Hector Cohen

Mixed adenocarcinoma and neuroendocrine carcinoma arising in the urachus. A case report and review of the literature.

Primary urachal carcinomas are very rare urological malignancies. In the present article we report an unusual case of a small cell carcinoma with neurendocrine features and adenocarcinoma arising in the urachus, and review the literature. The results of the immunohistochemical studies are presented.

Human Herpesvirus 8 in Primary Effusion Lymphoma in an HIV-Seronegative Male

BACKGROUND: AIDS-related body cavity-based lymphoma, or primary effusion lymphoma (PEL), is a distinct clinicopathologic entity that occurs predominantly in immunosuppressed patients infected with human herpesvirus 8 (HHV-8), also known as Kaposis sarcoma-associated herpesvirus. Although it rarely occurs in human immunodeficiency virus (HIV)-negative patients, we report such a case here. CASE: A 74-year-old male, who was HIV and Epstein-Barr virus (EBV) negative, was admitted to the hospital with dyspnea and chest pain. Chest radiography and computed tomography showed right pleural effusion. Cytologic analysis of the pleural effusion revealed a high grade lymphoma with round nuclei, prominent nucleoli and abundant cytoplasm. Polymerase chain reaction performed on the pleural effusion was positive for HHV-8 and negative for EBV. On molecular studies, the immunoglobulin heavy and kappa light chains were rearranged. Flow cytometry revealed a hyperploid fraction with DNA index of 1.29 expressing CD30. Immuno-staining for HHV-8 from a cell block was positive. Electron microscopy revealed lymphomalike cells, many in various stages of apoptosis, with large nucleoli and clusters of viruslike particles in the nucleoplasm. CONCLUSION: A firm diagnosis of PEL can be established by the examination ofcells from the lymphomatous effusion by a combination of cytology, molecular genetics, phenotypic features, immunostaining and electron microscopy. To our knowledge, this is the first case in which immunostaining for anti-HHV-8 monoclonal antibodies was used to support the diagnosis.

Xanthogranulomatous Appendicitis - An Incidental Finding of Localized Pathology

The clinical, histopathological, and electron microscopic features of an unusual case of xanthogranulomatous appendicitis are reported. The patient, a 37-year-old female, presented with typical signs of acute appendicitis and the appendix appeared slightly dilated at laparatomy. The histopathological sections showed numerous xanthoma cells mixed with inspissated fecaliths. Electron microscopy disclosed the presence of xanthoma cells filled with electron-lucent lipid droplets of variable size. The ultrastructural characteristics of these cells enabled the distinction of two types of lipid-laden histiocytes, in relationship to the size of the lipid droplets. Since the lipid droplets were seen also in cells other than histiocytes, it appears that these changes are secondary to a common mechanism,comprising factors such as obstruction, hemorrhage, inflammation,and local hypoxia.

Collecting duct carcinoma of kidney: a cytological study and case report.

An intraoperative cytological imprint of a well study case of collecting duct carcinoma of the kidney is reported. Papillary structures, fibrotic desmoplastic stroma, tubular formations, and tumoral cells with high grade cytological atypia were found. Cytological details described help to avoid misinterpretation of collecting duct carcinoma as a metastatic tumor. The peculiar morphology, the immunohistochemical and biological behavior of this rare tumor justifies its classification in a special group. Diagn Cytopathol 1996;15:136–138.

Frozen section examination of endometrial curettings in the diagnosis of ectopic pregnancy.

Background.  The aim of our study was to determine the accuracy and validity of frozen section analysis of endometrial curettings in differentiating between abnormal intrauterine and ectopic pregnancies.

Myoblastomatoid carcinoma of the breast: An unusual variant of apocrine carcinoma: Report of a case with fine-needle aspiration cytology and immunohistochemical study

Fine‐needle aspiration cytology, immunohistochemistry, and histopathologic findings are described in a case of myoblastomatoid carcinoma of the breast. The aspirate contained many small and large clusters of cohesive atypical cells with abundant foamy‐to‐granular cytoplasm and nuclei that show moderate pleomorphism. These tumors can be easily misinterpreted as either fibrohistiocytic or myoblastomatoid (granular cell) tumors, and by using immunohistochemical stains, the epithelial origin can be elucidated. This case report provides the first description of the fine‐needle aspiration cytomorphology of this distinctive variant of apocrine carcinoma. Diagn. Cytopathol. 16:145–148, 1997.

The Lipofuscin-Iron Association in Pigmentosis Tubae

Pigmentosis tubae (PT) is a rare condition characterized by the presence of numerous lipofuscin-laden macrophages in the lamina propria of the fallopian tube. Two women, who also had endometriotic ovarian cysts, showed polypoid pigmented tubal mucosae. In addition to lipofuscin, occasional cells showed spotty positivity for iron. Ultrastructural examination of the tubal mucosa showed the lipofuscin-containing bodies, which were similar to lipofuscin-containing lysosomes found in other pigmented conditions. Cytoplasmatic ferritin and hemosiderin in siderosomes were observed in macrophages and endothelial cells of the lamina propria. The present study is the first to demonstrate the presence of iron-containing particles and lipofuscin in the residual bodies of PT. The origin of the excess iron is not clear, but erythrophagocytosis and an abnormal tubal environment could play a role. Iron-promoted lipid peroxidation may alter the lysosomal membranes and contribute to the excessive accumulation of lipofuscin in these cells.

Localized amyloidosis in nasopharyngeal carcinoma diagnosed by fine needle aspiration and electron microscopy. A case report.

BACKGROUND The association of amyloidosis and tumors is well known, but only rarely has it been found in the nasopharynx. Moreover, only a single case of tumor-associated amyloidosis in the nasopharynx has been diagnosed by exfoliative cytology and reported in the English-language literature. We describe a case of localized amyloidosis in metastatic nasopharyngeal carcinoma diagnosed by fine needle aspiration and confirmed by histology and electron microscopy. CASE Bilateral neck enlargement appeared six months before consultation in a 57-year-old man. Both masses were resected, and during exploration of the nasopharynx, several blind biopsies were taken. Smears from the fine needle aspirate showed malignant epithelial cells, consistent with metastatic carcinoma, and Congo red stain showed the presence of amyloid. Histologic examination of the resected cervical masses and nasopharyngeal biopsies confirmed the diagnosis of nasopharyngeal carcinoma, nonkeratinizing variant with amyloid, and metastases in two lymph nodes. Electron microscopic examination of a lymph node showed extracellular, ribbon-like amyloid deposits as well as masses of amorphous amyloid, apparently intracellular. CONCLUSION The origin of this form of amyloidosis is unclear in this patient since he had no other known etiologic factors for the condition. Increased awareness of the potential association of these two conditions and the use of fine needle aspiration may reveal a higher frequency than hitherto reported.

Uterine metastasis from gastric cancer

Stemmermann (2) in 1961 reported eight cases of endometrial metastasis, of which seven originated in the stomach. In 1984 Mazur et al. (3) reviewed 149 documented cases of metastasis to the female genital tract reported between the years 1950 to 1981. The extragenital primary neoplasms were of nonhematopoetic origin, and the metastases were found in the adnexa, uterus, vagina and vulva, with ovary and vagina being the most frequent metastatic sites. Most of the extragenital malignancies were adenocarcinomas from the gastrointestinal tract. In this review there was only one case of a metastasis to the endometrium arising from gastric carcinoma. Kumar and Hart (4), in 1982, reviewed 63 cases of metastatic cancers to the uterine body from extragenital neoplasms, reported during the years 1923-1980 six originated from the stomach. Kumar and Schneider (5 ) , in 1983, reported 1 1 cases of metastases to the uterus from extrapelvic primary tumors. The tumors were breast (five patients), stomach (three patients), and colon (two patients). In 1990 Kim et al. (1) reported a case of uterine metastases from gastric carcinoma. The mechanism of uterine metastasis from stomach cancer is not clearly understood; direct intraluminal spread from the ovary through Fallopian tube, or lymphatic or hematogenous spread are all considered possible (1). The collective experience from the literature indicates that tumors of the breast, stomach, rectum and colon, melanoma, and lung are the extragenital tumors most likely to metastasize to the uterine cervix or corpus (2, 3, 4). The relative frequencies of the various primary tumors tend to reflect the prevalence of those tumors in the population at risk. For example, in the Stemmermann report (2), the stomach was the primary source of the endometrial metastases in seven out of eight cases. However, most of the patients in that series were Oriental, and gastric carcinoma is more frequent in that patient population (3). Although clinically important metastases to the female genital tract are infrequent, these lesions can be insidious, presenting as a primary disease at the metastatic site. Metastastic tumors may precede the diagnosis of a primary tumor. The presence of such metastases usually indicates a widespread tumor; consequently there are few 5-year survivors (4). Uterine metastasis from gastric cancer

Small Intestinal Amyloidosis: A Rare Cause of Diverticular Disease

Systemic amyloidosis frequently involves the small intestine. However, its association with diverticular disease has been seldom reported to date. To draw attention to this rare but potentially harmful association, we herein present an additional case of small bowel diverticular disease associated with amyloidosis.