Great mimickers: Tumor-like lesions of uterine corpus.

OBJECTIVE: The objective of the study was to evaluate the relative occurrence of uterine corpus tumor-like lesions and to establish a clinicopathological correlation. METHODS: A 5-year study was conducted on histopathologically diagnosed cases of tumor-like lesions of the uterine corpus. The lesions were classified according to the recent World Health Organization classification. Relevant clinical findings and histomorphologic details were noted and analyzed. RESULTS: A total of 85 cases of tumor-like lesions were included in the study. Multiparous women (88.2%) were most commonly affected and endometrial polyp (89.4%) was the most common lesion. Endometrial polyp showed a definite predilection during the 3rd and 4th decades of life (56.6%) whereas Arias-Stella reaction was seen in pregnant women and squamous metaplasia was seen in peri and postmenopausal women. Patients with endometrial polyp presented mostly with heavy menstrual bleeding (HMB) (32%) and Arias-Stella reaction with HMB. Two cases of squamous metaplasia one presented with HMB and pain in the abdomen. Most of the endometrial polyps were single (90.8%) and sessile (68.4%), hyperplastic type (56.6%) and the adjacent endometrium were mostly atrophic (42.1%) or in proliferative phase (34.2%). The mean age in years of premenopausal women was 39.34 ± 5.01 and postmenopausal women were 62.66 ± 7.26. The mean size of the polyp, parity, number of polyps and association with leiomyoma was not significantly different between premenopausal and postmenopausal women. Adenomyosis was seen in 11 cases of the endometrial polyp. CONCLUSIONS: Although tumor-like lesions of the uterine corpus as the name suggests tend to mimic the tumors, certain clinical and histopathological features can help in making the accurate diagnosis and thus avoid unnecessary radical surgeries.

FNAC of lymph nodes in HIV positive patients-a diagnostic boon.

OBJECTIVES: The goal of this study is to examine the fine-needle aspiration cytology (FNAC) features of lymph node lesions in human immunodeficiency virus (HIV)-positive patients and to evaluate the role of FNAC in diagnosis. This study also aims to analyze the cytological patterns and available clinicopathological parameters of FNAC. MATERIALS AND METHODS: This study was carried out in the Department of Pathology at Government Medical College Miraj and P.V.P.G.H. Sangli from August 2012 to July 2014. FNAC was conducted for all HIV-positive patients with lymphadenopathy referred into this department. A total 70 lymph nodes were aspirated from different sites in 60 HIV-positive cases. RESULTS: The mean age of presentation was 32.4 years with a male predominance (66.7%). The cervical lymph node was the most commonly involved site (70%). The most common lesion was tuberculous lymphadenitis (66.66%) followed by reactive lymphadenitis (13.33%). The most common staining pattern in acid fast bacilli (AFB)-positive tuberculous lymphadenitis was grade 1 (87.88%). The overall AFB positivity in tuberculous lymphadenitis in the present study was 82.5%. The most common cytological pattern was caseous necrosis with epithelioid cell granulomas (60%). The mean CD4 count showed an inverse relationship with increasing grade of AFB positivity. The mean CD4 count was lowest in caseous necrosis-only pattern (330.2 cells/µL). All the cases were consistent with HIV type A lymphadenopathy. Two cases of malignancy was also seen. CONCLUSIONS: FNAC is a rapid and cheap procedure that can help in establishing the diagnosis in a large number of cases. It also helps in segregating the lesions that need further evaluation. Comparison of lymph node lesions with CD4 counts, AFB grading, and hematological alterations reflects immunity, stage of disease, and disease activity, thus aiding in better treatment.

Primary actinomycosis of breast-A diagnosis on cytology.

Primary actinomycosis of breast is a rare disease with only a few cases reported in the literature. We present a case of a 25-year-old lactating woman with primary actinomycosis of breast which was diagnosed on cytology. The patient presented with lump in left breast with dull aching pain. Fine-needle aspiration cytology smears showed acute suppurative inflammation with presence of fluffy basophilic colonies on Hematoxylin and Eosin staining and branched, Gram positive filamentous bacilli on Gram staining. The bacilli were non-acid fast with 1% Zeihl Neelsen stain. A diagnosis of actinomycosis was suggested on cytology. Histopathological examination revealed an abscess with few Gram positive basophilic granules surrounded by eosinophilic Splendore-Hoeppli material thus confirming the diagnosis of actinomycosis. Meticulous search for microorganisms with the aid of special stains should be done on cytology smears before labeling an inflammatory lesion as nonspecific. Diagn. Cytopathol. 2016;44:693-695. © 2016 Wiley Periodicals, Inc.

Extralobar sequestration of lung associated with congenital diaphragmatic hernia and malrotation of gut.

Extralobar sequestration of lung is a rare congenital malformation frequently diagnosed during repair of congenital diaphragmatic hernia. However, the combined association of congenital diaphragmatic hernia with both pulmonary sequestration and malrotation of gut is rare. We report a case of a 1-year-old girl with extralobar sequestration of lung and malrotation of gut detected during the repair of diaphragmatic hernia. The histopathological examination of the sequestered lobe revealed dilated bronchioles, alveolar ducts and alveoli along with dilated subpleural and peribronchiolar lymphatics and areas of type II congenital pulmonary airway malformation.

Cytodiagnosis of congenital mesoblastic nephroma: a case report.

Mesoblastic nephroma (MN) is the most common renal tumor diagnosed in infancy. A case of congenital MN was diagnosed in a 6-month old child by fine-needle aspiration cytology. The smears were cellular and consisted of plump spindle cells arranged in clusters along with scattered naked nuclei in the background. Blastemal, epithelial, or glomeruloid structures were not seen. Considering the age and the cytomorphology, a diagnosis of cellular variant of MN was offered which was confirmed on histopathology. Unlike Wilms tumor, preoperative chemotherapy is not required for MN. Hence cytologic diagnosis is important.

Malignant peripheral nerve sheath tumor with primitive neuroepithelial differentiation in an adult: a case report.

Primitive neuroepithelial differentiation in malignant peripheral nerve sheath tumors (MPNSTs) has been reported in children but is extremely rare in adults. The authors report the case of a 70-year-old woman who presented with swelling of the right leg of 1-month duration. Fine-needle aspiration cytology was suggestive of a benign peripheral nerve sheath tumor. Histopathological examination of the excised mass revealed a MPNST with spindle-cell areas and a few round-cell areas with rosettes. The spindle cells showed positive immunoreactivity for S-100 protein and vimentin and negativity for desmin, confirming their nerve sheath origin. The round cells were immunoreactive for synaptophysin and chromogranin, indicating primitive neuroepithelial differentiation. These cells did not stain for CD99, which is consistently expressed by the cells of primitive neuroectodermal tumors (PNETs) of bone and soft tissue but not by central nervous system (CNS) PNETs or medulloblastomas. In this case, the PNET-like focus resembled a CNS-PNET.