Emperipolesis in a common breast malignancy. A case report

BACKGROUND: Emperipolesis is a phenomenon characterized by the presence of leukocytes/lymphocytes within the cytoplasm of other cells. The present report describes this unusual observation within epithelial cancer cells of the breast. CASE: A 52-year-old female presented with a hard, adherent lump over the right breast for one year. Fine needle aspiration and histopathologic examination of the tumor showed features of infiltrating duct carcinoma with emperipolesis as a striking feature of the tumor cells. The tumor showed a near-total response to neoadjuvant chemotherapy. CONCLUSION: The mechanism and biologic significance of emperipolesis in producing a near-total response to neoadjuvant chemotherapy in the present case suggest its role in inducing a tumoricidal effect, possibly involving a cascade of chemokines.     

Testicular degeneration in a male goat. A case report

Semen samples from an 18-month-old infertile Lamancha buck contained less than 10% motile spermatozoa and a high incidence of morphological abnormalities. Degenerate detached heads, tightly coiled tails, and thickened midpieces were the prominent morphological defects, affecting 46%, 30%, and 15% of ejaculated spermatozoa, respectively. At necropsy, the diagnosis of testicular degeneration was made, characterized by focal, noninflammatory seminiferous tubule occlusion and mineralization, with a more generalized sloughing of tubular germinal epithelium. When examining spermatozoa morphology from various sites of the excurrent ducts, detached heads were readily seen in efferent duct fluid (> 30% incidence) and the coiled tails and other midpiece defects became prominent with passage through the caput epididymis.     

Neurilemoma of the breast in a man. A case report.

A case of neurilemoma of the left breast in an 83-year-old man is presented, including the fine needle aspiration and biopsy diagnosis. A review of the literature did not reveal the existence of such a tumor in a man's breast. The aspirate yielded a cellular smear composed of clusters of spindle-shaped cells showing minimal atypia and Verocay bodies. The final diagnosis was established on the excised mass through histopathologic study.     

Cytologic findings in a fetal intracranial teratoma. A case report

BACKGROUND: Fetal neoplasms are very rare. Recently we had the opportunity to examine the fine needle aspiration (FNA) biopsy of a fetal intracranial teratoma. CASE: The tumor was found in a 30-week-gestation fetus; the mother was 32 years old, gravida 4, para 1. She presented with a rapid increase in abdominal girth over a two-week period. An ultrasound scan showed severe fetal hydrocephalus and a massive intracranial tumor thought to be a teratoma because of variations in echogenicity and spotty calcification. An FNA biopsy was performed under ultrasound guidance. It showed mainly neuroepithelial cells, so a differential diagnosis of malignant neuroepithelial tumor was considered. At autopsy, several other tissue types were found in the tumor, consistent with a teratoma. CONCLUSION: Advances in diagnosis of fetal anomalies by ultrasound have been associated with an increase in the use of fetal interventions performed in utero. This includes the availability of fetal surgery in some centers. FNA biopsy of fetal lesions does not appear to be well described. Increased experience with this technique is necessary if its full potential is to be realized.     

Asteroid bodies in a lymph node aspirate. A case report

BACKGROUND: Sarcoidosis, a multisystem disease with tbe potential to occur at any site, has varied clinical manifestations. Cutaneous lesions, seen in one-third of patients, may precede systemic manifestations. Identification of asteroid bodies in aspirated material may aid early diagnosis in the appropriate clinical setting. CASE: A 37-year-old woman had multiple asymptomatic, buff-colored, sucutaneous nodules, 0.5-1.0 cm in diameter, on the scalp, face, dorsum of the wrist and back of the elbows for 2 months. On examination, firm, nontender right inguinal and epitrochlear lymphadenopathy, 2 x 1 cm each, was detected. The epitrochlear lymph node aspirate showed noncaseating epithelioid granulomas, multinucleate giant cells and asteroid bodies. Subsequent biopsy of 1 of the subcutaneous nodules corroborated the aspiration cytology findings. Following the diagnosis of sarcoidosis, other investigations were done. Erythrocyte sedimentation rate was 66 mm at the end of 1 hour, Mantoux test was negative, and chest radiograph showed bilateral reticulonodular shadows. Angiotensin-converting enzyme level was significantly elevated. CONCLUSION: This case draws attention to 1 of the rare cytologic findings of sarcoidosis. Differentiation from other granulomatous lesions, especially when special stains are negative, is difficult. In our case, a lymph node aspirate showing asteroid bodies in a background of granulomatous inflammation supported the diagnosis.     

Paracoccidioides brasiliensis in a postpartum Pap smear. A case report

BACKGROUND: There are several reported cases that describe female genital tract infections with opportunistic fungi, such as Blastomyces dermatitidis, Coccidioides immitis, Aspergillus flavus, Cryptococcus neoformans and Mucor. We describe a case of paracoccidiodomycosis limited to the uterine cervix. To the best of our knowledge, no such case has been described before in the English-language literature. CASE: A 27-year-old, healthy female, gravida 3, para 2, abortion 1, presented for a routine gynecologic examination at six weeks' postpartum. Her past medical history was unremarkable. A routine cervical/endocervical smear revealed the presence of multiple fungal forms at different stages of development with a characteristic "pilot's wheel" appearance consistent with Paracoccidioides brasiliensis. Detailed medical examination of the patient did not reveal the presence of the primary infection in any other system. Cultures of the endometrium revealed no growth of the fungal organisms. The patient was asymptomatic, and therefore no therapy was initiated. Repeat Papanicolaou smears were negative for organisms. CONCLUSION: Paracoccidioidomycosis can present as a limited form, involving the cervix only. Identification and recognition of the infection are important in cytopathology.     

Pulmonary blastoma. A case report.

Pulmonary blastoma occurred in a 71-year-old man. Bronchial brushing specimens showed numerous epithelial cells and only a few mesenchymal cell clusters. The epithelial cells were round to oval, more uniform and smaller than ordinary adenocarcinoma cells. The nuclear:cytoplasmic ratio of these cells was increased, with an even chromatin distribution, and nucleoli were inconspicuous. Mesenchymal cell clusters were markedly hypercellular and consisted of small and short spindle-shaped cells with hyperchromatic nuclei. Although it is very difficult to diagnose pulmonary blastoma correctly by cytology, the possibility of pulmonary blastoma should be considered when small, nonsquamous neoplastic cells are observed, particularly in association with small and short spindle-shaped cells reminiscent of mesenchymal origin.     

X-Y translocation. A case report

Summary A translocation of genetic material involving the long arm of the X chromosome and the heterochromatic portion of the Y chromosome is reported in a young woman. The phenotypic effect of this translocation and loss of almost half of the long arm of the X chromosome is described.     

Patau syndrome with a long survival. A case report

Trisomy 13 is a clinically severe entity; 85% of the patients do not survive beyond one year, and most children die before completing six months of age. We report a female child, 28 months old, white, the fourth child of a non-consanguineous couple, who presented trisomy 13. The child was born at term, from a vaginal delivery, weighing 2600 g. At birth, she was cyanotic, icteric, spastic, and cried weakly. The initial clinical examination detected polydactyly in the left hand, congenital clubfoot and convex soles, ocular hypertelorism, a low nasal bridge, numerous hemangiomas distributed throughout the body, cardiomegaly, and perimembranous inter-ventricular communication. There was no cleft lip or palate. On physical examination at 18 months old, the child weighed 6,900 g, had a cephalic perimeter of 41 cm, a thoracic perimeter of 43 cm and was 76 cm tall. At 28 months, she weighed 10,760 g and was 88.5 cm tall. Neuropsychomotor development retardation was evident from birth and, according to the psychologist and the social assistant of APAE (Handicapped Parents and Friends Association) in Cangu?u, Rio Grande do Sul, there was a noticeable improvement after physiotherapy and recreational sessions.     

Cytology of a chromophobe pituitary adenoma. A case report

A pituitary tumor with suprasellar and extrasellar extension was investigated by means of the squash-smear cytologic technique. The dominant cell type was large, round to oval cells, with pale-staining, finely granular cytoplasm. The nuclei of these cells often contained single or multiple inclusions of uncertain nature. There also were cells with eosinophilic cytoplasm, usually collected in small nests. Hyperchromatic "naked" nuclei, in various shapes, were immersed in a homogeneous, faintly staining ground substance. Mitotic figures were detected easily. Cytology of these combined cell types allowed the intraoperative diagnosis of a rather pleomorphic pituitary adenoma.     

Exfoliative cytology of a lymphoepithelioma-like carcinoma in a cervical smear. A case report

BACKGROUND: Lymphoepithelioma-like carcinoma of the cervix (LELC) is cytologically identical to its counterparts at other sites, such as the nasopharynx. LELC can be suspected on a cervical cytologic smear. The differential diagnosis includes nonkeratinizing squamous cell carcinoma with prominent stromal inflammation, carcinoma with intense stromal eosinophilia, glassy cell carcinoma, malignant lymphoma (especially lymphoepitheloid-Lennerts lymphoma) and metastatic Schmincke-Regaud tumor. CASE: A 55-year-old female presented with an ulcerated endophytic tumor in the cervix. Exfoliative cytology showed uniform, large tumor cells, often associated with inflammatory cells, with round or oval nuclei and one or more prominent nucleoli. The cytoplasm was finely granular to flocculent, and the nuclei were uniformly vesicular. The chromatin was peripherally marginated. The cell borders were indistinct. There was no evidence of dyskeratotic or keratinized cells, koilocytes or glandlike formations. These findings were highly suspicious for LELC and were confirmed by biopsy. Flow cytometry showed DNA aneuploidy, with a DNA index of 1.08. In situ hybridization was negative for human papillomavirus 16 and 18. CONCLUSION: LELC of the uterine cervix has cytologic features that are sufficiently characteristic for a specific cytologic diagnosis. The diagnosis, nevertheless, has to be proven by histology.     

Cytologic diagnosis of a metastatic oligodendroglioma in a pleural effusion. A case report

BACKGROUND: Extraneural metastasis of oligodendroglioma is extremely rare and is diagnosed primarily by biopsy or autopsy and very occasionally by fine needle cytologic examination. We report a case of metastatic oligodendroglioma diagnosed by cytologic examination of a pleural effusion. Such a diagnosis has not been reported before. CASE: A 64-year-old woman developed anemia and bilateral pleural effusion 7 years after an operation for an oligodendroglioma over the left frontal lobe. Cytologic examination of the pleural effusion showed aggregates of atypical polygonal cells containing round, hyperchromatic nuclei and scanty, granular cytoplasm in Liu's and Papanicolaou stain and cell blocks. Immunohistochemical staining of the tumor cells revealed a positive reaction for antibodies to glial fibrillary acidic protein, S-100 and Olig2. Pleural biopsy confirmed the cytologic diagnosis of pleural effusion. A pathologic fracture of the right humeral and femoral bones was noted 1 month later, and the specimen also showed infiltrating oligodendroglioma cells in bone tissue. CONCLUSION: To the best of our knowledge, this is the first metastatic oligodendroglioma diagnosed by pleural cytology. Fine needle cytology can provide a reliable and rapid way to detect an extracranial metastatic oligodendroglioma in different organs.     

Reappearance of catatonia. A case report

We describe a patient who was ill for more than 15 years. She was treated predominantly as a neurological case because of multiple motor signs. The diagnosis of catatonia was considered at the time when she was hospitalized in a psychiatric hospital after a suicidal attempt. The "therapeutic blindness", which was obviously present during 15 years of her illness, is discussed: the ICD--10 is perhaps misleading regarding this diagnosis while it associates it too tightly only to schizophrenia.     

Primary effusion lymphoma. A case report

BACKGROUND: Primary effusion lymphoma (PEL) is a rare type of lymphoma that presents as an effusion, seldom with evidence of a solid neoplasm elsewhere; thus, cytology is the basic diagnostic method. It usually occurs in HIV-positive males with a history of Kaposi's sarcoma (KS), and DNA sequences of human herpesvirus 8 (HHV-8) are detected by molecular analysis. The distinct morphologic, immunophenotypic, molecular and clinical characteristics render this neoplasm a new pathologic entity. CASE: A 57-year-old, HIV-positive man presented to the hospital with ascites and absence of neoplasm on radiologic investigation. Cytologic evaluation of the ascitic fluid revealed the presence of highly atypical, pleomorphic lymphoid cells. Immunocytochemistry of the lymphoma cells was positive for CD45 (leukocyte common antigen), CD30 and epithelial membrane antigen antigens and negative for panB, panT and cytokeratin antigens. DNA sequences of HHV-8 were identified by polymerase chain reaction (PCR), and DNA ploidy analysis showed aneuploidy. The patient died 5 months after the diagnosis. CONCLUSION: Conventional and ThinPrep (Cytyc Corp., Boxborough, Massachusetts, U.S.A.) cytology, in combination with immunocytochemistry and PCR for HHV-8 DNA sequences, can lead to an accurate diagnosis of PEL. DNA ploidy analysis confirms the aggressive nature of this neoplasm.     

Malakoplakia of bone. A case report

BACKGROUND: Malakoplakia is an uncommon but distinctive granulomatous disease, characterized by an accumulation of histiocytes or Von Hansemann cells containing intracytoplasmic, laminated Michaelis-Gutmann bodies. CASE: A 3-year-old male presented with a tender swelling in the left gluteal region that had been present for one month. Smears made from a fine needle aspirate showed large histiocytic cells containing intracytoplasmic, basophilic, laminated, targetoid Michaelis-Gutmann bodies resembling Von Hansemann cells in malakoplakia. Histopathology confirmed the diagnosis of malakoplakia of bone. CONCLUSION: This case, histologically proven to be malakoplakia, demonstrated regression of the lesion following therapy. The characteristic cytologic features and presence of Von Hansemann cells may in themselves be diagnostic and obviate the need for biopsy.