Diff-Quik cytologic recognition of Chlamydophila psittaci in orolabial lesions of Stevens-Johnson Syndrome.

BACKGROUND: Chlamydophila psittaci causes psittacosis, an ornithosis acquired usually from infected birds. The disease is often focal and pneumonic but on rare instances can be protean and fatal. Diagnosis is by Chlamydophila serology, which may take as long as 21 days or more. The recovery of the organisms from mice, eggs or tissue culture inoculated with the patient's blood or sputum is tedious and dangerous for laboratory personnel. On occasion, C psittaci inclusion bodies have also been detected in infected cells by fluorescent antibody, Giemsa or Gimenez staining. This report describes heretofore not previously reported recognition of the causative organisms in Diff-Quik-stained clinical cytologic materials. CASE: A 17-year-old man presented with fever and sore throat, associated with Steven-Johnson syndrome, of 6 days' duration. In the touch and scrape smears of the orolabial mucosal lesions, C psittaci inclusion bodies were recognizable in Diff-Quik-stained but not with Papanicolaou-stained smears and Gram stain. There were few to numerous organisms per macrophage, which were enlarged or bloated and usually collared by polymorphonuclear leukocytes. The diagnosis was supported by a therapeutic trial with doxycycline and confirmed by a positive third serological tests for C psittaci 3 weeks after discharge. CONCLUSION: In a suspected or probable case of ornithosis, a rapid diagnosis of C psittaci inclusion bodies is possible in clinical cytology materials using Diff-Quik.

Herpes simplex virus type-1 pneumonitis in immunocompetent young woman.

A healthy young woman presented with an overwhelming hyperacute herpes simplex virus-1 pneumonia that dramatically responded to intravenous acyclovir. It is postulated that the infection was a reactivation of latent virus in the vagal ganglia, in the absence of retrograde extension of herpes labialis/gingivostomatitis, or hematogenous spread from extragenital and other sources of infection. It is also postulated that the patient's amazing improvement overnight was a real-time coincidence of spontaneous recovery from the viral infection and prompt initiation of acyclovir treatment.

The role of fine needle aspiration cytology in medical-surgical missions.

OBJECTIVE: To relate a 6-year, short-term experience of utilizing fine needle aspiration cytology (FNAC) during medical-surgical missions in the impoverished areas of the Philippines. STUDY DESIGN: FNAC is a simple, accurate, fast and economical procedure and requires the simplest devices to implement. During medical-surgical missions to the poorest areas in the Third World countries, where there is almost complete lack of tissue processing and frozen section evaluation, and scarcity of laboratory testing, FNAC becomes a practical technique to use. FNAC in these situations plays an important role as an alternative diagnostic modality to surgery. RESULTS: Our week-long mission experience for 6 different years of successful application of FNAC is described. CONCLUSION: While the mission volunteers have gained extremely rewarding experience in these limited mission works, FNAC has proven to be a very useful adjunct in the delivery of short-term health care during medical-surgical treatment even in a less-than-ideal setting.

Clear cell hidradenocarcinoma developing in pacemaker pocket.

An octagenerian woman developed clear cell hidradenocarcinoma, a rare neoplasm of eccrine sweat gland origin, 4 years following pacemaker implantation in her right lateral chest. The tumor immunohistochemically mimicked a metastatic lobular breast carcinoma, for example, strongly positive estrogen, weakly positive progesterone, and weakly reactive mammoglobin. A complete surgical excision of the tumor was complemented with ipsilateral dissection of involved adjacent axillary lymph nodes. Recommended irradiation was refused by the patient. Retrospective 3-year mammogram review, 2-year postsurgery follow-up, and complete postmortem evaluation failed to prove a primary breast malignancy or other metastatic lesion elsewhere.

Sebaceous lymphadenoma identified by fine needle aspiration biopsy: a case report.

BACKGROUND: Sebaceous lymphadenoma of the parotid gland is a rare benign neoplasm. This is the first reported case of fine needle aspiration biopsy (FNAB) findings for sebaceous lymphadenoma of the parotid gland. CASE: A 60-year-old male presented with painless, bilateral parotid swelling noted for 5 months. The swelling was more pronounced on the right. Examination revealed bilaterally prominent parotid glands with diffuse firmness but no discrete masses. There was no evidence of facial nerve dysfunction. Laboratory evaluation was negative for infectious and autoimmune etiologies. Magnetic resonance imaging revealed bilateral cystic parotid masses. FNAB of the right parotid was obtained to assist with preoperative counseling. It revealed lymphoid and salivary gland parenchymal cells. The patient underwent a right superficial parotidectomy. The surgical specimen of the parotid mass confirmed the diagnosis of sebaceous lymphadenoma on the tissue section. The contralateral parotid mass had not been excised at this writing. CONCLUSION: This report is the first to describe the FNAB findings of the unusual benign parotid neoplasm sebaceous lymphadenoma. Though the definitive diagnosis of any parotid mass requires tissue, generally obtained via parotidectomy, an FNAB diagnosis can be useful in counseling a patient prior to definitive biopsy.

Cutaneous tumefaction in empyema necessitatis.

BACKGROUND: Empyema necessitatis refers to a collection of exudative fluid that extends directly from the pleural cavity to the thoracic wall to form a mass in the extrapleural soft tissue of the chest. It was an uncommon complication of tuberculous pleural effusion even in the pre-antibiotic era, and has also been associated with bacterial lung abscess, actinomycosis, blastomycosis, and malignancies. METHODS: Seven instances of chest wall mass lesion secondary to empyema necessitatis, diagnosed by fine-needle aspiration biopsy (FNAB), are reported. RESULTS: Three cases were tuberculous, two were mesotheliomatous, one was caused by pulmonary small cell carcinoma, and another was due to coexisting Actinomyces and Actinobacillus. In all patients, subsequent pleural fluid cytologies demonstrated empyema with the respective etiologies identified. CONCLUSIONS: The usefulness of FNAB in the diagnosis of empyema necessitatis, supported by radiographic imaging and ancillary procedures, is well illustrated by these seven cases.

Parotid abscess due to salmonella enteritidis: A case report.

BACKGROUND: Salmonella infection of the parotid gland is rare. CASE: An instance in a 50-year-old man of Salmonella enteritidis parotiditis initially recognized by microbial culture of a fine needle aspiration cytology material is described. The identified predisposing factor was chronic alcoholic abuse. For the infection source, a carrier state of salmonella parotitis was postulated, which progressed to focal abscess and was subsequently complicated by bacteremia and hematogenous spread to the liver, spleen and lungs. CONCLUSION: Salmonella should be included in the differential consideration of head and neck abscesses in immunocompromised individuals and treated aggressively.

HIV and HHV-8 negative primary effusion lymphoma in a patient with hepatitis C virus-related liver cirrhosis.

Primary effusion lymphoma (PEL) or body cavity-based lymphoma (BCBL) is a unique subgroup of B-cell lymphomas that exhibits exclusive or dominant involvement of serous body cavities without a detectable tumor mass. We present a case of a PEL/BCBL that exclusively involved the peritoneal cavity of a 58-year-old immunocompetent male with hepatitis C virus (HCV)-related liver cirrhosis. The lymphoma cells were large, highly atypical and expressed CD19, CD20, CD22, CD10, HLA-DR, and CD45 with kappa light chain restriction. Unlike typical PEL/BCBL, human herpesvirus type 8/Kaposi sarcoma herpes virus (HHV-8/KSHV) genomic sequence was not present in the lymphoma cells and there was no serologic evidence of human immunodeficiency virus (HIV) infection. This is the fourth reported case of HHV-8 negative, HIV negative PEL/BCBL in a patient with associated HCV-related cirrhosis and review of these cases showed some consistent clinicopathological features, i.e. exclusive involvement of the peritoneal cavity and phenotypic expression of B-cell associated antigens in contrast to the generally null phenotype PEL/BCBL. The occurrence of these cases suggests that HCV may play an etiological role in a subcategory of PEL/BCBL not associated with HHV-8.

Aneurysm of the dorsalis pedis artery -- a case report.

Aneurysms of the pedal arteries are uncommon; however, they can be identified upon clinical exam and confirmed by angiogram and color-flow duplex scan. Surgical treatment options include ligation or primary repair. The authors present a case of an aneurysm of the dorsalis pedis artery in a diabetic patient. Primary repair of the aneurysm was accomplished using a venous autograft patch. The postoperative course was uneventful and the artery remains patent in follow-up.