HighlightsPerinodular hydropic degeneration represents a clinical and a histopathological diagnostic challenge.In our case there was rapid tumor growth and the histomorphology mimicked that of myxoid smooth muscle tumors.The pathologist should be aware of this entity to avoid overdiagnosis.

HighlightsHemorrhagic spindle cell tumor with amianthoid fibers is extremely rare.The present case adds to the very limited data available on this entity.The tumor in the present case reached a relatively large size and raised clinical suspicion for lymphoma.This tumor is a mimicker for many benign and malignant conditions.This tumor must be considered to avoid the misinterpretation as primary malignant spindle cell lesion or metastasis.

Highlights Osseous metaplasia with ectopic bone formation is extremely rare in benign thyroid disorders. Only thirteen cases of sporadic goiter with heterotopic bone formation are reported. Osseous metaplasia can be a pitfall in the diagnosis of multinodular goiter. Ruling out comorbidities is mandatory.

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Patient: Male, 46Final Diagnosis: Poorly cohesive cell carcinoma of the gallbladderSymptoms: Abdominal painMedication: —Clinical Procedure: Surgery and chemotherapySpecialty: PathologyObjective:Rare diseaseBackground:Poorly cohesive cell carcinoma of the gallbladder is extremely rare.Case Report:Here we present a case of a 46-year-old male with the clinical diagnosis of acute cholecystitis. The ultrasound showed gallbladder wall thickening and multiple stones. Cholecystectomy was performed, and the gross examination revealed linitis plastica-like thickening of the gallbladder wall. The microscopic examination revealed diffuse infiltration by a poorly differentiated tumor with signet rings. Another component with insular growth pattern and salt-and-pepper nuclei was present. Immunohistochemical findings were consistent with poorly cohesive cell carcinoma of the gallbladder. Imaging studies revealed regional lymph nodes involvement, in addition to peritoneal and liver metastases. The patient was given chemotherapy, and there was no evidence of disease progression at 4 months post-operation.Conclusions:This case supported that all cholecystectomy specimens must be examined. In addition, although poorly cohesive cell carcinoma was reported to be aggressive, the present case showed a protracted clinical course; this pointed to the need for early clinicoradiological suspicion. This is the first case of poorly cohesive cell carcinoma of the gallbladder with a neuroendocrine-like morphology that mimics mixed adenoneuroendocrine carcinoma. Immunohistochemistry is invaluable in such a scenario.