Nonclassical focal nodular hyperplasia of the liver in a chronic alcoholic: a diagnostic dilemma on FNAC.

In a 49 year old male, a chronic alcoholic with hepatomegaly, a subcapsular nodular lesion was detected in the right lobe of the liver. On fine needle aspiration cytology, hepatocellular carcinoma was considered. Excision of the lesion showed features of nonclassical focal nodular hyperplasia with large cell dysplasia that caused the diagnostic dilemma on cytology.

Primary meningeal melanocytoma.

Meningeal melanocytoma is an uncommon benign pigmented primary lesion that has to be distinguished as a pathological entity separate from other benign melanin containing tumours as well as its overtly malignant counterpart, melanoma. In the present study, a 58 year old lady presented with bilateral sensory and motor symptoms in the lower limbs. The MRI scan showed a dumb-bell shaped lesion in the spinal canal at 6th cervical vertebra to 1st thoracic vertebra (C6-T1) level mimicking a schwannoma and histologically proved to be melanocytoma.

Primary cardiac sarcoma.

Primary cardiac sarcomas are uncommon entities. The diagnosis of sarcoma is not made preoperatively because of the rarity of the lesion and the nonspecific nature of the signs and symptoms. This is a report of a case of primary sarcoma arising from the left atrium, in a patient who presented with acute dyspnoea; the sarcoma resembled an atrial myxoma on echocardiography.

Chondrolipoma of tongue.

Although lipomas can occur in any part of the body, they are found infrequently in the oral cavity. Variants of lipoma have been described according to the type of tissue present; a lipoma with cartilaginous metaplasia is a chondrolipoma which is a rare variant. We describe a chondrolipoma of tongue in a 36 year old lady.

Histopathological study of solitary nodules of thyroid.

OBJECTIVE: To determine the incidence of various thyroid disorders manifesting as Solitary Thyroid Nodule and also to evaluate the histomorphology of the lesions. MATERIALS AND METHODS: Hundred specimens of Solitary Thyroid Nodules were studied for gross characteristics, microscopic features, age and sex incidence. RESULTS: Of the 100 cases of Solitary Thyroid Nodules, 66% were non neoplastic and 34% were neoplastic. Among the neoplasms, 21% were malignant and 13% were benign. The age incidence ranged from 20-50 years for non neoplastic lesions and 20-40 years for neoplasms. A female preponderance was seen for both non neoplastic and neoplastic conditions. The solitary nodules involved the right side of the thyroid more commonly than the left. Involutional colloid nodule was the predominant type of solitary nodule (52%). Among the malignant neoplasms, papillary carcinoma was the commonest solitary nodule (13%). One case each of hyalinising trabecular adenoma, columnar cell variant of papillary carcinoma and medullary carcinoma unusually presenting as solitary nodules were encountered in the present study. CONCLUSION: Histomorphologic evaluation of Solitary Thyroid Nodules presenting without a background setting of multinodular goiter is challenging and mandatory as the diagnoses ranges from the common non neoplastic lesions like involuting nodules to the rare neoplastic conditions like medullary carcinoma.

Superficial angiomyxoma of the external ear not associated with Carney's complex: a case report.

Superficial angiomyxomas are rare tumours and multiple tumours occurring in the external ear are invariably associated with Carney's complex. In the present study, a solitary superficial angiomyxoma was found in a 20 year old lady; and there was no evidence of any of the components of Carney's complex at the time of presentation or at the end of 2 years of follow-up, after the surgical excision of the tumour.

Fine needle aspiration diagnosis in HIV-related lymphadenopathy in Mangalore, India.

OBJECTIVE: To evaluate the usefulness of fine needle aspiration (FNA) study of lymph nodes in HIV-positive patients. STUDY DESIGN: The study was conducted at Kasturba Medical College, Mangalore, India. Samples from lymph nodes of 48 HIV-positive patients were taken and air dried, and wet smears were made. After staining with routine cytologic stains and special stains, detailed cytomorphologic study was conducted. RESULTS: Tuberculosis accounted for nearly half (48%) the cases,followed by HIV lymphadenitis (36%), lymphoma (10%), suppurative lymphadenitis (2%), Mycobacterium avium-intracellulare lymphadenitis (2%) and metastases (2%), in descending order of their frequency. A suppurative picture, which was found in 13% of cases of tuberculous lymphadenitis in AIDS patients, occasionally was misleading without the help of acid fast bacilli stain. CONCLUSION: FNA is a useful tool in the diagnosis of lymphadenopathy in HIV-positive patients provided that proper safety measures are taken to avoid contracting the infection.

Holoacardius acephalus-myelecephalus.

Holoacardius acephalus is a rare anomaly occurring in twin pregnancy. This case was an amorphic monstrous mass with only lower limb buds showing five digits and no definite human form unlike those reported in the Indian literature which either showed the presence of other body parts like thorax, abdomen and head and neck structures or were totally undifferentiated. The other twin had intra uterine growth retardation. This case came to the hospital in labour. As this condition can be recognised in the antenatal period, diagnosis of this anomaly is important for better perinatal outcome.

A study of the haematologic spectrum of myelodysplastic syndrome.

In 31 patients of myelodysplastic syndrome, RAEB-t was the commonest subtype (29%), and RARS, the lease common (6.4%); 19.4% were characterised as the unclassifiable (UC) group. Pallor was the dominant sign (90.3%). Low haemoglobin in RA & RARS (p<0.05), thrombocytopenia in RAEB-t (p<0.01) and high leuco/monocyte counts in CMML (p<0.001) were observed. Neutropenia occurred most frequently in RAEB & RAEB-t and circulating blasts in all cases of RAEB-t and CMML. Bicytopenia was the commonest finding (58.1%) and pancytopenia the least (16.1%). 84% of marrows were hypercellular and trilineage dysplasia was seen in 68% of patients. Megaloblastoid dyserythropoiesis was the predominant feature in all cases, dysgranulopoiesis in all cases of RAEB, RAEB-t and CMML, and micromegokaryocytes in all cases of RARS, RAEB & CMML were seen. RAEB-t and RAEB (33.3% each) were the predominant groups which progressed to leukemia, FAB AML-M2, being the commonest type (60%).

Fine needle aspiration cytology of the Ewing's sarcoma family of tumors.

OBJECTIVE: To study the cytomorphologic features of the Ewing's sarcoma (ES) family of tumors. STUDY DESIGN: During a period of eight years (1990-1997), 123 soft tissue tumors and 65 bone tumors were evaluated by fine needle aspiration cytology (FNAC); 14 cases were diagnosed as in the ES family of tumors. The ages of the patients ranged from 8 to 30 years. All the cases were histologically confirmed. RESULTS: Of 14 cases of the ES family of tumors, 7 were ES, 3 extraosseous ES (EOE), 2 peripheral primitive neuroectodermal tumor (PPNET) and 2 Askin tumor. Cytologically, smears from all the cases showed round tumor cells with a high nuclear/cytoplasmic ratio. On detailed examination, subtle differentiating features were observed. The cells in ES had finer nuclear chromatin in comparison to those of PPNET and Askin tumor, and punched-out clear cytoplasmic vacuoles were present. PPNET showed nuclear molding, unipolar cytoplasmic tags and Homer-Wright rosettes. Histologically, all cases of ES and EOE and one case of Askin tumor showed periodic acid-Schiff-positive inclusions. CONCLUSION: FNAC features coupled with clinical findings enable a rapid diagnosis of the ES family of tumors, from which treatment modalities can be determined.

Ovarian strumal carcinoid--report of a case that matastasized.

Ovarian teratomas are known for their ability to form a wide variety of tissues. One unusual example of this potential is the strumal carcinoid in which the thyroid tissue is found in intimate association with carcinoid tumor. Although considered as a malignant transformation of struma ovarii, it is almost always benign. We report a rare case of strumal carcionid in a 44 year old lady who had metastasis in the contralateral ovary, myometrium and lungs.