Quick trio of cases! Can you diagnose them all?

Anatomic pathologists and pathology enthusiasts - check out these cases.  These are fairly routine cases from Kijabe.  Can you get them?  First to email me (Thomas Long) with all 3 correct diagnoses will be recognized on the blog.  Differential diagnoses will not be accepted.  One guess per case.

Case 1:  The patient is a 28 year old Kenyan man with HIV.  He complained of dysphagia and the oesophago-gastro-duodenal (OGD) endoscopy showed a mass.  Biopsy is pictured below.  What is your diagnosis?

Case 2:  A 36 year old Kenyan woman presents with a cervical mass.  Radical hysterectomy with lymph node dissection is performed.  Mass and lymph node are pictured.  Diagnosis?

Case 3:  Now for some cytology.  A 45 year old Kenyan man presents with a left inguinal mass.  FNA is performed.  Diagnosis?

ANSWERS:

1.  This nodule in the esophagus of someone who has HIV and is likely immunocompromised contains numerous foamy macrophages and especially on highest power (oil immersion, 100x) clearly shows intracellular organisms morphologically suspicious for histoplasmosis.

2.  The pictures are intentionally from lower power.  There is a solid-appearing invasive carcinoma.  The most common diagnosis and the one that comes to mind first would generally be squamous cell carcinoma, but the lesson here is that not all that is solid is squamous.  If you look carefully, there are gland-forming lumens, most easily identified on the lymph node metastasis.  Additionally, the cells are rounder and less angulated than typical squamous cells, and there is no keratinization or other obvious squamous feature other than somewhat eosinophilic cytoplasm.  Here is a higher power view of more obvious gland formation:

3.  This cytologic specimen is first positive for a epithelioid to spindled, cohesive malignancy.  But the nuclear features (round with some prominent nucleoli) and especially the abundant cytoplasmic pigment with a somewhat granular quality, are highly suspicious and essentially diagnostic of melanoma, in this case metastatic to an inguinal lymph node.  This patient had a primary on the foot, and this likely falls into the category of acral melanoma, which is the most common form of melanoma in African Americans, and probably also Africans.  We saw a couple of cases (both fairly advanced), and that's about all the skin cancer we saw during my rotation.