Prajwala Gupta

Isolated epitrochlear filarial lymphadenopathy: cytomorphological diagnosis of an unusual presentation

Filariasis is a major public health problem in tropical countries like India. Despite the large number of people at risk, detection of eggs with or without larva (microfilaria) on fine-needle aspiration cytology is very unusual, especially in an uncommon site or incidentally detected in clinically unsuspected cases of filariasis with the absence of microfilariae in the peripheral blood. A 19-year-old male presented with swelling over medial aspect of left arm (just above the elbow), with no other specific signs and symptoms. Fine needle aspiration cytology revealed an adult gravid female filarial worm in a background of reactive lymphoid cells and lymphohistiocytic clusters. We report a case with elaborate fine needle aspiration cytology findings of filarial worm infestation with unusual presentation of isolated epitrochlear lymph node involvement in a clinically unsuspected case and recommend clinicians and pathologists to consider a high index of suspicion for such infections at uncommon sites especially in endemic territories, as early diagnosis and treatment prevent the more severe manifestations of disease.

Dedifferentiated adenoid cystic carcinoma ex pleomorphic adenoma of the parotid

Carcinoma ex pleomorphic adenoma (Ca ex PA) is defined as a carcinoma arising from a primary (de novo) or recurrent benign pleomorphic adenoma. The most common histological subtype is adenocarcinoma, not otherwise specified, salivary duct carcinoma, mucoepidermoid carcinoma, and adenoid cystic carcinoma (ACC). Few case reports of de novo dedifferentiation in ACC are there in the literature, mostly involving minor salivary glands. The dedifferentiated adenoid cystic carcinoma arising in a pleomorphic adenoma of the parotid gland has not been reported earlier. The present case highlights this rare histological subtype seen in Ca ex PA and the role of extensive histopathological examination and immunohistochemistry.

Cytomorphological diagnosis of isolated cutaneous aspergillosis in an immunocompetent host

1. Stoler MH, Bonfiglio TA, Steigbigel RT, Pereira M. An atypical subcutaneous infection associated with acquired immune deficiency syndrome. Am J Pathol 1983;80:714-8. 2. Bernabeu-Wittel J, Luque R, Corbí R, Mantrana Bermejo M, Navarrete M, Vallejo A, et al. Bacillary angiomatosis with atypical clinical presentation in an immunocompetent patient. Indian J Dermatol Venereol Leprol 2010;76:682-5. 3. Velho PE, Cintra ML, Uthida-Tanaka AM, de Moraes AM, Mariotto A. What do we (not) know about the human bartonelloses? Braz J Infect Dis 2003;7:1-6. 4. Chian CA, Arrese JE, Piérard GE. Skin manifestations of Bartonella infections. Int J Dermatol 2002;41:461-6.

Cytodiagnosis of extramedullary hematopoiesis in serous effusion: A rare presentation unfolding the underlying etiology

Extramedullary hematopoiesis (EMH) usually involves reticuloendothelial system. However, it rarely may be present in the serous body effusions. In our case, the fluid cytology of both peritoneal and pleural fluid was diagnostic of the EMH in a patient with an undiagnosed underlying etiology.

Fine needle aspiration cytology of thyroid metastasis: An unusual presentation of cervical carcinoma; a case report and review of literature.

I N D I A N J O U R N A L O F P A T H O L O G Y A N D M I C R O B I O L O G Y ¦ V O L U M E 6 0 ¦ I S S U E 2 ¦ A P R I L J U N E 2 0 1 7 298 with raised IgE levels and eosinophilia that was seen in both AD and HC. Eczema, dermatitis (resembling AD) with eosinophilia, and raised IgE levels are also features of rare autosomal dominant hyper-IgE syndrome (HIES), and staphylococcal skin abscesses which is a feature of the latter can occur in AD due to secondary infections. TH17 cells, however, readily helps distinguish the two as TH17 cells are markedly reduced or absent in HIES but raised in AD.

Pulmonary Hamartoma Mimicking Malignancy: A Cytopathological Diagnosis

Pulmonary Hamartomas (PH) are benign tumour-like lesions of lung with an uncommon occurrence and pose a diagnostic challenge on chest radiograph. Fine Needle Aspiration Cytology (FNAC) can lead to a definitive diagnosis as well as distinguishes these from malignant lung mass. Most of the patients are asymptomatic and incidentally detected on routine chest radiographs. We report a case of pulmonary hamartoma where the patient was symptomatic and a possibility of malignant neoplasm was considered until the FNAC concluded the diagnosis.

Primary Salivary Gland Malignancy of Trachea: A Clinical Masquerader

Primary tracheal malignancies are rare and present with non specific symptoms hence delaying the diagnosis. A 41-year-old male presented with repeated paroxysmal episodes of breathlessness for which he was being treated with bronchodilators and steroids. Computed Tomography (CT) chest was done revealing a small polypoidal mass lesion arising from lower trachea/carina. On fibre optic bronchoscopy an infiltrative growth was seen at the lower end of trachea following which biopsy was obtained. On histopathologic examination a diagnosis of primary adenoid cystic carcinoma was made. It was concluded that in a case of refractory obstructive pulmonary disease, primary tracheal tumours should be considered as an important differential diagnosis. CT chest, bronchoscopy and biopsy play a vital role in making an accurate diagnosis of such a clinical masquerader.

Cytodiagnosis of disseminated histoplasmosis in an immunocompetent individual with molluscum contagiosum-like skin lesions and lymphadenopathy

Disseminated histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum (H. capsulatum). The early clinical manifestations are nonspecific, often lead to diagnostic difficulty, and is misdiagnosed as tuberculosis and seen usually in immunosuppressed states. Fine needle aspiration cytology (FNAC) is a simple, safe, and quick technique to establish the initial diagnosis of H. capsulatum, thereby prompting early treatment. The skin involvement is rare in disseminated disease and we describe a case of disseminated histoplasmosis in an immunocompetent patient with unusual molluscum contagiosum like umbilicated skin lesions and FNAC of the cervical lymph node was the only tool for rapid and early confirmatory diagnosis.

Sinonasal malignant melanoma with metastasis: Immunohistochemistry meeting the diagnostic challenge

Sinonasal malignant melanoma is one of the uncommon and highly aggressive tumors of the sinonasal cavity. Cytomorphological features in a metastatic lymph node may reveal a diagnosis of malignant melanoma. This case had nondiagnostic cytological and histopathological features, which could suggest malignant melanoma. Immunohistochemistry in such cases becomes the primary method for establishing the diagnosis of malignant melanoma at an uncommon site.

Fine-needle aspiration cytology of isolated skull nodule: Unfolding the clinical spectrum.

Follicular thyroid carcinoma (FTC) has been classified as either minimally invasive or widely invasive carcinoma and shows a propensity for blood-borne metastasis. Most common sites of metastasis are lung and bone followed by brain, liver, and skin. Minimally invasive FTC (MIFTC) is characterized by limited capsular and/or vascular invasion with good long-term outcomes, some cases of which show a poor prognosis because of severe distant metastasis. Skull metastasis in adults commonly arises from the lung, breast, and prostate and uncommonly from the thyroid. In our case, fine-needle aspiration cytology of isolated skull nodule was a reliable tool in the diagnosis of metastasis and suggesting the primary in thyroid thereby prompting early workup of a patient. The case is unique since it represents the rare disseminated metastasis from MIFTC with incomplete capsular penetration alone without angioinvasion that can behave as aggressively as a widely invasive FTC.