Incidental Pathogenic Fibrin-Associated Diffuse Large B-cell Lymphoma Found During Aorto-Biiliac Bypass.

Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is in and of itself a rare entity and is a subset of the Epstein-Barr virus (EBV)-associated lymphoma. Due to its indolent course, FA-DLBCL is generally an incidental finding on histopathological examinations. We present the first reported case of FA-DLBCL found within a native aortic thrombus during an aorto-biiliac bypass. This is a 77-year-old male who was taken to the operative theater for open aorto-biiliac bypass secondary to aortooclusive disease resulting in intermittent claudication and gangrene of the right lower extremity digits. Intraoperatively, suspicious inflammatory changes were noted around the aorta. Pathological evaluation of the thrombus within the aorta noted cells of B-cell lineage with BCL2 and MYC positivity in addition to CD30 and EBV positivity. Postoperatively, the patient's course was complicated by acute tubular necrosis, uremia, dialysis dependence, intubation, and cardiac arrhythmias including cardiac arrest. He was able to recover from these complications, however, he ultimately chose to self-enroll in hospice care. An extensive literature review of over 128 mentions of FA-DLBCL noted a complete paucity of reported cases of FA-DLBCL within a native aorta. The patient's clinical presentation and histopathology without mass-forming lesions lead to the diagnosis of FA-DLBCL. FA-DLBCL is an extremely rare EBV+ lymphoproliferative disorder associated with chronic inflammation (DLBCL-CI). FA-DLBCL is a rare condition without defined uniform treatment. This article serves to highlight the first reported case of FA-DLBCL found within an abdominal aortic thrombus in a native aorta. Given the paucity of literature on this condition, postoperative treatment and long-term outcomes should be the focus of this condition.

Rasburicase-induced haemolysis and methemoglobinemia: an ongoing issue.

We report a case of a 91-year-old Caucasian woman with a history of chronic lymphocytic leukaemia who developed acute hypoxic respiratory failure (AHRF) requiring intubation for less than 24 hours after receiving rasburicase. Laboratory workup was significant for methemoglobinemia and acute anaemia, and blood film demonstrated evidence of oxidative haemolysis with bite cells. The patient was given a presumptive diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency and was managed conservatively with successful resolution of AHRF and stabilisation of haemoglobin level. Seven days after admission, she passed away due to subsequent complications; hence, follow-up G6PD level could not be obtained. Haemolytic anaemia and methemoglobinemia in the setting of recent rasburicase administration should raise clinical suspicion for G6PD deficiency. In non-emergent cases, patients should be screened prior to receiving rasburicase regardless of risk factors. Because rasburicase is often needed emergently, patients at high risk of tumour lysis syndrome should be screened early for G6PD deficiency.

Gastroblastoma in a 28-year-old man with nodal metastasis: proof of the malignant potential.

Gastroblastoma is a newly defined neoplasm of children and young adults with only 4 reported cases to date. Morphologically, the tumor is a mixture of epithelial structures and stromal elements with minimal cytologic atypia. In these 4 reported cases, there were no metastases or postresection recurrences. We report a case of gastroblastoma in a 28-year-old man with a histologic nodal metastasis and clinical distant metastases.

Retrospective evaluation of instituted standard adequacy criteria for on-site adequacy assessment of thyroid fine-needle aspiration.

This retrospective study was conducted to investigate the impact of using instituted standard criteria for on-site assessment of specimen adequacy on fine-needle aspiration (FNA) diagnosis of thyroid nodules. The study included a total of 1,031 thyroid FNAs that were performed and assisted with on-site adequacy assessment using instituted standard criteria from July 2006 to March 2009. Adequate specimens require the presence of at least six groups of follicular cells in total on Diff-Quik stained smears with a minimum of 10 cells in each group. Agreement on specimen adequacy between on-site and final assessment, nondiagnostic rate, distribution of cytologic diagnoses, and cytohistologic concordance for cases with surgical follow-up was evaluated. Implementing the instituted standard criteria resulted in 93% level of agreement on specimen adequacy between on-site and final assessment. Nondiagnostic rate upon final assessment was 10.7%. Cytohistologic concordant rate reached 93.9% and 82.3% for nonneoplastic and neoplastic lesions, respectively. Most importantly, this approach to standardization not only provided diagnostic consistency among cytopathologists, but also minimized confusions and enhanced effective communication. Thus, high satisfactions have been achieved from endocrinologists/radiologists who utilized our on-site assessment service and/or participated in the management of thyroid nodules.