The fine needle aspiration appearances of Kikuchi's lymphadenitis.

OBJECTIVE: To describe the fine needle aspiration cytological appearances of Kikuchi's lymphadenitis. METHODS: Cytological review with histological correlation of all cases of Kikuchi's disease (KD) in which there had been an antecedent fine needle aspirate of the involved lymph node prior to lymph node excision between 2001 and 2006. RESULTS: Twelve cases of KD were identified in which cytological and histological material was available. In eight cases the original prospective diagnosis of necrotizing non-granulomatous lymphadenitis consistent with KD had been suggested on the lymph node aspirate. Review of these cytological samples identified abundant extra- and intracellular apoptotic debris - the latter embedded in the cytoplasm of crescentic and phagocytic macrophages, set in a background reactive lymphoid population. Three of 12 cases were initially reported as in keeping with nonspecific reactive lymphadenopathy. Review identified intracellular apoptotic debris but no conspicuous extracellular nuclear debris. One case had originally been reported as possible non-Hodgkin's lymphoma. Histological review of the excised lymph nodes in all 12 cases showed the classical appearances of KD. CONCLUSION: The accurate diagnosis of KD on fine needle aspiration is possible given correct clinical data, an adequately sampled and well-prepared specimen in which the characteristic intra- and extracellular apoptotic nuclear debris with admixed crescentic macrophages are identified on a reactive lymphoid background.

Intra-operative imprint cytology for assessing the sentinel node in breast cancer: results of its routine use over 8 years.

INTRODUCTION: Intra-operative imprint cytology (IIC) for analysing sentinel lymph node/s (SLN) in breast cancer allows definitive axillary surgery as a one-step procedure. Most reported studies are research oriented. This study reports long-term results of IIC done as routine clinical practice. MATERIALS AND METHODS: Eight hundred ninety-six female, operable breast cancer patients underwent SLN biopsy over an 8-year period (January 1999-December 2006). Data were extracted retrospectively from medical records. SLNs were sent intra-operatively to the laboratory where they were bisected, touch imprinted and stained with Hematoxylin & Eosin. Patients with positive IIC had axillary clearance. Formal histological analyses of SLNs were compared with IIC findings. The impact of routine pre-operative axillary ultrasound (introduced in 2003) on IIC sensitivity and specificity was also assessed. RESULTS: Median age was 61 years (26-89) and median tumour size was 18 mm (2-100). A total of 244/896 patients had SLN metastases on final paraffin histology of which 177 were correctly detected by IIC (67 false negatives). 39/67 false negatives could be attributed to sampling error. The overall sensitivity and specificity of IIC for the identification of SLN metastases was 73% and 100%, respectively. The sensitivity of IIC after introduction of pre-operative axillary ultrasound decreased from 75% to 71%. DISCUSSION: Routine use of IIC for analysis of the SLN in breast cancer allows complete axillary surgery during a single anaesthetic for a majority of patients undergoing SLN biopsy. Almost two thirds of positive axillae were spared a second operation. False negative results are frequent and patients should be warned about the potential need for further axillary surgery.

IgA multiple myeloma presenting as non-obstructive jaundice.

Multiple myeloma can occasionally present with jaundice. The underlying process may be pancreatic head myeloma infiltration causing obstructive jaundice or hepatic amyloid deposition resulting in cholestatic jaundice. A rare case of myeloma presenting as jaundice due to hepatic myeloma infiltration is reported.

Fat necrosis of the breast: a cytological and clinical study.

Fat necrosis of the breast is a sterile condition that usually results from trauma to the breast. It may present with a breast lump that, on clinical and mammographic examination, can mimic malignancy. The literature suggests that fat necrosis of the breast can only be diagnosed accurately by histological examinations of breast biopsies. In this paper, we review the findings of a series of 35 patients in whom fat necrosis was diagnosed on fine needle aspiration cytology. Repeated fine needle aspiration cytology with close follow-up have proven to be a reliable method of establishing the diagnosis of fat necrosis of the breast, thereby reducing the necessity for open biopsy.

Skin involvement in Kikuchi's disease: an immunocytochemical and immunofluorescence study.

Kikuchi's disease (KD) is a benign self-limiting febrile illness usually affecting young women, which is manifested clinically by fever and cervical lymphadenopathy. Skin involvement in KD is very rare and is evident clinically in the form of skin rashes and nodules. We describe one such case of KD in a 33-year-old Bulgarian woman who presented with cervical and axillary lymphadenopathy and who developed a transient facial rash. Biopsy of axillary lymph nodes showed the characteristic features of KD with infiltration of the lymph node paracortex by apoptotic plasmacytoid monocytes. Biopsies of the facial skin showed two features: (1) dermal infiltration by apoptotic plasmacytoid monocytes; (2) on immunofluorescence studies of frozen sections prepared from involved and uninvolved facial skin, deposition of immunoglobulins and complement at the dermoepidermal junction and in the walls of dermal blood vessels. Such immunofluorescence findings in the skin of patients with KD have never been described. These findings suggest the presence of an autoimmune reaction as a component of KD.

Epidermoid anal cancer in HIV infected patients.

Anal cancer associated with human immunodeficiency virus (HIV) infection is an unusual clinical situation in which the appropriate management remains unclear. Experience of treatment and follow-up is presented of six patients with histologically confirmed invasive epidermoid anal cancer on a background of HIV infection. Durable complete responses with acceptable toxicity occurred in two patients with moderate immunosuppression and Stage I-II tumours treated with a combination of concomitant chemotherapy (5-fluorouracil and mitomycin-C) and pelvic radiotherapy (45 Gy in 25 fractions). One patient treated with radiotherapy alone (60 Gy in 30 fractions in two phases) had a complete response. Two patients, one with Stage III tumour and the other with pre-existing acquired immunodeficiency syndrome, died within 6 months of treatment. Moderate to severe perianal skin reactions commonly occurred. Although the world experience of managing anal cancer in HIV infected individuals is small, this and other reports support the use of chemoradiotherapy in selected patients. The appropriate treatment of patients with more advanced tumours and/or advanced HIV infection is uncertain.

Simultaneous medullary carcinoma, occult papillary carcinoma and lymphocytic thyroiditis.

A 55-year-old female underwent total thyroidectomy for medullary carcinoma of the left lobe of the thyroid. The right lobe showed an incidental occult papillary carcinoma. There was also diffuse lymphocytic thyroiditis. Immunohistochemistry for calcitonin and thyroglobin confirmed the separate histogenesis for both carcinomas. The coexistence of medullarry and papillary carcinoma of the thyroid is rare and the literature usually documents mixed tumours with features of both carcinomas, rather than independent tumours, as in our case.

Multiple oncocytic cysts of the larynx.

Oncocytic metaplasia in laryngeal epithelium is uncommon. Oncocytes have been described in the lining of laryngeal cysts and such cysts have been reported in the literature under a variety of names. There is an ongoing debate about the exact nature of 'oncocytic cysts', which tend to be solitary. An unusual case of multiple oncocytic cysts of the larynx is described. The pathology and treatment are discussed.

Cavitation of mesenteric lymph nodes: a rare complication of coeliac disease, associated with a poor outcome.

Five cases are presented, all of which showed peculiar cavitation of mesenteric lymph nodes. Clinically, three presented with abdominal symptoms, a mass or obstruction, warranting laparotomy. Two patients showed cavitating mesenteric lymph nodes at autopsy. Lymph nodes were enlarged with central, partly cystic degeneration; milky fluid exuded from the cut surface. In each case, investigation showed intestinal villous atrophy and splenic atrophy; coeliac disease was confirmed by response to gluten withdrawal. Three patients died, two from cachexia and the other from pneumonia; the other two are alive and well one year and six years after presentation. Review of the literature shows 12 previously reported cases, with a mortality of about 50%. The diagnosis is made by the histopathologist, alerting appropriate treatment. The pathogenesis is unknown.