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Fellegara G.,Centro Diagnostico Italiano CDI | Rosai J.,International Center for Oncologic Pathology Consultations
American Journal of Surgical Pathology | Year: 2015

During the course of our consultation activity, we have recognized a peculiar form of thyroiditis in which multiple foci of fibrosis, most of which were associated with reactive atypia of the surrounding follicles, are present. We have referred to this condition, both in our consultation reports and in the third series of A.F.I.P. Fascicle on Tumors of the Thyroid Gland, as "multifocal fibrosing thyroiditis" or (less frequently) "multifocal sclerosing thyroiditis," which are descriptive terms that highlight the benign/inflammatory nature of the process, its multiplicity, and its unknown pathogenesis. The aim of this study is to better define the morphologic features of this process and correlate it with some clinical data. With this purpose, the consultation files of one of the authors (J.R.) were searched for cases coded as multifocal fibrosing thyroiditis or multifocal sclerosing thyroiditis in a 20-year period ranging from January 1989 to December 2009. A total of 55 cases were identified that displayed the above-listed features. There were 51 (93%) female and 4 (7%) male patients (F/M=12.75), with ages ranging between 15 and 71 years (mean age, 47.03 y; median age, 44.5 y). Microscopically, multiple foci of fibrosis were identified in all cases, their number ranging from 2 to 51 per case (mean number, 16), with a mean diameter of 3 mm (range: 0.36 to 15.1 mm). Although heterogenous in shape and size, the individual foci were rather similar to each other in composition, being characterized by a fibrotic poorly cellular center that merged with a cellular peripheral zone. Some of the follicular structures present at the periphery of the scar and - to a lesser extent - those entrapped inside it underwent complex reactive and regenerative (atypical) changes that simulated malignancy. We discuss the differential diagnosis with other benign and malignant thyroid conditions and speculate about its pathogenesis and possible relationship with papillary thyroid microcarcinoma. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.

Ramirez Y.,Pontifical Xavierian University | Fellegara G.,Centro Diagnostico Italiano CDI | Bugiani M.,VU University Amsterdam
International Journal of Surgical Pathology | Year: 2012

Eccrine porocarcinoma is a potentially fatal form of sweat gland carcinoma, due to its propensity to metastasize through lymph vessels. The authors report the case of a 69-year-old female who presented with swelling of the right leg and an ulcerated lesion of the right great toe. The initial histologic diagnosis was invasive squamous cell carcinoma. On follow-up, the patient developed lymphangitic tumor spread in the right leg, associated with right inguinal lymphadenopathy and lesions in vulva and flank. Reevaluation of the toe lesion led to a revised diagnosis of eccrine porocarcinoma. The patient also had 2 basal cell carcinomas of the multicentric/superficial type in the skin overlying the left breast. Past history included chronic ingestion of liquore arsenic (Fowler's solution) in early adulthood as treatment for dermatitis herpetiformis. © The Author(s) 2012.

Flamminio F.,University of Bologna | Tosi A.L.,University of Bologna | Fellegara G.,Centro Diagnostico Italiano CDI
International Journal of Surgical Pathology | Year: 2011

The presence of "crushing" artifacts in histological sections is a very common finding and represents a potentially major pitfall for the surgical pathologist, particularly in small biopsy specimens. Microscopically, it appears as bluish clusters in which the cellular details are not recognizable. Here the authors report examples of this phenomenon that have been reported or that they have personally observed and emphasize some diagnostic clue to avoid its overinterpretation and the dire clinical consequences that this may entail. © The Author(s) 2011.

Fellegara G.,Centro Diagnostico Italiano CDI | Rosai J.,Centro Diagnostico Italiano CDI
International Journal of Surgical Pathology | Year: 2013

We report the case of a 69-year-old man who underwent a radical left nephrectomy for a renal mass. Microscopically, the features were those of a clear cell-type renal cell carcinoma associated with 2 foci of capillary hemangioma-like vascular proliferation in the adjacent renal parenchyma. The main differential diagnosis and the possible pathogenesis of this vascular lesion are discussed. © The Author(s) 2013.

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