Sinonasal seromucinous hamartoma: a review of the literature and a case report with focal myoepithelial cells.

Seromucinous hamartoma is a benign lesion of the sinonasal tract. Since its description in 1974, only a small number of additional cases have been reported. It is composed of a proliferation of seromucinous glands and ducts within a variable fibrous stroma. The serous component typically stains positively for S100 (at least focally) and lacks p63 positive abluminal cells. The lack of myoepithelial/basal cells is an important diagnostic feature of seromucinous hamartoma; their absence could lead to an incorrect diagnosis of low-grade sinonasal adenocarcinoma. We report the case of a polypoid mass resected from the posterior nasal cavity and nasopharynx of a 54-year-old woman. The lesion contained a population of small and large glands lined by cuboidal to flattened cells within a hypocellular stroma varying from dense and sclerotic to myxoid. Additionally, there was a superficial focus of ciliated invaginated surface epithelium and glands. Throughout the lesion there were no cytologic or architectural features of malignancy. The histologic features were diagnostic of seromucinous hamartoma. Immunohistochemistry showed focal S100 positivity of the serous glands. However, in contrast to previously reported cases, the glands focally showed an outer basal layer that was calponin, p63 and actin positive. Our case demonstrates two important points. First, complete absence of p63 staining should not necessarily be a required feature in the diagnosis of seromucinous hamartoma. Second, the ciliated larger glands--in keeping with respiratory epithelial adenomatoid hamartoma (REAH)--support the suggestion that seromucinous hamartoma and REAH are a spectrum of lesions, often seen together.

Transjugular liver biopsy with use of the shark jaw needle: diagnostic yield, complications, and cost-effectiveness.

PURPOSE: Obtaining transjugular liver biopsy specimens with use of single-use needle systems is expensive, whereas biopsy specimens obtained with use of reusable needle systems are frequently associated with inadequate core specimens. The authors report their experience with the reusable Cook Shark Jaw biopsy needle, including diagnostic yield, complications, and cost-effectiveness. MATERIALS AND METHODS: A retrospective audit was performed of a cohort of 134 patients who underwent 136 transjugular liver biopsies with use of a reusable 16-gauge Shark Jaw needle during a 30-month period. Specimen adequacy and complication rates were assessed and direct costs of expendable components calculated. Cost-effectiveness was expressed as cost-per-successful biopsy. RESULTS: Biopsies were technically successful in 126 of 136 (93%) patients, with diagnostic histologic core specimens obtained in 124 of 126 (98%) patients, for an overall success rate of 91%. Complications included capsular penetration in six (4.4%) patients, cardiac arrhythmia in two (1.5%) patients, and puncture site hematoma or bleeding in 10 (7.4%) patients. Three tract embolizations were performed for capsular penetration. No instances of subcapsular hematoma, hemoperitoneum, or sepsis occurred, and no deaths were attributed to the procedure. The cost of expendable components totaled $103 per biopsy, corresponding to a cost-effectiveness of $113/successful biopsy. CONCLUSION: Transjugular liver biopsy specimens obtained with use of the Shark Jaw needle have a diagnostic yield comparable to those obtained with use of single-use biopsy systems, at a substantially lower cost with no increase in serious complications.