Seminars in Diagnostic Pathology

Approximately 5% of gynecological malignancies are associated with paraneoplastic hypercalcemia. Awareness of its association with certain tumor types allows for earlier disease detection and facilitates monitoring of treatment response and disease recurrence. We review the salient clinicopathological features, differential diagnosis and management issues in some of these gynecological tumors, namely: small cell carcinoma, hypercalcemic type; ovarian clear cell carcinoma, dysgerminoma and juvenile granulosa cell tumors...

A variety of cutaneous abnormalities can be seen in patients with malignant diseases, some of which are infectious, with others representing direct involvement of the skin by the underlying disorder. Yet another group of lesions can be regarded as associated markers of the malignant process, and, as such, are termed "paraneoplastic." This review considers the latter collection of conditions, grouping them by the generic type of malignancy that is usually linked to the paraneoplasia. Some of the processes show a predominant association with alimentary tract malignancies (acanthosis nigricans, acrodermatitis paraneoplastica, florid cutaneous papillomatosis, necrolytic migratory erythema, palmoplantar keratoderma, pancreatic fat necrosis, and pityriasis rotunda)...

Hamartomas are benign lesions composed of aberrant disorganized growth of mature tissues. Choristomas are similar, except that they are composed of tissues not normally found at the anatomic site in which the lesion is arising. A wide range of hamartomas and choristomas can arise in the skin and soft tissue. Some of these may cause diagnostic difficulty and potentially be mistaken for neoplasms. Some neoplasms may resemble hamaratomas. Here we review the current clinical and pathologic features of these lesions, both common and rare, and discuss how to distinguish them from other entities in the differential diagnosis...

Hamartomas and malformations of the liver are rare and can lead to diagnostic challenges. Most present as mass lesions that can mimic true neoplasms of the liver on imaging and sometimes on histology, one example being focal nodular hyperplasia. The primary cell type in the hamartomas and malformations can be biliary, vascular, or hepatic. Biliary lesions include bile duct hamartomas and simple liver cysts. Other cystic malformations include the ciliated hepatic foregut cysts and mesothelial cysts. Vascular malformations include telangiectasias, arteriovenous malformations, and hereditary lymphedema...

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Developmental abnormalities and malformations of the breast are rare and encompass a variety of genetic, syndromic, acquired and sporadic conditions. Abnormalities in development may include irregularities in the nipple areolar complex and/or the underlying glandular tissue, resulting in under or overdevelopment of breasts. Age of presentation and clinical severity is dependent on the underlying biologic cause. Abnormalities may involve the entirety of unilateral or bilateral breasts, particularly in association with syndromic conditions or endocrine abnormalities...

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Congenital and hamartomatous lesions of the gastrointestinal tract cause diagnostic challenges for surgical pathologists. Many of these are merely histologic curiosities, whereas others have substantial clinical implications because they herald cancer syndromes or associated anomalies. Although a comprehensive discussion of all developmental abnormalities that can occur in the gastrointestinal tract is beyond the scope of a single manuscript, some entities are more likely to be encountered by surgical pathologists, have important clinical consequences, or pose diagnostic difficulties...

Tumor-like malformative lesions are seen throughout the body, and they may be confused with true neoplasms by clinicians and pathologists alike. In the lungs, they are principally represented by hamartomas-which may contain chondroid, adipocytic, fibroblastic, and myxoid tissue, with entrapped bronchiolar epithelium-and congenital pulmonary airway malformations (CPAMs). The latter have been subdivided into 5 groups, based on their histological features, but they basically comprise proliferations of malformed bronchopulmonary tissues of different types...

Hamartomas are an overgrowth of mature tissues that normally occur in an area of the body, but with disorganization and often with one element predominating. Choristomas on the other hand, are a mass of tissue histologically normal for a part of the body other than the one in which it is located (heterotopic/ectopic). Many reports use choristoma and heterotopia interchangeably. What is included in the definition of hamartoma or choristoma varies. Malformations may be sometimes considered to be hamartomas and many ectopias could be included in the definition of choristoma...

Non-neoplastic skin lesions comprise a sizable group of disorders with variable etiologies and clinical manifestations. They can be grouped into vesiculopustular dermatitides; spongiotic and psoriasiform diseases; lichenoid dermatitides; lymphoid infiltrates of the dermis; granulomatous processes; bullous disorders; vasculopathies; panniculitides; deposition disorders; and defects in maintenance of dermal connective tissue. The use of histochemical methods continues to be an indispensable adjunct to conventional microscopy in the further characterization of such lesions...

The value of histochemical analysis in the diagnosis of medical renal diseases has long been known, and its use continues currently. Depending on the particular disorder in question, a variety of "special" stains may be applied to renal biopsies. These include the periodic acid-Schiff, Masson trichrome, Jones, von Kossa, Verhoeff-van Gieson, Congo Red, and toluidine blue methods, among others. This review considers the application of such techniques in the assessment of vascular, glomerular, and tubulointerstitial lesions of the kidney...

Histochemical methods (HM) were, at one time, extensively used in all facets of anatomic pathology, including analysis of soft tissue lesions. That situation has changed with the advent of other adjunctive procedures, but HM still do contribute meaningfully to the evaluation of several tumefactive conditions in the soft tissue. This brief review considers selected neoplastic, quasineoplastic, and pseudoneoplastic lesions in that category, with emphasis on their histochemical properties.

The alimentary tract serves as host to a large number of diseases. In the non-neoplastic group of disorders, conventional histochemistry continues to play an important diagnostic role. It is particularly important in recognizing specific infectious diseases, such as Helicobacter gastritis, Whipple disease, intestinal tuberculosis and other forms of mycobacteriosis, malakoplakia, intestinal spirochetosis, fungal enteritides, amebiasis, cryptosporidiosis, isosporiasis, and microsporidiosis. Those conditions and their histochemical properties are discussed in this review, along with the use of histochemistry in the characterization of structural gastrointestinal disorders...

No abstract text is available yet for this article.

Neuropathologists have a long and storied history of utilizing histochemistry in the characterization and diagnosis of neurological diseases. This review considers stains that are used for the identification of neurons, neuritic processes and axons, myelin sheaths, neuroglial cells, and connective tissue in the nervous system. Rapid histochemical-smear methods for intraoperative diagnosis are also discussed, along with possible roles for lectin-histochemistry in diagnostic neuropathology.

Histochemistry has an important, continuing role in the current assessment of hepatic biopsies and resection specimens. The evaluation of connective tissue elements in the liver can be accomplished with such methods as the Masson trichrome, Snook reticulin, Vierhoff van Gieson, orcein, and Victoria blue stains. The results contribute to the diagnosis of acute and chronic hepatitis, submassive necrosis, venous outflow obstruction, steatohepatitis, and cirrhosis. Fat stains done on frozen sections of liver tissue are routinely performed in the evaluation of donor liver allograft biopsies...

Histochemistry has a history which, in some ways, goes back to ancient times. The desire for humans to understand the workings of their bodies, and the roles that various chemicals have in them, is long-standing. This review considers the evolution of histochemistry and cytochemistry as scientific disciplines, culminating in the pairing of those techniques with basic biochemistry. They have served as the bases for a synthesis of microscopy, chemistry, immunology, and molecular biology, particularly in the practice of anatomic pathology...

Sarcoidosis is a multi-system disease of unknown etiology, usually affecting the respiratory tract and other organs, and is characterized by the formation of nonnecrotizing epithelioid granulomas. The diagnosis depends on a combination of a typical clinicoradiological presentation, the finding of nonnecrotizing epithelioid granulomas in a tissue biopsy, and exclusion of other possible diseases, especially those of infectious etiology. The granulomas contain epithelioid cells, giant cells, CD4+ T cells in their center, and CD8+ T lymphocytes and B lymphocytes at their periphery...

Nonspecific interstitial pneumonia (NSIP) is a form of chronic interstitial pneumonia that should be separated from the other idiopathic interstitial pneumonias, including most importantly, usual interstitial pneumonia (UIP). Diagnosis is predicated on identification of characteristic findings in a surgical lung biopsy in the appropriate clinical and radiological context. Affected patients may have a variety of underlying or associated conditions, although most have a form of idiopathic lung disease associated with a more favorable prognosis than UIP/idiopathic pulmonary fibrosis (IPF)...