Minute pulmonary meningothelial-like nodules simulating a metastatic lung adenocarcinoma: A case report

Minute pulmonary meningothelial-like nodules (MPMNs) are relatively rare lesions that located at the pleura or parenchyma of the lung. They are usually found incidentally at autopsy or in surgical specimens. We presented a case of asymptomatic 47-year-old woman with an abnormal shadow in the right upper lung field found by a routine chest X ray. A computed tomography (CT) scan of the thorax revealed a hyperdense subpleural mass, which histologically conformed to adenocarcinoma. A resection of the right upper lobe discovered preponderance of small multiple lesions under the pleura. Microscopically, they were an interstitial nodular proliferation of oval or spindle-shape cells arranged in a zellenballen nesting pattern near small veins. Immunohistochemical and cytological analyses confirmed the diagnosis of MPMNs. Coexistence of multiple MPMNs and lung adenocarcinoma can be a differential diagnostic problem due to suspected metastasis of the primary carcinoma. To obtain an accurate diagnosis, the clinical findings should completely conform to histological, immunohistochemical, and cytological ones

Multisystem Langerhans cell histiocytosis coexisting with metastasizing adenocarcinoma of the lung: A case report

Introduction. Langerhans cell histiocytosis (LCH) is an uncommon disease of unknown etiology characterized by uncontrolled proliferation and infiltration of various organs by Langerhans cells. Case report. We presented a 54-year-old man, heavy smoker, with dyspnea, cough, hemoptysis, headache and ataxia, who died shortly after admission to our hospital. On the autopsy, tumor was found in the posterior segment of the right upper pulmonary lobe as well as a right-sided occipitoparietal lesion which penetrated into the right ventricle resulting in internal and external hematocephalus. Histologically and immunohistohemically, the diagnosis of primary lung adenocarcinoma with brain metastasis was made (tumor cells showed positivity for CK7 and TTF-1 which confirmed the diagnosis). In the lung parenchyma around the tumor, as well as in brain tissue around the metastatic adenocarcinoma histiocytic lesions were found. Light microscopic examination of the other organs also showed histiocytic lesions involving the pituitary gland, hypothalamus, spleen and mediastinal lymph nodes. Immunohistochemical studies revealed CD68, S-100 and CD1a immunoreactivity within the histiocytes upon which the diagnosis of Langerhans' cells histiocytosis was made. Conclusion. The multisystem form of LCH with extensive organ involvement was an incidental finding, while metastatic lung adenocarcinoma to the brain that led to hematocephalus was the cause of death

Diagnostic relevance of fine needle aspiration cytology in nodular thyroid lesions

Background/Aim. Fine needle aspiration cytology (FNAC) of the thyroid gland has been used as an initial investigative procedure of thyroid nodule(s) in the Department of Pathology at the Institute of Oncology of Vojvodina for more than 20 years. This procedure is rapid, inexpensive and technologically simple, yet it has found only limited, albeit increasing acceptance in medical practice in Serbia. The aim of the study was to evaluate our FNAC findings by correlating cytological results with histological diagnosis and to define the sensitivity, diagnostic accuracy and positive predictive value of FNAC. Methods. A total of 266 patients with thyroid swellings were aspirated in one year investigated period at our Institute out of whom 69 underwent surgery between May 2008 and May 2009. The cytological results correlated with clinical features, ultrasound investigations (US) and subsequent histopathological examination of the resected tissue. Results. By the use of cytology we found out thyroid carcinoma in 10 patients, and by histopathological examination in 12. We obtained 83% sensitivity, 100% specificity and 97% of diagnostic accuracy of FNAC. Conclusion. The obtained results confirm the importance of FNAC in preoperative assesment of thyroid nodule

Testicular (gonadal stromal) fibroma: Case report

Testicular fibroma is a rare benign tumor of gradual growth, usually in the third and fourth decade, in the form of a hypoechogenous nodule with clear boundaries and is usually not accompanied by hormonal abnormalities. Metastasis and recurrence of disease were not noted. A 40-year-old male saught medical attention due to pain in the lower back that spread to the pubic bones and the groin. During physical examination, a painless nodule with clear boundaries was palpated in the right testicle, and the ultrasonographic examination revealed hypoechogenic zone with vague boundaries of about 10 mm in diameter. Standard biochemical analyses of blood and urine tests and tumor markers (CEA, CA 125, CA 19-9, AFP and βHCG) were within the physiological limit. Histopathologic analysis set a diagnosis of testicular fibroma. The absence of sex cords in the tumor tissue made it possible to diagnose the patient using standard staining methods, but in cases where these elements can be histologically verified, immunohistochemical analysis should be introduced into a routine diagnostic algorithm

Clear cell sarcoma of the nuchal region with metastasis in stomach

Clear cell sarcoma/malignant melanoma of soft parts is a rare malignant tumor that originates from the neural crest. It is most common in young men in the lower limbs, grows slowly in the form of deep localized nodes around the tendons, fascia, and aponeurosis. Prognosis is poor, local recurrences and metastases are common. We present a case of a 53-year-old patient who sought medical attention due to the presence of a tumefaction in the nuchal neck region, followed by pain, heightened sensitivity, and numbness in his right hand. After excision, histological examination, and application of immunohistochemical and histochemical methods, malignant melanoma of soft tissues was diagnosed. Fourteen months after the excision of the neck tumor, a metastatic stomach disease was diagnosed. Larger tumors with necrosis, expressed pleomorphisam, and increased mitotic activity give metastases before local recurrence. Diagnosis is set using immunohistochemical methods after surgical excision of the tumor and the prognosis of the disease depends on the size of tumor and complete surgical excision

Changes in the bronchial epithelium between the second and the fifth day after the previous biopsy

BACKGROUND: Regenerative changes may be found in bronchia, in the area of previous biopsy. Superficial epithelium in the injured area proliferates migrates and differentiates, primarily towards the squamous cells, and then towards cup-shaped, i.e. column cells with cilia. Regenerative changes can be misinterpreted for epidermoid carcinoma. The highest level of similarity of regenerative changes and epidermoid carcinoma is between the second and the fifth day after the previous biopsy. MATERIALS AND METHODS: In this research, we used 66 biopsy samples. They were classified into two groups (33 re-biopsied between the second and the fifth day and 33 with diagnostically confirmed epidermoid carcinoma). In both groups, the same morphological parameters were monitored and then tested by means of z test with 5% tolerance ( a=0.05). RESULTS: Morphological changes that are typical for epithelium in regeneration, are the following: Fibrin (z=4.41; P=0.000) granulocytes (z=4.79; P=0.000), granulocytes in epithelium (z=6.92 P=0.000), infiltration into granulation tissue. Tumor changes are the following: Presence of mononuclear cells (z=-3.63; P=0.0003), diskeratosis (z=-4.29; P=0.000), nuclear polymorphism (z=-4.22; P=0.000), hyperchromatism (z=-3.83; P=0.000), and infiltration into connective tissue (z=-5.76 P=0.000). Changes, which are useless for differentiation of regeneration and carcinoma, are the following: Nucleoli (z=-1.77; P=0.0763), multinuclear cells (z=0.25; P=0.8041), mitoses (z=-1.44; P=0.151), interruption of the basal membrane (z=1.07; P=0.2866). CONCLUSION: Presence of squamous epithelium located in fibrin and/or granulation tissue saturated with granulocytes is a morphological characteristic of regenerative epithelium. Presence of squamous epithelium, with symptoms of severe polymorphism of nuclei, with hyperchromatism, with monocellular diskeratosis, located in cellular tissue saturated with mononuclear cells, is a characteristic of malignant epithelium

Chronic necrotizing pulmonary aspergillosis

Introduction. Chronic necrotizing pulmonary aspergillosis (CNPA) is a cavitary, infectious process of lung parenchyma with slow progressive course. Vascular invasion and dissemination to other organs are unusual. Case report. We presented a 25-year old man with bilineal acute leukaemia who developed pulmonary and systemic symptoms. Chest CT showed nodular consolidations and cavitary lesions in both lungs. Bronchial biopsy revealed necrotic hyphae but it was negative for Aspergillus by culture. Serum was positive for antibodies to Aspergillus, but it was negative for antigens. A thoracoscopic lung biopsy of the upper left lobe revealed necrosis of lung tissue, with acute and chronic inflammation of the cavity wall and the presence of hyphae consistent with Aspergillus species. Conclusion. Although confirmation of the diagnosis is difficult, a combination of characteristic clinical, radiological and histological findings and either serological results positive for Aspergillus or the isolation of Aspergillus from respiratory samples are highly indicative of CNPA

Institute of Lung Diseases of Vojvodina,

Minute pulmonary meningothelial-like nodules simulating a metastatic lung adenocarcinoma: A case repor