Histiocytic lesion masquerading as papillary carcinoma thyroid-A case report.

ABSTRACT: Langerhans cell histiocytosis (LCH) is a rare clonal neoplasm derived from Langerhans-type cells that express CD 1a, langerin, and S 100 on immunohistochemistry. LCH usually involves multiple sites and multiple systems or multiple sites in a single system. Solitary LCH commonly involves the bones (especially the skull), lymph nodes, skin, and lungs. Solitary LCH of the thyroid is an extremely rare disease with a few reported cases in the indexed literature and poses a diagnostic dilemma for both the clinician and pathologist. Histopathology along with ancillary tests forms the gold standard for diagnosis. Surgical resection alone offers a good prognosis once multisystemic involvement has been ruled out. Herein is reported one such case of solitary LCH in a young male patient who remains disease-free after 2 years of follow-up.

Evaluating the Role of Glycemic Control in Modulating Pulmonary Function Among Smokers With Diabetes Mellitus: A Systematic Review.

BACKGROUND: Diabetes mellitus (DM) impacts multiple body systems, including lung function, and this impact can be further complicated by smoking. The connection between blood sugar control and lung health in individuals with diabetes who smoke has been extensively studied, but findings have been varied. This systematic review sought to compile and assess the research on how blood sugar control influences lung function in smokers with diabetes. METHODS: We searched several databases, including PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, and Google Scholar, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included studies that looked at lung function tests in smokers with diabetes and examined the relationship with blood sugar control, as indicated by hemoglobin A1c (HbA1c) levels. We conducted thorough quality assessments, data extraction, and analysis. RESULTS: We identified five relevant studies. The data from these studies indicated a clear trend: smokers with diabetes who had higher HbA1c levels typically showed worse lung function than those with better blood sugar control. Decreases in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were the most frequently observed issues. Some studies also pointed to a complex relationship between HbA1c levels and lung function, particularly when HbA1c was below 7.0%. CONCLUSION: Our review indicates that smokers with DM who have poor blood sugar control tend to have worse lung function. These findings highlight the importance of managing blood sugar to help maintain lung health in these individuals. Further long-term research is needed to clarify the exact relationship and whether improving blood sugar control can reverse lung problems.

Sarcomatoid Carcinoma of Renal Pelvis with Abundant Heterologous Osteosarcomatous Element: A Case Report.

A 47-year-old male presented with haematuria and flank pain for two weeks. Ultrasonography and renal scan revealed a poorly functioning left kidney with multiple calculi. Simple nephrectomy was performed and the specimen revealed a mass in his renal pelvis which showed both carcinomatous and sarcomatous components on microscopy. The sarcomatous component consisted of diffuse pleomorphic osteoblasts with intervening lacy osteoid, giving an osteosarcoma-like appearance. These areas of tumour were strongly positive for vimentin and osteopontin. The carcinomatous component was transitional cell carcinoma. Patchy areas of squamous cell carcinoma which were positive for pancytokeratin on immunostaining were also seen. Few weeks later, the patient presented with metastatic lesions in the sacrum. After nephrectomy, the patient underwent palliative radiotherapy of the spine followed by sunitinib therapy. A month later, there was recurrence at the site of surgery. The patient succumbed to his illness within five months of diagnosis. This report describes an extremely rare case of carcinoma, renal pelvis with predominantly osteosarcomatous areas.

Comfort and compressional characteristics of padding bandages.

BACKGROUND: Padding bandage is an essential component of the multi-layer compression system used for chronic venous management. Padding plays a critical role in managing pressure over bony prominences and ensuring uniform pressure distribution around the limb circumference. Moreover, it helps in the management of heat, moisture and body fluids or exudates during the course of treatment to provide comfort to the patients. OBJECTIVE: To study the effect of structural and constructional parameters on the compressional (pressure absorption or distribution) and comfort (air, moisture and heat transmission) characteristics of the padding. METHODS: This research focuses on the examination of polypropylene based nonwoven padding samples. Critical factors, i.e., fiber linear density, needling density and mass per unit area, have been chosen for this study to find their significance on the performance of padding. Simple laboratory based methods have been proposed to examine pressure reduction and comfort characteristics of the padding. RESULTS: Pressure absorption by the padding decreases with increase in mass per unit area and needling density of the padding. A padding composed of thicker fiber absorbs more pressure compared to padding made from thinner fiber. On examining comfort, it was found that the air and moisture vapor transmission increase with decrease in mass per unit area and needling density but have opposite effects with fiber linear density (p<0.01). The heat transmission decreases with increase in both mass per unit area and fiber linear density but has opposite effect for needling density. CONCLUSION: Padding composed of thick fiber with low mass per unit area and needling density could be more effective in pressure management and ensuring comfort. These results could be very useful for health practitioners, fabric engineers and manufactures to understand the significance of fibrous materials and their role in compression management, and could be further used as design consideration to optimized padding performance.

Virilizing cystic juvenile granulosa cell tumour of the ovary: a case report.

We report a rare case of virilizing cystic juvenile granulosa cell tumour of the ovary diagnosed by histopathological examination in a 17-year-old female presented with mass abdomen for two months, growing of the hairs on the face and abdomen and deepening of voice for one year.

Axillary schwannoma with extensive cystic degeneration.

Schwannoma affect mainly head, neck, and flexor aspect of the limbs. Neurogenic tumors arising from the brachial plexus are rare and axillary schwannoma is extremely uncommon. Cystic degeneration is common in longstanding cases and which when aspirated may yield only macrophages or lymphocytes leading to false diagnosis of the case in spite of strong clinical suspicion. We report one such rare case of a solitary axillary schwannoma with extensive cystic degeneration, which was misdiagnosed on fine needle aspiration cytology and subsequently confirmed by the histopathological examination and immunohistochemistry.

Role of fine-needle aspiration cytology in the prompt diagnosis of recurrence of visceral leishmaniasis presented as isolated cervical leishmanial lymphadenopathy.

We report a case of isolated cervical leishmanial lymphadenopathy diagnosed by fine-needle aspiration cytology (FNAC) in apparently cured case of visceral leishmaniasis. A 28-year-old female presented with cervical lymphnode enlargement to surgery outpatient department and was subjected for FNAC. Smear showed numerous Leishmania donovani bodies in the cytoplasm of macrophages and giant cells, and extracellular spaces. She was treated by Amphotericin B for alternate 14 days and the size of the lymphnode regressed. She was found asymptomatic for 1 year of follow-up.

Fine needle aspiration cytology in diagnosis of pure neuritic leprosy.

Leprosy is a chronic infection affecting mainly the skin and peripheral nerve. Pure neuritic form of this disease manifests by involvement of the nerve in the absence of skin lesions. Therefore, it can sometimes create a diagnostic problem. It often requires a nerve biopsy for diagnosis, which is an invasive procedure and may lead to neural deficit. Fine needle aspiration cytology (FNAC) of an affected nerve can be a valuable and less invasive procedure for the diagnosis of such cases. We report five suspected cases of pure neuritic Hansen's disease involving the common and superficial peroneal, ulnar, and median nerve, who underwent FNAC. Smears revealed nerve fibers infiltrated by chronic inflammatory cells in all cases, presence of epithelioid cells granulomas, and Langhans giant cells in three cases, and acid fast bacilli in two cases. In conclusion, FNAC is a safe, less invasive, and time saving procedure for the diagnosis of pure neuritic leprosy.

Primary stromal sarcoma of breast with malignant fibrous histiocytoma-like features causing diagnostic dilemma on fine-needle aspiration cytology in a patient with squamous cell carcinoma of cervix: a case report.

A variety of malignant spindle-cell tumors are known to occur in the breast, which are collectively referred to as "breast spindle-cell tumors." Their interpretation on fine-needle aspiration cytology (FNAC) can be highly tricky. Here, we report a case. A 47-year-old female presented with a hard, mobile lump in the right breast for 4 months. Five years previous to this, she was treated with radiotherapy for squamous-cell carcinoma (SCC) of cervix. FNA of the breast lump showed high-cell yield with clusters, fascicles, and dissociated cells displaying spindle-cell morphology, with marked pleomorphism, many bizarre uninucleate/multinucleate giant cells, and a striking mitotic activity. At places, the cells in a necrotic background simulated keratinized squamous cells. Considering the past history of SCC of cervix, the first possibility of metastatic SCC with a differential diagnosis of metaplastic carcinoma, malignant phylloides, and a primary sarcoma of the breast was considered. Subsequent trucut/excision biopsy with appropriate immunomarkers revealed it to be a case of primary stromal sarcoma of the breast with malignant fibrous histiocytoma (MFH)-like features. Malignant spindle-cell tumor of breast in a patient with SCC of cervix (which also has a tendency to manifest with spindle cell morphology) can cause genuine diagnostic difficulty. In such patients, use of appropriate panel of markers is mandatory for distinguishing between the metastatic SCC from cervix and other more commonly occurring spindle-cell malignancies of the breast.

Tuberculosis of the oral cavity affecting alveolus: a case report.

We report a first case of tuberculosis of oral cavity affecting the left alveolus from Nepal in a 63-year-old male who came to otorhinolaryngology outpatient department with a complaint of an ulcer in the oral cavity and pain in bilateral ear and throat. An ulcer measuring 1.8 cm in diameter with irregular friable margin and bleeding on touch was found in the left upper alveolar region of the oral cavity. Biopsy from the ulcer margin revealed histological features of necrotizing granulomatous lesion. Stain for acid fast bacilli was positive.

Diagnosis of sternomastoid tumor of infancy by fine-needle aspiration cytology.

Sternomastoid tumor of infancy, also known as fibromatosis colli or muscular torticollis, is a benign fibroblastic lesion of the sternocleidomastoid muscle presenting as a firm, fusiform, non-tender neck mass of 1-3 cm in greatest dimension in the perinatal period. Various modalities are used for the diagnosis including radiographic studies, fine-needle aspiration cytology (FNAC), and open biopsy. We report eight cases of sternomastoid tumor of infancy diagnosed by FNAC. The objective of the study is to present the role of FNAC in the diagnosis of sternomastoid tumor with its cytomorphological features. FNA was done by using 23-guage needle and 10 ml disposable plastic syringe. The wet smears were fixed in 95% ethanol and processed for Papanicolaou stain. The dried smears were stained with May-Grünwald-Giemsa stain. The smears were studied for cytomorphologic features. The age of the patients ranged between 2 and 10 weeks. Male: Female ratio was 1.6:1. Six of eight had history of prolonged labor, two had history of breech presentation, and three had history of forceps assisted vaginal delivery. Cytologic findings included singly scattered and loose clusters of benign fibroblasts with moderate amount of unipolar to bipolar cytoplasm and plumped, ovoid nuclei. Many multinucleated giant cells consistent with atrophic muscle fibers were also seen. FNAC is a reliable, safe, and cost-effective method and can provide a rapid and reliable diagnosis of sternomastoid tumor of infancy.

Role of fine needle aspiration cytology in diagnosis of filarial infestation.

Filariasis is a tropical disease transmitted by the Culex mosquitoes. The diagnosis of it is conventionally made by demonstrating microfilariae in the peripheral blood smear. However; microfilariae and adult filarial worm have been incidentally detected in fine needle aspirates of various lesions in clinically unsuspected cases. The cases of filariasis diagnosed by fine needle aspiration cytology (FNAC) were retrieved from the archives of the Cytopathology laboratory between the periods of January 1998 to February 2009. Both Papanicolaou- and May-Grunwald-Giemsa-stained smears were available in all the cases. A total of 26 diagnosed cases of filariasis were found, of which 19 were related to funiculo-epididymitis, four presented with breast lump, and three cases with lymphadenopathy. Smears revealed fragments of adult worm in 12 cases including 10 gravid female worm containing eggs and microfilariae and two male adult worm; whereas in remaining 14 cases only microfilariae or eggs were seen. Unfertilized eggs were seen in three cases and fertilized eggs were seen in five cases. Tissue response in the form of eosinophils in 16 cases, acute inflammatory exudate in five cases, macrophages in 22 cases, epitheloid cell granulomas in five cases, giant cells in four cases, lymphocytes in 10 cases, and plasma cells in three cases were seen. Adherence of polymorphonuclear leukocytes, eosinophils, and epithelioid cells were observed in four cases. On conclusion, filaria may affect the epididymis, spermatic cord, breast, and lymph node, and the accurate diagnosis can be easily and conveniently achieved by FNAC without any requirement of biopsy.

Significance of eosinophils in diagnosing Hashimoto's thyroiditis on fine-needle aspiration cytology.

BACKGROUND: Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism in those areas of the world where iodine levels are sufficient. Fine-needle aspiration cytology (FNAC) can accurately diagnose this lesion in most of the patients. However, a small percentage of cases may be missed due to inherent limitations of this procedure. Therefore, cytologic clues to increase sensitivity of diagnosis need to be searched for. AIMS: To assess whether an eosinophilic infiltration of the thyroid gland has a higher association with HT than colloid goiter. MATERIALS AND METHODS: The study was a case-control study. Smears obtained by FNAC of 50 case, each of HT (which served as cases) and colloid goiter (which served as controls) were observed. The number of eosinophils and neutrophils per high-power field (HPF) was counted in all the smears. The eosinophil-neutrophil ratio in the smears, diagnosed as HT, was then compared with that of colloid goiter using unpaired t-test. RESULTS: Smears diagnosed as HT was found to have a significantly higher eosinophil-neutrophil ratio than smears diagnosed as colloid goiter (P value 0.0001). CONCLUSION: Eosinophilic infiltration of the thyroid gland has higher association with Hashimoto thyroiditis.

Chondroid syringoma diagnosed by fine needle aspiration cytology.

Chondroid syringoma is a rare benign skin adnexal tumor of eccrine/apocrine origin affecting commonly the head and neck region. It used to be previously called as mixed tumor of skin because of the presence of both the epithelial and mesenchymal components. There are only few case reports describing the fine needle aspiration cytologic features of chondroid syringoma for diagnosis. We studied a 20-year-old male case from Taplejung district of Nepal came to Otorhinolaryngology out patient department with the complaints of painless, progressively enlarging swelling on the dorsum of nose. On examination, 2.0 x 2.0 cm, firm, non-tender swelling was seen on the right side of dorsum of nose. Overlying skin was normal, and the swelling was fixed to the skin but freely mobile over underlying structure. A clinical diagnosis of dermoid cyst was entertained, and the case was subjected to FNAC. FNA yielded mucoid material which on microscopy showed clusters of round cells with moderate to abundant cytoplasm embedded in chondromyxoid ground substance. The nuclei were monomorphic, centrally to eccentrically located and had fine chromatin. On the basis of these cytologic features, a diagnosis of chondroid syringoma was made. We concluded that Chondroid syringoma may be considered as a rare differential diagnosis in the swelling of head and neck region and the diagnosis can be easily confirmed or ruled out by means of fine needle aspiration cytology.

Granuloma in sputum cytology of pulmonary tuberculosis: a case report.

BACKGROUND: Presence of epithelioid cell granuloma and Langhans' giant cells in sputum cytology in cases of pulmonary tuberculosis is of very uncommon occurrence. Only a few reports could be found in the English-language literature. CASE: A 73-year-old man, a chronic smoker for 50 years, reported to the medical out-patient department with complaints of cough and significant weight loss for the past 1 year. Routine sputum cytology revealed epithelioid cell granuloma along with Langhans' giant cells. Ziehl-Neelsen stain showed presence of multiple acid-fast bacilli (AFB). Chest radiography showed opacity of the airways and areas of cavitations in bilateral parahilar location and diffuse nodular opacity in bilateral lung fields. CONCLUSION: Albeit of very rare occurrence, presence of epithelioid cell granuloma and Langhans' giant cells, along with demonstration of AFB in routine sputum cytology, is capable of providing a conclusive diagnosis in appropriate clinical context, obviating the need of additional investigation.

Primary laryngeal leishmaniasis: a rare case report.

Laryngeal leishmaniasis is extremely rare. We report a case of primary laryngeal leishmaniasis in a 70-year-old male who was admitted with complaints of gradual progressive hoarseness of the voice, dyspnea, cough for the past 3 months and noisy breathing for the past 5 days. An X-ray of the soft tissue of the neck showed a prevertebral soft tissue mass causing narrowing of the airway at the C6-C7 vertebral level. A computerized tomography (CT) scan showed a soft tissue mass in the subglottic region causing significant narrowing of the airway. A direct laryngoscopy showed a pinkish-white, friable mass involving the subglottic region and the anterior half of the vocal cords. With the clinical suspicion of malignancy, an endoscopic biopsy was done. A histopathological examination showed diffuse mixed inflammatory cell infiltrate in subepithelium with numerous Leishmania donovani bodies in the cytoplasm of histiocytes.

Mature solid teratoma of the rectum: report of a case.

A case of an unusual occurrence of mature solid teratoma of the rectum is reported with a review of the literature. A 30-year-old woman presented with bleeding per anum without any alteration in her bowel habits. Sigmoidoscopy revealed a pedunculated polypoidal mass arising from the posterior wall of the rectum. A polypectomy specimen on microscopy showed the components of all the three germ layers. This may be the largest polypoidal type of rectal teratoma reported in the English literature to date. A review of the literature indicated only 50 previously reported cases, with all except one being female. The common presentations include prolapse and bleeding per anum.

Diagnosis of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) by fine needle aspiration cytology.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a rare benign disease of unknown etiology presenting with massive lymphadenopathy. We report four cases of this disease retrieved from the archives of cytopathology laboratory, BPKIHS, Dharan, Nepal, during the period of January 2002 to October 2007. The cytologic morphology revealed lymphocytes, plasma cells, and single to multinucleated histiocytes with well preserved lymphocytes in their cytoplasm (emperipolesis or lymphophagocytosis). It is concluded that FNAC is a useful and reliable tool for the diagnosis of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and biopsy can be avoided in these patients, thereby reducing patient inconvenience and health care cost.

Selenomethionine prevents degeneration induced by overexpression of wild-type human alpha-synuclein during differentiation of neuroblastoma cells.

OBJECTIVE: High levels of wild-type alpha-synuclein are found in autopsied brain samples of idiopathic Parkinson's disease (PD), some familial PD, some Alzheimer's disease (AD) and Down's syndrome with dementia. Therefore, we have investigated whether overexpression of wild-type alpha-synuclein causes degeneration during adenosine, 3',5'-cyclic monophosphate (cAMP)-induced differentiation of murine neuroblastoma (NB) cells in culture. We have also studied whether selenomethionine can modify the effect of overexpression of alpha-synuclein during differentiation of NB cells. METHODS: To study these issues, we established a murine neuroblastoma (NB) clone (NBP2-PN54-C20) that expressed high levels of wild-type human alpha-synuclein as determined by real time PCR and Western blot. We have utilized RO20-1724, an inhibitor of cyclic nucleotide phosphodiesterase, and prostaglandin A1 (PGA1), a stimulator of adenylate cyclase, or RO20-1724 and dibutyryl cAMP to induce terminal differentiation in over 95% of the cell population by elevating the intracellular levels of cAMP in NB cells. The viability of cells was determined by MTT assay and LDH leakage assay, and the degeneration was documented by photomicrographs. RESULTS: The results showed that overexpression of human wild-type alpha-synuclein decreased viability and increased degenerative changes in comparison to those observed in vector control cells, when differentiation was induced by treatment with RO20-1724 and PGA1, but not with RO20-1724 and dibutyryl cAMP. When selenomethionine was added to NB cells overexpressing alpha-synuclein immediately after the addition of RO20-1724 and PGA1, the viability and degenerative changes were markedly reduced, suggesting the involvement of increased oxidative stress in the mechanism of action of alpha-synuclein. This protective effect was not observed after treatment with sodium selenite or methionine. CONCLUSIONS: Data suggested that Overexpression of wild-type human alpha-synuclein-decreased viability and increased the levels of degenerative changes during differentiation of NB cells were reduced by selenomethionine treatment. This suggest that one of mechanisms of action alpha-synuclein may involve increased oxidative stress.