Nodular subcutaneous histoplasmosis. A case report with diagnosis by fine needle aspiration biopsy.

Fine needle aspiration biopsy (FNAB) of a solitary subcutaneous nodule in the upper arm of a patient being treated with corticosteroids for chronic obstructive pulmonary disease contained numerous spherical, unstained, refractile particles mixed with necrotic cellular material and rare intact histiocytes with yeastlike inclusions. The morphology of the extracytoplasmic spheroids and cytoplasmic inclusions, as demonstrated with Gomori methenamine silver stain, was characteristic of Histoplasma capsulatum var capsulatum. This organism's identification was confirmed by excisional biopsy and microbiologic testing. If the characteristic intrahistiocytic, yeastlike forms are rare or absent, recognition of this peculiar, uncommonly encountered extracellular pattern is crucial to the diagnosis of infection with H capsulatum. This pattern may become more common with increased numbers of immunosuppressed patients and increased use of FNAB.

Papilloma of Bartholin's gland duct cyst: first report of a case.

A 50-year-old woman underwent excision of a vaginal cyst. Its distal end lay in the submucosal tissue of the posterior lateral aspect of the vulvar vestibule near the orifice of Bartholin's gland. The caudal wall of the cyst contained a papilloma with an epithelial lining which consisted of columnar and stratified polygonal cells resembling squamous and transitional epithelium. The histochemical attributes of the papillary epithelium were homologous to those of Bartholin's gland. Immunohistochemical studies supported glandular and squamous differentiation. Evolution from a dysontogenetic remnant of Müllerian origin cannot be excluded with certainty, but location and histopathology were consistent with origin from Bartholin's gland duct. The presence of mucin and the absence of a smooth muscle investment exclude derivation from Gartner's duct. Cysts of Bartholin's gland are common, but solid benign tumors are rare. We have been unable to find a report of a papilloma of either vulva or vagina with features similar to those in our patient.

Small cell neuroendocrine carcinoma of the vagina.

A 65-year-old woman with a history of recurrent vaginal intraepithelial neoplasia was found to have small cell carcinoma (SCC). Exfoliative cytology was instrumental in the discovery of each episode of vaginal neoplasia. Thorough examination of the patient established the tumor as being primary to the vagina, and immunohistochemistry confirmed it to be a neuroendocrine SCC. Eleven patients with neuroendocrine SCC of the vagina have been reported previously. Morphologic characteristics and histogenesis are discussed within the context of the embryology and natural history of extrapulmonary-genital SCC. They have been classified in the amine precursor uptake and decarboxylation family of neoplasms. Originally, a neuroectodermal origin was proposed, but derivation now is thought to be from multipotential epithelial stem cells of the genital tract. Neuroendocrine SCC tends to be an aggressive neoplasm with a propensity for early spread. Long-term survival for patients with vaginal SCC has not been documented. Therapeutic decisions regarding SCC from this site have been based on information gained from the treatment of these tumors elsewhere. Combined modality therapy using initial surgery and adjuvant treatment, including systemic chemotherapy and local exposure to radiation, has produced an apparent complete response in our patient.

Granular cell tumor of a digital nerve.

Granular cell tumor is an infrequently encountered albeit not rare neoplasm considered to be of neuroectodermal origin. An example of a benign granular cell tumor originating within a digital nerve is presented. The authors employed routine light microscopic techniques and immunostaining which demonstrate features of the granular cells reflecting structural and functional characteristics of Schwann's cells and support neuroectodermal derivation. Granular cell tumor is ubiquitous in location but occurs more frequently in tongue, skin and subcutaneous tissue. Clinical features are not specific, and a histologic evaluation is required for diagnosis. Circumscription and lack of cellular pleomorphism define a benign process. However, irrespective of its histologic appearance, the biologic potential is uncertain. Complete excision suffices as treatment for benign tumors.

Congenital palpebral lipoblastoma. First report of a case.

Lipoblastoma, an uncommon benign tumor of adipose tissue, occurs in infants and young children. Anatomic sites usually involved include extremities, neck, trunk, retroperitoneum, and mediastinum. To our knowledge, no cases involving the eyelids have previously been reported. Its clinical presentation and appearance are not distinctive; diagnosis and differentiation from other lipocytic tumors are achieved via routine light-microscopic studies. Lipoblastoma is composed of fat cells exhibiting a broad spectrum of differentiation. Simple excision suffices as treatment.

An epithelial and spindle cell breast tumour of myoepithelial origin. An immunohistochemical and ultrastructural study.

An infiltrating epithelial and spindle cell neoplasm developed in the breast of a 63-year-old female. An excisional biopsy was performed. Recurrence with rapid growth due to cyst development eventually resulted in more radical surgery. Interim fine needle aspirations had established its partially cystic nature. The unique microscopic appearance prompted the application of immunohistochemistry and electron microscopy. The tumour cells were found to exhibit characteristics denoting squamous and myoepithelial differentiation. Histopathological features of malignancy were absent. Our findings demonstrate the differentiation potential of breast epithelium. They are in concordance with the results of previous studies which delineate the histochemical and ultrastructural features of myoepithelial and establish the relationship of these cells to squamous metaplasia.

Malakoplakia of prostate gland.

Malakoplakia of the prostate gland has rarely been reported. Its presentation often mimics carcinoma of the prostate. We report a case in a sixty-three-year-old patient who had a previous history of other granulomatous disease.