Carcinoma erysipeloides as a presenting feature of breast carcinoma: A case report and brief review of literature.

Carcinoma erysipeloides (CE) is an uncommon but distinctive form of cutaneous metastasis that usually manifests clinically as a fixed erythematous patch or plaque resembling cellulitis or erysipelas. The inflamed area may show a distinct raised edge at the periphery and also edema secondary to lymphatic obstruction. Histologically, dense carcinoma cells in the dermal vascular channels and dense perivascular lymphocytic infiltrate may be seen. CE may rarely be the first sign of "silent" tumor of breast. We report a case of a 52-year-old married lady who presented with a three months history of pruritic erythematous patches over the left side of the breast that was resistant to all topical treatments and was diagnosed as erysipeloid breast carcinoma.

Nevus lipomatosus cutaneous superficialis with focal lipocytic pagetoid epidermal spread and secondary calcinosis cutis: a case report.

A case of nevus lipomatosus cutaneous superficialis is presented, wherein the lesion occurred as a gluteal swelling in a 6-year-old boy. On histopathology examination, it consisted of typical superficial expanses of mature adipose tissue in the papillary dermis of the polypoidal lesion. It was accompanied by 2 unusual findings, which consisted of the focal presence of lipocytes at the epidermal­dermal junction in the pagetoid manner and the prominent deposition of calcium resulting in calcinosis cutis­like lesions. Calcinosis cutis in the present case occurred as dystrophic calcification in focal fat necrosis changes of the lesion, whereas the focal pagetoid spread of fat cells is likely related to the same hamartomatous adipose tissue growth that ultimately results in the nevus lipomatosus.

Transformation of blackgram (Vigna mungo (L.) Hepper) by barley chitinase and ribosome-inactivating protein genes towards improving resistance to Corynespora leaf spot fungal disease.

Blackgram (Vigna mungo (L.) Hepper), an important grain legume crop, is sensitive to many fungal pathogens including Corynespora cassiicola, the causal agent of corynespora leaf spot disease. In the present study, plasmid pGJ42 harboring neomycin phosphotransferase (nptII) a selectable marker gene, the barley antifungal genes chitinase (AAA56786) and ribosome-inactivating protein (RIP; AAA32951) were used for the transformation, to develop fungal resistance for the first time in blackgram. The presence and integration of transgene into the blackgram genome was confirmed by PCR and Southern analysis with an overall transformation frequency of 10.2 %. Kanamycin selection and PCR analysis of T0 progeny revealed the inheritance of transgene in Mendelian fashion (3:1). Transgenic plants (T1), evaluated for fungal resistance by in vitro antifungal assay, arrested the growth of C. cassiicola up to 25-40 % over the wild-type plants. In fungal bio-assay screening, the transgenic plants (T1) sprayed with C. cassiicola spores showed a delay in onset of disease along with their lesser extent in terms of average number of diseased leaves and reduced number and size of lesions. The percent disease protection among different transformed lines varies in the range of 27-47 % compare to control (untransformed) plants. These results demonstrate potentiality of chitinase and RIP from a heterologous source in developing fungal disease protection in blackgram and can be helpful in increasing the production of blackgram.

Fine needle aspiration cytology diagnosis of tailgut cyst: a rare entity.

BACKGROUND: Tailgut cyst is a rare tumor believed to originate from small portions of the embryonic tailgut, which normally disappear in early fetal development. It is often misdiagnosed due to the general unfamiliarity with this entity and also because of its clinical presentation similar to other more common diseases such as perianal fistulas and abscesses. CASE: The authors take this opportunity to report a case of tailgut cyst in a 21-year-old Saudi female. The patient had presented with painful low back swelling, which had been gradually increasing in size. The case was diagnosed by fine needle aspiration cytology (FNAC) as tailgut cyst and later confirmed by histopathology. CONCLUSION: Tailgut cysts are congenital cystic hamartomatous lesions, which are rare in occurrence. They are generally benign, but malignancy has also been reported, which is even rarer in occurrence. FNAC is an effective diagnostic tool, which if applied appropriately can be used for the early detection of rarer lesions such as tailgut cyst.

Non-pharmacological and pharmacological prevention of episodic migraine and chronic daily headache.

Episodic Migraine and Chronic Daily Headache are common disorders affecting millions of Americans, with a significantly disproportionate affect on women. West Virginia, due to its high obesity rates and lower socioeconomic status, is likely more heavily affected by these conditions. Prevention of episodic migraine goes well beyond the limited scope of medications and includes many areas which physicians need to be knowledgeable, including lifestyle modifications, trigger avoidance, and relaxation therapies. The prevention of progression of episodic headaches to chronic headaches includes a number of options, possibly most importantly the prevention of medication overuse from either over-the-counter or prescription medications. Despite limited evidence based pharmacologic options for the prevention of headaches, there are many safe and effective mechanisms in which physicians can help their patients limit the burden of migraine and prevent the progression toward chronic daily headache.

A morphological survey of root grooves and their influence on periodontal attachment loss.

UNLABELLED: Periodontal health reflects a balance between harmful and protective elements in the gingival marginal area. The total plaque mass, specific periodontopathogens, the tooth morphology, and local environmental factors may challenge this balance. The periodontal ligament attachment loss shifts this balance adversely toward the periodontal disease. OBJECTIVES: The aim of this retrospective study was to determine the significance of proximal root grooves as a risk factor in the periodontal attachment loss; the effect of their dimensions and locations has been evaluated. MATERIALS AND METHODS: One hundred (100) extracted formalin stored single rooted permanent anterior teeth were studied by staining with 0.1% toludine blue to visualize attached periodontal ligament remnants. On each tooth, the loss of attachment was measured from the cemento-enamel junction to the most coronal level of the stained periodontal ligament remnants. RESULTS: The prevalence of proximal root grooves was found to be 81% and a statistically significant greater loss of attachment was present on grooved than on non-grooved surfaces (p < 0.01). CONCLUSIONS: Generally, there was direct relationship between groove location, its dimensions, and maximum loss of attachment. The results suggest that proximal root grooves should be considered in periodontal diagnosis, prognosis, and treatment planning.

Cutaneous metastases of internal malignancies: a clinicopathologic study.

BACKGROUND: Secondary tumor deposits in the skin represent advanced malignancy and are of uncommon occurrence. The clinical presentation of these lesions is variable, and the clinical impression is rarely correct, except in cases of known primary malignancies. AIM: To summarize the clinical and histopathological findings in biopsy-proven cutaneous metastases. METHODS: The present study has analyzed 14 cases of cutaneous metastases from internal malignant neoplasms, excluding hematolymphoid neoplasms. The clinical parameters analyzed include presentation of deposits and their relation to the primary tumor. The histological features of cutaneous metastases were compared with the primary tumors and the frequency of common features in them were evaluated. RESULTS: Cutaneous metastases from internal organ malignancies showed a prevalence rate of approximately 2%. Eight cases (56%) presented as primary manifestations of the tumor; biopsy evaluation in these cases suggested the possible primary tumor site and triggered further evaluation and imaging studies. Four patients, undergoing treatment for a known malignant tumor, had recurrence of the tumor in the form of cutaneous metastatic deposits. In the remaining two patients, cutaneous metastases of the tumor appeared simultaneously with the primary neoplasm and represented a higher stage of malignancy. CONCLUSIONS: Skin biopsy findings were significant in all cases. The morphological patterns of cutaneous metastases corresponded with the primary tumors and their evaluation helped localize unknown primary malignancies. In cases with known primaries, cutaneous metastases upstaged the malignancy and affected the prognosis.

Ectomesenchymal chondromyxoid tumor of the tongue masquerading as pleomorphic adenoma on fine needle aspiration cytology smears: a case report.

BACKGROUND: Ectomesenchymal chondromyxoid tumor (ECMT) of the tongue is a relatively uncommonly recognized entity, first characterized in 1995 when Smith et al described the clinicopathologic features in 19 cases. The reported incidence of this tumor is still limited, and the recognition of its presenting features is not widespread. Although the tumor histology is typical, the fine needle aspiration cytology (FNAC) features can be mistaken for those of other myxoid lesions. CASE: A 47-year-old woman presented with a nodule on the dorsal surface of the tongue that had been present for 3 months. Fine needle aspiration smears from the nodule showed abundant myxoid to fibrillary stromal fragments and clusters of oval and polygonal to spindled cells with uniform nuclei. A cytologic diagnosis of pleomorphic adenoma was given. Subsequent histopathologic evaluation of the excised tumor revealed ECMT. CONCLUSION: Because of its abundant chondromyxoid stroma, ECMT shares morphologic similarities with other myxoid lesions, especially the salivary gland tumors, on histologic evaluation. The FNAC features of this tumor have not been reported before. The lack of awareness of ECMT as a tumor entity and nonexposure to the cytologic features may cause errors in the cytologic diagnosis.

Cytomorphologic features of chondroid neoplasms: a comparative study.

OBJECTIVE: To perform a comparative analysis of fine needle aspiration cytology (FNAC) features of chondroid tumors and their significance in diagnosis. STUDY DESIGN: A retrospective evaluation of 17 chondroid tumors diagnosed by FNAC was done. Cytologic features were detailed and compared among different chondroid tumor types and with available histology. RESULTS: The 17 cases comprised enchondroma (5), osteochondroma (1), chondroblastoma (2), chondromyxoid fibroma (2) and chondrosarcoma (7). Chondroblastoma and chondromyxoid fibroma were specifically diagnosed in all 4 cases by FNAC due to characteristic cytology. However, the cytologic appearance of enchondromas overlapped significantly with that of well-differentiated chondrosarcoma, but the correct diagnosis was made by interpreting cytology with clinicoradiologic correlation. The cytologic features of high chondroid fragment cellularity, irregular cell arrangement in fragments, prominent nucleoli, and moderate to severe nuclear hyperchromasia and mitotic activity were limited to chondrosarcoma. The single error consisted of a case of osteogenic sarcoma, chondroblastic type, that was interpreted as chondrosarcoma. CONCLUSION: FNAC smears interpreted in the light of clinical and radiologic findings demonstrated high diagnostic accuracy. It is important to be aware of the cytology of uncommon chondroid tumors such as chondroblastoma and chondromyxoid fibroma as well as of the overlap of cytologic features between enchondroma and chondrosarcoma to avoid diagnostic pitfalls.

Panniculitis: clinical overlap and the significance of biopsy findings.

BACKGROUND: Panniculitides are well-recognized clinicopathologic entities but the non-specificity of their clinical and pathological features often troubles the diagnostician. METHODS: This study retrospectively evaluates the clinical overlaps and the significance of histological findings among various panniculitides. RESULTS: The clinical evaluation in 55 panniculitides cases suggested the diagnosis of typical erythema nodosum (EN) in 26 cases, atypical EN in 17 cases, atypical nodular vasculitis (NV) in two cases, soft tissue infection in five cases and five cases remained unclassified. Skin biopsy evaluation provided definite panniculitis diagnosis in 53 cases including EN (28 cases), leukocytoclastic vasculitis (seven cases), NV (four cases), superficial thrombophlebitis (ST) (two cases), eosinophillic panniculitis (EP) (three cases), infection-related panniculitis (five cases), and one case each of erythema nodosum leprosum (ENL), lupus panniculitis (LP), pancreatic fat necrosis and acne conglobata with two cases remaining unclassified. Histologically, 'predominantly septal' and 'mixed panniculitis' were the chief inflammatory patterns in EN cases, while mixed panniculitis was seen in most LCV cases and predominantly lobular and mixed panniculitis in NV cases. CONCLUSIONS: Biopsy evaluation of a panniculitis lesion is usually significant, and the application of a combination of histologic features rather than of a single biopsy finding or an inflammatory pattern is helpful in the diagnosis of panniculitis.

Lymph node infarction and its association with lymphoma: a short series and literature review.

AIMS: Lymph node infarction is an extremely rare phenomenon. An infarcted lymph node can proceed, or occur simultaneously with, lymphoma. In the present study we review the literature on lymph node infarction and describe our experience of such cases. METHODS: Six cases of lymph nodes with a diagnosis of lymph node infarction were archived from the records of the Pathology Department. Clinical information of the patients was obtained from the case records. Haematoxylin andeosin stained sections were reviewed. RESULTS: A diagnosis of non-Hodgkin lymphoma was made in 5 of the 6 patients. The diagnosis was made concurrent to the lymph node infarction in 2 cases while in 3 cases the diagnosis was made on subsequent follow up biopsies. The aetiology of lymph node infarction could not be established in one case. CONCLUSION: The pathologist should be cautious when examining an infarcted lymph node. Though all patients might not develop lymphoma, they require a close follow-up and repeat biopsies to detect the subsequent development of lymphoma.

Left-sided gastroschisis with meromelia of the limbs: a rare association.

Gastroschisis is a malformation of the anterior abdominal wall that presents as herniation of abdominal contents through a paramedian abdominal defect, usually to the right side of the midline. The defect involves all the layers of the abdominal wall and there is no membranous covering. In newborns with isolated gastroschisis, the overall prognosis is very good. In rare cases, gastroschisis is associated with other congenital malformations, making the prognosis worse. We herein report a rare case of left-sided gastroschisis associated with meromelia of the limbs.

Pleomorphic adenoma: Cytologic variations and potential diagnostic pitfalls.

The diverse morphological features encountered in pleomorphic adenoma (PA) may cause diagnostic errors in fine needle aspiration cytology (FNAC). The present study was performed to evaluate the variations in the cytological features of pleomorphic adenoma and to assess the efficacy of FNAC in its diagnosis. Fifty cases diagnosed as PA on FNAC were retrieved from the records of the Pathology Department. Cytologic smears and sections were reviewed and the cytologic diagnoses were compared with the definitive histologic diagnoses. In cases correctly diagnosed on aspiration, morphological variables like patterns of the epithelial component, type and extent of the mesenchymal matrix, metaplastic cells, hyaline globules, cystic change, giant cells, crystalline deposits, nuclear inclusions/grooves, and nuclear atypia were evaluated. The extreme diversity in morphologic features seen in histologic sections was reflected in the smears of PA. Metaplastic changes were observed more frequently in sections, while nuclear changes like inclusions/grooves were more commonly seen in smears. Other morphological features like cylindromatous pattern, giant cells and crystalline deposits were observed with equal frequency in smears and sections. Cytohistologic agreement was present in 45 of the 50 cases (90%). In 5 cases diagnosed as pleomorphic adenoma on FNAC, the histology revealed 1 case each of schwannoma, perineurioma, ectomesenchymal chondromyxoid tumor of tongue, adenoid cystic carcinoma and mucoepidermoid carcinoma. FNAC is a fairly accurate pre-operative procedure for the diagnosis of PA. The cytopathologist needs to be aware of the cytologic variations in pleomorphic adenoma so as to avoid diagnostic errors.

Histopathological patterns of female breast lesions at secondary level care in Saudi Arabia.

OBJECTIVE: The objective of this study was to characterize the histopathological patterns of female breast lesions encountered at a secondary level care centre in Al Hassa, Saudi Arabia, with special emphasis on multiplicity of benign lesions, their proliferative nature and level of risk for progression. METHODS: In this retrospective, hospital record-based descriptive study, all histopathology records of patients attending King Fahd Hospital in Hofuf, Al Hassa between January 2001 and December 2007, were reviewed using a structured compilation form. Nine and hundred-sixty nine histopathology reports were legible and included. Data regarding type of specimens, age, laterality of the lesions and the prominent cellular morphology were analyzed. RESULTS: Out of 969 records reviewed, benign lesions accounted for 60.1%, followed by malignancy (21.4%) and inflammatory lesions (18.5%). Multiple benign lesions were found in 51.1% and more than two lesions in 21.1% of cases. Non-proliferative breast lesions with low risk were reported in 81.4%, intermediate risk lesion without hyperplastic atypia in 14.6%, while high risk lesions with atypia were only 4.0%. Infiltrating ductal carcinoma was the dominant lesion among the latter and 62.1% of cases were diagnosed before the age of 50 years. CONCLUSION: Benign breast lesion multiplicity is frequent among Saudi female patients; with or without atypia these lesions represent a sizable risk of potential progression to breast cancer. Meticulous follow up with frequent screening may be useful for prevention of cancer development and early intervention in affected patients.

Fibrocongestive splenomegaly in sickle cell disease: a distinct clinicopathological entity in the Eastern province of Saudi Arabia.

Sickle cell disease displays a unique progression in the Eastern province of Saudi Arabia, where splenomegaly with hypersplenism is noted with high frequency in the adolescent and adult patients. The late persistence of splenomegaly although likely reflects the milder progression of sickle cell disease in this region; nevertheless, it predisposes the patients to increased morbidity. The present study documents the characteristic clinicopathological features of splenomegaly associated with sickle cell disease in the Al-Hassa region of Eastern province Saudi Arabia. Forty-four cases of sickle cell disease patients in whom splenectomy was performed during 1999-2003 were studied. The hemoglobinopathy profiles of the patients (age range 5-42 years) comprised sickle cell anemia (8 cases), sickle cell anemia with high fetal hemoglobin (23 cases), and sickle cell-beta degrees thalassemia (13 cases). All patients had manifestations of hypersplenism and 39 patients experienced episodes of minor-type sequestration crisis. Splenectomy was effective in ameliorating the hematological abnormalities in all cases, without any major complications in the follow-up period. The splenectomy specimens showed moderate-to-marked enlargement in most cases, with histological features of fibrocongestive splenomegaly and prominent Gandy-gamma body formations. Micro-infarcts in 27 cases and gross infarctions in 9 cases were evident. The relationship of persistent splenomegaly with higher fetal hemoglobin levels and splenic hypofunction is examined along with the significance of splenectomy in these cases.

Fine-needle aspiration diagnosis of primary cutaneous cryptococcosis in an immunocompetent patient: a case report.

We report a case of a primary cutaneous cryptococcosis (PCC) in immunocompetent man diagnosed by fine-needle aspiration (FNA) and confirmed by special stains and culture study. The patient presented with a 2-wk history of two separate skin nodules over the forehead and the left lumbar region. FNA smears revealed a necrotizing suppurative granulomatous inflammation with numerous yeasts of Cryptococcus surrounded by clear halos, which were present within multinucleated giant cells and in the intercellular spaces. This was confirmed subsequently by special stains and a culture of the aspirated material. This case report reemphasizes the role of FNA as a useful modality in the early diagnosis of cutaneous cryptococcosis, especially in clinically unsuspected cases.

Subcutaneous dirofilariasis caused by Dirofilaria repens.

Human dirofilariasis caused by Dirofilaria repens D. repens is a common zoonosis in the Mediterranean countries and parts of South Asia. During the last decade, it has been reported from countries previously considered non-endemic. This is likely due to the increased awareness regarding Dirofilaria infection. In some such cases however, dirofilariasis correlated with the travel of the patient to the endemic areas. We present the case of a Saudi male who had D. repens infection in the subcutaneous tissues of the forearm. The patient had traveled to Iraq, Syria, United Arab Emirates and Kuwait in the last 2 years. However, the known Dirofilaria endemic countries were not visited. Any prior occurrence of the human dirofilariasis in the Kingdom of Saudi Arabia is not documented. Lack of epidemiological studies or incidence reports in the Arabian region precludes any factual evaluation of Dirofilaria prevalence, which requires increased awareness amongst health workers regarding its potential occurrence in the native population.

Advancing age and the risk of nasal carriage of Staphylococcus aureus among patients on long-term hospital-based hemodialysis.

BACKGROUND: Elevated nasal carriage rates of Staphylococcus aureus and ensuing complications among the elderly and in those on long-term hemodialysis (HD) are well recognized. The aim of the present study was to determine the extent to which advancing age is associated with the risk of persistent S. aureus nasal carriage among end-stage renal disease (ESRD) patients on long-term HD. PATIENTS AND METHODS: This prospective study involved 205 ESRD patients enrolled for maintenance HD from July 1997 to July 2000. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA) or methicillin-resistant S. aureus (MRSA). Five standardized swabs were taken from the anterior nares of all the patients on long-term HD. S. aureus nasal carriage rates were estimated and compared among ESRD patients of different age groups. RESULTS: Overall, a prevalence of 38.05% (78/205) for S. aureus nasal carriage was observed, including 27.3% (56/205) for MSSA and 10.7% (22/205) for MRSA. Patients aged 75 to 84 years had the highest (84.6%, 11/13) prevalence of S. aureus nasal carriage (RR, 7.000, 95% CI, 4.350-11.763, P<0.00001). Those aged 65 to 74 years had the next highest (49.0%, 25/51) nasal carriage rates (RR, 4.083, 95% CI, 2.302-7.658, P<0.0001) while patients aged 15 to 24 years (reference group) had the lowest (12.8%, 1/8) prevalence of nasal carriage. The 75 to 84 year age group also had the highest rates of MSSA (46.2%, 6/13), (RR- 3.833, 95% CI, 2.144-7.234, P<0.0001) and MRSA (38.5 %, 5/13) (RR, 6.333, 95%CI, 2.767-16.198, P<0.0001) nasal carriage compared to the reference group. CONCLUSIONS: Significantly higher persistent MSSA and MRSA nasal carriage rates among ESRD patients >75 years of age are suggestive of an elevated risk of potentially serious S. aureus- related complications among the very elderly during long-term HD. These findings might be helpful in the identification of elderly HD patients as a high-risk group for S. aureus-linked vascular access-related septicemia (VRS) and to evolve appropriate preventive strategies.

Comparison of specimen adequacy in fine-needle aspiration biopsies performed by surgeons and pathologists.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) may yield different results depending on its operator. We compared the proportions of unsatisfactory aspirates obtained by pathologists vs. surgeons. METHODS: In a retrospective review, all FNAB reports and slides performed between March 2002 and February 2003 were grouped by organ/site and according to whether they were done by a pathologist or a surgeon. The proportions of unsatisfactory aspirates for pathologists and surgeons were compared. RESULTS: Of 692 FNABs, 390 were performed by pathologists at the FNAC clinic and the remainder by surgeons. Overall, 15.5% of aspirates obtained were unsatisfactory (n=107). Of aspirates obtained by surgeons, 29.5% were unsatisfactory, compared to 4.6 % of those obtained by pathologists (P<0.001). Pathologists had significantly lower proportions of unsatisfactory aspirates in all sites. A 33% reduction in the number of lymph node excisional biopsies has been reported subsequent to establishment of the FNAC clinic. CONCLUSIONS: The advantages of a pathologist performing FNAB are that a rapid evaluation can be rendered regarding specimen adequacy and the need for repeating the procedure. In addition, pathologists can direct the distribution of aspirated material for other tests such as culture study, flow cytometry and electron microscopy, as indicated by preliminary evaluation of the smears. These factors significantly lower the proportions of unsatisfactory specimens and improve the diagnostic accuracy of FNAB technique.