Rashmi Arora

Follicular thyroid carcinoma with metastasis to skin diagnosed by fine needle aspiration cytology

In April 2006, a 55-year-old female presented with a thyroid mass and multiple skin nodules on scalp, forehead and neck. Fine needle aspiration cytology of thyroid mass and multiple skin nodules show tumor cells clusters in a repetitive microfollicular pattern on May-Grunwald-Giemsa stain suggestive of follicular thyroid carcinoma with metastasis to skin. Although follicular carcinoma have a propensity for vascular invasion and hematogenous dissemination, skin is not commonly involved. Only a few cases of cutaneous metastasis from follicular thyroid carcinoma are reported in the English language literature.

Lymphatic filariasis: aspiration of adult gravid female worm from a soft tissue swelling.

Sir, A 35 year-old male resident of Bihar, presented with a soft tissue swelling along the medial aspect of right arm, measuring 2 cm in diameter, of 4 months duration, associated with local pain. He had low grade fever since 2 months and his routine hemogram was normal. His erythrocyte sedimentation rate (ESR) was 64 mm at the end of 1 hour. Clinical diagnosis of tuberculosis was made. Fine needle aspiration cytology (FNAC) from the nodule yielded fluid along with a creamy white thread. Smears showed adult gravid female filarial worm having an intact outer cuticle layer and body cavity containing paired uteri filled with different stages of developing microfilariae. Also, few microfilariae were seen protruding out from the breach in the cuticle layer [Figure 1]. In addition, numerous embryos and coiled larvae [Figure 2] and fully straightened larvae of Wuchereria bancrofti which were sheathed and had no nuclei in the tail end were seen. The background was composed of inflammatory cells including neutrophils, lymphocytes, macrophages and eosinophils. Figure 1 Adult gravid female worm with numerous microfilariae (Giemsa, ×40) Figure 2 (a) Embryonated eggs and coiled microfilariae (Giemsa, ×100), (b) coiled microfilariae (Giemsa, ×100) The patient was then treated with oral diethylcarbamazine and his swelling disappeared. He was followed for 4 months and is doing well. Filariasis is a major health problem in tropical countries including the Indian subcontinent. It is caused by any of three closely related parasitic nematodes - Wuchereria bancrofti, Brugia malayi or Brugia timori. Wuchereria bancrofti, a human nematode parasite, is capable of producing disease due to migration of adult parasite through the lymphatic system.[1] The adult Wuchereria bancrofti may produce lesions by involving the lymphatics of the lower limbs, spermatic cord, epididymis, testis, retroperitoneum and female breast.[1] Its typical presentation are elephantiasis, chronic lymphoedema, epididymitis, funiculitis and lymphadenitis.[1,2] In spite of a large number of such lesions diagnosed on cytology, it is unusual to find adult filarial worms. Most people with microfilaraemia do not show signs or symptoms of the disease but are important source of infection in the community. Symptomatic lymphatic filariasis has very low microfilaraemia. Thus, disease and infection do not necessarily accompany each other.[3] In the present case, the patient had a solitary swelling from which fluid and fragment of adult worm was aspirated. There are a few reports of adult filarial worms in aspirates of soft tissue swellings,[1,3] lymph node[4,5] and epididymal nodules. In all these cases, the swelling was painless and the patient was asymptomatic. In none of the cases, a clinical diagnosis of filariasis was considered. Most of the soft tissue swellings associated with fever are diagnosed as tuberculous or pyogenic. FNAC can distinguish between these swellings accurately and plays an important role in their correct diagnosis. Thus, in countries where lymphatic filariasis is endemic, it should be considered in the clinical differential diagnosis of a soft tissue swelling. FNAC is a convenient and effective diagnostic method in patients with soft tissue mass. Thus, to conclude, identification of parasite in cytology smears plays an important role in diagnosis of disease and institution of specific treatment.

Multifocal renal angiomyolipoma presenting as massive intraabdominal hemorrhage.

Angiomyolipomata of the kidney are unusual lesions composed of abnormal thick walled blood vessels, smooth muscle and adipose elements. These are asymptomatic and occasionally present with flank pain, a palpable mass or gross hematuria. They may be associated with tuberous sclerosis. The risk of bleeding is increased with size, and lesions greater than 4 cm have more than 50% chance of significant bleeding. An unusual case of multifocal renal angiomyolipoma associated with tuberous sclerosis and presenting as massive intra abdominal hemorrhage is reported.

Ovarian fibroma: An unusual morphological presentation with elevated CA-125

This paper reports a case of a 42 year old female patient who presented with a large multi septate, predominantly cystic ovarian mass with elevated CA-125 levels. A diagnosis of malignant ovarian tumour was made on grounds of pre operative investigations and radical surgery was planned. Histopathological examination however revealed an ovarian fibroma with cystic change reinforcing the non specificity of CA-125 as a marker of ovarian malignancy and establishing the importance of a proper histopathological examination even in the most obvious of cases.

Squamous predominant Teratoid Wilms' tumor

Teratoid Wilms tumor is an unusual histological variant of nephroblastoma with predominant heterologous component. Frequently present components include adipose tissue, glial tissue, muscle, cartilage or bone. The presence of squamous epithelial component on the other hand is rarely reported. We describe a case of unilateral teratoid Wilms’ tumor in a 2-year-old boy with lung metastasis. In this case, tumor showed the familiar triphasic histologic pattern of nephroblastoma along with extensive squamous epithelial component.

Congenital mesoblastic nephroma: a rare pediatric neoplasm.

Abstract Congenital mesoblastic nephroma is a stromal neoplasm of infancy. It has been referred to as mesenchymal, cystic or leiomyomatous hamartoma. Th ese tumors are centered around the hilus of the kidney. Mesoblastic nephromas need to be distinguished from other pediatric renal neoplasms as these lesions are treated by complete surgical excision without chemotherapy unless gross residual tumor remains. Here, we describe the gross and microscopic features of mesoblastic nephroma in a twenty-day old infant. ÖZ Konjenital mezoblastik nefrom, bebeklik döneminin stromal neoplazisidir. Mezenkimal, kistik veya leyomyomatöz hamartom olarak kabul edilmektedir. Bu tümörler böbrekte hilus civarında yerleşim gösterir. Mezoblastik nefromlar makroskopik rezidü olmadığı takdirde kemoterapiye gerek kalmadan cerrahi eksizyon ile tedavi edildikleri için diğer pediatrik renal tümörlerden ayırt edilmelidir. Burada, 20 günlük bir bebekte saptanan mezoblastik nefromun makroskopik ve mikroskopik özellikleri tanımlanmaktadır.

Congenital granular cell lesion in newborn mandible

Congenital granular cell lesion (CGCL) is a rare non-neoplastic lesion found in newborns also known as Neumanns tumor. This benign lesion occurs predominantly in females mostly as a single mass. The histogenesis and natural history of the lesion remains obscure. It arises from the mucosa of the gingiva, either from the maxillary or mandibular alveolar ridge. The lesion is more common in the maxillary alveolar ridge than the mandibular.The present report describes a case of congenital granular cell lesion in an eight-day-old female child who was born with a mass on the anterior mandibular alveolar ridge. The mass was protruding from her mouth and compromised feeding. A clinical diagnosis of teratoma was suggested. Histologically, cells of this lesion are identical to granular cell tumor (neuroectodermal type) and show intense diastase-resistant Periodic Acid Schiff positivity. Immunohistochemically, cells are positive for vimentin but negative for S-100 and desmin, thus suggesting that CGCL is possibly derived from primitive gingival mesenchymal cells rather than having schwannian origin.

Mobile orbital Cysticercus cyst--an unusual presentation.

Introduction Cysticercus commonly affects the central nervous system, skin and skeletal muscles. Eyes are involved in 5–46% of the cases and there, the most common site of infection is subretinal and intravitreal. Cysticercosis is the most common intra-orbital parasitic infestation. In extraocular cysticercosis, the involvement includes extraocular muscles or subconjunctival regions in most cases. Other uncommon sites involved by orbital Cysticercus include the lacrimal gland, the eyelids, the anterior lacrimal crest and the deep orbit. In Cysticercus infection of the orbit, the site of lodgement of a Cysticercus cyst is usually near its rim and only very rarely in the depths of the orbit. The classical presentation of an orbital cyst is that of an anterior orbital mass with a severe inflammatory reaction while the patient also can have ptosis, optic neuritis and restriction of ocular movements. Here we report the case of a young girl who presented to us with a solitary, freely mobile, left orbital wall Cysticercus cyst unattached to any other structure in the orbit.

Fibromatosis of thyroid gland-a case report.

Fibromatosis covers a broad group of benign fibrous tissue proliferations of varied microscopic appearances that are intermediate in their biological behaviour between bengin fibrous tumour and fibrosarcoma, Extra abdominal fibromatosis in the neck occassionally cause serious sequellae when aggressive invasion of vital structure occurs. However, the principle of wide excision is difficult to apply in some patients because of the important organs surrounding the tumour. We describe a primary spindle cell tumour of thyroid that raised initial diagnostic problems and was eventually diagnosed as fibromatosis of thyroid gland.

Lepromatous leprosy-negative images giving the diagnostic clue

On aspiration, the nodule yielded pus‐like material. Giemsa‐stained FNA smears revealed inflammatory exudate consisting of macrophages, few lymphocytes, and neutrophils. Macrophage showed foamy cytoplasm with intracellular unstained clefts interpreted as negative images. Similar extracellular‐negative images were also seen [Figure 1]. The smears were then destained and restained with Fite stain which showed alcohol fast M. leprae in globi and singly [Figure 2]. Based on negative images and M. leprae in globi on Fite stain, cytological diagnosis of lepromatous leprosy was rendered. The case was then referred to dermatology OPD, and the diagnosis of lepromatous leprosy was confirmed on biopsy. Access this article online Website: www.ijpmonline.org PMID: 29323094 DOI: 10.4103/IJPM.IJPM_363_16 Quick Response Code: Im a g e