Shanta Krishnamurthy

Primary carcinoid tumor of the liver: Report of four resected cases including one with gastrin production

Four cases of primary hepatic carcinoid were identified during a retrospective study of liver resections for primary tumor. The cases included two adult males, one adult female, and a 9‐year‐old boy in whom gastrin levels were documented. The estimation of gastrin levels was prompted by symptoms suggestive of acid‐peptic disease. One patient died postoperatively. The other three are alive and well at 3 years, 2 years, and at 1 year, respectively, after surgery, outcomes distinctly different from hepatocellular carcinomas. Diagnostic difficulties may be experienced in histologic assessment, and this may require recourse to immunohistochemistry and electron microscopy. Long‐term follow‐up and careful exclusion of a possible primary elsewhere are necessary for establishing the primary nature of liver carcinoids.

Fine Needle aspiration cytology of undifferentiated (Embryonal) sarcoma of the liver : A case report

BACKGROUND Undifferentiated sarcoma of the liver is a rare tumor of childhood. The histology has been well documented, but the histogenesis is controversial. The cytologic characteristics of this neoplasm in aspiration material have not been previously documented. CASE The cytologic features in a 9-year-old male were pleomorphic malignant cells, multinucleate giant cells, numerous hyaline globules and myxoid matrix. CONCLUSION The cytologic features of undifferentiated sarcoma of the liver are distinctive and different from those of other childhood liver tumors. Awareness of the tumors cytomorphology can result in a confident preoperative diagnosis.

Stromal Fragments in Invasive Carcinoma

OBJECTIVE: To analyze three cases of stromal fragments in invasive carcinoma that created diagnostic difficulty in aspiration cytology. STUDY DESIGN: A retrospective review of fine needle aspiration cytology (FNAC) smears of a breast tumor, scalp tumor and neck mass. Cytomorphologic features of all the smears were reviewed after histology became available. RESULTS : FNAC smears revealed a biphasic pattern: a carcinomatous component and a stromal component that was either discrete or in close apposition to the carcinoma. The cytopathologist had suggested the diagnosis of a biphasic tumor in each case-phyllodes, malignant skin adnexal and salivary gland tumor. Histopathology revealed an invasive carcinoma with altered stroma in the first two cases and metastatic lymph node with perinodal soft tissue extension in the third case. CONCLUSION: Stromal changes in response to infiltrating carcinoma are well documented in surgical pathology. However, these may also be encountered in FNAC smears. The above cases stress the importance of recognizing stromal fragments in aspiration cytology in order to avoid diagnostic errors.

Dermatofibrosarcoma protuberans metastatic to the lung. A case report.

A case is presented of dermatofibrosarcoma protuberans of the gluteal region with metastasis to the lung appearing 7 years after wide excision of the primary lesion. The world literature is reviewed. The clinical and pathologic features of dermatofibrosarcoma are reviewed and treatment is discussed, with the aim of emphasizing the need for long-term follow-up examination of lymph nodes and for metastases following wide excision of these lesions.

Emperipolesis as a key feature in imprint cytology of the thymus : A report of two cases

BACKGROUND Imprint cytology of the thymus has not received much attention. Cytology of the thymus is important because the uninvolved thymus may be needled during aspiration procedures. CASES In two cases, during surgery for carcinoma of the thyroid, we received thymic tissue mistakenly sampled as a pretracheal lymph node for frozen section to rule out metastasis. Imprint smears were studied. The presence of thymocytes in the cytoplasm of thymic epithelial cells (emperipolesis) was the most significant feature in the imprints. However, it was not detected on histology. CONCLUSION Thymic epithelial cells provide mechanical support and play a major role in the maturation of lymphocytes (thymocytes). They are observed as emperipolesis on imprint cytology. Its utility in identifying thymic cells in aspiration cytology needs to be investigated.

Extra-adrenal non-functioning paraganglioma.

Extraadrenal non-functioning retroperitoneal paragangliomas are rare tumors. We herein report a case of retroperitoneal tumor which posed a diagnostic and management problem. Review of the literature shows only 16 previously reported cases of extraadrenal paraganglioma which underwent complete surgical excision.