Zoon Balanitis and Lichen Sclerosus: An Uncommon Association

Zoon balanitis and lichen sclerosus are both chronic inflammatory disorders of the genital mucosa that usually affect middle-aged or elderly uncircumcised men.Although the precise etiology of Zoon balanitis is still unclear, a pathogenic role of irritant and mechanical factors has been suggested. Therefore, foreskin sclerosis and phimosis caused by male genital lichen sclerosus may trigger the development of Zoon balanitis. However, until the present, only three cases with clinical and histopathologic features consistent with synchronous presentation of both disorders have been described. We report the case of a 70-year-old male who developed Zoon balanitis in association with lichen sclerosus, that cleared only after circumcision.

Histopathologic Findings Associated With Matrix Metalloproteinases Proceeding to Recurrence of Primary Spontaneous Pneumothorax in Adolescents

Background: Primary spontaneous pneumothorax is potentially life-threatening, and its recurrence is always a serious problem. Pathological examination provides molecular insights into the pathophysiology of primary spontaneous pneumothorax.Objectives: To investigate the association of histopathologic features of primary spontaneous pneumothorax with matrix metalloproteinase expression and their relevance to the recurrence.Methods: A total of 217 tissue section slides in 172 adolescent patients with primary spontaneous pneumothorax were retrospectively reviewed from January 2001 to June 2020. All histopathologic features were recorded and pathologic findings related to ipsilateral recurrence and second surgery were analyzed. Serum levels of matrix metalloproteinases were prospectively measured in 25 primary spontaneous pneumothorax patients receiving surgery and 18 healthy controls. Their relevance to the histopathologic features of primary spontaneous pneumothorax related to its recurrence was also examined.Results: The major presenting histopathologic findings of primary spontaneous pneumothorax were bleb/bulla (98%) followed by fibrosis (68%). Low prevalence of the pathologic findings of granulation tissue and macrophage accumulation were significantly associated with recurrent primary spontaneous pneumothorax, whereas fibrosis was significantly higher in patients receiving more than once surgery. Furthermore, the ratios of matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-1 and matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 were significantly higher in theses pathological findings as well as multinucleated giant cells and mesothelial cell hyperplasia in comparison with healthy controls.Conclusions: Low prevalence of macrophage accumulation and granulation tissue related to the overexpression of matrix metalloproteinase-2 and−9 activities may contribute to healing impairment and primary spontaneous pneumothorax recurrence.

Pregnancy-associated breast cancer: the influence of gestational age

Whether PABC tumors arise before or during pregnancy and whether histopathology is affected by gestational age is currently unclear. The present study assesses the influence of gestational age and lactation on the histopathologic profile of PABC. We identified 744 patients with PABC (defined as breast cancer during pregnancy or 6-months following delivery). Histopathologic features were compared between pregnant and postpartum patients. Median age at diagnosis was 34.2 years and majority of cancers were diagnosed during pregnancy (71.3%). Within pregnant patients, tumors were significantly more often ER-negative in second and third trimesters (57.4%), as compared to first trimesters (41.9%) (p=0.036). Similarly, a PR-negative status was reported significantly less often within first trimesters (38.0%) compared to second and third trimesters (57.1%) (p=0.032). For HER2 status no significant differences were observed between gestational trimesters or lactating versus non-lactating patients. In postpartum patients, grade III tumors were found in over 80%, with high percentages of ER-negative tumors reaching 63% in those lactating versus 49% in non-lactating patients. This study demonstrates the varying histopathologic profile of PABC by gestational age and lactation status. Second and third trimester cancers display most typically the common ER/PR-negative phenotype, which is commonly reported in literature. The increased ER-negative status and percentage grade III tumors in lactating versus non-lactating patients also suggest presence of additional factors further diversify histology. This indicates the need for clear definitions of PABC and the role of potential subgroups, which may provide a stepping stone for further in-depth research into PABC-carcinogenesis.

Pitfalls in the Histopathologic Diagnosis of Meningioma: Report of Three Rare Variants of Meningioma and Literature Review

Meningioma is a common primary tumor of the central nervous system and one of the most encountered brain tumors. Although classic histopathologic features of meningioma are relatively common and make its diagnosis straightforward, certain variants possess unusual histologic features causing diagnostic challenges. We reported three cases of clear cell meningioma, microcytic meningioma, and angiomatous meningioma report, variants with potential deceptive morphologies, and discuss their distinguishing morphologic features.