Aarathi R Rau

Apocrine (cutaneous) sweat gland carcinoma of axilla with signet ring cells: A diagnostic dilemma on fine-needle aspiration cytology

Carcinoma arising in the apocrine sweat glands is rare and there are few reports describing the cytological features of this neoplasm. We describe the cytological features of a histologically confirmed apocrine carcinoma occurring in a 55‐year‐old man who presented with an ulcerated mass in the right axilla. Fine‐needle aspiration cytology revealed features of a signet ring adenocarcinoma. The significance of this infrequently encountered neoplasm lies in its potential for diagnostic confusion with more common lesions containing signet ring cells. In an axillary mass lesion, cytological features along with clinical correlation are essential to distinguish primary apocrine carcinoma from mammary neoplasms with signet ring cells and other metastatic adenocarcinomas. Diagn. Cytopathol. 2008;36:739–741.

Bone marrow biopsy in non-Hodgkin lymphoma: A morphological study

CONTEXT Bone marrow (BM) biopsy is an integral part of staging work-up for non-Hodgkin lymphoma (NHL). AIMS To study the characteristics of BM involvement in NHL with respect to incidence, histologic pattern and morphology of infiltration and its discordance with the histology of primary anatomic site. SETTINGS AND DESIGN Forty-nine cases of NHL in which BM biopsy was performed for staging were included in this study, the primary site being classified according to the WHO classification for NHL. MATERIALS AND METHODS A prospective study of 49 cases was conducted. Bilateral BM biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. RESULTS BM biopsy showed involvement by lymphoma in 27 cases (55.10%). Unilateral positivity was found in four cases (14.81% cases). The overall incidence of marrow involvement by NHL was 55.1%. The incidence of involvement was higher in T-cell lymphomas when compared with B-cell lymphomas and predominant pattern of involvement was mixed. Diffuse large B-cell lymphomas had the lowest incidence in all the B-cell lymphomas. A discordant histology between BM and primary anatomic site was found in 29.63% (8/27) of the cases, where it was seen more in follicular lymphomas and diffuse large B-cell lymphomas. CONCLUSIONS Critical examination of BM biopsies can increase the diagnostic accuracy, thereby contributing to the prognosis and appropriate treatment modalities.

Poorly differentiated (insular) thyroid carcinoma arising in a long-standing colloid goitre: A cytological dilemma.

Poorly differentiated (insular) thyroid carcinoma (PDITC) is an uncommon thyroglobulin producing neoplasm intermediate in aggressiveness between well-differentiated carcinomas of follicular cell origin and undifferentiated anaplastic carcinoma. Its cytomorphological recognition is essential for planning surgery and subsequent management as it is known for its aggressive behavior, advanced stage at presentation, local recurrences and rapid dissemination. We report a case of PDITC arising in a long-standing goiter, in which presence of microfollicular structures and minimal necrosis resulted in difficulty in distinguishing it from a follicular neoplasm of thyroid.

HIV lymphadenitis of the salivary gland: A case with cytological and histological correlation

Human immunodeficiency virus infection associated lymphadenitis of the salivary glands (HIVLSG) and benign lymphoepithelial cysts are described as early events in HIV patients. The diagnosis is not usually made clinically as it mimics a salivary gland tumor. We present here a patient with two painless nodules in the right parotid and submandibular glands. The cytological diagnosis was florid reactive lymphoid hyperplasia. Histopathology revealed features of HIVLSG with multiple, small, cystic, benign lymphoepithelial lesions.

Morphological evaluation of cystitis glandularis.

Cystitis cystica and cystitis glandularis (CG) are relatively common appearances in the urinary bladder though CG may occasionally mimic a neoplasm. Microscopically, two types of CG are recognized, the usual type and intestinal type. This study was undertaken to study the morphology of CG and to highlight the differences in morphology between CG and adenocarcinoma. Eleven cases of CG were seen, of which 3 cases showed predominantly CG, usual type and eight cases showed CG of intestinal type. One case of primary adenocarcinoma was included in this study, where the adjacent bladder mucosa showed CG. Evaluation of the histological features of CG, especially intestinal type helps in correct categorization of this lesion and differentiation from adenocarcinoma of the bladder.

Subareolar abscess in the male breast

Dear Dr. Bedrossian: Normally the lactiferous sinuses are lined by two layers of cuboidal cells except at the terminal funnel-shaped ampulla that opens on the nipple surface, which is lined by squamous epithelium. In subareolar abscess (SA), the lining of the lactiferous sinus shows squamous metaplasia, dilation, and keratin plugging. Secondary infection and rupture of this duct into the surrounding parenchyma results in abscess formation and evokes a foreign-body granulomatous response to the escaped keratinous material. The abscess then breaks open through the skin at the base of the nipple or on the areola forming a sinus that discharges pus. Although usually unilateral, it may be bilateral and often associated with congenital or acquired nipple retraction.

Pleomorphic lobular carcinoma of the breast - a diagnostic dilemma

Pleomorphic lobular carcinoma of the breast has been identified as a histological variant of infiltrating lobular carcinoma (ILC) with poor prognosis. Thus, cytological recognition of this tumour is important. It is characterized by pleomorphism to a degree that contrasts with the cytologic uniformity of classic ILC. Due to this feature it is often misinterpreted as infiltrating ductal carcinoma and diagnosed only on appreciating the Indian file and targetoid pattern of lobular carcinomas on histology. We report three cases with this unusual tumour that can present a diagnostic dilemma on cytology.

Lipofibromatous Hamartoma of the Median Nerve in Association with or without Macrodactyly

Lipofibromatous hamartoma is a rare tumour-like condition involving the peripheral nerves, particularly the median nerve. It commonly affects the volar aspect of the hands, wrists and forearms of young adults. Most patients present either early with macrodactyly or later with a forearm mass lesion or symptoms consistent with compressive neuropathy of the involved nerve. The clinical and histomorphological findings of five patients with lipofibromatous hamartoma of the median nerve are analysed. The presentation, pathological features and differential diagnosis of neural lipofibromas are discussed along with a brief review of the literature. Of the five cases of lipofibromatous hamartoma, all were seen to involve the median nerve, occurring in four women and one man. Three of these cases had associated macrodactyly which was congenital in two and was seen from childhood in one. Microscopic examination showed fibrofatty tissue surrounding and infiltrating along the epineurium and perineurium. The nerve bundles were splayed apart by the infiltrating adipose tissue. Neural fibrolipomatous hamartoma is a benign condition. Most respond to conservative management with surgical exploration, biopsy and carpal tunnel release to decompress the nerve. Correct diagnosis of this uncommon lesion is important as surgical excision of the lesion may lead to loss of neurological function.

Imprint cytology of pancreatoblastoma: A case report and review of the literature

Pancreatoblastoma is a rare tumor with ∼60 cases described in the English literature and only five case reports illustrating the cytologic findings, four by fine‐needle aspiration cytology and one by imprint cytology. We herein report the sixth case diagnosed by imprint cytology. Both the cytologic and histopathologic literatures are reviewed, and the pathologic variations observed in our case are also documented. Diagn. Cytopathol. 2009.

Utility of reticulin stain in the diagnosis of a completely infarcted chorangioma

This report highlights the utility of the reticulin stain in a completely infarcted chorangioma that facilitated the diagnosis. The patient had normal spontaneous delivery with good neonatal outcome in spite of the large size of the chorangioma and the presence of hydramnios in the antenatal period which may perhaps be due to the complete infarction of the tumor.