M Aziz, MD
New York Medical College, Pathology, Alumnus
- Professor of Pathology-Senior surgical pathologist USA
President, Research Writing & Publication (RWP), LLCedit
Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, which includes both benign and malignant forms. Gestational trophoblastic neoplasia (GTN) includes both benign and malignant tumors of gestational trophoblasts.... more
Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, which includes both benign and malignant forms. Gestational trophoblastic neoplasia (GTN) includes both benign and malignant tumors of gestational trophoblasts. Placental site trophoblastic disease (PSTT) is a rare and potentially aggressive neoplasm originating from placental intermediate trophoblastic cells (ITC) at the implantation site. PSTT represents an abnormal proliferation of ITCs, which are involved in the embryo's implantation and the placenta's formation. ITCs are different from Cytotrophoblasts (CT) and syncytiotrophoblasts (ST). CTs are villous stem cells with high mitotic activity, while the STs, another villous cell, synthesize the human chorionic gonadotropin (hCG) and form the chorionic villi. The extravillous ITCs have features of the other two cells and are responsible for endometrial invasion and implantation. A 32-year-old female presented with symptoms indicative of a PSTT. Following a thorough diagnostic workup, including imaging and histopathological examination, the diagnosis of a localized PSTT was confirmed. Given the patient's desire for future fertility, a fertility-preserving approach was prioritized. She underwent a localized surgical procedure to excise the tumor while maintaining the integrity of her reproductive organs. Postoperative monitoring showed no evidence of residual disease or metastasis. This case highlights the feasibility and success of fertility-preserving surgery in the management of localized PSTT, emphasizing the importance of individualized treatment planning to balance oncologic control with fertility preservation.
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Telangiectatic osteosarcoma (TOS) is a rare and aggressive subtype of osteosarcoma, accounting for less than 10% of all osteosarcomas. Extensive blood-filled spaces characterize it and present a diagnostic challenge due to its... more
Telangiectatic osteosarcoma (TOS) is a rare and aggressive subtype of osteosarcoma, accounting for less than 10% of all osteosarcomas. Extensive blood-filled spaces characterize it and present a diagnostic challenge due to its radiographic similarities with aneurysmal bone cysts and other benign and malignant vascular lesions. Herein, we report a case of TOS in a 12-year-old girl, highlighting the clinical, radiological, and pathological features.
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Breast fibromatosis (BF) is a rare, low-grade infiltrative spindle cell neoplasm from the breast connective tissue composed of fibroblasts and myofibroblasts. It is benign but has locally aggressive proliferation within the breast. It... more
Breast fibromatosis (BF) is a rare, low-grade infiltrative spindle cell neoplasm from the breast connective tissue composed of fibroblasts and myofibroblasts. It is benign but has locally aggressive proliferation within the breast. It accounts for less than 0.2% of all breast tumors. Clinically, it often presents as a firm, painless, and immobile mass, which can be mistaken for malignancy due to its infiltrative growth pattern. In breast pathology, distinguishing between various conditions is crucial for effective diagnosis and appropriate treatment. Two such conditions that are often confused are BF and breast desmoid tumor (BDT). While they may share similarities, understanding their differences is essential for accurate medical management. BF arises from the fibrous connective tissue within the breast. However, BDT originates from deep fascial planes within the breast and exhibits an infiltrative growth pattern into surrounding tissues, analogous to soft tissue desmoids elsewhere in the body. It is generally accepted to consider BDT a more infiltrating form of BF. We present a case of a 38-year-old woman diagnosed with BF, and we review the relevant literature.
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Radiation-induced angiosarcoma (RIAS) of the breast is a rare aggressive malignancy following radiotherapy for the treatment of a previous breast condition. We present a case of a 49-year-old female who developed RIAS after treatment of... more
Radiation-induced angiosarcoma (RIAS) of the breast is a rare aggressive malignancy following radiotherapy for the treatment of a previous breast condition. We present a case of a 49-year-old female who developed RIAS after treatment of breast ductal carcinoma by lumpectomy and postoperative radiation. The RIAS developed at the site of the prior breast carcinoma. The diagnosis of RIAS was challenging and required extensive immunohistochemistry (IHC) studies to rule out all other possible differential diagnoses, including benign and malignant conditions. The patient underwent a total mastectomy as the primary surgical intervention, followed by a regimen of postoperative chemotherapy to target any residual cancer cells and reduce the risk of recurrence. After three years of rigorous follow-up, the patient remains free of disease, showcasing the effectiveness of the combined surgical and chemotherapeutic approach in managing this challenging tumor. This case underscores the importance of vigilant long-term monitoring and a multidisciplinary treatment strategy in improving outcomes for patients with post-radiation breast angiosarcoma.
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Pseudoangiomatous Stromal Hyperplasia (PASH) is a rare, benign proliferative condition of the breast stroma that can mimic more serious vascular lesions. Accurate diagnosis is critical to avoid unnecessary aggressive treatments. This case... more
Pseudoangiomatous Stromal Hyperplasia (PASH) is a rare, benign proliferative condition of the breast stroma that can mimic more serious vascular lesions. Accurate diagnosis is critical to avoid unnecessary aggressive treatments. This case report highlights the clinical presentation, differential diagnosis, and the importance of detailed immunohistochemistry (IHC) studies in differentiating PASH from vascular lesions.
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Gastrointestinal clear cell sarcoma (GICCS) is a rare and aggressive tumor that primarily affects the digestive system. When comparing soft parts' conventional clear cell sarcoma (CCS) to GICCS, there have been notably fewer instances of... more
Gastrointestinal clear cell sarcoma (GICCS) is a rare and aggressive tumor that primarily affects the digestive system. When comparing soft parts' conventional clear cell sarcoma (CCS) to GICCS, there have been notably fewer instances of CCS emerging in the gastrointestinal tract. We describe a case of a 28-year-old man who presented with a large abdominal mass and liver metastasis. Diagnosing this case was initially difficult and challenging, but with the appropriate application of immunohistochemistry (IHC) and molecular studies, the correct diagnosis of GICCS was rendered. Literature review shows that other terms are used to describe GICCS, including clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLGT), gastrointestinal neuroectodermal tumor (GNET), and gastrointestinal clear cell sarcoma/gastrointestinal neuroectodermal tumor GICCS/GNET. It is frequently difficult to determine if cases reported represent one or the other of these tumors due to their similarities, and it has been debated whether they could represent variations of the same entity, which we believe is the case. In this report, we will refer to gastrointestinal clear cell sarcoma as "CCSLGT," distinct from conventional clear cell sarcoma in other body sites. We discuss and clarify the nomenclatures used to describe this type of sarcoma. We also present the unique presentation, diagnostic evaluation, and treatment approach of a patient diagnosed with gastrointestinal clear cell sarcoma. Through a review of the literature, this report highlights the challenges in diagnosing this rare tumor and the importance of considering it in the differential diagnosis of gastrointestinal malignancies.
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A granular cell tumor (GCT) is a rare neoplasm that can occur in various body parts, including the axillary region. This case report provides an overview of a 22-year-old man who initially presented with an axillary mass and later... more
A granular cell tumor (GCT) is a rare neoplasm that can occur in various body parts, including the axillary region. This case report provides an overview of a 22-year-old man who initially presented with an axillary mass and later received a diagnosis of a granular cell tumor. The mass was originally suspected of having a lymphoproliferative process, among other types of tumors. The report discusses the clinical presentation, imaging findings, histopathological characteristics, and treatment approach for this condition. Radiologically and pathologically, GCT can mimic other benign or malignant neoplasms. An accurate diagnosis is vital for proper treatment. This report emphasizes the importance of including GCT in the differential diagnosis of axillary masses, as well as the need for thorough diagnostic evaluation to ensure appropriate management and optimal outcomes for patients with this rare entity.
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Soft tissue chondromas (STCs) are benign cartilaginous tumors that usually develop in the soft tissues rather than the bone. Both soft tissue chondromas and enchondromas (ECs) are benign cartilaginous tumors, and while these terms may... more
Soft tissue chondromas (STCs) are benign cartilaginous tumors that usually develop in the soft tissues rather than the bone. Both soft tissue chondromas and enchondromas (ECs) are benign cartilaginous tumors, and while these terms may seem interchangeable, there are subtle differences between the two entities that can greatly impact diagnosis and treatment options. ECs primarily occur within the medullary canal of long bones or the small bones of the hands or feet. Conversely, STCs typically originate from soft tissues like tendons, ligaments, or joint capsules, without any connection to the underlying bone. Histopathological examination establishes a definitive diagnosis by revealing mature hyaline cartilage with characteristic
chondrocytes. A surgical excision aims to completely remove the condition to prevent its recurrence. Awareness and accurate diagnosis of soft tissue chondroma are crucial for effective management and favorable outcomes. We report a case of soft tissue chondroma involving the left foot of a 49-year-old man, and we briefly review the relevant literature.
chondrocytes. A surgical excision aims to completely remove the condition to prevent its recurrence. Awareness and accurate diagnosis of soft tissue chondroma are crucial for effective management and favorable outcomes. We report a case of soft tissue chondroma involving the left foot of a 49-year-old man, and we briefly review the relevant literature.
Chondroid lipoma (CL) is a rare soft tissue tumor that usually occurs in middle-aged adults and is slightly more common in women. It is characterized by well-circumscribed groups of mature adipocytes of fatty tissue associated with... more
Chondroid lipoma (CL) is a rare soft tissue tumor that usually occurs in middle-aged adults and is slightly more common in women. It is characterized by well-circumscribed groups of mature adipocytes of fatty tissue associated with islands of the chondromyxoid matrix but not mature chondrocytes. Clinically, CL appears as a slowly growing, painless mass in the extremities, especially the back and neck. CL must be distinguished from chondrolipoma (CLP), another benign lipoma characterized by mature adipocytes and chondrocytes. Immunohistochemistry (IHC) studies are often positive for S-100 protein and vimentin and are useful in differentiating CL from other tumors with similar histomorphology. The presence of mixed lipomatous and chondroid matrix tissue makes CL a challenging diagnosis and can be misdiagnosed as other benign or malignant tumors, and the patient does not receive the appropriate management. Although benign, an accurate diagnosis and successful surgery are required to prevent recurrence and ensure the patient has a good outcome. We present the case of a 31-year-old woman who presented with a large left shoulder soft tissue mass. The mass was suspicious for sarcoma, but with the appropriate use of IHC and molecular studies, the diagnosis of chondroid lipoma was rendered, and the patient received the proper treatment.
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Microglandular adenosis (MGA) is a benign breast tumor, but it is considered a non-obligate precursor to invasive breast carcinoma. MGA has a few different morphological variations, including microglandular adenosis (MGA), atypical... more
Microglandular adenosis (MGA) is a benign breast tumor, but it is considered a non-obligate precursor to invasive breast carcinoma. MGA has a few different morphological variations, including microglandular adenosis (MGA), atypical microglandular adenosis (AMGA), and breast carcinoma-associated microglandular adenosis (BCMGA). Initially, with the identification of MGA, it was classified as a benign lesion; however, recent molecular studies have demonstrated an association between MGA, AMGA, and BCMGA. As a precancerous tumor, a definitive diagnosis of MGA is essential, including reporting the degree of atypia if present. We present the case of a 39-year-old woman whose routine mammogram revealed an irregular density, leading to her diagnosis of AMGA. We provide a brief review of the pertinent literature, including diagnosis, differential diagnosis, molecular studies, management, and outcome of MGA.
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Less than 2% of all uterine tumors are endometrial stromal tumors (ESTs), which are uncommon malignancies of endometrial stromal origin. Our understanding of ESTs has increased, and recent developments in cytogenetics and molecular... more
Less than 2% of all uterine tumors are endometrial stromal tumors (ESTs), which are uncommon malignancies of endometrial stromal origin. Our understanding of ESTs has increased, and recent developments in cytogenetics and molecular biology have helped to clarify and organize their classification into more useful categories. As a result, endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma (HGESS), and undifferentiated uterine sarcoma (UUS) are the four categories recognized by the latest published 2014 WHO tumor classification system. These tumors can exhibit complicated cytogenetic abnormalities without specific rearrangements (as in UUSs) or a relatively simple karyotype with a defining chromosomal rearrangement (like in most ESNs, LGESSs, and YWHAE-rearranged HGESS) at the molecular level. Seldom does low-grade endometrial stromal sarcoma (LGESS) exhibit high-grade histologic transformation or show combined low-grade and high-grade morphologic characteristics. We report a case of a 47-year-old lady who had a benign uterine tumor removed. She experienced a uterine mass seven years later, which was eventually diagnosed as an endometrial stromal tumor with mixed features of high-and low-grade endometrial sarcoma. We also provide a brief overview of relevant literature.
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Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive type of sarcoma with a poor prognosis commonly affecting children and young adults. This is a relatively recently identified type of sarcoma with a challenging diagnosis... more
Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive type of sarcoma with a poor prognosis commonly affecting children and young adults. This is a relatively recently identified type of sarcoma with a challenging diagnosis requiring demonstration of the expected cytogenetic abnormality of reciprocal translocation t (11; 22) (q13; q12) that fuses the Ewing's sarcoma gene on chromosome 22 to the Wilms' tumor gene on chromosome 11. DSRCT is rare, and due to the limited literature on this tumor, the diagnosis can be extremely challenging without identifying this cytogenetic abnormality. Here, we present a case of a 28-year-old man who presented with marked abdominal pain and distension. After pathological examination, the tumor was diagnosed as a DSRCT of the abdominal peritoneum. We add a case to this tumor's limited literature and briefly review the pertinent literature.
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Breast invasive apocrine carcinoma (IAC) is a rare type of breast carcinoma with a frequency of only three or four instances per million women. The literature has contradicting information regarding the prognosis of invasive apocrine... more
Breast invasive apocrine carcinoma (IAC) is a rare type of breast carcinoma with a frequency of only three or four instances per million women. The literature has contradicting information regarding the prognosis of invasive apocrine carcinoma (IAC), which the tumors' inconsistent classification may cause. These days, standard variables such as nodal status, tumor size, and grade dictate the prognosis of IAC. Targeted androgenic therapy (AT) treatment is growing, and clinical trials have shown encouraging outcomes. Apocrine changes are common in many breast lesions, including benign and malignant neoplasms. It is vital to be aware of this rare breast carcinoma and differentiate it from other benign breast conditions with apocrine changes. We report a case of a 69-year-old woman with breast IAC. We also review the literature on this rare tumor, including presentation, differential diagnosis, immunohistochemistry (IHC) studies, management, and prognosis.
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Ewing sarcoma (EWS) is an uncommon malignancy of the family of small blue round-cell tumors, with several known translocations involving EWSR1 and the ETS family transcription factors. EWS occurs in bone and soft tissue but rarely in... more
Ewing sarcoma (EWS) is an uncommon malignancy of the family of small blue round-cell tumors, with several known translocations involving EWSR1 and the ETS family transcription factors. EWS occurs in bone and soft tissue but rarely in skin. Radiological imaging and clinical presentation are not specific enough to conclude the diagnosis of extraskeletal cutaneous Ewing's sarcoma (CES). In a few small studies, there have been reports of better CES prognoses than other EWS types. Tissue sampling (tissue biopsy or aspiration cytology) and enough immunohistochemistry (IHC) and translocation molecular genetic studies must be done together to make a final diagnosis. We present a case of a 73-year-old female who presented with a cutaneous cheek lesion that was initially misdiagnosed as a benign adnexal tumor. IHC and cytogenetic tests eventually confirmed the tumor's diagnosis of CES after two recurrences. The definitive diagnosis was based solely on fine needle aspiration (FNA) material.
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Diffuse Mesothelioma (DM) is an uncommon, aggressive malignant tumor of the mesothelial cells of the pleura, peritoneum, pericardium, and testicular tunica vaginalis. DM is historically associated with occupational asbestos exposure, and... more
Diffuse Mesothelioma (DM) is an uncommon, aggressive malignant tumor of the mesothelial cells of the pleura, peritoneum, pericardium, and testicular tunica vaginalis. DM is historically associated with occupational asbestos exposure, and the latent period can be up to 40 years or more. The main histological types of DM are diffuse epithelioid Mesothelioma (DEM), diffuse sarcomatoid Mesothelioma (DSM), and diffuse biphasic Mesothelioma (DBM). According to the 2021 WHO classification of tumors of the pleura, the presence of >10% of each of the epithelioid and sarcomatoid patterns in definitive resection specimens or any percentage of each component in small biopsy and cytology specimens is sufficient to make the diagnosis of diffuse biphasic Mesothelioma (DBM). However, a definitive diagnosis of DBM in small tissue samples can be challenging and lead to an incorrect diagnosis. Considering the legal impact of a diagnosis of DM, optimal diagnosis requires a comprehensive panel of immunohistochemistry (IHC) studies and confirmatory molecular testing. We report a case of a 69-year-old woman with a history of asbestos exposure who presented with multiple pleural, pericardial, and peritoneal plaques and was initially misdiagnosed as sarcomatoid carcinoma. A comprehensive panel of IHC studies and molecular testing confirmed the diagnosis of DBM.
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Correctly diagnosing and communicating results to patients is one of the most effective ways to ensure proper patient care and maximize effective treatment strategies. When nomenclature contradicts, it can create confusion and barriers... more
Correctly diagnosing and communicating results to patients is one of the most effective ways to ensure proper patient care and maximize effective treatment strategies. When nomenclature contradicts, it can create confusion and barriers between patients and physicians. One example is the diagnosis of a glomus tumor (GT), which has also been referred to as a paraganglioma (PG). However, a glomus tumor is not a paraganglioma and awareness of this distinction is essential. The case we present is a 25-year-old female who presented with a painful left shoulder mass. The mass was surgically excised, and the pathological examination diagnosed it as a glomus tumor. We review the literature regarding this tumor and clarify the distinction between glomus tumor and paraganglioma.
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Synovial sarcoma (SS) is an uncommon tumor of the soft tissue. The etiology of this tumor is mainly unknown. The name "synovial sarcoma" is misleading, as it has no connection with the synovium despite occurring mostly juxta-articular.... more
Synovial sarcoma (SS) is an uncommon tumor of the soft tissue. The etiology of this tumor is mainly unknown. The name "synovial sarcoma" is misleading, as it has no connection with the synovium despite occurring mostly juxta-articular. The tumor does not arise from or differentiate toward synovium. Due to the rarity of SS, a definitive diagnosis can be challenging. One variant of SS is biphasic synovial sarcoma (BSS). This type of SS displays a dual-cell population, which can lead to incorrect diagnosis when sampling is inadequate. We present a case of a 12-year-old boy who presented with biphasic synovial sarcoma confirmed by molecular testing and misdiagnosed as a malignant adnexal skin tumor. BSS is uncommon and can be confused with other benign and malignant soft tissue tumors. A correct diagnosis of SS is significant as early studies of the utility of targeted medicine and T cell receptor-based immunotherapy are promising for clinical use. We also reviewed the pertinent literature, including differential diagnosis, pathology, recent immunohistochemical and genetic findings, management, and prognosis.
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Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) are the most common types of invasive breast carcinoma. However, there are several cases where both ductal and lobular characteristic features are present in the same... more
Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) are the most common types of invasive breast carcinoma. However, there are several cases where both ductal and lobular characteristic features are
present in the same tumor. These types of mixed tumors are referred to as invasive mixed ductal lobular carcinoma (mDLC). Mixed ductal lobular carcinoma represents a unique clinical entity that integrates certain
attributes from both lobular and ductal breast carcinoma. Mucinous breast carcinoma is an uncommon type defined as pure mucinous carcinoma (PMC) when it shows at least 90% mucinous component and mixed
mucinous carcinoma (MMC) when it shows less than 50% mucinous component. The categorization of invasive breast cancer into discrete subtypes based on tumor histology holds specific importance for diagnostic and prognostic considerations. This report details a case of invasive mixed ductal lobular carcinoma in a 42-year-old woman, notable for the absence of a mucinous component in the primary tumors. At the same time, two out of nine positive axillary lymph nodes exhibit characteristics consistent with mucinous carcinoma. We review the
relevant literature and attempt to understand the mechanisms behind the phenomenon of the changing features of a metastatic tumor from the primary tumor.
present in the same tumor. These types of mixed tumors are referred to as invasive mixed ductal lobular carcinoma (mDLC). Mixed ductal lobular carcinoma represents a unique clinical entity that integrates certain
attributes from both lobular and ductal breast carcinoma. Mucinous breast carcinoma is an uncommon type defined as pure mucinous carcinoma (PMC) when it shows at least 90% mucinous component and mixed
mucinous carcinoma (MMC) when it shows less than 50% mucinous component. The categorization of invasive breast cancer into discrete subtypes based on tumor histology holds specific importance for diagnostic and prognostic considerations. This report details a case of invasive mixed ductal lobular carcinoma in a 42-year-old woman, notable for the absence of a mucinous component in the primary tumors. At the same time, two out of nine positive axillary lymph nodes exhibit characteristics consistent with mucinous carcinoma. We review the
relevant literature and attempt to understand the mechanisms behind the phenomenon of the changing features of a metastatic tumor from the primary tumor.
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Synovial chondromatosis (SC) is a rare, locally aggressive, benign tumor that presents as a lobulated bundle of hyaline cartilaginous nodules in the joint spaces, sub-synovial tissue, or tenosynovium. SC mainly affects large... more
Synovial chondromatosis (SC) is a rare, locally aggressive, benign tumor that presents as a lobulated bundle of hyaline cartilaginous nodules in the joint spaces, sub-synovial tissue, or tenosynovium. SC mainly affects large joints, particularly the knee joint. Although malignant transformation of SC to chondrosarcoma (CS) is possible, only a few cases have been reported. Radiologically, SC can present as an aggressive benign tumor, and adequate tissue sampling is essential for a proper diagnosis in cases of malignant transformation. Insufficient tissue biopsy sampling may miss the transformed malignant areas, resulting in a diagnosis of a benign cartilaginous tumor and inadequate patient management. We report a case of intermediate to high-grade chondrosarcoma occurring in the background of synovial chondromatosis. We also review the current literature on SC and CS and discuss the pathophysiology of the malignant transformation.
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Primary pulmonary lymphomas (PPLs) are very uncommon types of lymphomas, usually B-cell-derived lymphomas; reports of primary pulmonary peripheral T-cell lymphoma (PTCL) are not commonly reported. These patients are diagnosed with... more
Primary pulmonary lymphomas (PPLs) are very uncommon types of lymphomas, usually B-cell-derived lymphomas; reports of primary pulmonary peripheral T-cell lymphoma (PTCL) are not commonly reported. These patients are diagnosed with PTCL-not otherwise specified (PTCL-NOS) since they cannot be further categorized into discrete disease categories. PTCL-NOS is the most common subtype, accounting for about 22% of PTCL cases in Asia and 30-35% of PTCL cases in Europe and North America. Most cases with PTCL-NOS manifest as nodal lymphomas, yet extra-nodal involvement during the disease's early stages or relapses is not unusual. We present a case of a 59-year-old female with a history of left breast mucinous ductal carcinoma who presented with multiple lung nodules initially mistaken for metastatic breast carcinoma. Specific histomorphologic features and immunohistochemistry analysis confirmed the diagnosis of primary peripheral pulmonary T-cell lymphoma, not otherwise specified. We review the pertinent literature, including clinical presentation, diagnosis, pathology, and management.
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Neurothekeomas are uncommon benign superficial cutaneous tumors with various histologic patterns, such as myxoid, cellular, or mixed types, depending primarily on the quantity of myxoid matrix present. They generally affect the head and... more
Neurothekeomas are uncommon benign superficial cutaneous tumors with various histologic patterns, such as myxoid, cellular, or mixed types, depending primarily on the quantity of myxoid matrix present. They generally affect the head and neck, are more common in women than men, and typically start in the second and early third decades of life. Once believed to originate from the nerve sheath, the source is now thought to be fibroblasts that can differentiate into myofibroblasts and entice histiocytes. Neurothekeomas can present a significant challenge for pathologists to diagnose, and strict histomorphologic features and immunohistochemistry studies are essential to establish the diagnosis. We present a recurrent scalp myxoid Neurothekeoma case in a 7-year-old girl and review the pertinent literature.
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Ovarian teratoma is most frequently found in children and adolescents. It comprises a combination of adult and embryonic tissues from the three germ cell layers: ectoderm, mesoderm, and endoderm. According to the current WHO grading... more
Ovarian teratoma is most frequently found in children and adolescents. It comprises a combination of adult and embryonic tissues from the three germ cell layers: ectoderm, mesoderm, and endoderm. According to the current WHO grading system, the tumor can be divided into mature (benign) and immature (malignant) based on the existence and quantity of the immature component. The microscopic grade of the initial tumor best predicts the chance of extraovarian dissemination, and size and stage have been linked to survival. Immature elements might be present in small foci or large amounts. An incorrect diagnosis of a benign teratoma with inadequate treatment and a poor prognosis can result from insufficient pathological sampling missing the immature tissue. No matter how they present clinically or grossly, all teratomas must be extensively sampled in the pathology lab to look for any potential immature components. A teratoma is challenging for pathologists to diagnose, much like every other gonadal germ cell tumor, and an accurate diagnosis has significant therapeutic and prognostic ramifications. Here, we present the case of a 13-year-old girl with a high-grade metastatic giant 23 cm immature teratoma and review the relevant literature. The patient had several peritoneal implants at the time of surgery, and the tumor had grown to the pelvic wall. Following surgical debulking and chemotherapy, the patient's tumor recurred after two years with liver and lung metastases.
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Mammary Paget's disease (MPD) of the breast is a rare form of breast cancer. It accounts for a very small percentage of breast cancers in women, and much less in men It rarely occurs as an isolated entity and is usually associated with... more
Mammary Paget's disease (MPD) of the breast is a rare form of breast cancer. It accounts for a very small percentage of breast cancers in women, and much less in men It rarely occurs as an isolated entity and is usually associated with carcinoma in situ or invasive adenocarcinoma in most cases. In situ histology is seen in one third of the cases. Paget's disease is rarely diagnosed in people under the age of 45. Paget's disease affects people of all ethnic and racial groups. However, people of Asian descent are less likely to be affected. Surgical treatment of Paget's disease (radical or conservative) is controversial. There is no established standardized treatment, and treatment decisions are based on other associated conditions. There is currently no evidence that either surgical approach (conservative surgery or mastectomy) improves survival. Prognosis depends on the presence of a palpable mass and the invasiveness of the cancer. We present a case of a 37-year-old woman who presented with recurrent mixed ductal lobular carcinoma associated with Paget's disease. Paget's disease diagnosis was completely established based on cytology material sampling only. The patient was treated with bilateral mastectomy with no nipple sparing. The patient was followed for four years with no evidence of metastasis or recurrence.
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Osteoblastoma-like osteosarcoma (OBLOS), is a rare malignant lesion with risks of both local recurrence and distant metastasis. It is considered a rare variant of osteosarcoma. The distinction between (OBLOS), and aggressive osteoblastoma... more
Osteoblastoma-like osteosarcoma (OBLOS), is a rare malignant lesion with risks of both local recurrence and distant metastasis. It is considered a rare variant of osteosarcoma. The distinction between (OBLOS), and aggressive osteoblastoma is still debatable and challenging. Based on the initial clinical, radiological, and histological findings, a definitive diagnosis might only sometimes be achievable. On the other hand, the significance of a proper diagnosis must be accomplished because the approach to treatment varies greatly depending on the type of lesion. Sufficient tissue sampling is essential to provide the proper diagnosis. In clinicopathological and radiological discordance cases, a high index of suspicion and significant experience are requirements for an appropriate diagnosis. The OBLOS is categorized as a conventional (high-grade) osteosarcoma in the World Health Organization (WHO) classification system. However, several cases that have been published have been identified as low-grade malignant tumors. There are no precise morphological criteria to discriminate between low-and high-grade lesions. We describe a case of osteoblastoma-like osteosarcoma in an 11-year-old boy involving the right proximal humerus. We provide a brief review of the pertinent literature including diagnosis, differential diagnosis, debatable grading of this type of tumors, management, and prognosis.
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Primary perivascular epithelioid cell neoplasms (PEComas) of bone are rare mesenchymal tumors. Histologically, they are composed predominantly of perivascular epithelioid cells and have the capacity to metastasize. PEComas have been... more
Primary perivascular epithelioid cell neoplasms (PEComas) of bone are rare mesenchymal tumors. Histologically, they are composed predominantly of perivascular epithelioid cells and have the capacity to metastasize. PEComas have been reported within intra-abdominal and intra-pelvic organs. To the best of our knowledge, only seven primary PEComas of bone have been described in the English literature. We present two cases of PEComa of bone, one arising from the distal fibula and one from the acetabulum. Both were treated by surgical excision and one also received adjuvant chemotherapy.
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1. Goedert JJ. The epidemiology of acquired immunodeficiency syndrome malignancies. Semin. Oncol. 2000; 27; 390–401. 2. Cathomas G, McGandy CE, Terracciano LM, Itin PH, De Rosa G, Gudat F. Detection of herpesvirus-like DNA by nested PCR... more
1. Goedert JJ. The epidemiology of acquired immunodeficiency syndrome malignancies. Semin. Oncol. 2000; 27; 390–401. 2. Cathomas G, McGandy CE, Terracciano LM, Itin PH, De Rosa G, Gudat F. Detection of herpesvirus-like DNA by nested PCR on archival skin biopsy specimens of various forms of Kaposi sarcoma. J. Clin. Pathol. 1996; 49; 631–633. 3. Cheuk W, Wong KO, Wong CS, Dinkel JE, Ben-Dor D, Chan JK. Immunostaining for human herpesvirus 8 latent nuclear antigen-1 helps distinguish Kaposi sarcoma from its mimickers. Am. J. Clin. Pathol. 2004; 121; 335–342. 4. Lasota J, Miettinen M. Absence of Kaposi’s sarcoma-associated virus (human herpesvirus-8) sequences in angiosarcoma. Virchows Arch. 1999; 434; 51–56. 5. Lebbe C, Pellet C, Flageul B et al. Sequences of human herpesvirus 8 are not detected in various non-Kaposi sarcoma vascular lesions. Arch. Dermatol. 1997; 133; 919–920. 6. Karpati S, Desaknai S, Desaknai M, Biro J, Nagy K, Horvath A. Human herpesvirus type 8-positive facial angiosarcoma developing at the site of botulinum toxin injection for blepharospasm. Br. J. Dermatol. 2000; 143; 660–662. 7. McDonagh DP, Liu J, Gaffey MJ, Layfield LJ, Azumi N, Traweek ST. Detection of Kaposi’s sarcoma-associated herpesviruslike DNA sequence in angiosarcoma. Am. J. Pathol. 1996; 149; 1363–1368. 8. Remick SC, Patnaik M, Ziran NM et al. Human herpesvirus-8associated disseminated angiosarcoma in an HIV-seronegative woman: report of a case and limited case-control virologic study in vascular tumors. Am. J. Med. 2000; 108; 660–664. 9. Ahmed I, Hamacher KL. Angiosarcoma in a chronically immunosuppressed renal transplant recipient: report of a case and review of the literature. Am. J. Dermatopathol. 2002; 24; 330–335. 10. Fink-Puches R, Zochling N, Wolf P, Back B, Kerl H, Soyer HP. No detection of human herpesvirus 8 in different types of cutaneous angiosarcoma. Arch. Dermatol. 2002; 138; 131–132. 11. Schmid H, Zietz C. Human herpesvirus 8 and angiosarcoma: analysis of 40 cases and review of the literature. Pathology 2005; 37; 284–287. 12. Gessi M, Cattani P, Maggiano N et al. Demonstration of human herpesvirus 8 in a case of primary vaginal epithelioid angiosarcoma by in situ hybridization, electron microscopy, and polymerase chain reaction. Diagn. Mol. Pathol. 2002; 11; 146–151. 13. Ioachim HL, Adsay V, Giancotti FR, Dorsett B, Melamed J. Kaposi’s sarcoma of internal organs. A multiparameter study of 86 cases. Cancer 1995; 75; 1376–1385. Malignancy in giant cell tumour of bone: is there a reproducible histological threshold? A study of three giant cell tumours with worrisome features
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Proximal epithelioid sarcoma is a rare malignancy that develops from the proximal part of the body and occurs more commonly in young people. Because of its aggressive nature, high recurrence potential, and high ability to metastasize, it... more
Proximal epithelioid sarcoma is a rare malignancy that develops from the proximal part of the body and occurs more commonly in young people. Because of its aggressive nature, high recurrence potential, and high ability to metastasize, it needs careful clinical long-term monitoring. This report intends to provide more insight to proximal epithelioid sarcoma due to its rarity. We report a case of a 31-year-old male, presented with proximal-type epithelioid sarcoma in his right ischio-rectal fossa and inguinal lymph nodes metastasis, confirmed by cytology sampling examination utilizing ultrasound fine-needle aspiration. We review the cytohistological presentation, molecular basis, immunochemistry, prognosis, and treatment of epithelioid sarcoma.
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Clear-cell chondrosarcoma (CCC) is a rare histological subtype of chondrosarcoma with a predilection for the proximal femur and humerus with epiphyseal involvement. Radiographic analysis displays a lytic lesion with destructive expansion... more
Clear-cell chondrosarcoma (CCC) is a rare histological subtype of chondrosarcoma with a predilection for the proximal femur and humerus with epiphyseal involvement. Radiographic analysis displays a lytic lesion with destructive expansion and sharp sclerotic margins. Due to its slow disease course, it is often misdiagnosed. Surgical excision is the treatment of choice for these patients; however, local recurrence and metastasis may occur. This report presents a case of CCC of the right femur in a 29-year-old man treated with distal femur resection and right knee reconstruction. At his 4-year follow-up, no recurrence or metastasis had occurred.
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Osteosarcoma (OS) is the most prevalent primary malignant bone tumor. It typically affects people in their second decade of life, though it occasionally affects people over 40. The distal femur, proximal tibia, and proximal humerus are... more
Osteosarcoma (OS) is the most prevalent primary malignant bone tumor. It typically affects people in their second decade of life, though it occasionally affects people over 40. The distal femur, proximal tibia, and proximal humerus are the primary sites of osteosarcoma that occur most frequently. Parosteal, periosteal, and high-grade surface osteosarcoma are the three types of cortical surface osteosarcoma. Conventional parosteal osteosarcoma (CPOS) is the well-differentiated end of the spectrum. Parosteal osteosarcoma is uncommon tumor, which originates from periosseous tissues adjacent to the cortex and has a slow growth rate but frequently demonstrates a high degree of histological differentiation. Dedifferentiated parosteal osteosarcoma (DPOS) is a rare variant of low-grade parosteal osteosarcoma that can progress to high-grade osteosarcoma with MDM2 and/or CDK4 gene amplifications in most of the cases. Adequate tissue sampling of the tumor is essential rule out possible high-grade component representing a DPOS. We present a case of DPOS, missed in the initial biopsy, but was later identified in the excision specimen.
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Tumors that have only one typical cell morphology are known as monophasic tumors. In addition to the sarcomatous component, biphasic tumors have variable areas of two types of cells, typically gland-like epithelial structures and... more
Tumors that have only one typical cell morphology are known as monophasic tumors. In addition to the sarcomatous component, biphasic tumors have variable areas of two types of cells, typically gland-like epithelial structures and mesenchymal sarcomatoid elements. Sarcomatoid urothelial carcinoma (SUC) is an example of these biphasic tumors. Historically, these neoplasms have been assigned different names, including sarcomatoid carcinoma, carcinosarcoma, collision tumors, spindle cell carcinoma, myxoid sarcomatoid carcinoma, and metaplastic carcinoma. The World Health Organization (WHO) classification of urinary tract tumors, fifth edition, 2021, recognizes the controversy surrounding the nomenclature of this tumor; consequently, it uses the term "sarcomatoid carcinoma" to describe all these lesions and does not differentiate between sarcomatoid carcinoma (SC) and carcinosarcoma (CS). Patients are prone to misdiagnosis and missed diagnoses due to the nonspecific nature of these diseases' clinical manifestations, and the pathological stage is typically detected late. As a result, these patients' overall prognoses are poor. Despite the lack of specific treatment guidelines, surgery remains the treatment of choice in published reports for SUC. Because renal pelvis sarcomas are rare, when examining a renal pelvis tumor with spindle cell features, sarcomatoid carcinoma is the more likely diagnosis, not sarcoma. We report a case of a 55-year-old woman who presented with SUC involving the renal pelvis extending to the ureter and surrounding retroperitoneal area. We discuss and clarify the controversial nomenclature of this tumor and review the current literature.
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Meningiomas (MEs) are the most commonly reported primary tumor of central nervous system origin, and although most neoplasms are benign, a small proportion exemplifies an aggressive profile characterized by high recurrence rates,... more
Meningiomas (MEs) are the most commonly reported primary tumor of central nervous system origin, and although most neoplasms are benign, a small proportion exemplifies an aggressive profile characterized by high recurrence rates, pleomorphic histology, and overall resistance to standard treatment. Atypical meningiomas (AMs) are WHO grade 2 tumors with high heterogeneity and invasiveness, which are unique in their clinical presentation, imaging, pathology, treatment, and prognosis. Standard initial therapy for malignant meningiomas includes maximal safe surgical resection followed by focal radiation in some instances. The role of chemotherapy during the recurrence of these aggressive meningiomas is less clear. The prognosis is poor, and the recurrence of malignant meningiomas is high. Extracranial metastasis of an intracranial meningioma is rare. We discuss the clinical, radiological, and histopathological presentation of a 32-year-old man with pulmonary metastases from a recurrent atypical meningioma and review the literature about meningioma and its different grades. Our case highlights the deficiencies of atypical and anaplastic meningioma treatment methodologies and alerts clinicians to the chance of extracranial metastasis of meningioma
Primary cutaneous diffuse large B-cell lymphoma of the leg (PCDLBCL-LT) is a distinct type of lymphoma with a poor prognosis. It represents 20% of all primary cutaneous B-cell lymphomas. Due to its universal association with poor clinical... more
Primary cutaneous diffuse large B-cell lymphoma of the leg (PCDLBCL-LT) is a distinct type of lymphoma with a poor prognosis. It represents 20% of all primary cutaneous B-cell lymphomas. Due to its universal association with poor clinical outcomes, it is essential to establish a definitive diagnosis as soon as possible to begin optimal treatment. Only 10% to 15% of patients experience this lymphoma outside the lower extremities. Extracutaneous dissemination occurs in 10% to 20% of PCDLBCL-LT cases, and the clinical course is typically rapid. Combinations of anthracycline-containing chemotherapies and rituximab can improve prognosis despite the advanced age of many patients. Unfortunately, this type of lymphoma can be easily mistaken for other skin conditions, which can cause treatment delays. Interestingly, some recently published cases report spontaneous regression of PLDLBCL-LT without chemotherapy treatment. We present a case of a 46-year-old man with PCDLBCL-LT involving his left leg, which was initially treated for a possible cutaneous inflammatory condition. Later, the proper diagnosis of PCDLBCL-LT was made, and the patient received the optimal treatment. We also provide a brief review of the pertinent literature.
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Basal cell carcinoma (BCC) is the most common skin lesion diagnosed in Caucasians and can be easily managed with surgical excision. However, a minority of patients develop advanced BCC, including locally advanced and metastatic disease.... more
Basal cell carcinoma (BCC) is the most common skin lesion diagnosed in Caucasians and can be easily managed with surgical excision. However, a minority of patients develop advanced BCC, including locally advanced and metastatic disease. Several risk factors have been identified for metastatic potential that should be monitored in patients with a history of BCC to facilitate early intervention and prevent dismal outcomes. Current systemic therapies for metastatic disease include Hedgehog pathway inhibitors, PD1 checkpoint inhibitors, and other developing drugs. We present a case of metastatic basal cell carcinoma (mBCC) to the iliac bone in a patient with human immunodeficiency virus (HIV) infection with a discussion of risk factors for metastasis and a brief review of relevant literature.
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The purpose of this study was to review autopsy and gallium scan findings in two different acquired immune deficiency syndrome (AIDS) patient populations who had a confirmed diagnosis of tuberculosis (TB) to identify organs involved and... more
The purpose of this study was to review autopsy and gallium scan findings in two different acquired immune deficiency syndrome (AIDS) patient populations who had a confirmed diagnosis of tuberculosis (TB) to identify organs involved and accuracy of clinical diagnosis. The first group was ...
Research Interests: Tuberculosis, Complication, Humans, Female, Male, and 15 moreClavicle, Clinical Sciences, Middle Aged, Autopsy, Radiography, Single Photon Emission Computed Tomography, Adult, Sensitivity, Radiopharmaceuticals, Pulmonary Tuberculosis, Axilla, Acquired immunodeficiency syndrome, Inguinal canal, Mediastinum, and Retroperitoneal space
Adenosarcoma (AS), mullerian or extramullerianis an uncommon biphasic tumor that displays malignant stromal and benign epithelial components. Assessing for sarcomatous overgrowth and myometrial invasion, which are... more
Adenosarcoma (AS), mullerian or extramullerianis an uncommon biphasic tumor that displays malignant stromal and benign epithelial components. Assessing for sarcomatous overgrowth and myometrial invasion, which are critical prognostic factors, is crucial in all cases. AS, typically respond well to optimal surgical resection and generally are low-grade tumors. However, the high-grade mixed tumor variant, the adenosarcoma with sarcomatous overgrowth (ASSO), is frequently associated with invasion, metastasis, and a poor prognosis. The pathogenesis of the extrauterine Müllerian adenosarcoma (EMAS) is not well determined. However, several studies have suggested that endometriotic foci might undergo a neoplastic transformation. It is well established that endometriosis-related cancer can be caused by exogenous hormonal therapy. We report a case of a 41-year-old woman who presented with recurrent high-grade adenosarcoma arising from pelvic endometriosis. In this report, we review the current literature and present the clinical, histopathologic, Immunohistochemistry (IHC) profile, and molecular biology of adenosarcoma.
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The knowledge that the body possesses natural defenses to combat cancer existed long before the modern period, with multiple anecdotal reports of tumors miraculously disappearing, sometimes spontaneously or after a febrile or infectious... more
The knowledge that the body possesses natural defenses to combat cancer existed long before the modern period, with multiple anecdotal reports of tumors miraculously disappearing, sometimes spontaneously or after a febrile or infectious episode. Spontaneous tumor regression of untreated malignant tumors is currently a well-accepted albeit rare phenomenon, and it is recognized that immunosuppression is associated with a higher cancer risk. The treatment of bladder carcinoma by intravesical administration of live attenuated Bacillus Calmette-Guérin bacteria was shown to be very effective in 1976 and is now standard treatment. Effective immunity against cancer involves complex interactions between the tumor, the host, and the environment. Cancer immunotherapy uses various strategies to augment tumor immunity and represents a paradigm shift in treating cancer, since attention has become more focused on the "biologic passport" of the individual tumor rather than the site of origin of the tumor. The different types of cancer immunotherapies discussed here include biologic modifiers, such as cytokines and vaccines, adoptive cell therapies, oncolytic viruses, and antibodies against immune checkpoint inhibitors, such as the co-inhibitory T-cell receptor PD-1 and one of its ligands, programmed death-ligand 1.
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BOOK CHAPTER: Textbook: Women's Primary Health Care-Office Practice and Procedures Authors: Patricia Wasserman and Mohamed Aziz Editors: Vicki L Seltzer, Warren H. Pearse Publisher: McGraw-Hill, 2000, New York, Edition 2. ISBN:... more
BOOK CHAPTER:
Textbook: Women's Primary Health Care-Office Practice and Procedures
Authors: Patricia Wasserman and Mohamed Aziz
Editors: Vicki L Seltzer, Warren H. Pearse
Publisher: McGraw-Hill, 2000, New York, Edition 2.
ISBN: 0-07-058044-8
Textbook: Women's Primary Health Care-Office Practice and Procedures
Authors: Patricia Wasserman and Mohamed Aziz
Editors: Vicki L Seltzer, Warren H. Pearse
Publisher: McGraw-Hill, 2000, New York, Edition 2.
ISBN: 0-07-058044-8