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This article provides an overview of the pathology of Epstein-Barr virus (EBV)–associated lymphoepithelioma-like gastric carcinoma, highlighting its unique morphology and clinical features. Lymphoepithelioma-like gastric carcinoma is a rare neoplasm of the stomach with a better prognosis than conventional adenocarcinoma. Most lymphoepithelioma-like gastric carcinomas are associated with EBV infection, while a subset is associated with microsatellite instability. Even though there is a very strong association with EBV, its exact role in carcinogenesis still remains to be elucidated in those cancers that harbor EBV. Distinctive histology and demonstration of EBV using in situ hybridization, polymerase chain reaction, or Southern blotting and immunohistochemistry for the DNA mismatch repair genes or polymerase chain reaction analysis of microsatellite loci to assess microsatellite instability helps to make the diagnosis.

Primary neoplasms of the mesentery are very rare. They are usually of mesenchymal origin and include desmoid tumor, lipoma, liposarcoma, and fibrosarcoma. Metastatic carcinomas and lymphoma are more common. We report a rare case of localized mesenteric Castleman's disease, presenting as intestinal obstruction. Clinical and radiological findings were suspicious for lymphoma. Localized mesenteric Castleman's disease, though rare, has to be considered in the differential diagnosis of mesenteric tumors, particularly in the young and in the absence of history for other tumor, an abnormal blood picture, or splenomegaly.

Background: The outcome of primary sclerosing cholangitis (PSC) after liver transplantation can be affected by recurrent PSC (rPSC) and subsequent graft failure. IgG4-related sclerosing disease is a recently described entity that has a similar morphological appearance to PSC, making the distinction difficult. However, IgG4-related sclerosing cholangitis has an excellent prognosis since it is steroid sensitive, but the impact of IgG4 on rPSC after liver transplant is still unknown. Objectives: To determine the association between IgG4 positive immunochemical staining in liver explants and recurrence of primary sclerosing cholangitis post-liver transplantation. Methods: Clinical information on all adult patients who underwent liver transplantation for PSC from 1990 to 2014 at our institution was obtained. IgG4 immunochemical staining was performed on the porta-hepatis region of these patient’s explanted livers. Immunochemical staining was considered to be positive if the score was > 5 cells/high power field (HPF). Results: Eighty patients met inclusion criteria. IgG4 staining was positive in 21 subjects. Median time for follow-up in the IgG4 positive group was 99.6 months compared to 152.6 months in the IgG4 negative. There were more instances of rPSC in the IgG4 negative group compared to the IgG4 positive group (26% vs. 5%, P < 0.009), and rPSC occurred earlier in the IgG4 negative group (P = 0.016). The frequency of graft failure, however was not significantly different among the two groups. Conclusions: The presence of IgG4 positive cells in liver explants of patient’s transplanted for PSC is associated with fewer episodes of and longer time to recurrent PSC. In addition, IgG4 status of the liver explants does not affect graft survival. Presence of IgG4 positive cells may suggest protective effect against recurrence of PSC.

This article provides an overview of the pathology of Epstein-Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma, highlighting its unique morphology and clinical features. Lymphoepithelioma-like gastric carcinoma is a rare neoplasm of the stomach with a better prognosis than conventional adenocarcinoma. Most lymphoepithelioma-like gastric carcinomas are associated with EBV infection, while a subset is associated with microsatellite instability. Even though there is a very strong association with EBV, its exact role in carcinogenesis still remains to be elucidated in those cancers that harbor EBV. Distinctive histology and demonstration of EBV using in situ hybridization, polymerase chain reaction, or Southern blotting and immunohistochemistry for the DNA mismatch repair genes or polymerase chain reaction analysis of microsatellite loci to assess microsatellite instability helps to make the diagnosis.