Proximal-type epithelioid sarcoma of the maxilla with metastasis to the scalp: Cytologic findings of an unusual malignant tumor.

Epithelioid sarcoma of proximal type (ESPT), a subtype of epithelioid sarcoma, is an uncommon malignant neoplasm of the soft tissue with histo- and cytologic features similar to epithelioid sarcoma, classic type and to the more commonly encountered extra-renal malignant rhabdoid tumor (EMRT). Unlike classic epithelioid sarcoma, ESPT usually involves pelvic, perineal, and genital regions and has an aggressive clinical course. Like EMRT, ESPT can have aberrations of the INI1 gene on chromosome 22q, which results in the loss of INI1 protein expression. We describe here the cytological findings of an ESPT metastatic to the scalp in a 14-year-old boy. Cytological preparations showed a discohesive population of pleomorphic ovoid to polygonal cells with large irregular nuclei and prominent nucleoli. Isolated cells with rhabdoid features were noted. These cells had abundant cytoplasm and occasional intracytoplasmic hyaline inclusions. In the light of the patient's clinical history of a known primary ESPT of the maxilla, the cytologic features were distinct enough to render a diagnosis of a metastatic lesion to the skull.

MALT lymphoma of the floor of the mouth: a case report.

MALT (mucosa-associated lymphoid tissue) lymphomas are low-grade extranodal B-cell lymphomas that may involve various sites in the head and neck including the thyroid, salivary, and lacrimal glands. Development of MALT lymphoma in the head and neck is often associated with autoimmune diseases such as Sjögren syndrome or Hashimoto thyroiditis. Here we report a case of a MALT lymphoma of the floor of the mouth that likely arose in the sublingual gland. The patient was successfully treated with external-beam radiation therapy and remained disease-free at the 4-year follow-up.

Cytology of a sarcomatoid renal cell carcinoma with unusual coexpression of S-100 protein: a case report, review of the literature and cytologic-histologic correlation.

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive variant of renal cell carcinoma; it is an uncommon, malignant neoplasm, and its diagnosis is usually based on the histologic evaluation of a nephrectomy specimen. Patients are treated with systemic therapy and, generally, a nephrectomy is not performed. Therefore, arriving at an accurate diagnosis is critical for planning further management. Cytomorphological findings of SRCC have rarely been reported. This article reports the cytological findings in a case of SRCC composed predominantly of spindle cells and discusses its differential diagnosis in a 50-year-old female who presented with sharp right groin pain. A CT scan showed an enlargement of the right kidney. Cytology smears showed a malignant neoplasm composed predominantly of spindle cells. A panel of immunohistochemical stains performed on a core biopsy confirmed the epithelial nature of the spindle cells. A diffuse positive staining of the neoplastic cells for S-100 protein was also observed. It has been reported in the medical literature that almost all SRCC cases demonstrate negative staining for S-100 protein, with only a single case having been reported as focally positive. The cytologic differential diagnosis of spindle cell neoplasm with expression of S-100 protein should be broadened to include SRCC. Furthermore, the S-100 protein expression in SRCC that was observed in this case merits further investigation.

Pulmonary and cardiovascular complications of obesity: an autopsy study of 76 obese subjects.

CONTEXT: Obesity is associated with sleep disordered breathing and cardiovascular morbidity, but the relationship between pulmonary hypertension, heart disease, and obesity is unknown. OBJECTIVE: To determine the prevalence of pulmonary and cardiovascular disease in obese subjects undergoing autopsy at a large medical center. DESIGN: A search through autopsy records from an 11-year period identified 76 subjects with a body mass index greater than 30 kg/m(2) and 46 age-matched, nonobese controls. Clinical data were collected from medical charts and autopsy records. Formalin-fixed, paraffin-embedded sections of lungs and heart were reviewed for each subject. The presence of pulmonary edema, hemorrhage, diffuse alveolar damage, thrombi, and pulmonary hypertensive changes, including intimal fibrosis, medial hypertrophy, muscularization of arterioles, alveolar capillary hemangiomatosis, hemosiderosis, and iron encrustation were documented. Hearts were examined for the presence of cardiomegaly, ventricular hypertrophy, coronary artery atherosclerosis, acute infarction, fibrosis, and inflammation. Differences between the obese and control groups were compared using a statistical software program. RESULTS: The obese group demonstrated a greater occurrence of diabetes mellitus, systemic hypertension, pulmonary edema, hemorrhage, and pulmonary hypertensive changes compared with the control group. Alveolar capillary hemangiomatosis was exclusively observed in the obese subjects. Cardiomegaly and left ventricular hypertrophy were present in all obese subjects; approximately one third of the obese subjects had no coronary atherosclerosis. CONCLUSIONS: Pulmonary hypertensive changes, including venous hypertension and capillary hemangiomatosis, were observed in 72% of obese subjects. Cardiomegaly with biventricular hypertrophy was present in all obese subjects and was suggestive of obesity cardiomyopathy.

Multiple pilomatrixomas: case report and literature review.

Pilomatrixoma is a rare, benign, circumscribed, calcifying epithelial neoplasm that is derived from hair matrix cells. Multiple pilomatrixomas are uncommon. We describe a case of multiple pilomatrixomas in a 23-year-old black woman who presented with lesions on her face and back. Based on the results of the clinical examination, she was provisionally diagnosed with either calcified sebaceous cysts or calcified lymph nodes. She underwent surgical excision of the masses. On histopathology, the lesions were identified as pilomatrixomas. We attribute our original failure to diagnose this condition to our lack of familiarity with it. We discuss the presentation, differential diagnosis, and other characteristics of pilomatrixomas.

Do cytogenetic abnormalities precede morphologic abnormalities in a developing malignant condition?

Cytogenetic evaluation of bone marrow and neoplastic tissues plays a critical role in determining patient management and prognosis. Here, we highlight two cases in which the cytogenetic studies challenge the common practice of using hematologic and morphologic changes as key factors in malignant disease management. The first case is that of a lymph node sample from a 40-yr-old non-Hodgkin's lymphoma (NHL) patient sent for determination of disease progress. Hematologic studies showed no evidence of transformation to high-grade NHL (>15% blasts with rare mitotic figures). Cytogenetic studies of lymph node showed multiple clonal abnormalities, most notably a der(18) from a t(14;18) which is associated with high-grade NHL. After two cycles of chemotherapy with fludarabine, the patient did not show any clinical response, suggesting possible progression to high-grade lymphoma. The second case is of a patient with a history of human immunodeficiency virus and blastic natural killer leukemia/lymphoma. Hematologic studies of ascitic fluid classified the patient as having pleural effusion lymphoma whereas bone marrow analysis showed no malignancy. Bone marrow cytogenetic studies showed multiple clonal abnormalities including a t(8;14), which is commonly associated with Burkitt's lymphoma (BL). To our knowledge, this is the first case wherein a morphologically normal bone marrow showed presence of clonal abnormalities consistent with BL or Pleural effusion lymphoma. After two cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, the patient's general condition and ascitis improved and she was discharged. These studies clearly demonstrate that genetic changes often precede morphologic changes in a developing malignant condition. Therefore, the critical information needed for care of patients with malignant disorders may be incomplete or inaccurate if cytogenetic evaluation is overlooked.

The effects of intradermal and topical mitomycin C on wound healing.

OBJECTIVE: To determine the effect of intradermal and topical mitomycin C (MMC) on skin wound healing. STUDY DESIGN/SETTING: A prospective, controlled study in a rat wound model performed in an academic medical center. RESULTS: Intradermal and topical MMC application decreased wound integrity when compared with saline-treated animals at 1 week, 2 weeks, 1 month, and 6 months. Skin necrosis occurred in animals that received intradermal MMC. Hemotoxylin and eosin and immunohistochemical staining showed no consistent difference between treatment arms. Fibrosis and collagen deposition were reduced in MMC-treated wounds on trichrome staining. CONCLUSIONS: MMC-treated wounds showed decreased wound strength compared with controls. Intradermal MMC can cause skin necrosis. Histologic findings did not always correspond with clinical data. SIGNIFICANCE: The data suggest cautious use of MMC in clinical situations when wound breaking strength is critical.