple teats. They were pink to black, flattened to round, and sometimes crusted. Histologically, the lesions were usually pigmented (16/17), plaque-like to nodular masses composed of polygonal cells arranged in anastomosing trabeculae and bilayered ducts and/or cysts, with a fibrous to mucinous (Alcian blue-positive) stroma and squamous cysts (12/17). Scattered epithelial cells contained single, discrete, clear cytoplasmic vacuoles. Atypia was mild, and the mitotic count per 2.37 mm2 varied from 0 to 15 (average 2.7). Immunohistochemistry was performed on 14 of the lesions from 8 dogs. Epithelial cells were 100% panCK+ and included basally located CK14+/CK5_6+/p63+/calponin− cells and nonbasal CK19+/CK7+ cells. Cells manifesting squamous differentiation were usually panCK+/CK14+/CK5_6+/CK19−/CK7−/p63±/calponin−. In addition to fibroblasts, vimentin positivity was found in disseminated, round to stellate stromal and intraepithelial cells that often had black, granular, cytoplasmic pigment (consistent with dendritic/phagocytic cells and/or melanocytes). Of the 8 dogs for which clinical follow-up information was available, all were still alive and well, with no significant teat changes, development of mammary lesions or other masses 4 to 22 months (median 12.5) after biopsy. The histologic, immunohistochemical, and clinical findings were consistent with teat duct and sinus adenomatous hyperplasia. This is an uncommon, benign proliferative lesion that can involve multiple teats of female and male, small breed dogs.

Intravascular Fasciitis of the Jugular Vein Mimicking Thrombosis and Sarcoma: A Case Report

Background: Intravascular fasciitis is a rare disease that is a reactive proliferative lesion of myofibroblasts. There are rare reports that intravascular fasciitis has invaded the jugular vein as seen in this case.Case Presentation: A 41-year-old female presented with right neck dull pain for 20 days. The appearance of the subcutaneous mass was oval, pink hyaline, well-demarcated, and measuring ~5 mm in diameter. Microscopically, the mass was composed of spindle cells arranged in intersecting fascicles. Immunohistochemical stains showed that the spindle cells were positive for smooth muscle actin and negative for S-100, Desmin, MyoD1, and elastin stains. The nuclei of the spindle cells were relatively uniform, and mitotic activity was observed. The overall morphological and immunohistochemical features are consistent with intravascular fasciitis.Conclusion: Due to the rapid growth and vascular invasion, intravascular fasciitis created a high risk of misdiagnosing it as a sarcoma or thrombosis. Reporting this uncommon case, we raise awareness of this non-neoplastic lesion, and careful, light microscopic examination combined with immunohistochemical staining aids in the diagnosis of intravascular fasciitis.

Central giant cell granuloma in the mandibula: clinical, radiological and histopathological study in 2 clinical cases

Central giant cell granuloma (CGCG) is a benign and proliferative lesion of the jaw, with an unknown etiology. It is widely considered to be a neoplastic lesion. The current etiology of GCGC is still unclear, although local inflammation, bleeding, and trauma have been suggested. The biological behavior of CGCG of the jaw varies from resting to aggressive with destructive expansion. The incidence in the general population is very low, and patients are generally under 30 years of age females. In this study, we report two cases of GCGC in 8-year-old and 13 year old girls treated surgically.

Pseudo-Placentational Endometrial Hyperplasia in the Bitch: Case Series

Canine pseudo-placentational endometrial hyperplasia differs from the classical form of cystic endometrial hyperplasia for the well-organized tissue architecture resembling the canine placenta. After the discovery, it has been inconstantly reported. The present work reports the clinicopathological details of six spontaneous cases retrieved retrospectively from a large database. The lesion was found in young non-pregnant female dogs (median 2.0 years) at the end of dioestrus. It could be imaged by ultrasound and was always grossly detectable as single or multiple uterine enlargements of 2–3 cm in diameter with a villous whitish tissue growing on the mucosa and occluding the lumen. Histology confirmed the tissue architecture of the canine placenta with a basal glandular layer, a connective band, a spongy layer and a tortuous and compact labyrinth, often poorly recognizable. The pseudo-placentational hyperplasia is a non-inflammatory proliferative lesion although numerous mast cells inhabit the connective band, and a superimposed inflammatory infiltrate was seen in a case. Canine pseudo-placentational endometrial hyperplasia has very peculiar features, and it is a model for canine placentation and may help to better understand the cystic endometrial hyperplasia/pyometra complex.

Classical Lobular Carcinoma In Situ Arising From an Intraductal Papilloma of the Breast: A Case Report

Intraductal papilloma of the breast is a benign, mass-forming, proliferative lesion with a papillary architecture confined within a duct. Lobular neoplasia can rarely arise from an intraductal papilloma of the breast. In this article, we report the morphologic features of a rare case of classical LCIS (lobular carcinoma in situ) arising from an intraductal papilloma in a 76-year-old woman. The monomorphic dyscohesive cells were present between the myoepithelial and luminal epithelial layer in the periphery of the papilloma. These cells partially obliterated the spaces between the papillae forming solid sheets. The monomorphic dyscohesive cells showed lack of E-cadherin expression and uniform staining for estrogen receptor. We review the histologic differential diagnosis and stress the importance of correct classification to ensure optimal care for patients. We also propose a new criterion for the distinction of lobular neoplasia within a papilloma.

Using Deep Learning Artificial Intelligence Algorithms to Verify N-Nitroso-N-Methylurea and Urethane Positive Control Proliferative Changes in Tg-RasH2 Mouse Carcinogenicity Studies

In Tg-rasH2 carcinogenicity mouse models, a positive control group is treated with a carcinogen such as urethane or N-nitroso-N-methylurea to test study validity based on the presence of the expected proliferative lesions in the transgenic mice. We hypothesized that artificial intelligence–based deep learning (DL) could provide decision support for the toxicologic pathologist by screening for the proliferative changes, verifying the expected pattern for the positive control groups. Whole slide images (WSIs) of the lungs, thymus, and stomach from positive control groups were used for supervised training of a convolutional neural network (CNN). A single pathologist annotated WSIs of normal and abnormal tissue regions for training the CNN-based supervised classifier using INHAND criteria. The algorithm was evaluated using a subset of tissue regions that were not used for training and then additional tissues were evaluated blindly by 2 independent pathologists. A binary output (proliferative classes present or not) from the pathologists was compared to that of the CNN classifier. The CNN model grouped proliferative lesion positive and negative animals at high concordance with the pathologists. This process simulated a workflow for review of these studies, whereby a DL algorithm could provide decision support for the pathologists in a nonclinical study.

Outcomes of surgery for giant cell tumors of the tendon sheath within the hand.

Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterised by relatively high recurrence rate after surgery. The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumours, in a long-term (a mean of 4,2 year) follow-up. Patients and methods. Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated on), at a mean of 4,2 year follow-up. The final assessment was performed in a form of phone interview. Results. The tumours most frequently were located in fingers - 42 cases (72%). In 31 patients (53%) the lesion had well-defined capsule, and in 11 (19%) a satellite nodules were found around the main tumour. A total of 9 relapses (21%) occurred, all within first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with the recurrence, the primary lesion had not well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained from mild pain of the scar and/or numbness of the part of the involved finger. Conclusions. The main factor influencing the high rate of recurrence was incomplete tumour excision, what resulted from inadequately accurate surgery and the tumour morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping greater surgical margin at resection of the non-capsulated lesions was emphasised, what may translate into reducing of the recurrence rate.

Etiology and Management of Inflammatory Papillary Hyperplasia in Completely Edentulous Patients - A Review

Oral mucosa of complete denture wearing patients is subjected to varying amount of stresses as compared to patient having natural teeth. This can leads to different type of oral mucosal lesions like denture stomatitis, epulis fissuratum, angular cheilitis, traumatic ulcers, inflammatory papillary hyperplasia (IPH) etc. IPH is a type of chronic inflammatory proliferative lesion characterized by numerous small, wart like edematous red papillary growth most commonly seen in deepest part of the palate. Review of literature suggest denture associated widely distributed etiology for IPH like over accentuation of palatal relief and vacuum chamber in upper denture, old ill fitting dentures, poor denture hygiene, continuous denture wearing habit, faulty occlusion, skidding of instable denture etc. Treatment for IPH varies with the severity of the condition and may range from conservative to surgical depending on clinical presentation. Conservative approach include discontinuing use of ill fitting denture, correction of faulty prostheses, improving the oral and denture hygiene and antifungal drugs. However, the surgical approach is used when the lesion is more aggressive and this include supraperiosteal excision, resesctive surgery, cryotherapy, and electrosurgery, blade-loop surgery, fulguration, and mucoabrasion or laser surgery. As a method of prevention patient should be advised to avoid continuous day and night wearing of denture. Additionally, avoid providing excessive relief in the palatal region, as these areas become site for bacterial and fungal colonization. Patients should be well motivated for proper care and maintenance of denture hygiene and also for the importance of periodic dental visits and follow-ups.