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INTRODUCTION: Idiopathic granulomatous lobular mastitis (IGLM) is an inflammatory disease of the breast with an obscure etiology. It occurs mainly in women of reproductive age, and the lesion mimics carcinoma of the breast both clinically and radiologically. CASE PRESENTATION: We present the case of a 29-year-old female who visited our hospital in Kancheepuram, Tamil Nadu, with a 4 × 3 cm lump in the upper outer quadrant of her left breast. The clinical and radiological findings were indicative of a malignant lesion; however, fine-needle aspiration cytology (FNAC) revealed features of granulomatous mastitis, and the subsequent histology of the excised lump confirmed the diagnosis of IGLM. CONCLUSIONS: IGLM should be considered as one of the differential diagnoses when granulomas are encountered in breast FNAC and biopsy. A definitive diagnosis of IGLM can be made by identifying its characteristic histomorphology and ruling out other causes for granulomatous inflammation. An exact diagnosis is essential since the treatment for different granulomatous conditions of the breast varies.
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Heterotopic adrenal cortex is usually found in the kidney, retroperitoneum and spermatic cord. It is common among pediatric age group and rarely encountered in adults. Our case presented with swelling in the right inguinal region with on and off dragging pain. On clinical examination testis was absent in the right scotal sac which was confirmed with ultrasonogram. The clinical diagnosis was right side undescended testis. Orchidectomy was performed and on microscopic examination we incidentally found out an ectopic adrenal cortical rest in the rete testis with atropic changes in the testis. Though the ectopic adrenal tissue was indolent in our case, literature suggests that it can undergo transformations like hyperplasia, adenoma and carcinoma, leading to undesirable complications. We present this case for the rarity at this age and site, and for the awareness that it may cause complications if left untreated.
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BACKGROUND: Fine needle aspiration cytology (FNAC) is an important investigation in preoperative diagnosis of thyroid lesions. Follicular variant of papillary carcinoma thyroid (FVPTC) is a well defined entity in histopathology, but its diagnosis in FNAC is usually missed and is challenging compared to classic papillary thyroid carcinoma. AIMS: The purpose of this study is to retrospectively analyze cytological features in histologically confirmed cases of FVPTC, compare them with literature and document the features that could increase the sensitivity of FNAC diagnosis. MATERIALS AND METHODS: Cytological smears from 22 histologically confirmed cases of FVPTC were evaluated for microscopic pattern and nuclear features by two independent pathologists and results compared with previous studies. Statistical analysis was done based on bivariate Pearson's correlation coefficient. RESULTS: Among 22 cases 21 were female and one male with age range 21 - 50 years. All patients had a solitary nodule except one with multicentric presentation. Preoperative cytological diagnosis were, classic papillary thyroid carcinoma (PTC); 7, FVPTC; 3, suspicious for PTC; 4, follicular neoplasm; 5 and adenomatous goiter;3. Diagnosis upon cytological review were, FVPTC; 11, classic PTC; 7 , suspicious for PTC; 2, follicular adenoma;1 and adenomatous goiter; 1. CONCLUSION: We conclude that cellular smears with features as observed in our case like microfollicular pattern, syncytial clusters, fine powdery chromatin, anisonucleosis and nucleomegaly should alert the pathologist to look carefully for other more specific features like nuclear grooves and nuclear pseudoinclusions. This approach will help in avoiding misdiagnosis of FVPTC and would aid in choosing the right treatment modality.
