Cytomorphologic differentiation of Hodgkin's lymphoma and Ki-1+ anaplastic large cell lymphoma in fine needle aspirates.

OBJECTIVE: To cytomorphologically differentiate Hodgkin's lymphoma (HL) from Ki-1+ anaplastic large cell lymphoma (ALCL) in fine needle aspirates. STUDY DESIGN: We blindly reviewed 63 fine needle aspiration (FNA) smears from histologically and immunophenotypically proven cases of ALCL (n = 15) and HL (n = 48). The smears were reviewed for the following criteria: (1) estimated percentages of abnormal cells, (2) pattern of the smears (polymorphous vs. dimorphous), and (3) presence or absence of multilobated cells. RESULTS: All cases were phenotyped by immunohistochemistry for CD3, CD15, CD20, CD30 and CD45, with flow cytometric immunophenotpyping in 41 cases. Flow cytometric phenotyping was not successful in any of the cases. The smears were polymorphous in all 15 cases of ALCL and in 1 case of HL (2%). The percentage of abnormal cells ranged from 10% to 90% in cases of ALCL (median, 30%) whereas it ranged from 1% to 25% in HL (median 3%; P = .0003). Three cases of HL showed abnormal cells constituting > or = 20% of the smears. They were all grade 2 disease. Multilobated cells were identified in 14 of the 15 cases of ALCL (93%) and in 3 of the 48 cases of HL (6.25%; P = .0008). CONCLUSION: Our findings indicate that the differentiation of ALCL from HL can be achieved in FNA smears through identification of abnormal cells representing > 30% of the population, a spectrum of abnormal cells and the presence of multilobated nuclei. Rare cases of grade 2 HL may be difficult to differentiate from ALCL.

Acute appendicitis in patients with sickle cell disease.

OBJECTIVE: Patients with sickle cell disease (SCD) often present with abdominal pain, usually attributed to vaso-occlusive crisis, but not rarely, it may be caused by other surgical conditions. Acute appendicitis although common in patients with SCD, it is rare and has a rapid course with a high incidence of perforation. METHODS: Over a period of 7 years from 1995 to 2001, only 8 patients with SCD out of 1563 (0.5%) patients with acute appendicitis underwent operation at Qatif Central Hospital, Qatif, Kingdom of Saudi Arabia. Their histological slides were reviewed and the findings were compared to those with sickle cell trait (9 patients) and control group (28 patients). RESULTS: All patients with SCD and in spite of a short duration of symptoms had a moderate to severe inflammation and the vessels were packed with sickle red blood cells (RBCs) except one who had an intact mucosa, extensive transmural hemorrhage and congested blood vessels with sickled RBCs without inflammatory cell infiltrate. The mucosa was intact in only one patient with SCD when compared to 5 (55.6%) in those with sickle cell trait and 6 (21.4%) in the control group and in the majority (87.5%) of those with SCD there were moderate to severe mucosal ulcerations when compared to those with sickle cell trait (44.4%) or controls (64.3%). CONCLUSION: In patients with SCD, acute appendicitis is rare, and these appendicular changes were a sequelae of blockage of appendiceal vessels by sickled RBCs leading to congestion, edema, and ischemia with subsequent mucosal ulceration and marked inflammatory cell infiltrate.

Mesenteric lipoblastoma in a 2-year-old child.

An usual case of mesenteric lipoblastoma in a 2-year-old child is presented, and the literature on the subject is reviewed.

Idiopathic granulomatus lobular mastitis. A forgotten clinical diagnosis.

OBJECTIVE: To review clinicopathological features of all cases diagnosed as idiopathic granulomatous lobular mastitis (IGLM) in our hospital and compare them with other data from the Kingdom of Saudi Arabia. METHODS: Reports of all breast specimens received in histopathology laboratory in Qatif Central Hospital, Kingdom of Saudi Arabia over a 14 year period (1988 through to 2002) were collected and those diagnosed as IGLM were selected for analysis of both pathological material and clinical data. RESULTS: Eleven patients representing 1.6% of all breast specimens were diagnosed as IGLM. The mean age was 35 years (range 25-50). Both breasts were equally affected. The most frequent presenting symptom was a breast mass of 2-22 weeks duration. The most common clinical diagnosis was chronic abscess (5 patients). Relation to pregnancy, lactation or oral contraceptives pills was elicited in 4 patients. Recurrence at different time intervals occurred in 3 patients. Microscopically there was an evident granulomatous inflammation mostly in lobular distribution. Ductal inflammation with epithelial changes was noted in most cases. Staining and cultures were negative for both mycobacterium and fungal organisms. CONCLUSION: Granulomatous mastitis is not unheard of and clinicians should keep it in their list of differential diagnosis of breast lumps so appropriate handling of breast specimens including microbiological studies can be pursued. Utility of fine needle aspiration biopsy as a diagnostic tool is to be considered.

An unusual cause of breast enlargement in a 5-year-old boy.

A 5-year-old male developed painless enlargement of the left breast and was found to have a soft, mobile, and nontender swelling that was excised. Histological examination revealed a galactocele, which is a very rare cause of breast enlargement in male infants and children.

Kikuchi[corrected]-Fujimoto [corrected] disease.

OBJECTIVE: Kukuchi-Fujimito disease is a rare, benign and self limiting condition, which usually presents with lymphadenopathy or fever of an unknown etiology, or both. Its rarity, as well as the similarity of its clinical features to other more common conditions, contribute to overlooking it in the differential diagnosis of patients presenting with lymphadenopathy or fever of an unknown etiology. METHODS: The study was carried out at Qatif Central Hospital, Qatif, Kingdom of Saudi Arabia. All lymph node excisional biopsies received in the histopathology laboratory between 1989 and 1999 were evaluated and those diagnosed as Kukuchi-Fujimito disease were reviewed for clinical data and histological findings. RESULTS: A total of 6 cases were diagnosed as Kukuchi-Fujimito disease out of 390 lymph node biopsies. All patients were young with an average age of 21.5 years and equal sex distribution. Enlarged cervical lymph nodes with or without fever were the most familiar presenting symptoms. Anemia and leukopenia were observed in 3 patients. There was no recurrence of the lymphadenopathy over a period of 1-12 years follow up. CONCLUSION: Kukuchi-Fujimito disease although rare should be included in the differential diagnosis of patients presenting with lymphadenopathy as well as fever of an unknown origin. To obviate unnecessary investigations and therapeutic trials, these patients should undergo early lymph node biopsy which must be interpreted by an experienced pathologist.