Littoral cell angioma of the spleen: Cytological findings and review of the literature.

Littoral cell angioma (LCA) is a unique lesion of the spleen that arises from the cells lining the venous sinuses of the splenic red pulp and shows the features of combined endothelial and histiocytic differentiation. Several cases of LCA have been reported in the literature; however, the cytological findings have been described for only a few cases. We report the case of an 11-year-old boy with anemia, epigastric abdominal pain, and splenomegaly. The splenic lesions showed anastomosing vascular channels with cyst-like spaces filled by many sloughed endothelial cells, which were positive for CD68 and CD31 and negative for CD34. Scraping cytology revealed isolated and clusters of three-dimensional bland looking, epithelioid foamy tumoral cells with low nuclear cytoplasmic ratio, which mostly contained intracytoplasmic hemosiderin pigment. Although the fine needle aspiration cytology of splenic lesions is uncommon and LCA is a rare splenic lesion, it must be noted in the differential diagnosis of any splenic vascular neoplasm.

Infantile hepatic hemangioendothelioma: report of a case with fine needle aspiration findings.

BACKGROUND: Infantile hepatic hemangioendothelioma is a rare tumor. Cytologic and histologic differentiation from other hepatic tumors is necessary to determine appropriate therapy. Fine needle aspiration cytology of this rare tumor has not been reported in the literature before. CASE: A 5-month-old female infant presented with hepatomegaly. Computed tomography revealed numerous nodules occupying the entire liver parenchyma that were considered to be metastatic tumors. However, the primary tumor was not detected. Cytology smears revealed numerous clusters of and isolated, benign-looking, cuboidal, round cells that were diagnosed as benign tumors, and a laparotomy was advised. Histology of the nodules showed infantile hepatic hemangioendothelioma. The patient is alive and undergoing supportive therapy. CONCLUSION: A vascular lesion should be considered in a fine needle aspiration biopsy of liver masses in infants, especially when the clinical features are not consistent with a metastatic malignancy. Immunoreactivity for factor VII-related antigen, CD34 and cytokeratin-7 is helpful in establishing the diagnosis.

Accuracy of intra-operative frozen section consultation in south of Iran during four years.

BACKGROUND: Accuracy of intraoperative frozen section diagnosis is an important part of quality control in surgical pathology. In this study we try to evaluate the frozen section diagnosis in our center, a referral center in southern Iran. MATERIALS AND METHODS: During the four-year-period of study, all the frozen sections in the affiliated hospitals of Shiraz University of Medical Sciences were evaluated. Discrepant cases were studied to find out reasons for their inaccuracies. RESULTS: In the four years, 759 frozen sections have been done, 25 of which showed discordant results. The most common site of frozen section and discrepancy was in central nervous system tumors. The reason for inaccuracy in frozen section diagnosis in 52% of cases was proved to be interpretative, 44% sampling error and the remainder due to lack of clinical information of the pathologist. CONCLUSION: Accuracy of our intraoperative consultation is comparable with other centers in Western countries. Most of the discrepancies can be prevented by providing more clinical information for the pathologist and more accurate sampling.

A diagnostic pitfall of fine needle aspiration cytology in testicular papillary serous cyst adenoma: a case report.

BACKGROUND: Testicular neoplasmns resembling ovarian serous tumors are rarely reported. We describe the first fine needle aspiration biopsy (FNAB) finding of this type of tumor. CASE: A 35-year-old man presented with an enlarged right testis. Based on clinical observation, we hypothesized that it was a malignant tumor. FNA cytology findings revealed numerous papillary clusters, glandular-like structures and many isolated round cells. Metastatic papillary adenocarcinoma was suspected based on FNAB cytology. A right radical orchiectomy was performed, and histologic tissue examination was used to diagnose the tumor as a benign papillary serous cystadenoma. CONCLUSION: Papillary serous cystadenoma of the testis is a rare tumor. The cytologic findings of this tumor are confusing and difficult to diagnose. Clusters of epithelial cells with a high nuclear to cytoplasm ratio are mistaken for features of a malignant tumor.

Tracheal replacement by autogenous aorta.

BACKGROUND: Tracheal defects may occur after trauma or prolonged intubation. Resection of tracheal tumors also poses a major challenge for substitution. In an effort to solve this problem, different techniques have been tried with little success. We report on a new animal model which showed acceptable results with fewer complications. METHODS: We replaced 5 cm of cervical trachea in 10 dogs with harvested infra-renal aorta and repaired the aortic defect with Dacron graft. RESULTS: Necropsy of the grafted aorta and anastomotic site revealed well healed anastomosis in all animals together with ciliated columnar epithelium coverage of grafted aorta and neovascularization of aortic wall. CONCLUSION: Aortic graft is preferable to other substitutes because of less antigenicity, less vascularity, and no mucous secretions or peristalsis.

The effect of silver nitrate, chloroformic garlic extract, and normal saline in induction of sclerosing cholangitis in rabbits.

OBJECTIVE: To evaluate the effects of 0.5% silver nitrate, 20% chloroformic garlic extract, and 0.9% normal saline in induction of sclerosing cholangitis in the bile ducts of rabbits. METHODS: During a-6-months period from April to September 2006 in Shiraz University Laboratory Animal Research Center, we selected 3 equal groups of rabbits. We injected 0.5% silver nitrate, 20% chloroformic garlic extract, and 0.9% normal saline into the bile ducts of each group. The animals were euthanized, and autopsied after 4 months and the liver and bile ducts were removed and studied histopathologically. Cholangiography was undertaken to evaluate the presence and extent of any sclerosing cholangitis. RESULTS: Animals showed sclerosing cholangitis in silver nitrate group (7 [58%]), one (8%) in chloroformic garlic extract group and one (7%) in normal saline group. The difference between silver nitrate and chloroformic garlic extract groups were statistically significant and similar results were noticed between chloroformic garlic extract and normal saline groups. CONCLUSION: Twenty percent of chloroformic garlic extract had fewer complications such as sclerosing cholangitis, compared to other materials.

Comparison of Carnoy's solution and 96% ethyl alcohol fixation in bloody Pap smears.

OBJECTIVE: To compare 2 methods of fixation in bloody Pap smears with Carnoy's solution and 96% ethyl alcohol. STUDY DESIGN: After observation of contact bleeding, 2 samples were prepared from cervical cells with conventional Pap smear. One sample was fixed in 96% ethyl alcohol and another sample was fixed in Carnoy's solution. RESULTS: Of 450 slides, 410 were selected for study. In study of cell adequacy, diagnosis of squamous cells and glandular cells was better in Carnoy's-fixed slides. Blood contamination of slides was reduced in Carnoy's-fixed slides (13.85% vs. 49.51%), and clearance of slides was increased in Carnoy's-fixed slides. Diagnosis of inflammatory cells and pathogenic microorganisms in was increased in Carnoy's-fixed slides, but no difference was seen in diagnosis of epithelial cell and glandular cell abnormalities. CONCLUSION: Carnoy's solution can be used as an effective fixative in bloody smears in conventional Pap tests.

Osteochondroma of the trochlea presenting as acquired Brown syndrome: a case report.

The following is a rare observational case report of a 16-year-old boy who presented with acquired Brown syndrome associated with a painless slowly growing mass in the supranasal area of the left eye. Meticulous surgical removal of the mass resulted in recovery of superior oblique muscle function. Histopathology was consistent with osteochondroma of the trochlea. To the knowledge of the authors, this is the first reported case of osteochondroma of the trochlea causing acquired Brown syndrome.

Familial pulmonary alveolar microlithiasis diagnosed by bronchoalveolar lavage. A case report.

BACKGROUND: Familial alveolar microlithiasis is a rare lung disease. In this study we describe the cytologic features of this disease in bronchoalveolar lavage. CASE: A 10-year-old girl and her uncle, a 50-year-old man, had dyspnea and diffuse interstitial pattern on chest radiograph with no defined cause at a period of 10 years apart. Open lung biopsy in the girl and transbronchial lung biopsy plus bronchoalveolar lavage (BAL) in the man were per-formed to determine the diagnosis. In cyopen lung biopsy the diagnosis was alveolar microlithiasis. BAL revealed rehtypical microliths (calcospherites), and th transbronchial lung biopsy performed in the same patient failed to disclose superficially reset any significant pathology. In cytologic a smears, extracellular and intracellular concentrically layered purple-brown, round-to-oval microliths were clearly seen. Cyanophilic periodic acid-Schiff positive intracytoplasmic amorphous material was also frequently seen in alveolar macrophages. CONCLUSION: Familial alveolar microlithiasis is a rare interstitial lung disease that can be easily diagnosed by BAL. This procedure is a very useful tool in diagnosing and classifying some interstitial lung diseases.

Aberrant thymus and parathyroid gland presenting as a recurrent lateral neck mass: a case report.

We report an interesting case of a recurrent left lateral neck mass in a 6-year-old boy. When the tumor failed to disappear after a course of antibiotic therapy, it was excised. Histologic study revealed that the encapsulated mass contained a parathyroid gland embedded within a histologically normal thymus. The presence of thymic and parathyroid tissue within a single capsule supports the idea that these two structures have a common embryologic origin. The combination of thymic and parathyroid tissue in a neck mass in a patient so young is rarely reported.

Nasal cytobrush cytology: evaluation of the hyperchromatic supranuclear stria.

OBJECTIVE: To evaluate the hyperchromatic supranuclear stria (SNS) in various types of rhinopathies. STUDY DESIGN: The study included 42 patients with rhinopathies and a control group consisting of 28 healthy adults. The rhinopathy group was categorized into 4 subgroups, including allergic rhinitis, infective rhinitis, vasomotor rhinitis and mixed group. Cytologic samples were obtained by cytobrush from the middle one third of the inferior turbinate. RESULTS: The hyperchromatic SNS was present in the majority of ciliated cells in a high percentage in the control group (91.7%), whereas in the pathologic group it was 40%. The difference is significant (p = 0.0000). CONCLUSION: Nasal cytology is a simple, reliable tool for the diagnosis of rhinopathies.

Giant cystic metaplastic carcinoma of the breast: a case report with diagnosis by fine needle aspiration.

BACKGROUND: Breast cysts are mainly benign and are reported in association with fibrocystic disease and phyllodes tumor. Rarely have cystic changes been reported to occur in malignant tumors. They are usually small but large in rare cases. Giant breast cysts are very rare, and only a few cases have been reported. CASE: A 37-year-old woman presented with a rapidly growing breast mass. Mammography showed a huge, well-circumscribed cystic mass (17 x 16 x 16 cm) suggestive of a benign lesion. Cytologic examination revealed a highly cellular tumor composed of malignant cells of various sizes and shapes in a necrotic background. The smears were diagnosed as positive for malignancy and suggested metaplastic carcinoma. Mastectomy was performed, and histologic study confirmed the cytologic diagnosis. CONCLUSION: This is the first reported case of a breast cyst of this size. Clinically the cyst was confused with a benign lesion. The fine needle aspiration aided the diagnosis and planning of treatment.

Testicular fine needle aspiration cytology in male infertility.

OBJECTIVE: To compare the accuracy of testicular fine needle aspiration and biopsy for diagnostic and therapeutic purposes. STUDY DESIGN: A comparison of testicular fine needle aspiration and biopsy was performed on 34 infertile men over a 2-year period. RESULTS: Concordance of the 2 tests was evident in 88% of cases. In discordant cases fine needle aspiration yielded more than biopsy, considering the existence of secondary spermatocytes and spermatids. Charcot-Bottcher crystalloids were frequently seen in the cytoplasm of Sertoli cells in normal and abnormal spermatogenesis. CONCLUSION: Testicular fine needle aspiration is a simple and cost-effective method of evaluating testicular pathology in male factor infertility. It may yield more diagnostic and therapeutic material than does biopsy.

Gastric xanthoma: a diagnostic problem on brushing cytology smears.

OBJECTIVE: To describe the cytologic findings of gastric xanthomas and to compare them with the findings of signet-ring adenocarcinoma because atypical xanthoma cells can be easily confused with signet-ring adenocarcinoma cells. STUDY DESIGN: Five cases of gastric xanthoma that were confirmed by biopsy reports were selected for study. The patients' ages ranged between 50 and 58 years; 4 were men and 1 was a woman. Twenty-one cases of signet-ring adenocarcinoma confirmed by biopsy reports were selected for comparison. Special staining was performed. RESULTS: The brushing cytology smears of the 5 cases of xanthoma revealed atypical cells, so initially they were reported as suspicious for signet-ring adenocarcinoma and biopsy examination advised. After learning of the histologic diagnosis of xanthoma, we performed special staining. The xanthoma cells were negative with periodic acid-Schiff (PAS) stain but showed a positive reaction with Oil red 0 and weakly positive reaction with Masson trichrome. Signet-ring adenocarcinoma cells showed a strongly positive reaction with PAS stain. CONCLUSION: Gastric brushing cytology findings of xanthomas have not been described before. At times the differentiation of atypical xanthoma cells from signet-ring adenocarcinoma cells is very difficult on brushing cytology smears. In this study the nuclear changes and special stains helped differentiate the 2 lesions.

Osteoclastomalike giant cell tumor of the parotid gland: report of a case with fine needle aspiration diagnosis.

BACKGROUND: Osteoclastomalike giant cell tumor of the parotid gland has been reported rarely. The tumor has occurred rarely at many sites, such as thyroid, pancreas, soft tissue, breast, skin, heart, colon, lung, kidney, ovary and bladder. The exact origin of the tumor is unclear. However, osteoclastlike giant cells have been considered either part of a stromal process reactive to a neoplasm or a component of a primary neoplasm. CASE: A 35-year-old female presented with a mass in the left parotid gland clinically diagnosed as a pleomorphic adenoma. Fine needle aspiration (FNA) was advised before surgical excision. FNA smears revealed numerous osteoclastlike, multinucleated giant cells and many malignant-looking mononuclear cells. The smears were diagnosed as positive for malignancy, suggestive of osteoclastomalike giant cell tumor. The tumor was excised, and histopathologic study confirmed the cytologic diagnosis. CONCLUSION: The cytologic findings of osteoclastomalike giant cell tumor of the parotid gland have not been previously reported. FNA aided the diagnosis and planning of treatment. FNA is important in the diagnosis of parotid tumors.

Cytologic findings in calcifying epithelial odontogenic tumor: a case report.

BACKGROUND: Calcifying epithelial odontogenic tumor (CEOT), or Pindborg's tumor, is a rare, benign, odontogenic neoplasm first described by Pindborg in 1955. It is most commonly seen in the fourth and fifth decades of life, usually arises in the mandibular premolar-molar areas and accounts for approximately 1% of all intraosseous odontogenic tumors. This report describes the cytologic findings in a case of CEOT. CASE: A 62-year-old woman was referred to the ear, nose and throat clinic with a right maxillary mass. The fine needle aspiration (FNA) smears showed numerous calcifications; amorphous, eosinophilic material; and clusters of round epithelial cells embedded in a bloody background. The smears were diagnosed as suspicious for malignancy. Maxillectomy was done. The histologic sections were diagnosed as CEOT. CONCLUSION: FNA findings of calcifying epithelial odontogenic tumor have been described rarely. The clusters of epithelial cells with prominent nucleoli are mistaken for features of a malignant tumor.

Nasal glioma (neuroglial heterotopia) mimicking an astrocytoma: case report.

Nasal glioma is a rare benign tumor that usually occurs during infancy. We report a case of nasal glioma in a 6-month-old boy in which the histomorphologic features resembled those of an anaplastic astrocytoma.