Hyalinizing trabecular carcinoma of the thyroid gland: report of two cases of follicular cell thyroid carcinoma with hyalinizing trabecular pattern.

Recently tumors have been reported that have an architectural pattern and cellularity similar to hyalinizing trabecular adenoma and show either parafollicular differentiation or histological findings suggestive of malignant neoplasm of the follicular cells. This study describes two cases of thyroid carcinoma of follicular cells that displayed a hylinizing trabecular pattern. The first case was a 25-year-old euthyroid woman with a cold thyroid nodule in the right lobe. On fine needle aspiration a diagnosis of papillary carcinoma was rendered. The thyroidectomy disclosed a 2-cm, firm, brown, encapsulated tumor in the right lobe. The tumor had a growth pattern and cytologic features similar to those described in hyalinizing trabecular adenoma. The differences between these neoplasms were the presence of mitotic figures, prominence of the nucleolus, capsular blood vessel invasion, and microtubule groups in the endoplasmic reticulum. The second case was a 19-year-old euthyroid woman with a cold thyroid nodule in the left lobe. A cytologic diagnosis of follicular proliferation was rendered. A 4-cm, firm, whitish, encapsulated nodule was found in the left lobectomy. The tumor cells were arranged in two clear-cut patterns: a trabecular hyalinizing pattern with a small focus of papillary growth, and a follicular pattern. These findings confirm the existence of malignant thyroid tumors with a hyalinizing trabecular pattern and illustrate the nonspecificity of this peculiar pattern, since it may also be seen in papillary carcinomas of the thyroid. The relationship between hyalinizing trabecular adenoma and papillary carcinoma of the thyroid is commented on.

Mandibular lymphomas with sclerosis.

Two cases of non-Hodgkin's lymphoma that show a sarcomatoid pattern within the jaw are described. Their primary origin in bone was demonstrated by radiologic studies. In one case, diagnosis was delayed because the clinical picture suggested inflammatory periodontal disease. In both cases, the histologic picture was similar to that of a sarcomatoid neoplasm with intense stromal sclerosis; hemimandibulectomy was performed in one case. The tumor contained cells with large, irregular, sometimes lobulated nuclei and high mitotic activity, and perforated mandibular bone with infiltration into adjacent soft tissues. The lymphoid nature of these neoplasms was demonstrated by immunohistochemical and ultrastructural study.

Value of ploidy pattern and nuclear texture in the diagnosis of primary hyperparathyroidism.

OBJECTIVE: To determine if there are subvisual differences (quantitation of DNA and study of chromatin texture) that distinguish single-gland parathyroid disease (adenoma) from multiple-gland disease (hyperplasia). STUDY DESIGN: Forty-eight parathyroid glands from 41 patients with primary hyperparathyroidism were studied. Cytometric differences between the chief cells and clear cells were sought. An image cytometer was used to study histologic sections stained with DNA stain reagent. In each case a total of 200 cells were measured in consecutive fields. To distinguish chief cells from clear cells, a sample of 15,600 cells collected in consecutive fields in 78 histologic sections was analyzed. RESULTS: The results indicated that none of the continuous variables differentiated between single-gland and multiple-gland parathyroid disease. The most common ploidy pattern was diploid (25/45), followed by hypodiploid (7/45) and polyploid (5/45). A tetraploid population > 3% was found in 18/45 of the cases and was more frequent in single-gland lesions (15/34) than in multiple-gland lesions (3/11). The most significant discrete variables were growth pattern and binucleation or multinucleation. Clear and chief cells were classified correctly in 61.3% of the crossover validation tests using the standard deviation of nuclear shape karyometric variable and in 76.3% using the standard deviation of maximal correlation coefficient karyometric variable. Although ploidy pattern did not show significant differences, polyploidy, aneuploidy and tetraploidy > 3% were slightly more common in chief cells. CONCLUSION: In primary hyperparathyroidism there are no subvisual differences that can distinguish adenoma from hyperplasia. Nonetheless, by cytometry, most parathyroid cells can be classified correctly as clear or chief cells.

Diffuse tenosynovial giant cell tumor of soft tissues. Report of a case with cytologic and cytogenetic findings.

Extraarticular diffuse tenosynovial giant cell tumor is an unusual lesion the cytologic picture of which has not been discussed much in the literature. Fine needle aspiration biopsy of a nonpainful mass in the right shoulder in an 18-year-old woman revealed a highly cellular lesion consisting of polygonal cells and multinuclear giant cells with scant nuclear pleomorphism and a marked tendency toward xanthomization. Electron microscopy identified two basic cell populations among many intermediate forms: cells with scant filopodia and abundant ribosomes and cells with well-developed prolongations and numerous mitochondria, lysosomes and lipid drops. The karyotype of the tumor cells obtained from a surgically excised specimen showed a clonal population with 45, XX, t(1;2) (pter->p22::q24->pter), t(1:14)(qter->p13::q13->ter). The cytologic differential diagnosis included other tenosynovial lesions containing xanthomatous cells. Cytogenetic findings are discussed in relation to chromosomal alterations previously found in related lesions (nodular tenosynovitis and pigmented articular villonodular synovitis).

Papillary cystic neoplasm of the pancreas with liver metastasis coexisting with thyroid papillary carcinoma.

BACKGROUND: Papillary cystic neoplasm of the pancreas is an uncommon neoplasm that usually appears to be benign or to have a very low potential for metastasis. We report a case of a patient with papillary and cystic neoplasm of the pancreas, which metastasized to the liver and concomitantly presented a stage I thyroid papillary carcinoma. CASE DESCRIPTION: The patient was a 38-year-old woman with a 12-year history of abdominal pain. She was first admitted to the hospital 3 years after symptoms began, and an exploratory laparotomy revealed a pancreatic cystic lesion that was diagnosed as a pancreatic pseudocyst, which drained by cystojejunosotomy. Nine years after onset, a stage I thyroid papillary carcinoma was excised. One-and-a-half years later, the patient was readmitted to the hospital for evaluation of a palpable abdominal mass. Abdominal computerized axial tomography disclosed a large pancreatic tumor and two nodular lesions of the liver. Papillary cystic neoplasm of the pancreas was diagnosed by cytologic, histologic, and ultrastructural studies of samples obtained directly from the pancreatic mass using fine-needle aspiration biopsy. The patient underwent palliative chemotherapy with mitomycin C, 4-epiadriamycin, and 5-fluorouracil. One year after this treatment began, a computerized axial tomography scan showed persistence of the pancreatic mass, with more prominent cystic spaces, increase in size and in number of the lesions in the liver, slight increase in the lesion of the right ovary, and a new lesion that also had solid and cystic areas in the spleen. CONCLUSION: The pathologic and clinical features of patients with papillary cystic neoplasm of the pancreas, based on tumoral extension, reveal localized tumors (88.2%), tumors with local infiltration or recurrence (6.2%), and tumors with metastasis at a distance (5.6%). Although strong similarities exist among the three groups, there are certain differences in age of presentation, previous clinical diagnosis of pseudocyst, and tumor location.

Glomus tumour of the oropharynx.

Haemangiopericytoma and glomus tumours are infrequent neoplasms in otorrhinolaryngology. A case of glomus tumour with haemangiopericytomatous features of the left amygdalar fossa is reported. Its clinical, surgical and histological features are described. This case report supports the unitary concept of smooth muscle tumours of the small vascular wall.

Paragangliomas. Static cytometric studies of nuclear DNA patterns.

BACKGROUND: The biologic behavior of most paragangliomas cannot be predicted from their histologic appearance. Recently, cytometric studies have found an association between an aggressive clinical behavior and the presence of a hyperdiploid or tetraploid range in the DNA nuclear content. METHODS: The authors have studied morphometric (nuclear area and nuclear form factor) and DNA densitometric (integral optical density and DNA ploidy) features of 23 cases of paraganglioma by means of slide cytophotometry with the microTICAS system (University of Chicago, Chicago, IL). The samples were selected from paraffin-embedded tissue, and representative sections were stained with the Feulgen technique. The differences between groups (cervical versus extracervical paragangliomas) were investigated with the Mann-Whitney test and Fisher discriminant linear function. RESULTS: The densitometric study showed aneuploid cell lines in 15 of 16 noncervical paragangliomas (with a DNA index within the tetraploid range), whereas 3 of 7 cervical paragangliomas were aneuploid and only 1 case did not have not a diploid cell line (with a DNA index within the peridiploid range). Mean ploidy (4.33 arbitrary units [AU] and 2.72 AU, respectively), nuclear area (58.74 microns 2 and 32.08 microns 2, respectively), the minor and major DNA indices (1.09-1.24 and 1.83-1.96, respectively), and DNA content variability (2c deviation indices [2cDI] of 8.62 and 1.88 AU, respectively) were higher in noncervical paragangliomas. With Fisher linear discriminant function, mean nuclear area (P = 0.0008), 2cDI (P = 0.0030), and the minor DNA index of each cell proliferation were correlated with location. None of the variables established statistically significant differences in comparisons of malignant and benign paragangliomas. CONCLUSIONS: Karyometric and DNA densitometric parameters have limited value in determining the prognosis of paragangliomas, although they are correlated with tumoral location, which is still an indicator in establishing the prognosis of these neoplasms.

[Abscessing rhombencephalitis caused by Listeria in an iummunodepressed patient]. / Rombencefalitis abscesificante por Listeria en paciente inmunodeprimido.

The cerebral trunk infection by Listeria monocytogenes is a very rare process, with only 24 described cases and only 2 in immunodepressed patients. We present a new case of cerebral trunk encephalitis caused by Listeria in a patient diagnosed of Polyarteritis nodosa on steroids and cyclophosamide treatment and fatal evolution, and whose hemoculture, spinal fluid culture and cranial CT scan did not contribute to the diagnosis. A necrotizing lesion in the protuberance with mesencephalic extension was observed in the necropsy study in which intra- and extracellular Gram + and silver positive bacilli were detected. Since L. monocytogenes was suspected as the causative agent, indirect immunofluorescence was performed on histological preparations with hyperimmune anti-L. monocytogenes serum giving a clearly positive result. In our case, this technique permitted the etiological diagnosis in the absence of positive cultures.