Christian Fredrik Lindboe

A review of 1050 pathology reports from colorectal adenocarcinoma specimens examined at the Department of Pathology, Sørlandet sykehus HF, Kristiansand, Norway during the period 1995-2006 revealed a poor performance of most doctors concerning lymph node harvest. A mean of 8.1 nodes per specimen (range 12.3-2.1) and a mean proportion of 22.3% of specimens with ≥12 lymph nodes (range 47.1-0%) were found. A small pilot study was undertaken in 2007 to evaluate the effect of prolonged formalin fixation and the use of a special lymph node fixative [glacial acetic acid, ethanol, water and formaldehyde (GEWF) solution] with regard to the number of retrieved nodes. This showed that one extra day formalin fixation and the use of GEWF solution considerably enhanced the detection of lymph nodes, particularly those of smaller size. Based on these findings, our routines concerning handling of colorectal cancer specimens were changed during 2007. After this time all specimens have been fixed in a mixture of GEWF solution and formalin for at least 48 h and the doctors have been encouraged to find as many lymph nodes as possible. In cases revealing <12 nodes after microscopical examination, the specimens have been re-examined and searched for additional nodes. A review of lymph node retrieval in 423 cases of colorectal cancer during the period 2008-2010 showed that the mean number of nodes per specimen had increased to 16.8 (range 29.0-13.3) and the proportion of specimens with ≥12 nodes to 78.0% (range 96.8-63.6%). Thus, these changes of routines which were easy to implement without significant extra costs have considerably improved lymph node harvest at our department. The use of a special lymph node fixative (e.g. GEWF solution) is highly recommended not only for detection of nodes in colorectal specimens, but also for retrieval of lymph nodes embedded in fat tissue generally.

In a series of 1117 dermatofibromas (69% women and 31% men), there were 25 cases (2.2%) with basaloid cell hyperplasia (BCH) of the overlying epidermis. This type of hyperplasia, which closely resembled a basal cell carcinoma (BCC), was predominantly seen in men (14 vs. 11 cases). To determine the nature of these BCHs, we applied a panel of 18 antibodies that are commonly used to classify epithelial proliferations on 6 cases with sufficient amounts of BCH and on 20 BCCs of various types. The number of CK20-positive Merkel cells was found to be increased in 4 cases of BCH, whereas these cells were completely absent or reduced in all BCCs. The significance of this finding must be interpreted with caution, but it must be regarded as a promising method to distinguish between reactive BCHs and neoplastic BCCs. Except for this rather subtle finding, none of the antibodies used could discriminate between the 2 conditions.

A 23-year-old man was operated for a skin tumor in the right axilla. Histological examination revealed findings consistent with a syringocystadenoma papilliferum. However, most of the papillary structures showed a disorganized proliferation of atypical cells without invasive growth, that is, a syringocystadenocarcinoma papilliferum in situ. Immunohistochemistry disclosed a different staining profile between the basal cells of the papillary structures and those of the columnar and atypical cells which reacted similarly. However, the atypical cells showed a stronger and more extensive expression of S-100 protein and CD56 than the columnar epithelium and a few of them also reacted with CEA. Ki-67 staining highlighted the increased proliferative activity of the atypical cells. The best antibody for depicting the basal cells was p63. In the present case immunohistochemistry was of little help to support the diagnosis of malignant transformation since the differences between the atypical and regular columnar cells were small and of a quantitative character only.

Large cell neuroendocrine carcinoma of the ovary is a recently described tumour entity that is now included in the WHO classification of primary ovarian neoplasms. Although mostly in stage I at diagnosis, this tumour shows an aggressive clinical behaviour with subsequent metastases and mean survival is less than one year. In addition to the neuroendocrine carcinoma, most cases also have a malignant surface epithelial tumour component. I here report a 64‐year‐old woman who was operated on for a right‐sided ovarian large cell neuroendocrine carcinoma without a surface epithelial component, which constitutes only the second reported tumour of this “pure” kind. Histological and immunohistochemical findings are described and a review of the literature is presented. The patient was treated postoperatively with chemotherapy. She developed bleomycin‐induced lung fibrosis that responded well to treatment with steroids. There have been no signs of local tumour recurrence or metastases at follow‐up examinations during the first 9 months after the operation.

We report the case of a 66-year-old man who was diagnosed as having prostatic adenocarcinoma with widespread skeletal metastases. After treatment with a luteinizing hormone-releasing hormone analog for one year, a second biopsy revealed transformation of the tumour into a carcinosarcoma with heterogeneous and unusual findings in the carcinomatous as well as the sarcomatous component. Among others, these included a papillary growth pattern and a liposarcomatous differentiation. The patient died 5 months after the diagnosis of carcinosarcoma.

Xanthomas of the urinary bladder are rare lesions of reactive nature. They present as yellow-white mucosal plaques that may be mistaken for a neoplastic process. A biopsy displays stromal accumulation of lipid macrophages without accompanying inflammatory component. This article presents a 78-year-old woman who had a tumour-suspect xanthoma of the urinary bladder occurring subsequent to several resections of non-invasive carcinomas.