Myofibroblastoma of the Breast: A Morphologic and Immunohistochemical Study of Three Cases.

Myofibroblastoma (MFB) of the breast is an uncommon entity of benign spindle neoplasms of the breast. This tumour possesses a broad spectrum of histomorphological patterns. Distinguishing of myofibroblastoma variants from malignant mimics of this benign neoplasm is essential for pathologists to avoid further invasive surgical procedures. In this article, we report the clinical, morphological, and immunohistochemical features of three cases, including two females and one male patient with mammary myofibroblastoma with emphasis on the histomorphological findings. As there is not yet enough information about MFB, more reports of MFB are still required to more clarify the pathogenesis and potential predisposing factors of this rare type of breast tumours.

Multiple Auer Rods in Fine-Needle Aspiration Smears of Medullary Thyroid Carcinoma: An Unusual Finding.

BACKGROUND: Medullary thyroid carcinoma (MTC) is a rare tumor. Fine-needle aspiration (FNA) cytology is a popular method for the preoperative diagnosis of MTC. CASE REPORT: A 45-year-old man was referred to our center for a palpable thyroid nodule. Ultrasound-guided FNA was carried out for the patient. Cytology slides showed many isolated and small clusters of round to oval cells, some with a moderate amount of cytoplasm and red cytoplasmic granules. Rare cells showed multiple red Auer rods. Histology confirmed the diagnosis of MTC. CONCLUSION: Cytologic findings of MTC in FNA are variable, and several rare cytologic findings have been reported. Cytoplasmic red granules are one of the usual findings, whereas detection of cells containing multiple Auer rods is an unusual finding, which has not been reported so far.

Tracheal Adenoid Cystic Carcinoma Presented with Chronic Asthma Diagnosed by Bronchial Washing Cytology.

Adenoid cystic carcinoma is a tumor that mainly arises from salivary glands and is present rarely in airways with nonspecific symptoms. Diagnosis based on bronchial washing cytology is rarely reported because this tumor is usually lined by normal mucosa. A 35-year-old woman was referred to our center as a case of unresponsive asthma and hemoptysis for the past year. CT scan showed tracheal mass. Bronchoscopy was done followed by bronchial washing cytology and biopsy. Cytology smears revealed sheets and three-dimensional clusters of small cells, and some of them arranged around hyaline mucoid globules. Cell block and biopsy showed classic pathological findings of adenoid cystic carcinoma. Adenoid cystic carcinoma of the airways can be manifested with nonspecific symptoms and should be considered in the differential diagnosis of airway diseases and asthma. This tumor is rarely seen in the bronchial washing specimen. Characteristic cytological findings and using cell block preparation differentiate adenoid cystic carcinoma from other tumors.

Cytological Findings in Benign Phyllodes Tumors.

OBJECTIVE: Phyllodes tumors are fibroepithelial breast lesions with many cytological and histopathological similarities to fibroadenomas. The aim of this study was to investigate cytological findings in benign phyllodes tumors. STUDY DESIGN: Seventy-six histologically proven cases of benign phyllodes tumors were selected from 1982 to 2017. Cytological criteria, including cellularity, the number and shape of epithelial clusters, the shape and number of stromal fragments, and the presence of atypia, were evaluated. RESULTS: Cytological slides were hypercellular and showed dimorphic populations of cells. The epithelial clusters were moderate in amount and had a bonsai-like configuration. The stromal fragments consisted of oval-to-spindle shaped cells with preservation of the cytoplasm. Some popcorn-like cells and intranuclear inclusions in stromal cells and deposition of pinkish and amorphous material at the border of the stromal fragments were also noted in the stromal cells. CONCLUSION: Stromal hypercellularity and large amounts of stromal fragments, the presence of bonsai-like epithelial clusters, and deposition of amorphous pinkish material at the border of the stromal fragments, as well as newly observed findings including the presence of intranuclear inclusions and popcorn-like nuclei in the stromal cells, can aid in the diagnosis of phyllodes tumors.

Fine-needle aspiration study of cystic papillary thyroid carcinoma: Rare cytological findings.

BACKGROUND: Cystic papillary thyroid carcinoma (CPTC) is a variant of papillary carcinoma that has many mimickers in cytological grounds. AIM: To study the cytomorphologic features of CPTC and compare them to those of other cystic thyroid lesions using fine-needle aspiration cytology (FNAC). We also aimed to identify the cytomorphologic features that distinguish CPTC from other cystic thyroid lesions. MATERIALS AND METHODS: Seventy-three cases of CPTC were included in the study. The cytomorphologic features of these cases were analyzed. The FNA smears of other thyroid lesions with cystic changes (300 colloid goiters, 290 adenomatoid nodules, 11 follicular neoplasms, and 9 hurtle cell neoplasm) were also studied. RESULTS: The smears in CPTC revealed isolated follicular cells, small groups of cells with scalloped margins, cell swirls, small clusters with a cartwheel pattern, papillary clusters, intranuclear inclusions, nuclear grooves, sticky colloid, intracellular colloids, psammoma bodies, multinucleated giant cells, and foamy and hemosiderin laden macrophages. Small groups of cells with scalloped borders, cellular swirls, and small clusters with a cartwheel pattern were seen in CPTC, but not in other cystic lesions. Interestingly, mesothelial-like cells and hemophagocytic cells were seen in five and three cases of CPTC, respectively, but not in other cystic lesions. CONCLUSION: Mesothelial-like cells and hemophagocytic cells were observed in five and three cases of CPTC, respectively. Similar finding have not been previously reported in the literature.

Intranuclear Pseudo-inclusions and Grooves in Fine Needle Aspiration Cytology of Pulmonary Carcinoid Tumor.

Cytologic findings of pulmonary carcinoid have been well described. We report new cytological findings in a case of carcinoid tumor. The patient is a 36-year-old man presenting with hemoptysis of about six months in duration. Chest CT scans showed a well-defined round polypoid lesion measuring 1 × 1 cm within the right upper lobe of the bronchus with hyperinflation of the right upper lobe. Trans-bronchial fine needle aspiration and biopsy were done. Cytologic smears showed isolated and loose clusters of uniform round to spindle shape cells with round centrally located nuclei, fine granular (salt and pepper) chromatin and pale cytoplasm. Intranuclear pseudo-inclusions and grooves were seen in some tumor cells. No mitotic figures or necrosis were evident. A cytological diagnosis of carcinoid tumor was made and histopathologic examination and subsequent immunohistochemical study confirmed the diagnosis. Carcinoid tumor may be reliably diagnosed on fine needle aspiration cytology smears. Intranuclear pseudo-inclusions and grooves may be evident in tumor cells.

Diagnostic Accuracy of Fine Needle Aspiration Cytology versus Concurrent Core Needle Biopsy in Evaluation of Intrathoracic Lesions: a Retrospective Comparative Study.

BACKGROUND: Transthoracic fine needle aspiration (FNA) cytology and core needle biopsy (CNB) are two commonly used approaches for the diagnosis of suspected neoplastic intrathoracic lesions. This study compared the diagnostic accuracy of FNA cytology and concurrent CNB in the evaluation of intrathoracic lesions. MATERIALS AND METHODS: We studied FNA cytology and concurrent CNB specimens of 127 patients retrospectively, using hematoxylin and eosin (H and E), immunohistochemistry, and, on certain occasions cytochemistry. Information regarding additional tissue tests was derived from the electronic archives of the Department of Pathology and Laboratory Medicine as well as patient records. Diagnostic accuracy was calculated for each test. RESULTS: Of 127 cases, 22 were inconclusive and excluded from the study. The remaining 105 were categorized into 73 (69.5%) malignant lesions and 32 (30.5%) benign lesions. FNA and CNB findings were in complete agreement in 63 cases (60%). The accuracy and confidence intervals (CIs) of FNA and CNB for malignant tumors were 86.3% (CI: 79.3-90.7) and 93.2% (CI: 87.3- 96.0 ) respectively. For epithelial malignant neoplasms, a definitive diagnosis was made in 44.8% of cases by FNA and 80.6% by CNB. The diagnostic accuracy of CNB for nonepithelial malignant neoplasms was 83.3% compared with 50% for FNA. Of the 32 benign cases, we made specific diagnoses in 16 with diagnostic accuracy of 81.3% and 6.3% for CNB and FNA, respectively. CONCLUSIONS: Our findings suggest that FNA is comparable to CNB in the diagnosis of malignant epithelial lesions whereas diagnostic accuracy of CNB for nonepithlial malignant neoplasms is superior to that for FNA. Further, for histological typing of tumors and examining tumor origin, immunohistochemical work up plays an important role.

Intestinal seromuscular tunneling: a novel method for ureteral replacement--an experimental design.

BACKGROUND: Long-segment ureteral injuries may have different etiologies. Although multiple procedures have been previously used for ureteral replacement, none of them had optimum results, and replacement of long segments of injured ureter is still a challenging surgical problem. In this article, we have hypothesized that it may be possible to use intestinal seromuscular tunneling as a novel method for ureteral replacement. METHODS: This experimental study was conducted on eight dogs. After cutting the ureter at about its mid-part and ligating the distal part, a 10-cm tunnel was made in the seromuscular layer of small intestine using a metallic probe, and a catheter was passed through it. Proximal and distal ends of the tunnel were anastomosed to proximal end of ureter and urinary bladder, respectively. After 8 weeks, the dogs were killed, and their whole urinary system was sent for histopathologic examinations. RESULTS: No complication was noted during the post-op period. Histopathologic examinations confirmed that the seromuscular tunnel was well patent, lined by pseudostratified transitional epithelium and without any inflammatory reaction. CONCLUSION: Our study shows that ureteral replacement by intestinal seromuscular tunneling is anatomically possible at least in animal model. However, more well-designed prospective studies are needed to confirm its long-term functional results.

Thalidomide affects experimental endometriosis: a randomized controlled study in the rat.

AIM: This study aimed to assess the efficacy of thalidomide for treatment of experimental endometriosis. METHODS: This study was a parallel-group, double-blind, stratified, randomized controlled animal trial with 1:1 allocation ratio. Endometriosis was induced experimentally in 23 mature, nulligravid, female Sprague-Dawley rats, weighing approximately 200 g and aged 2 months. A checkpoint surgery was performed 6 weeks later. Then, the rats were randomly allocated into the thalidomide (22 mg/day p.o.) and control (0.5 mL saline 0.9%/day p.o.) groups of nine. After 6 weeks, they were killed. Before each laparotomy, blood for leukocyte and lymphocyte counts and during them, implants for histopathology and peritoneal fluid for interleukin (IL)-6, tumor necrosis factor-α and vascular endothelial growth factor (VEGF)-A concentrations (by enzyme-linked immunoassay) were collected. Allocation and stratified randomization were done using a computer, based on the obtained histopathology scores of the implants of the checkpoint surgery. RESULTS: The histopathology scores (the main outcome measure) were 2.00 ± 1.55 versus 0.44 ± 1.01 (P = 0.035). The comparisons of after-treatment counts of leukocytes, lymphocytes, VEGF-A and IL-6 between the two groups were statistically significant. CONCLUSION: The results of this study are in favor of therapeutic implication of thalidomide in experimental endometriosis in rats. This is the first time thalidomide has been evaluated on endometriosis in an animal model.

Amebic liver abscess: fine needle aspiration diagnosis.

OBJECTIVE: To describe the findings in fine needle aspiration (FNA) of an amebic liver abscess (ALA). STUDY DESIGN: Seven patients (6 men and 1 woman between 52 and 60 years of age) treated for amebic dysentery with multiple liver lesions were selected for ultrasound (US)-guided FNA. The clinical differential diagnosis was malignancy. Abdominal US of the patients revealed multiple, variably sized, well-defined, hypoechoic, cystic liver lesions. FNA of these lesions was performed. RESULTS: Smears of the aspirated material showed necrotic material with mixed inflammatory cells and Entamoeba histolytica trophozoites consisting of round blue bodies with well-defined borders containing a single, eccentrically located nucleus with central karyosome and engulfed red blood cells in the cytoplasm. There were also Charcot-Leyden crystals. ALA was diagnosed. CONCLUSION: FNA can yield the correct diagnosis of ALA and allows early initiation of treatment. ALA should be considered in the differential diagnosis of space-occupying lesions of the liver.

Histopathological changes in rabbit gastric mucosa after chronic exposure to pickled vegetables: an experimental study.

Gastric cancer (GC) is very common in Iran. Daily consumption of pickled vegetables is a routine dietary habit in most areas of Iran. Because pickled vegetables have been associated with GC it can be of importance to study the relationship between the two. We have therefore studied the histo-morphological effects of pickled vegetables on the Rabbit gastric mucosa. Forty and twenty healthy male rabbits were respectively allocated in the experimental and control groups. The rabbits were fed freely with pickled (experimental group) and fresh vegetables (control group) for 1 yr. The gastric mucosa of rabbits was examined and the results were compared. In addition to all the rabbits of the control group, 14 rabbits (35%) of the experimental group had normal gastric mucosa. The rest showed abnormal changes including atypia-so called indefinite for dysplasia-in 10 (25%), low-grade dysplasia in 14 (35%), and high-grade dysplasia in 2 (5%). The analysis showed significant difference between results of the 2 groups (P < 0.001). Daily consumption of pickled vegetables can produce atypical and dysplastic changes in the gastric mucosa. Such preneoplastic changes can potentially transform to gastric carcinoma. This process could be prevented by reduction or cessation of daily pickled food consumption.

Eosinophilic pleural effusion: a rare complication of extracorporeal shock wave lithotripsy.

Background. Extracorporeal shock wave lithotripsy has been widely used to treat renal stones. The procedure is relatively safe with minor complications. Case. The patient is a 32-year-old man who presented with left sided pleural effusion after extracorporeal shock wave lithotripsy. Results. The pleural effusion study revealed an exudative fluid rich in eosinophils (30%). So, the diagnosis of eosinophilic pleural effusion as a complication of lithotripsy was made. Conclusion. Extracorporeal shock wave lithotripsy should be regarded as an etiology of unexplained eosinophilic pleural effusion after this procedure.

Visceral leishmaniasis-associated hemophagocytosis: a single center experience.

BACKGROUND: Kala-azar is a multisystem infection of the reticuloendothelial system. Various hematologic abnormalities have been described in kala-azar including hemophagocytic syndrome (HPS).  METHODS: We reviewed bone marrow aspirate smears from 18 documented cases of kala-azar complicated by HPS.  RESULTS: The bone marrow smears were hypercellular with erythroid hyperplasia. Megaloblastic changes, foamy macrophages, activated macrophages with cytoplasmic vacuoles and elongated cytoplasmic process, intra- and extracellular amastigotes, cytoplasmic fragments (blue bodies), plasma cells with inclusions and hemophagocytic cells were seen. Leishman bodies (amastigotes) were also found in some hemophagocytic cells. CONCLUSION: Kala-azar should be considered as an etiology of HPS, particularly in endemic areas.

Cytologic findings of urogenital mesenteric cyst.

Mesenteric cysts are heterogeneous groups of lesions. Most of them are developmental cysts of lymphatic and enteric origin or cystic neoplasm such as mesothelioma or cystic teratoma. Urogenital cysts are a subcategory of developmental cysts of the mesentery. They are thought to arise from vestigial remnants of urogenital apparatus. These cysts may show evidence of mesonephric or metanephric differentiation. An 11 -year -old boy was presented with undescended testis. During preoperative work- up, an incidental cystic lesion was discovered which was attached to the ileum. Aspiration cytology of the cyst content revealed cuboidal to columnar cells; some of them were ciliated. Histologic examination showed a cyst with fibromuscular wall, lined by Mullerian type ciliated epithelium; so the diagnosis of urogenital mesenteric cyst of Mullerian type was made. Urogenital cysts are rare lesions, but they should be considered in differential diagnosis of any cystic lesion of the mesentery. Cytology could be a useful method for evaluation and revealing the nature of these cysts.

The effects of levamisole on experimental endometriosis: a randomized controlled trial in a rat model.

PURPOSE: To assess the effects of levamisole on experimental endometriosis in rats through the histopathology of the implants, the blood leukocyte and lymphocyte counts and the concentrations of interleukin-6, vascular endothelial growth factor-A and tumor necrosis factor-alpha in the peritoneal environment at the three healthy, endometriotic and post-treatment milestones. METHODS: Twenty-two 8-week-old Sprague-Dawley rats with normal estrus cycles were recruited in a prospective, parallel-group, placebo-controlled, double-blind, stratified-randomized animal trial with the equal allocation ratio of 1:1 challenging the efficacy of levamisole. Endometriosis was induced. After 6 weeks, laparotomy was performed to randomly excise one implant for histopathology assessment. Based on the results, they were stratified randomized and allocated (by software) to two groups of nine: levamisole (5 mg/rat/day) or placebo. After 6 weeks, necropsy was done. Two days before each laparotomy, blood samples and during the procedure, peritoneal wash were collected for ELISA. RESULTS: Seven rats showed success in treatment in the levamisole group, while three did in the other group. The histopathology results descriptively revealed a drop in the levamisole group, which was not meaningful statistically (0.66 ± 1.32 vs. 2.00 ± 1.50, p = 0.065). The comparisons of the post-treatment leukocytes and lymphocytes in the groups showed significant differences (11088.88 ± 5869.50 vs. 4677.77 ± 3476.98, p = 0.008, and 8588.88 ± 5721.32 vs. 3511.11 ± 2835.24, p = 0.014, respectively). The results of the cytokines were mostly, but not completely, in favor of the efficacy of levamisole. CONCLUSION: This study indicates a possible successful role for levamisole in the treatment of experimental endometriosis. Further studies to assess the effects of high dose levamisole on endometriosis are recommended.

Confusing cytological findings in myositis ossificans.

BACKGROUND: Myositis ossificans (MO) is a rare non-neoplastic heterotopic ossification of soft tissue. Histological examination is the gold standard method for diagnosis, but fine needle aspiration (FNA) cytology may aid in presumptive diagnosis of this lesion. CASES: Nine patients with chief complaint of soft tissue mass with clinically suspected MO were selected. FNA of the mass showed low to hypercellular smears, composed of some amorphous pink to bluish material on Wright-Giemsa stain. The predominant cells were oval to spindle-shaped, resembling fibroblasts. Some cells had a high nucleo-cytoplasmic ratio with hyperchromatic nuclei, an irregular nuclear border and prominent nucleoli. Bland-looking osteoblasts and uni- and binucleated chondrocytes were also noted. FNA diagnosis of 4 patients was suggestive of osteosarcoma and of 2 patients suggestive of chondrosarcoma, 2 patients were diagnosed with a benign process and 1 was deferred due to hypocellularity of the smears. Histological examination of the corresponding surgical specimen confirmed the diagnosis of MO. CONCLUSION: MO cannot be diagnosed on FNA smears without analyzing the clinical and radiological findings. Experience shows that otherwise MO is mostly misdiagnosed as a malignant lesion.

Osseous Metaplasia in Castleman's Disease: A Case Report.

Background. Castleman's disease is a benign lymphoproliferative disorder. The disease may be localized or multicentric. Three histologic variants are recognized: hyaline vascular, plasma cell, and mixed types. Case. A 20-year-old man presented with large left axillary mass. The histologic examination of the resected mass showed follicular pattern with large nodules of mantle cells arranged concentrically around atrophic and vascularized germinal centers. There was also some benign-appearing bone trabeculae interspersed with lymphoid tissue. The diagnosis of Castleman's disease, hyaline-vascular type with osseous metaplasia, was made.

Pulmonary extramedullary hematopoiesis in a patient with chronic asthma resembling lung cancer: a case report.

Background. Extramedullary hematopoiesis is most often seen in reticuloendothelial organs specially spleen, liver, or lymph nodes, and it is rarely seen in lung parenchyma. Almost all reported cases of pulmonary extramedullary hematopoiesis occurred following myeloproliferative disorders specially myelofibrosis. Other less common underlying causes are thalassemia syndromes and other hemoglobinopathies. There was not any reported case of pulmonary extramedullary hematopoiesis in asthmatic patients in the medical literature. Case. Here we reported a 65-year-old lady who was a known case of bronchial asthma with recent developed right lower lobe lung mass. Chest X-ray and CT studies showed an infiltrating mass resembling malignancy. Fine needle aspiration cytology of mass revealed pulmonary extramedullary hematopoiesis. The patient followed for 10 months with serial physical examination and laboratory evaluations which were unremarkable. Conclusion. Extramedullary hematopoiesis of lung parenchyma can be mistaken for lung cancer radiologically. Although previous reported cases occurred with myelofibrosis or hemoglobinopathies, we are reporting the first case of asthma-associated extramedullary hematopoiesis.

Pemphigus vulgaris of skin: cytological findings and pitfalls.

BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune bullous lesion of the skin and mucous membranes characterized by suprabasal clefting and acantholysis. The responsible autoantibody is desmoglein 3, a protein constituent of the desmosome. The diagnosis of PV is based on histological examination and immunofluorescence study. In addition, cytological smears could also be informative for the initial diagnosis of PV. CASES: Fifteen patients, 7 men and 8 women, with skin bullous disease clinically suspected of being PV were selected for cytological study. The bullae were ruptured and two smears were prepared from the fluid and stained with the Wright-Giemsa and Papanicolaou methods. The smears were taken from both new and old bullae. They showed acantholytic cells (Tzanck cells), some with amoeboid-like cytoplasmic projections, eosinophils, basophils, various forms of typical and atypical lymphocytes with irregular nuclear borders and cerebriform nuclei and dysplastic acantholytic cells with a high nucleo-cytoplasmic ratio and prominent nucleoli. The dysplastic cells were seen only in the old bullae. Histological examination and immunofluorescence study of the lesions confirmed the diagnosis of PV. CONCLUSION: PV can be diagnosed by cytology. Without a clinical history of PV, the presence of atypical lymphocytes and dysplastic cells may lead to a false diagnosis of malignancy.

Gaucher-like cells in retroperitoneal extramedullary hematopoietic tumor diagnosed by fine needle aspiration: a case report.

BACKGROUND: Extramedullary hematopoiesis (EMH) can present as a diffuse lesion or as a solitary mass. EMH is most commonly seen in patients with hematologic disorders and rarely in asymptomatic patients. The liver, spleen and lymph nodes are the most common EMH sites. However, EMH has also been seen at unusual sites, including adrenal glands, breast, thymus, thyroid, kidney, epididymis, lung, pleura, peripheral nerves and dura mater. The diagnosis of this lesion on fine needle aspiration (FNA) smears has rarely been described. CASE: A 20-year-old man with Cooley's anemia presented with a retroperitoneal tumor for the past 3 months that was clinically diagnosed as malignant. Ultrasonographically guided FNA cytology showed bone marrow cells composed of myelocytes, lymphocytes, erythroblasts and megakaryocytes, which were consistent with an extramedullary hematopoietic tumor. Histologic sections of the excised tumor confirmed the FNA diagnosis. Interestingly, Gaucher-like cells were frequently seen in the smears. CONCLUSION: The FNA findings of EMH can be confused with those of inflammatory pseudotumor, Hodgkin lymphoma, myeloproliferative disorders and granulocytic sarcoma. Clinical history can be helpful for interpreting FNA findings in an EMH diagnosis.