Diabetic Muscle Infarction (Myonecrosis): Underdiagnosed or Underreported?

Diabetic muscle infarction is a rare complication of diabetes. It is seen more in Type 1 DM than Type 2 DM, but in both it is associated with longer duration of diabetes, poor glycemic control with or without microvascular complications. We present a case report of a 47 year diabetic male, who presented with sudden onset of painful swelling of the left thigh muscles (vastus group). The patient had microvascular complications of diabetes. Apart for mild elevation of CPK and LDH other investigations were normal. MRI findings of left thigh showed T2 hyperintensities in the involved muscles which established the diagnosis. Muscle biopsy revealed necrosis of the muscle fibres, presence of inflammatory cell infiltrates and hyalinization of the blood vessels with luminal narrowing which is characteristic of diabetic muscle infarction. The patient was treated with immobilization, analgesics and adequate blood sugar control. This case highlights the rarity of finding vascular changes as well as the poor prognosis and the occurrence of fatal complications in near future.

Extramedullary plasmacytoma of thyroid - a mimicker of medullary carcinoma at fine needle aspiration cytology: A case report.

A rare case of extra medullary plasmacytoma (EMP) of thyroid gland in a 60 year old male, occurring against a background of Hashimoto's thyroiditis is reported. The fine needle aspiration cytology (FNAC) initially done as an outpatient procedure, showed atypical epithelial cells on a background of amyloid. Considering these findings we gave a diagnosis of medullary carcinoma. Histology of the total thyroidectomy specimen showed an extensive infiltration of neoplastic plasma cells against a background of Hashimoto's thyroiditis, with a bizarre Hurthle cell change. Immunohistochemistry on the histology sections confirmed the diagnosis of solitary plasmacytoma of thyroid against a background of Hashimoto's thyroiditis.

Role of fine-needle aspiration cytology and fluid cytology in extra-pulmonary tuberculosis.

Extra-pulmonary tuberculosis is the presence of disease in an organ without obvious involvement of the lungs (World Health Organization, Tuberculosis Fact sheet, 2006). The present article focuses on the incidence of extra-pulmonary tuberculosis as an emerging and clinically significant disease to be reckoned with in the present era. It also highlights fine-needle aspiration cytology (FNAC) as an inexpensive, less invasive procedure for early diagnosis of such tuberculosis and timely initiation of specific therapy. All cases of proved tuberculosis presenting to the M.V.J. Medical College and Research Hospital were recorded over a period of two years (2008-2010); and categorized as pulmonary and extra-pulmonary cases. A total of 96 cases of tuberculosis were observed; extra-pulmonary tuberculosis was seen in 64 cases. Of these 56 cases were from lymphnodes and 8 from extra-nodal sites which included tuberculous dactylitis (two cases), tuberculous mastitis (two cases), tuberculous synovial effusion (one case), pericardial effusion (one case), epididymo-orchitis (one case), and cold abscess (one case). The cytology patterns observed included granulomatous inflammation and necrosis with or without acid fast bacilli.

Squamous cell carcinoma arising from congenital lymphedema.

Congenital lymphedema is a rare type of primary lymphedema occurring at birth or developing shortly later. Primary lymphedema can be classified according to whether it is familial or sporadic. The primary congenital familial lymphedema is also known as Milroy's disease. Majority of primary cases are sporadic type. Chronic lymphedema can be secondary to infections, surgery with lymph node excision, trauma, lymphadenectomy, radiotherapy, filarial infection, and so on. It is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema; the most documented associations are lymphangiosarcoma, basal cell carcinoma, lymphoma, malignant melanoma, and Kaposi's sarcoma. A total of 13 cases of squamous cell carcinoma arising from chronic (primary or acquired) lymphedema have been reported, and only 3 cases of congenital lymphedema presented with squamous cell carcinoma as reported. A 32-year-old young male presented with chronic unilateral left lower limb lymphedema of 28 years duration. In addition, he had a 3-month history of a fungating cutaneous lesion on the lateral side measuring 2 cm × 1 cm in size. Fine-needle aspiration cytology was performed on the later mass, and a diagnosis of angiosarcoma was made. At histopathology, the appearances did not confirm angiosarcoma. However, an impression of carcinoma was made as squamous cells were observed in sheets. Immunohistochemistry was performed using markers for CD31, factor VIII (FVIII), and MiB. The epithelial marker cytokeratin was positive for squamoid cells and MiB index of 75%. The vascular markers FVIII and CD31 were negative, thus ruling out angiosarcoma. The final diagnosis was given as infiltrating squamous cell carcinoma in chronic lymphedema.

Cytodiagnosis of secretory carcinoma of the breast: a report on two cases.

Secretory carcinoma of the breast is a rare (<1%) low grade breast carcinoma which shows distinct features at histology. Diagnosis of this carcinoma at fine needle aspiration cytology (FNAC) is difficult. Two cases of secretory carcinoma of the breast presenting as a breast mass, one in a 24-year-old female and the other in a 40-year-old female are reported, highlighting their appearance at FNAC. In both the cases the aspirates were cellular and consisted of clusters and single cells with uniform round nuclei showing minimal nuclear atypia. Most of the cells had moderate to abundant cytoplasm with prominent intracytoplasmic vacuoles. Many cells showed a plasmacytoid appearance and others were binucleate. A typical amphophilic bubbly cytoplasm of the tumor cells was observed. Both cases were confirmed as secretory carcinoma on histology. The differences in cell morphology at FNAC of secretory carcinoma of the breast from other breast carcinomas, and its utility of making a preoperative diagnosis are discussed.

Kidney disease in Bahrain: a biopsy based epidemiologic study.

The aim of this study was to establish the incidence of renal diseases in Bahrain based on biopsy proven results during the period from January 2003 to October 2006. We studied a total of 145 biopsies obtained from 130 patients; glomerular diseases constituted 64.8%, renal allograft biopsies 23.4%, chronic glomerulosclerosis 8.9%, and others 4.1% of the total. Primary and secondary glomerular diseases were presented equally. The incidence of renal biopsies 5.4/100,000 per year. Minimal change disease-focal segmental glomerulosclerosis (MCD-FSGS) complex was the commonest of all primary glomerular diseases, and lupus nephritis was the commonest secondary glomerulopathy in the biopsied patients. We conclude that there was no significant change in the pattern of glomerulonephritis in Bahrain in comparison with our previous report.

Cytodiagnosis of primary neuritic leprosy

The diagnosis of primary neuritic leprosy (PNL) and its differentiation from other causes of peripheral neuropathy is difficult since acid-fast bacilli (AFB) smears and skin biopsy are negative from anesthetic areas. A biopsy of the involved nerve is the only conclusive method of diagnosis. Such a biopsy may not necessarily be free of complications when a large nerve is involved. However, fine needle aspiration has in this study proved to be a simple technique to demonstrate inflammation granulomas and AFB from these involved nerves in 18 of the 27 cases suspected to have PNL. The validity of the cytological classification into morphological subtypes may have to be supplemented by a large series of studies.