Mahboob Hasan

FNA diagnosis of adrenal myelolipoma: A rare entity

Dear Dr. Bedrossian: Myelolipoma is a benign tumor consisting of mature fat interspersed with hematopoietic elements resembling bone marrow. Adrenal myelolipomas are rare benign nonfunctioning tumors that are mostly detected incidentally by imaging. These usually do not present with any symptom unless they are large enough to become clinically apparent. A 36-year-old male presented to Jaber Al-Ahmed, Armed Forces Hospital, Kuwait with an abdominal lump in the right lumbar region for the past three months. The mass was 12.5 3 6 cm in size, mobile, spherical, and firm in consistency. The patient was of average built, and his vitals and routine investigations were within normal limits. Fine-needle aspiration cytology (FNAC) under ultrasonographic guidance was done, which showed scattered cells of myeloid series along with interspersed fat cells (Fig. 1). A tentative diagnosis of adrenal myelolipoma was rendered. Right adrenalectomy was performed, and the tissue was sent for histopathological examination. On gross examination, the mass was oval in shape, yellowish brown, and measured around 12.5 cm. The cut section was bright yellow in color with foci of red–brown discoloration (Fig. 2). Microscopically, the tumor consisted mainly of mature adipose tissue with scattered islands of hematopoietic cells (Fig. 3). Thus, a diagnosis of adrenal myelolipoma was confirmed. Adrenal myelolipoma is an unusual benign lesion characterized by the presence of adult fat containing active bone marrow elements within the adrenal gland. The lesion occurs most frequently in middle life with no sex predilection. Circumscribed bone marrow like structures were first recognized by Gierke in the year 1905, but it was only in 1929 that Oberling gave the name ‘‘myelolipoma’’ for the lesion. Most of the cases are found incidentally, either at autopsy or through radiological imaging done for other reasons, primarily because these present asymptomatically. It is only when the lesion attains a large size and is predominantly fatty that it becomes clinically apparent. Myelolipoma manifests in four distinct clinicopathologic patterns: isolated adrenal myelolipoma, adrenal

Cytological evaluation of enlarged lymph nodes in metastatic disease: A hospital-based assessment

Background: Lymphadenopathy is a heterogeneous entity with many underlying causes, ranging from self-limiting benign disease to severe neoplastic proliferations. Fine-needle aspiration is a cost-effective and reliable tool for initial investigation of enlarged lymph nodes. Materials and Methods: A study was conducted on 326 patients with metastatic disease in order to evaluate the efficacy of cytology in diagnosing malignancies metastatizing to the lymph node and predicting their primary origin as well as to find the relative frequency of different malignancies. The findings were also correlated with histopathology. Results: Cervical lymph nodes were the most frequently involved group, followed by axillary, supraclavicular, and inguinal lymph nodes. Squamous cell carcinoma (SCC) and adenocarcinoma were the most common cytological diagnosis. Among the cases with known primary tumors, head and neck was the most common site followed by breast carcinoma. Most common lymph node group to be aspirated in cases with unknown primary was cervical lymph node, and SCC was most frequently diagnosed cases. Sensitivity and positive predictive value of cytological diagnosis were calculated to be 100% and 93.1%, respectively. Conclusion: Fine-needle aspiration cytology has a very high sensitivity and positive predictive value and hence, a presumptive diagnosis can be made along with the detection of the primary site in case of metastatic disease.

Cholesterol granuloma of the orbit: An atypical presentation

Cholesterol granuloma is a rare, well-defined lesion of the orbit. In the orbit, diploe of the frontal bone is involved almost exclusively. We report an atypical case of cholesterol granuloma involving superomedial quadrant of orbit. A 42-year-old male presented with progressive, painless, proptosis with infero-temporal displacement of left eye. A large mass was felt beneath the bony orbital margin in the superomedial quadrant of the left orbit. Computerized tomography (CT) scan revealed an extraconal superomedial, heterogeneous enhancing mass which was isodense with brain and pushing the globe inferolaterally and anteriorly. Excision biopsy of the tumor revealed the typical features of a cholesterol granuloma without any epithelial elements. Cholesterol granuloma of the orbit is a rare entity, but it can be diagnosed and differentiated from other lesions of the superior orbit by its characteristic clinical, radiological and histopathological features. An appropriate intervention in time carries a good prognosis with almost no recurrence.

Idiopathic lymphocytoma cutis: a diagnostic dilemma.

Lymphocytoma cutis, also known as cutaneous B cell pseudolymphoma, represents a spectrum of disease that shares similar clinical and histological features and simulates cutaneous lymphoma clinically and histologically. Clinically it is manifested as asymptomatic, indolent, nodular lesions of different sizes varying between 2 and 5 cm, usually solitary, mainly on exposed area of the body like face and neck. The presence of polymorphous cell infiltrates comprising of T and B lymphocytes, plasma cells, oeosinophils, histiocytes and dendritic cells along with lack of atypical lymphocytes after incisional biopsy support diagnosis of pseudolymphoma. Final diagnosis is made on immunohistochemistry.

Plantar angiomyxolipoma in a child

Angiomyxolipoma, a lipoma variant with myxoid areas and vascular proliferation was originally described in 1996 and till date has only 12 cases in published literature. Only two cases have been reported in children involving buccal mucosa and knee, respectively. The authors report a case of angiomyxolipoma, on the plantar surface of the left foot, in a 4-year-old male child who presented to our institution in Abha city (Kingdom of Saudi Arabia). The significant differential diagnosis of this neoplasm from other similar lipomatous tumours occurring in adult and paediatric population is discussed. The importance of recognising these tumours lies in their recognition as separate entity and the present case may add to the knowledge, clinical behaviour and prognosis of these less reported lipomatous neoplasms.

Magnitude of neurogenic tumor burden in pediatric population: A tertiary care center study

Objective: Progress in the diagnosis and treatment of childhood neoplasm in the past few decades is one of the most gratifying achievements in the field of oncology. This study was aimed to ascertain the burden (incidence and prevalence) and histopathologic features of neurogenic tumors occurring in the pediatric population. Materials and Methods: The study evaluated a total of 492 cases of pediatric tumors over a period of 8 years from 2007 to 2015, including patients of 0–12 years of age group; attending the out-patients and in-patients Department of Pediatrics and Pediatric Surgery at Jawaharlal Nehru Medical College, AMU, Aligarh, with the complaints of tumor or tumor associated sign and symptoms. Clinical profile, hematological and histopathological examination along with immunohistochemical analysis were implicated to attain a conclusive diagnosis. Result: Out of 492 pediatric tumor cases, 255 (52%) cases were benign and 237 (48%) cases were malignant. Neurogenic tumor (brain tumors) comprised 49 (10%) of the total case, being most common malignant solid neoplasm and second most common (next to leukemia) overall malignancy, constituting 49/237 (21%) cases. Astrocytoma 22/49 (45%) cases were the most common type brain tumor followed by medulloblastoma 15/49 (31%), ependymoma 9/49 (18%), and craniopharyngioma 3/49 (6%). Conclusion: Effective management of pediatric neurogenic tumor is a multipronged approach involving effort of good Pediatric neurosurgeon, Pathologist and a host of Oncology specialists with insight into childhood neoplasms.

Cystic glioblastoma multiforme masquerading as a cerebral tuberculoma.

Glioblastoma multiforme (GBM) is by far the most common and most aggressive malignant neoplasm of the primary brain tumours. It arises from the astrocytes and classified as WHO grade 4 astrocytoma. Diagnosis of GBM is sometimes difficult as radiological picture sometimes mimic with cerebral tuberculoma. In both the cases contrast-enhanced CT may show similar finding of a mass lesion with a hypodense centre surrounded by a ring of enhancement and any cyst if present. In the present case, a 45-year-old male patient presented with seizures and headache, a provisional diagnosis of tuberculoma was made on the basis of clinical and CT findings. However, on grounds of suspicion the patient was operated and fluid from the cyst was sent peroperatively for cytopathological examination which suggested the diagnosis of cystic GBM. This helped the surgeon to do maximum debulking of the tumour. Diagnosis was further confirmed by histopathology.