Binucleate Cells in Cytosmears: What do They Signify?

BACKGROUND: Although the classic Reed-Sternberg (RS) cell is considered a diagnostic of Hodgkin's disease, RS-like cells have been noted in various benign and malignant conditions. The presence of these cells can be a diagnostic challenge. AIMS: Our aim was to see if cells morphologically resembling or identical to RS cells occur in conditions other than Hodgkin lymphoma (HL) and what proportion of cases show binucleate cells in various benign and malignant conditions. We also want to discuss the diagnostic utility of cytomorphological features in predicting HL. MATERIAL AND METHODS: This study is a retrospective analysis of 2086 cytology cases. The cytosmears were screened for the presence of binucleate cells. A detailed cytomorphological analysis of cytosmears with binucleate cells was performed, and the diagnostic utility of cytomorphological criteria in delineating HL was examined. RESULTS: Out of 2086 smears, 55 (2.6%) cytosmears showed binucleated RS/RS-like cells. Out of these 55 cases, 6 were HL, 3 cases were non-HL (NHL), 3 were sarcoma, 32 were carcinoma, and 11 were benign/inflammatory lesions. The presence of prominent eosinophilic nucleoli, granulomas, and eosinophils had good sensitivity and specificity in predicting the diagnosis of HL. CONCLUSION: A detailed cytomorphological analysis is of limited value in categorizing the RS and RS-like cells. However, few cytomorphological features such as prominent eosinophilic nucleoli, eosinophils, granulomas, and lack of clustering of atypical cells can help us in predicting HL.

Intracranial bony ball - An ossified variant of meningioma.

An ossified variant of meningioma in the intracranial region is very rare. We report a case of a 28-year-old female who presented with headache for 4 years. Imaging revealed an extra-axial calcified mass in the left parieto-occipital lobe. The differential diagnosis included osteoblastoma both intracranial and periosteal, calcifying pseudotumor of the neural axis, hyperostosis of the cranium, and ossifying fibroma. She underwent excision of the calcified space occupying lesion. Histopathology was suggestive of an ossified meningioma. At the end of 2-year follow-up, she was asymptomatic with no signs of recurrence.

Subcutaneous Fungal Cyst Masquerading as Benign Lesions - A Series of Eight Cases.

BACKGROUND: Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and are usually localised. We present a series of eight cases with subcutaneous fungal cystic lesions masquerading as benign lesions. MATERIALS AND METHODS: A retrospective study was conducted on subcutaneous fungal infections seen between January 2007 to July 2014 in the Department of Pathology. Eight patients with biopsy proven subcutaneous fungal infection were included. We collected and analysed their demographic, clinical and histopathological details. RESULTS: Among eight patients, six were male and two were female. The mean age was 47 years (Range: 21-70). All the eight patients presented with non-tender cystic swelling. The size of the swellings varied from a minimum of 3x3 cm to maximum of 10x4 cm. Out of eight, hand was involved in three, forearm in one, elbow in two, leg in one and foot in one. On H&E staining, all the cases showed fibro collagenous cyst wall, lined by histiocytes, granulomatous reaction, foreign body type of giant cells with acute and chronic inflammatory infiltrate containing fungal elements. Six were identified as hyalohyphomycosis and two were identified as phaeohyphomycotic cysts based on pigmentation of hyphae. CONCLUSION: Fungal infection should be suspected in all subcutaneous cystic lesions. Excised tissue should always be sent for culture and histopathology.