The most common mesenchymal tumors of the gastrointestinal tract are gastrointestinal stromal tumors (GIST) and smooth muscle neoplasms; however, other soft tissue tumors may also present in the intestines and cause diagnostic dilemmas. We report the case of a 27-year old primigravid, with no known complications, who underwent cesarean section for cephalopelvic disproportion. Intraoperatively, a well-demarcated, solid mass measuring 1.5 x 1.0 x 0.7 cm was noted at the jejunum. The patient underwent segmental resection of the mass. Microscopic examination of the mass reveals a non-encapsulated, solid mass composed of bland spindle cells and dense, hyalinized collagen in whorls and bundles. Dystrophic calcifications and a lymphoplasmacytic inflammatory infiltrate are seen within the collagen bundles. Immunohistochemical staining with desmin, CD117, and DOG-1 was done, which are all negative. The case was signed out as calcifying fibrous tumor (CFT). Inclusion of CFTs in the differential diagnoses for mesenchymal tumors of the gastrointestinal tract is important, as these neoplasms are benign and have an excellent prognosis.
Jejunum ; Neoplasms

This is the case of a 37-year-old female patient presenting with a 10-year history of a gradually enlarging right infra-auricular mass. A parotidectomy was performed. The surgical pathology specimen consisted of an 18 cm diameter encapsulated nodular mass with a homogenous, cream-tan solid surface. Microscopic section showed an encapsulated neoplasm with abundant chondromyxoid stroma and tubular epithelial elements characteristic of a pleomorphic adenoma. (Figure 1) Randomly scattered within the tumor were foci of haphazard and complex glands. (Figure 2) These glands exhibited nuclear pleomorphism, luminal necrosis, and mitoses compatible with an adenocarcinomatous proliferation. (Figure 3) Based on these features, the case was signed out as an intracapsular carcinoma ex pleomorphic adenoma.

Carcinoma ex pleomorphic adenoma is a carcinoma arising from a pre-existing pleomorphic adenoma. The antecedent benign tumor may either be a long-standing one, often with a history measured in decades, or characterized by a protracted history of excisions and multiple recurrences.1,2 The carcinoma on the other hand is either epithelial or myoepithelial in derivation. By morphologic sub-type, the most commonly reported carcinoma arising in a pleomorphic adenoma is a salivary duct carcinoma or an adenocarcinoma that is not otherwise specified (NOS).1,3 Residual pleomorphic adenoma tissue is identifiable either in its typical morphology, a chondromyxoid stroma, or a hyalinized sclerotic nodule.1

Aside from the type of carcinoma arising from the pleomorphic adenoma, another parameter that has to be reported is the extent of involvement by the carcinomatous component. A carcinoma that is entirely limited to within the parent tumor that is still enclosed by a complete capsule is termed an "intracapsular" or "non-invasive" carcinoma ex pleomorphic adenoma.1,2 Once the carcinoma breaches the capsule and infiltrates the surrounding tissue, then it is considered invasive. If the invasion is less than 4 - 6 mm beyond the capsular border, the tumor is termed "minimally invasive". Carcinomatous elements that extend beyond this threshold is termed "widely invasive".1 This threshold is greater than the previous threshold of 1.5 mm recommended in an earlier edition of the WHO classification although the present edition does state that this threshold is preliminary and requires further validation.1,2,4 It has to be pointed out though that quantifying invasion may not always be possible in tumors that have positive margins, those that are intrinsically unencapsulated such as minor salivary gland tumors, and those with complex multinodular growth patterns such as in recurrent pleomorphic adenoma.1 This difficulty has to be stated in the report and what conditions preclude quantifying the degree of invasion.

Non-invasive carcinoma ex pleomorphic adenoma has quite a good outcome with very low reported rates of recurrence or regional metastasis. In a review of thirty cases and a report of an additional three cases, only one case showed recurrence or metastasis.3 This favorable outcome certainly contrasts with that of the widely invasive type where metastasis is reported to occur in up to 70% of cases.1 Another review of ten cases showed one case developing metastasis, and recommended that non-invasive cases should thus still be followed up closely after primary treatment because regional or distant metastasis can occur.2

To the best of our knowledge, there are no published local data on the incidence of early malignant transformation of pleomorphic adenomas in the Filipino population. Hence, we take this opportunity to report this case. Awareness of the entity and prudent liberal sampling of these tumors may help address this gap.

 

Human ; Carcinoma ; Adenoma ; Neoplasms

Introduction: A size of more than 10 cm suggests that a soft tissue tumor might be malignant. Pertinent ancillary diagnostic testing, such as immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), may be done to confirm the diagnosis. Several studies have shown that size may be a useful criterion in determining which tumors are candidates for further molecular testing. MDM2 and p16 are IHC markers for atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS). Objectives: The primary objective of this study is to determine the proportion of tumors signed out as “lipomas” from 2017 to 2019, and measuring at least 10 cm, that express MDM2 and p16 on IHC and warrant revision as ALT/WDLPS. Methodology: This is a descriptive, retrospective cohort study in which all lipomas from 2017 to 2019 that measured at least 10 cm were included. The size, age of the patient, and location of each tumor were documented. The slides of all eligible cases were reviewed and immunohistochemically stained for MDM2 and p16. For each case, the intensity and immunoreactivity of each stain were assessed using a modified, four-tier scoring system. Fisher’s exact test was used to determine if a significant number of tumors expressed MDM2 or p16. Results: Thirty (30) cases satisfied the inclusion and exclusion criteria. The average size of these tumors is 15.10 cm. There is no sex predilection. The most common location of these tumors is the extremities. None of the tumors expressed MDM2, and only one case was p16-positive. The case positive for p16 also showed cytologic atypia and variability in cell size, resulting in the revision of its diagnosis from lipoma to atypical lipomatous tumor. The rate of diagnosis revision after slide review and IHC studies is 3.33%. Conclusion None of the adipocytic tumors that measured at least 10 cm in diameter and were signed out as lipomas was MDM2 positive, and only one case was p16-positive. Thus, morphology remains the cornerstone in the diagnosis of adipocytic tumors. Careful microscopic evaluation is necessary to establish the diagnosis of malignancy in these tumors. Ancillary tests should only be considered in cases where the pathologic features are equivocal.
Neoplasms ; Adipose Tissue ; Lipoma ; Extremities

Objectives: To determine the overall diagnostic yield of bronchoscopy-guided sampling methods in detecting lung cancer at the University of the Philippines, Philippine General Hospital. The diagnostic yield, equivalent to sensitivity, is defined as the number of bronchoscopic sampling or biopsy procedures with a diagnosis of malignancy divided by the total number of confirmed malignant cases. Methods: This is a cross-sectional, retrospective sensitivity study involving bronchoscopy procedures from January 2014 to December 2018. Surgical Pathology and Cytology Reports of eligible cases were accessed through the institutional Laboratory Information System. Sensitive patient information was omitted, and each case was assigned a unique code. The overall diagnostic yield/sensitivity of bronchoscopy and the diagnostic yield/sensitivity of each technique were calculated. Results: A total of 100 patients satisfied the inclusion and exclusion criteria. Primary lung malignancies are more common in males and the elderly. The most common primary lung cancer is adenocarcinoma (33%). Bronchoscopy, regardless of whether single or multiple techniques were used, has a diagnostic yield of 86% (CI: 77.6-92.1%). Of the individual techniques, those that obtain solid tissues (endobronchial and transbronchial biopsies; 88.2% [CI: 78.1-94.8%] and 80.0% [CI: 28.4-99.5%], respectively) have higher yields compared to techniques that obtain cytologic samples (bronchial washing and brushing; 54.2% [43.7-64.4%] and 70.1% [58.6-80%], respectively). Conclusion Bronchoscopy, as a diagnostic procedure for pulmonary malignancies, has relatively high sensitivity and may be used for lesions located centrally and can be inspected visually. A multidisciplinary approach to patient selection for bronchoscopy helps improve the utility of the various bronchoscopic techniques.
Lung Neoplasms ; Bronchoscopy ; Cytodiagnosis ; Pathology, Surgical