Removal notice to: Anterior mediastinal cholesterol granuloma - A case report

This abstract from abstract [Pathology 2020; 52(S1): S82] has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This abstract has been removed at the request of the Authors and the Editor in Chief due to patient consent issues.

Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

Aims: Chronic diseases impose a substantial healthcare burden. This study sought to evaluate the clinical and economic impact of new disease management (DM) programs, targeting four major chronic disease groups: diabetes, coronary heart disease (CHD)/hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF)/chronic kidney disease (CKD).Materials and methods: Between March 1, 2015, and February 28, 2018, members with Blue Cross Blue Shield of Louisiana insurance were contacted and enrolled in a DM program if they were aged 18 years through 64 years, eligible for a DM program, and had not been previously enrolled in a DM program. Active enrollees of a DM program ("IN" group) were compared to members who were not yet enrolled ("OUT" group). Average per member per month (PMPM) costs were aggregated annually to document any descriptive trends. Multivariable model estimates were used to compare PMPM costs for all IN subjects and all OUT subjects. Total medical savings were evaluated for the following time intervals: 1-12 months, 13-24 months, and 25-36 months.Results: For all four DM programs, average costs PMPM trended upward over time for the OUT cohort, while they remained relatively stable for the IN cohort. Some evidence also showed that DM programs improved clinical outcomes, such as hemoglobin A1c values. A difference in difference analysis showed PMPM savings for all four programs combined of $31.61, $50.45, and $53.72 after 1, 2, and 3 years, respectively. Multivariable modeling results showed total savings after 3 years of $14,460,174 for all DM programs combined.Limitations: Although multivariable models adjusted for several clinical, demographic, and economic characteristics; it is possible that some important confounders were missing due to lack of data.Conclusions: DM programs implemented to control diabetes, CHD/HTN, CHF/CKD, and asthma/COPD are cost-effective and show some evidence of improved clinical outcomes.

Polyarteritis nodosa presenting atypically as appendicitis and pyelonephritis in a single patient

A 17-year-old man presented to the emergency department 10 days postlaparoscopic appendicectomy with ongoing lower abdominal pain. The pain was associated with fevers, chills, sweating and constipation. There were no other associated symptoms. On examination, there was suprapubic and right lower quadrant tenderness and an elevated blood pressure (140/90 mm Hg). The patient later developed severe bilateral flank pain. Investigations revealed elevated C reactive protein, leukocyturia and microscopic haematuria. Blood and urine cultures were negative. CT angiogram demonstrated bilateral wedge-shaped peripheral renal hypodensities suggestive of several peripheral infarcts with intrarenal microaneurysms. Treatment with steroids and cyclophosphamide was initiated, leading to significant clinical improvement. Review of the histological appendix specimen revealed features consistent with small-medium vessel vasculitis.

Sporadic Burkitt's lymphoma masquerading as an intussuscepted Meckel's diverticulum in a 9-year-old child

We report the case of a 9-year-old boy who presented with abdominal pain and was found to have an intussusception with a sporadic Burkitt's lymphoma (BL) lead point. Our case was unusual in that the patient did not present with the typical clinical features of BL, nor was he in a high-risk demographic for this uncommon disease.

Anti-glomerular basement membrane glomerulonephritis following nintedanib for idiopathic pulmonary fibrosis: a case report

BACKGROUND

We report a previously unrecognized and unreported case of a patient with anti-glomerular basement membrane glomerulonephritis following nintedanib, an orally active small molecule tyrosine kinase inhibitor.

CASE PRESENTATION

A 59-year-old Caucasian woman with a history of idiopathic pulmonary fibrosis presented with severe acute kidney injury (creatinine 285 umol/L) secondary to anti-glomerular basement membrane glomerulonephritis disease 4 months after commencement of nintedanib. She had hematuria with red blood cell casts, nephrotic range proteinuria (3.5g/24 hours) and significantly elevated anti-glomerular basement membrane glomerulonephritis titers at 860 chemiluminescent units. A kidney biopsy confirmed severe crescentic glomerulonephritis with linear immunoglobulin G deposition in glomerular basement membrane. Despite the commencement of treatment with plasma exchange and cyclophosphamide, she remained dialysis dependent. Nintedanib was discontinued.

CONCLUSIONS

Onset of acute anti-glomerular basement membrane glomerulonephritis was found to be associated with recent nintedanib use suggesting that nintedanib may be a potential trigger for anti-glomerular basement membrane glomerulonephritis. This case highlights the importance of close monitoring of patients receiving new targeted therapies. Management of novel targeted agents in patients receiving dialysis is challenging because of the scarcity of specific data.

Alveolar proteinosis associated with aluminium dust inhalation

Secondary alveolar proteinosis is a rare lung disease which may be triggered by a variety of inhaled particles. The diagnosis is made by detection of anti-granulocyte-macrophage colony-stimulating factor antibodies in bronchoalveolar lavage fluid, which appears milky white and contains lamellar bodies. Aluminium has been suggested as a possible cause, but there is little evidence in the literature to support this assertion. We report the case of a 46-year-old former boilermaker and boat builder who developed secondary alveolar proteinosis following sustained heavy aluminium exposure. The presence of aluminium was confirmed both by histological examination and metallurgical analysis of a mediastinal lymph node. Despite cessation of exposure to aluminium and treatment with whole-lung lavage which normally results in improvements in both symptoms and lung function, the outcome was poor and novel therapies are now being used for this patient. It may be that the natural history in aluminium-related alveolar proteinosis is different, with the metal playing a mediating role in the disease process. Our case further supports the link between aluminium and secondary alveolar proteinosis and highlights the need for measures to prevent excessive aluminium inhalation in relevant industries.

Persistent splenomegaly in an adult female with homozygous sickle cell anemia

Sickle cell anemia (SCA) is associated with repeated episodes of erythrostasis in the spleen, which lead to thrombosis and infarction of the spleen resulting in "autosplenectomy" which is usually complete by 8 years of age. We present a case of a 22-year-old female who presented with complaints of fever, bone pain and joint swelling. On examination she had pallor, icterus and moderate splenomegaly. Her hemoglobin was 7.5 g/dl. Peripheral smear showed many sickled red cells. Slide test for sickling was positive with 2% sodium metabisulphite. Hemoglobin electrophoresis revealed a single band in the hemoglobin S, D, and G region. No band was seen in the HbA & HbA(2) region. HbF level was 0%. USG showed an enlarged spleen with few defined hypoechoeic lesion. We present this case because of rarity of association of homozygous SCA with splenomegaly in this age group, the confusion that echogenic lesions in spleen can create and to emphasize the risk of sequestration crises, which remains in such cases.

Status of iodine deficiency in district Kangra, Himachal Pradesh after 60 years of salt iodization

BACKGROUND/OBJECTIVES

District Kangra, Himachal Pradesh(HP), India is a known endemic area for iodine deficiency disorders (IDD) since 1956. The present study was conducted in district Kangra, Himachal Pradesh with the objective to assess the prevalence of iodine deficiency in school-age children.

SUBJECTS/METHODS

A total of 1864 children in the age group of 6-12 years were included. Clinical examination of thyroid of all children was undertaken. 'On the spot' urine samples were collected from 463 children. The salt samples were collected from 327 children.

RESULTS

The total goiter prevalence of 15.8% was found. The proportion of children with urinary iodine excretion (UIE) levels <50.0, 50.0-99.9 and ≥ 100 μg/l was 2.2, 14.3 and 83.5%, respectively. The median UIE level was 200 μg/l. About 82.3% of the families were consuming salt with iodine content ≥ 15 ppm.

CONCLUSION

The population in district Kangra is possibly in a transition phase from iodine deficient (as revealed by total goiter rate of 15.8%) to iodine sufficiency (as revealed by median UIE levels of 200 μg/l).

Granular cell ameloblastoma: enigmatic cells in an unusual neoplasm

An unusual granular variant of ameloblastoma presenting as a mandibular mass in a 43-year-old woman is described. These visually striking tumors display unusual and inconsistent immunohistochemical staining patterns although differential diagnosis from other granular cell lesions of the head and neck is usually not problematic.

Postaural inflammatory pseudotumor: an extremely unusual complication of trauma in a child

We report the case of a 12-year-old boy who presented with a rapidly enlarging, painless mass behind the ear following trauma to the area. The mass was excised, and histopathologic and immunohistochemical evaluations revealed it to be an inflammatory pseudotumor. At 1 year postoperatively, the child exhibited no evidence of recurrence.

A diagnostic system for electrical faults in a high current discharge plasma setup

A diagnostic system to detect electrical faults inside a coaxial high current discharge device is presented here. This technique utilizes two biconical antennas picking up electromagnetic radiation from the discharge device, a voltage divider sensing input voltage, and a Rogowski coil measuring the main discharge current. A computer program then analyses frequency components in these signals and provides information as to whether the discharge event was normal or any breakdown fault occurred inside the coaxial device. The diagnostic system is developed for a 450 kV and 50 kA capillary discharge plasma setup. For the setup various possible faults are analyzed by electrical simulation, followed by experimental results. In the case of normal discharge through the capillary load the dominant frequency is ∼4 MHz. Under faulty conditions, the peak in magnitude versus frequency plot of the antenna signal changes according to the fault position which involves different paths causing variation in the equivalent circuit elements.

Myxoma of the temporal bone: an uncommon neoplasm

We report the case of an 11-year-old girl who presented with a soft-tissue mass that filled the left external auditory canal and a discharge that resembled chronic suppurative otitis media. The patient underwent mastoid exploration with complete excision of the mass. Findings on the excision biopsy were consistent with a myxoma of the temporal bone. At follow-up 2 years postoperatively, the patient remained disease-free. To the best of our knowledge, this is only the 12th case of a myxoma of the temporal bone to be reported in the English-language literature.

Alteration in coagulation profile and incidence of DVT in laparoscopic cholecystectomy

INTRODUCTION

Although laparoscopic cholecystectomy appears to be less traumatic to the patients than open surgery, decreased venous return from lower extremities and hypercoagulability occurring in patients undergoing elective laparoscopic cholecystectomy with CO(2) pneumoperitoneum makes it a potent risk factor for deep venous thrombosis.

METHODS

The observational study of 50 patients undergoing elective laparoscopic cholecystectomy was designed to study alteration in PT, APTT, D-dimer and antithrombin III, which were measured preoperatively, 6 and 24h postoperatively. It was accompanied by color duplex ultrasound of bilateral lower limbs preoperatively and 7th day postoperatively to look for evidence of deep venous thrombosis.

RESULTS

Significant postoperative decrease in APTT and antithrombin III suggested activation of coagulation while decrease in d-dimer suggested activation of fibrinolysis. Values of PT had no statistically significant postoperative changes. Age, body mass index and duration of pneumoperitoneum were found to correlate with significant activation of coagulation and fibrinolysis. None of the patients developed clinical or radiological evidence of deep venous thrombosis in the postoperative period.

CONCLUSIONS

CO(2) pneumoperitoneum enhances the activation of coagulation and fibrinolysis associated with laparoscopic cholecystectomy. Patients with risk factors like old age, obesity or with expected long duration of laparoscopic surgery are likely to have significant activation of coagulation, making them a vulnerable risk group for development of postoperative deep vein thrombosis, warranting some form of thromboprophylaxis.

Chemical synthesis, pharmacological characterization, and possible formation in unicellular fungi of 3-hydroxy-anandamide

The fungal pathogen Candida albicans transforms arachidonic acid (AA) into 3-hydroxyarachidonic acid [3R-HETE], and we investigated if its nonpathogenic and 3R-HETE-producing close relative, Dipodascopsis uninucleata, could similarly transform the endocannabinoid/endovanilloid anandamide into 3-hydroxyanandamide (3-HAEA). We found that D. uninucleata converts anandamide into 3-HAEA, and we therefore developed an enantiodivergent synthesis for this compound to study its pharmacological activity. Both enantiomers of 3-HAEA were as active as anandamide at elevating intracellular Ca2+ via TRPV1 receptors overexpressed in HEK-293 cells, while a approximately 70-90-fold and approximately 45-60-fold lower affinity at cannabinoid CB1 and CB2 receptors was instead observed. Patch clamp recordings showed that 3R-HAEA activates a TRPV1-like current in TRPV1-expressing HEK-293 cells. Thus, 3R-HETE-producing yeasts might convert anandamide released by host cells at the site of infection into 3R-HAEA, and this event might contribute to the inflammatory and algogenous responses associated to fungal diseases.

Osteomyelosclerosis with thalassemia trait: report of a rare association, study of platelet function tests and review of literature

Idiopathic myelofibrosis is a chronic myeloproliferative disorder characterized by excessive connective tissue deposition in the bone marrow. It presents with leucoerythroblastic anemia and massive splenomegaly. It is termed osteomyelosclerosis in the presence of primitive bone formation in the bone marrow and radiological presence of osteosclerosis. A 40-year-old male, known case of thalassemia trait presented with fatigue and lump in the abdomen for two months. Physical examination showed splenomegaly 8.5 cm below costal margin. X-ray examination revealed multiple osteosclerotic lesions involving the pelvis and long bones. Hemogram showed: hemoglobin 7.8 gm/dl, TLC 47,500/mm(3); DLC was polymorphs 49%, lymphocytes 7%, eosinophils 4%, basophils 4%, blasts 5%, promyelocytes 2%, myelocytes 14%, metamyelocytes 10%. Platelet count was 60,000/mm(3). Peripheral blood film showed leucoerythroblastic blood picture with features of dysmyelopoiesis. Bone marrow aspiration was diluted with peripheral blood. Bone marrow biopsy showed replacement of marrow by grade III reticulin fibrosis. Bony trabaculae were wide and thick. Platelet function studies were abnormal. The clinical, radiological and hematological features suggested a diagnosis of osteomyelosclerosis. We present this case because no similar association of osteomyelosclerosis with thalassemia trait has been described in English literature to date. This is the first study from India, which describes platelet function tests in a patient with osteomyelosclerosis.

Abdominal tuberculosis presenting as ileocolic intussusception in an infant

Intussusception is the most common cause of intestinal obstruction in children, with a peak in children 5 to 7 months of age. Identifiable causes are found in 90% of adults, whereas in infants and young children the majority are idiopathic. We report a case of abdominal tuberculosis (ATB) presenting as an ileocolic intussusception in an infant. A 6-month-old infant presented with features of acute intestinal obstruction. Peroperatively, ileocolic intussusception was found. Histological examination revealed caseating epitheloid cell granulomas with positivity for acid-fast bacilli. Only 3 cases of ATB presenting as intussusception have been previously reported in the literature, with only 1 case presenting in a child. This appears to be the 2nd case of ATB presenting as an intussusception in a child and also in an infant. Tuberculosis should also be kept in the differential diagnosis of lead point of intussusception, even in the age group in which most cases are idiopathic, especially in endemic areas.

Biological role of hepoxilins: upregulation of phospholipid hydroperoxide glutathione peroxidase as a cellular response to oxidative stress?

The 12S-lipoxygenase (12S-LOX) pathway of arachidonic acid (AA) metabolism is bifurcated at 12(S)-hydroperoxy-5Z,8Z,10E (12S-HpETE) in the reduction route to form 12S-hydroxy-eicosatetraenoic acid (12S-HETE) and in 8(S/R)-hydroxy-11(S),12S-trans-epoxyeicosa-5Z,9E,14Z-trienoic acid (HXA3) synthase pathway, previously known as isomerization route, to form hepoxilins. Earlier we showed that the HXA3 formation is restricted to cellular systems devoid of hydroperoxide reducing enzymes, e.g. GPxs, thus causing a persistent oxidative stress situation. Here, we show that HXA3 at as low as 100 nM concentration upregulates phospholipid hydroperoxide glutathione peroxidase (PHGPx) mRNA and protein expressions, whereas other metabolites of AA metabolism 12S-HpETE and 12S-HETE failed to stimulate the PHGPx. Moreover, the decrease in 12S-HpETE below a threshold value of the hydroperoxide tone causes both suppression of the overall 12S-LOX activity and a shift from HXA3 formation towards 12S-HETE formation. We therefore propose that under persistent oxidative stress the formation of HXA3 and the HXA3-induced upregulation of PHGPx constitute a compensatory defense response to protect the vitality and functionality of the cell.

Unsuspected multiples myeloma presenting as bilateral pleural effusion - a cytological diagnosis

Background

Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis.

Case Presentation

A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin's Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type).

Conclusion

Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age.

Tubercular and chronic pyogenic osteomyelitis of cranio-facial bones: a retrospective analysis

AIM

To analyse current trends in our population with respect to the presentation, diagnosis and management of tubercular and chronic pyogenic osteomyelitis of the cranio-facial bones.

DESIGN

Retrospective study.

SETTING

Tertiary healthcare centre.

PATIENTS AND METHODS

The study population comprised 14 patients with tubercular and chronic pyogenic osteomyelitis who were managed in the otorhinolaryngology department between May 2002 and December 2005.

RESULTS

Odontogenic infections, sinus infections and aural infections were the most commonly identified aetiological factors. Most of the patients presented with swelling, pain and discharging sinus. The diagnosis was established on the basis of clinical evaluation, radiological investigations and histopathological analysis, with six cases diagnosed with tubercular osteomyelitis and eight cases with chronic pyogenic osteomyelitis. All the patients were initially commenced on oral antibiotics, which were continued for two weeks in all cases with chronic pyogenic osteomyelitis. All the patients with pyogenic osteomyelitis underwent surgical management, with one patient requiring repeated surgical interventions. All the patients with tubercular osteomyelitis received anti-tubercular chemotherapy, with complete cure.

CONCLUSIONS

Osteomyelitis of the cranio-facial bones is an uncommon entity which requires a high index of clinical suspicion along with radiological and histopathological investigations in order to establish the diagnosis. Tubercular osteomyelitis is clinically and radiologically indistinguishable from pyogenic osteomyelitis, and the two conditions can be differentiated only on the basis of histopathological evaluation of involved tissue.

Multicystic nephroma: a case report

BACKGROUND

Cystic nephroma is an uncommon pediatric renal neoplasm. It needs to be differentiated from cystic partially differentiated nephroblastoma and from other renal neoplasms 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' tumor on computed tomography. Fine needle aspiration cytology showed cellular smears composed of monomorphic, 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 the cytologic smears, the blastemal component was absent.

CONCLUSION

This case highlights 1 extreme and unexpected cytologic appearance of cystic nephroma; it may result in misdiagnosis.

Clinico-pathological profile of 22 cases of cystic renal dysplasia

Renal dysplasia is one of the major renal developmental anomaly characterized by abnormal structural organization and development of metanephric elements. It is usually detected antenatally or in early childhood. The kidney may be multicystic, aplastic, hypoplastic or duplex. We studied 22 cases of cystic renal dysplasia diagnosed over a period often years to identify the spectrum of morphological changes in dysplastic kidney, with special emphasis on mesenchymal changes. Clinical, radiological and gross morphologicalfeatures were noted. Microscopic features were studied in detail, including the epithelial and mesenchymal changes. Twenty-one of the 22 cases studied were children. One case was a 21-year-old adult, which is a rare age at presentation. Male to female ratio was 1.1:1. One of our patients had contra-lateral ureteric stenosis, a rare anomaly reported with renal dysplasia. Ten patients, all autopsy cases, had multi-system congenital anomalies. As cystic renal dysplasia is not a hereditary disease, it must be differentiated from polycystic kidney disease. Other differential diagnoses are cystic nephroma and cystic partially differentiated nephroblastoma. Histopathological examination is the final diagnostic tool since radiological features alone may not be sufficient to exclude other cystic renal lesions. Cartilage may not be seen in all cases of renal dysplasia. Once diagnosed, other associated anomalies should also be looked for.

Familial calcific band-shaped keratopathy: Report of two new cases with early recurrence

We report two siblings with the rare entity of familial calcific band-shaped keratopathy (BSK). Detailed ophthalmic and systemic investigations failed to reveal any underlying causative pathology. Topical disodium ethylenediamine-tetraacetate (EDTA) was applied for 30 min to all four eyes. In addition the right eye of the younger sibling required a superficial keratectomy. An improvement in corneal clarity was seen in the immediate postoperative period in both siblings. Histopathology of the keratectomy specimen revealed linear extracellular sub-epithelial granular calcium deposits. However, an early recurrence was noted in all four eyes at four weeks postoperatively. We report the second instance in the English literature of this entity. Band-shaped keratopathy presenting without an obvious etiology merits a complete systemic and ophthalmic workup. Patients with familial idiopathic BSK could be cases with poor prognosis for treatment with EDTA due to an early recurrence of the disease.

Acetylsalicylic acid as antifungal in Eremothecium and other yeasts

Interesting distribution patterns of acetylsalicylic acid (ASA, aspirin) sensitive 3-hydroxy (OH) oxylipins were previously reported in some representatives of the yeast genus Eremothecium--an important group of plant pathogens. Using immunofluorescence microscopy and 3-OH oxylipin specific antibodies in this study, we were able to map the presence of these compounds also in other Eremothecium species. In Eremothecium cymbalariae, these oxylipins were found to cover mostly the spiky tips of narrowly triangular ascospores while in Eremothecium gossypii, oxylipins covered the whole spindle-shaped ascospore with terminal appendages. The presence of these oxylipins was confirmed by chemical analysis. When ASA, a 3-OH oxylipin inhibitor, was added to these yeasts in increasing concentrations, the sexual stage was found to be the most sensitive. Our results suggest that 3-OH oxylipins, produced by mitochondria through incomplete beta-oxidation, are associated with the development of the sexual stages in both yeasts. Strikingly, preliminary studies on yeast growth suggest that yeasts, characterized by mainly an aerobic respiration rather than a fermentative pathway, are more sensitive to ASA than yeasts characterized by both pathways. These data further support the role of mitochondria in sexual as well as asexual reproduction of yeasts and its role to serve as a target for ASA antifungal action.

Bilateral micropapillary serous carcinoma of the ovary: a case report

BACKGROUND

Micropapillary serous carcinoma (MPSC), a recently described entity in the group of serous borderline tumor, needs to be recognized and separated from serous borderline tumor of usual type (SBT) as MPSC has a worse prognosis.

CASE REPORT

We report the case of a 21-year-old female with gradually increasing lump abdomen for 6 months. Ultrasonography showed bilateral ovarian enlargement with cysts. Laparotomy revealed both ovaries to be enlarged and right ovary showed capsular breach. With a per-operative diagnosis of bilateral malignant ovarian tumor, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Multiple sections from both ovaries showed non-invasive micropapillary serous carcinoma with right ovary showing surface growth but no definite capsular breach. The final histological diagnosis was bilateral micropapillary serous carcinoma. The patient has been asymptomatic in 10-month follow-up.

CONCLUSION

MPSC, classified as serous borderline tumor, needs to be differentiated from APST as well as conventional serous carcinoma. It is diagnosed according to strict criteria laid down. Multiple sections should be studied to exclude invasion. Adequate peritoneal sampling should be performed to look for implants, which is of prognostic significance.

Malignant fibrous histiocytoma of the chest wall masquerading as medullary breast carcinoma: a case report

BACKGROUND

Cytologic diagnosis of malignant fibrous histiocytoma can be problematic, as these neoplasms are known to mimic multiple other conditions.

CASE

A fine needle aspirate from a 60-year-old woman was diagnosed at 2 institutions as medullary carcinoma of the breast. The patient received neo-adjuvant chemoradiotherapy before the tumor war excised. Gross pathologic examination and histomorphology on routine staining were compatible with the cytologic diagnosis. The accurate diagnosis of pleomorphic-storiform-type malignant fibrous histiocytoma was a surprise and was established with immunocytochemical stains. In retrospect, it was thought that clinical and radiologic overlap, creating a high index of suspicion for a breast neoplasm and compounding the cytologic appearance of a medullary carcinoma with spindle cell metaplasia and syncytial cells, was responsible for the error.

CONCLUSION

This case highlights a potential cytodiagnostic pitfall and the importance of establishing a definitive tissue diagnosis in the face of equivocal cytologic findings.

S-100 as a useful auxiliary diagnostic aid in tuberculoid leprosy

BACKGROUND

The diagnosis of tuberculoid leprosy is often difficult on hematoxylin and eosin (H&E) due to the absence of demonstrable nerve destruction. This study evaluates the utility of S-100 staining in identifying nerve fragmentation and differentiation of tuberculoid leprosy from other cutaneous granulomatous diseases.

METHODS

Fifty cases of leprosy including 38 borderline tuberculoid (BT), two tuberculoid (TT), and 10 indeterminate leprosy (IL) were studied. Eleven controls of non-lepromatous cutaneous granulomatous lesions were included. S-100 was used for identifying the following dermal nerve patterns: infiltrated (A), fragmented (B), absent (C), and intact (D) nerves.

RESULTS

On H&E, only 18/38 (47.4%) BT cases and 1/2 (50%) TT cases revealed neural inflammation. On S-100 staining of BT cases, 28/38 (73.7%) showed pattern B followed by patterns C and A in 8/38 (21.1%) and 2/38 (5.3%) cases, respectively. Both the TT cases showed pattern B. Only intact nerves (D) were seen in all the control cases. S-100 identified nerve damage in 4/10 (40%) IL cases. The patterns A, B, and C had sensitivity, specificity, and positive and negative predictive values of 100% in diagnosing tuberculoid (BT + TT) leprosy.

CONCLUSIONS

S-100 is superior to H&E in identifying nerve fragmentation (p < 0.01). It also aids the differential diagnosis of tuberculoid leprosy.

Spindle cell carcinoma of head and neck: an immunohistochemical and molecular approach to its pathogenesis

BACKGROUND

Spindle cell carcinoma (SpCC) is a rare microscopic type of cancer of the mouth and oropharynx. Although SpCC is thought to arise from squamous cell carcinoma (SCC), it carries a worse prognosis.

AIM

To find out the difference in immunohistochemical expression of cytokeratin, vimentin and smooth-muscle actin, and mutational alterations in the K-ras oncogene between the two tumours, in an attempt to characterise SpCC.

METHODS

Immunohistochemical analysis was performed by standard avidin-biotin complex method in 35 cases each of SpCCs and SCCs. DNA extracted from paraffin wax-embedded tumours was used for PCR followed by single-strand conformation polymorphism for mutational analysis of K-ras exon 1 and exon 2.

RESULTS

In the SpCC group, cytokeratin positivity was significantly higher in epithelial areas (52.2%) than in spindle cell areas (16.1%), whereas vimentin was more positive in spindle cell areas (18.7%) than epithelial areas (2.7%). Cells intermediate between epithelial and spindle cell areas were consistently positive for both cytokeratin and vimentin. Cytokeratin was found to be significantly more positive in SCC (72.6%) than the squamous component and spindle cell component of SpCC. In this study, no mutation was detected in the K-ras gene of either the SpCC or SCC group.

CONCLUSIONS

The spindle cell component of SpCC is intermixed with cells that are morphologically mesenchymal but express dual antigen-positivity characteristic of epithelial (cytokeratin) and mesenchymal (vimentin) cells. These, possibly, are cells in transition suggesting that SpCC may be a sarcomatous metaplasia of SCC.

Benign vascular tumors of female genital tract

Vascular tumors are rare in female genital tract (FGT). The aim of this study was to analyze the distribution of vascular tumors in FGT and to highlight their clinicopathologic features. As a retrospective study, clinical features including imaging studies, gross findings, and microscopic features of cases (ten) diagnosed as having vascular tumors of FGT over 4 years were reviewed. The age range of our cases was 12-52 years. The presenting complaint was abdominal pain/mass, postcoital bleeding, and vaginal and vulval mass. In most cases, duration of symptoms was 6 months to 2 years. Only one case had a long-standing history of 8 years. The vascular tumors occurred most commonly in ovary (six), followed by vulva (two), and one each in cervix and vagina. Clinical diagnoses ranged from cystadenoma in ovarian tumors to endocervical polyp in cervical tumor. Histologically, all were benign vascular neoplasms, ranging from hemangioma (five), lymphangioma (one), lymphangioma circumscriptum (one) to angiomatosis (two) and arteriovenous malformation (one). Thus, we conclude that vascular lesions in FGT can present with symptoms similar to epithelial malignancies and may lead to unwarranted radical surgery. Vascular lesions of cervix and vulvovaginal region pose special problem during pregnancy. Risk of Kasabach-Merritt coagulopathy has to be considered in larger vascular tumors. Most of these cases can be treated by surgery.

Benign vascular tumors of female genital tract

Vascular tumors are rare in female genital tract (FGT). The aim of this study was to analyze the distribution of vascular tumors in FGT and to highlight their clinicopathologic features. As a retrospective study, clinical features including imaging studies, gross findings, and microscopic features of cases (ten) diagnosed as having vascular tumors of FGT over 4 years were reviewed. The age range of our cases was 12–52 years. The presenting complaint was abdominal pain/mass, postcoital bleeding, and vaginal and vulval mass. In most cases, duration of symptoms was 6 months to 2 years. Only one case had a long-standing history of 8 years. The vascular tumors occurred most commonly in ovary (six), followed by vulva (two), and one each in cervix and vagina. Clinical diagnoses ranged from cystadenoma in ovarian tumors to endocervical polyp in cervical tumor. Histologically, all were benign vascular neoplasms, ranging from hemangioma (five), lymphangioma (one), lymphangioma circumscriptum (one) to angiomatosis (two) and arteriovenous malformation (one). Thus, we conclude that vascular lesions in FGT can present with symptoms similar to epithelial malignancies and may lead to unwarranted radical surgery. Vascular lesions of cervix and vulvovaginal region pose special problem during pregnancy. Risk of Kasabach–Merritt coagulopathy has to be considered in larger vascular tumors. Most of these cases can be treated by surgery.