No abstract

A 55-year-old woman underwent radical mastectomy and axillary node dissection because of an invasive ductal carcinoma with neuroendocrine features. Histologically, all 22 sampled lymph nodes had widespread cystic inclusions lined by a regular, serous-type epithelium positive for cytokeratin-7, WT-1, CA125, and estrogen receptors. Papillary projections were found in the lumen of some cysts. The lesions were consistent with florid, papillary endosalpingiosis (FPE), a hitherto unreported condition in a supradiaphragmatic location. Metastases from papillary carcinomas of ovary, breast, or thyroid were excluded considering the lesion's immunophenotype (negative for mammaglobin and TTF-1) and the absence of both atypical features and a concurrent abdominal serous tumor. In only one node, lesions co-existed with a metastasis of breast carcinoma. Supradiaphragmatic FPE represents a pitfall in the differential diagnosis of metastases, especially in sentinel nodes, since it may increase their size and reveal an unusual ultrasonographic image. Clinicopathologic findings and a focused immunohistochemical study led to the correct diagnosis of this benign lesion.

The association of a uterine sarcoma botryoides of the adolescence with a primitive neuroectodermal tumor is reported in a 12-year-old patient who presented with abnormal vaginal bleeding that occurred after passing per vaginam a polypoid mass. The sarcoma botryoides of the adolescence exhibited foci of cartilage and a central area of primitive neuroectodermal tumor with a trabecular, adamantiform histology and prominent angiogenesis. Primitive neuroectodermal tumor was positive for vimentin, synaptophysin, neuron-specific enolase, CD99, and SOX2 and negative for both the FLI-1 fusion protein and the rearrangement of ESWR1 gene. The neoplasm exhibited a nonaggressive behavior similar to sarcoma botryoides of the adolescence, being alive and well 3 y after its presentation. This is possibly related to its polypoid nature and the absence of invasive features at its uterine insertion level. A conservative approach without further resection and chemotherapy was indicated taking into account the patient's age.