Fine needle aspiration of poorly differentiated rhabdomyosarcoma presenting with quadriparesis. A case report

BACKGROUND

The diagnosis of metastatic poorly differentiated rhabdomyosarcoma (RMS) in lymph node specimens by fine needle aspiration presents a difficult problem since it is virtually indistinguishable from other small round cell neoplasms.

CASE

Fine needle aspiration was performed under radiologic guidance on an extradural, space-occupying lesion of unknown etiology in the region of the C-6 and C-7 vertebrae in a 20-year-old male who was hospitalized with quadriparesis. Cytologic examination suggested a metastatic tumor consistent with the diagnosis of rhabdomyosarcoma. A subsequent search for the primary tumor site revealed a soft tissue swelling in the right calf muscle. Light microscopic, ultrastructural and immunocytochemical examination of multiple Tru-cut biopsy specimens from the swelling in the right calf muscle confirmed the diagnosis of poorly differentiated embryonal rhabdomyosarcoma.

CONCLUSION

Immunostaining is useful for muscle proteins in the detection of poorly differentiated forms of embryonal rhabdomyosarcoma. Electron microscopy is of limited use in such cases.

Observer variation in AgNOR counts in neoplastic breast lesions

OBJECTIVE

To determine interobserver and intraobserver variability of AgNOR quantitation in neoplastic lesions of the breast.

STUDY DESIGN

Forty-five cases, 20 benign and 25 malignant lesions, were included in the study. Counts were performed on one slide from each case within a pre-marked area of about 1 cm2 in a standardized manner by two observers blind to the histopathologic diagnosis and independent of each other and repeated after two weeks. Interobserver and intraobserver agreement was assessed using the Bland-Altman method.

RESULTS

Our results showed small mean interobserver and intraobserver differences but wide limits of agreement.

CONCLUSION

Observer variation in AgNOR counts is too high for the method to be of any diagnostic or prognostic relevance.

Diagnostic relevance of silver stained nucleolar organizer region (AgNORs) in benign and malignant breast lesions

The present study is planned to assess the diagnostic relevance of silver stained nucleolar organizer regions (NORs) in discriminating benign from malignant lesions of the breast and to ascertain the interobserver variability in the enumeration of AgNOR counts. Forty four specimens of benign and malignant breast tissues were studied and mean number of silver stained nucleolar organizer regions (MNORA) have been counted in paraffin sections. Malignant lesions have a higher number of MNORA than benign lesions. These results also showed correlation between the AgNOR counts and size of the tumor, axillary lymph node status and age of the patient. Our results also indicate a close agreement between the two observers with limits of agreement. However, AgNOR counts are of little diagnostic importance since a broad zone of overlap exists between benign and malignant breast diseases despite significant higher mean counts in malignant lesions. AgNOR sequence could perhaps be of use to differentiate those two histological indistinguishable lesions. The tumor size and axillary lymph node involvement suggested to its prognostic significance also. Interobserver agreement further suggests the utility of AgNOR counts as diagnostic or prognostic discriminants in breast malignancies.

Histopathology of auricular appendages in rheumatic heart disease

Forty-four left auricular appendages removed from patients presenting clinically as rheumatic heart disease (RHD) were subjected to histopathologic examination. The aim was to identify the changes so far reported in RHD. It was found that Aschoff's nodules, though specific for RHD, are much less frequent than the other changes reported. Viewing the histopathologic alterations in the perspective of clinical data is important in identifying the rheumatic process.

Spontaneous rupture of the oesophagus: case report of a delayed diagnosis and subsequent management

Spontaneous rupture of the oesophagus is a rare but potentially fatal condition. Initially described by Boerhaave in 1724, this condition remained a pathological curiosity until a subsequent case was reported by Barrett in 1946. The diagnosis is often difficult and, thus, the appropriate management is delayed. An oesophageal disruption may occur within the mediastinum or between the mediastinum and the visceral lung pleura, resulting in an oesophago-pleural fistula. We report a case of a spontaneously occurring oesophageal disruption which was successfully managed with minimum surgical intervention.

Diagnostic value of gene probes and its correlation with clinical profile of leprosy in children

Clinico-bacteriological profile of 73 leprosy patients below 16 years of age was studied. Majority of the patients were males and fell in 11-16 years age group (p < 0.05). Skin lesions were present in all cases on both exposed as well as unexposed areas and their number increased with advancing age. Cutaneous sensations were affected in most of the patients while nerve thickening was observed in 41. As age increased, the disease moved from the tuberculoid end of spectrum towards the lepromatous end (p < 0.05) and the positivity of the skin smears increased (p < 0.05). Majority of the paucibacillary cases were lepromin positive while most multibacillary cases were lepromin negative (p < 0.01). Two M. leprae specific gene probes were applied in 42 cases to assess their diagnostic value. Eighty one per cent cases were picked up by the probes indicating presence of active bacilli. These included all lepromin positive cases, all smear positive cases, and most of smear negative cases (p < 0.05). Seven children with inconclusive histology were also positive. Drug treatment and inadequate size of biopsy sample could explain the negative probe results in 19% cases. This study highlights the immense potential of gene probes in diagnosing leprosy in children.

Microfilaria in bronchial aspirate

A 65-year-old female was evaluated for suspected bronchogenic carcinoma. The chest x-ray revealed a left parahilar opacity with a raised left dome of diaphragm. Fiberbronchoscopy showed an oedematous and hyperemic left main bronchus but no growth was visualised. Bronchial biopsy did not show any evidence of neoplasm. However, the bronchial aspirate smear examination showed one microfilaria. Post bronchoscopic roentgenogram done on the next day revealed clearing of left parahilar shadow and a normal diaphragm. The patient responded well to 300 mg of diethylcarbamazine given in divided doses for 3 weeks.

A case of bilateral pulmonary hydatid cysts

A case of bilateral hydatid lung disease is reported who presented with a history of short duration and large opacities in both lung fields. A trial of medical treatment with albendazole 400 mg BD for 6 weeks failed. The patient was managed by surgical intervention which also ultimately established the diagnosis of hydatid disease.

Unusual orbital foreign bodies

Retained intraorbital organic foreign bodies, particularly wooden, are commonly encountered in ophthalmologic practice. We treated two children who had sustained such injury while playing. They presented to us with non-healing sinus with purulent discharge. In one of the patients, X-rays and CT scan helped to clinch the diagnosis, whereas in the other patient diagnosis was possible by correlating history with clinical findings. Surgical exploration in both patients helped us to remove the foreign bodies. Surprisingly, both the foreign bodies were 7 cm long wooden pieces. We, however, caution that management of such cases should be conservative and that surgical exploration be done only in case of complication. From our experience, we recommend proper localisation by all possible means, blunt dissection, careful haemostasis coupled with excellent lighting and exposure in the atraumatic removal of intraorbital foreign bodies.

Cellular immune response of patients with uveitis to peptide M, a retinal S-antigen fragment

Peptide M, an 18-amino acid fragment from position 303 to position 320 of retinal S-antigen, produces experimental autoimmune uveitis (EAU), similar to that produced by native S-antigen, in several vertebrate species including nonhuman primates. It was observed that 12 of the 39 (30.7%) patients with uveitis, 1 of the 29 (3.4%) patients with systemic connective tissue disorders (CTD) without eye involvement, 2 of the 7 (5.8%) patients of CTD with uveitis, 1 of the 17 (5.8%) patients with diabetic retinopathy, and none of the 19 normal healthy controls showed a significant lymphoproliferative response to peptide M (stimulation index of 3 or more). Yeast histone H3 peptide gave a positive response in 1 (2.5%), 2 (6.8%), 1 (14.2%), 2 (11.7%), and 2 (10.5%) individuals, respectively, in the different groups studied. In a few cases a positive response to yeast histone H3 peptide was observed without significant stimulation to peptide M. These findings indicate that peptide M could also be an immunogenic epitope of S-antigen in humans and be aetiopathologically related to uveitis in a subset of patients with this disease. However, unlike experimental animals, the responses to peptide M and yeast histone H3 were nonconcordant, necessitating further studies.

Immunocytochemical detection of prolactin binding sites in fine needle aspiration smears of breast lesions

Specific prolactin (PRL) binding sites were demonstrated in the fine needle aspiration cytology (FNAC) specimens from 68 patients with benign and malignant diseases of the breast using highly sensitive technique of DNP hapten sandwich staining procedure and antibody against human PRL. In 16 patients, immunocytochemical staining was also carried out on paraffin embedded sections of corresponding lesions. FNAC specimens included 52 neoplasms and 16 non-proliferative and proliferative benign breast disease. The reaction varied in different lesions, being maximum (72%) in malignant tumours and 60 per cent in benign tumours. However, benign breast disease showed a reaction that varied with the lesion. The technique was found to be simple, sensitive and economical for demonstrating specific PRL binding sites in cytology specimens of breast lesions.

Role of fine needle aspiration cytology in the diagnosis of lymphadenopathy

Fine needle aspiration cytology (FNAC) and open biopsy of same enlarged lymph nodes were performed in 59 patients with lymphadenopathy. When histopathological and cytological examinations were compared, an accuracy of 91.5% was achieved with FNAC in the cases of lymphadenopathy of various etiologies. Thus, fine needle aspiration cytology being reliable, safe, rapid and economical procedure, is useful as an outdoor diagnostic procedure for diagnosing lymphadenopathy of various etiologies.

Angiomatoid malignant fibrous histiocytoma of the eyelid

A 20 year old female had an angiomatoid malignant fibrous histiocytoma of her left upper eyelid extending into the orbit, frontal and temporal regions. The tumor was excised and radiotherapy was given. Nine months follow-up did not reveal any recurrence.

Effects of commonly used NSAID's on gastric mucosa. A clinico-endoscopic and histopathological study

Non steroidal anti-inflammatory drugs (NSAID's) are one of the most commonly used agents in clinical practice today. All these drugs are known to produce gastro-intestinal lesions. In the present study we found that aspirin, indomethacin and phenylbutazone caused gastric mucosal damage in 90.9%, 100%, respectively while ibuprofen and paracetamol caused gastric mucosal damage in 33.3% and 37.5% respectively. Thus latter two drugs were safer NSAID's. Further more we have demonstrated that endoscopic monitoring of the patients on NSAID's is a sensitive method of early detection of gastric mucosal damage. This monitoring may be particularly valuable in high risk subjects on NSAID's.

Effects of commonly used non steroidal anti-inflammatory drugs on gastric mucosa. A clinical, endoscopic and histopathological study

Non steroidal anti-inflammatory drugs (NSAIDS) are known to produce gastro-intestinal lesions. In the present work we found that aspirin, indomethacin and oxyphenbutazone caused gastric mucosal damage in 90.9%, 100% and 100% respectively, while ibuprofen and paracetamol caused damage in 33.3% and 37.5% of cases respectively. Thus the latter two drugs were much safer NSAIDs. Furthermore we demonstrated that endoscopic monitoring of patients on NSAIDs is a sensitive method for early detection of gastric mucosal damage. This monitoring may be particularly valuable in high risk subjects on NSAIDs.

Highly specific sites of prolactin binding in benign and malignant breast tissue

An immunocytochemical method involving the application of polyclonal antisera to human prolactin (PRL) followed by a highly sensitive and a modified version of dinitrophenyl (DNP) hapten sandwich staining procedure using anti-DNP IgM monoclonal antibody has been used to detect PRL binding in benign and malignant breast tissue. The technique was applied to 5 microns thick sections of paraffin embedded formalin fixed tissue. Out of 107 breast biopsies 40 were carcinomas, 41 were fibroadenomas, 18 were benign cystic disease and 8 were gynaecomastia. In cases of carcinoma positive staining was observed in 82.5% cases whereas in fibroadenoma the positivity was in 57% cases only. The positive reaction in fibroadenoma was mainly due to the presence of apocrine metaplasia associated with the tumour. Also PRL was present in greater proportion in post menopausal patients as compared to premenopausal cancer patients. These findings suggest the presence of specific PRL binding sites in breast tissue. The staining was restricted to epithelial cells and background staining of the stroma was minimally seen in these cases. Positively stained breast carcinoma may represent an apocrine subset of the carcinoma.

Ultrastructural reappraisal of endometrial glandular changes in women wearing Cu-T200 device for longer duration

The present communication deals with the effects of Copper-T200 Sq mm intrauterine device on the endometrial glands in the women using it for a longer duration i.e. up 8 years. The ultrastructural changes in the lining endometrial glands were studied during both non-ovulatory and ovulatory phases of the menstrual cycle. The ultrastructural studies demonstrated significant progressive changes in the lining endothelial cells of endometrial glands. The findings showed marked accumulation of glycogen in the cells in secretory phase of the endometrial cycle. Ultrastructural changes in glandular lining cells were more pronounced in women using Cu-IUCD for 4-8 years having distorted morphology with disrupted cell organelles, swollen mitochondria, irregular pattern of microvilli, deposition of electron dense material on cell surface and narrowing of glandular lumen.

Effects of scrotal hydrocele over testicular histology

Forty four biopsies were performed on testes during hydrocele operations. They show alteration in 52.2 percent of the biopsies. There is variable effect of size and duration of hydrocele on the morphogenesis of testes. However, size and duration are not the only influencing factors and there is need to analyse the histological changes in hydrocele of different etiology.