Plasmacytoma with involvement of the urinary bladder. Report of a case diagnosed by urine cytology

BACKGROUND: Plasmacytoma of the bladder is a rare but important entity. We report a case of plasmacytoma of the bladder that was diagnosed by urinary cytology. CASE: A 71-year-old male with a history of multiple myeloma presented in renal failure. Renal ultrasound revealed right-sided, moderate hydronephrosis with a 4 x 4-cm, posterolateral, obstructing mass. Magnetic resonance imaging demonstrated a bladder mass involving the bladder base, right lateral wall and dome with extension into the perivesical tissues on the right. The mass showed a moderate degree of enhancement following intravenous gadolinium administration. Urine cytology was performed to evaluate for bladder carcinoma or other malignancies besides plasmacytoma. The specimen was signed out as multiple myeloma of the bladder. Cystoscopy and biopsy were subsequently performed on the bladder mass. The diagnosis of plasmocytoma was made, confirming the urine cytology diagnosis. CONCLUSION: Urinary cytology can be a diagnostic tool for plasmocytoma involving the bladder.     

Histopathologic and gross effects of testicular biopsy in the dog

Eighty-one mixed breed intact male dogs were divided into three groups: Group 1 = left testicle biopsied by Trucut needle method (n=36); Group 2 = left testicle biopsied by Incisional method (n = 39); Group 3 = not biopsied (n = 6). The dogs were castrated 1 to 36 d following biopsy. The biopsy specimens and both testicles were examined for gross and histologic lesions. There was no effect of biopsy on testicle circumference. There was a positive correlation (r(2) = 0.93) between testicular circumference and occurrence of lesions. Incisional biopsies induced more gross lesions (67 vs 33%), and more histologic lesions (135 vs 43). The histologic lesions included hypospermatogenesis, coagulation necrosis, tubular degeneration, interstitial fibrosis and inflammation. In addition, the lesions observed in Incisional biopsy specimens were of greater severity and incidence than Trucut biopsy specimens (87 vs 35%). It was concluded that Incisional biopsy induced an increase in frequency and severity of lesions compared with Trucut biopsy of the canine testicle.     

UNDESCENDED TESTICLE COMPLICATING ACUTE APPENDICITIS

1. Symptoms referable to compression of the spermatic cord and incarceration of right testicle, obscure the underlying pathologic changes occurring in the vermiform appendix.2. Testicular underdevelopment and resulting subnormal cerebration.3. Operative technique:(a) Pre-operative diagnosis: Incarceration of right testicle and possible perforative appendicitis.(b) Descent of right incarcerated testicle. Bassini closure.(c) Exploratory laparotomy: Intramuscular gridiron incision.4. Operative findings:(a) Strangulation and incarceration of undescended right testicle and spermatic cord in inguinal canal.(b) Copious pus, free in peritoneal cavity. An adherent, sloughing, perforative, retrocecal appendix identified, left undisturbed and free drainage established.5. Progress:(a) Eventful recovery from acute suppurative appendicitis following drainage of appendical focus.(b) Marked development following the operative descent of an incarcerated testicle in a backward boy, age twelve, who had a bilateral cryptorchism.     

Anal canal plasmacytoma—An uncommon presentation site

Background

Extramedullary plasmacytomas (EMP) are rare plasma cell tumors that arise outside the bone marrow. They are most often located in the head and neck region, but may also occur in the other locations. The lower gastrointestinal EMP represents less than 5% of all cases, and location in the anal canal is exceedingly rare.

Aim

We present an exceedingly rare case of anal canal plasmacytoma, aiming to achieve a better understanding of this rare entity.

Methods

We report a case of a 61-year-old man with a bulky mass in the anal canal. The lesion measured about 6 cm and invaded in all layers of the anal canal wall. The biopsy was performed and revealed a round and plasmocitoid cell population with a solid growth pattern and necrosis. The tumoral cells have express CD79a and CD138 with lambda chains. There was no evidence of disease in other locations and these features were consistent with the diagnosis of an extra-osseous plasmacytoma. The patient was submitted to conformal radiotherapy 50.4 Gy total dose, 1.8 Gy per fraction. After 24 months, the patient is asymptomatic and the lesion has completely disappeared.

Conclusions

EMP accounts for approximately 3% of plasma cell malignancies. The median age is about 60 years, and the majority of patients are male. The treatment of choice for extramedullary plasmacytoma is radiation therapy in a dosage of about 50 Gy. Patients should be followed-up for life with repeated bone marrow aspiration and protein studies to detect the development of multiple myeloma.     

Keratinomyces ceretanicus sp. nov., a psychrophilic dermatophyte from soil

A patient presented with pain in the right lower back, radiating down the right leg. Initial pelvic X-rays did not reveal any lesion. A follow up computerized tomography (CT) scan and technitium scan showed a sharply lytic lesion of the right ilium extending to the right sacroiliac joint. Open biopsy revealed a granulomatous inflammation with many budding yeast from consistent with Blastomyces dermatitidis. Subsequent culture confirmed this identification. There was no other site of fungal infection. Two courses of Amphotericin B (each to 2 g total dose) failed to eradicate this infection. The patient is now responding to Ketoconazole.     

Infertility in a cryptorchid bull: a case report

A unilateral cryptorchid bull stationed in an AI center for 3.5 yr was studied to determine if maintaining such a bull could be justified. The following parameters were determined: quantity and quality of the ejaculates, basal and stimulated plasma testosterone concentrations, and the histology and testosterone concentrations of the testicles. The bull produced 232 ejaculates of which 125 (53.8%) were immediately discarded; the rest (107 ejaculations) were processed into pellets. Two of the 107 frozen ejaculates (2%) were found to be of excellent quality, 37 were (34.5%) of good quality, 45 were (42%) of satisfactory quality and 23 were (21.5%) of poor quality. Treatment of the calf with GnRH and hCG at 4 and 5 mo of age did not initiate the descent of the retained testicle. Testosterone concentrations measured at 14 mo, after hCG stimulus, indicated that the bull had impaired steroidogenesis when compared with 2 control bull calves. Post mortem examination revealed a small left testicle in the inguinal canal and a normal right testicle as well as normal secondary sex glands. During the breeding period at the AI center, the bull's peripheral testosterone concentrations decreased from 2.2 to 0.95 ng/ml Testosterone concentrations in the parenchymal tissue of the scrotal testicle were higher than in the parenchyma of the retained testicle (98.2 vs 53.9 ng/g). In contrast, the epididymis of the scrotal testicle had a lower testosterone concentration than the epididymis of the retained testicle (10.8 vs 33. 0 ng/g). On histological examination no spermatozoa were found in the retained testicle, the Sertoli cells showed fat degeneration, and fibrotic tissue surrounded the tubuli seminiferi. No pathological changes were found in the normal scrotal testicle. In conclusion, no justification was found for maintaining such a bull in the AI center for breeding purposes.     

Incidence of carcinoma in situ of germ cells in contralateral testis of men with testicular tumours.

Biopsy specimens from the contralateral testicle in 50 consecutive patients with germinal testicular cancer were examined for carcinoma in situ. Three out of 21 men with seminomas and one out of 29 with other types of germinal cancer (8%) had carcinoma in situ in the contralateral testicle without any clinical signs. One of these men developed early invasive germ-cell cancer 46 months after carcinoma in situ was first diagnosed. The others have been followed up for less than a year without signs of tumour growth. If these results are confirmed routine biopsy of the contralateral testicle in patients with germinal cancer may be indicated.     

Plasmacytoma with aberrant expression of myeloid markers, T-cell markers, and cytokeratin.

Plasmacytomas are localized neoplastic proliferations of monoclonal plasma cells. When multifocal, the process is referred to as multiple myeloma. These lesions exhibit a pattern of antigen expression and cytomorphology that usually leads to a ready diagnosis. However, potentially troublesome variations in immunophenotype occur. We describe a case of a plasmacytoma from a patient who presented with sudden onset of pain and a lytic lesion of the left proximal humerus. Hematoxylin and eosin-stained sections showed a lymphoproliferative lesion composed of large lymphoid cells, some with plasmacytoid and immunoblastic features. The lesion also showed significant mitotic activity. Immunohistochemical staining was positive for CD45 (LCA), CD56 (N-CAM), CD43 (MT1), and cytokeratin CAM5.2. There was also clonal staining for lambda light chains. In addition, flow cytometric analysis showed positivity for myeloid markers such as CD13, CD33, CD38, and CD138. Significant negative markers include CD20 (L26), CD45RO (UCHL-1), and CD79alpha. The unusual phenotypic features of this plasmacytoma illustrate potential diagnostic pitfalls. It is important to fully study such lesions to correctly classify them, because this has significant impact on prognosis and management.     

Acid alpha-naphthyl acetate esterase in hairy cell leukemia cells and other cells of the hematopoietic system.

The activity of alpha-naphthyl acetate esterase at an acid pH (ANAE) was investigated in 10 cases of hairy cell leukemia. All 10 cases, including two cases with only a few tartrate-resistant acid phosphatase-reactive cells, revealed a moderate or strong ANAE reaction. There was a characteristic pattern of activity consisting of small, medium-size, or large distinct granules often distributed in a semicircle in the cytoplasm, but sparing the nucleus of hairy cells. This reaction pattern was not found in T cells, T cell-derived leukemias, normal B cells, a number of B-cell lymphomas, myeloid cells, myeloid leukemias (including monocyte-derived leukemias), reticulum cell sarcoma, or malignant reticulosis. The cells from some B-cell lymphomas and plasmacytoma showed a relatively homogeneous pattern of fine or moderately coarse ANAE-positive granules that was similar to that of hairy cells only in some cases of plasmacytoma. Thus, fine to coarse granular ANAE reactivity is characteristic of hairy cells and is of potential diagnostic value for hairy cell leukemia.     

Primary central nervous system plasmablastic lymphoma presenting in human immunodeficiency virus-negative but Epstein-Barr virus-positive patient: A case report

ABSTRACT: We report a 32-year-old Outer Mongolian man, with plasmablastic lymphoma (PBL) primarily occured in the central nervous system and diagnosed by surgical resection. This patient appeared headache and Magnetic resonance imaging (MRI) showed multiple lesions in the right cerebral hemisphere including the right frontal-parietal lobe and right basal ganglia and the left cerebellum, he was diagnosed as lymphoma by stereotactic biopsy in January 2009 in local hospital, and was given radiotherapy 33 times after the biopsy. The patient was admitted to The Military General Hospital of Beijing PLA., Beijing, P.R. China on March 9th, 2011, with chief complaints of right limbs convulsioned suddenly, then fell down and lose of his consciousness, then awoke after 4 to 5 minutes, with symptoms of angulus oris numbness and the right upper limb powerless ten days ago. MRI of the brain revealed a well-defined hyperdense and enhancing mass in the left frontalparietal lobe, the meninges are closely related, there was extensive peritumoural edema noted with pressure effects, as evident by effacement of the left lateral ventricles and a 0.5 cm shift of the midline to the right side. Surgical resection showed markedly atypical, large singly dispersed or cohesive proliferation of plasmacytoid cells with frequent abnormal mitoses and binucleation, some neoplastic cells were large with round or oval nuclei and showed coarse chromatin and smaller or unapparent nucleoli, some neoplastic cells with prominent nucleoli, apoptosis and necrosis were often presented. Immunohistochemistry staining and gene rearrangement together with other supportive investigation confirmed the diagnosis of primary central nervous system plasmablastic lymphoma. A month later, he was started on chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, leurocristime and prednisone) for a week. Other supportive treatment was provided for symptomatic epilepsy. The patient regained muscle strength in both upper limbs and right lower limb and the symptomatic epilepsy was controlled after two weeks. Then the patient was discharged. Follow-up data shows the patient to be alive eleven months after discharge. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1649317674697046.     

Spermatogénèse et Paraplégie

In this article, the paraplegics’ possibilities for procreation will be examined. A first chapter will deal with the testicle functioning along with the study of hormonal measuring and testicle histology (study involving 100 patients). As a result, it appears that, after a testicle biopsy, there is a testicle lesion of neurological origin that is sometimes irreversible. On the contrary, the endocrinal testicle lesions have proved reversible under stimulation or spontaneously. A second chapter will deal with the different techniques to obtain an ejaculation and the semen analysis. The techniques that were used being: massage by vibrator, electroejaculation, ejaculation through pharmacological stimulation. The study focuses on 124 ejaculatory tests among which 64 forward ejaculations (52%) and 4 bachward ejaculations (3%) were obtained. The resulting semen analysis revealed a spermatozoon count greater than 20 millions per millilitre (that is 51,5%) and smaller than 5 millions in 11 cases (16%).     

Plasmacytoma of the breast. Unusual initial presentation of myeloma: report of two cases and review of the literature

Two patients who presented initially with breast masses proven to be plasmacytomas, are described. In both cases the breast masses led to the diagnosis of multiple myeloma, which was retrospectively already present at the time of the breast biopsy. One patient with IgG lambda-type myeloma developed plasma cell leukemia and amyloidosis and failed to respond to radiochemotherapy. The second patient was in complete remission, four years after therapy, but has subsequently relapsed and died. All cases of breast plasmacytoma, described in the medical literatures are reviewed, and guidelines for future therapy are suggested.     

Carcinoma and multiple lymphomas in one patient: establishing the diagnoses and analyzing risk factors

Multiple malignancies may occur in the same patient, and a few reports describe cases with multiple hematologic and non-hematologic neoplasms. We report the case of a patient who showed the sequential occurrence of four different lymphoid neoplasms together with a squamous cell carcinoma of the lung. A 62-year-old man with adenopathy was admitted to the hospital, and lymph node biopsy was positive for low-grade follicular lymphoma. He achieved a partial remission with chemotherapy. Two years later, a PET-CT scan showed a left hilar mass in the lung; biopsy showed a squamous cell carcinoma. Simultaneously, he was diagnosed with diffuse large B cell lymphoma in a neck lymph node; after chemo- and radiotherapy, he achieved a complete response. A restaging PET-CT scan 2 years later revealed a retroperitoneal nodule, and biopsy again showed a low-grade follicular lymphoma, while a biopsy of a cutaneous scalp lesion showed a CD30-positive peripheral T cell lymphoma. After some months, a liver biopsy and a right cervical lymph node biopsy showed a CD30-positive peripheral T cell lymphoma consistent with anaplastic lymphoma kinase-negative anaplastic large cell lymphoma. Flow cytometry and cytogenetic and molecular genetic analysis performed at diagnosis and during the patient’s follow-up confirmed the presence of two clonally distinct B cell lymphomas, while the two T cell neoplasms were confirmed to be clonally related. We discuss the relationship between multiple neoplasms occurring in the same patient and the various possible risk factors involved in their development.     

Extramedullary plasmacytoma imitating neoplasm of the gallbladder fossa after cholecystectomy

Extramedullary plasmacytomas are plasma cell tumors that arise outside of the bone marrow. They account for approximately 3% of plasma cell neoplasms and are most frequently located in the head and neck region. Five months after undergoing cholecystectomy, a 69-year-old patient presented with the pain under the right costal margin and a 12 kg weight loss. Computed tomography of the abdomen demonstrated irregular, vascular mass in the gallbladder fossa that dents towards the duodenum and the pylorus and lowers caudally to the hepatic flexure. His laboratory tests indicated normocytic anemia and showed elevated sedimentation rate. During operative procedure, a tumorous mass in the gallbladder fossa was found, inseparable of the peritoneum of the hepatoduodenal ligament and the IVb liver segment. Histopathological examination and immunohistochemical staining determined the diagnosis of the plasmacytoma. Total resection of the tumor was achieved and after 24-month follow-up patient showed no signs of local recurrence or dissemination of the disease.     

Repetitive testicular biopsy in the ram during pubertal development

A procedure for testicular biopsy was developed and tested in rams at 14, 18 and 22 wk of age. The biopsy procedure produced a tissue sample with minimal cell-to-cell disruption and caused no detectable detriment to testicular development in rams. At least three biopsies from the same testis were obtained at 4-wk intervals without influencing the developmental patterns of either the biopsied or nonbiopsied testicle. Data obtained by biopsy indicated that the testes of Suffolk rams reached a comparable stage of development (22 wk of age) approximately 4 wk later than the testes of Finnsheep rams (18 wk of age). These results demonstrate that repetitive testicular biopsy can be performed successfully in the ram during pubertal development. The biopsy procedure allows repeated sampling of the same animal and offers a reasonable alternative to castration.     

Germ-cell malignant tumours in father and son.

Germ-cell malignant tumours occurred in a man and his son. The father, who had a teratoma of the right testicle removed 24 years ago, is presently alive and well. The son, who had a choriocarcinoma presenting as an abdominal mass, possibly originating in the testicle, died within 7 months of the diagnosis with metastases in the lungs, liver and retroperitoneum. This report documents the third such case of germ-cell neoplasms occurring in father and son.     

Fine needle aspiration cytology in extramedullary plasmacytoma

OBJECTIVE: Extramedullary plasmacytoma is a rare plasma cell neoplasm. It can occur as the sole manifestation of plasma cell neoplasm, as a metastasis from another extramedullary plasmacytoma, as a solitary plasmacytoma of the bone or as a consequence of multiple myeloma. These plasma cell tumors can occur anywhere and have to be differentiated from other neoplasms, infectious processes and chloroma. STUDY DESIGN: We report the findings of fine needle aspiration cytology (FNAC) in 18 patients with extramedullary plasmacytoma. In six patients extramedullary plasmacytoma was the initial presentation of plasma cell neoplasm. In the remaining 12 patients the tumors occurred under or after treatment of plasma cell disease. RESULTS: Eleven lesions were located in the skin, seven in the lymph nodes, one in the liver and another in the spleen. Two patients with known diagnoses of plasma cell disease were thought, before FNAC, to have an infection, and two had a histologic diagnosis of non-Hodgkin's lymphoma. In 13 of 18 patients, cytologic smears showed anaplastic plasma cells. CONCLUSION: FNAC is a front-line investigative procedure in diagnosing extramedullary plasmacytoma.     

肺放线菌病1 例报告并文献复习

目的：分析肺放线菌病的临床表现、诊断及治疗,提高对肺放线菌病的认识。方法：回顾性分析我科收治的1 例肺放线菌病 患者的临床资料,并对相关文献进行复习。结果：本例患者,43 岁,男性,以咳嗽、咳血性痰为主要临床表现,胸部CT 提示右肺上 叶结节,经皮肺穿刺活检结果确诊肺放线菌病,青霉素治疗效果好。结论：肺放线菌病是放线菌感染引起的一种少见的呼吸系统 疾病,起病隐匿,呈渐进性过程,临床表现及影像学检查均无特异性,放线菌可在肺部引起化脓性肺炎,并经叶间隙、胸膜侵犯胸 壁、肋骨,形成窦道及破坏骨质。确诊有赖于病理学或微生物学证据,主要可采用青霉素抗感染治疗,在疑似肿瘤的情况下,需通 过外科手术治疗,既可以明确诊断也避免病变进一步引起肺、胸壁等组织的不可逆性破坏。     

Invasive maxilar sinusitis by Rhizopus oryzae

We herein present a diabetic with non Hodgkin lymphoma patient that had been treated with steroids and developed fungal invasive sinusitis. The patient had intensive facial pain that did not respond to antibiotics and on clinical inspection had a necrotic lesion on right nasal area. A smear and biopsy tissue showed broad non septate hyphae and on cultures Rhizopus oryzae was isolated. There was an unfavorable outcome, and the patient died even though liposomal Amphotericin B was administered and surgical treatment was performed.