Primary mucinous adenocarcinoma of the ureter and renal pelvis: A case report.

ABSTRACT: Primary adenocarcinoma rarely occurs in the upper urinary tract and accounts for less than 1% of the urothelial tumors. Here we present a case report of a 45-year-old female patient who presented with a lump in the abdomen and pain in the right lumbar region for 2 months. Various radiological investigations revealed right-sided hydronephrosis with enhancing masses in the right proximal ureter and renal pelvis associated with multiple calculi. A gross examination of the right nephrectomy specimen revealed multiple cystic areas filled with mucinous material and papillary projections in the renal pelvis. A necrotic growth was observed in the right proximal ureter in association with the staghorn calculus in the renal pelvis. Histological examination of the ureteric mass and solid areas from the renal pelvis showed acini and papillary projections lined by pseudostratified columnar epithelium showing malignant changes. Surrounding areas also revealed intestinal metaplasia with moderate to marked dysplasia in some places. The ureteric malignancy was observed to infiltrate the inner two-thirds of the wall of the ureteric muscular layer and extend until the margin of excision. Thus, a diagnosis of mucinous adenocarcinoma of the ureter and renal pelvis with intestinal metaplasia and dysplasia that occurred in association with a large staghorn calculus was made.

Histopathological Spectrum of Tumor and Tumor-like Lesions of the Paratestis in a Tertiary Care Hospital.

OBJECTIVES: Tumors and tumor-like lesions (TLL) of the paratesticular region are rare. Very few studies depicting the spectrum of lesions of this location are available in the literature. Malignant neoplasms arising in the paratesticular region represent only 7.0% of malignant tumors presenting as a scrotal mass. TLL and benign tumors are of great interest, because of their topography they can simulate a neoplasm in the paratesticular structures. We sought to study the incidence, nature, pattern, clinical, immune, and histopathological characteristics of tumors and TLL of the paratestis. METHODS: In this six-year study, records of the cases were reviewed and the histopathology slides were reassessed. Blocks were retrieved and stained immunohistochemically for relevant markers. RESULTS: A total of 47 cases of tumor and TLL of the paratestis were diagnosed over a six-year period. The patients ranged from one to 76 years old and most presented with a scrotal mass. Of these, seven (14.9%) were benign. Lipoma was the most common benign tumor. One case each of adenomatoid tumor, scrotal hemangioma, solitary fibrous tumor, and papillary cyst adenoma were reported. The TLL (70.2%) comprised of 17 cases of epididymal cyst, seven cases of tuberculous epididymitis, four cases of filarial epididymitis, two cases each of non-specific granulomatous epididymitis and fibromatous periorchitis, and one case of mesothelial cyst. Seven malignant tumors (14.9%) were diagnosed all of which were sarcomas. All seven were primary to the paratesticular region. The most common malignant tumor was embryonal rhabdomyosarcoma. One case each of malignant mesothelioma, malignant fibrous histiocytoma, atypical lipomatous tumor/well-differentiated liposarcoma, and myxoid liposarcoma were identified. CONCLUSION: Neoplasms of the paratesticular region affect patients of all ages, with potentially life-threatening sequelae. Awareness of the entire spectrum and meticulous histopathological examination and immunohistochemical studies are of prime importance in the diagnosis of the various lesions as these influence the mode of therapy and subsequent prognosis of the patient.

Omphalocele, exstrophy of cloaca, imperforate anus and spinal defect (OEIS Complex) with overlapping features of body stalk anomaly (limb body wall complex).

OEIS is an extremely rare constellation of malformations, which includes omphalocele, exstrophy of cloaca, imperforate anus, and spinal defect. We report here autopsy findings in a case of OEIS complex, which apart from the major anomalies of the complex had bilateral club foot that is, congenital talipes equinovarus, right hydroureter, and body stalk anomaly. The umbilical cord was absent, and the umbilical vessels were embedded in an amniotic sheet, which connected the skin margin of the anterior body wall defect to the placenta, this feature being the hallmark of limb body wall complex (LBWC). This case further supports the view that OEIS and LBWC represent a continuous spectrum of abnormalities rather than separate conditions and may share a common etiology and pathogenetic mechanism as proposed by some authors.

Tracheal agenesis with broncho-esophageal fistula in VACTERL / TACRD association.

Tracheal agenesis (TA) is an extremely rare malformation. We report here autopsy findings in a case of TA with bronchoesophageal fistula of Floyd type III. The other malformations present included laryngeal atresia, Right lung hypolobulation, ventricular septal defect in membranous portion, bilateral cystic renal dysplasia, spleninculus, Meckel's diverticulum, and imperforate anus. The constellations of malformations present in our case have overlapping features with Vertebral anomalies, Anal atresia, Cardiovascular anomalies, Tracheo-esophageal fistula, Esophageal atresia, Renal anomalies, Limb anomalies and Tracheal atresia or laryngo tracheal atresia, Cardiac anomalies, Renal anomalies, Duodenal atresia association described previously in the literature.

Rabies viral encephalitis with proable 25 year incubation period!

We report a case of rabies viral encephalitis in a 48-year-old male with an unusually long incubation period, historically suspected to be more than 20 years. The case was referred for histological diagnosis following alleged medical negligence to the forensic department. The histology and immunocytochemical demonstration of rabies viral antigen established the diagnosis unequivocally. The case manifested initially with hydrophobia and aggressive behavior, although he suddenly went to the bathroom and drank a small amount of water. History of dog bite 25 years back was elicited retrospectively following clinical suspicion. There was no subsequent history to suggest nonbite exposure to a rabid dog to consider recent event causing the disease, although this cannot be totally excluded.

Resultados preliminares da utilizaçäo de cultivos de anéis de traquéia para o estudo de estirpes brasileiras do vírus da bronquite infecciosa das galinhas / A preliminary use of tracheal organ cultures for evaluating Brazilian infectious bronchitis virus strains

Tracheal organ cultures (TOC) were prepared and used for evaluating four Brazilian isolates of infectious bronchitis virus (IBV). IBV field isolates and vaccine strains were titrated in TOC and results compared to those from chicken embrionated eggs. Serum neutralization (SN) employing IBV strain-specific serum was performed for evaluating relationships between isolates. Titration results of tests performed in TOC or eggs were in mutual agreement and were considered for validating the adapted TOC methodology as alternative for virological studies in our laboratory. Sera specific to M41 (Massachusetts) or A5968 (Connecticut) did neutralize their respective IBV strains only. Field strains 208 and 29-78 specific sera did neutralize Massachusetts serotype strains M41 and H120, but PM2 serum did only M41. Strain PM4 specific serum did not neutralize any of the reference IBV analyzed, including M41, A5968 and H120 and may indicate that the isolate is serologically different from the Massachusetts serotype, currently adopted for vaccine strains in Brazil

Malignant phyllodes tumor metastatic to the forearm: a case report.

We describe the cytological features of a malignant phyllodes tumor, in a 40-yr-old female, that metastasized to the forearm, and we correlate these findings with the criteria suggested by other authors for predicting the clinical and metastatic behavior of this tumor. The diagnosis of metastasis was based on fine-needle aspiration (FNA) cytology. One year prior, the patient had undergone mastectomy of the left breast for malignant phyllodes tumor, as proven by histopathology. The patient then presented with right forearm swelling, 1 yr later. FNA cytology was performed, and the diagnosis was metastatic malignant phyllodes tumor. Histologic review of the breast tumor revealed stromal overgrowth, which is the most important histologic criterion for predicting the metastatic behavior of malignant phyllodes tumor as reported by some authors.

Solid and papillary epithelial neoplasm of the pancreas. Report of a case with diagnosis by fine needle aspiration cytology.

BACKGROUND: Solid and papillary epithelial neoplasm of the pancreas is a distinct clinicopathologic entity. It has a benign clinical course, and surgical resection can be curative. CASE: A 17-year-old female presented with a mass measuring about 12 cm in the epigastrium and left hypochondrium. Fine needle aspiration cytology (FNAC) showed papillae with a central fibrovascular core and lined with many layers of bland-appearing cells exhibiting nuclear grooving. These features, along with ultrasound and computed tomographic findings, led to an accurate preoperative diagnosis. CONCLUSION: In the setting of typical clinical and radiologic findings, it is possible to make a correct preoperative diagnosis by FNAC. Doing so has important implications for management.

Infarction after fine needle aspiration. A report of four cases.

BACKGROUND: Fine needle aspiration (FNA) is a well-established and safe method for the rapid diagnosis of palpable and deep-seated masses. A few clinically important complications, including bleeding, pneumothorax, infection and inflammatory reactions, result from FNA. Little attention has been focused on tissue changes resulting from FNA. In a small number of cases FNA has been followed by varying degrees of necrosis. This has occurred in thyroid nodules, salivary glands, breast fibroadenomas, lymph nodes and renal cell carcinoma. CASES: Four cases of infarction followed FNA biopsy. All 4 (1 papillary carcinoma of the thyroid, 1 pleomorphic adenoma of the parotid gland and 2 fibroadenomas of the breast) were diagnosed by FNA. Subsequent histologic study of the surgical specimens revealed massive necrosis of the neoplasms. CONCLUSION: Necrosis associated with infarction may cause diagnostic problems in two settings. FNA yielding necrotic debris may result in a false negative diagnosis in repeat aspiration. Alternatively, post-FNA infarction may obscure the nature of a neoplasm diagnosed by FNA, making histologic confirmation difficult.

Fine needle aspiration cytology of adenoma of the nipple. A case report.

BACKGROUND: Adenoma (papillary adenoma, florid papillomatosis, subareolar duct papillomatosis, erosive adenomatosis) of the nipple is an uncommon lesion and can be mistaken clinically for Paget's disease and pathologically be misinterpreted as an adenocarcinoma. CASE: A case of adenoma of the nipple was studied by cytology and histopathology. CONCLUSION: Recognition of this benign lesion on cytology will prevent unnecessary radical surgery. Local excision alone suffices.

Role of fine needle aspiration cytology as the initial modality in the investigation of thyroid lesions.

OBJECTIVE: To study the utility of fine needle aspiration (FNA) cytology as the initial modality in the investigation of thyroid lesions. STUDY DESIGN: Fine needle aspiration biopsies performed on patients presenting with diffuse or nodular thyroid enlargement and solitary thyroid nodules at the Goa Medical College Hospitals, Bambolim Goa, India, from January 1986 to June 1993, were reviewed. Two thousand four biopsies were performed on 1,992 patients, with 12 patients undergoing repeat FNA biopsy at different times due to an inconclusive primary result. These repeat biopsies were also inconclusive and were excluded from the series, leaving 1,992 cases. Two hundred thirty-eight of these 1,992 cases underwent surgery, either excision of the nodule or some form of thyroidectomy for a cytologically suspicious diagnosis, compression symptoms or cosmetic reasons, and a cytohistopathologic correlation was established in these cases. Twenty-five of the 238 cases that had inadequate cytologic findings were excluded, and the accuracy was studied in the remaining 213 cases. RESULTS: The results of FNA classified 1,557 (78.16%) of these cases as benign, 151 (7.58%) as suspicious, 30 (1.51%) as malignant and 254 (12.75%) as unsatisfactory. Cytohistopathologic correlation was established in 238 cases, which were operated on. Nine (5.5%) of 163 cases with an FNA diagnosis of benign, 10 (26.3%) of 38 cases with an FNA diagnosis of suspicious and 11 (91.67%) of 12 cases with an FNA diagnosis of malignant were histologically malignant. CONCLUSION: FNA biopsy of the thyroid can be used effectively as the initial modality in the evaluation of thyroid lesions, both nodular and diffuse. It is very useful in detecting neoplastic foci in multinodular goiter and also in evaluating solitary thyroid nodules.

Fine needle aspiration of the spleen in hairy cell leukemia. A case report.

Hairy cell leukemia (HCL), or leukemic reticuloendotheliosis, first described by Bouroncle in 1958, is a chronic lymphoproliferative disorder of B-cell origin that is manifest primarily in the blood, marrow and spleen. The hairy cells often contain a tartrate-resistant acid phosphatase (TRAP) isoenzyme and show prominent cytoplasmic projections. We report a rare case of hairy cell leukemia wherein the total white blood cell count in the peripheral blood was 20 x 10(9)/L, there were hairy cells in the peripheral blood, and the bone marrow aspirate was a dry tap. Fine needle aspiration of the spleen was performed. The splenic smears showed a monotonous population of abnormal lymphoid cells, some with the hairlike cytoplasmic projections. TRAP staining was positive. HCL must be differentiated from splenic B-cell lymphoma with circulating villous lymphocytes.

Extralobar bronchopulmonary sequestration: a case report.

Bronchopulmonary sequestration of the lung is a rare but well recognised congenital abnormality, which is clinically important because of the potential for medical and surgical complications. We report a case of extralobar bronchopulmonary sequestration on the left side in a newborn infant.