Janice R. Safneck

Malignant astrocytoma of the optic nerve in a child.

Malignant gliomas of optic nerve and chiasm are rare, rapidly fatal neoplasms of adulthood. This report documents the occurrence of a malignant astrocytoma of the optic nerve in an 11-year-old boy who 9 years previously had a cerebellar medulloblastoma treated with surgery and irradiation. This malignant optic nerve glioma followed the same aggressive clinical course as that seen in adults, with death 9 months after diagnosis despite surgery and chemotherapy. Radiation may have been an important factor in the development of this malignant tumor which is almost never seen in the pediatric age group.

Endophthalmitis: A review of recent trends

Endophthalmitis is a feared complication of trauma, surgical procedures and septicemia. Although uncommon, its potential for significant visual loss is well recognized. Especially over the past decade, complicated surgeries and medical techniques have increased and seriously ill patients are being sustained in ever increasing numbers. New pathogens are being recognized and known ones reclassified thanks to advances in molecular analysis. Continuously evolving PCR methodologies also add a new dimension to the diagnosis of infectious endophthalmitis. As well, medical literature is now truly international, encompassing studies from around the world that expand our understanding of ocular infectious disease. This report reviews some of these changes as they relate to endophthalmitis and particularly to the spectrum of organisms involved.

Endophthalmitis Due to Blastomyces Dermatitidis: Case Report and Review of the Literature

Blastomycosis very rarely affects ocular structures other than the eyelid. It is even more unusual for involvement to occur in the absence of active widespread disease. The authors report a 71-year-old woman with unresponsive endophthalmitis of the right eye who underwent enucleation. Results of microscopic examination of the globe showed severe acute and chronic granulomatous and nongranulomatous endophthalmitis as well as numerous fungi having the histologic features of Blastomyces dermatitidis. Although constitutional symptoms (weight loss, fatigue, night sweats) were noted by the patient, multiple investigations failed to disclose any evidence of systemic disease.

Fine Needle Aspiration Biopsy Findings in Lymphoepithelial Carcinoma of Salivary Gland

OBJECTIVE To study the fine needle aspiration cytology of lymphoepithelial carcinoma of salivary gland (LECSG). STUDY DESIGN Needle aspirates from five primary and two metastatic LECSGs were reviewed. RESULTS Three aspirates showed very scant cellularity with rare tumor cells originally misinterpreted as lymphohistiocytic cells. Six fine needle aspiration biopsies (FNABs) contained medium to large polygonal and spindled cells with one or more prominent nucleoli. Five aspirates also displayed a heterogeneous population of lymphoid cells, while a sixth had much necrotic debris and only a few lymphocytes admixed with tumor cells. CONCLUSION In the clinical setting of an Inuit or Chinese patient with a salivary gland mass, an FNAB with these features should suggest the possibility of LECSG.

Cytologic features of primary adenoid cystic carcinoma of the uterine cervix. A case report.

BACKGROUND Adenoid cystic carcinoma of the cervix is a rare, aggressive neoplasm generally found in postmenopausal women. CASE A cervical cytology specimen was obtained by endocervical brush from an 80-year-old woman with histologically confirmed primary adenoid cystic carcinoma of the cervix. Both small cells arranged in a cribriform (cylindromatous) pattern and moderately dysplastic squamous cells (high grade squamous intraepithelial lesion) were evident. CONCLUSION Although the endocervical brush technique may yield well-preserved cells and tissue fragments morphologically characteristic of adenoid cystic carcinoma of the cervix, confusion with more common tumors, such as endometrial adenocarcinoma, still may create cytologic diagnostic difficulties.

Adipose-Derived Stromal Vascular Fraction Differentially Expands Breast Progenitors in Tissue Adjacent to Tumors Compared to Healthy Breast Tissue.

Background: Autologous fat grafts supplemented with adipose-derived stromal vascular fraction are used in reconstructive and cosmetic breast procedures. Stromal vascular fraction contains adipose-derived stem cells that are thought to encourage wound healing, tissue regeneration, and graft retention. Although use of stromal vascular fraction has provided exciting perspectives for aesthetic procedures, no studies have yet been conducted to determine whether its cells contribute to breast tissue regeneration. The authors examined the effect of these cells on the expansion of human breast epithelial progenitors. Methods: From patients undergoing reconstructive breast surgery following mastectomies, abdominal fat, matching tissue adjacent to breast tumors, and the contralateral non–tumor-containing breast tissue were obtained. Ex vivo co-cultures using breast epithelial cells and the stromal vascular fraction cells were used to study the expansion potential of breast progenitors. Breast reduction samples were collected as a source of healthy breast cells. Results: The authors observed that progenitors present in healthy breast tissue or contralateral non–tumor-containing breast tissue showed significant and robust expansion in the presence of stromal vascular fraction (5.2- and 4.8-fold, respectively). Whereas the healthy progenitors expanded up to 3-fold without the stromal vascular fraction cells, the expansion of tissue adjacent to breast tumor progenitors required the presence of stromal vascular fraction cells, leading to a 7-fold expansion, which was significantly higher than the expansion of healthy progenitors with stromal vascular fraction. Conclusions: The use of stromal vascular fraction might be more beneficial to reconstructive operations following mastectomies compared with cosmetic corrections of the healthy breast. Future studies are required to examine the potential risk factors associated with its use. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Adult Colloid Milium of the Eyelid

PURPOSE To report a patient with bilateral upper and lower eyelid margin nodules that proved to be adult colloid milium. METHODS After clinical study, biopsy specimens were obtained and analyzed histologically and ultrastructurally. RESULTS Adult colloid milium can be diagnosed by clinicopathologic correlation. CONCLUSION Adult colloid milium should be included in the differential diagnosis of eyelid margin nodules.

Keeping an open mind about meningitis: a case report of carcinomatous meningitis.

Carcinomatous meningitis is defined as leptomeningeal infiltration by malignant cells. A case of carcinomatous meningitis, originally diagnosed as viral meningitis, is presented here to highlight the importance of maintaining a broad differential diagnosis in patients with evidence of meningeal irritation. Clinical and laboratory clues that suggest a diagnosis of carcinomatous meningitis in a patient with meningeal irritation include the presence and type of underlying malignancy (more common with breast cancer, lung cancer, and melanoma), absence of fever, presence of radicular pain, evidence of both cranial and spinal involvement, consistent cerebrospinal fluid (CSF) findings (increased opening pressure, elevated protein concentration, decreased glucose, increased white cell count), and supportive neuroimaging. Diagnosis is based on positive CSF cytology results, which may require multiple lumbar puncture procedures to obtain. For patients with a known primary malignancy who present to the emergency department with symptoms and/or signs of meningeal irritation, carcinomatous meningitis should be included in the differential diagnosis.

Genetic profiling by single-nucleotide polymorphism-based array analysis defines three distinct subtypes of orbital meningioma

Orbital meningiomas can be classified as primary optic nerve sheath (ON) meningiomas, primary intraorbital ectopic (Ob) meningiomas and spheno‐orbital (Sph‐Ob) meningiomas based on anatomic site. Single‐nucleotide polymorphism (SNP)‐based array analysis with the Illumina 300K platform was performed on formalin‐fixed, paraffin‐embedded tissue from 19 orbital meningiomas (5 ON, 4 Ob and 10 Sph‐Ob meningiomas). Tumors were World Health Organization (WHO) grade I except for two grade II meningiomas, and one was NF2‐associated. We found genomic alterations in 68% (13 of 19) of orbital meningiomas. Sph‐Ob tumors frequently exhibited monosomy 22/22q loss (70%; 7/10) and deletion of chromosome 1p, 6q and 19p (50% each; 5/10). Among genetic alterations, loss of chromosome 1p and 6q were more frequent in clinically progressive tumors. Chromosome 22q loss also was detected in the majority of Ob meningiomas (75%; 3/4) but was infrequent in ON meningiomas (20%; 1/5). In general, Ob tumors had fewer chromosome alterations than Sph‐Ob and ON tumors. Unlike Sph‐Ob meningiomas, most of the Ob and ON meningiomas did not progress even after incomplete excision, although follow‐up was limited in some cases. Our study suggests that ON, Ob and Sph‐Ob meningiomas are three molecularly distinct entities. Our results also suggest that molecular subclassification may have prognostic implications.

Fine needle aspiration biopsy of a small round cell tumor exhibiting both neural and myogenic differentiation. A case report.

BACKGROUND Divergent differentiation may not be detected in the limited material available in a fine needle aspiration biopsy (FNAB). CASE A small round cell malignancy showed neural features ultrastructurally on FNAB, in keeping with primitive neuroectodermal tumor, but desmin and actin positivity on surgical biopsy, suggesting rhabdomyosarcoma. CONCLUSION Accurate classification of small round cell tumors by FNAB is more likely to occur when both electron microscopy and immunocytochemistry are employed since these tumors may express divergent differentiation.