Reed–Sternberg Cells in Pericardial Effusion - Rare Finding in a Case of Nodular Sclerosis Classical Hodgkin Lymphoma.

Causes of malignant pericardial eff usion include metastatic carcinomas, acute leukemias, chronic leukemias, non-Hodgkin lymphoma, and rarely Hodgkin lymphoma. We report here a case of nodular sclerosis classic Hodgkin lymphoma presenting with massive pericardial eff usion. Cytological fi ndings of the pericardial fl uid and histopathology of the lymph node are presented. A 13-year-old girl came with complaints of a cough and progressive breathlessness for 5 months. She also had B symptoms. Imaging showed massive pericardial eff usion, along with mediastinal, cervical, and abdominal lymphadenopathy. Pericardiocentesis was done. A cytology of the pericardial fl uid showed large atypical Reed–Sternberg (RS) - like cells in a background of lymphocytes, eosinophils and plasma cells – suggestive of Hodgkin lymphoma. Cervical lymph node biopsy and immunohistochemistry confi rmed the diagnosis of classical Hodgkin lymphoma – nodular sclerosis subtype. Th e institution of chemotherapy resulted in signifi cant decrease in pericardial eff usion, and the patient was discharged in a satisfactory condition. Hodgkin lymphoma presenting clinically with massive pericardial eff usion and showing RS cells in the pericardial fl uid is very rare. A cytopathologist needs to be aware of this possibility which will facilitate early diagnosis and treatment.

Mullerian choristoma in a case of spinal dysraphism.

It is extremely rare to fi nd mullerian choristomas in association with spinal dysraphism, with <10 cases published in English literature. We report a case of heterotopic uterus and fallopian tube-like tissue within a lumbar subcutaneous lipoma associated with spina bifi da and tethered cord. A 21-year-old lady presented with lumbar swelling since birth and dull pain in the lower back. Magnetic resonance imaging showed spina bifi da at level L3 and L4, tethering of the cord and a subcutaneous lipomatous swelling. Biopsy revealed lobules of fi broadipose tissue embedded in which were seen organoid cystic structures containing prominent smooth muscle coats in their wall. These cystic structures were lined by the endometrium and showed fallopian tube-like papillary infoldings. Immunohistochemistry showed estrogen receptor positivity in the epithelium, stroma, and smooth muscles. The epithelial cells were also positive for cancer antigen 125 and cytokeratin 7 while the stromal cells showed CD10 positivity, supporting mullerian derivation. The pathogenesis and differential diagnosis of such lesions is discussed.

Bilateral granulocytic sarcoma (chloroma) of the breast in CML in blast crisis: a case report.

A 35 year old lady was diagnosed as having chronic myeloid leukemia in May 1999 and thereafter started on chemotherapy. Three years later the patient presented with bilateral breast masses. FNAC from both the breast lesions showed leukemic infiltration (granulocytic sarcoma). The peripheral blood picture showed blastic transformation. Breast is an uncommon site for development of granulocytic sarcoma. We present this case because of its unusual location and bilateral nature.

Sarcomatoid carcinoma (carcinosarcoma) of the esophagus with extensive areas of osseous differentiation: a case report.

A 46 year old male presented with progressively increasing dysphagia and weight loss. Esophagoscopy showed a large polypoidal growth involving the middle segment of esophagus. Histologically bulk of the tumour had a sarcoma-like appearance composed of spindly pleomorphic cells along with extensive areas of bone formation. The epithelial element was represented by a small area of squamous cell carcinoma. One of the draining lymph nodes also showed small islands of squamous cell carcinoma. A diagnosis of sarcomatoid carcinoma was made. Sarcomatoid carcinoma of the esophagus, also termed carcinosarcoma, pseudosarcoma, and spindle cell carcinoma is an unusual malignant tumour of the esophagus. The proportion of carcinomatous and sarcomatous component may vary from case to case. Rarely, the sarcomatous component may exhibit osseous differentiation as in our case.