China Science » Environmental Science and Ecology

Anaplastic oligodendroglioma: a case report with characteristic cytologicfeatures, including minigemistocytes

admin — Sun, 13 Apr 2008 02:53:29 +0000

BACKGROUND: Absolute criteria for grading oligodendrogliomas are somewhatpoorly defined in contrast to those for grading astrocytic tumors, and cytologic features ofanaplastic oligodendrogliomas have been poorly described. CASE: A 63-year-old man presented with atoppling gait. Radiologic examination revealed a 7-cm mass with calcifications in the right frontallobe. Intraoperative smears of the tumor showed hypercellular, loosely cohesive cell clusters andsingle cells with nuclear pleomorphism, numerous apoptotic cells and no discernible fibrillaryprocesses. Many bland-looking round cells with cyanophilic cytoplasm and eccentrically locatednuclei, so-called minigemistocytes, were intermingled among atypical cells. Cryostat sections showedcellular nests consisting of tumor cells with oval nuclei and clear cytoplasm. These cells wereproliferating in the finely reticulated vascular stroma, and the tumor had an infiltrative marginwith areas of focal necrosis and numerous calcifications. The diagnosis of anaplasticoligodendroglioma, World Health Organization grade 3, was made, and the results of fluorescence insitu hybridization (chromosome 1q deletion) supported the diagnosis. CONCLUSION: Intraoperativediagnosis of anaplastic oligodendroglioma may not be easy but is possible with judiciousconsideration of several features: high cellularity, no fibrillary processes, nuclear atypia,pleomorphism, abundant apoptotic cells, occasional mitotic figures, coagulative necrosis,endothelial hyperplasia and characteristic conspicuous minigemistocytes.

Mitsuhashi,T　Shimizu,Y　Ban,S　Ogawa,F　Matsutani,M　Shimizu,M　Hirose,T
Department of Pathology, Saitama Medical School, Saitama, Japan.mitsut@mail.tains.tohoku.ac.jp

Diagnostic　 Undifferentiated　 Neoplasms　 Cancer cells grading systemIntraoperative

I***ssue 4,5,6 finished.

Cerebrotendinous xanthomatosis:a case report.

admin — Sun, 13 Apr 2008 02:51:16 +0000

BACKGROUND: Cerebrotendinous xanthomatosis is a rare, autosomal recessive,inherited lipid storage disease characterized by accumulation of cholestanol and cholesterol in mosttissues. The disease is caused by mutations in the sterol 27-hydroxylase gene, leading to a blockin bile synthesis, with accumulation of substrates for this enzyme, including cholesterol, resultingin an increase in the conversion of cholesterol to cholestanol. CASE: A 26-year-old woman presentedwith gradually increasing bilateral ankle swelling. She had a history of bilateral cataracts andleft-sided hemiparesis. She had mental retardation, with a history of delayed milestone development.Her serum cholesterol levels were elevated. Aspiration of both ankle swellings revealed histiocytesand many foreign body giant cells. There were numerous rectangular to rhomboid crystals in thebackground. CONCLUSION: Very few articles are available on the cytologic features of tendinousxanthomas; hence we tried to highlight these features.

Srinivas,BH　Patnayak,R　Rao,IS　Prayaga,A　Khan,AK　Narasimhlu,G
Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad,Andhra Pradesh, India.

Xanthomatosis, Cerebrotendinous　 Cholesterol brief historical notes,excludes case histories

Multicystic nephroma: a case report

admin — Sun, 13 Apr 2008 02:49:06 +0000

BACKGROUND: Cystic nephroma is an uncommon pediatric renal neoplasm. It needsto be differentiated from cystic partially differentiated nephroblastoma and from other renalneoplasms showing extensive cystic change. It is scantily reported in the cytology literature. CASE:A 7-month-old female with a left-sided abdominal lump was diagnosed as having cystic Wilms’ tumoron computed tomography. Fine needle aspiration cytology showed cellular smears composed ofmonomorphic, round to oval cells, suggestive of a small round cell tumor, possibly rhabdomyosarcoma.However, histopathologic examination showed it to be a multicystic nephroma. On review of thecytologic smears, the blastemal component was absent. CONCLUSION: This case highlights 1 extreme andunexpected cytologic appearance of cystic nephroma; it may result in misdiagnosis.

Gupta,R　Dhingra,K　Singh,S　Nigam,S　Jain,S
Department of Pathology, Maulana Azad Medical College, New Delhi, India.

Renal　 Nephroblastoma　 Neoplasms Case Report

Sporotrichosis in an HIV-positive man with oral lesions:a case report

admin — Sun, 13 Apr 2008 02:47:55 +0000

BACKGROUND: Sporotrichosis is a granulomatous fungal infection caused bySporothrix schenckii, which frequently causes cutaneous or lymphocutaneous lesions and rarely hasoral manifestations. CASE: A 38-year-old, white, HIV-positive man complained of a 5.0-cm,symptomatic, ulcerated lesion with thin, superficial granulation in the soft palate extending to theuvula. Exfoliative cytology of this oral lesion showed chronic granulomatous inflammatoryalterations and extracellular fungal structures consisting of periodic acid-Schiff-positive buddingcells and spherical or elongated (cigar bodies) free spore forms. CONCLUSION: The clinical andcytologic findings allowed the diagnosis of sporotrichosis, demonstrating the importance ofcytodiagnosis in fungal diseases.

Fontes,PC　Kitakawa,D　Carvalho,YR　Brandao,AA　Cabral,LA　Almeida,JD
Postgraduate Program in Oral Biopathology and Department of Biosciences andOral Diagnosis, Sao Jose dos Campos Dental School, Sao Jose dos Campos, Sao Paulo, Brazil.

Lesion, NOS　 Oral　 Sporotrichosis Male population group

Fine needle aspiration cytology in follicular dendritic cell sarcoma:areport of two cases

admin — Sun, 13 Apr 2008 02:46:36 +0000

BACKGROUND: Since the first description of extranodalfollicular dendriticcell sarcoma in 1994, there has been a gradual increase in understanding of the morphologic featuresand clinical presentation of this tumor. However, difficulties persist in making cytologicdiagnosis. CASES: Two cases of follicular dendritic cell sarcoma with fine needle aspirationcytology (FNAC) findings were reported. The first patient was a Chinese woman who presented with aright tonsillar mass, which was followed by right submandibular recurrence. The second patient was aChinese man with known history of Castleman’s disease of the nasopharynx complicated by folliculardendritic cell sarcoma, followed by tumor recurrence in cervical lymph nodes. FNAC of both recurrentcases showed isolated or syncytial sheets of tumor cells containing eosinophilic granularcytoplasm, ill-defined cell borders, round to oval nuclei, solitary round eosinophilic nucleoli andfine chromatin. CONCLUSION: The tumor cells in follicular dendritic cell sarcoma show cytologicfeatures reminiscent of native follicular dendritic cells but with a greater than expected cellnumber and nuclear pleomorphism. These cells may be immunohistochemically inert for folliculardendritic cell markers CD21 and CD35. A presumptive diagnosis on the basis of cytologic examinationis possible when paying attention to the subtle morphologic features.

Fan,YS　Ng,WK　Chan,A　Chan,GS　Tsang,J　Chim,CS　Ip,P
Department of Pathology and Clinical Biochemistry, Queen Mary Hospital, HongKong SAR, China. fanyuenshan@hotmail.com

Dendritic Cells　 Malignant neoplasm musculoskeletal　 Neoplasms Fine needlebiopsy, NOS

Intraoperative cytologic diagnosis of symptomatic carcinoma (pulmonary smallcell carcinoma) metastatic to the pituitary gland:a case report

admin — Sun, 13 Apr 2008 02:45:04 +0000

BACKGROUND: Carcinoma metastatic to the pituitary gland is infrequent and hasbeen reportedly detected in approximately 1% of pituitary surgical cases. It may masquerade as apituitary adenoma both clinically and radiologically. CASE: A 49-year-old man presented with a1-month history of severe headache, diplopia and blurred vision. Neurologic examination revealedbitemporal hemianopsia and left sixth nerve palsy. The initial radiologic diagnosis based onmagnetic resonance imaging was pituitary adenoma. A biopsy of the lesion was performed. Whileintraoperative frozen section examination could not completely exclude an “atypical” pituitaryadenoma, cytologic touch imprint findings were diagnostic of metastatic small cell carcinoma.Subsequently, additional workup revealed that the patient had a mass lesion in the right lung andright-sided mediastinal lymphadenopathy on chest computed tomography. This was a rare case ofpituitary metastasis as the first manifestation of an occult malignancy. CONCLUSION: Forintraoperative diagnosis at the time ofpituitary surgery, cytologic imprints can be used reliably tomake a diagnosis not only of pituitary adenoma but also of metastatic lesions. It is appropriate incurrent neuropathology practice that the imprint method be used as the sole modality forintraoperative consultation for pituitary lesions.

Takei,H　Buckleair,L　Goodman,JC　Powell,SZ
Department of Pathology and Laboratory Medicine, Baylor College of Medicine,Houston, Texas 77030-3498, USA. htakei@bcm.tmc.edu

Carcinoma　 Diagnostic　 Metastatic to　 Lesion, NOS Adenoma

Testicular juvenile granulosa cell tumor:a case report

admin — Sun, 13 Apr 2008 02:39:10 +0000

BACKGROUND: Juvenile granulosa cell tumors of the testis are rare gonadalstromal tumors of the pediatric age. They represent the most common neoplasms of the testis in thefirst 6 months of life. A testicular cystic mass is detected, or it can appear as an abdominal oringuinal mass. Differential diagnosis for testicular tumors at this age includes teratoma, simplecyst, epidermoid cyst, lymphangioma and testicular torsion. Association with ambiguous genitalia andsex chromosome abnormalities has been reported. Orchiectomy alone is recommended, because no caseof metastasis or recurrence has been reported. CASE: We report a case of a 3-month-old male infantwith a testicular juvenile granulosa cell tumor mass initially evaluated by fine needle biopsy,which disclosed single or cohesive groups of vimentin, alpha-inhibin and S-100-positive spindlecells with regular nuclei and fine chromatin and inconspicuous nucleoli. Orchiectomy was performed,and histology revealed a juvenile granulosa cell tumor. CONCLUSION: Even though juvenile granulosacell tumor is the most common neoplasm of the testis in the first 6 months of life, we found noreports describing its cytologic features. In this setting, fine needle aspiration cytology is auseful tool for initial and therapeutic management.

Barroca,H　Gil-da-Costa,MJ　Mariz,C
Anatomy and Pathology Service, Sao Joao Hospital, Porto, Portugal.hbarroca@gmail.com

Neoplasms　 Juvenile　 Granulosa Cells　 month Testis

Primary intramuscular infestation of Echinococcus granulosus misdiagnosed asa soft tissue tumor:a case report

admin — Sun, 13 Apr 2008 02:37:54 +0000

BACKGROUND: The occurrence of a primary intramuscular infestation ofEchinococcus granulosus is extremely rare. CASE: A 70-year-old woman with primary skeletal musclehydatidosis initially presented with a soft tissue mass. Clinical and radiologic examinationrevealed a huge cystic mass in the right quadriceps muscle without any visceral organ involvement.Since the differential diagnosis included a soft tissue tumor, fine needle aspiration cytology wasperformed, and a diagnosis of hydatid disease was made. CONCLUSION: This very rare case of primaryintramuscular infestation of E granulosus was clinically misdiagnosed as a soft tissue tumor.Hydatid disease, albeit rare, should be considered in the differential diagnosis of a soft tissuemass.

Insabato,L　Marino,G　Fazioli,F　Iacono,V　Mascolo,M　Palombini,L
Section of Pathology, Department of Biomorphological and Functional Sciences,University of Naples “Federico II”, Naples, Italy. insabato@unina.it

　Soft tissues, NOS　 Neoplasms　 Echinococcus granulosus　 Mass, NOSDifferential diagnostic aspects

Mycobacterium kansasii infection diagnosed by pleural fluid cytology:a casereport

admin — Sun, 13 Apr 2008 02:36:44 +0000

BACKGROUND: Identification of disseminated nontuberculous Mycobacteriuminfection is a challenge, especially when it occurs in patients without a known cause ofimmunosuppression. Acid-fast organisms in the pleural fluid are rare and easily missed, especiallywhen they occur in patients without a clinical suspicion of infection. The classical cytologicpicture of tuberculous pleural fluid with lymphocytosis and paucity of mesothelial cells is notseen. CASE: A 57-year-old man presented with chronic neutrophilia of unknown etiology together withchest pain and bilateral pleural effusions. Pleural fluid cytology revealed organisms seen in thecytoplasm of numerous macrophages and neutrophils, creating a “negative image” on Diff-Quik smears.Acid-fast stains demonstrated intracellular acid-fast bacilli consistent with mycobacteria.Microbiologic studies with DNA probe technology resulted in identification of the mycobacterialorganism as Mycobacterium kansasii. CONCLUSION: Nontuberculous Mycobacterium should be included inthe differential diagnosis in patients with inflammatory, exudative pleural effusions.

Domfeh,AB　Nodit,L　Gradowski,JF　Bastacky,S
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh,Pennsylvania, and University of Alabama, Birmingham, Alabama 15213, USA.

Liquid substance　 Fast　 Organisms (MeSH Category) Acids

Fine needle aspiration cytology of juvenile hyaline fibromatosis:casereport

admin — Sun, 13 Apr 2008 02:34:48 +0000

BACKGROUND: Juvenile hyaline fibromatosis (YHF) is a rare inherited disordercharacterized by tumorous growth of hyalinized fibrous tissue. No report on cytomorphology of thiscondition is available in English on MEDLINE. CASE REPORT: A 6-year-old girl had multiple nontendernodules on both ear lobes, nose and scalp. Fine needle aspiration of the nodule on the left earrevealed benign, spindle-shaped cells with an eosinophilic ground substance in the background. Thediagnosis of JHF was made following cytologic and histopathologic studies. CONCLUSION: Fine needleaspiration cytology is reliable for the diagnosis of JHF.

Geethamani,V　Ravindra,S　Reddy,VV
Department of Pathology, Kempegowda Institute of Medical Sciences, andVictoria Hospital, Bangalore, India. drgeethavenkat@yahoo.co.in

Fine needle biopsy, NOS　 Diagnostic Juvenile Fibromatosis