Cytologic diagnosis of central neurocytoma in intraoperative squash preparations: a report of 2 cases.

BACKGROUND: Central neurocytoma is a rare central nervous system tumor typically found in the lateral ventricles and at the spectrum pellucidum. Two patients with central neurocytoma underwent intraoperative frozen section diagnoses, and the cytologic evaluations are described. CASES: Case 1 was a 21-year-old female who complained about reduced visual acuity. Magnetic resonance imaging (MRI) showed enhancement of a ventricular tumor. Over 80% of the tumor was removed, but after 14 months' follow-up, the disease progressed and regrowth occurred. The patient had a second tumor resection with gamma knife surgery. Case 2 was a 30-year-old female who presented with headaches. An MRI showed an enhancement of a ventricular tumor, and complete tumor removal was achieved. Cellular samples of both cases typically revealed ill-defined cytoplarm, oval nuclei with finely granular chromatin and micronucleoli. A fibrillose matrix in the background was noted. A typical appearance of perinuclear halo was also recognized. In both cases histopathologic examination was consistent with a central neurocytoma. Immunohistochemistry of both tumors was synaptophysin(+), NSE (+), NeuN(+), GFAP(-), but MIB-1 labeling index was 3.4% in case 1 and 1.1% in case 2. CONCLUSION: These are 2 illustrative cases in which the authors report cytologic evaluation of central neurocytomna in intraoperative preparations. These tumors possess distinct cellular features that help with the intraoperative distinction from other intraventricular tumors. Moreover, it should be emphasized that immunostains for neural markers are essential for distinguishing them from other clear cell tumors of the brain, especially oligodendroglioma and clear cell ependymomal neoplasm. A combination of imaging, cytomorphology and immunohistochemical features of central neurocytoma can help to differentiate this condition from other intraventricular tumors. It is thought that careful scrutiny of intraoperative preparations allows one to make a distinction.

Langerhans cell histiocytosis of the skull on cytologic squash preparations.

We present a case in which a primary cytodiagnosis of Langerhans cell histiocytosis (LCH) of the skull was made using squash preparations. The patient, a 25-year-old male, presented with raised intracranial pressure and decreased visual acuity. Magnetic resonance imaging revealed a large skull lesion with osteolytic features in the left frontal bone. The patient underwent surgical resection by the extended basal frontal epidural approach. The squash preparation smears were cellular and demonstrated a mixed population of small, mature lymphocytes, eosinophils, and a high histiocytes content. The histiocytes occurred as isolated or loosely cohesive and clustered. They possessed abundant cytoplasm with rounded cell shape and had characteristic nuclear features, composed of fine chromatin and delicate nuclear membranes. The cytologic features of these histiocytes were consistent with Langerhans cells (LCs). A final impression of LCH of the skull was rendered. Subsequent histopathology confirmed the diagnosis. LCs reacted with both S-100 protein and CD1a immunohistochemically. The demonstration of Birbeck granules on electron microscopic study was also noted. Whenever squash preparation yields a mixed population of mature lymphocytes, eosinophils, and histiocytes, the cytologists should be aware of and consider LCH as a diagnostic possibility.

Multidetector CT angiography using a dual-head power injector and bolus tracking for the diagnosis of aortic aneurysms at reduced contrast material dosage.

RATIONALE AND OBJECTIVES: To establish the utility of multidetector computed tomography (CT) angiography using dual-head power injector in the diagnosis of aortic diseases. METHODS: In a prospective study, 151 patients with aortic diseases were examined by four-detector CT. Scanning was performed using bolus tracking technique. In all patients nonionic contrast was injected at the rate of 1.5 mL/sec. One hundred one patients were examined with dual-head power injector using 0.6 mL/kg contrast flushed by 30 mL of saline solution (group D). Fifty patients were examined with single-head power injector using 1.0 mL/kg contrast only (group S). We evaluated CT values at descending aorta, upper abdominal aorta, abdominal aortic bifurcation, and bilateral common femoral arteries. RESULTS: There were no statistically significant difference of CT values at descending aorta, upper abdominal aorta, abdominal aortic bifurcation, and right common femoral artery. At left common femoral artery, CT values in group D were higher than those in group S with statistically difference (P < .05). In group D, about 40% dose reduction was achieved without reducing image qualities. CONCLUSION: Multidetector CT angiography using dual-head power injector was valuable for the contrast dose reduction of aortic diseases.

Cytologic diagnosis of brain metastasis from hepatocellular carcinoma by squash preparation.

Hepatocellular carcinoma (HCC) metastasizes to the brain is rare instances. In published series and case reports of metastatic HCC, diagnosis of central nervous system metastases has been determined by histologic methods. We present a case of metastatic HCC of brain diagnosed by squash cytologic preparation. A 69-year-old male, HCV positive, suffering from post-hepatitic cirrhosis, initially diagnosed at age 68 with HCC presented with headaches of increasing frequency and severity. A computed tomography scan confirmed a 3-cm nodule in the right parietal lobe of the brain. Squash cytology was performed intraoperatively and preparations of a small tissue fragment resected from the mass showed medium-to-large-sized, well-cohesive clusters or sheets of uniform tumor cells. The tumor cells are highly cellular and contain solitary tumor cells in loose groupings as well as many fragments. They also appear somewhat bizarre and contain large, round, or ovoid nuclei with prominent nucleoli. Cytologic diagnosis of metastatic HCC was rendered reported and confirmed by a subsequent frozen section examination. To the best of our knowledge, this is the first reported case in which HCC was reported as brain metastasis, by using squash cytology. We suggest that intraoperative squash cytologic examination be viewed as a useful initial approach in the diagnosis of metastatic brain tumor.

Cytologic diagnosis of endosalpingiosis with pregnant women presenting in peritoneal fluid: a case report.

The cytologic appearance of endosalpingiosis in peritoneal fluid cytology smears has not been extensively described. We report a case of endosalpingiosis in a 29-year-old pregnant female who presented with peritoneal fluid. Dense papillary epithelial clusters with indistinct ciliated cells were found in the Papanicolaou-stained smears. However, long and delicate cilia were obvious in papillary cluster with scanning electron microscopy. Cell nuclei were oval, with finely dispersed chromatin and uniform nuclear membrane. Peritoneal fluid cytology with these findings may be helpful to suggest the probable preoperative diagnosis of endosalpingiosis or benign glandular inclusions involving the pelvic peritoneum.

Papillary clusters as a diagnostic pitfall in urinary cytology of pseudosarcomatous fibromyxoid tumor of the bladder. A case report.

BACKGROUND: Pseudosarcomatous fibromyxoid tumor (PFT) of the urinary bladder is an uncommon benign lesion that can involve any site in the bladder. Cellular features of PFT of the bladder are exceedingly rare. We describe the urinary cytology in a PFT patient who displayed numerous papillary fragments that suggested a malignant tumor. CASE: A 52-year-old man was seen at the hospital for evaluation of gross hematuria. At cystoscopy, the urologist observed a 3-cm, smooth, polypoid and ulcerated mass extending from the trigone to the bladder neck. Urinary cytology showed many papillary clusters with irregular nuclear margins in the bloody cell background. No spindle cells were noted. Cytology was interpreted as papillary growth, factor transitional cell carcinoma, grade 2-3. A laparotomy with partial resection of the urinary bladder was carried out, and histologically the tumor was composed of spindle, stellate, fibroblastic cells embedded in myxoid stroma with little collagen. Immunohistochemical and ultrastructural studies revealed the fibroblastic nature of the lesion. The final diagnosis was PFT of the bladder on the basis of histologic examination of the resected material. CONCLUSION: Papillary fragments are a diagnostic pitfall in urinary cytology of PFT lesions.