Aims
Myxoid liposarcoma (MLPS) is characterised by DNA damage‐inducible transcript 3 (DDIT3) gene rearrangements, confirmation of which is commonly used diagnostically. Recently, DDIT3 immunohistochemistry (IHC) has been reported to be highly sensitive and, when strict criteria are employed, specific for the diagnosis of MLPS. The aim of this study was to independently investigate DDIT3 IHC as a diagnostic marker for MLPS.
Methods and results
DDIT3 IHC was performed on 52 MLPS and on 152 mimics on whole sections, and on 515 non‐MLPS sarcomas in tissue microarray format. Only one MLPS (which had undergone acid‐based decalcification) was completely negative. With inclusion of this case if any nuclear expression is considered to indicate positivity, the overall sensitivity of DDIT3 is 98% (51 of 52 cases) and the specificity is 94% (633 of 667 non‐MLPS cases are negative). If a cut‐off of >10% of neoplastic cells is required for positivity, then the sensitivity remains 98% (51/52) and the specificity is 98.5% (657 of 667 non‐MLPS cases are negative). If a cut‐off of >50% of cells is required for positivity, then the sensitivity is 96% (50 of 52 cases) but the specificity improves to 100%.
Conclusions
Diffuse nuclear DDIT3 expression occurs in the overwhelming majority of MLPSs, and can be used to confirm the diagnosis in most cases without the need for molecular testing. A complete absence of expression argues strongly against MLPS, and almost completely excludes this diagnosis, particularly if there is consideration of technical factors such as decalcification. The significance of focal DDIT3 expression should be interpreted in the morphological and clinical context, although most tumours showing only focal expression are not MLPS.
Uterine lipomas are a rare benign gynaecological tumour of uncertain histogenesis. Clinically, a uterine lipoma may be mistaken for leiomyoma or a malignant tumour. Radiological findings may be suggestive but can also often be inconclusive. However, it has a distinctive appearance on histopathological examination. We present a case of uterine lipoma in a 70-year-old woman, to increase awareness of this unusual entity.
We present a case of fatal sarcoidosis, the cause of death being presumed arrhythmia from cardiac sarcoidosis. The disease involved the lungs, heart, spleen and liver. On examination of the liver, there were five lesions macroscopically, showing a characteristic central stellate scar. 1 Histology revealed bland hepatocytes, fibrous septae and bile ductular reaction, along with fibrosis and giant cells. Immunohistochemistry showed a map-like staining pattern for glutamine synthetase. Sarcoidosis commonly involves the liver, following the lungs and mediastinal lymph nodes in frequency. 2 It can be associated with nodular regenerative hyperplasia of the liver. 3 To our knowledge, focal nodular hyperplasia has not previously been reported in association with sarcoidosis. The pathogenesis of focal nodular hyperplasia has been postulated as involving hypoperfusion or hyperperfusion, and is often associated with haemangiomata. 1 This case demonstrates development of multiple focal nodular hyperplasia in association with sarcoidosis of the liver, not previously described.
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