Muralee Dharan

Seasonal Variation of Gonadotropins and Gonadal Steroids Receptors in the Human Pineal Gland

Recently abnormal melatonin secretion was demonstrated in hypogonadal male patients which was normalized during testosterone administration. These results suggested that both gonadal steroids and gonadotropins may modulate melatonin secretion, probably by activating specific receptors in the pineal gland. We used immunohistochemistry to localize luteinizing hormone, follicle stimulating hormone, estrogen and androgen receptors in human pineal glands. Tissues were obtained at autopsy from 53 adult males (aged 19-94 years) over a period of 1 year. Positive staining for the four types of receptors was evident in all 53 specimens examined. The percent of positively stained cells revealed a significant seasonal variation of gonadotropin receptors with higher values in the winter than in the summer. Day-night difference was evident only for follicle stimulating hormone-receptors during the summer and winter, with higher values at night. Androgen receptors and estrogen receptors were present in all specimens but did not reveal day-night or seasonal variations. These data demonstrate the presence of gonadotropin and gonadal steroid receptors in the human pineal gland. Gonadotropin receptors exhibited seasonal variation with higher values in the winter.

Combined Adrenal Myelolipoma and Medullary Hyperplasia

Objective: A patient is reported with hypertension due to combined medullary adrenal hyperplasia and myelolipoma. Methods: A 52-year-old woman with long-standing hypertension was evaluated for an incidentally discoveredlargetumor of the left adrenal. Left adrenalectomy was performed for a presumptive clinical diagnosis of pheochromocytoma. Results: Histopathologic examination revealed a mixed tumor consisting of a large myelolipoma with infiltrating foci of adrenal medulla. Conclusions: A patient is described with hypertension, myelolipoma and adrenal medullary hyperplasia; following adrenalectomy, however, blood pressure and biochemical abnormalities normalized.

Pheochromocytoma due to unilateral adrenal medullary hyperplasia

We describe two male patients, aged 17 and 47 years, with clinical and biochemical features of pheochromocytoma. Both patients had normal‐sized adrenal glands on abdominal CT scan and abnormal unilateral uptake of I‐123 metaiodobenzylguanidine (MIBG) on scintigraphy. The surgical adrenalectomy revealed normal macroscopic glands in both patients. Histological examination showed adrenal medullary hyperplasia with adrenal cortico‐medullary ratios of 2 : 1 and 4 : 1. Unilateral adrenalectomy resulted in amelioration of symptoms and normalization of catecholamines excretion. DNA examination for RET proto‐oncogene revealed no mutations in exons 10, 11, 13, 14 and 16. Our results suggest that diffuse adrenal medullary hyperplasia may be the initial pathological change in the adrenal gland leading, subsequently, to the development of nodular hyperplasia and adrenal medullary tumor. These results indicate that the syndrome of pheochromocytoma may occur as an unilateral adrenal medullary hyperplasia in patients without evidence for multiple endocrine neoplasia.

Basement membrane material (hyaline globules) in synovial sarcoma : A case report with description of a potential diagnostic pitfall

BACKGROUND Synovial sarcoma (SS), a malignant mesenchymal tumor, has a biphasic growth pattern characteristically. Histologically and cytologically the tumor can pose diagnostic difficulty when the epithelial component is predominant. CASE REPORT A 22-year-old female presented with a rapidly enlarging mass on the lower left side of the neck. Fine needle aspiration of the tumor yielded abundant, discohesive round-oval cells mingled with amorphous hyaline material, raising a suspicion of medullary carcinoma of the thyroid. In addition, air-dried, Giemsa-stained smears demonstrated rosettelike structures with central magenta globular material, mimicking adenoid cystic carcinoma. However, histologic examination of the excised tumor, including immunohistochemical and ultrastructural studies, proved it to be a typical SS with copious basement membrane accumulations. CONCLUSION The cytologic appearance of SS can be confusing. However, a false diagnosis may be avoided if adequate needle sampling is ensured and clinical correlation considered.

The Adjunctive Value of CD10 Immunostaining on Cell Block Preparations in Pelvic Endometriosis

OBJECTIVE To evaluate the utility of CD10 immunostaining on cell block preparations from pelvic washing cytology material obtained during laparoscopy in cases of pelvic endometriosis (PE). STUDY DESIGN Six premenopausal women presenting with ovarian masses underwent a laparoscopic procedure. In addition to routine cytospin preparations, cell blocks were prepared using the formalin-fixed, paraffin-embedded method from the pelvic washings in each case. Immunocytochemistry using monoclonal antibodies for cytokeratin (CK) 7, CK20, CD10, estrogen receptor (ER), progesterone receptor (PR) and CA125 was performed on sections from cell blocks using the streptavidin-biotin peroxidase complex. RESULTS Clusters of epithelial cells (3 cases) and stromal cells (2 cases) were seen in a background rich in hemosiderin-laden macrophages and poorly preserved mesothelial cells on cytospin smears. CD10 and CK7 were consistently positive in the stromal and epithelial components, respectively, in all cases on cell block sections. Variable staining reactions were noted for ER, PR and CA125. CONCLUSION CD10 immunostaining is a useful ancillary method in the diagnosis of endometriosis. Its routine use on cell block preparations from pelvic washings in women undergoing a laparoscopic procedure is recommended.

Metastatic minor salivary gland colloid carcinoma in the parotid region after parotidectomy for pleomorphic adenoma: a case report.

BACKGROUND Primary colloid or mucinous carcinoma of the salivary glands is extremely rare. Only a few cases have been reported that originated in the minor salivary glands. an even more exceptional presentation is as a metastatic tumor in the parotid region subsequent to superficial parotidectomy for pleomorphic adenoma. The case presented here posed a diagnostic dilemma that could be resolved only after a thorough reevaluation of the previous cytologic and histologic material and detection of the occult primary tumor in the hypopharynx following an extensive clinical and radiologic workup. CASE A 75-year-old female underwent fine needle aspiration of the left parotid and was diagnosed as having pleomorphic adenoma. A superficial parotidectomy removed the tumor completely, and the diagnosis was confirmed. Six months following the surgery, the patient developed an enlarged nodular mass in the ipsilateral parotid region, with fine needle aspiration showing colloid (mucinous) adenocarcinoma, which proved to be a metastatic colloid (mucinous) carcinoma on excisional biopsy. The clinical and radiologic workup in search of a primary lesion led to an occult tumor in the left hypopharyngeal mucosa. CONCLUSION Unusual presentations of rare tumors can cause considerable diagnostic difficulties to both the clinician and cytopathologist. Awareness of these rarities is important to ensure the best patient care and to avoid unnecessary investigative and therapeutic procedures.

Hyaline globules in ectopic decidua in a pregnant woman with cervical squamous cell carcinoma

Decidual reaction in pelvic lymph nodes has been increasingly documented during pregnancy. This may pose diagnostic difficulty during intraoperative frozen section (FS) and cytological consultation in women undergoing surgical procedures for cervical Squamous cell carcinoma (SCC). A 34‐year‐woman diagnosed to have invasive SCC (stage IB1) of the cervix at 14th week of her first pregnancy underwent abdominal radical trachelectomy and pelvic lymphadenectomy at 22 weeks of gestation. Cytological smears of two of the lymph nodes from intraoperative FS revealed isolated eosinophilic hyaline globules (HG) measuring 45–50 microns, in addition to large polygonal cells with amphophilic cytoplasm and hypochromatic nuclei and occasional squamous‐looking cells with atypical hyperchomatic nuclei. These findings posed a diagnostic dilemma at intraoperative consultation and no definitive diagnosis was rendered. The formlin‐fixed, paraffin‐embedded histological sections of the same lymph nodes showed ectopic decidua with no evidence of metastatic SCC. Decidual cells are a cause of concern for both cytologists and histopathologists. In pregnant women complicated by cervical cancer intraoperative evaluation of pelvic lymph nodes is of utmost importance in order to adopt the optimal conservative treatment modality. In the absence of clear cut evidence of malignancy, a diagnosis of metastatic SCC should not be rendered. Diagn. Cytopathol. 2009.

Hemifacial spasm associated with external carotid artery compression of the facial nerve

We report a unique case of hemifacial spasm due to compression of the facial nerve by the main trunk of the external carotid artery within the parotid space. Decompression of the facial nerve as well as partial section of the proximal trunk of the nerve, caused the hemifacial spasm to disappear. Our case gives support to the theory that hemifacial spasm can be caused by pressure on the facial nerve along all its course and not only in its intra-cranial portion.