Fine needle aspiration cytology of high grade mucoepidermoid carcinoma of the breast: a case report.

BACKGROUND: Primary mucoepidermoid carcinoma of the breast is a very unusual tumor. It is often misdiagnosed, masquerading under different diagnoses. The cytologic assessment is especially difficult when the lesion is high grade. One reported case was initially diagnosed by fine needle aspiration cytology. CASE: A 69-year-old woman presented with a 6 x 4-cm tumor located in the upper outer quadrant of the right breast. The first cytologic diagnosis suggested ductal carcinoma with atypical squamous metaplasia; further review disclosed that the clusters of epithelial ductal cells displayed a mixed pattern of glandular, squamous and intermediate cells. There also was a scant intracellular and extracellular mucous substance, confirming the diagnosis of mucoepidermoid carcinoma. Histochemistry and immunohistochemistry, performed on the tumor and lymph node metastases, showed cellular staining for periodic acid-Schiff, and keratin, epithelial membrane antigen and carcinoembryonic antigen demonstrated the epithelial origin. The high expression of Ki-67, as well as the finding of 24 metastasized nodes in the axilla, demonstrated the tumor's aggressiveness. CONCLUSION: Fine needle aspiration cytology is a very reliable tool in achieving a fast and accurate diagnosis of primary mucoepidermoid carcinoma of the breast.

DNA quantification as prognostic factor in a case of acinar cell carcinoma of the parotid gland, diagnosed by FNA.

Hereby we present a case of a 43-years-old male who complained of a three years history preauricular painful mass. Fine needle aspiration cytology was performed, diagnosing of compatible with acinar cell carcinoma, thus DNA quantification by image cytometry was carried out. Biological parameters studied (ploidy, S-phase, 5-c exceeding rate) showed that it is a low grade of malignancy lesion. Total parotidectomy conservative of facial nerve was recommended, without regional lymphadenectomy. Patient remains, one year later, asymptomatic and free of disease.

Spindle cell malignant melanoma metastatic to the breast from a pigmented lesion on the back. A case report.

BACKGROUND: Tumors metastatic to the breast are quite unusual (1.2% of all tumors). Malignant melanoma is an exception and is one of the principal metastasizing tumors, described mainly as a primary tumor. There are 5 different cytologic patterns; the spindled pattern is very uncommon, more difficult to diagnose and can be confused with a wide range of sarcomatous lesions. Nevertheless, there are some cytologic features that allow differentiation from similar tumors. CASE: A 30-year-old woman presented with a firm, deep, nontender mass in the upper outer quadrant of the right breast. Fine needle aspiration cytology was performed, and the aspiration smears showed spindle-shaped neoplastic cells arranged singly or in clusters with marked nuclear atypia. Melanin pigment was sometimes seen in the cytoplasm of some cells. Pathologic study of the breast tumor corroborated the diagnosis, and later study revealed lymph node metastases and relapse in the breast area and on a scar on the back. Two years earlier, biopsy of a pigmented lesion on the back was diagnosed as a cellular blue nevus. CONCLUSION: The cytologic features of spindle cell melanoma are distinctive. The presence of atypical fusiform cells with elongated cytoplasm; enlarged nuclei, some of them binucleated or multinucleated; prominent nucleoli; intranuclear cytoplasmic inclusions; and melanin pigment can help to diagnose these unusual metastases to the breast. This case was the first of malignant metastatic melanoma with the spindled pattern in which the diagnosis was made by fine needle aspiration cytology.

Malignant mesothelioma of the tunica vaginalis. Report of a case without risk factors and review of the literature.

Malignant mesothelioma of the tunica vaginalis testis is an aggressive tumour with local recurrence being distant metastases the main feature of the clinical course. Usually appears over the fourth decade, having a strong relationship with occupational exposure to asbestos and long lasting hydrocele. We introduce a case of a 78-year-old caucasian male who developed a malignant mesothelioma without personal history of hydrocele or exposure to asbestos. A revision of the current literature is performed to summarize the recent therapeutic options as well as new diagnostic tools.

[Descriptive study of HPV prevalence in a private consultation]. / Estudio descriptivo de la prevalencia de HPV en una consulta privada.

Human papillomavirus (HPV) infection is the main aethiological factor in the development of squamous cervical neoplasia. Nowadays molecular hybridization is the most adequated method to detect HPV. Study is based on the HPV assay by means of mixed hybridization and capture of specific sequences of viral DNA. Detection of HPV by hybridization and capture is a very useful technique in patients with non-definitive cytologies of viral action, but that display high clinical suspect for such a infection. The cervical cancer screening increases its sensibility and specificity by a combined study of cytology and hibridization. The highest benefit is for those cases classified initially as ASCUS, in which the HPV results point out a more accurate diagnosis and guide subsequent adequate therapy. The results show that for normal cytology up to 87.1% was negative for virus, in the ASCUS group a 56.76% was positive for HPV, in the 32 LSIL cases a 43.8% was negative for HPV, while only a 33% of the HSIL II was negative, finally there were no negative cases for HSIL III, finding an 11.1% for low risk and low plus high risk, and a 77.8% for high risk alone. In spite of the clear relationship between cytology and HPV determination, one must be careful in establishing the treatment for the cases that displayed high risk HPV with cytology within normal limits or ASCUS. We consider these patients as high risk ones thus being suitable for a more strict follow up, keeping more aggressive procedures for the cases with cytologic manifestations.

[Lipoma arborescens of the bicipital bursa]. / Lipoma arborescente de la bursa bicipital.

Lipoma arborescens is a rare benign entity characterized by proliferation of villous fat tissue in subsynovial layer that usually affects the knee joint. We report a case of lipoma arborescens in bicipitoradial bursa of the elbow in a 44 year-old female patient. In spite of this rare location, radiographic findings by ultrasonography and magnetic resonance imaging made diagnosis possible.

Fibroblast growth factor receptor 3 mutations in epidermal nevi and associated low grade bladder tumors.

Epidermal nevi (EN) are benign lesions presenting at birth or in childhood. Based on the occurrence of fibroblast growth factor receptor 3 (FGFR3) mutations in seborrheic keratosis and urothelial carcinomas (UC), and the identification of two young patients with EN and UC, we hypothesized that mutations might occur in EN. The R248C mutation was found in 6/23 (26.1%) EN but it was absent from unaffected skin. In two patients with EN and UC, both lesions were FGFR3 wild type. Our findings indicate that: (1) FGFR3 mutations occur in mosaicism and can cause EN and (2) other genes are involved in EN.

Epidermal naevus syndrome (Solomon's syndrome) associated with bladder cancer in a 20-year-old female.

Epidermal naevus syndrome was first described by Solomon et al. in 1968, based on a study of 12 patients. Herein we report the case of a 20-year-old female diagnosed with epidermal naevus syndrome at the age of 3 years. Subsequently she experienced several different symptoms and at the last exploration a suspicious lesion was found in her bladder. The definitive pathology diagnosis was transitional cell carcinoma of the bladder, which is extremely rare in patients aged <21 years. It seems that this neoplastic lesion was directly related to the essential pathology of the patient, namely epidermal naevus syndrome.

Postabortal haemorrhage and disseminated intravascular coagulation due to placenta accreta.

We describe the case of a second trimester placenta accreta presenting as postabortal haemorrhage complicated by disseminated intravascular coagulation, requiring hysterectomy.