Hydatid disease of the parotid gland: a rare case report

A 40-year-old female suffering from hydatid disease located in the parotid gland is presented. Although Greece remains an endemic area for echinococcosis, this presentation of the disease is rare. Total excision of the cyst with partial parotidectomy was performed. The patient refused to receive general anesthesia and the operation was carried out under local anesthesia. Perioperative adjuvant medical therapy with albendazole was administered. In a two-year follow-up no recurrence has occurred.     

Schwannomalike mixed tumor of the parotid gland: a case report

BACKGROUND: Schwannomalike mixed tumor is a rare benign tumor of the parotid glands. CASE: A 75-year-old woman presented with a tumor 3 cm in diameter localized in her left parotid gland. Fine needle aspiration (FNA) of the lesion revealed 2 types of cells: 1 with elongated, wavy, hyperchromatic nuclei and a scant cytoplasmic border and 1 with larger, weakly staining nuclei and more abundant cytoplasm. Morphologic examinations were performed. CONCLUSION: FNA cytology was very useful in the diagnosis of this rare tumor of the parotid gland.     

Multifocal fibromatosis: a case report

We present of rare case of multifocal fibromatosis in a 52 year-old women. In 1996, she was first evaluated for a tumour of the right breast and on the basis of the surgical specimen the extra-abdominal fibromatosis was diagnosed. Four years later, she was reevaluated for the tumor of the right lung, and then in 2001 for the lesion of the right parietal pleura. Microscopic examination of pulmonary and pleural lesions revealed histological pattern almost identical with the breast tumor. The recurrent lesions were located proximally to the primary one.     

Hepatocellular carcinoma and focal nodular hyperplasia associated with norethandrolone-therapy: a case report

A 33-year-old woman was treated for severe aplastic anemia with norethandrolone over a period of four years, with a cumulative dose of 25 g. In the fifth year of therapy two intrahepatic tumors were detected and were classified as hepatocellular carcinoma and as focal nodular hyperplasia, respectively.     

Oncocytic carcinoma of the parotid gland. A case report

BACKGROUND: Oncocytic carcinoma is a rare malignant tumor of the salivary gland. Abundant, granular, eosinophilic cytoplasm is recognized as an oncocytic feature that reflects an accumulation of mitochondria. Ultrastructural study or immunohistochemical staining using antimitochondrial antibody can confirm the oncocytic nature of the tumor. However, there have been no data on whether immunocytochemical staining for human mitochondria aids in the confirmation of the oncocytic nature of oncocytic carcinoma. CASE: A 61-year-old man presented with a swelling in the left lower cheek. Computed tomography demonstrated a solid, isodense tumor in the parotid gland. An excisional biopsy of the tumor was performed, and an enlarged regional lymph node was removed. Imprint cytology of the lymph node showed cohesive cell clusters with lymphocytes. The clusters were composed of tumor cells that had characteristic abundant, granular cytoplasm and round to oval, centrally or eccentrically located nuclei with increased, fine chromatin and distinct nucleoli. Immunocytochemical staining revealed granular immunoreactivity of the cytoplasm for human mitochondria. Histology demonstrated tumor invasion in the normal gland and adjacent skeletal muscles. All tumor cells showed positive cytoplasm with antimitochondrial antibody by immunohistochemistry. Ultrastructural studies demonstrated packed mitochondria in the cytoplasm of the tumor. CONCLUSION: Immunocytochemical staining for human mitochondria help confirm the oncocytic nature of oncocytic carcinoma in cytologic specimens.     

Magnetic resonance imaging with pathological correlation in a case of mantle cell lymphoma of the parotid gland: a case report

Introduction

Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial

Case presentations

Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity. Intensive care unit treatment included antibiotics, hydration, enteral nutrition, early tracheostomy and mechanical ventilation. Intravenous magnesium therapy controlled spasticity without the need for additional muscle relaxants. Their medications were continued for up to 26 days, and adjusted as needed to control spasticity. Plasma magnesium levels, which were measured twice a day, remained in the 3 to 4.5 mmol/L range. We did not observe hemodynamic instability, arrhythmias or other complications related to magnesium therapy in these patients. All patients improved, came off mechanical ventilation, and were discharged from the intensive care unit in a stable condition.

Conclusion

In comparison with previous reports, our case series contributes the following meaningful additional information: intravenous magnesium therapy was used on patients already requiring mechanical ventilation and remained effective for up to 26 days (significantly longer than in previous reports) without significant toxicity in two patients. The overall outcome was good in all our patients. However, the optimal dose, optimal duration and maximum safe duration of intravenous magnesium therapy are unknown. Therefore, until more data on the safety and efficacy of magnesium therapy are available, its use should be limited to carefully selected tetanus cases.     

Inflammatory pseudotumor of the parotid gland: report of a case with fine needle aspiration cytology

BACKGROUND: Inflammatory pseudotumor is a rare lesion of the parotid gland. It usually presents as a mass lesion; thus, the clinical and radiologicfeatures often suggest malignancy. To the best of our knowledge, fine needle aspiration cytologic findings in parotid inflammatory pseudotumor have not been reported previously. CASE: A 59-year-old male presented with a palpable right parotid mass. Computed tomography revealed a mass measuring 2.5 cm in diameter. Fine needle aspiration cytology showed inflammatory cells, foamy histiocytes and groups of spindle-shaped cells without cytologic atypia. A diagnosis of inflammatory pseudotumor was suggested and was confirmed on histology. CONCLUSION: In the presence of a clinically evident mass in the parotid gland and fine needle aspiration cytologic features of inflammatory cells with sheets of spindle cells, the diagnosis of inflammatory pseudotumor should be suspected. The differential diagnosis of this unusual parotid gland lesion principally includes sialadenitis and myoepithelioma.     

Granular cell tumor of the parotid gland. A case report

BACKGROUND: Granular cell tumor (GCT) is a relatively uncommon soft tissue tumor of putative Schwann cell origin. This tumor can occur in multiple sites as a small, nontender nodule, but the parotid gland is unusual, and only several cases have been reported. CASE: A 46-year-old woman presented with a slowly growing mass in the left preauricular region for three years. Imaging studies confirmed a nodular lesion in the superficial lobe of the left parotid gland. Fine needle aspiration (FNA) cytology revealed scattered cellular clusters and single cells with abundant granular cytoplasm and indistinct cell borders. Background exhibited eosinophilic, granular, cytoplasmic material, and some scattered naked nuclei were also noted. Histologic examination with supportive immunohistochemical and ultrastructural studies confirmed GCT. CONCLUSION: GCT of the parotid gland is very unusual. Recognition of this tumor is important to make a definitive diagnosis before an operation. FNA is useful procedure in GCT of parotid gland for a preoperative diagnosis and proper treatment.     

Myoepithelial carcinoma arising in a pleomorphic adenoma of the parotid gland: report of a case with cytopathologic findings

BACKGROUND: Carcinoma arising in a mixed tumor, or carcinoma ex pleomorphic adenoma (CEPA), is an uncommon primary salivary gland neoplasm. Among the various types of carcinomas that can be seen histologically in a CEPA, myoepithelial carcinoma is one of the rarest forms. CASE: A 76-year-old woman presented with an incidental parotid/parapharyngeal mass. Computed tomography-guide fine needle aspiration (FNA) showed a biphasic neoplasm with epithelial and stromal components consistent with pleomorphic adenoma (PA). However, in addition, a distinct population of discohesive atypical and pleomorphic cells with high nuclear/cytoplasmic ratio was noted in the background. In the cytopathologic diagnosis a suspicion was raised about a possible CEPA. Subsequent resection of the parotid mass confirmed the presence of low grade myoepithelial carcinoma arising in a PA. CONCLUSION: Although uncommon, CEPA should be suspected on FNA when atypical cytomorphologic characteristics are observed. In rare cases a myoepithelial carcinoma also arises in a preexisting PA, necessitating an accurate interpretation for more definitive therapy.     

Spindle cell fragments in focal nodular hyperplasia of the liver. A case report

BACKGROUND: There are only few reports on the fine needle aspiration cytology (FNAC) findings of focal nodular hyperplasia (FNH) of the liver. CASE: A 30-year-old woman who had undergone surgery for a leiomyosarcoma of the calf, was found to have a hepatic mass five years later on imaging during routine follow-up. Fine needle aspiration was performed to rule out metastasis. Cytology revealed a few fragments of bland-looking spindle cells in a metachromatic stroma along with benign hepatocytes and bile duct cells. It was interpreted as "consistent with metastasis of leiomyosarcoma." The excised mass showed histologic features typical of FNH. CONCLUSION: Spindle cell fragments have not been previously observed in the FNAC of FNH. These fragments probably represent the muscular wall of the abnormal blood vessels of FNH. If smooth muscle fragment is seen accompanying benign hepatocytes and bile duct cells, one should consider the diagnosis of FNH in the needle aspirate.     

Epithelial-myoepithelial carcinoma of the parotid gland,unusual malignancy radiologically simulating a benign lesion: case report

Background

Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are widely used in the clinical diagnosis of parotid gland tumors and their efficacy in identifying benign lesions is well documented. However, problems arise when facing some malignant lesions. Only few cases of salivary gland low grade malignant tumors have been previously reported in the literature complete with the radiological features.

Case presentation

We here describe a case of epithelial-myoepithelial carcinoma (EMC) of the parotid gland, a low grade malignant tumor, with spread to an intraparotid lymph node and with CT and MRI findings mimicking a benign lesion.

Conclusion

All the images revealed sharply outlined profiles and a homogeneous enhancement of the nodule, suggesting a benign tumor and demonstrating that a radiological evaluation of the lesion alone may be unsatisfactory and misleading in the diagnosis of salivary gland tumours, especially in the case of low grade malignant tumors, such as EMC.

     

Fine needle aspiration cytology of dedifferentiated acinic cell carcinoma of the parotid gland: a case report

BACKGROUND: Dedifferentiation of acinic cell carcinoma (ACC) to undifferentiated carcinoma occurs rarely and entails a poor prognosis. Most cases of dedifferentiation occur as recurrences of a previously excised ACC. More rarely the neoplasm presents with areas of well-differentiated ACC coexisting with dedifferentiated ones. CASE: An 85-year-old man presented with 2 nodular areas in the right parotid area. Fine needle aspiration of both nodules was performed. In both cases cytology revealed a double epithelial component in similar proportions. The first one corresponded to cohesive groups of small to intermediate-sized, polygonal cells with round, monomorphic nuclei. They were distributed in small and larger, branching groups with acinic morphology. Intermixed with this population, irregular groups of larger, pleomorphic cells with irregular nuclei, prominent nucleoli and scarce cytoplasm were present. In addition, smears showed an abundant lymphoid background. A cytologic diagnosis of "salivary carcinoma with coexisting areas of acinic cell differentiation and high grade, undifferentiated carcinoma" was given. Histopathology revealed a well-differentiated ACC with areas of high grade undifferentiated carcinoma (dedifferentiated ACC). CONCLUSION: The current case expands the cytomorphologic spectrum of ACC. Cytology may permit the preoperative recognition of dedifferentiation, allowing a more sound therapeutic approach.     

Osteoclastomalike giant cell tumor of the parotid gland: report of a case with fine needle aspiration diagnosis

BACKGROUND: Osteoclastomalike giant cell tumor of the parotid gland has been reported rarely. The tumor has occurred rarely at many sites, such as thyroid, pancreas, soft tissue, breast, skin, heart, colon, lung, kidney, ovary and bladder. The exact origin of the tumor is unclear. However, osteoclastlike giant cells have been considered either part of a stromal process reactive to a neoplasm or a component of a primary neoplasm. CASE: A 35-year-old female presented with a mass in the left parotid gland clinically diagnosed as a pleomorphic adenoma. Fine needle aspiration (FNA) was advised before surgical excision. FNA smears revealed numerous osteoclastlike, multinucleated giant cells and many malignant-looking mononuclear cells. The smears were diagnosed as positive for malignancy, suggestive of osteoclastomalike giant cell tumor. The tumor was excised, and histopathologic study confirmed the cytologic diagnosis. CONCLUSION: The cytologic findings of osteoclastomalike giant cell tumor of the parotid gland have not been previously reported. FNA aided the diagnosis and planning of treatment. FNA is important in the diagnosis of parotid tumors.     

Myoepithelioma of the parotid gland initially diagnosed by fine needle aspiration cytology and immunocytochemistry: a case report

BACKGROUND: Myoepithelioma is a rare, benign tumor of the salivary gland, most commonly affecting the parotid gland. Although the cytologic features of myoepithelioma are documented in a few case reports, it has rarely been diagnosed preoperatively by fine needle aspiration (FNA) cytology. CASE: A 33-year-old man presented with a left parotid swelling 2.5 cm in diameter and of about 5 years' duration. FNA smears showed bundles of spindle-shaped cells as well as plasmacytoid and stellate cells in sheets and dissociated forms. A few cells had nuclear grooves, and occasional cells showed intranuclear cytoplasmic inclusions. In May-Grünwald-Giemsa-stained smears, most of the cells had reddish cytoplasm. Red to purple, myxoid matrix was present as a scanty fibrillar substance and as globules surrounded by tumor cells vaguely reminiscent of adenoid cystic carcinoma. A cytodiagnosis of myoepithelioma was given and corroborated by immunocytochemical staining, which revealed a positive reaction for vimentin, smooth muscle actin and S-100 protein. Epithelial membrane antigen yielded a negative reaction except for a few plasmacytoid cells with weakly positive staining. Histopathology of the resected tumor and immunohistochemical staining confirmed the cytodiagnosis of myoepithelioma. CONCLUSION: FNA cytologic features together with immunocytochemical studies on smears can offer a preoperative diagnosis of myoepithelioma.     

Sclerosing polycystic adenosis of the left parotid gland: report of a case with fine needle aspiration cytology

BACKGROUND: Sclerosing polycystic adenosis (SPCA) of major salivary glands is a rare recently described entity. We report a case of SPCA of the left parotid gland, including the cytologic and histopathologic findings. CASE: A 20-year-old man presented with a left parotid mass that had been growing slowly for 3 years. Fine needle aspiration cytology showed many syncytial cell clusters of variable size and some ductal structures with an inflammatory background. The cells forming syncytial clusters were large and polygonal, with abundant, eosinophilic, granular or lacelike cytoplasm. Apocrine differentiation with decapitation secretion was commonly seen. The ductal cells had a relatively high nuclear/cytoplasmic ratio, with granular cytoplasm. Grossly, the 5-cm lesion was a discrete, pale, cystic nodule embedded within the parotid gland parenchyma. Microscopically, the lesion was a nonencapsulated, circumscribed mass of sclerotic and hyalinized, collagenous tissue with lymphoplasmacytic infiltration. Sclerosing adenosis and cystic ducts with frequent apocrinelike cells were commonly seen. Some acinar cells contained eosinophilic, intracytoplasmic granules of various sizes. CONCLUSION: The presence of syncytial clusters with apocrine metaplasia and ductal structures in a lymphoplasmacytic background should suggest a diagnosis of SPCA of a major salivary gland.     

Preoperative fine needle aspiration cytologic diagnosis of spindle cell myoepithelioma of the parotid gland: a case report

BACKGROUND: There are only rare case reports of preoperative fine needle aspiration cytologic (FNAC) diagnosis of myoepithelioma of the salivary gland. Myoepitheliomas with pure spindle cell morphology may simulate a variety of benign or malignant spindle cell soft tissue tumors. CASE: A 54-year-old woman presented with a history of progressively increasing swelling in the right parotid region. The clinical diagnosis was parotid malignancy. Routine FNAC yielded highly particulate material. The smears were cellular, with tissue fragments, clusters of spindle cells and numerous small globules and strands of bright magenta material. High cellular yield and pure spindle cell population with an accentuated chromatin pattern in Papanicolaou-stained smears simulated a low-grade spindle cell soft tissue sarcoma. A vague resemblance to a schwannoma was also noted. However, based on the characteristic findings of the May-Grünwald-Giemsa (MGG)-stained smears, a preoperative diagnosis of myoepithelioma was made and confirmed by subsequent histopathologic examination and immunohistochemistry. CONCLUSION: Cytologically, spindle cell myoepithelioma of the salivary gland may simulate low-grade spindle cell soft tissue sarcoma or schwannoma. However, optimal sampling of the lesion and logical interpretation of the MGG-stained smears, in the appropriate clinical situation, allow a confident preoperative diagnosis of these tumors.     

Metastatic minor salivary gland colloid carcinoma in the parotid region after parotidectomy for pleomorphic adenoma: a case report

BACKGROUND: Primary colloid or mucinous carcinoma of the salivary glands is extremely rare. Only a few cases have been reported that originated in the minor salivary glands. an even more exceptional presentation is as a metastatic tumor in the parotid region subsequent to superficial parotidectomy for pleomorphic adenoma. The case presented here posed a diagnostic dilemma that could be resolved only after a thorough reevaluation of the previous cytologic and histologic material and detection of the occult primary tumor in the hypopharynx following an extensive clinical and radiologic workup. CASE: A 75-year-old female underwent fine needle aspiration of the left parotid and was diagnosed as having pleomorphic adenoma. A superficial parotidectomy removed the tumor completely, and the diagnosis was confirmed. Six months following the surgery, the patient developed an enlarged nodular mass in the ipsilateral parotid region, with fine needle aspiration showing colloid (mucinous) adenocarcinoma, which proved to be a metastatic colloid (mucinous) carcinoma on excisional biopsy. The clinical and radiologic workup in search of a primary lesion led to an occult tumor in the left hypopharyngeal mucosa. CONCLUSION: Unusual presentations of rare tumors can cause considerable diagnostic difficulties to both the clinician and cytopathologist. Awareness of these rarities is important to ensure the best patient care and to avoid unnecessary investigative and therapeutic procedures.     

Pseudoangiomatous stromal hyperplasia of breast: a case report

Aim: To present a case of pseudoangiomatous stromal hyperplasia (PASH) and its findings under 1. mammography - MG, 2. ultrasonography - USG and 3. magnetic resonance imaging - MRI. Materials and methods: A woman 39 years of age with a history of mass in her right breast of 3 months duration was subjected to a routine examination of the mass using MG & USG. According to the modality findings a core cut biopsy was done following which the samples were send for histological analysis. Later, MRI was done as advocated by the surgeon to get a better picture of the extent of the lesion prior to surgery. Results: Bilateral mammogram views revealed in the patient's right breast a huge well-bordered tumour of lobulated contour without halo sign. Sonography revealed a big well-demarcated tumour in the central part of the right breast which was cystic and lobulated in shape. Histological analysis of the sample confirmed pseudoangiomatous stromal hyperplasia (PASH). MRI under a breast array coil revealed a mass of 85x75x35mm in the right breast. Finally, based on the clinical, radiological and histological report the mass was diagnosed as benign and despite the massive size of the mass, tumour excision alone was done and not mastectomy. The right breast after the huge tumour excision was almost normal in size compared to the left. Conclusion: PASH should be included in the differential diagnosis of a circumscribed or partially circumscribed mass, especially in the pre-menopausal female population. These benign masses often grow over time and can recur locally. Radiological diagnosis of PASH is usually done by MG and USG followed by core cut biopsy for histological analysis. However great the mass is, excision only of the tumor mass is recommended and not mastectomy.