Role of intraoperative smear cytology in the diagnosis of anaplastic oligodendroglioma. A case report

BACKGROUND: While the intraoperative smear cytology of oligodendroglioma is well documented, the cytologic features of anaplastic oligodendroglioma have been described rarely. CASE: A 41-year-old man with a previous history of a brain tumor five years earlier presented with recurrent neurologic symptoms. Radiologic examination revealed a predominantly cystic tumor with solid areas and calcifications arising from the left temporal lobe. Intraoperative smears of the tumor were hypercellular, disclosing loosely cohesive and single cells resembling oligodendrocytes with mitotic activity and moderate anisonucleosis. The background displayed a characteristic vacuolated appearance. Tissue submitted for frozen section showed a tumor with an infiltrative margin with areas of perineuronal satellitosis. CONCLUSION: A diagnosis of anaplastic oligodendroglioma can be made intraoperatively with the aid of smear cytology in conjunction with frozen section, assisting intraoperative management.     

Cytologic characteristics of intracytoplasmic refractile eosinophilic granular bodies in anaplastic oligodendroglioma: a case report

BACKGROUND: Oligodendrogliomas, which have a relatively better prognosis than tumors of the astrocytic lineage, have few morphologic clues for diagnosis. CASE: To address this problem, eosinophilic refractile inclusions were examined cytologically in the tumor of a 59-year-old man, using surgical materials for rapid diagnosis. Cytologic, histologic, and immunohistochemical findings were compatible with the refractile eosinophilic inclusions found in oligodendroglial tumors. The tumor cells presented a sheet-like epithelial pattern, forming no overlapping cell clusters, with an ill-defined cytoplasmic membrane, and nuclei that appeared to be naked, approximately 2 times the size of a red blood cell (approximately 7 microm) in diameter. It was easier to examine the cells and inclusions by cytologic preparations than by histology. CONCLUSION: The inclusions were thought to be a diagnostic clue for oligodendrogliomas, especially on cytology, and cytology was more useful than histology.     

Biphenotypic acute leukemia: a case report

We describe an uncommon case of acute leukemia in which leukemic blasts expressed myeloid antigens and cyCD79alpha molecule. In this 49-year old male patient, two distinct blast populations were detected in peripheral blood and bone marrow samples: one of small size resembling lymphoblasts and another with pink cytoplasmic granules resembling myeloblasts. Cytochemical reaction for myeloperoxidase was negative in both cell types. Conventional cytogenetic analysis showed a normal karyotype (46 XY) in all metaphases studied, while gene rearrangement analysis by seminested PCR of the immunoglobulin heavy chain (Ig-H) and T-cell-gamma chain (TCR-gamma) receptor, showed a germline configuration of the TCR and clonal rearrangement of Ig-H chain genes. Multicolour cytofluorimetric analysis showed that bone marrow and peripheral blood blasts expressed CD19, CD79alpha bright, CD22 and terminal deoxynucleotidyl transferase (TdT) as lymphoid markers, CD13, CD117, CD15 as myeloid markers, CD34, HLA-DR as stem cell markers. CD33 myeloid antigen was expressed by 50% of the blastic population. No differences in the immunophenotypic profile were detected in the two blast populations which were identified by morphology. According to EGIL (European Group of Immunological Classification of Leukemias) and WHO (World Health Organization) criteria, a diagnosis of biphenotypic acute leukemia (BAL) was made. The patient was treated with AML induction therapy followed by autologous stem cell transplantation, but relapse free survival was 6 months. The patient died a few weeks later due to unresponsiveness to salvage chemotherapy regimens. We conclude that patients with BAL should have a risk stratification with treatment tailored to their immunophenotype and gene rearrangement profiles.     

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.     

Widespread posttracheostomy atypia simulating squamous cell carcinoma. A case report

Squamous atypia appears as a benign posttracheostomy phenomenon occasionally mistaken for squamous carcinoma. Most often seen are clumps of atypical metaplastic cells with irregular nuclear rims and chromatin that can be either finely dispersed or coarsely clumped. The cytoplasm is thick, and the cytoplasmic membrane is sharply outlined. We describe a case of squamous atypia occurring in a patient 30 years after laryngectomy. The atypia was so extreme that segmental bronchoscopy was performed to search for occult carcinoma. No carcinoma was found, but numerous atypical cells were found in the segmental bronchi sampled by endobronchial brushings. This finding indicates that posttracheostomy atypia can involve respiratory mucosa distant from the tracheal (stump) mucosa. Sputum and bronchoscopic samples received from patients with tracheostomies should be screened with a clear understanding of the morphologically distinct atypia encountered.     

Cytodiagnosis of granulocytic sarcoma presenting as superior vena cava syndrome in acute myeloblastic leukemia. A case report.

We describe a rare case of acute myeloblastic leukemia presenting with superior vena cava syndrome due to a mediastinal granulocytic sarcoma. The morphologic diagnosis of granulocytic sarcoma was obtained from computed tomography-guided fine needle aspiration cytology. This is the second such case described in the world literature.     

Hyaluronan synthesis by anaplastic large cell lymphoma with massive lymphomatous effusion. A case report

BACKGROUND: Hyaluronan (HA) synthesis is frequently observed in malignant mesothelioma cells, whereas it is rarely found in lymphoma cells. Previous studies have reported that a high HA concentration in the serum was related to poor prognosis in lymphomas, although the mechanism was not elucidated. We recently encountered a case of anaplastic large cell lymphoma with an HA-rich, massive, lymphomatous effusion. Several studies were performed to clarify the character of this unusual lymphoma and to observe whether the lymphoma cells synthesized HA. CASE: A 59-year-old female was admitted with abdominal pain. Radiologic studies revealed a pleural effusion and paraaortic lymph node swelling. A biopsied specimen was compatible with anaplastic large cell lymphoma. Detailed cytologic observations revealed that the lymphoma cells in the pleural effusion had alcian blue-positive, productive material in the prominent Golgi area and microvillous structures on the surface. Further studies found that most of the lymphoma cells had HA-binding protein and expressed CD44 antigen, a receptor for HA. In addition, the HA concentration in the supernatant of the primary culture cells was extremely high and increased time dependently. CONCLUSION: These observations suggest that the lymphoma cells synthesized and released HA. Interactions of the released HA and CD44 on the surface might play an important role in the peculiar serosal growth of lymphoma cells.     

急性早幼粒细胞白血病患者小孢根霉变种感染1例

报道1例由小孢根霉变种导致的皮肤毛霉病.患者女,30岁.因患急性早幼粒细胞白血病,化疗后继发口腔颌面部小孢根霉变种感染,表现为发热、右侧颊黏膜水肿,皮损中央溃疡、焦痂,周边组织炎性水肿,以面颊部、颌下区为中心明显肿胀,逐渐累及右侧颈部及右下颌,进行性加重.坏死组织涂片镜检显示有粗大、无分隔直角菌丝,真菌学检查鉴定为小孢根霉,分子测序证实为小孢根霉变种.给予两性霉素B、伊曲康唑静脉滴注和手术清创,坏死组织连续3次真菌培养均未培养出小孢根霉变种,患者体温逐渐恢复正常,治疗2周后颔面部肿胀明显减退,浅表淋巴结未触及肿大,4周后额部及右眼睑肿胀已完全消退,伤口结痂愈合.随访2 a,右侧颌下可见长约2 cm手术疤痕,未见皮肤毛霉病复发.     

Spontaneous remission of acute myeloid leukemia. A report of a case and brief review of the literature

A patient with acute myelomonocytic leukemia who experienced a spontaneous remission, is reported. He had precedent and concurrent bacterial infections as most of these cases described. Low peripheral WBC and myeloblasts, Auer-rod positive blasts, bone marrow eosinophilia with atypical eosinophils, and a partial deletion of chromosome 16 were favorable prognostic parameters. A brief review of the literature and possible explanations for the regulation of granulopoiesis are presented.     

Metastatic anaplastic carcinoma of the thyroid mimicking squamous cell carcinoma: report of a case of a challenging cytologic diagnosis

BACKGROUND: The probability of anaplastic transformation in a differentiated thyroid carcinoma (DTC) is <2%. Admixture of DTC and undifferentiated carcinoma can occasionally be found in thyroidectomy specimens, or the undifferentiated tumor may develop in metastatic foci months or years after removal of the primary tumor. CASE: Anaplastic transformation of a metastatic DTC was diagnosed at autopsy in a 71-year-old female. At the time of her total thyroidectomy for follicular carcinoma, she already had several lung nodules, which diminished in size upon 131I treatment. Five years later the patient developed a new, pleura-based lung mass. The mass extended along the paraspinal soft tissue and involved the kidney. Fine needle aspiration biopsy of the paraspinal mass resulted in a diagnosis of metastatic squamous cell carcinoma. Two months later the patient died. Histologic evaluation of the lung nodules and pleura-based mass revealed areas of follicular carcinoma intermixed with a various patterns of undifferentiated carcinoma. The paraspinal and kidney mass consisted entirely of anaplastic tumor, including areas of squamoid differentiation. CONCLUSION: In patients with a history of DTC who develop a rapidly growing mass elsewhere, a possibility of metastatic DTC with anaplastic transformation must be considered.     

Cervical cytology and immunohistochemical features in endometrial adenocarcinoma simulating microglandular hyperplasia. A case report

BACKGROUND: The histology of a few cases of adenocarcinoma simulating cervical microglandular hyperplasia (MGH-AdCa) has been reported. However, the cytologic features of MGH-AdCa in cervical smears and the immunohistochemical profile have not been described. CASE: A 73-year-old female presented with vaginal bleeding. The cervical Pap smear was initially interpreted by the cytotechnologist as "reactive endocervical cells" and was referred for cytopathologist review. The final interpretation was atypical glandular cells of undetermined significance (AGUS), probably neoplastic. Endometrial biopsy and total abdominal hysterectomy with bilateral salpingo-oophorectomy showed International Federation of Gynecologists and Obstetricians grade 1 endometrial carcinoma. The superficial component of the tumor resembled cervical microglandular hyperplasia (MGH); the deeper component had an endometrioid pattern. The Pap smear predominantly showed a glandular component with features of MGH. However, the presence of scattered single cells with hyperchromatic nuclei, one to three nucleoli, easily detectable mitotic figures, randomly scattered apoptotic bodies and focal, watery diathesis suggested a neoplastic process. Immunohistochemistry was studied on paraffin sections. In addition to other markers, the tumor cells were immunoreactive for carcinoembryonic antigen (CEA). CONCLUSION: Although the cervical Pap smear in this case had an MGH-like pattern, some features were atypical enough to suggest a diagnosis of AGUS, probably neoplastic. CEA immunoreactivity of MGH-AdCa could also help to differentiate it from MGH.     

Metastatic balloon cell melanoma: a case report

BACKGROUND: The protean morphology of malignant melanoma is diagnostically challenging. Balloon cell melanoma is a histologic variant composed predominantly or entirely of large cells with abundant, vacuolated cytoplasm. It shares the cytologic features of the other subcategories of malignant melanoma, such as discohesion, nuclear pleomorphism and intranuclear cytoplasmic pseudoinclusions, but generally lacks melanin pigment and, as the name would suggest, is characterized by the presence of numerous cytoplasmic vacuoles. CASE: A 55-year-old man presented with an enlarged right cervical lymph node. Clinically and radiographically this mass was considered to be metastatic; however, the patient had no known primary neoplasm. Fine needle aspiration biopsy (FNAB) and cytologic examination showed numerous discohesive, variably sized, malignant cells with abundant, vacuolated cytoplasm and pleomorphic nuclei with irregular nuclear contours, macronucleoli and frequent intranuclear cytoplasmic pseudoinclusions. Pigment was not identified. These features, along with strong immunohistochemical positivity for S-100, HMB-45 and Melan-A, suggested the diagnosis of balloon cell melanoma. A right parotidectomy and lymph node dissection were performed, and histologic tissue evaluation confirmed the diagnosis. CONCLUSION: This case of lymph node balloon cell melanoma metastasis was diagnosed by FNAB.     

Anaplastic oligodendroglioma: a case report with characteristic cytologic features, including minigemistocytes

BACKGROUND: Absolute criteria for grading oligodendrogliomas are somewhat poorly defined in contrast to those for grading astrocytic tumors, and cytologic features of anaplastic oligodendrogliomas have been poorly described. CASE: A 63-year-old man presented with a toppling gait. Radiologic examination revealed a 7-cm mass with calcifications in the right frontal lobe. Intraoperative smears of the tumor showed hypercellular, loosely cohesive cell clusters and single cells with nuclear pleomorphism, numerous apoptotic cells and no discernible fibrillary processes. Many bland-looking round cells with cyanophilic cytoplasm and eccentrically located nuclei, so-called minigemistocytes, were intermingled among atypical cells. Cryostat sections showed cellular nests consisting of tumor cells with oval nuclei and clear cytoplasm. These cells were proliferating in the finely reticulated vascular stroma, and the tumor had an infiltrative margin with areas of focal necrosis and numerous calcifications. The diagnosis of anaplastic oligodendroglioma, World Health Organization grade 3, was made, and the results of fluorescence in situ hybridization (chromosome 1q deletion) supported the diagnosis. CONCLUSION: Intraoperative diagnosis of anaplastic oligodendroglioma may not be easy but is possible with judicious consideration of several features: high cellularity, no fibrillary processes, nuclear atypia, pleomorphism, abundant apoptotic cells, occasional mitotic figures, coagulative necrosis, endothelial hyperplasia and characteristic conspicuous minigemistocytes.     

Myeloid sarcoma of the tongue as a first manifestation of acute promyelocytic leukemia: A case report

IntroductionWe describe a 35-year-old male patient showing a myeloid sarcoma (MS) of the tongue as the first manifestation of acute promyelocytic leukemia (APL). The MS can appear in all parts of the human body, but it is extremely rare in the tongue.Clinical caseThe main symptoms were a pain in the tongue, asthenia, gingivorrhagia, fever. We found a tumor in the tongue, which was irregular in size and located in the posterior region of the right lateral edge of the tongue. The diagnosis of MS was made by the anatomopathological and immunohistochemical study, while the definite diagnosis of APL was confirmed by the molecular test. The treatment of APL was based on the administration of trans-retinoic acid 45 mg/m² daily continuously and daunorubicin 60 mg/m² every other day for 4 doses, with a favorable therapeutic response to APL and MS.ConclusionPromyelocytic myeloid cells can infiltrate many organs extramedullary, such as the tongue, and this might precede bone marrow infiltration. The early identification of myeloid sarcoma allows to carry out an early treatment of the APL.     

Acute myelogenous leukemia relapsing as granulocytic sarcoma of the cervix. A case report

BACKGROUND: Granulocytic sarcoma of the uterine cervix is an unusual manifestation of acute myeloid leukemia, representing soft tissue masses of leukemic myeloblasts. An often misdiagnosed entity, it is often confused with other inflammatory or neoplastic conditions, including large cell lymphoma. CASE: A 67-year-old female presented with acute myelogenous leukemia and a normal karyotype. After eight years in complete remission, abdominal pain and an ulcerated mass in the uterine cervix developed, with a normal peripheral blood smear. Vaginal cytology examination revealed myeloid blasts, which, on subsequent cervical biopsy, stained positive for leukocyte common antigen, Kp-1 (CD68), antimyeloperoxidase, lysozyme and chloroacetate esterase, confirming the cytologic diagnosis. K-ras was not mutated at codon 12 or 13. Chemotherapy induced a complete remission, followed nine months later by central nervous system and then systemic relapse. The patient died 13 months after being diagnosed with granulocytic sarcoma of the cervix. CONCLUSION: This case illustrates the value of vaginal cytology and histologic biopsy evaluation in patients with acute myelogenous leukemia, including those without evidence of systemic disease. The characteristic cytologic features of granulocytic sarcoma led to the correct diagnosis. Histologic biopsy evaluation, including immunohistochemistry for myeloid markers, proved of value in confirming the diagnosis.