CT and MRI Findings of Sclerosing Angiomatoid Nodular Transformation of the Spleen: Spoke Wheel Pattern

Sclerosing angiomatoid nodular transformation of the spleen is a recently described benign pathologic entity that is characterized by round shaped vascular spaces that are lined by endothelial cells, and the spaces are circumscribed by granulomatoid structures. Microscopically, all the reported cases had multiple angiomatoid nodules in a fibrosclerotic stroma. Each angiomatoid nodule was made up of slit-like, round or irregular shaped vascular spaces that were lined by endothelial cells and interspersed ovoid cells. We present here the CT and dynamic gadolinium-enhanced MR findings of a patient with sclerosing angiomatoid nodular transformation. The spoke-wheel pattern that was observed on MRI in this case may be an important imaging clue for making the correct diagnosis of this benign lesion

Cytokeratin-negative small cell lung carcinoma

Cytokeratins (CK) are good markers of epithelial tumors, and most of carcinomas including small cell lung carcinoma (SCLC) expresses CK. Herein reported is a case of SCLC without CK expression

Intraosseous Rosai-Dorfman disease diagnosed by touch imprint cytology evaluation: A case series

Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease (RDD) is a rare benign disorder that primarily affects the lymph nodes. Localized lymphadenopathy is the most common clinical manifestation of this disorder. However, RDD has been described in several extra-nodal sites including the head and neck region, soft tissue, skin, upper respiratory tract, gastro-intestinal tract and central nervous system (CNS). Involvement of the bone is considered very rare, occurring in less than 10% patients. RDD is one of the histiocytoses and the differential diagnosis includes entities such as Langerhans cell histiocytosis and Erdheim-Chester disease. In the rare intraosseous variant, the clinical and radiologic differential diagnosis is broader and includes neoplasms such as osteosarcoma and Ewing sarcoma. In this report, we describe three cases of extra-nodal, intraosseous RDD where touch imprint cytology played a crucial role in diagnosis. Two of the cases initially presented with involvement of the head and neck region and later developed intraosseous disease; while the third patient presented with primary bone involvement. The diagnosis was established by core biopsy with touch imprints of the bone lesions. The cytologic samples showed numerous histiocytes, often with neutrophils within their cytoplasm (emperipolesis) in addition to lymphocytes and plasma cells. The diagnosis of RDD was confirmed with appropriate immunohistochemical stains. Our account of these three cases of intraosseous Rosai-Dorfman disease highlights the role of cytology in the diagnosis of this rare entity

A rare case of gingival metastases from papillary thyroid carcinoma

Metastatic oral malignancy accounts for 1% of all oral cancers. Oral soft tissue involvement is rare and accounts for less than 0.1% of all oral tumours with the attached gingiva being the commonest site affected. We present the first reported case of a papillary thyroid carcinoma (PTC) with sarcomatoid transformation giving rise to gingival metastasis. A 71 year old man with a history of PTC presented with an asymptomatic gingival swelling adjacent to his lower right lateral incisor. Subsequent biopsy of the lesion confirmed PTC metastasis with aggressive sarcomatoid features. We present a clinical photograph of the gingival swelling and the pathology images demonstrating both the papillary and sarcomatoid features of the gingival biopsy. The prognosis of PTC is usually excellent but some histological variants of PTC behave more aggressively. The histology in our case demonstrated solid areas and sarcomatoid transformation and behaved far more aggressively than typical PTC. Sarcomatoid transformation in PTC has not been previously described and indicates a poor prognosis and the need for planning urgent palliation. These lesions can present a diagnostic challenge to both pathologists and clinicians in identifying the lesion as metastatic and locating the primary cancer. This case demonstrates the need for vigilance amongst health professionals when presented with an oral soft tissue mass in patients with a known primary malignancy. This may be the first evidence of disseminated disease and emphasises a low threshold to biopsy oral soft tissue lesions in patients with a history of malignant disease

A Case of Rosai-Dorfman Disease with Highly Elevated Serum Ferritin

Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease is a rare disorder characterized by proliferation of distinctive histiocytes within lymph node sinuses and lymphatics, sometimes involving extranodal sites. However, clinical suspicion is difficult and there is also a lack of useful diagnostic markers for this disorder prior to histological confirmation. High elevation of serum ferritin is known to be a useful diagnostic marker for various hematologic diseases, including hemophagocytic lymphohistiocytosis and lymphoma. Here, we report a case of fever of unknown origin that presented along with highly elevated serum ferritin (5,780 ng/mL), and was finally diagnosed as Rosai-Dorfman disease by lymph node biopsy

Ethmoidal osteoid osteoma with orbital and intracranial extension – a case report

BACKGROUND: Osteoid osteoma is a benign bone neoplasm which is seen in the long bones of appendicular skeleton. It is rarely seen in the cranium. Skull base osteoid osteoma is extremely rare and has been anecdotally reported. CASE PRESENTATION: The authors report a case of a large osteoid osteoma of the ethmoid with intraorbital and intracranial extension in a 33 year old male patient. He presented with loss of vision in the left eye. The intra-cranial extension was excised through a single burr-hole fronto-orbitotomy. The ethmoid and orbital portions were approached and excised through a Weber-Ferguson incision and inferior orbitotomy. Radical excision of the tumor could thus be achieved through a craniofacial approach. CONCLUSION: Although benign and rare, skull base osteoid osteoma can present with neurological deficit due to its mass effect and involvement of vital structures. A multispeciality team approach is advisable in such cases if radical excision is to be achieved. A craniofacial approach made radical single stage excision of this multicompartmental osteoid osteoma possible with an uneventful postoperative period

Epithelioid Hemangioma Involving Three Contiguous Bones: a Case Report with a Review of the Literature

An epithelioid hemangioma involving three contiguous bones in continuity has, to the best of our knowledge, not been reported in the literature. A case of a 48-year-old man presented with radiating pain to the lower thoracic region for two years. A radiograph and CT scan revealed both permeative osteolytic and multiple trabeculated lesions involving the left posterior part of the 10th rib as well as the 9th and 10th vertebral bodies in continuity and was misled as a malignant or infectious lesion. The histopathology and immuno-histochemistry of the lesion confirmed the diagnosis of an epithelioid hemangioma. The lesion was still stable as of three years after surgery