Fine-needle aspiration of a presacral myelolipoma: a case presentation with flow cytometry and immunohistochemical studies.

Myelolipomas are benign soft-tissue tumors predominantly found in the adrenal gland. Extra-adrenal myelolipomas are rare, with about 30 previous cases reported. Approximately half of the reported cases were located in the presacral region. These were usually found at autopsy or during the workup of vague abdominal symptoms. Histologically, these lesions show bone marrow elements, with adipose tissue and scattered lymphoid aggregates. Radiologically-guided fine-needle aspiration (FNA) is helpful in establishing the diagnosis, thus obviating resection in some patients. We report on a case of an incidental presacral myelolipoma that underwent examination by computer tomography, magnetic resonance imaging, FNA, and immunohistochemical staining. This lesion was also analyzed by flow cytometry. To our knowledge, the use of the latter technique in the characterization of such tumors has not been previously reported.

Nephrogenic adenoma mimicking carcinoma: a potential pitfall in cytodiagnosis.

Nephrogenic adenoma of the urinary bladder and urethra is an uncommon benign lesion of the urinary epithelium that can cytologically and histologically mimic malignancy. We report on the cytologic findings of a case of nephrogenic adenoma of the urethra that mimicked malignancy in an 84-yr-old woman. The differential diagnosis of this problematic lesion is discussed, and the literature describing the cytologic features is reviewed.

Fine-needle aspiration cytology of lymphangioma of the parotid gland in an adult.

Lymphangioma or cystic hygroma is an uncommon benign congenital tumor of lymphatics that is seen in children and, rarely, adults. Lymphangioma primarily involving the parotid gland is an extremely uncommon occurrence in adults. We report on the cytologic findings of a parotid lymphangioma in a 34-yr-old man which showed 13 cc of yellow fluid with red blood cells, lymphocytes, and rare fragments of benign-appearing salivary gland epithelium. The differential diagnosis of cystic parotid gland lesions in adults may include Warthin's tumor, lymphoma, benign lymphoepithelial lesions, branchial cleft cysts, chronic sialadenitis, cystic low-grade mucoepidermoid carcinoma, and cystic pleomorphic adenoma. In this case, the fine-needle aspiration findings along with the magnetic resonance imaging (MRI) findings of a multiloculated cystic mass in the parotid gland allowed the diagnosis of lymphangioma.

Fine-needle aspiration cytology of small-cell carcinoma of the parotid.

Small-cell carcinomas arise uncommonly in extrapulmonary sites and are rare primary neoplasms in the salivary glands. We report on the aspiration cytology and immunohistochemical findings of a small-cell carcinoma of the parotid gland in an 81-yr-old man.

Fine-needle aspiration cytology of pancreatoblastoma.

Pancreatoblastoma is a rare pancreatic neoplasm seen most commonly in the pediatric age group. We report on the aspiration cytology and immunohistochemical findings of a pancreatoblastoma in a 16-yr-old male.

Fine-needle aspiration cytology of esophageal leiomyomatosis.

Leiomyomata are the most common benign neoplasms of the esophagus, but they are still very rare in comparison to malignant tumors of this organ. We report on the aspiration cytology findings of a case of esophageal leiomyomatosis in a 19-yr-old man. Diagn. Cytopathol. 1999;21:197-199.

In vitro displacement of phenytoin from protein binding by nonsteroidal antiinflammatory drugs tolmetin, ibuprofen, and naproxen in normal and uremic sera.

Displacement of phenytoin (90% bound to albumin) by other highly albumin-bound drugs like salicylate has been well documented. Other widely used nonsteroidal antiinflammatory drugs like tolmetin, ibuprofen, and naproxen are also strongly bound to albumin and can potentially displace phenytoin. However, phenytoin-ibuprofen interaction has been poorly studied in the past, and interaction of phenytoin with tolmetin or naproxen has not been studied before. For normal serum pool (albumin 3.7 g/dl), we observed significant increases in free phenytoin concentrations only with antiinflammatory drug concentrations at the upper end of therapeutic or above therapeutic concentrations. However, for the uremic pool (albumin 2.9 g/dl), displacement of phenytoin was significant even at the lower end of therapeutic concentrations of those antiinflammatory drugs. Of the three antiinflammatory drugs we studied, ibuprofen caused the highest displacement of phenytoin.

Renal chromophobe cell carcinoma: limitations of paraffin-embedded tissue.

Chromophobe cell carcinoma of the kidney is distinguished from other renal cortical tumors by the ultrastructural presence of numerous cytoplasmic vesicles of unknown composition. Failure to detect vesicles in paraffin-embedded tissue in the archival material of 10 putative chromophobe cell tumors stimulated an investigation into the effects of fixatives and dehydrating solvents on vesicle integrity. We found that although vesicles are removed by dehydrating agents during paraffin embedding, osmium tetroxide postfixation prevents vesicle loss during dehydration for electron microscopy. We conclude that paraffin-embedded tissue is useless for histochemical studies of vesicle composition and cannot be employed for the ultrastructural confirmation of a histologic diagnosis of chromophobe cell carcinoma since the intracellular vesicles are no longer present.

Papillary renal tumors. Morphologic, cytochemical, and genotypic features.

BACKGROUND: Papillary renal tumors lack alterations of chromosome 3 and show trisomy of chromosomes 7 and 17, genotypic features distinct from nonpapillary carcinomas. METHODS: The authors examined 39 papillary renal neoplasms to identify morphologic features allowing distinction of high grade from low grade tumors. Twenty-nine papillary tumors and 13 nonpapillary tumors were examined for the presence of trisomy of chromosome 7 using fluorescence in situ hybridization. Data recorded included tumor size, stage, grade, architectural pattern, and the presence of glycogen, foam cells, and iron. RESULTS: Nineteen tumors were classified as low grade and 20 as high grade. The high grade tumors more often formed tall papillae with solid and tubular areas and had more intracellular glycogen, whereas the low grade tumors were more often trabecular. There was no significant difference in tumor size or iron deposition. High grade tumors were of higher stage. Foam cells more commonly were noted in low grade tumors. Sixty-seven percent of low grade, 43% of high grade, and none of the nonpapillary tumors showed trisomy of chromosome 7. Metastases developed only in patients with high grade papillary tumors (10/19, 7 within 2 years of diagnosis), all of whom died of disease. CONCLUSIONS: Papillary renal carcinomas with high nuclear grade are more likely to behave in an aggressive fashion, whereas those with low nuclear grade may be associated with longer disease free survival. Furthermore, trisomy of chromosome 7 can be identified by fluorescence in situ hybridization and is useful in differentiating true papillary from nonpapillary renal neoplasms.