Meeta Singh

Pseudogaucher cells obscuring multiple myeloma: a case report

Gaucher-like or pseudo-Gaucher cells have been noted in a variety of conditions including acute lymphoblastic leukemia, Hodgkins disease, thalassemia, and multiple myeloma. They have an eccentric, lobulated nucleus, foamy cytoplasm but lack the tubular inclusions seen in Gaucher cells. The pseudo-Gaucher cells have distinct appearances on electron microscopy which distinguish them from true Gaucher cells.Increased pseudo-Gaucher cells probably reflects the increased load of leukocyte membrane derived glucosylceramide presented to macrophages under conditions of high cell turnover when the normal pathways for its removal may be saturated.We present a case of a 72-year-old Indian Aryan female, in which the bone marrow contained sheets of histiocytes with features mimicking gaucher cells. These pseudo-Gaucher cells obscured neoplastic plasma cells causing diagnostic difficulty.

Epidermal inclusion cyst in breast: Is it so rare?

Background: Epidermal inclusion cyst in the breast (EICB) is very rare. It presents as breast lump mainly in peri-areolar region and needs to be differentiated from other breast lesions with predominance of squamous cells. Aim: To analyze the role of fine needle aspiration cytology (FNAC) in patients presenting with breast lump. Materials and Methods: The present study is a retrospective study over the period of past 2 years, where the patients presented with firm breast lumps. Six of these cases were diagnosed as EICB on FNAC. Smears from these cases were reviewed for cytomorphological findings and correlated with clinico-radiological details. Results: Patients ranged in age from 25 to 60 years, and female to male sex ratio was 2:1 (female 4, male 2). Mammography was done in women (4), which showed solid, well-defined mass lesions in peri-areolar region and were suggestive of benign breast lesions (3) and infective lesion (1). FNA was performed; Giemsa-stained smears showed predominantly mature benign squamous cell and anucleated squames in all cases, thus one of the cytological diagnoses was EICB. Five of these cases had histological confirmation. Conclusion: EIC of breast is not that rare lesion as considered. The patients may not seek medical attention because of small painless swelling; unless the lump increases in size or becomes painful. FNAC is confirmatory in the presence of a typical pultaceous aspirate and cytomorphological features of EIC. Thus, FNAC plays a crucial role in its diagnosis and management. Symptomatic cases should be readily excised and need histological correlation to rule out any potential complications that can arise in these cysts.

Signet ring carcinoma parotid gland: A case report

Signet ring adenocarcinoma is a recently characterized entity occurring in the minor salivary glands. All reported cases have occurred in minor salivary gland. Pure signet ring adenocarcinoma of a major salivary gland has not been reported in the literature.

Adult neuroblastoma of the ovary: A rare tumor with review of literature

Neuroblastoma is a tumor of pediatric age group and is extremely rare in adults. Common sites involved in adults are almost similar to that seen in children like retroperitoneum, adrenal gland, pelvis and mediastinum. Ovarian neuroblastoma has never been reported in the literature before. We, hereby, present a case of a 38-year-old lady with bilateral ovarian neuroblastoma diagnosed as Krukenbergs tumor clinicoradiologically.

Hypertriglyceridemia Thalassemia Syndrome: A Report of 4 Cases

Abstract Hypertriglyceridemia in children can be familial or acquired. Acquired forms of hypertriglyceridemia in children may be associated with several other diseases obesity, diabetes mellitus, uremia/dialysis, hypothyroidism, nephrotic syndrome, drugs etc. Hypertriglyceridemia with β-thalassemia major is an association of unknown pathogenesis which is rarely described in the literature but is important to recognize, for the prevention of complications and proper management of thalassemic children.

Osteoclastic giant cell rich carcinoma cervix: A rare entity

Osteoclastic giant cells have been reported in a diverse range of malignancies wherein they need to be separated from tumour giant cells and sarcomatoid variants. Other than pancreatic carcinomas, ...

Mixed corticomedullary tumour with myelolipoma: a rare coexistence

Sir,Mixed corticomedullary tumour (MCMT) of the adrenal gland is an extremely rare neoplasm with fewer than 10 cases reported in the literature so far.1–6 First described in 1969 by Mathison and Wa...

Clear cell hepatocellular carcinoma: Back to the basics for diagnosis

Hepatocellular carcinoma (HCC) is a common cancer world-wide with a higher incidence in Asia. Clear cell variant of HCC (CCHCC) has a frequency ranging from 0.4% to 37%. The presence of 90-100% clear cells is rare. In the present case, a 35-year-old female patient presented with fever and a large abdominal mass in the right hypochondrium. Histology of the tumor revealed >95% clear cells and after taking multiple sections from different areas of tumor only few scattered cells with eosinophilic cytoplasm were found. Immunohistochemistry with Hep Par 1, Glypican 3 and polyclonal carcinoembryonic antigen were negative as were all other markers for metastatic clear cell tumors. Histological diagnosis was based on routine H and E sections showing a histological pattern of architecture with thickened trabeculae. We describe a rare case of CCHCC with >95% clear cells and no immunoreactivity in tumor cells in a non-cirrhotic liver.

Unusual fungal bodies in conventional cervical smears: Report of nine cases

Candida spp have often been reported in cervical cytology, other fungal organisms are very rare in modern literature. We report nine cases of conventional cervical smears showing Penicillium, Aspergillus, and Cladosporium spp in healthy imunocompetent females. Penicillium spp seen in four out of nine smears, Cladosporium spp alone in three out of nine smears, and Cladosporium spp along with Aspergillus spp in two out of nine smears. A detail of these nine cases is presented with discussion on importance of these structures when observed in conventional cervical smears. Awareness of such contaminants is important to differentiate from true infection for relevant therapeutic implications. A systematic step‐wise approach to such structures is also suggested. Diagn. Cytopathol. 2015;43:234–237.

Incidental detection of an isolated microfilaria in squash cytology of an oligodendroglioma: the unexpected 'worm' in the pie.

able to identify PML intraoperatively, and cytology preparations, widely regarded as a valuable asset in the intraoperative interpretation of brain biopsies, can showcase the diagnostic features of PML beautifully. The cytology of our case is similar to the descriptions of Yu et al., who reviewed the cytological features of 16 cases of PML in HIV-positive patients, reporting abundant foamy macrophages and astrocytes with markedly atypical nuclei and elongated fibrillary cell processes. Enlarged oligodendroglia with smudged chromatin are also seen. This case reminds us of the need for prudence when pathologists encounter many macrophages in a ‘brain tumour’ sent for intraoperative consultation, which should raise the non-neoplastic diagnostic considerations of demyelination, infarction and infection. The lack of necrosis and polymorphonuclear inflammation helps to distinguish demyelination from the last two entities, and the presence of a few reactive lymphocytes is still compatible with PML, especially in the setting of immune reconstitution. In the context of immunosuppression and brain lesions, the major differential diagnoses are lymphoma (characterized by discohesive large atypical lymphocytes which may demonstrate angiocentricity on smear) and toxoplasmosis (a necrotizing cerebritis/abscess in which careful cytological examination may yield bradyzoites and tachyzoites). The markedly atypical astrocytes of PML may prompt consideration of a high-grade glioma diagnosis, but, in the absence of a densely cellular infiltrative lesion with endothelial proliferation, atypical mitoses and necrosis, a glioblastoma diagnosis is not supported. The presence of some p53 immunopositive glia should not trigger a tumour diagnosis as JC virus-infected cells can express p53. Other than glioblastoma, the strikingly atypical astrocytes seen in PML are relatively unique and, when combined with oligodendroglia housing viral inclusions and foamy macrophages, a specific diagnosis can bemade intraoperatively. Immunohistochemistry for SV40, another polyoma virus, relies on cross-reactivity for JC virus and is useful in confirming a PML diagnosis; in situ hybridization (ISH) for JC virus is also widely employed.