Leonardo D. Santos

Serous oligocystic adenoma of the pancreas: a clinicopathological and immunohistochemical study of three cases with ultrastructural findings

Aims: Serous oligocystic adenoma of the pancreas is an uncommon benign neoplasm and is a recently described entity. To date, there are 19 adult cases of this tumour. We report three additional cases, two with macrocystic and one with unilocular types. We describe their clinicopathological, immunohistochemical and ultrastructural findings and review the worlds literature. Methods: For a 10‐year period, we reviewed all benign cystic lesions of the pancreas with emphasis on serous oligocystic adenoma. We characterised serous oligocystic adenoma as an ill‐demarcated or encapsulated mass, composed largely or exclusively of macrocysts (cysts measuring 20 mm or more) but few in number (oligolocular). Grossly, it may contain only a single cyst (unilocular) of any size with a few satellite cysts observed on histological examination. Special stains and immunohistochemistry as well as electron microscopy were performed on three and two cases of serous oligocystic adenoma, respectively. Results: Between 1990 and 2000, we collected 26 benign cystic lesions of the pancreas, three of which were serous oligocystic adenomas (two with macrocystic and one with unilocular types). Many of the cells lining the cysts showed PAS positivity. There was negative staining for PAS with diastase digestion, Alcian blue and mucicarmine. All cases showed positive staining for CAM5.2, AE1/AE3, EMA and CK7. The proliferation index marker was low. There was negative staining for CK20, insulin, glucagon, somatostatin, synaptophysin, chromogranin A, CEA and p53. Ultrastructural studies on two cases revealed similar findings. The single row of uniform epithelial cells lining the cysts was composed of simple cuboidal to flat cells which rested on a thin basal lamina. Their nuclei were round to ovoid. Glycogen granules were identified in the cytoplasm. Short microvilli emerged from the epithelial apical surface. Adjacent tumour cells were connected by microfilaments. Conclusions: Serous oligocystic adenomas of the pancreas are uncommon benign tumours. Prior to this study, 19 adults with these lesions were reported in the worlds literature. No correct pre‐operative diagnosis was carried out on all 22 cases. The 20 patients with follow‐up ranging from 2 months to 5 years did not show tumour recurrence or malignant transformation.

Glomus coccygeum may mimic glomus tumour

Summary We reviewed all cases of pilonidal sinus excision specimens from our surgical pathology records from 1990 to 2000 to determine the presence of glomus coccygeum. We found only two cases of glomus coccygeum, also known as coccygeal body. We describe the histology and immunohistochemical findings of two glomera coccygea incidentally discovered in pilonidal sinus excision specimens, and review the worlds English literature.

Automatic cell segmentation in microscopic color images using ellipse fitting and watershed

This paper presents an efficient and innovative method for the automated counting of cells in a microscopic image. The performance of watershed-based algorithms for the segmentation of clustered cells has been well demonstrated. The strength of our algorithm lies in the fact that it incorporates knowledge of color in the image. Our method uses the watershed transform with iterative shape alignment and is shown to be more accurate in retaining cell shape. We report a sensitivity of 97% and specificity of 96% when all color bands are used. Our methods could be of value to computer-based systems designed to objectively interpret microscopic images, since they provide a means for accurate cell segmentation.

Cystadenoma of the seminal vesicle: report of a case with ultrastructural findings

Summary Cystadenomas of the seminal vesicles are extremely rare benign tumours. We have not been able to find more than 10 cases in the literature. A benign cystadenoma of the seminal vesicle is described in a 49‐year‐old man. The clinical presentation, gross appearance, microscopic characteristics, immunohistochemical and ultrastructural findings of this uncommon tumour are discussed. The purpose of this paper is to report an unusual case of cystadenoma of the seminal vesicle and review the 10 previously reported cases in the English literature.

Nodular hyperplasia of Bartholin’s gland

Aims: There has been very little mention of benign solid lesions of the Bartholins gland (BG) in pathology and gynaecology textbooks, and very few cases have been reported in the literature. Among these lesions, the distinction between nodular hyperplasia (NH) and adenoma has not been well defined. We report ten cases of NH of the BG, describe their clinicopathological, immunohistochemical and ultrastructural findings, and review the literature. Methods: We examined retrospectively all lesions involving BGs from our surgical pathology records from 1990 to 2004 with emphasis on NH. To separate NH from adenoma, we applied the criteria proposed by Koenig and Tavassoli. Special stains (PAS with and without prior digestion, Mayers mucicarmine and Alcian blue with and without hyaluronidase) and immunohistochemistry (CAM5.2, AE1/AE3, HMWK, monoclonal CEA, EMA, ER, PR, ALA, SMA, Ki‐67, p53 and polyclonal CEA) were performed on NHs. Two cases were examined ultrastructurally. Results: Using specific criteria, ten cases (age range 23–45 years; mean 36.1) of NH were identified, two of which were diagnosed previously as adenoma, but re‐classified as NH. Clinically, these lesions were described either as Bartholins duct cysts (BDCs) or vulvar lumps. Grossly, NHs were solid, tan and unencapsulated, measuring 12.5–45.0 mm in maximum dimension (mean 23.8). Histologically, the NHs were composed of a proliferation of mucus‐secreting acini with preservation of the normal duct‐to‐acinar relationship. Chronic inflammation and squamous metaplasia were present. Eight lesions focally involved the surgical margins. Intracytoplasmic and intra‐luminal secretions were positive for PAS with and without digestion, Alcian blue with and without hyaluronidase and mucicarmine. All lesions showed positive staining for CAM5.2, AE1/AE3, HMWK, EMA, and polyclonal CEA. There was negative staining for Ki‐67, ER, PR, ALA, p53 and monoclonal CEA. Periacinar myoepithelial cells stained for SMA. Ultrastructurally, the findings included abundant intracytoplasmic secretory granules, granulofibrillar bodies, prominent Golgi and ribosomes. Myoepithelial cells were identified. There was no tumour recurrence or malignant transformation in eight patients with clinical follow‐up. Conclusion: NH of the BG is a rare lesion with benign behaviour. It is a distinct entity and can be separated histologically from an adenoma.

Case report: plexiform schwannoma of the vulva

Summary We describe a case of plexiform schwannoma, a benign tumour of the peripheral nerve sheath, arising in the labia of a 5‐year‐old girl who presented with a mass in the vulva. Light and electron microscopy, special stains and immunohistochemistry studies were done on the excised specimen. A Medline search revealed a single case of vulvar plexiform schwannoma which was reported in 1983.

Cytologic Diagnosis of Suppurative Cholecystitis due to Candida albicans and Actinomyces

BACKGROUND Cholecystitis is a common inflammatory disease of the gallbladder. Actinomycosis and candidiasis of the gallbladder are uncommon causes of acute cholecystitis. There has been no previous report on the cytologic diagnosis of actinomycosis and candidiasis from aspirated gallbladder bile intraoperatively. CASES Purulent bile was intraoperatively aspirated from the gallbladder of 71-year-old Indian and a 30-year-old Australian woman. The specimens were sent for cytologic examination. The first case revealed sulphur granules characteristic of Actinomyces spp. The second case showed budding spores and pseudohyphae of Candida spp. Pure colonies of Candida albicans grew from the bile culture. CONCLUSION Actinomycosis and candidiasis rarely cause acute suppurative cholecystitis. Initial diagnosis can be made by cytologic examination of the aspirated purulent bile intraoperatively.

Plexiform angiomyxoid myofibroblastic tumour of the stomach: a case report

Sir,Plexiform angiomyxoid myofibroblastic tumour (PAMT) is a new mesenchymal myofibroblastic neoplasm of the stomach which was originally described by Takahashi et al.1 PAMT was described as a mese...

Perineal cutaneous ciliated cyst in a male.

Sir, Cutaneous ciliated cyst of the perineum is an exceedingly rare benign tumour. Only four cases have been reported in the literature, three of which involved women. We report the clinical, histological and immunohistochemical features of a ciliated cyst in the perineum of an adult man. A 53-year-old Vietnamese male had been complaining of rectal bleeding for several years. On physical examination, there was a 40-mm soft, solitary, painless lump with an intact overlying skin located in the right perineal region. The patient claimed he was not aware of this polypoid mass. The clinical diagnosis was a subcutaneous lipoma. Colonoscopy revealed no abnormality. The perineal lesion was completely removed under local anaesthesia and the postoperative course was unremarkable. His history revealed he had undergone a haemorrhoidectomy 10 years ago. Macroscopically, the specimen consisted of a 35625610-mm polypoid mass covered by an intact, pigmented skin measuring 24 mm across. On sectioning, there was an intradermal unilocular, well-circumscribed, unencapsulated cyst measuring 20 mm across which contained pale brown material. The inner cyst wall was generally smooth. Microscopic examination revealed a unilocular cyst with no definite capsule located in the deep dermis (Fig. 1). Columnar ciliated cells (Fig. 2) with focal pseudostratification lined the cyst. Scattered neutrophils infiltrated the epithelium which was focally folded but no papillary structures. Within the pale cytoplasm, there were occasional vacuoles near the luminal surface containing periodic acid-Schiff (PAS)-positive, diastase-resistant and Alcian blue-positive mucin, but no true goblet cells or secretions. In areas, the lining epithelium showed transition to squamous metaplasia (Fig. 3) and focal superficial ulceration. There was no evidence of necrosis, atypia or mitosis. The lumen contained granular eosinophilic material with scattered calcifications. The dermis was devoid of adnexal structures. There was a moderate amount of chronic inflammatory cells composed predominantly of lymphocytes as well as macrophages, plasma cells, mast cells and rare eosinophils around the cyst which was surrounded by a bland fibroconnective tissue stroma. The blood vessels around the cyst were dilated and congested. Deep to the cyst, fatty tissue and skeletal muscle were present showing no unusual features. Immunohistochemistry demonstrated positive membrane staining for epithelial membrane antigen (EMA; clone E29, 1:150 dilution; Dako, Denmark), vimentin (clone V9, 1:150; Dako) and cytoplasmic staining for pankeratin (clone AE1/AE3, 1:100; Dako) and low molecular weight cytokeratin (clone CAM 5.2, 1:3; Becton-Dickinson, USA). There was negative staining Fig. 1 Perineal cutaneous ciliated cyst (*) in the dermis with an overlying intact skin (H&E, original magnification, 620).

Cervical endometriosis : Case series and review of literature

Cervical endometriosis is uncommon and usually an incidental or retrospective finding on histopathology reports. It can be asymptomatic or present with a diverse range of persistent symptoms and even life‐threatening hemorrhage. The condition can be managed expectantly in asymptomatic patients, however persistent symptoms may warrant surgery. We encountered four cases of histologically proven cervical endometriosis at our tertiary hospital in New South Wales, Australia. All our patients had different symptoms, presentations and indications for their surgery leading to their diagnosis. This review is to report these cases followed by discussion with a review of the literature.