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The adnexae can also be penetrated by the infiltrate of polymorphous lymphoid cells. Carlson J W, Fletcher C D 2007 Immunohistochemistry for betacatenin in the differential diagnosis of spindle cell lesions: analysis of a series and review of the literature. One has to recognize either chondroid differentiation or mineralization to diagnose chondroblastoma. Histologically, spiradenoma consists of one or more, often oval to spherical, distinct lobules located within the deep dermis or subcutaneous tissue. Patients with nonossifying fibroma are usually younger than 20 years, whereas benign fibrous histiocytomas occur in adults. The main drawback to this method is that discovery of new genes in the disease of interest is impossible. Convincingly recorded examples of benign schwannoma undergoing malignant change are very rare. In this regard, pulmonary adenocarcinomas with extensive signet ring cell features have been noted to be especially aggressive. The rules used for making a diagnosis of a chondrosarcoma in a small bone are different from those for a larger bone. Sundararajan V, Robinson-Smith T M, Lowry A M 2003 Duodenal gangliocytic paraganglioma with lymph node metastasis: a case report and review of the literature. Diffuse uveal pigmentation with involvement of the adjacent sclera, congenital melanosis oculi, is actually a congenital nevus of the iris, ciliary body, and choroid. Subclassification of these lesions has been somewhat controversial; nevertheless the presently available system seems to be both reproducible and meaningful clinically. However, the potential legal consequences of a misdiagnosis produce a chilling effect in commiting to a benign diagnosis. Placeo T, Tassi D 1953 Considerazioni cliniche su 62 osservazioni di lipoma arborescente posttraumatico del ginocchio come entit patologica a se sante ed associata a lesione meniscale. Note that the acinar tissue and the ducts are from existing gland and not part of the tumor, although one duct shows squamous metaplasia. They are stellate shaped with cytoplasmic processes embracing the acini, or spindle shaped surrounding the intercalated ducts, and cannot be distinguished reliably from basal cells on light microscopy. In some areas, the tumor cells can assume a more epithelioid appearance with round nuclei and more abundant cytoplasm. A mononuclear infiltrate of lymphocytes, plasma cells, or both, is usually present. Lowgrade adenosquamous carcinoma should be distinguished from highgrade adenosquamous carcinoma, in which the adenocarcinomatous component mingles with metaplastic squamous epithelium, often with a pagetoid distribution. Unfortunately, no reliable or specific markers can unequivocally establish the diagnosis of malignant mesothelioma, and the diagnosis is therefore one of exclusion based on the pattern of immunoreactivity for a panel of antibodies. Histologically, pleural leiomyosarcomas are similar to their soft tissue counterparts. Neoplasms are usually divided into benign and malignant, with very little room to accept intermediate biologic forms. Consequently, care should be taken to distinguish multicentric gliomas and metastatic spread from ill-defined gliomas before considering the diagnosis of gliomatosis cerebri. Grossly, the tumors grow as thick, fleshy pleural plaques and masses that extend along the pleural surface and encase the lung. Therefore the possibility of Langerhans cell histiocytosis always should be considered before making a diagnosis of osteomyelitis. Leiomyosarcoma in childhood407-409 is rare and may be located in viscera or in somatic soft tissue. In this field, an intensely positive Rosenthal fiber is embedded in the dense, fibrous, astrocytic matrix. Enchondromatosis, characterized by the presence of multiple benign osseous cartilage lesions, includes rare subtypes, but the majority of patients with enchondromatosis have a developmental disorder known as Ollier disease. Sheets and strands of polyhedral epithelial cells lie in a fibrous, often hyalinized stroma, which may contain extensive dystrophic or cementum-like calcifications.

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The multiple form is often referred to as the "turban tumor" because it may cover the entire scalp. Laryngoceles may present clinically with hoarseness or as a cystic neck mass that may fluctuate in size because of communication with the laryngeal lumen. The lesions are discovered in adults, and some may occur in the setting of nevus sebaceous. The solid pattern is characterized by smooth-contoured or focally jagged sheets and islands of closely packed basaloid cells. Flieder D B, Moran C A, Suster S 1997 Primary alveolar soft-part sarcoma of the mediastinum: a clinicopathological and immunohistochemical study of two cases. The shadow cells are anucleate but retain the essential morphology of the basaloid cells. Sclerosing Epithelioid Fibrosarcoma Sclerosing epithelioid fibrosarcoma345-347 is very uncommon but increasingly recognized, affects mainly young to middle-aged adults of either sex, and presents as a deepseated mass on the limbs or trunk. They affect women slightly more than men, and have no specific clinical attributes. Ectomesenchymoma211-214 is an exceptionally rare tumor, of which fewer than 30 convincing cases have been reported. Patients who had a combination of choroidal invasion, scleral invasion, and invasion of the optic nerve posterior to the lamina may also benefit from adjuvant chemotherapy. Glioblastomas are the second most common brain tumor in the population older than 45 years and account for about 21% of gliomas overall, with an incidence ranging from 3 to 3. Alveolar rhabdomyosarcoma462-464 is characterized generally by rather larger, more rounded undifferentiated cells with larger nuclei than those in the embryonal variant, admixed with variable numbers of eosinophilic rhabdomyoblasts and multinucleate giant cells with peripheral (wreath-like) nuclei. This approach to diagnosis has long proved its value through correlation with response to therapy and clinical outcomes. Others have rounded nests of small, regular basaloid cells, with a poroma-like intraepidermal component. The main histologic differential diagnoses are with lentigo simplex, which lacks theques, and junctional lentiginous melanocytic nevus, which is not circumscribed. These tumors were first described by Klemperer and Rabin287 as a form of localized fibrous mesothelioma. Br J Ind Med 37: 222225 Batsakis J G, Holtz F, Sueper R H 1968 Adenocarcinoma of the nasal and paranasal cavities. The first group of lesions, which have variously been termed ectopic meningothelial hamartoma,221 cutaneous meningeal heterotopia,222 or sequestrated meningocele,223 are essentially hamartomas that arise either on the scalp (especially in the occipital region) or over the spinal column. In the majority of cases local marginal excision is adequate and any microscopic residual lesional tissue undergoes spontaneous attrition, generally seeming to leave little or no scar. Notably, myxoid liposarcoma very often gives rise to metastases in other soft tissue locations and also in bone,79 before involving visceral sites. The differential diagnosis also includes angiomatoid malignant fibrous histiocytoma (see Chapter 24), spindle cell hemangioma (see Chapter 3), and spindle cell melanoma. Basal cell carcinomas almost never metastasize unless they have been present for many years and have attained large size or deep infiltration. It is practical, however, to regard most sebaceous neoplasms under two broad categories-sebaceous adenoma and sebaceous carcinoma. In some extreme cases, the entire seborrheic keratosis undergoes regression, evidenced by remnants of the original lesion and a clinical history of a lesion that changed. Kan A E, Rogers M 1989 Juvenile hyaline fibromatosis: an expanded clinicopathologic spectrum. The tumors present clinically with diffuse pleural thickening and hemorrhagic effusion. Yarnal J R, Golish J A, Van der Kuypt F 1981 Laryngeal tuberculosis presenting as carcinoma. Lee J C, Fletcher C D 2011 Malignant fat-forming solitary fibrous tumor (so-called "lipomatous hemangiopericytoma"): clinicopathologic analysis of 14 cases. Donati P, Amantea A, Balus L 1989 Eccrine angiomatous hamartoma: a lipomatous variant. Plasmacytomas may be associated with amyloid production, but in these lesions is a neoplastic mass consisting of a relatively pure population of plasma cells exhibiting monotypic staining for immunoglobulin light chains.

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Regardless of the other pathologies present, this group of women has no increased risk for development of carcinoma over a 15year period compared with the general population. Ki-67 labeling indices are quite variable and show considerable overlap with ordinary pituitary adenomas. This seems to reflect the fact that, at the ultrastructural level, no more than about 50% of cases show extensive, well-developed schwannian differentiation, whereas the other cases show fibroblastic, perineurial, or mixed features to a varying degree. J Mol Diagn 11: 194-200 Harrison C J, Foroni L 2002 Cytogenetics and molecular genetics of acute lymphoblastic leukemia. The proportion of these cells within the lesion as a whole is variable, but, when they are numerous, confusion with sarcoma, especially rhabdomyosarcoma, is frequent. Selikoff I J, Churg J, Hammond E C 1965 Relation between exposure in asbestos and mesothelioma. The ganglionic population is irregularly distributed and exhibits great cytologic pleomorphism, including bizarre and binucleate forms. At times, granulomatous osteomyelitis is in the differential diagnosis when a prominent number of osteoclast-type giant cells are present. Martuza R L, Eldridge R 1988 Neurofibromatosis 2 (bilateral acoustic neurofibromatosis). Strayer D S, Santa Cruz D J 1980 Carcinoma in situ of the skin: a review of histopathology. In keeping with the circumscription visible grossly, the border of the tumor is pushing rather than infiltrative. In unusual circumstances, they may arise within the pulmonary parenchyma, in the periphery of the lung, without direct connection to a bronchial structure. Note the "disregard" of these neoplastic melanocytes for the neighboring epithelial cells, as manifested by the separation of the melanocytes from the keratinocytes. They are usually located on the chest, but they also can be found on the face, back, limbs, and, rarely, elsewhere. Clin Oncol 9: 311318 Parfrey N A, Doyle C T 1985 Elastosis in benign and malignant breast disease. Therefore it is generally not possible to rule out osteosarcoma on needle biopsy specimens. In adequately sampled material, the low-power appearance includes the presence of geographic necrosis characterized by bluish or so-called gritty necrosis. B, Comparison of cytologic features shows that the tumor cells are bland looking in the low-grade component (left) and mildly atypical with larger nuclei in the intermediate-grade component (right). Electron microscopy reveals tonofilaments, wellformed desmosomes, and hemidesmosomes, confirming the pure epithelial differentiation of the tumor. However, rounded or irregular-shaped solid epithelial islands are almost always present. Barletta J A, Yeap B Y, Chirieac L R 2010 Prognostic significance of grading in lung adenocarcinoma. Coalescence of these cysts may reasonably explain a sudden acceleration in the degree of proptosis and provide a measure of comfort to the surgeon and parents that there is no malignant change in the nerve. Ultrastructurally, benign schwannoma (including its variants) is composed of cells with small cell bodies and elongated, interdigitating cytoplasmic processes invested by a complete external lamina that is often reduplicated. Batsakis J G 1996 Sclerosing polycystic adenosis: newly recognized salivary gland lesion-a form of chronic sialadenitis. Criteria, including microsatellite instability testing, have been established to identify families at risk for Lynch syndrome. Use of internal control cells in this fashion protects against the effects of poor fixation. Benign Melanocytic Lesions Melanocytic nevus is a biologically stable clinical macule, plaque, papule, or polyp that is prevalent in virtually 100% of light-skinned individuals and is almost always histologically symmetric, with increased numbers of melanocytes in the epidermis, dermis, or both. It is the combinatorial diversity of V-(D)-J joining that accounts for much of the variability of antigen receptor structure and hence the specificity of these receptors for different antigens. Ultrastructurally, the cells have abundant cytoplasm with filopodia,1187 numerous lysosomes with phagocytosed material, lipid vacuoles, and variable amounts of intracytoplasmic filaments. Because the number of neoplastic cells markedly varies in the affected structures, including the subpial regions, this diagnosis is rarely possible with limited or nontargeted surgical biopsies. Pilomyxoid Astrocytoma One histopathologic variant, the pilomyxoid astrocytoma, warrants particular notice.

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At the very bottom is the reference sequence, with each nucleotide appearing as a colored line, and the amino acid sequence beneath. Fibroepithelioma (Pinkus)322 presents clinically as a papule or plaque, usually located on the back of the trunk. Tubular and cribriform patterns of pleomorphic cells containing eosinophilic cytoplasm. The caruncle is covered by nonkeratinizing squamous epithelium, often containing goblet cells, but the subepithelial connective tissue contains adnexal structures such as pilosebaceous units and sweat glands. Medulloepithelioma may also be intraocular, arising from the ciliary body, and secondarily infiltrate the retina and optic nerve (see also Chapter 29). Macroscopic Appearances the lesions vary considerably in size from 1 to 20 cm, although the majority measure between 2 and 5 cm. Note the large cells with prominent nucleoli in a smear preparation of a large cell medulloblastoma (inset). Within theques, the spindle cells often follow the line of the adjacent surface or adnexal epithelium. One example that tends to arise mainly in young adults and may show rapid growth is aneurysmal fibrous histiocytoma. The tumor had few areas that were cytodifferentiated corresponding to ganglioneuroblastoma. Am J Surg Pathol 23: 523-529 Brannon R B, Willard C C 2003 Oncocytic mucoepidermoid carcinoma of parotid gland origin. J Clin Pathol 45: 517520 Parham D M, Hagen N, Brown R A 1992 Simplified method of grading primary carcinomas of the breast. The basic pericanalicular and intracanalicular growth patterns are seen, but the stroma is likely to be cellular rather than hyalinized. They are usually skin colored, to blue, to black papules that range from a few millimeters to several centimeters in size. The distinction between osteosarcoma and osteoblastoma can be difficult in some instances. Dickson R I, Flores A D 1985 Nasopharyngeal carcinoma: an evaluation of 134 patients treated between 1971-1980. Nuclear palisading is infrequent (and, in fact, is no more common than in leiomyosarcoma or synovial sarcoma) and meissnerian differentiation is very rare. Interestingly, combined assessment of tumor size, vascular invasion and tumor necrosis (as determined histologically), and perhaps growth pattern appear to be as effective as grading in predicting outcome. They form wellcircumscribed oval masses that have a cut section that may resemble normal breast tissue, a lipoma, or a fibroadenoma. Granules are often round, regular, and uniformly dense and surrounded by a limiting membrane. B, the cyst is lined by mucinous cells supported by an underlying layer of intermediate cells. Williams G D, Hoffman S, Schwartz I S 1984 Malignant transformation in a plexiform neurofibroma of the median nerve. The growth pattern consists of a mixture of tubules and papillary tufts covered by a two-cell layer: an apical cuboidal cell and a subjacent myoepithelial cell. Morphologically, they are characterized for the most part by large xanthomatous cells with variably atypical nuclei, admixed with which are numerous neutrophil polymorphs, unassociated with necrosis. Histologically, the dermal and subcutaneous blood vessels are dilated and stuffed with tumor cells that are somewhat pleomorphic. Lesions usually found on the anogenital mucous membranes are grouped under the term condyloma. Dermal Nerve Sheath Myxoma (Neurothekeoma) Clinical Features Dermal nerve sheath myxoma arises most often as a solitary, painless, superficial swelling on the upper limb or head and neck of adolescents or young adults. Additional staining can be seen for neuron-specific enolase, Leu 7, neurofilament protein, epithelial membrane antigen, and carcinoembryonic antigen. Hruban R H, Bhagavan B S, Epstein J I 1989 Massive retroperitoneal angiomyolipoma.

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Tissue sections from a giant cell glioblastoma showing a tumor almost completely composed of giant multinucleated cells intermixed with smaller, polygonal cells with astrocytic features. Soft Tissue Angiofibroma Soft tissue angiofibroma is a very recently described benign soft tissue neoplasm, occurring most often in the limbs of adults. Paal E, Miettinen M 2001 Retroperitoneal leiomyomas: a clinicopathologic and immunohistochemical study of 56 cases with a comparison to retroperitoneal leiomyosarcomas. Radiologically, the tumor may present as pulmonary nodules or as diffuse pulmonary infiltrates. Up to 10% of patients with granular cell tumor have multiple lesions,111,115,116 and this phenomenon appears to be more common in blacks. The most important prognostic factor for patients with Waldeyer ring lymphoma is the clinical stage. Lymphoid follicles are frequently present, and small lymphocytes may infiltrate the epithelium. Pathologists should report the presence of the surface plaque and make special mention of the presence of this plaque at the lateral margins. Tubule or gland (acinar) formation is a histologic feature that reflects degree of tumor differentiation and its resem blance to the normal glandular tissue of the breast. Because they may be multiple it is not unusual for new lesions to become apparent, even close to the site of a previous biopsy. The desmoplastic trichoepithelioma246,326 range of symmetric, welldemarcated tumors are composed of compressed follicular epithelium within a desmoplastic dermis. Gherlinzoni F, Rock M, Picci P 1983 Chondromyxoid fibroma: the experience at the Istituto Ortopedico Rizzoli. Etiologic causes may include tobacco smoking (most common) and excessive alcohol use. The mononuclear cells are round to oval and usually uniformly distributed throughout the lesion. Wiernik G, Millard P R, Haybittle J L 1991 the predictive value of histological classification into degrees of differentiation of squamous cell carcinoma of the larynx and hypopharynx compared with the survival of patients. A single field of a small cell glioblastoma readily demonstrates the typically dense cellularity and ill-defined cell borders. Columnar cells replace the normal acinar lining cells, and the normal configuration of the terminal duct lobular unit is changed to a group of visibly dilated duct-like structure. Burns B V, Axon P R, Pahade A 2001 "Hairy polyp" of the pharynx in association with an ipsilateral branchial sinus: evidence that the 433. El Shennawy M, Khafagy M, Ishak E 1980 Rhabdomyosarcoma of head and neck in children. Histologically, these are multinodular and diffusely infiltrative lesions composed of fairly monomorphic eosinophilic cells that are variably round and epithelioid or more spindle shaped, set in a densely collagenous stroma. The stroma is characteristically edematous with many capillaries and sinusoids; it can be so loose that tumor strands may appear to be "floating in the air. The process of evaluating histologic features to ascertain the malignant potential of the intermediate-grade diffuse-type astrocytic tumors imposes a static histopathologic designation for a heterogeneous and dynamic growth process. Histologically, the surface epithelium is composed of intact respiratory epithelium but may show squamous metaplasia. The cytoplasm is very granular, and the nucleus is large with coarse chromatin and a prominent nucleolus. Reconstructions of multiple levels through these lesions demonstrate the numerous perforating connections to the epidermis. Extraocular extension Some tumors infiltrate into the sclera along emissary vessels and nerves. The most common symptoms include hoarseness and a neck mass, less often sore throat, dysphagia, hemoptysis, and otalgia. Histologic Appearances In the typical squamous cell papilloma the epithelium is of fairly uniform thickness, with variable keratinization or hyperkeratosis, and covers cores of loose vascular connective tissue. Oligodendroglioma may have cells displaying eccentric nuclei and eosinophilic glassy cytoplasm, the so-called "minigemistocytes. Deyrup A T, Tretiakova M, Montag A G 2006 Estrogen receptorbeta expression in extra-abdominal fibromatoses: an analysis of 40 cases. Differential Diagnosis Histologically the lesion may be identical to osteoblastoma, but the clear association with a tooth root allows the diagnosis. Necrotizing sialometaplasia is a reactive lesion that enters into the differential diagnosis of squamous cell carcinoma.

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The predominance of some of these unusual morphologic features has served as the basis for the creation of several histologic variants of lung adenocarcinoma. Most such lesions can be subclassified reproducibly, enabling more reliable prediction of clinical behavior. Endobronchial Lipoma Endobronchial lipomas are unusual lesions most often seen in adults. Wenig B M, Weiss S W, Gnepp D R 1990 Laryngeal and hypopharyngeal liposarcoma: a clinicopathologic study of 10 cases with a comparison to soft tissue counterparts. Spindelzellenund/oder epitheloidzellennaevus: eine klinische analyse von 652 tumoren. The frontoparietal regions are most commonly involved, but the tumors may also arise in other hemispheric sites; combined sites are quite common. Some tumors composed of cells usually not thought to be primarily dermal, such as those with cells of myeloid or lymphoid phenotype, may also have a prominent dermal component and are included in this section. Litzky L A, Brooks J J 1992 Cytokeratin immunoreactivity in malignant fibrous histiocytoma and spindle cell tumors: comparison between frozen and paraffin-embedded tissues. The surface of the eye should be carefully checked for evidence of extraocular extension by tumor, a finding that adversely affects outcome. However, each lymphocyte has two chances at completing a productive antigen receptor gene rearrangement, because both alleles for each gene can rearrange, although rearrangement in the second allele is suppressed if the first allele is productive. Smaller tumors can be found incidentally in unrelated magnetic resonance imaging examinations. A small number of patients with osteosarcoma have involvement of multiple skeletal sites (multicentric osteosarcoma), either synchronous or metachronous, but without evidence of visceral metastases. Well characterized but very rare Malignant variants of Malignant variants have rarely other odontogenic been described for most epithelial tumors tumors. Papillary Hyperplasia of the Palate this occurs in the vault of the palate under a denture as a coarsely granular mass of soft tissue. It is this capacity of craniopharyngiomas to insinuate themselves among vital structures that makes their radical removal difficult and potentially very hazardous. Small islands of odontogenic epithelium may be present but are not necessary to make the diagnosis. If the lesion is being surgically excised, it is important for the pathologist to examine the gross specimen to determine if the surgeon has curetted the area in question. Winkelmann R K, Peters M S 1985 Atypical fibroxanthoma: a study with antibody to S-100 protein. Molecular analyses of chromosomal translocations show that the recombination-associated chromosomal breaks typically result in altered gene expression, by either dysregulated expression of a nearby gene or direct disruption of a gene at one or both breakpoints. Am J Surg Pathol 22: 1125-1131 Banerjee S S, Eyden B P 1996 Neuroendocrine differentiation in eccrine carcinoma [correspondence]. The proliferative nature of the cartilage and the presence of spindle cells between trabeculae frequently lead to a mistaken diagnosis of either chondrosarcoma or osteosarcoma. Gangliocytomas are rare, slowgrowing tumors composed of mature ganglionic neurons. Care must be taken to interpret these cor rectly to avoid overdiagnosis of malignancy (see later section on encysted papillary carcinoma). In this example of astroblastoma, tumor cells show some degree of anaplastic features (A). Other histologic variations in blue nevi include the wide range of entities with both histologic patterns, the mixed blue nevi. The most common site of occurrence is the posterior aspect of one or both vocal cords, although it may uncommonly occur along the middle third or anterior portions of the true vocal cords. In view of the fact that some degree of subjectivity may enter into the recognition of lymphoid atypia by light microscopic features alone, demonstration of monoclonality by immunohistochemical or molecular biologic studies may be helpful. Green P, Whittaker R P 1975 Benign chondroblastoma: case report with pulmonary metastasis. Chromosomal deletions can result from the loss of a whole chromosome, leaving only one homolog (monosomy); loss of whole chromosomal arms; or loss of interstitial segments of a chromosomal arm, as in the 5q- syndrome associated with myelodysplasia. Monosomy 3 is not distributed randomly throughout the tumor, and random fineneedle aspiration biopsy sampling may not yield cells that are prognostically representative of the most aggressive tumor cell population. If variation exists in the number of mitoses in different areas of the tumor then the least dif ferentiated area.

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C, Tumor cells with moderate cellular atypia are disposed in a trabecular-festooning pattern and accompanied by myxoid matrix. Sometimes the basaloid cells appear plump and spindled, streaming in the longitudinal direction of the tumor islands. It is a nuclear steroid receptor and can be mea sured by several methods, the older ones being ligand binding, then immunoassays, and now immunocyto chemistry, which can be performed on routine histologic sections of tumor. B, Immunohistochemical stain for pan-human papillomavirus shows positive staining in multiple nuclei. The solid nests of cells may contain squamous cells, squamous pearls, or squamous cyst formation and express high molecular weight cytokeratins. Odontogenic cysts and tumors are derived from the dental tissues and show variable features that may recapitulate stages of tooth development. Note the lobular pattern and mixture of granular eosinophilic cells and adipocytes. It should also be remembered that epidermotropic metastases from a melanoma elsewhere may closely simulate melanoma in situ. Other common features are the presence of a thick fibrous capsule, in which there may be a dense lymphocytic infiltrate, and the finding of quite numerous foamy (xanthomatous) cells within the tumor. Bipolar, fibrillary, and elongated (piloid) cells are admixed with areas of stellate cells with short processes that resemble protoplasmic astrocytes. Alam N A, Olpin S, Leigh I M 2005 Fumarate hydratase mutations and predisposition to cutaneous leiomyomas, uterine leiomyomas and renal cancer. The cells located in the peripheral portions of the clear cell islands are often much smaller, with eosinophilic cytoplasm and a squamoid quality. Cytogenetic analysis revealed specific abnormalities of chromosome 22, either monosomy or partial deletion on 22q11. Acta Neurochir (Wien) 150: 915-919 Cumberworth V L, Friedmann I, Glover G W 1994 Late metastasis of breast carcinoma to the external auditory canal. More typically the coexistence of mucinous and squamous differentiation occurs in highgrade tumors in which no particular prognostic benefit appears to exist. The nuclei do not demonstrate nuclear lobation, indentation, or longitudinal grooving as seen in Langerhans cell histiocytes. A, Adenocarcinomatous gland-forming component to the left and squamous component to the right. A form of subungual melanoma that produces metaplastic bone and cartilage may be mistaken for subungual exostosis. Invasive cancer will efface the normal architecture and may be associated with lymphovascular invasion, neurotropism, and invasion into muscle, bone, and cartilage. Schmidt L, Myers J 2010 Bronchioloalveolar carcinoma and the significance of invasion: predicting biologic behavior. Artlich A, Schmidt D 1990 Immunohistochemical profile of meningiomas and their histological subtypes. Crossreactivity with some reticulum cells and lymphoid cells may lead to falsepositive results when using some cytokeratin anti bodies. Sclerosing rhabdomyosarcoma473-476 was more recently recognized and also appears to be genetically unrelated to the embryonal or alveolar subtypes. Clear cell chondrosarcoma is an unusual chondroid neoplasm, representing approximately 2% of all chondrosarcomas. These cells may also rarely prove difficult to distinguish from melanocytes, and, in cases where the cytoplasm is not particularly vacuolated or clear, they may resemble atypical kerati nocytes such as those seen in other forms of chronic dermatitis. The main distin guishing features from invasive tubular carcinoma are the lobulocentric configuration, the disorderly proliferation of microtubules lined by twolayered epithelium, and the lack of separate tubular structures with clear lumina, set in a desmoplastic stroma. Tabar L, Duffy S W, Krusemo V B 1987 Detection method tumour size and node metastases in breast cancers diagnosed during a trial of breast cancer screening. Dixon J M, Scott W N, Miller W R 1985 Natural history of cystic disease: the importance of cyst type.

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