Touch imprint cytological diagnosis of nodal Langerhans cell histiocytosis.

Touch imprint cytological diagnosis of nodal Langerhans cell histiocytosis. Langerhans cell histiocytosis (LCH) is a rare neoplasm of the mononuclear phagocytic immunoregulatory system of unknown aetiology. Nodal involvement is uncommon. Cytological findings have seldom been described. A case study of LCH, arising in a submandibular node of a 42-year-old female, is reported. Fine needle aspiration smears were highly cellular and composed of a mixed cell population including eosinophils, lymphocytes, neutrophils, and macrophages. Imprint slides from the surgical specimen of the excised node exhibited Langerhans cells with nuclear grooves, leading to a diagnosis suggestive of LCH. Immunohistochemical staining of the node sections with CD1a and S-100 confirmed this diagnosis. In conclusion, cytology may favorably contribute to the diagnosis of LCH.

Accessory parotid gland carcinoma ex pleomorphic adenoma. Case study diagnosed by fine needle aspiration.

OBJECTIVE: The accessory parotid gland is salivary tissue separated from the main parotid gland and lying on masseter muscle. It has secondary duct emptying into the Stensen's duct. The accessory parotid gland exists in 21-61% of individuals. However, the appearance of an accessory parotid tumor is rare, with a reported frequency of 1-7.7% of all parotid gland tumors. Carcinoma ex pleomorphic adenoma arises from a pre-existing benign mixed tumor. Most of these tumors will have malignant epithelial component, but not malignant stromal component. Reports of Fine Needle Aspiration Cytological (FNAC) diagnosis of malignant mixed tumor are uncommon and have been limited to cases arising in the parotid. We report a case of carcinoma ex pleomorphic adenoma of the accessory lobe of the parotid, and address the cytopathology features and pitfalls of this condition. CASE: A 73 aged female presented with a right nontender midcheek mass. The lesion had been present 18 months, with a recent increase in size. FNA was performed and the smears demonstrated features indicative of pleomorphic adenoma admixed with findings indicative of a poorly differentiated carcinoma. CONCLUSION: FNAC can accurately diagnose carcinoma ex pleomorphic adenoma when strongly fixed requirements are implemented.

Neck nodal metastases from unknown primary: case series.

BACKGROUND: Neck nodal metastases from occult primary constitute about 5%-10% of all hosts harboring carcinoma of unknown primary site. Metastases in the upper and middle neck (levels I-II-III-IV-V) are generally attributed to head and neck cancers, whereas the lower neck (level IV) involvement is often associated with primaries below the clavicles. Diagnostic procedures include a careful clinical evaluation and a fiberoptic endoscopic examination of the head and neck mucosa, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computerized tomography (CT) scan, and magnetic resonance radiology (MRI). The most frequent histological finding is squamous cell carcinoma, particularly when the upper neck is involved. SETTINGS: We report three cases of patients presented with nodal metastases of the neck from unknown primary site and we also describe the diagnostic and therapeutic approach employed in each one. RESULTS: One patient harbored a neuroendocrine metastatic deposit, the second patient a poorly differentiated carcinoma and the third one a malignant melanoma. CONCLUSIONS: Diagnostic procedures should be aimed at clarifying the histology of the nodal metastases and detecting the primary tumor site.

Thyroglossal duct cyst: case series.

OBJECTIVE: Thyroglossal duct cysts are remnants of the embryonic thyroglossal duct that may occur anywhere from the base of the tongue to the thyroid gland. The majority, however, are found at the level of the thyrohyoid membrane, under the deep cervical fascia. They are midline or just off the midline, and move up and down upon swallowing. This paper presents five case reports of TDC seen in the Department of Ear-Nose-Throat Surgery Regional Hospital Of Chania, Crete, Greece. It also discusses the different diagnostic approaches and differential diagnoses of the lesion. STUDY DESIGN: The medical records of patients admitted from 1995-2006 were reviewed for patients treated for TDC. History and examination reports were studied. When possible, results and reports of special investigations were obtained and the investigations were re-evaluated. Surgical operation notes and histology reports were obtained and the histologic slides were re-examined as necessary. RESULTS: Five cases of thyroglossal duct cyst treated in our department are described with each having a different clinical picture. CONCLUSIONS: Although the clinical and histological presentations of these five cases are not rare, they do illustrate how varied thyroglossal duct cysts can be with respect to patient age, anatomic site, or associated signs and symptoms.

Brushing cytology in cutaneous lesions of the head and neck.

BACKGROUND: Brushing cytology is a well established diagnostic procedure used by gynaecologists, physicians and surgeons to obtain representative samples from lesions. Our aim was to evaluate its reliability in ulcerative and tumour-like conditions arising in the skin of the head and neck. METHODS: Over 28 months, 86 patients with suspected cutaneous malignant lesions underwent a cytological examination with a cytobrush within the otolaryngology department. RESULTS: Cytological analysis identified 63 out of 64 histologically documented malignant tumours (60 primary basal cell and squamous cell carcinomas and three metastatic adenocarcinomas), and 21 out of 22 benign lesions. There was one false positive and one false negative result. CONCLUSIONS: Brushing cytology of suspected cutaneous malignant lesions is a rapid and reliable diagnostic method which helps the clinician to decide on appropriate planning and treatment. The technique can be performed as an out-patient procedure, and smear preparation can be done in the laboratory, even at a peripheral hospital.

Management of second branchial cleft abnormalities in adults.

OBJECTIVE: Branchial cleft anomalies are developmental disorders of the neck. Our aim is to report the diagnostic and treatment procedure followed in three cases of second branchial cleft abnormalities in adults. METHODOLOGY: A patient aged over 40 underwent surgical excision of a well-encapsulated cystic neck structure and two further patients of a branchial sinus and branchial fistula respectively. Prior to surgery the patients were assessed by means of imaging techniques, FNA cytology and cytometric DNA analysis. RESULTS: Neutrophils, debris, mature squamous epithelial cells including degenerate forms and lymphoid cells were the key features in the cytological diagnosis. DNA analysis of the pre-operative cytological material in two cases revealed euploidy, thus indicating no malignancy. Histological examination of the lesions after excision established the diagnosis in all cases. No recurrences were reported. CONCLUSIONS: Although congenital lesions, the second branchial cleft abnormalities usually present in adulthood and have to be distinguished from benign and malignant lateral neck swellings. FNA cytology as well as DNA ploidy determination contributes to the establishment of the diagnosis of branchial cleft abnormalities and their differential diagnosis.