Sputum cytodiagnosis of disseminated histiocytic lymphoma. A case report

Cytohistologic evidence of pulmonary involvement with histiocytic lymphoma was discovered in a patient nine years after the original clinical diagnosis was made. The positive sputum cytologic diagnosis confirmed the radiologic impression of pulmonary involvement, which was substantiated by an open lung biopsy. This case report demonstrates the value of periodic sputum cytology in the diagnosis and management of histiocytic lymphoma. Sputum cytology should be utilized more frequently in the monitoring of pulmonary histiocytic lymphoma.     

Fine needle aspiration diagnosis of osteitis fibrosa cystica (brown tumor of bone): a case report

BACKGROUND: Fine needle aspiration (FNA) cytologic diagnosis of bone lesions is controversial; opponents cite its low sensitivity and proponents emphasize its cost-effectiveness, specificity and rapid turnaround time. The focus of FNA cytology is most often to exclude malignancy, which may contribute to incomplete information sharing on the part of the health care team and the published low sensitivity of diagnostic cytology of osseous lesions. It is therefore incumbent upon cytopathologists to formulate a complete differential diagnosis of osseous lesions. CASE: A 72-year-old man, admitted for severe abdominal pain, underwent diagnostic computed tomography (CT) examination that incidentally revealed multiple abdominal and pelvic lytic bone lesions. CT-guided FNA of a lesion revealed bland histiocytic and spindled cells, prominent hemosiderin pigment and scattered multinucleated cells, findings consistent with osteitis fibrosa cystica. Subsequent consultation with the medical team revealed the patient's underlying secondary hyperparathyroidism. CONCLUSION: This case emphasizes the importance of correlating clinical history and radiologic findings to the accurate cytologic diagnosis of bone lesions. The benign cytomorphologic features of brown tumor should not be overlooked or be considered nondiagnostic in the hunt for suspected malignancy. FNA allowed confident exclusion of a malignant process and prevented unnecessary surgery and its inherent risks.     

Asbestos bodies in fine needle aspirates of lung masses. Markers of underlying pathology

Analysis of 52 transthoracic-mass aspirates that contained asbestos bodies (ABs) showed the mass to be due to pathology other than (or superimposed upon) asbestosis in every case. Malignancy accounted for 30 masses, all of which were carcinomas except for one mesothelioma. The remaining 22 lesions were benign, with tuberculosis or lung abscesses accounting for the majority. Fine needle aspiration (FNA) detection of the pathology (benign or malignant) associated with ABs was diminished, probably due to asbestos-induced fibrosis. Other diagnostic methods, including bronchial studies, mediastinoscopy and even exploratory thoracotomy, were required to document 20% of the neoplasms and 50% of the benign lesions. The results of this series support the view that ABs in FNA specimens from localized or dominant parenchymal lung masses are significant markers of underlying pathology, whether or not cellular evidence of that pathology is observed in the aspirated material.     

Lung Changes in Woodworkers

Pathological changes were observed in the lungs of two workers who had been exposed to wood dust for many years. The cause of death in each case was unrelated to the lung condition. The histopathological changes in the lung were: (1) centrilobular fibrosis and emphysema, (2) the presence of intra-alveolar basophilic particles which had excited a histiocytic and foreign body reaction. Special studies of these bodies tended to confirm the suspicion that they were particles of wood dust. Studies have shown that woodworkers are in an environment heavily saturated with wood dust. The present study suggests that the wood dust is inhaled into the alveoli and may lead to changes in the lungs.     

Diagnostic applications of an immunoperoxidase method in hematopathology.

The diagnostic usefulness and reliability, in particular in relation to methodologic problems and limitations, of an immunoperoxidase method are discussed, based upon an initial 3-yr experience with more than 400 cases. It has been found necessary to employ certain control preparations in each study case in order to avoid interpretational errors which can derive from variation in distribution of plasma proteins, in preservation of immunoreactivity with different fixatives, and in nonspecific binding of antiserum. The method is suitable for detection of immunoglobulin components only among lymphoid cells corresponding to late stages in the (B-cell) sequence of transformation. One case has been identified in which the results of the method are inconsistent with additional data, that of large cell neoplasm of apparent epithelial nature with a monotypic immunoglobulin staining pattern. Cytoplasmic lysozyme was present in a variety of different disease processes, including adenocarcinoma and granulocytic, monocytic, and histiocytic proliferations.     

Morphogenesis and pathogenesis of chronic lung diseases. XX. Effects of repeated hypersensitivity reactions upon experimental immuno-granulomas of the lung

In order to analyse the effects of repeated hypersensitivity reactions upon chronic lung lesions, lung granulomas were experimentally induced in rabbits by an intravenous injection of 1 ml of the complete Freund's adjuvant added with 10 per cent human gammaglobulin. Groups of rabbits with 14- and 21-day-granulomas were intratracheally challenged with 1.000 I.U. human gammaglobulin injected two or three times at 7-9 days interval. The responses of the lung tissue were of the Arthus type with neutrophil granulocytic accumulations and proteasic action; the intensity of cell accumulations was decreasing after the 2nd and 3rd challenge. The lesional evolution after challenge showed intra- and perigranulomatous infiltrations with alkaline-phosphatase positive lymphocytes and plasma cells. The density of the intragranulomatous reticulin network developed after the hypersensitivity reactions increased progressively and was morphometrically assessed as statistically significant. Cellular and fibrillar lesions led to the restructuring of the lung tissue.     

A novel porcine circovirus-like agent p1 is associated with wasting syndromes in pigs

A novel porcine pathogen tentatively named P1, which was obtained from the sera of the pigs exhibiting clinical signs of postweaning multisystemic wasting syndrome (PMWS) experimentally caused the classical clinic signs and pathologic lesions of the disease in pigs by direct in vivo injection with P1 DNA plasmids. Twenty colostrum-fed (CF) pigs that were free of PCV2 and P1 at 1 month of age were randomly designated equally to two groups. Group 1 pigs were each injected with 400 μg of the cloned P1 plasmid DNA into the superficial inguinal lymph nodes and Group 2 were injected with same amount of the empty pSK vector DNA and served as controls. Viremias were positively detected in 8 of 10 P1 infected pigs from 14-21 days post-inoculation (dpi). The 8 infected animals showed pallor of skin and diarrhea. Gross lesions in the pigs euthanized on 35 dpi were similarly characterized by encephalemia, haemorrhage of the bladder mucosa, haemorrhage of the superficial inguinal lymph nodes, lung atrophy and haemorrhage. Histopathological lesions were arteriectasis and telangiectasia of the cavitas subarachnoidealis, interstitial pneumonia, mild atrophy of the cardiac muscle cells, histiocytic hyperplasia of the follicles in the tonsils, and haemorrhage of the inguinal lymph nodes. P1 DNA and antigens were confirmed by PCR and immunohistochemistry in the tissues and organs of the infected pigs, including the pancreas, bladders, testicles/ovaries, brains, lungs and liver. There were no obvious clinical signs and pathological lesions in the control pigs. This study demonstrated that P1 infection is one of the important pathologic agents on pig farms.     

Inflammatory pseudotumor of the lung diagnosed as granulomatous lesion by preoperative brushing cytology. A case report

The clinical and cytologic features of a case of inflammatory pseudotumor of the lung are presented. Chest roentgenograms revealed a solitary circumscribed round mass in a nine-year-old boy. The mass was diagnosed as a granulomatous lesion by bronchoscopic brushing cytology. Although smears and cultures of sputum and brushing specimens were negative for tuberculosis, a tuberculin reaction was positive and antitubercular therapy was instituted. Since the mass had grown further after six months of therapy, an open lung biopsy was performed to resect the lesion and establish the diagnosis. Imprint smears of the cut surface of the lesion showed cytologic features similar to those of the brushings: short, spindle-shaped cells with a tendency to be arranged in stori-form patterns against a background of minimal necrotic debris. Histopathology established the final diagnosis of inflammatory pseudotumor, a rare granulomatous lesion radiologically resembling a true tumor. Since this lesion usually occurs in younger patients, inflammatory pseudotumor should be considered in pediatric cases with an intrapulmonary lesion that shows histiocytic spindle-shaped cells in stori-form patterns, but whose smears and cultures test negative for tuberculosis.     

Gene Expression Profiling of Histiocytic Sarcomas in a Canine Model: The Predisposed Flatcoated Retriever Dog

Background

The determination of altered expression of genes in specific tumor types and their effect upon cellular processes may create insight in tumorigenesis and help to design better treatments. The Flatcoated retriever is a dog breed with an exceptionally high incidence of histiocytic sarcomas. The breed develops two distinct entities of histiocytic neoplasia, a soft tissue form and a visceral form. Gene expression studies of these tumors have value for comparable human diseases such as histiocytic/dendritic cell sarcoma for which knowledge is difficult to accrue due to their rare occurrence. In addition, such studies may help in the search for genetic aberrations underlying the genetic predisposition in this dog breed.

Methods

Microarray analysis and pathway analyses were performed on fresh-frozen tissues obtained from Flatcoated retrievers with localized, soft tissue histiocytic sarcomas (STHS) and disseminated, visceral histiocytic sarcomas (VHS) and on normal canine spleens from various breeds. Expression differences of nine genes were validated with quantitative real-time PCR (qPCR) analyses.

Results

QPCR analyses identified the significantly altered expression of nine genes; PPBP, SpiC, VCAM1, ENPEP, ITGAD (down-regulated), and GTSF1, Col3a1, CD90 and LUM (up-regulated) in the comparison of both the soft tissue and the visceral form with healthy spleen. DAVID pathway analyses revealed 24 pathways that were significantly involved in the development of HS in general, most of which were involved in the DNA repair and replication process.

Conclusions

This study identified altered expression of nine genes not yet implicated in histiocytic sarcoma manifestations in the dog nor in comparable human histiocytic/dendritic sarcomas. Exploration of the downside effect of canine inbreeding strategies for the study of similar sarcomas in humans might also lead to the identification of genes related to these rare malignancies in the human.     

Primary lesion of a non-Hodgkin's lymphoma occurring in a skin tatoo: case report.

A case of histiocytic lymphoma in a tattoo is presented. The incidence, clinical problems, diagnostic difficulties, treatment, and possible etiology are discussed.     

Transthoracic needle aspiration biopsy in Wegener's granulomatosis. Morphologic findings in five cases

Percutaneous needle aspiration biopsies of the lung from five patients with Wegener's granulomatosis were reviewed. Three of the patients presented with the generalized form of the disease while two presented with the limited pulmonary form; one of the latter subsequently developed disseminated disease. The morphologic findings in the pulmonary aspirates were similar in all cases. The cytologic preparations contained neutrophils entrapped within necrotic debris plus scattered but prominent histiocytic giant cells, which often had nuclei arranged in rings or horseshoes, in a background of lymphocytes, epithelioid histiocytes and reactive pneumocytes. Cell block preparations showed discrete areas of necrosis containing a neutrophilic infiltrate and focally palisaded by epithelioid histiocytes. The intervening viable tissue contained prominent histiocytic giant cells and chronic inflammatory cells enmeshed in a fibrous matrix. One cell block contained a small artery with a small focus of possible granulomatous arteritis. While an open lung biopsy is generally required for a definitive diagnosis, the pathologist may encounter unsuspected Wegener's granulomatosis in a needle aspirate. Recognition of the findings observed in these cases should alert the pathologist to the possibility of Wegener's granulomatosis so that an open lung biopsy can be performed if clinically indicated and cytotoxic therapy can be promptly instituted if the diagnosis of this entity is confirmed.     

An infection of cow with Mortierella wolfii

A Japanese black cow from a farm in Gunma prefecture showed pyrexia, anorexia and depression. An autopsy revealed hepatic lesions consisting of numerous approximately spherical pale lesions scattered about on the surface and cut parts. The inflammatory lesions were observed in the right lobe of the lung. A part of the trachea was whitish and thickened. Histologically, necrotic foci were observed throughout most of the liver with fungal proliferation about the blood vessels. The lesions of the lung were seriously exudative and the fungus was also present in some of the bronchiole and on bloodvessel walls. Mortierella wolfii was isolated from the liver. The hyphae in the liver were identical in appearance with those seen in the tissues of rabbits experimentally inoculated with M. wolfii.This report is the first case of M. wolfii infection in Japan     

A Case of Human Hepatic Alveolar Echinococcosis Accompanied by Lung and Brain Metastases

Alveolar echinococcosis (AE) is considered as a fatal zoonosis caused by the larvae of Echinococcus multilocularis. The lungs and brain are the most common metastatic organs. We report a human case of hepatic alveolar echinococcosis accompanied by lung and brain metastasis. In particular, the patient had a history of tuberculosis and the lung lesions were easily misdiagnosed as lung abscesses. The lesions of liver and lung underwent radical resection and confirmed as alveolar echinococcosis by pathological examination. The patient had no surgical complications after operation and was discharged after symptomatic treatment. Unfortunately, the patient later developed multiple intracerebral AE metastases. We required the patient to take albendazole orally for life and follow up.     

Metastatic cervical carcinoma to the thyroid gland: a case report and review of the literature

Although metastases within the thyroid gland are rare, they are not as infrequent as generally believed. Asymptomatic breast, lung, and renal cell carcinomas may metastasize to the thyroid. When they become symptomatic, diagnosis relies upon fine needle aspiration cytology. We report the case of a squamous cell cervical cancer that presented metastatic lesions to the thyroid gland four years after the initial diagnosis. The procedures used to confirm the diagnosis, stage, and subsequently manage the patient are described. We present both a review of the necessary clinical investigation and the therapeutic options open to these patients. We conclude that patients who present swelling or palpable nodules in the thyroid side and have a history of a previous malignancy must be considered for metastatic disease.     

Spontaneous cardiomyopathy resembling acute rheumatic heart disease in an owl monkey.

A wild-caught male Aotus vociferans died spontaneously during quarantine. Histologic examination of the heart showed several small myocardial arteries replaced with fibrinoid necrosis and adjacent inflammation that included lymphocytes and large histiocytic cells. Less often, similar inflammatory foci were observed in the myocardium interstitium. The lesions observed in the heart of the owl monkey resembled Aschoff bodies.     

Pulmonary mucormycosis diagnosed by fine needle aspiration cytology. A case report

BACKGROUND: The usefulness of fine needle aspiration cytology (FNAC) in the diagnosis of lung lesions is well documented. Fungal lesions are among nonneoplastic lesions of the lung in which FNAC has proven a useful technique in both immunocompromised and immunocompetent patients. These include cryptococcosis, aspergillosis, histoplasmosis and coccidiodomycosis. Pulmonary mucormycosis, an aggressive fungal infection, is rarely diagnosed on FNAC. We report a case of isolated pulmonary mucormycosis diagnosed on FNAC. CASE: A 62-year-old renal transplant recipient with diabetes mellitus and hypertension, asymptomatic for four months, presented with tachypnea, generalized malaise and weakness. Radiologic studies showed an enlarging, cavitating lesion in the right lung. Computed tomography-guided fine needle aspiration performed on the lung lesion showed fungal profiles with broad, ribbonlike, aseptate hyphae with right-angled branching consistent with the Zygomycetes class of fungi, which includes Rhizopus and Mucor species. Fungal cultures confirmed the presence of Rhizopus. The patient underwent right pneumonectomy, was placed on liposomal amphotericin B therapy and discharged with good pulmonary status and stable kidney function. CONCLUSION: FNAC is a useful technique in the diagnosis of pulmonary mucormycosis.     

Diagnosis of xanthogranulomatous cholecystitis by fine needle aspiration biopsy. A case report

Xanthogranulomatous cholecystitis is an uncommon benign thickening of the gallbladder wall characterized histopathologically by extensive histiocytic infiltration. A case is presented in which a 62-year-old woman with clinical cholecystitis was found at surgery to have a markedly thick-walled, adherent gallbladder, raising the differential diagnosis of an inflammatory versus an infiltrating neoplastic process. Intraoperative fine needle aspiration (FNA) biopsy revealed abundant foamy histiocytes ("xanthoma cells"), both dispersed and in clusters associated with capillaries suggestive of organization. Occasional multinucleated giant cells and columnar epithelial cells were also present. The differential diagnosis of histiocytic processes sampled by FNA biopsy is reviewed.     

Lung pathogenesis. V. The stereotype development of bronchial and lobular pathological reactions (a systemic approach)

Taking into account the present data upon the general stereotyping of different pathological processes of various nature challenged by the extremely numerous environmental actions, a structural analysis of the peculiarities presented by such reactions at the lung level, mainly on bronchial and lobular structures, was attempted. It was shown that the first damaged structures and their behaviour impose the peculiarities of the subsequently developed reactions which manifest a certain stereotyping, different when bronchi or lobules are the first lesioned. Relationships between bronchial and lobular lesions were also analysed and pointed out their role in the development of the whole complex process of the lung. This special aspect of lung complex pathogenesis was also emphasized.     

Cytomorphology and immunocytochemistry of fine needle aspirates from blastic non-Hodgkin's lymphomas

Fine needle aspirates from 54 consecutive patients with primary or recurrent blastic (high-grade malignant) non-Hodgkin's lymphomas (NHLs) were analyzed by cytomorphology and immunocytochemistry. The cytologic diagnoses induced follicular center-cell-derived (centroblastic or anaplastic centrocytic) lymphoma (31 cases), immunoblastic lymphoma (11 cases), lymphoblastic lymphoma (9 cases) and histiocytic lymphoma (3 cases). Immunocytochemistry showed a B-cell phenotype of the neoplastic lymphocytes in all lymphoblastic lymphomas, 29 follicle center-cell lymphomas and 4 immunoblastic lymphomas. Four of the immunoblastic lymphomas were of T-cell origin while one case was not evaluable due to necrosis. A histiocytic origin was confirmed in two of the three cases that had a cytologic diagnosis of histiocytic lymphoma; the third case was shown by immunocytochemistry to be a true Ki-1-positive large cell lymphoma. Histologic and immunohistochemical analysis were performed on surgical biopsies from 18 patients. The results were in agreement with those on the fine needle aspiration (FNA) material in 14 cases. Three lymphomas could be phenotyped on aspirated material while marker studies on excised material were inconclusive. One lymph node aspirate contained mostly necrotic cells, which were unsatisfactory for adequate immunocytochemistry. However, sections from a removed tonsil from the same patient could be used for conclusive histology and phenotyping. In conclusion, the high diagnostic accuracy of combined cytomorphologic and immunocytochemical assessment of FNA samples validates the use of the technique in the diagnostic work-up of blastic (high-grade malignant) NHLs. In fact, the diagnostic accuracy seems so high that the technique can safely be used in the final diagnosis of blastic NHLs.