Utilization of antihepatocyte clone OCH1E5 (Hep Par 1) in histological evaluation of liver tumors.

Diagnosis of hepatocellular carcinoma (HCC) is not always easy on simple hematoxylin and eosin (H&E) stain. The diagnostic problems arise when tumor shows pseudoglandular, pleomorphic or clear cell differentiation. Various tumors markers have been described with varying sensitivity and specificity. Monoclonal antibody Hep Par 1 (OCH1E5) which is specific for hepatocytes offers great help in separation of these tumors. The aim of the present study was to determine utility of Hep Par 1 (OCH1E5) in differentiating HCC from metastatic tumors and cholangiocarcinoma. Total of 62 cases of liver tumors obtained from biopsies, resected or autopsy specimens were included in the study. Slides having representative sections were subjected to immunohistochemistry with monoclonal antibody Hep Par 1 (Dako Corp) using avidin biotin technique with primary antibody dilution of 1:40. Adjacent nontumorous hepatocytes were taken as positive control. Slides were examined by experienced pathologist without any information of clinical or H&E diagnosis. Cases were considered positive for Hep Par 1 if tumor cells showed cytoplasmic brown colored granules. The intensity and distribution (diffuse/ focal) of immunoreactivity was noted. Subsequently immunohistochemistry results were correlated with histology and clinical diagnosis. Hep Par 1 antibody was positive in 26 (42 %) and negative in 36 (58 %) liver tumors. On correlating with H&E sections, out of 26 positive cases, 25 (89.2%) were HCC and one was the case of metastasis of mucin secreting adenocarcinoma. From 36 tumors with negative staining 3 were cases of HCC, 27 metastatic adenocarcinomas and 6 cholangiocarcinomas. Only one case of liver metastasis of mucin secreting adenocarcinoma showed positivity. None of the cases of cholangiocarcinoma showed positivity for Hep Par 1. The three HCCs which did not take up staining for Hep Par 1 were 2 cases of moderately differentiated HCC having pseudoglandular pattern and a case of well differentiated HCC with trabecular arrangement. In 11(44%) cases staining was diffuse while in 14 (56%) it was focal but intense. Hep Par 1 is a useful marker in differentiating HCC from metastaic tumors and cholangiocarcinoma with sensitivity and specificity of 89 % and 97 % respectively and positive predictive value of 96 %. However one should be aware of limitations of immunohistochemistry.

Insulinoma--a case report.

Insulinoma is a rare pancreatic endocrine tumour characterised by hyperinsulinemic hypoglycemia. It is important to surgically remove this tumour as it can cause potentially lethal hypoglycemia. We report a case of insulinoma presenting with unconsciousness following repeated episodes of inability to arise from sleep and convulsions. Biochemical investigation revealed hypoglycemia and hyperinsulinemia. The diagnosis of Insulinoma is often delayed due to misattribution of symptoms to psychiatric or neurological disorders. In this case, same delay lead to fatal outcome for this patient.

Haemophagocytosis in tuberculosis--a case report.

Reactive histiocytosis with hemophagocytosis is most commonly associated with viral infections. Appearance of hemophagocytosis in the tissues is associated with a rapid progression of the underlying disease, and therefore it is important to diagnose and treat the etiological factor at the earliest. Hemophagocytosis is uncommonly associated with tuberculosis and we report one such case.

Neuroendocrine differentiation in hepatocellular carcinoma.

A patient with hepatocellular carcinoma with neuroendocrine features is reported. Identification of this tumor is essential due to its aggressive behavior and the differences in the treatment and clinical control of the patient.

The role of fine-needle aspiration cytology of the testis in the diagnostic evaluation of infertility.

OBJECTIVE: To compare the diagnostic value of cytological smears of fine-needle aspirate with that of histological sections obtained by testicular biopsy in the evaluation of infertility. PATIENTS AND METHODS: The study included 60 patients with azoospermia or severe oligospermia (sperm counts of < 5 million/mL). A detailed history was taken and the external genitalia examined. Testicular samples were obtained by fine-needle aspiration using a 10 mL syringe and 21 G needle; the air-dried smears were stained using the May-Grunwald-Giemsa method. A testicular biopsy was taken after exploring the same tract and these sections were stained with haematoxylin and eosin. The cytological smears and histological sections were examined separately and the results compared. RESULTS: The cytological smears were divided into three groups: normal, with all spermatogenic cells present; Sertoli-cell only syndrome; and spermatogenic arrest (all spermatogenic cells present except spermatids and spermatozoa). There was a good correlation between the diagnosis on the cytological smears and histological sections in 58 of 60 patients (97%). In two patients there was scanty aspirate and few cells, giving an inaccurate diagnosis. Interstitial cells were not detected on cytological smears. In three patients, Sertoli-cell only was diagnosed on cytology, and histology revealed additional features of Leydig cell hyperplasia. CONCLUSION: Fine-needle aspiration of the testis is a simple and minimally invasive technique for diagnostic evaluation, especially in patients with obstructive azoospermia. Patients with abnormal findings on fine-needle aspiration cytology may be evaluated histologically by further biopsy.

Cytologic diagnosis of a melanotic neuroectodermal tumor of infancy occurring in the cranial bones.

Melanotic neutroectodermal tumor of infancy (MNTI) is a rare, usually benign tumor commonly occurring in the maxilla. MNTIs at unusual sites like the cranium clinically mimic malignant small round cell tumors. Consequently, a correct preoperative cytologic diagnosis of MNTI at these sites helps in the surgical management of the patient. We report on a cytologically diagnosed case of MNTI in the frontotemporal region of the skull in an infant. Aspirates from the lesion were cellular, with a bimodal population mainly of small neuroblast-like cells admixed with a few large epithelioid cells with melanin granules. In the present case, following the cytologic diagnosis a wide local excision was carried out, and the histologic examination confirmed the cytologic diagnosis. Diagn. Cytopathol. 1999;21:280-283.

Fine needle aspiration cytology of adenomatoid tumor. A case report.

BACKGROUND: Adenomatoid tumor is a benign neoplasm of the male and female genital tract. The epididymis is the most common site. CASE: A 25-year-old male presented with a swelling in the left side of the epididymis. Cytology showed monotonous cells arranged in sheets, cords and glandular patterns. The cell showed eccentric vesicular nuclei with fine chromatin and abundant, vacuolated cytoplasm. CONCLUSION: With the help of fine needle aspiration cytology, an accurate diagnosis of adenomatoid tumor is possible and can relieve anxiety and uncertainty in both the patient and physician.

Peliosis of spleen presenting as splenic rupture with haemoperitoneum--a case report.

Peliosis of spleen is usually associated with peliosis of liver. Oval to round markedly dilated blood filled cystic spaces predominantly in parafollicular area is the characteristic feature of peliosis to differentiate it from congested sinuses. Exposure to viruses chemicals, contraceptive steroids or chronic debilitating disorders including malignancies are the various possible etiological factors. Though peliosis may remain asymptomatic, fatal intraperitoneal haemorrhage may occur due to its rupture. We report a case of peliosis of spleen presenting as splenic rupture with haemoperitoneum.

Immunohistochemistry of thyroid carcinoma--an experience with thyroglobulin and calcitonin.

A retrospective immunohistochemical study of 33 cases of primary thyroid carcinomas and 5 cases of metastases to thyroid was carried out. The immunostaining for thyroglobulin and calcitonin was done by peroxidase-anti-peroxidase (PAP) technique. The optimum staining results were obtained by proper standardisation of the staining procedure and reagents. The sections were systematically evaluated for immunostaining intensity and distribution. The observations revealed that thyroglobulin and calcitonin could be useful as sensitive and specific histogenetic markers for follicular and parafollicular cell derived thyroid carcinomas respectively. However, there was no absolute correlation between thyroglobulin positivity and grade of differentiation. The immunostaining could not differentiate follicular adenoma from follicular carcinoma. More extensive study using other markers may be useful for better patient management.

Aspiration cytology of tubular adenomas of the breast. An analysis of eight cases.

OBJECTIVE: To analyze fine needle aspirates from tubular adenomas of the breast and elucidate cytologic features unique to these tumors. STUDY DESIGN: Fine needle aspiration (FNA) cytology smears from eight tubular adenomas were reviewed, with special attention given to architectural features and individual cell characteristics. Smears were then compared with those from 25 fibroadenomas and 2 tubular carcinomas for analyzing the distinguishing features. RESULTS: Aspirates from tubular adenomas revealed cells arranged as small, three-dimensional balls or clusters, tubules of different shapes and less frequently as closely approximated acini. Cells were uniform, with pale cytoplasm, which showed magenta granules in the Giemsa smears from two tumors. Straight tubules, closely approximated acini and intracytoplasmic granules were not seen in aspirates from fibroadenomas. The tubules in tubular adenomas always showed myoepithelial cells and were more open than the angulated tubules of tubular carcinoma. CONCLUSION: Tubular adenomas on FNA cytology specifically show cells arranged as small, three-dimensional balls, tubules or closely approximated acini. Cells are uniform and sometimes show intracytoplasmic granules in Giemsa-stained smears.

Mammary hamartomas--a report of 15 cases.

The mammary hamartoma is a poorly recognised benign breast neoplasm. For diagnosis one usually correlates the clinical, mammographic, gross and histologic features. This study of fifteen cases emphasises the histomorphologic criteria for diagnosis especially in the absence of mammographic picture, viz. a clinically palpable, well encapsulated mass which on histology shows normal breast epithelium admixed with fat, fibrous tissue and other mesenchymal elements. The epithelium in the hamartomas studied showed changes seen in normal breast especially in the progestational phase of the menstrual cycle. The stroma was either densely collagenous, hyalinised or cellular and admixed with fat in various proportion in thirteen cases, muscle in two cases and thick muscular arteries in four cases. It also showed pseudoangiomatous hyperplasia in seven cases. The importance of this change and probable evolution is discussed therein.

Fine-needle aspiration cytology of sinus histiocytosis with massive lymphadenopathy: a case report.

Cytological findings of sinus histiocytosis with massive lymphadenopathy (SHML), involving bilateral cervical lymph nodes of a 12-yr-old boy, are presented here. A striking feature was the presence of large histiocytes with abundant pale cytoplasm containing well-preserved lymphocytes, plasma cells, and occasional neutrophils, scattered in a background of reactive lymphoid cells. Subsequent open biopsy of the lymph node mass confirmed the cytologic findings. Cytologic features of SHML are virtually diagnostic and can negate the need for an open biopsy in most cases.

Cytohistomorphology of prostatic lesions--by FNAC & scrape methods.

A pilot study of transrectal fine needle aspiration biopsy was conducted in 44 patients, above the age of 50 years, who presented with features of obstructive uropathy during a one year period between August 1990 and April 1991. Histopathological study was carried out in 23 out of 44 patients, who underwent total prostatectomy or transurethral resection following the aspiration biopsy procedure. In 21 patients FNAB by the transrectal route could not be obtained because of technical difficulties; therefore intraoperative scrape cytology was studied prior to histopathology, of the fresh prostatic specimen. A good cytohistopathological correlation was obtained by both methods; an accuracy of 95.6% and 95.2% with FNAC and scrape respectively. A wide range of benign and malignant lesions were studied.

Malignant melanoma of nasopharynx extending to the nose with metastasis in the neck.

Malignant melanoma is a rare tumor in otorhinolaryngology. In this paper, we have reported the first case of melanoma of nasopharynx which we came across in 20 years of ENT practice. A 55 year old male patient with complaints of swelling of nose and left side of neck, nasal blockage and epistaxis was diagnosed as melanoma of nose with metastasis in the neck based on clinical and radiological examination. The tumour was excised by lateral rhinotomy with supraomohyoid block dissection on the left side. The tumour was found to originate from lateral wall of nasopharynx and middle turbinate. The surgery was followed by radiotherapy. Diagnosis of melanoma was confirmed on histopathology. During 30 months follow-up, no recurrence was noticed.

Experience with bone marrow trephine biopsy.

One hundred and ten bone marrow trephine biopsies were studied from January 1987 to July 1989, using Zenker's acetic acid as fixative and routine paraffin embedding. Trephine biopsies were useful in differential diagnosis of cytopenias, especially when bone marrow aspiration was hypocellular or a dry tap, and in staging of lymphomas and multiple myeloma.