Vulvar tumors are not very common and account for about 4% of all cancers affecting the female genital organs. Frequently, malignant neoplasia of this site have squamous phenotype and the rare cases of metastasization are reported in the locoregional lymph nodes and in the surrounding organs. We report a case of metastasization of a vulvar squamous cell carcinoma in an unusual place such as the parietal pleura, in a relapsing patient that was submitted to a surgical vulvectomy the previous year.

Pregnancy luteoma is a distinctive non-neoplastic hormone dependent lesion arising in pregnancy and mimicking an ovarian tumour. Fewer than 200 cases have been described in the English-language literature. Its clinical and morphological features are characteristic and must be considered in order to prevent diagnostic misinterpretation. To the best of our knowledge the association of pregnancy luteoma with endometriosis has not been reported in literature to date.

Chemotherapy may induce mass lesion in rare conditions, which can be easily mistaken as a residual tumor mass. In this report, we describe a mass affecting spleen in a patient received chemotherapy for non Hodgkin diffuse large B cell lymphoma. This mass proved histologically to be non neoplastic formed of sheets of histiocytes and xanthoma cells, which is called histiocyte-rich pseudotumor. This report describes this rare lesion and the possible differential diagnosis.

Papillary breast lesions are a heterogeneous group of tumors which mainly arise in the central mammary region, ranging from benign to malignant. Among them, solid papillary carcinoma (SPC) represents a very uncommon variant with indolent clinical behavior and excellent prognosis. The categorization of papillary lesions as benign, atypical or malignant is often difficult even for experienced pathologists. Furthermore, for prognostic purposes, to decide whether to consider a lesions as in situ when it is not associated with frank invasive foci of carcinoma may be problematic. We present a case of solid papillary carcinoma arising in the nipple with an expansive and circumscribed growth, mimicking an in situ lesion of the breast on the hematoxylin and eosin stained sections, but in which a myoepithelial layer around neoplastic nodules could not be detected by using immunohistochemistry. To the best of our knowledge, primary origin in the nipple is very rare for SPCs and it has been described only once in the literature. The case we herein illustrate is of interest not only because of its origin in the nipple, but also because of its not in situ, but invasive, although expansive and not infiltrative growth. In the differential diagnosis, nipple disorders as adenoma and syringomatous adenoma, usual ductal hyperplasia (UDH), papilloma, intracystic papillary carcinoma, lobular carcinoma in situ, ductal carcinoma in situ and skin adnexal tumors are considered.

To determine the ability of cytohistology and cytokeratin 20 (CK 20) expression in malignant and atypical cells (AUC) from urine to serve as a diagnostic tool for assessing urothelial carcinoma (UC).

A large variety of rare benign and malignant tumors may sporadically affect the lung. Computed tomography (CT) findings of unusual primary lung tumors are often nonspecific. However, there are some rare pulmonary tumors with imaging features overlapping those of other conditions, thus making radiologic diagnosis challenging. The aim of this review was to correlate CT and histopathological features of a variety of unusual lung tumors to better clarify when and to what extent radiological diagnosis is reliable.

Microsatellite instability (MSI) is a hypermutable phenotype that usually arises from either a germline mutation in components of the mismatch repair (MMR) machinery (i.e. hMLH1, MSH2, MSH6 and PMS2) in patients with Lynch syndrome (LS) or somatic hypermethylation of the hMLH1 promoter in sporadic carcinomas. In all colorectal cancers (CRC) is possible to identify the MMR deficiency through protein expression by immunoistochemistry (IHC). Recently, the predictive role of MMR deficiency in reduced chemotherapy benefit and the introduction of universal screening for Lynch syndrome suggest to include MMR testing into routine clinical practice. In this scenario is mandatory to update the minimal requirements for MMR IHC standardization and evaluation. According to international guidelines, these are the GIPAD and AIFEG suggestions for MMR IHC testing.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The discovery of the occurrence of activating KIT mutations and KIT expression in GISTs opened the way to the unequivocal diagnosis of these tumors and to their successful treatment with imatinib, a tyrosin kinase inhibitor. Since then, research progress revealed molecular GIST triggers alternative to KIT, implying heterogeneous analytic approaches and prognostic expectations. Several targeted therapies, variably specific for each GIST trigger, have been developed or are being investigated. Thus, GISTs eventually revealed a family of diseases rather than a single tumor type. All these events had an unprecedented impact on pathology practice, constituting at the same time a heavy burden and an exciting challenge, ultimately putting pathologists in the spotlight as never before. This review will discuss the most recent advances concerning GISTs, highlighting the tasks of pathologists facing these tumors, with an emphasis on traps potentially compromising a correct diagnosis.

Osteosarcoma (OS) is a common primary malignant tumor of bones that produces osteoid matrix. Telangiectatic osteosarcoma (TOS) is a rare variant of OS. It affects the long bones especially the lower end of femur and the upper ends of tibia and humerus, a distribution similar to the conventional osteosarcoma. The rib involvement is very infrequent. We present a case of TOS of the rib that posed a diagnostic difficulty owing to its unusual location and to its resemblance to giant cell tumor and aneurysmal bone cyst. Correspondence.

Signet ring carcinoma (SRCC) of gallbladder is an extremely rare tumor accounting for approximately 3% of all gallbladder carcinomas, with a handful of case reports in the literature. We report a case of signet ring cell carcinoma of the gallbladder in a 70 year-old female who was operated upon after the preoperative diagnosis of cholecystitis with cholelithiasis, based on ultrasonographic findings and subsequently diagnosed as signet ring cell carcinoma of the gallbladder on histopathological examination. Grossly there was no discrete growth, instead tumor presented as linitis plastica like diffuse thickening of the gallbladder wall. Microscopic examination revealed a diffusely infiltrative carcinoma comprised exclusively of signet ring cells and confirmed by periodic acid-Schiff (PAS), Alcian blue & Cytokeratin 7 stains. Post -operative clinico-radiological workup was done to exclude secondary. This highly aggressive signet ring cell carcinoma of gallbladder is being reported because of its rarity, its unique histomorphological features and diagnostic inadequacy of the routinely performed ultrasonography as well as highlighting the use of special stains and immunohistochemistry to exclude other possibilities. Our case highlights that routine histopathological examination of all the cholecystectomy specimens is a must to facilitate the early diagnosis of aggressive signet ring cell carcinoma gallbladder.

A pathological complete response in a patient affected by multiple synchronous, breast and lung primary malignancies is reported. A 63-year-old woman presented with an invasive ductal carcinoma of the breast and a lung adenocarcinoma. After multidisciplinary discussion, the patient underwent pulmonary left lower lobectomy followed by radio-chemotherapy with cisplatin and vinorelbine and started hormone therapy with letrozole. Ten months later, a left mastectomy with axillary lymph nodes dissection was performed. Histologically, a pathological complete response (pCR) was documented. With a review of the Literature, we discuss the issue of multiple primary malignancies, with its diagnostic and therapeutic implications. In cases of multiple synchronous malignancies it has been highlighted the importance of the choice of the best therapeutic approach for both the malignancies, reducing collateral individual effects.

We present two cases of occult gastric carcinoma associated to a large pulmonary tumors thrombosis microangiopathy (PTTM). The first case is a 28 years-old man. He was dead due to a respiratory failure. Autopsy showed a whitish indurated mass invading the stomach wall. Histological findings showed a primary "signet ring" gastric adenocarcinoma with pulmonary carcinomatosis and multiple PTTM and a heart metastasis. The second case is a 24 years-old pregnant woman. The main symptoms were nausea and stomach discomfort and they were seen as pregnancy signs. She was dead because of respiratory failure, 10 hours after a vaginal delivery. Autopsy showed the absence of any cause of death related to the delivery and the presence of a whitish indurated mass in the stomach. Histological findings showed a primary "signet ring" gastric adenocarcinoma, with pulmonary carcinomatosis and multiple PTTM.

The differential diagnosis among complete moles, partial moles and hydatidiform abortions may be challenging during routine diagnostic activity. These entities share the histological aspect of enlarged villi, but here we summarize also some peculiar features of all of them. If histology does not clarify this distinction, the immunohistochemistry is the most important tool for pathologists to complete such diagnosis. The correct management of immunohistochemistry and of further possible analysis is also reviewed. Lastly, the most important antibodies, starting from p57, are presented.

Human papillomavirus (HPV)-related head and neck squamous cell carcinomas (HNSCC) are radiosensitive tumors and have a better prognosis than the conventional keratinizing HNSCC. Despite extensive radiographic and clinical evaluation in approximately 3% to 5% of patients who present with cervical lymph node metastases, the primary tumor remains occult. The lack of a clinically identifiable primary tumor usually leads to more aggressive therapy, which can result in higher morbidity. Herein, we report a case of a patient with an occult HPV-related HNSCC, diagnosed detecting HPV in a fine needle aspiration cytology (FNAC) of metastatic laterocervical lymph nodes.

EBUS-TBNA and EUS-FNA are minimally invasive techniques rapidly gaining ground in the non-surgical invasive diagnostic approach to thoracic diseases due to their high accuracy and low morbidity and mortality compared to surgical techniques. Moreover, in the diagnosis and staging of lung cancer the combination of the two techniques is superior to either test alone. In this review we focus on the role of EBUS-TBNA and EUS-FNA in both malignant and non-malignant thoracic diseases.

The interest in better understanding the immune-microenvironment and tumor cells crosstalk, recently leads to focus on immune checkpoints role, notably on PD-1/PD-L1 axis. The current backdrop concerning cancer immunotherapy is constantly evolving and new biomarkers still need to be granted in this dynamic context. This review tries to get lights on PD-L1 complex scenario mainly focusing on troubling issues in assessing this marker in daily practice. It's still necessary to look deeper into this matter in order to make easier the pathologists-oncologist interaction.

Ovarian fibroma is a benign stromal tumour composed of spindle/ovoid fibroblastic cells producing collagen. Approximally 10% of fibromas are densely cellular with small amount of collagen. In these cases, if mild nuclear atypia is present, they are best addressed as cellular fibroma. However cellular fibroma may show a greater mitotic activity and therefore they should be referred as mitotically active cellular fibromas. Mostly benign, it is necessary to differentiate them from malignant tumours such as fibrosarcomas.

Signet-ring cell ependymoma is a rare variant of ependymoma with only seven cases described in literature. Biological behavior and prognosis of this entity are not well-known until now. We present a case of a 49-year-old female with a history of headache and gait instability. Magnetic resonance imaging showed an upper cervical tumor with cystic component and mural nodule. The patient underwent surgery. Microscopically some cells displayed an eccentric nucleus compressed to the periphery by vacuolated cytoplasm. Perivascular pseudorosettes and ependymal rosettes were seen only focally. The cells were positive for glial fibrillary acidic protein and epithelial membrane antigen. The diagnosis was ependymoma with diffuse signet-ring features, grade II according to the World Health Organization. It may be difficult to diagnose this unusual variant of ependymoma especially on small biopsies or frozen sections. A complete examination of the specimen is recommended with immunohistochemical confirmation to rule out potential morphologic mimics, such as metastatic adenocarcinomas and gliomas in the differential diagnosis.

Pain is one of the most common symptoms in cancer patients, especially in advanced disease. However, pain also accompanies a significant percentage of patients during diagnostic and therapeutic procedures. In some patients pain may be the first symptom of the disease. The causes of pain in cancer patients are often multifactorial including direct and indirect cancer effects, anticancer therapy and co-morbidities. Moreover, pain in cancer patients often has mixed pathophysiology including both nociceptive and neuropathic components, especially in patients with bone metastases. In this article, basic knowledge regarding epidemiology, pathophysiology and clinical features of pain in cancer patients with a primary tumour localised in lung, gastrointestinal tract (stomach, colon and pancreas), breast in women and prostate in men are presented. Pain is a common symptom in cancer patients and its appropriate assessment and treatment may significantly improve in patients' and families' quality of life.