Endobronchial Glandular Papilloma With Atypical Histologic Characteristics: A Case Report and Literature Review

Papilloma of the lung is a rare benign entity and can be solitary or multiple. Solitary papilloma is subclassified into three categories: squamous papilloma, glandular papilloma, and mixed squamous and glandular papilloma. Glandular papilloma is the rarest subtype among them and occurs mostly in the sixth decade without any relation to smoking, syndrome, or infection. Histology is characterized by mixture of pseudostratified, columnar, nonciliated, mucinous epithelium-lined papillary fronds without any mitoses, necrosis, or atypia. The differential diagnosis can be broad depending upon the histologic features present in a particular case and may include both benign and malignant entities. We present here a patient with glandular endobronchial papilloma showing unusual clinical history and atypical histologic features, which required extensive immunohistochemical evaluation to establish a final diagnosis.

Peripheral ameloblastoma underlying squamous cell papilloma after a third molar extraction

Peripheral ameloblastoma (PA) is a rare variant of ameloblastoma that presents as a slow-growing, painless mass in the gingival tissues or alveolar mucosa. It shares histologic features with conventional ameloblastoma but is less invasive and aggressive. This case report describes a 51-year-old female with a PA that simultaneously or subsequently developed underlying squamous cell papilloma after mandibular third molar extraction. Clinical examination revealed a pedunculated gingival lesion mimicking squamous cell papilloma. Histopathologic examination confirmed PA underlying squamous cell papilloma after an excisional biopsy. Imaging revealed mild bone resorption, leading to a further soft tissue excision and minimal osteoectomy to rule out intraosseous involvement. The patient remained asymptomatic without signs of recurrence in the 1-year follow-up. PA diagnosis can be challenging due to its clinical resemblance to other gingival lesions and histopathologic features. Treatment typically involves surgical excision, with long-term follow-up recommended due to possible recurrence and malignant transformation.

The Diagnostic Value of microRNA Expression Analysis in Detecting Intraductal Papillomas in Patients with Pathological Nipple Discharge

Patients with pathological nipple discharge (PND) often undergo local surgical procedures because standard radiologic imaging fails to identify the underlying cause. MicroRNA (MiRNA) expression analysis of nipple fluid holds potential for distinguishing between breast diseases. This study aimed to compare miRNA expression levels between nipple fluids from patients with PND to identify possible relevant miRNAs that could differentiate between intraductal papillomas and no abnormalities in the breast tissue. Nipple fluid samples from patients with PND without radiological and pathological suspicion for malignancy who underwent a ductoscopy procedure were analyzed. We used univariate and multivariate regression analyses to identify nipple fluid miRNAs differing between pathologically confirmed papillomas and breast tissue without abnormalities. A total of 27 nipple fluid samples from patients with PND were included for miRNA expression analysis. Out of the 22 miRNAs examined, only miR-145-5p was significantly differentially expressed (upregulated) in nipple fluid from patients with an intraductal papilloma compared to patients showing no breast abnormalities (OR 4.76, p = 0.046), with a diagnostic accuracy of 92%. miR-145-5p expression in nipple fluid differs for intraductal papillomas and breast tissue without abnormalities and, therefore, has potential as a diagnostic marker to signal presence of papillomas in PND patients. However, further refinement and validation in clinical trials are necessary to establish its clinical applicability.

Juvenile Papillomatosis of the Breast: a Report of Two Cases with Review of the literature

Background

Juvenile papillomatosis (JP) of the breast is a rare and benign proliferative disorder affecting young women. The affected patients tend to have an increased risk of breast cancer development during follow-up.

Objective

This article aims to highlight a rare entity of breast disease, that harbor risk of breast cancer.

Case Presentation

Here, we present 2 cases of JP in young females; the first case is a 13 year-old presented with spontaneous nipple discharge, while the other patient is a 24 year-old presented with a right breast lump. Both patients had a total excision of the breast lesions, revealing JP at histology. Discussion: Juvenile Papillomatosis is considered a clinicopathological entity and is usually misdiagnosed as fibroadenoma clinically and radiologically, which requires histological correlation. The histologic findings are well-defined (hyperplasia, papillomatosis, and multiple cysts with foamy histiocytes).The controversy in management between surgery and observation is because of insufficient knowledge about the direct relationship between JP and subsequent cancer.

Conclusion

Considering the risk of developing breast cancer in JP, enrolling patients and their families in a close follow-up and surveillance program is crucial.

Nipple Adenoma: A Benign Disease With a Suspicious Presentation

Nipple adenoma is a rare proliferative lesion that originates from the lactiferous ducts of the nipple. Though it is benign, the typical presentation includes suspicious symptoms-a firm nodule, crusting erosion, and/or discharge from the nipple. These findings can raise concern for malignancy and in particular, Paget's disease. We report two cases of this uncommon entity, highlighting the variable clinical presentation and keys to the diagnostic evaluation and management.

Swiss cheese disease: A rare case of juvenile papillomatosis of the breast mimicking carcinoma in a young female

Juvenile papillomatosis is a rare benign proliferative lesion of breast seen in young females. These patients have been reported to have a strong family history for carcinoma breast. It is rarely diagnosed preoperatively but has distinct histopathological features on postoperative examination. The subsequent treatment and prognosis vary accordingly. Here, we report a case of a 38-year-old female who was operated with a preliminary diagnosis of Mucinous carcinoma of left breast.

A rare case: Endobronchial solitary mixed papilloma

Endobronchial solitary papillomas are extremely rare lung neoplasms originating from the bronchial surface epithelium. They often present with cough or recurrent hemoptysis. These tumors are benign, but they should be followed closely because they may even have a low probability of malignant transformation features. It should be kept in mind that malignancy may develop especially if the patient is a smoker. Although the etiology is not known for certain, it is thought to be caused by human papillomavirus in some cases. A 43-year-old male patient was admitted with a complaint of chronic cough. Rigid bronchoscopy was performed for diagnostic and therapeutic purposes after imaging techniques revealed a lesion obstructing the lumen of the right main bronchus. The pathology result was reported as mixed bronchial papilloma. We aimed to present our case because of its rarity and to indicate that chronic cough must be further evaluated.

Biliary papillomatosis

Biliary papillomatosis (BP) is a rare disorder of the biliary tract characterized by the presence of multiple papillary adenomas spread along the biliary tree. Although benign, it carries a significant risk of malignant transformation. Due to low sensitivity and specificity of conventional radiologic modalities, the diagnosis as well as estimation of disease extent is difficult. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP) are superior although direct peroral cholangioscopy (POC) is currently the most accurate diagnostic method. Mainly because it provides more detailed information and makes targeted histological diagnosis possible. The treatment of biliary papillomatosis consists of surgical resection, liver transplantation (LT) or a combination of both. Unfortunately, the recurrence rate after radical surgery without LT remains high due to the diffuse distribution of the disease.

Appearances may be deceptive: florid cutaneous and mucosal papillomatosis

We present a case in which a patient presented with widespread cutaneous warty lesions misdiagnosed as warts 3 months before the diagnosis of his advanced gastric adenocarcinoma. Florid cutaneous and mucosal papillomatosis is a paraneoplastic dermatosis, following a parallel course with the underlying malignancy, which is most often gastric adenocarcinoma.

Case Report: Papillary Lesions at the Mouth Floor May Mimic Sialadenoma Papilliferum

Salivary gland tumor Sialadenoma papilliferum (SialP) clinically resembles papillary epithelial lesions, such as squamous papilloma (SqP) or verrucous leukoplakia. Pathological sampling including an adequate depth of both the mucosa and submucosa layer is required for discrimination between the diseases. Though ductal proliferation in the submucosa is characteristic in SialP, papillary lesions arising at the mouth floor, specifically near the ductal orifice, are more problematic. Salivary gland ductal ectasia, along with the overlying papillary hyperplasia, may mimic the biphasic tumorous growth pattern of SialP, making discrimination extremely difficult. Further cellular dysplasia in the papillary mucosal lesion raises the possibility of malignant transformation in a known benign lesion, SialP. Herein, we present a case of SqP at the mouth floor which mimicked both clinical and pathological features of SialP and compared it with a definite case of SialP. Moreover, we discuss major differential points that clinicians and pathologists should consider during diagnosis of oral papillary lesions arising near the salivary glands.

[Esophageal squamous papilloma - a case report]

Esophageal squamous cell papilloma (ESP) is recognised rarely. Usually it is the finding of diagnostic esophagogastroduodenoscopy (EGD). It is considered as asymptomatic benign lesion, in most cases solitary. Larger papilloma and papillomatous lesions are extremely rare and can cause dysphagia, odynophagia, or bleeding. Squamous cell papilloma of esophagus is the lesion of unknown potential for malignant transformation, which currently has no guidelines for endoscopic surveillance. The aim of the study was to present the patient diagnosed with squamous cell papillomas of oesophagus, method of treatment and endoscopic surveillance.

A CASE STUDY

The 65-year-old woman was referred for investigation of epigastric pain and heartburn. The EGG was performed. The normal esophageal mucosa was found with presence of several papillomatous structures from 3 to 8 mm in size within 25-30 cm of incisors line. One 3 mm ESP was completely removed. From the biggest lesion biopsy was obtained. Histopatological examination revealed squamous cell papilloma of oesophagus. However no HPV was detcted. Three months later patient underwent endoscopic resection of ESPs. Two, 8 mm lesions were removed completely by diathermic snare and five 3 mm lesions were removed by biopsy forceps. Histopatological examination of the resected specimen was the same as the previous examination and reveled squamous cell papilloma without HPV presence. After 6 months, no recurrence of papillomas was found in the control EGD, however, it was decided to conduct endoscopic surveillance and perform follow-up EGD in a year's time. Radical removal of squamous cell papillomas of the esophagus was performed using endoscopic resection. After 6 months recurrence of papillomas was not confirmed.

CONCLUSIONS

Esophageal squamous papillomas are efficiently removed by endoscopic resection. Esophagogastroduodenoscopy may be used as a method of endoscopic surveillance.

Squamous Cell Papilloma in a Student Aviator

BACKGROUND: Although oropharyngeal squamous cell papilloma (OSCP) is not uncommon in the general population, reports of OSCP in aviators are rare. This case report serves as a call for flight surgeons to consider all oropharyngeal pathology as a potential source of airway compromise during flight, and highlights regional risk factors for developing malignancies of the oropharynx.CASE REPORT: A 24-yr-old male foreign national student aviator from a central Asian country was at Fort Rucker for flight training. He presented to the clinic with a chief complaint of sore throat and cough for 2 d. He was afebrile but reported a history of a "throat" mass which was previously evaluated by a U.S. military otolaryngologist. Said mass was approximately 0.5 cm × 0.5 cm, irregular appearing, inflamed, and protruding from the inferior aspect of the right tonsil. Previous biopsy report revealed a squamous cell papilloma and, after consideration of the pilot's training program, active surveillance of the lesion was mutually agreed upon until the student's training had concluded and definitive excision was performed.DISCUSSION: A robust history and physical exam including an occupational, social, and environmental exposure history is crucial to diagnosis. Foreign national patients often have unique backgrounds that merit consideration when developing a differential diagnosis, assessment, and plan. In the field of Flight Medicine, a patient's occupational demands are essential to his or her care. In particular, any potential obstruction of the airway during flight must be considered, even if a pathology does not represent an immediate threat to the pilot's health.Swinson K, Burlile J, Pavelites J. Squamous cell papilloma in a student aviator. Aerosp Med Hum Perform. 2019; 90(11):978-981.

Benign breast papillary lesions diagnosed on core biopsy: upgrade rate and risk factors associated with malignancy on surgical excision

Evaluation of radiologically detected breast lesions is a common task in surgical pathology. Some benign lesions on biopsy are associated with an upgrade to in situ or invasive carcinoma on excision. The non-atypical breast papilloma has published upgrade rates of 0 to 29%. Traditionally, papillomas have been managed surgically, but the wide range of upgrade rates has raised uncertainty about the need for routine surgical excision. This study aims to identify risk factors associated with upgrade and determine the upgrade rate of non-atypical papillomas at our institution. In a retrospective review of pathology reports, we identified 266 patients with a diagnosis of benign papilloma on breast core biopsy. One hundred eighty-two patients underwent surgical resection. The final surgical pathology reports of all patients were reviewed and divided into one of two groups-benign or malignant. Twenty-one patients had a final diagnosis of in situ or invasive carcinoma, resulting in an upgrade rate of 12%. Radiologically detected lesions with calcifications were at higher risk for upgrade (OR = 4.45, 95% CI 1.08-18.27) than lesions without calcifications. Additionally, advanced patient age (OR = 1.07, 95% CI 1.03-1.13) and lesion size greater than 0.5 cm (OR = 2.59, 95% CI 0.38-17.48) was associated with upgrade to malignancy. Routine surgical excision of all papillomas is not recommended. Younger patients without high-risk features may benefit from clinical and radiologic follow-up alone. Accurate risk stratification will spare low-risk women unnecessary surgery.

Multiple flat-topped scaly violaceous papules

Epidermodysplasia verruciformis (EV) is an autosomal recessive genodermatosis characterized by susceptibility to beta-genus human papillomavirus (HPV) infection. Owing to TMC6/EVER1 and TMC8/EVER2 mutations that lead to abnormal transmembrane channels in the endoplasmic reticulum involved in immunological pathways, keratinocytes cannot combat infection from non-pathogenic HPV strains. Mutations involving RHOH, MST-1, CORO1A, and IL-7 have also been associated with EV in patients without TMC6 or TMC8 mutations. We highlight a 27-year-old man with multiple violaceous flat-topped papules with scale and irregular borders distributed on his chest, extremities, abdomen, and back. The striking physical examination and the subsequent biopsy findings of enlarged nests of cells in the granular and spinous layers with blue-gray cytoplasm and keratohyaline granules confirmed the diagnosis. We conclude with a brief discussion on the differential diagnosis, which includes confluent and reticulated papillomatosis, Darier disease, and disseminated superficial actinic porokeratosis.

Immunohistochemical Study of Four Fish Tumors

The present study supports the usefulness of ancillary techniques, such as immunohistochemistry, as a valid diagnostic tool in the field of fish oncology. The immunohistochemical patterns observed in four neoplasms on four individual teleosts belonging to different species are described. Cytokeratin, vimentin, actin, S100, calretinin, and Melan-A antibodies were used. Diagnoses of papilloma in a Bream Abramis brama, fibroma in a Sand Steenbras Lithognathus mormyrus, schwannoma in a Crucian Carp Carassius carassius, and melanoma in a spontaneously inbred Xiphophorus hybrid were made. Diagnosis of tumors in fish is not always easy to carry out, and the tool provided by antibodies used on mammalian tissue is essential for obtaining definitive, unambiguous, and inexpensive identification.

Nasal Papilloma due to HPV 11 infection

Human papillomaviruses cause almost all cervical carcinomas, but HPV infections have recently been established as a major etiologic factor for a subset of cancers arising from the oropharinx, including the base of tongue, tonsil, and other parts of the pharinx. Certain types of HPV are considered carcinogenic in humans: HPV 16 and HPV 18 are the most carcinogenic types; HPV 31, 33, 35,39,45,51,52,56,59,66 and 68 also are included in the group of carcinogenic HPV types (1,2,3,4,5). HPV 6 and 11 are associated with genital warts and papillomas are not believed to be carcinogenic (6). The aim of this paper is to show a case of a benignant papilloma of the nasal fossa due to a HPV 11 infection.

Conjuctival lesions - the relationship of papillomas and squamous cell carcinoma to HPV infection

The etiology of papilloma formation is multifactorial. There is a strong association between human papillomavirus (HPV) and the development of these conjunctival lesions. HPV is tumorigenic and commonly produces benign tumors with low malignant potential. Papillomas rarely go through malignant transformation.

MATERIAL AND METHODS

Retrospective study of patients with a diagnosis of conjunctival papilloma or squamous cell carcinoma.

RESULTS

From a collection of 125 patients with conjunctival non-pigmented tumours in the period from 2007 to 2017, in 119 (95.2%) patients histological examination confirmed papilloma and in 6 (4.8%) patients it confirmed carcinoma. Of the total number of patients, 39 were women (31.2%) and 86 men (68.8%). The mean age of patients was 68.4 years (range 20-94 years). Localization of lesions: bulbar conjunctiva - 65 (52.0%), upper eyelid tarsal conjunctiva + fornix - 6 (4.8%), lower eyelid + fornix - 27 (21.6%), caruncle - 20 (16.0%) and plica semilunaris - 7 (5.6%) patients. In the patient cohort we recorded 2 papillomas that were transformed into squamous cell carcinoma. HPV16 was positive in these patients, the carcinomas were from the area of the bulbar conjunctiva, and the surgical solution was associated with the perioperative administration of Mitomycin C. In one case, the inverted papilloma developed into orbital carcinoma within 2 years of primary excision, and the patient underwent radical surgical procedure (partial exenteration of the orbit) followed by radiotherapy.

CONCLUSION

Transformation of the papilloma into the carcinoma is rare, but it must always be taken into consideration in case of a recurrence of the disease. HPV can infect the conjunctiva. The ophthalmologist, in collaboration with a pathologist, may recommend appropriate laboratory tests to confirm the diagnosis. Long-term outpatient follow-up of patients after excision of the conjunctival papilloma is also necessary. Key words: epibulbar tumors, conjunctival tumors, papilloma, carcinoma.

Confluent and reticulated papillomatosis: Case series of 3 patients from Kedah, Malaysia and literature review

Confluent and reticulated papillomatosis (CRP) was first described in 1927 by Gougerot and further characterised by Carteud.1 It is relatively rare, and the exact pathophysiology was not well known. Over the years, multiple treatment modalities were proposed. We report our experience with three cases of CRP which showed complete clearance with tetracycline group of antibiotics.

Florid cutaneous papillomatosis as a marker of neoplastic recurrence

Florid cutaneous papillomatosis is a rare paraneoplastic dermatosis, most commonly associated with gastric adenocarcinoma. It is characterized by a sudden onset of hyperkeratotic papules, clinically indistinguishable from viral warts. We report an 80-year-old man who presented to our department with a two-month history of multiple verrucous lesions affecting the face, perioral region, and hands. Two years before, he was treated for a gastric adenocarcinoma with a subtotal gastrectomy, but showed no evidence of residual disease or recurrence. Given the clinical background, a diagnosis of florid cutaneous papillomatosis was considered. Skin biopsy excluded a viral origin, and tumour recurrence was later identified through an abdominal ultrasound. The onset of this entity is typically prior or concurrent with the diagnosis of the internal malignancy, but it may also represent the first sign of recurrence of a previously treated neoplasm. Its early recognition is essential to ensure a thorough investigation and prompt treatment.

The Risk of Breast Cancer Subsequent to Histologic Diagnosis of Benign Intraductal Papilloma Follow-Up Study of 339 Cases

The risk of developing breast cancer was investigated in 339 patients in whom histologically confirmed intraductal papilloma had been surgically removed. Follow-up ranged from 2 to 14 years, (average, 6.62 years). Ten breast cancers were observed, whereas 3 were expected on the basis of age-specific incidence rates drawn from local cancer registries (relative risk = 3.33, 95% confidence interval = 1.60-6.13). No significant difference in the relative risk was observed as far as papilloma type (single or multiple) was concerned. All breast cancers observed occurred in the same breast as the papilloma. Women in whom a benign intraductal papilloma has been excised should be carefully followed since they at are higher risk for ipsilateral breast cancer.

Early Detection of Ductal Breast Cancer: The Diagnostic Procedure for Pathological Discharge from the Nipple

Pathologic discharge from the nipple may be the only symptom of an early stage of carcinoma. Galactography is then the diagnostic method of choice to locate intraductal, nonpalpable lesions. The technique of galactography, the adequate surgical approach of pathologic galactographs (milk-duct segment resection), and the appropriate histological work-up of the surgical specimen are demonstrated. We report on 1918 galactographies in 1363 women with pathological discharge. In only 427 cases was a milk duct segment resection necessary (31.4%). In 8.5%, we found invasive intraductal cancer and in 2.9% ductal carcinomata in situ. Only 1 patient with breast cancer had axillary metastases. Extensive intraductal solid, papillary or adenomatous proliferations were found in 11.9% of the patients with excision. In 46.7% of the patients, papillomas were excised, a definitive treatment for this process. The supposition for success in the early diagnosis of cancer is close teamwork among the radiology, surgery and pathology services: the diagnostic result depends upon this. We attribute our yield of exact diagnosis to a very sophisticated histological work-up. We believe that this is necessary to avoid diagnostic failures.

Diagnostic difficulties in cases of papillary urothelial neoplasm of low malignant potential, urothelial proliferation of uncertain malignant potential, urothelial dysplasia and urothelial papilloma: A review of current literature

Tumours of the urinary tract are the fifth most frequent type of cancer. The most common types are urothelial tumours, among which, non-invasive urothelial neoplasms represent 45% of all cases. The 2016 WHO classification of urinary tract tumours introduced new classifications of non-invasive lesions. Besides urothelial papilloma (UP) and papillary urothelial neoplasm of low malignant potential (PUNLMP), as described in the former classification, the new classification also includes new entities such as urothelial proliferation of uncertain malignant potential (UPUMP) and urothelial dysplasia (UD). Of the aforementioned, UPUMP is the lesion that most commonly progresses, but solely to non-invasive carcinomas. UD is associated with a high risk of progression to invasive carcinoma. Understanding the biological character, and establishing the correct differential diagnosis in cases of non-invasive, non-cancerous lesions of the urinary bladder, will be of importance in establishing outcome predictions for future patients. A systematic review of the current literature allows us to systematize genetic, morphologic and prognostic factors of such lesions. Moreover, the collected data provide the basis for a proposed diagnostic algorithm which facilitates quick and effective differential diagnoses in cases of non-invasive non-cancerous urinary bladder lesions.

New insights into naevoid melanomas: a clinicopathological reassessment

AIMS

Because the term 'naevoid melanoma' has variable clinical and pathological interpretations, we aimed to clarify the features of melanomas referred to as naevoid.

METHODS AND RESULTS

A review was undertaken of 102 melanomas diagnosed histopathologically as naevoid melanomas and ascertained by European Organization for Research and Treatment of Cancer Melanoma Group Subcommittee pathologists from their records. We found these could be classified morphologically into three groups. Thirteen melanomas were overlying genuine naevi and were therefore excluded. Of the 89 melanomas considered to be naevoid, 11 presented clinically as exophytic papillomatous nodules with little junctional component and composed of small atypical cells showing numerous mitoses and no change with depth; we termed these 'papillomatous naevoid' melanomas. The other 78 were flat or only slightly raised, and had a superficial spreading melanoma-like component with maturation to a small cell, but still an atypical, dermal component; we termed these 'maturing naevoid' melanomas. We showed that papillomatous and maturing naevoid melanomas also have differing immunochemical profiles. Preliminary clinical follow-up suggested different outcomes for these two naevoid melanoma types.

CONCLUSIONS

Melanomas that have been classified as naevoid melanomas comprise two types with distinct clinical, histopathological and immunohistochemical features that may also be prognostically significant.

[A Case of Adenoma of the Nipple Suspected of Breast Cancer]

Adenoma of the nipple is a rare benign tumor, and it is important to distinguish from Paget's disease or breast cancer. A 45- year-old woman had found induration under the right areola before 2 months and visited our hospital. Ultrasonography showed a 2.4 cm solid tumor in a cystic lesion, which had high blood flow in E area of the right mammary gland. The tumor suspected as duct papillomatosis by core needle biopsy. No metastasis lesion was found by computed tomography and bone scintigraphy. But magnetic resonance imaging showed as a marginally clear tumor with contrast enhanced findings that were relatively early reinforced and prolonged. Because there was a possibility of malignancy based on these findings, tumorectomy was done with patient consent. Histological examination revealed usual ductal hyperplasia(duct papillomatosis)and no malignancy. No recurrence was seen for a year after operation. When diagnosing a tumor under areola, be careful not to misdiagnose malignancy.

Oral squamous papilloma occurring on the palate with review of literature

Squamous papillomas are common lesions occurring on skin, oral and nasal mucosa and male and female genital organs. Oral squamous cell papilloma (OSP) is a benign proliferation of the stratified squamous epithelium and is generally believed to be caused by Human Papilloma Viruses (HPV). It constitutes around 2.5% of all oral verruco-papillary lesions. We here, report a case of palatal OSP occurring in a 55-year-old male. The aetiological, clinical, diagnostic and treatment aspects of OSP are discussed here.

Sinonasal oncocytic Schneiderian papilloma accompanied by intravascular lymphoma: A case report on FDG-PET/CT imaging

INTRODUCTION

F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is useful for the staging and assessment of treatment response in patients with lymphoma. Occasionally, benign lesions demonstrate avid FDG uptake and result in false positive findings.

CASE

We report the case of an 82-year-old man presenting with cutaneous lesions, which were histopathologically diagnosed as intravascular lymphoma. FDG-PET/CT for staging demonstrated an FDG-avid mass extending from the right maxillary sinus to the nasal cavity, moderate uptake in the adrenal glands, mild uptake in the knee and the foot, and faint uptake in the skin and subcutaneous tissue of the legs. He subsequently underwent biopsy of the paranasal mass, which was diagnosed as oncocytic Schneiderian papilloma without lymphoma invasion. Glucose transporter (GLUT) 1 staining was highly positive in the papilloma cells, resulting in high FDG avidity. After completion of chemotherapy, the abnormal FDG uptakes in the skin, soft tissue, and adrenal glands disappeared on PET/CT. However, avid FDG uptake persisted in the sinonasal Schneiderian papilloma for 15 months before regression.

CONCLUSION

Benign tumors with oncocytic components may show avid FDG uptake. Therefore, correct diagnosis of oncocytic Schneiderian papilloma on FDG images is difficult when other accompanying malignant tumors, especially lymphoma, are present. If post-therapeutic PET/CT images show a discordant lesion, oncocytic tumors, albeit uncommon, should be considered in the differential diagnoses.

[Vesical urothelial papilloma]

INTRODUCTION

Vesical tumors of infancy are of a low incidence and isolated clinical cases exist, and therefore there are no protocols regarding treatment and monitoring. In addition, the histological criteria used until now are the ones in the WHO 2004 guidelines.

CLINICAL CASE

A 11 year old boy with non-specific abdominal pain. Upon abdominal ultrasound a tumor is observed near the left ureteral orifice, and proceeding with Thulium laser vaporization, a histological diagnosis is made: vesical urothelial papilloma.

COMMENTS

Different diagnostic and therapeutic methods are discussed, with particular emphasis on the importance of a correct diagnosis due to risk of confusion with carcinomas. Despite benign, there is a risk of malignant progression and we recommend pursuing clinical follow-ups and periodical ultrasounds, performing cystoscopy in case of suspicious findings on ultrasound.

Florid papillomatosis of the nipple: a rare presentation and review of the literature

Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare benign proliferative lesion originating from the lactiferous ducts of the nipple. It most commonly affects women in their fourth and fifth decades of life. Clinically, in most cases FP presents with serous or serosanguinous nipple discharge while in many cases an erythematoid or eroded lesion, a nodule or a swelling of the nipple may coexist thus resembling Paget's disease. We describe a case of FP with a very unusual clinical presentation. Diagnostic evaluation and management of the patient are discussed along with a review of the relevant literature. We conclude that FP should be always considered in the differential diagnosis of patients presenting with a rapidly enlarging nipple nodule even in the absence of any skin lesions or nipple discharge. Early diagnosis and prompt treatment are essential. Simple complete excision in order to eliminate the risk of recurrence is the treatment of choice for FP. Although in rare cases a coincidental ipsilateral or contralateral breast cancer has been reported, FP is considered as an entirely benign clinical entity associated with excellent prognosis.

Severe Persistent Orf in Young Goats

Orf (contagious ecthyma) is a viral disease of small and wild ruminants, humans, and less frequently other species. In sheep and goats, the disease is characterized by the formation of vesiculo-proliferative lesions in the skin of lips and nostril. Here, a form of generalized orf in 16 goat kids from 2 different locations in west Texas is described. The disease was characterized by multifocal, severe, proliferative dermatitis that persisted from about 2 months of age until the goat kids were euthanized 3 months later. All affected goats were Boer or Boer crosses under 1 year of age. The mean immunoglobulin concentration in sera of affected goats was elevated compared with healthy control goats. Severe to moderate lymphadenomegaly of the nodes draining the areas of the skin affected with orf lesions was present in all 16 goat kids. Suppurative arthritis, chronic fibrinous pneumonia, and premature thymic involution were found in 3, 5, and 7 of the goat kids, respectively. The skin lesions of 3 goat kids were infested with larvae of the opportunistic black garbage fly ( Ophira sp.). The orf virus was identified in skin lesions by isolation in Marbin—Darby ovine kidney cells, electron microscopy, and amplification of viral DNA by polymerase chain reaction. The orf virus was not detected in peripheral blood or lymph node mononuclear cells of any of the goats. Cross-neutralization experiments showed that an ovine orf virus antiserum raised in sheep was more effective in neutralizing a sheep orf virus isolate than a caprine orf virus isolate. The clinical and epidemiological characteristics of these orf cases may be the result of susceptibility factors within some individuals of the Boer breed of goats.

Idiopathic eruptive macular pigmentation with papillomatosis (IEMPP): A controversial entity

A 19-year-old man with a 6-month history of progressive development of hyperpigmented, velvety plaques on the face and body. A diagnosis of idiopathic eruptive macular pigmentation with papillomatosis (IEMPP) was determined. This entity is discussed.

Analysis of HSP90 Expression Is Valuable in the Differential Diagnosis of Ocular Surface Squamous Lesions

OBJECTIVES

The aim of this study was to evaluate heat shock protein 90 (HSP90) expression in squamous lesions (SLs) and to assess its diagnostic value for different lesions within the SL spectrum.

METHODS

A total of 70 conjunctival SLs, including 19 papillomas, 22 cases of conjunctival intraepithelial neoplasia (ConINs) I, 11 cases of ConIN II, six cases of ConIN III, and 12 squamous carcinomas (sqCAs), were evaluated using the German immunoreactive score against HSP90.

RESULTS

Cytoplasmic HSP90 expression differed between low- and high-grade lesions (P < .001). Among high-grade lesions, the nuclear HSP90 score was higher in the ConIN III-sqCA group than in the ConIN II group (P = .0162). A percentage of total thickness staining of less than 73% differentiated between ConIN III and sqCA.

CONCLUSIONS

The expression of HSP90 is particularly useful to differentiate low-grade from high-grade lesions of the conjunctiva. HSP90 may play an important role in the malignant transformation of SLs and could be a new target for therapy.