Seven cases of carcinoma mimicking angiosarcoma occurring in skin (3 cases), breast (3) and lung (1) are described. The cutaneous, pulmonary and one of the breast carcinomas were poorly differentiated and squamous in type; the other two breast tumours were poorly differentiated ductal carcinomas with focal squamous differentiation. Histologically, the pseudoangiosarcomatous pattern was due to complex anastomosing channels and spaces lined by neoplastic cells. The spaces contained hyaluronic acid. The neoplastic cells exhibited cytokeratin positivity but yielded negative results with the endothelial cell markers, factor VIII-related antigen and CD 3 4 (QB-END/lO). Two breast tumours showed binding of UEA-1. Ultrastructurally, unequivocal epithelial differentiation was demonstrated in six of the cases. Pathogenetically, these tumours appeared to be variants of acantholytic squamous cell carcinoma. Recognition of this unusual form of carcinoma is important, as an incorrect diagnosis of angiosarcoma may lead to inappropriate treatment and prognostication.

year old woman, the vulvectomy specimen Two cases of pseudoangiosarcomatous contained an irregular ulcerated tumour, carcinoma ofthe genitourinary tract, aris-infiltrating the left labia and extending into ing in the vulva in one and the bladder in the clitoris. In case 2, a 59 year old woman, the other, are presented. In case 1, an 84 the excised bladder showed diffuse thick-1059 on 9 May 2018 by guest. Protected by copyright.

A 74 year old man presented with signs and symptoms of mild cardiac failure. His face and chest were severely discoloured, which was thought to be due to cyanosis. He deteriorated and died of bronchopneumonia. At post mortem examination multiple organs, including the skin, showed silver pigment deposition; he also had a gastric malignant neuroendocrine tumour. He gave no history of contact with silver compounds. Systemic argyria caused by chronic ingestion of silver compounds is a rare condition which, apart from its cosmetic effects, is thought to be relatively harmless; it is not thought to be carcinogenic. This condition can pose diagnostic problems for both clinicians and pathologists. (J Clin Pathol 1994;47:556-557) On examination he showed a bluish discolouration of the skin of his face, neck, and upper chest which he claimed had been present for seven to eight years. Clinically, he was in mild cardiac failure and his blood tests revealed a hypochromic, microcytic anaemia (haemoglobin = 108 g/l), a raised erythrocyte sedimentation rate 34 mm/first hour and abnormal liver function tests (asparate transaminase 159 U/l (normal is <55), lactate dehydrogenase 762 U/I (normal is <300), alkaline phosphatase 720 U/I (normal is 30-135). His serum iron, methaemoglobin, and sulphaemoglobin concentrations were within the normal range.An ultrasound scan showed that his liver was enlarged with multiple space occupying lesions, consistent with metastatic tumour. Argyria was diagnosed from a skin biopsy specimen and he subsequently deteriorated and developed terminal bronchopneumonia.

Four cases of chondroid syringoma containing large numbers of hyaline or plasmacytoid cells are described. Three cases occurred in the hand and one in the foot. Hyaline cells are commonly seen in mixed tumours and myoepitheliomas of salivary glands and rarely in chondroid syringomas. The hyaline-cell change in three of the cases initially caused diagnostic difficulties and the possibility of sarcoma was raised in two cases. In addition to the characteristic hyaline cells, the presence of tubulo-glandulo-ductal structures, benign squamous epithelium and myxochondroid stroma aided diagnosis. Immunohistochemically, the hyaline cells exhibited positivity for vimentin, cytokeratin, S-100 protein, carcino-embryonic antigen, focal glial fibrillary acidic protein (3 cases), neuron-specific enolase (3 cases) and focal alpha-smooth muscle actin (2 cases). Occasional cells were Ber EP4 positive (2 cases). In some cells, a striking peripheral ring-like positivity for cytokeratin and S-100 protein was noted. Ultrastructurally, desmosomes, varying numbers of tonofibrils and non-bundling intermediate filaments were seen. Scanty fine filaments with vague focal densities were detected in some cells. Our studies suggest that the hyaline cells represent modified epithelial as well as myoepithelial cells. One of our cases also exhibited collagenous spherulosis.

Figure 3 . a The papillary component was positive for thyroglobulin. whereas b the medulbdry areas stained for calcitonin. References 1. Albores-Saavedra J. IlVolsi VA. Williams ED. Medullary carcinoma. Sem. Diagn. Puthol. 1985: 2; 137-146. 2. Rosai 1. Carcangiu ML. DeLellis RA. Tumors of the thyroid gland. Atlas o/ Tumor Pathology. Washington, DC: Armed Forces Institute of Pathology, 1992. 3. Sobrinho-SimBes M. Mixed medullary and follicular carcinoma of the thyroid. Histopathology 1993: 23: 287-289. 4. Tanda F. Massarelli G. Mingioni V. Bosincu I-. Moroni RV. Cossu A.Mixed follicular -parafollicular carcinoma of the thyroid: a light, electron microscopic and histoimmunologic study. Surg. Pathol. 1990: 3; 65-74, 5.Albores-Saavedra J. Gorraez da la Mom T. de la Torre-Rendon F.Gould E. Mixed medullary-papillary carcinoma of the thyroid a previously unrecognized variant of thyroid carcinoma. Hum.