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INTRODUCTION: Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) is a rare tumour of the pancreas which can mimic groove pancreatitis. CASE REPORT: We present a 49-year-old Indian male presented with constant, dull-aching epigastric pain for last 6 months radiating to back, not associated with jaundice, gastrointestinal bleed, fever or weight loss. He also had history of alcohol abuse for last 15 years. Physical examination was unremarkable. Laboratory investigations were within normal limits. Contrast enhanced computed tomography (CT) of the abdomen was suggestive of groove pancreatitis. CA 19.9, CEA and IgG4 levels were normal. Upper gastrointestinal endoscopy revealed an oedematous mucosa with narrowing of second part of duodenum. Endoscopic ultrasound (EUS) showed bulky pancreas with ill-defined heteroechoic head with periduodenal soft tissue thickening. EUS guided fine needle aspiration revealed chronic inflammatory cells. Based on the endoscopic findings and imaging, we suspected the diagnosis to be groove pancreatitis. He underwent open Whipple's pancreaticoduodenectomy. Histopathological evaluation revealed well differentiated neuroendocrine tumour and immunohistochemistry revealed features which was consistent with mixed neuroendocrine-non-neuroendocrine tumour (MiNEN). Post-operative period was uneventful and he was discharged on post-op day 7. A PET-CT scan was done to look for any silent metastasis and it was negative. He recieved 4 cycles of cisplatin-based chemotherapy. He was symptom free and doing well on 12 months follow up with no evidence of recurrence in surveillance CT imaging. DISCUSSION: Pancreatic MiNEN is characterised by presence of two malignant tissues, adenocarcinoma and NET, with one constituent involving at least 30% of the tumour. We report the pitfalls in diagnostic work-up which can lead to misdiagnosis of this rare entity. Specially due to admixture of different kinds of tissue, radiological investigations can be misleading. CONCLUSION: Our case highlights the fact that MiNEN of pancreas can mimic a benign condition like groove pancreatitis. If routine histopathological and immunohistochemical evaluation is not done on the resected samples, relying on radiological and fine-needle aspiration cytology evidences, the actual diagnosis could be missed.
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BACKGROUND: The role of aspiration cytology has largely been ignored in pediatric population. The present study was undertaken to evaluate the role of fine needle aspiration cytology (FNAC) in non-hematological neoplasms in children in our institution, which is a rural tertiary care center. MATERIALS AND METHODS: A total of 88 cases of non-hematological pediatric mass lesions were studied in which cytopathological diagnosis could be corroborated with histopathology. RESULTS: Out of all the cases, 70 (80%) cases were benign tumors and 18 (20%) were malignant tumors. Fibroadenoma (37.9%) comprised the majority of cases in the benign category while small round cell tumors (SRCTs) (44.4%) comprised the majority of cases in the malignant category. Definite diagnosis could be offered based on the cytomorphology in 79.5% cases, while in 20.5% of cases only a broad cytological classification could be offered. Among the malignant lesions, FNAC showed 100% sensitivity while a specific diagnosis was made in 90% of cases. CONCLUSION: FNAC proved to be a rapid and fairly accurate tool in diagnosing non-hematological tumors in the pediatric age group.
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BACKGROUND: Diagnosis of retroperitoneal lesions is one of the most difficult areas in surgical pathology. Both primary and metastatic tumors can grow silently in retroperitoneum before the appearance of clinical signs and symptoms. Guided aspiration cytology has shown a promising role in diagnosis of lesions in this region. AIMS: This study was undertaken to evaluate the reliability of guided fine-needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal masses and to study the spectrum of retroperitoneal lesions in a rural tertiary care hospital. MATERIALS AND METHODS: This study was done on 71 patients presenting with retroperitoneal masses over a period of 20 months in a tertiary care hospital. Ultrasound-guided FNAC was done and the smears were stained by MGG and H and E stains. Histopathological corroboration could be done on all neoplastic lesions along with some non-neoplastic lesions. RESULTS: Out of 71 cases, 48 cases (67.6%) were found to be neoplastic. Malignant tumors (35 cases) were more common than benign ones (13 cases). Malignant lesions were predominantly composed of lesions of lymph node (17 cases i.e. 48.57%) followed by sarcomas (5 cases) and germ cell tumors. Some uncommon retroperitoneal lesions like adrenal myelolipoma, renal angiomyolipoma, Burkitt's lymphoma and adrenocortical carcinoma were found in our study. Guided FNAC could diagnose all the malignant lesions with 100% accuracy except in 2 cases of poorly differentiated carcinoma which came out to be non-Hodgkin lymphoma on subsequent biopsies. CONCLUSION: Guided FNAC is an inexpensive, rapid and reliable method for diagnosis of retroperitoneal masses.
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Adrenocortical carcinoma (ACC) is a rare malignancy and cytodiagnosis of this tumor is not routinely encountered by a cytopathologist. Here, we report a case of ACC initially diagnosed by computed tomography (CT)-guided fine needle aspiration cytology (FNAC) with the help of immunocytochemistry. A 48-year-old lady presented with flank pain and abdominal mass for the last 6 months. A CT scan of her abdomen revealed a large mass arising from the upper part of the left kidney. CT-guided FNAC was performed. Cytologic smears showed pleomorphic large cells arranged discretely and in small aggregates against a myxoid background. The cells had a high nucleocytoplasmic ratio, anisonucleosis and conspicuous nucleoli. Based on cytomorphology, differential diagnoses of ACC and renal cell carcinoma (RCC) were made. On immunocytochemistry, the tumor cells were synaptophysin, inhibin, vimentin and Melan-A positive but cytokeratin and epithelial membrane antigen negative. Thus, a cytodiagnosis of myxoid ACC was made and histopathologic examination was suggested. Subsequent histologic examination and immunohistochemistry proved the case to be myxoid ACC.