ABSTRACT
BACKGROUND: Endoscopic ultrasound-guided fine needle aspiration is a well-established modality in detection and diagnosis of mediastinal lesions. Ganglioneuroma is a benign, rare, soft tissue neoplasm arising from sympathetic ganglion cells, and complete surgical resection is considered to be curative. Ganglioneuroma in a surgical specimen is a straightforward diagnosis; however, due to the infrequent occurrence of this entity, diagnosis by fine needle aspiration is more challenging. CASE: A case of paraesophageal ganglioneuroma was diagnosed by endoscopic ultrasound-guided fine needle aspiration. A 75-year-old man with a history of adenocarcinoma of the lung was noted to have a mediastinal mass on chest computed tomography. Upper endosonography identified a 40x17-mm mass extrinsic to the thoracic esophagus. An endoscopic ultrasound-guided fine needle aspiration of the mass revealed intermingled fragments of spindle cells and ganglion cells admixed within a fibromyxoid stroma. Immunohistochemistry showed that both the spindle and ganglion cell components were positive for S-100 protein and negative for pancytokeratin. This immunohistochemical profile established both the neurogenic origin of the spindle and ganglion cells. CONCLUSION: Our case represents 1 of the few reported cases of ganglioneuroma diagnosed by fine needle aspiration cytology and the second case diagnosed under endoscopic ultrasound guidance.
Subject(s)
Ganglioneuroma/diagnosis , Mediastinal Neoplasms/pathology , Soft Tissue Neoplasms/diagnosis , Aged , Biomarkers, Tumor/metabolism , Biopsy, Fine-Needle , Diagnosis, Differential , Endosonography , Esophagus/pathology , Ganglioneuroma/metabolism , Humans , Male , Mediastinal Neoplasms/metabolism , S100 Proteins/metabolism , Soft Tissue Neoplasms/metabolismSubject(s)
Breast Neoplasms/pathology , Carcinoma/secondary , Pineal Gland/pathology , Pinealoma/secondary , Carcinoma/cerebrospinal fluid , Carcinoma/therapy , Cerebrospinal Fluid/cytology , Cognition Disorders/etiology , Consciousness Disorders/etiology , Disease Progression , Drug Therapy , Fatal Outcome , Female , Headache/etiology , Humans , Magnetic Resonance Imaging , Meningeal Neoplasms/secondary , Middle Aged , Neoplasm Metastasis/pathology , Neoplasm Metastasis/physiopathology , Pinealoma/cerebrospinal fluid , Pinealoma/therapy , RadiotherapyABSTRACT
BACKGROUND: Histologically documented cases of parvoviral myocarditis are exceedingly rare. CASE PRESENTATION: Here, we report a 41-year old African American immunocompetent patient who died of parvoviral myocarditis after a 10 day illness characterized by fever, headaches, generalized arthralgias, and a maculopapular rash.Autopsy revealed an infiltrate myocarditis composed primarily of T-lymphocytes and macrophages associated with extensive myocardial fibrosis. The diagnosis of parvovirus was determined by polymerase chain reaction (PCR) on both pre-mortem serum and post-mortem myocardial tissue METHODS: DNA was extracted from tissue and serum and primers were used to amplify DNA sequences of parvovirus B19 using nested polymerase chain reaction (PCR). CONCLUSION: The diagnosis of parvovirus should be considered in cases of fatal myocarditis, and diagnosis can be confirmed at autopsy by molecular techniques.
ABSTRACT
BACKGROUND: Acinar cell carcinoma of the pancreas is a rare neoplasm. Although this tumor has been well characterized histologically, the morphological patterns in Fine Needle Aspiration Cytology have not been well defined. Unlike ductal adenocarcinomas, endocrine tumors, and solid pseudopapillary tumors of the pancreas with their characteristic FNA cytological features, acinar cell carcinomas pose a particular diagnostic challenge by sharing many cytomorphologic features with endocrine tumors of the pancreas. CASE PRESENTATION: A 37-year-old man presented with lower chest and left upper quadrant abdominal pain. Computed tomography revealed a 7.8 x 7.3 cm irregular, partially cystic mass in the body and tail of the pancreas, and two lesions in the liver compatible with metastases. Subsequently, the patient underwent endoscopic ultrasound-guided fine needle aspiration on one of the two metastatic liver masses. FNA cytology revealed abundant, loosely cohesive clusters of malignant epithelial cells with vaguely acinar and trabecular formations. The pleomorphic nuclei had fine granular chromatin and occasionally small nucleoli. There were scant to moderate amounts of cytoplasm. Scattered, strikingly large tumor cells with giant nuclei, prominent mitoses and associated necrosis were evident. A pancreatic endocrine tumor was suspected initially, but acinar cell carcinoma of the pancreas was confirmed by immunohistochemistry, cytochemical and ultrastructural studies. CONCLUSION: We describe a case of pancreatic acinar cell carcinoma with unusual cytomorphologic features mimicking an endocrine tumor of pancreas, encountered in endoscopic ultrasound-guided fine needle aspiration of a metastatic liver mass and discuss the diagnostic approach for this unusual pancreatic tumor in fine needle aspiration cytology.
