Nandita Ghosal

Diagnostic and clinical implications of pituicytoma

Pituicytoma is a rare, indolent, benign tumor of the sellar and suprasellar region arising from pituicytes of the neurohypophysis. It is most often diagnosed pre-operatively as a pituitary adenoma. We report two patients with pituicytoma operated on at our Institute over 8 years. Imaging of one patient showed a parasellar and medial temporal extension, which has not been reported to our knowledge. The radiological features that help distinguish this low-grade tumor from other sellar and parasellar tumors are discussed along with its distinct histological findings. The authors also review the literature on its clinical presentation, diagnosis, surgical management and outcome.

Metastatic anaplastic oligodendroglioma simulating acute leukemia. A case report.

BACKGROUND Anaplastic oligodendroglioma (OG) is an uncommon tumor that rarely metastasizes outside the central nervous system. Spread to the bone marrow (BM) is so rare that when it occurs in the course of follow-up of a case of OG, a disseminated second primary tumor may be a more likely possibility unless BM examination provides evidence to the contrary. Potentially misleading cytologic features of metastatic anaplastic OG can be seen in a BM touch preparation. CASE A 50-year-old man had undergone left frontal lobectomy in September 1999 for anaplastic OG and presented seven months later with evidence, on BM scan, of focal abnormal uptake at multiple sites. Bone marrow biopsy confirmed OG secondaries, which, on the touch preparation, appeared not only in clusters but also as single cells, simulating acute leukemia. CONCLUSION The morphology of anaplastic OG metastatic to BM simulates acute leukemia, as seen on the BM touch preparation. This is relevant particularly in the context of anaplastic OG on follow-up. This diagnostic pitfall can be heightened if a BM aspirate rather than biopsy is performed. Metastatic OG can be added to the list of tumors that metastasize to BM as single cells.

Cytomorphology of Lipomatous Tumors of Soft Tissue

OBJECTIVE To evaluate the cytomorphologic features of benign and malignant lipomatous tumors of soft tissue on fine needle aspirates (FNA) and determine if the variants of liposarcoma could be identified. STUDY DESIGN FNA of histologically documented benign (51 cases) and malignant (39 cases) lipomatous tumors were reviewed. Twenty-six of the 51 FNA from lipomas and 34 of the 39 FNA from malignant lipomatous tumors were satisfactory for evaluation. RESULTS FNA from 26 cases of lipomas were cellular, with lobulated, fibroadipose tissue. Thin and thick capillaries were seen in 92% and 65% of cases, though a chicken wire vascular pattern was seen in only 4 cases (15%). A cytodiagnosis of liposarcoma could be made in 23 cases (88%), and these could be further subtyped into well-differentiated (4 cases), myxoid (8), pleomorphic (4), round cell (3) and liposarcoma, ?type (4). Only 50% of the well-differentiated liposarcomas, 3 of the 10 pleomorphic liposarcomas and 8 of the 17 myxoid liposarcomas were diagnosed as such on FNA. Cytologic diagnosis of the remaining 9 cases of myxoid liposarcoma were pleomorphic liposarcoma (1); liposarcoma, ?type (3); malignant mesenchymal tumor (1); suspicious for malignancy (2); and benign (2). There were no false positives, but there were 3 false negative cases (1 well-differentiated and 2 myxoid liposarcoma). CONCLUSION Lipomas can be diagnosed readily. Arborizing vessels can be seen in lipomas and should be interpreted with caution. Subclassification of liposarcomas on FNA is possible but not very reliable. Myxoid liposarcomas pose a problem, and aspirates from them can mimic a wide range of morphologic subtypes. The role of FNA in identification of variants of liposarcoma is limited.

Rosette forming glioneuronal tumor pineal gland and tectum: An intraoperative diagnosis on smear Preparation

We present an extremely rare case of newly described entity called rosette forming glioneuronal tumor (RGNT), involving the pineal gland, tectum, and the adjacent thalamus in a 22‐year‐old male. Interestingly, the ventricular system was not involved in this case. The tumor was diagnosed intraoperatively on smear preparation on cytomorphology. If sampled adequately, it is fairly easy to diagnose RGNT on smear preparation as it has a very distinctive cytomorphology of being composed of two population of cell. One of the components is pilocytic astrocytoma and the other is composed of small cells with scant cytoplasm, vesicular nuclei, arranged around neuropil‐like material forming “neurocytic rosettes.” To the best of our knowledge, this is the first case of RGNT in this rare location being diagnosed intraoperatively on smear preparation. Diagn. Cytopathol. 2010;38:590–593. 2009 Wiley‐Liss, Inc.

Coexisting intracranial tumors with pituitary adenomas: Genetic association or coincidence?

The co-occurrence of two or more brain tumors with different histological features is rare. The authors report three rare cases of intracranial tumors associated with pituitary adenomas. Two of the pituitary tumors were functioning adenomas: a prolactinoma and a thyrotropin secreting adenoma. Two of the associated intracranial neoplasms were gliomas and one was a meningioma. Radiological and clinical examination for syndromal association was negative in all cases. We briefly discuss the presentation and treatment options of these cases and review the 19 previous publications in the literature of pituitary tumors occurring in association with other neoplasms and explore the possible links underlying these co-occurring neoplasms. Our three cases represent 0.86% of all pituitary tumors operated at our institute over a 9-year period.

Isolated sellar tuberculoma presenting with panhypopitutarism: clinical, diagnostic considerations and literature review

Tuberculosis, a common cause for chronic intracranial infections can mimic varied intracranial pathologies including tumours. Pituitary tuberculomas are rare lesions and are often diagnosed pre-operatively as pituitary tumours. We report a case of a 31-year-old lady with a sellar-suprasellar lesion who presented with panhypopituitarism. The patient underwent a trans-nasal, trans-sphenoidal surgical decompression of the lesion. Histopathology revealed a tuberculous lesion in the pituitary. The characteristic radiological features of sellar tuberculomas are discussed along with a review of literature. Atypical sellar radiology in the presence of a thickened pituitary stalk could point to pathology other than pituitary adenoma, possibly a chronic inflammatory condition like tuberculoma.

Langerhans cell histiocytosis infiltration in cerebrospinal fluid: a case report.

Langerhans cell histiocytosis (LCH) is a disease of unknown etiology characterized by a proliferation of histiocytic cells resembling the integumentary cells bearing the name of Langerhans cells. LCH can be unifocal or multifocal, with one‐ or many‐organ involvement. We present a case of LCH diagnosed in the cerebrospinal fluid of a patient with generalized lymphadenopathy and central nervous system involvement. Diagn. Cytopathol. 24:123–125, 2001.

Giant, solid, invasive prolactinoma in a prepubescent boy with gynecomastia.

Pituitary adenomas are extremely rare in prepubescent children. Most of these tumors are functioning adenomas, but can also present with vision disturbances and changes in body morphology. We discuss the presentation, management, and outcome of a giant, solid, invasive prolactinoma in a 7-year-old boy who presented with visual disturbances and gynecomastia. The child demonstrated significant improvement in vision and a reduction in size of the tumor after subtotal tumor decompression and treatment with oral bromocriptine for 4 months. Tumor decompression and oral dopamine agonist therapy comprise the accepted treatment for pediatric prolactinomas. To our knowledge, only two previous reports described a giant prolactinoma in a prepubescent child. The relevant literature on pediatric pituitary tumours and prolactinoma is reviewed.

Fibro-osseous lesion of the pineal region resembling osteoblastoma: a case report.

A case of unusual fibro‐osseous lesion resembling osteoblastoma of the pineal region is reported, in a 50‐year‐old man. The patient presented with a history of headache, vomiting and generalized tonic‐clonic seizures. CT scan showed a hyperdense lesion in the posterior third ventricle with obstructive hydrocephalus. On histopathology the lesion showed cellular areas with oval to polygonal cells showing clear to eosinophilic cytoplasm along with focal anastomosing network of osetoid‐like extracellular material lined by similar cells. The extracellular material was seen densely calcified at places with cement lines and Haversian canal formation. The cells were strongly immunoreactive for epithelial membrane antigen and focally for S‐100 protein and negative for glial fibrillary acidic protein.

Fourth-ventricular immature teratoma

Teratomas account for 3% of all childhood tumors. This group of non-germinomatous germ cell tumors exhibit cellular and structural characteristics associated with the three germ layers. The immature cells can differentiate into more malignant neoplasms. We report the presentation and management of a 4-year-old girl with an immature teratoma of the fourth ventricle. The outcome of this intracranial immature teratoma was poor, due to the patients age, the extensive lesion at presentation and the grade of the tumor.