Ravindra Kumar Saran

Fine Needle Aspiration Cytology in the Diagnosis of Tuberculous Mastitis

OBJECTIVE To study the relationship between granulomas in the breast and tuberculous mastitis. STUDY DESIGN Retrospective analysis of 22 breast aspirates that showed epithelioid cell granulomas. The aspirates were reviewed and the cytomorphologic findings summarized. RESULTS Aspiration cytology revealed epithelioid cell granulomas along with giant cells, necrosis and inflammatory cell infiltrate. Overall acid-fast bacillus (AFB) positivity was 22.7%. AFB positivity was greater in the presence of necrosis when epithelioid cells were absent. CONCLUSION In a country like India, the diagnosis of granulomatous mastitis must be made with caution, even in the absence of AFB. Only after a sufficient trial of antituberculosis treatment has been given and the patient fails to respond should an alternative diagnosis be suggested.

Desmoplastic ameloblastoma: a case report with fine-needle aspiration cytologic findings.

A case of desmoplastic ameloblastoma of the maxilla in a 25‐yr‐old woman is presented. Smears prepared from fine‐needle aspiration cytology showed two populations of cellular elements: cohesive epithelial clusters with basaloid morphology present, mostly in bidimensional, irregularly outlined clusters with ill‐formed palisading of nuclei at the periphery in some, and a mesenchymal component represented by 1) a sparse chunk of moderate‐sized tissue fragments made up of spindle‐ or ovoid‐shaped nuclei entrapped in mesenchymal matrix, and 2) many dissociated naked oval‐to‐spindle‐shaped nuclei. The presence of epithelial and mesenchymal components and their benign nature lead us to consider the possibility of benign odontogenic tumors 1) of epithelial origin, such as ameloblastma with a stromal component, e.g., desmoplastic ameloblastoma; 2) of mesenchymal origin, such as odontogenic fibroma; and 3) of mixed epithelial and mesenchymal origin, such as ameloblastic fibroma. Excision and histopathological examination of this lesion confirmed the diagnosis of desmoplastic ameloblastoma. In the given clinical setting and radiological examination, the above cytological features suggest a benign odontogenic tumor, rather than precisely diagnosing any of the entities mentioned above. However, it is important to distinguish between these, since the treatment varies accordingly. The differential diagnosis is discussed. Diagn. Cytopathol. 23:114–117, 2000.

Spermatocytic seminoma: a cytology and histology case report with review of the literature.

Fine‐needle aspiration cytology (FNAC) findings are described in a case of spermatocytic seminoma occurring in a 52‐yr‐old male, involving the left testis. The smears showed three populations of cells (small, medium, and large), with a preponderance of medium‐sized cells showing visible nucleoli. The background was clean, in contrast to the “tigroid” substance seen in classical seminoma. Low mitotic rate and absence of lymphocytes were the other features helpful in diagnosis. Because of these distinct morphological features, a preoperative diagnosis of spermatocytic seminoma was possible, with subsequent confirmation on histopathology. The case is being reported because of the rarity of this tumor, and because there have been only a few reported cases of FNAC diagnosis. Diagn. Cytopathol. 1999;20:233–236.

Metastatic Placental Site Trophoblastic Tumor: A Case Report

Placental site trophoblastic tumor (PSTT) is very rare. It is an unusual variant of gestational trophoblastic neoplasia usually confined to the uterus, although 10% of patients have metastases. The clinical behaviour of PSTT varies and despite knowledge of its histology, diagnosis of this rare form of trophoblastic disease and prediction of its biological behaviour remains difficult due to only a few cases reported in literature.

Multicentric Extranodal Rosai Dorfman Disease – A Cytological Diagnosis, with Histological Corroboration

Background: Rosai Dorfman disease (RDD) typically presents with massive bilateral cervical lymphadenopathy, a viral-like prodrome, elevated erythrocyte sedimentation rate, and polyclonal hypergammaglobulinemia. Other lymph nodes may be less commonly involved. Extranodal RDD is quite rare, and orbital disease accounts for only 10% of the extranodal sites of involvement. Multicentric disease has also been described, which is usually accompanied by lymphadenopathy either initially or later in the disease course. Case: We report an extremely rare extranodal multicentric disease in a diabetic patient, presenting with bilateral orbital involvement, causing ocular motility restriction, which was diagnosed on aspiration cytology of the orbital mass. This was followed in quick succession by new mass lesions in the lower back and infratemporal fossa. On extensive work-up, no lymphadenopathy was detected. The patient responded well to surgical debulking of the orbital lesions and systemic steroids. Conclusion: Fine needle aspiration cytology can be effectively applied for early diagnosis of multicentric extranodal RDD. Surgical debulking in such cases may be supplemented by systemic steroids.

Primary Actinomycosis of the Anterior Abdominal Wall: Rare Diagnosis of a Case by Fine Needle Aspiration Cytology

A 44-year-old male presented with left-sided abdominal pain and low grade fever of 2 months’ duration. A 4 × 4-cm, firm, mildly tender, diffuse lump was present in the left hypochondrial region. The superficial skin was normal. Routine laboratory tests showed peripheral blood eosinophilia of 6%. Contrast-enhanced computed tomography (CECT) showed a 5 × 4-cm lesion projecting into the abdomen from the anterior abdominal wall and not communicating with any internal organ (Figure 1A). Fine needle aspiration of the lump yielded scanty, purulent, particulate, grey-white

Composite pheochromocytoma masquerading as solid-pseudopapillary neoplasm of pancreas.

Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation.

Significance of Charcot Leyden crystals in liver cytology-A case report.

Charcot Leyden crystals are colorless, hexagonal, bipyramidal crystals formed from aggregation of material from disintegrating eosinophils. Eosinophilic infiltrate along with the presence of Charcot Leyden crystals is an indirect evidence of parasitic infestation. Here, we report a case where fine‐needle aspiration cytology smears prepared from hepatic space occupying lesion showed numerous Charcot Leyden crystals along with eosinophilic infiltrate, indicating parasitic infection. Diagn. Cytopathol. 2015;43:392–394.

Meningeal osteochondroma simulating meningioma with metaplastic change: a rare golf-ball-like lesion of non-meningothelial mesenchymal origin

Non-meningothelial mesenchymal tumors of the central nervous system (CNS), including those originating from the meninges, histologically correspond to tumors of soft tissue or bone. These individual entities arising from the meninges are rare, and probably have their origin in the multipotent primitive mesenchymal stem cells of the dura. Though it is a common bone tumor, the meningeal origin of osteochondroma has only very rarely been reported. We describe a case of a 35-year-old female with a well-demarcated, golf-ball-like osteochondroma of meningeal origin which was enucleated en bloc on craniotomy. Such a lesion can resemble a meningioma that exhibits metaplastic (osseous) change on imaging. However, provided that there is clinico-radiological awareness of such tumors, magnetic resonance imaging (MRI) can guide the way to this rare differential diagnosis, as it reflects the pathologic appearance of osteochondroma and allows the thickness of the cartilage cap to be estimated in order to check for rare malignant change. Complete excision along with the cartilage cap usually offers a favorable prognosis without recurrence.

Sphenoid wing lymphoplasmacyte-rich meningioma with occasional emperipolesis closely simulating an intracranial Rosai-Dorfman disease: a diagnostic dilemma.

In lymphoplasmacyte-rich meningioma (LRM) meningothelial whorls are overshadowed by exuberant infiltration by lymphocytes, plasma cells and few histiocytes. Hence, lesions with lymphoplasmacytic proliferation form the histological differentials. We describe the, to the best of our knowledge, first case of LRM with occasiona emperipolesis, creating a diagnostic dilemma with Rosai-Dorfman disease (RDD), around the region of sphenoid wing. LRM was favored due to the presence of epithelial membrane antigen (EMA) and vimentin positive meningothelial whorls, forming approximately 10% of the tumor tissue. Documentation of such cases may help to understand the importance of inflammatory cells and meningothelial whorls, as a manifestation of host response at the leptomeninges.