Prem Singh

Endometrial osseous metaplasia and mature bone formation with extramedullary hematopoiesis.

Sir, Endometrial osseous metaplasia is an uncommon disease with the presence of mature bone in the endometrium. The etiopathogenesis of this entity is still unclear.[1] The phenomenon of associated extramedullary hematopoiesis (EMH) is rare with only few cases reported in the world literature so far.[2] We report another such case of histologically proven endometrial osseous metaplasia and mature bone formation with EMH.

Primary Actinomycosis of the Breast Masquerading as Malignancy: Diagnosis by Fine Needle Aspiration Cytology

Dear Editors, n nA case of actinomycosis of the breast mimicking breast cancer is presented. Although it is not uncommon for actinomycosis to simulate cancer in other locations, the mammary involvement is unusual. The case was diagnosed by fine needle aspiration cytology (FNAC) and subsequently confirmed by histopathological examination. Actinomycosis is a rare cause of granulomatous suppurative mastitis, sometimes mimicking malignancy [1]. n nA 32-year-old woman presented to our institute with a history of a painful breast lump of 20 days duration. She was married, with a 2-year-old living male child. There was no history of fever, nipple discharge, breast trauma, orodental lesions, or respiratory problems. She was not diabetic and did not receive any immunosuppressive therapy. Local examination revealed a tender, firm to hard, partially fixed mass, measuring 7 × 8 cm, in the upper outer quadrant of the right breast. The overlying skin was hyperemic and edematous with no discharging sinuses. The contralateral breast and axillary lymph nodes were unremarkable. The oral cavity appeared normal. Hematological and biochemical parameters as well as chest X-rays were normal. FNAC of the right breast lump was performed. n nFNAC smears showed mixed inflammatory cells consisting of predominantly neutrophils, lymphocytes admixed with epithelioid cells, plasma cells, and giant cells in a necrotic background. Amidst the inflammatory cells, typical colonies of branching filamentous and beaded bacteria giving a ‘bales of wool’ appearance reminiscent of actinomycosis were seen (fig. u200b(fig.1).1). These were gram-positive and acid fast-negative. Cytology for malignant cells was negative. To confirm the diagnosis and exclude any possibility of malignancy, the lump was excised. Histopathological examination revealed suppurative and granulomatous inflammation with formation of micro-abscesses containing grains of Actinomyces israelii giving the cotton ball appearance; this was later confirmed by Grocotts methamine silver stain (fig. u200b(fig.2).2). The patient recovered after antibiotic treatment, and ultrasonographic follow-up was normal. n n n nFig. 1 n nActinomycosis. Fine needle aspiration cytology smear showing intertwined branching filaments giving a ‘bales of wool’ appearance against the background of inflammatory cells (May-Grunwald-Giemsa, x400). n n n n n nFig. 2 n nHistological section showing actinomycosis colonies in the centre of the abscess cavity (Grocotts Methamine Silver, x100). n n n nFirst described by Ammentrop in 1893, primary actinomycosis of the breast is very rare and most commonly caused by A. israelii which normally inhabits the mouth, colon, and vagina [2, 3]. Primary forms directly affect the breast but the etiology is unknown; possible causes include infection of the lactiferous ducts due to trauma during breast feeding or kissing. In secondary actinomycosis, extension of the primary infection is seen which could be through the thoracic cage, extending from the ribs, to the muscles, and finally the breast [4]. n nUsually presenting as recurrent abscesses with or without fistulas, the presentation of actinomycosis as a breast mass is unusual, rare, and difficult to differentiate from inflammatory carcinoma [2]. The pivotal role of FNAC in the diagnosis of actinomycosis presenting as a painful breast lump can not be emphasized enough. Being a non-traumatic and accurate diagnostic procedure, a diagnosis can be reached at an early stage and unnecessary major surgery can be avoided. Cytological diagnosis is a quick, easy, and cost-effective outpatient procedure which is easily acceptable for the patients [5]. Our case report suggests that primary actinomycosis can be reliably diagnosed by FNAC, and malignancy can be excluded.

Pseudocarcinomatous Hyperplasia of the Fallopian Tubes which was Associated with Female Genital Tract Tuberculosis, Histologically Mimicking Tubal Adenocarcinoma: A Diagnostic Challenge.

The benign proliferative and reactive processes of the fallopian tubes which are a result of female genital tract tuberculosis can mimick malignant neoplasms, both clinically and pathologically. Pseudocarcinomatous hyperplasia is a term which is applied to the florid form of epithelial hyperplasia with atypical features, that mimicks tubal adenocarcinoma. It may be encountered in the tuberculous and the non tuberculous forms of chronic salphingitis. We are reporting a case of a 30 years old female who presented to our institute with complaints of vaginal discharge and fever. She underwent panhysterectomy for uterine fibroids. Both her fallopian tubes revealed features of florid atypical epithelial hyperplasia, along with widespread caseating granulomatas. Ziehl Neelsen (ZN) staining of the lesion for acid fast bacilli (AFB) was positive. A diagnosis of pseudocarcinomatous hyperplasia of the fallopian tubes which was associated with female genital tract tuberculosis, which histologically mimicked tubal adenocarcinoma was made, which posed a diagnostic dilemma.

Emergency Diagnosis of Giant Cell Tumour (GCT) of Spine by Image Guided Fine Needle Aspiration Cytology (FNAC).

Giant cell tumour (GCT) of spine is an extremely rare neoplasm accounting 0.5% to 1.5% of all cases. The patient usually presents with weakness of lower limbs. We describe a case of 25-year-old male who presented with sudden onset of paraplegia. On plain radiograph there was an osteolytic lesion in T9 vertebra. Computed tomography (CT) scan revealed expansile lytic lesion in T9 vertebral body with involvement of posterior elements on right side with associated soft tissue mass in the extradural location extending into the spinal cord. Further Magnetic Resonance Imaging (MRI) scan (T1 contrast) showed the enhancing extradural mass involving spinal cord from D 8-10 levels. A provisional radiological diagnosis of GCT was made. A CT guided FNAC of the mass was performed which revealed typical cytological features of Giant cell tumour. Role of image guided Fine Needle Aspiration Cytology (FNAC) of vertebral mass and its role in emergency situations with clear emphasis on differential diagnosis is highlighted.

Unusual presentation of calvarial tuberculosis masquerading as a cutaneous neoplasm: diagnosis by fine needle aspiration cytology

Calvarial tuberculosis is a rare entity forming 0.2-1.3% of skeletal tuberculosis. Primary calvarial tuberculosis without evidence of tuberculous lesion elsewhere in the body is still rarer and sometimes clinically mimics cutaneous neoplasm. We describe a case of young girl who presented with swelling on the scalp in the region of the left frontal bone. She was suspected to be case of cutaneous neoplasm. Diagnosis was confirmed by Fine Needle Aspiration Cytology supplemented by radiological and microbiological investigations. The patient responded well to Anti-tubercular therapy without any surgical intervention.