Metastatic calcification involving the true vocal cord.

Metastatic calcification (MC) commonly results secondary to phosphorus and calcium dysregulation in end-stage renal disease (ESRD). Only once before has MC been reported to involve a true vocal cord. A 35-year-old man with ESRD and secondary hyperparathyroidism was evaluated for hoarseness. Three years ago, he underwent a total parathyroidectomy with parathyroid autograft to the forearm. Simultaneously, he had a left lobe thyroidectomy that displayed a papillary thyroid carcinoma. Since that time, he continued to have hyperphosphatemia and hypocalcemia. Laryngoscopy displayed a small papillomatous lesion on the right true vocal cord. He underwent excision of the vocal cord lesion; histologic examination demonstrated benign squamous epithelium with extensive submucosal calcification. In patients with ESRD with secondary dysregulation of serum phosphorus to calcium level balance, MC may involve variable anatomical locations, including the true vocal cords. Regarding histologic findings, pathologists must consider malignancies associated with calcification, mimicking a benign process.

Fine needle aspiration biopsy of metanephric adenoma: a case report.

BACKGROUND: Metanephric adenoma (MA) is a rare, benign renal neoplasm. Only 3 previous case reports describe the fine needle aspiration biopsy (FNAB) cytologic features of MA. Regarding treatment, radioflrequency ablation (RFA) is an emerging alternative to surgical resection of renal neoplasms in appropriately selected patients. CASE: A 49-year-old woman had a 3.3-cm cortical mass in the left kidney. Computed tomography-guided FNAB was performed, followed by RFA of the lesion. The aspirate smears displayed multiple aggregates of benign-appearing, tightly packed and overlapping nuclei surrounded by basement membrane- type material. The cohesive aggregates were arranged in tubular or tubulopapillary structures without fibrovascular cores. No atypia, mitotic figures or necrosis were present. Immunohistochemical (IHC) stains performed displayed positive staining for WT-1, CD57 and cytokeratin AE1/AE3 and equivocal staining for CD56. The AMACR, CK7 and EMA immunostains were negative. Although the differential diagnosis included adult Wilms' tumor and papillary renal cell carcinoma, the bland morphology and IHC staining pattern strongly favored a neoplasm consistent with MA. CONCLUSION: FNAB can be used to diagnose most renal neoplasms. A diagnosis of MA can be suggested on FNAB in the context of appropriate cytomorphology, IHC staining and cytogenetic analysis.

Fine-needle aspiration biopsy cytology of cutaneous calcinosis in a 74-year-old woman with dermatomyositis on methotrexate therapy: a case report.

BACKGROUND: Cutaneous calcinosis (CC) occurs in a variety of rheumatic diseases. Fine needle aspiration biopsy (FNAB) may be used in the office setting to evaluate such soft tissue lesions. For patients on methotrexate (MTX) therapy, methotrexate nodulosis (MN) should be considered in the differential diagnosis. CASE: A 74-year-old Caucasian woman with adult-onset dermatomyositis (ADM) on MTX therapy presented for evaluation of a right breast mass and multiple soft tissue nodules. FNABs of the right breast mass and a left upper extremity nodule both demonstrated benign calcified material. Six months later, the patient returned for evaluation of the persistent right breast mass and repeat FNAB revealed adenocarcinoma. Concurrently, a right hip soft tissue nodule was aspirated, demonstrating benign crystalline debris. MTX therapy was discontinued, and the patient subsequently underwent a lumpectomy of the right breast 1 month after FNAB diagnosis, displaying infiltrative ductal carcinoma. Of note, 2 months after her lumpectomy, MTX therapy was restarted and the patient continues to have adequate control of ADM symptoms with persistent, clinically benign soft tissue calcifications. CONCLUSION: Performing FNAB on soft tissue lesions can obviate needless tissue biopsies of CC in appropriate rheumatology patients, thus avoiding the risks and complications associated with more invasive procedures.

Cytomorphologic features of primary peritoneal mesothelioma in effusion, washing, and fine-needle aspiration biopsy specimens: examination of 49 cases at one institution, including post-intraperitoneal hyperthermic chemotherapy findings.

Primary peritoneal mesotheliomas (PPMs) are rare tumors of adults. At our institution, PPMs are treated with a combination of cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) in appropriate patients. We present a summary of cytologic features of PPM in 49 positive (malignant) specimens during a 15-year period at 1 institution. Of the corresponding 49 PPM histologic specimens, 46 were epithelial, 2 sarcomatoid, and 1 multicystic mesothelioma. This includes our experience with washing specimens obtained from patients with PPM following treatment with cytoreductive surgery combined with IPHC. The rarity of PPM makes this neoplasm unfamiliar to most pathologists. However, cytologic features can be diagnostic in a majority of cases. We present a summary of cytologic features that, in our experience, we find to be most useful in making or excluding a diagnosis of PPM. To our knowledge, this is the first large series reporting the cytomorphologic features of PPM in peritoneal effusions, pelvic washing specimens, and infradiaphragmatic fine-needle aspiration biopsy specimens.

Are pathologists accurately diagnosing eosinophilic esophagitis in children? A 9-year single academic institutional experience with interobserver observations.

Our aims were to evaluate (a) whether the incidence of eosinophilic esophagitis (EE) in children has increased, (b) whether the histologic diagnosis of EE has been accurate, and (c) potential interobserver variability in the counting of intraepithelial eosinophils in esophageal biopsies. A total of 1215 pediatric endoscopic esophageal biopsies were performed. In total, 289 biopsies were reviewed by one pathologist based on one of the following original histologic diagnoses: EE, reflux esophagitis (RE), or acute/chronic inflammation. EE was diagnosed when at least one high-power field (HPF) contained > or = 20 intraepithelial eosinophils. According to the first pathologist, 104 biopsies had a histologic diagnosis of EE; the prevalence remained relatively stable, ranging from 5.5 to 11 per 100 biopsies annually. In 36 cases, the reporting pathologist correctly diagnosed EE, and in another 34, EE was included in the differential diagnosis. From January 1997 to December 1998, the pathologist either correctly diagnosed EE or included it in the differential diagnosis in 6/13 cases. In contrast, from January 2004 to December 2005, 32/37 cases were included. In 34/104 cases, EE was misdiagnosed as RE. No case of RE was misdiagnosed as EE.A total of 58 cases had pathology reports that quantified the densest number of eosinophils per HPF. The agreement rate was 94.8%, with a kappa value of 0.888. The incidence of EE in children has been stable from January 1997 to December 2005. Overall, pathologists recognized EE in two thirds of cases. The increased diagnostic accuracy over time suggests pathologists are more aware of EE.