Sarkom svijetlih stanica – prikaz slučaja

The report covers the first case of clear cell sarcoma (malignant melanoma of soft tissue) recorded in the Croatian medical literature. It is a rare soft tissue tumor, constituting less than 1% of all soft tissue neoplasms, first reported by Enzinger in 1965. The tumor presents most often in adolescents and young adults, with its peak incidence in the third and fourth decade and slight female predominance. The tumor produces melanin, but it differs from melanoma in several important respects. The proper name for this neoplasm should be clear cell sarcoma of tendons and aponeuroses in order to prevent confusion with clear cell sarcoma of the kidney and other clear and spindle cell neoplasms. A 23-year-old female patient presented to our hospital with a 10 cm large, painless, lower right leg mass, and few palpable lymph nodes in the ipsilateral inguinum. Clinical examination (NMR, ultrasound ) showed an expansive tumor mass and few suspicious inguinal lymph nodes. Surgical treatment was indicated because of cytologically suspicious diagnosis of clear cell sarcoma or malignant melanoma . Histopathological and immunohistochemical analysis confirmed the origin of tumor cells and showed melanoma/ melanocytic differentiation including clear cell sarcoma (malignant melanoma of soft tissue). This case report provides evidence that the preoperative definitive diagnosis of primary CCSSP can be rendered if immunocytochemistry is used in addition to cytomorphology in a suitable clinical setting.U radu je prikazan prvi slučaj sarkoma svijetlih stanica (malignog melanoma mekih tkiva) zabilježen u hrvatskoj medicinskoj literaturi. Taj rijedak tumor mekih tkiva, koji čini manje od 1% svih novotvorina mekih tkiva, prvi je puta opisao Enzinger 1965. godine. Tumor se najčešće pojavljuje u adolescenata i mla|ih odraslih osoba, s najvećom incidencijom u trećoj i četvrtoj životnoj dekadi i nešto je češći u žena. Tumor proizvodi melaninski pigment, ali se ipak razlikuje od melanoma u više važnih značajki. Pravilan naziv za tumor trebao bi biti sarkom svijetlih stanica tetiva i aponeuroza kako bi se izbjegla zamjena sa sarkomima svijetlih stanica bubrega i drugim novotvorninama svijetlih i izduženih stanica. 23-godišnja pacijentica došla je u našu ustanovu s tumorskom masom na desnoj potkoljenici i nekoliko palpabilnih ingvinalnih čvorova. Klinički pregled (NMR i UZV) potvrdio je ekspanzivnu tumorsku masu i povećane ingvinalne limfne čvorove. Citološki se postavi sumnja na sarkom svijetlih stanica ili maligni melanom te se učini kirurški zahvat. Histokemijska i imunohistokemijska analiza potvrdila je melanocitnu diferencijaciju, tj. dijagnozu sarkoma svijetlih stanica (malignog melanoma mekih tkiva). Prikazani slučaj potvrdio je mišljenje da je preoperativna definitivna dijagnoza sarkoma svijetlih stanica mekih tkiva moguća ako se uz citomorfologiju i kliničke podatke učini i dodatna imunocitokemijska analiza

Zamke u postavljanju dijagnoze pilomatriksoma primjenom aspiracijske citodijagnostike – prikaz sedam slučajeva

Background: Pilomatrixoma is a benign tumor with differentiation toward hair cells. It is a rare, benign, slow-growing skin tumor firstly described by Malhebre and Chenantais in 1880. It usually occurs as a solitary lesion mostly located in the head and neck as a firm, deep-seated nodule covered by normal skin. Case: Our study evaluate retrospectively the clinical and cytomorphologic features of seven cases of pilomatrixoma. In the smears stained with MGG malignancy was excluded. The diagnosis of pilomatrixoma was confirmed by pathologist. A semiquantitative method was used in evaluation of the following features: basaloid cells, shadow cells, inflammatory cells, giant cells, naked nuclei, and debris (0 absent, 1+ mild amount, 2+ moderate, 3+ abundant). The maximum score obtained in FNA was for basaloid cells 13/21, shadow cells 14/21 and giant cells 11/21 while in the histological sections, the maximum score for basaloid cells was 20/21 and for shadow cells 17/21. Conclusion: The presence of basaloid cells, ghost cells and giant cells in cytological smears and also clinical information as a localization in the head and neck region, then a slowly growing tumor of the skin or subcutaneous tissue will allow a conclusive diagnosis of pilomatrixoma by FNA.Pilomatriksom je benigni tumor porijekla stanica dlačnog folikula. On je rijetki, benigni, sporo rastući kožni tumor kojeg su prvi puta opisali Malhebre i Chenantais 1880. godine. Pojavljuje se obično kao pojedinačna lezija, najčešće na glavi i vratu kao tvrdi, dublje smješten čvor prekriven normalnom kožom. Naša studija retrospektivno evaluira kliničke i citomorfološke značajke sedam slučajeva pilomatriksoma. U razmazima koji su bili bojeni MGGom isključen je malignitet. Dijagnoza pilomatriksoma potvrđena je histološki. Upotrebljena je semikvantitativna metoda u analizi sljedećih karakteristika: bazaloidne stanice, anuklerane stanice, upalne stanice, divovske stanice, gole jezgre, i detritus (O negativno, 1+ mala zastupljenost, 2+ srednja zastupljenost, 3+ obilno). Maksimalan rezultat dobiven aspiracijskom citodijagnostikom iznosio je za bazaloidne stanice 13/21, anuklearne stanice 14/21 i divovske stanice 11/21, dok su histološkom analizom dobiveni rezultati za bazaloidne stanice 20/21 i za anuklearne stanice 17/21. Prisutnost bazaloidnih stanica, anuklearnih stanica i divovskih stanica u citološkim razmazima kao i kliničke informacije o lokalizaciji u području glave i vrata, te o sporo rastućem tumoru kože i potkožnog tkiva upućivat će u citodijagnostici na zaključnu dijagnozu pilomatriksoma

Slabo diferencirani sinovijalni sarkom – prikaz slučaja

We report a rare case of primary poorly differentiated synovial sarcoma (SS) in axillary region confirmed by histology. SS accounts for 5-10% of soft tissue sarcomas. Approximately 20% of the cases have poorly differentiated appearance, most often characterized by undifferentiated round cell morphology resembling Ewing’s sarcoma. The differential diagnosis includes ES/PNET family of tumors, rhabdomyosarcoma, desmoid fibromatosis, and malignant melanoma. A 46-year-old female presented to our hospital complaining of a 10 cm slightly painful mass in the right axillary region of a 2-month duration. Clinical examination (CT, ultrasound ) showed an expansive tumor mass. Cytological analysis showed the diagnosis of suspected sarcoma. Surgical treatment was performed. Histopathological and immunohistochemical analysis confirmed the diagnosis of poorly differentiated SS. In spite of additional methods as immunocytochemistry, the poorly differentiated variant of SS can be easily mistaken for numerous other tumors in cytological smears due to its complex, overlapping morphology and still limited experience of cytopathologists in the field of rare soft tissue tumors. Nevertheless, recognition of this variant of SS is of a major concern for its worse prognosis.U radu prikazujemo rijedak slučaj primarnog slabo diferenciranog sinovijalnog sarkoma (SS) aksilarne regije čija je dijagnoza potvr|ena patohistološkom analizom. Sinovijalni sarkom čini 5-10% mekotkivnih sarkoma. Oko 20% slučajeva ima sliku slabo diferencirane varijante, malih okruglih stanica podsjećajući na Ewingov sarkom. Diferencijana dijagnoza uključuje ES/PNET skupinu tumora, rabdomiosarkom, desmoidnu fibromatozu i maligni melanom. Četrdesetšestogodišnja pacijentica primljena je u našu ustanovu žaleći se na lagano bolnu 10 cm veliku tumorsku masu u desnoj aksilarnoj regiji u trajanju od dva mjeseca. Klinički pregled (CT; UZV) potvrdili su ekspanzivnu tumorsku masu, a citološka analiza upućivala je na dijagnozu sarkoma te je učinjen operativni zahvat. Histološka i imunohistokemijska analiza potvrdila je dijagnozu slabo diferenciranog SS. Unatoč primjeni dodatnih metoda citološke analize, poput imunocitokemije, slabo diferencirana varijanta sinovijalnog sarkoma može se lako, zbog kompleksne, preklapajuće morfologije kao i ograničenog iskustva citologa na polju rijetkih tumora mekih tkiva, zamijeniti s drugim tumorima. Ipak prepoznavanje ove varijante SS od važnosti je zbog njegove lošije prognoze

Vrijednost citologije u dijagnostici lezija žlijezda slinovnica: naše iskustvo

The retrospective study was designed to evaluate salivary gland lesions diagnosed in the Department of Clinical Cytology and surgically treated in the Department of Head and Neck Surgery in the University Hospital for Tumors, Zagreb, Croatia between 1990 and 2004. We analyzed localization, histological type and concordance between cytology and final histological diagnosis. The study includes 286 patients treated for salivary gland lesions. All patients had fine-needle aspiration (FNA) cytology of the lesion before surgery. All the cytological specimens obtained were aspirated from palpable lesion or revealed during sonographic examination. The majority of lesions was localized in the parotid gland. There were 213 benign tumors, 40 benign lesions and 33 malignant tumors. The most common benign tumors were pleomorphic adenoma and Warthin\u27s tumor, while the most common malignant tumor was adenoid cystic carcinoma. Our results show overall accuracy of fine-needle aspiration cytology of 91%. The sensitivity in differentiating benign from malignant lesions was 61% and specificity was 95%. The positive predictive value was 61% and negative predictive value 95%. FNA cytology of salivary gland lesions is safe, easy to perform and valuable noninvasive method of preoperative diagnosis. It is accurate method and differentiates non-tumorous benign lesion, benign and malignant tumor, as well as grade of tumor malignancy.U retrospektivnoj studiji analizirane su lezije žlijezda slinovnica dijagnosticirane u Službi za kliničku citologiju i kirurški liječene u Službi za tumore glave i vrata Klinike za tumore u Zagrebu između 1990. i 2004. Analizirali smo lokalizaciju, histološki tip i podudarnost između citološkog i konačnog patohistološkog nalaza. Studija je uključila 286 bolesnika liječenih zbog lezija žlijezda slinovnica. Predoperativna obrada uključivala je citološku analizu kod svih bolesnika. Materijal za citološku analizu dobiven je aspiracijom iz palpabilne promjene ili pod kontrolom ultrazvuka. Većina lezija nalazila se u parotidnoj žlijezdi. Bilo je 213 dobroćudnih tumora, 40 dobroćudnih netumorskih promjena i 33 zloćudna tumora. Najčešći dobroćudni tumori bili su pleomorfni adenom i Warthinov tumor, najčešći maligni tumori bio je adenoid cistični karcinom. Naši rezultati pokazuju ukupnu točnost citološke analize 91%. Senzitivnost metode u razlikovanju benignih i malignih lezija bila je 61%, a specifičnost 95%. Pozitivna prediktivna vrijednost bila je 61%, a negativna prediktivna vrijednost bila je 95%. Citološka analiza lezija žlijezda slinovnica je sigurna, jednostavna i vrijedna neinvazivna metoda u preoperativnoj dijagnostici. Metoda je točna i razlikuje netumorske dobroćudne lezije, dobroćudne i zloćudne tumore, kao i stupanj diferenciranosti zloćudnih tumora

Adenom bradavice dojke – prikaz slučaja

The paper presents a case of a rare benign lesion of the breast - nipple adenoma. Nipple adenoma is a benign tumor without connective tissue cores composed of small tubules lined by epithelial and myoepithelial cells with or without proliferation of the epithelial component around collecting ducts. In 1955, Jones considered it as a separate clinical pathologic entity. The tumor most often develops in women between 40-50 years of age in the form of erythema, crust or ulceration, and it is therefore often mistaken for Paget\u27s disease. We report a case of a patient referred to our cytology laboratory for clinical suspicion of malignancy, with an erythematous, exulcerated nipple and occasional hemorrhagic discharge. The mammographic finding was normal and sonography indicated a smaller hypoechogenous zone immediately below the nipple. Scraping material for cytologic analysis was stained by the standard MGG staining raising the suspicion of a malignant tumor. The nipple containing a tumor of a firm consistency underwent PHD analysis. Biposies of standard H&E-stained sections showed the tumor partly covered with multilayered squamous epithelium, with ducts revealing scattered epithelial proliferation and the diagnosis of nipple adenoma was made. Due to its rare occurrence, clinical presentation and cytologic pattern of increased cellularity, dissociation of epithelial cells with occasional signs of atypia, the tumor is often misinterpreted and cytologically classified as carcinoma. For nipple lesions presented as exulcerated changes, and any changes in the nipple\u27s appearance in general, except for Paget\u27s disease, the possibility of a benign tumor ,such as adenoma of the nipple, should always be taken into consideration. The treatment of choice consists of the removal of the entire nipple since foci of carcinoma can sometimes, although rarely, be found in a nipple adenoma, too.U radu je prikazan slučaj rjeđega benignog tumora dojke – adenoma bradavice. Adenom bradavice je benigni tumor bez vezivne čahure građen od malih tubula obloženih epitelnim i mioepitelnim stanicama sa ili bez proliferacije epitelne komponente oko sabirnih kanalića. Kao zasebni kliničko patološki entitet 1955. ga izdvaja Jones. Tumor se najčešće pojavljuje u žena između 40-50 godine uz simptome često krvavog iscjetka te promjene bradavice u obliku eritema, kruste ili ulceracije zbog čega se klinički često zamijeni s Pagetovom bolesti. Izvještavamo o pacijentici koja je u citološki laboratorij upućena pod kliničkom sumnjom da se radi o malignoj bolesti, s eritematoznom, egzulceriranom bradavicom uz povremeni krvavi iscjedak. Mamografski nalaz je bio uredan, a UZV nalaz je pokazivao manju hipoehogenu zonu neposredno ispod bradavice. Materijal za citološku analizu dobije se metodom struganja, oboji standardno MGG-om te se citološki postavi sumnja na zloćudni tumor. Na PHD analizu se zaprimila bradavica s tumorom čvršće konzistencije. Biopsije standardnog H&E bojenja pokazivale su tumor koji je dijelom bio pokriven višeslojnim pločastim epitelom uz kanaliće u kojima se mjestimice vidjela i proliferacija epitela te se postavila dijagnoza adenoma bradavice. Zbog rijetke pojave ovog tumora, njegove kliničke prezentacije te citološke slike jake celularnosti, disocijacije stanica uz mjestimice izražene znakove atipije, nije neobično da se tumor citološki klasificira kao karcinom. Za lezije bradavice koje se prezentiraju kao egzulcerirane promjene, te općenito promijenjeni izgled bradavice, osim Pagetove bolesti treba svakako razmišljati i o benignim tumorima kao što je adenom bradavice. Terapija izbora je uklanjanje bradavice u cijelosti zato jer se, iako rijetko, mogu naći i žarišta karcinoma

Papilarni karcinom štitnjače poput Warthinovog tumora– prikaz slučaja

We report a rare case of Warthin tumor-like papillary thyroid carcinoma confi rmed by histology. It is an uncommon variant of papillary thyroid carcinoma with about 80 cases reported in the literature and it is often associated with lymphocytic thyroiditis. Morphologically, it resembles Warthin tumors of the salivary glands, with T and B lymphocytes infi ltrating the stalks of the papillae lined with large cells with abundant eosinophilic cytoplasm (oncocytic cells). The epidemiologic features of this variant of papillary thyroid carcinoma are similar to the classic papillary carcinoma. A 58-year-old female patient came to the ultrasound examination of cervical region and the examination detected twonodules; an isoechoic nodule 11 mm in greatest diameter with perilesional vascularisation in the left thyroid lobe and a solid-cystic nodule approximately 15 mm in greatest diameter in the right lobe of the thyroid gland. Ultrasound guided fine needle aspiration (FNA) was performed and cytological analysis indicated papillary carcinoma in the right thyroid lobe.Surgical treatment was performed. Histopathological analysis confi rmed the cytological diagnosis and the final histopathological diagnosis were Warthin tumor-like papillary thyroid carcinoma with lymphocytic thyroiditis and intraglandular tumor spread. Lymph node metastases were excluded as well as vascular invasion and nine months after surgery the patient is fine and disease-free. This tumor can be easily mistaken for Hurthle cell carcinoma and tall cell variant of papillary carcinoma both by FNA and histology but the lymphocytic infi ltrate within the stalks of the tumor papillae in the histology specimens is a distinctive factor for its diagnosis. The lymphocytic infi ltration in this variant of papillary carcinoma and association with lymphocytic thyroiditis may suggest the role of immunological mechanisms for its pathogenesis and prognosis. In the future, more studies are required for bett er understanding of its biological behaviour.Prikazujemo slučaj rijetke varijante papilarnog karcinoma štitnjače poput Warthinovog tumora. To je rijetka varijanta papilarnog karcinoma do sada opisana u literaturi u 80 slučaja i često je povezana s limfocitnim tireoiditisom. Morfološki, tumor oponaša Warthinov tumor žlijezda slinovnica, sa T i B limfocitima koji infi ltriraju stapke papila koje su obložene većim stanicama s obilnom eozinofi lnom citoplazmom (onkocitne stanice). Epidemiološke značajke ove varijante papilarnog karcinoma štitnjače istovjetne su klasičnom papilarnom karcinomu. 58-godišnja žena došla je na ultrazvučni pregled vrata i pregled je detektirao dva čvora; jedan izoehogeni, pojačano vaskulariziran veličine 11 mm u lijevom režnju štitnjače, i solidno-cistični čvor oko 15 mm u najvećem promjeru u desnom režnju štitnjače. Učinjena je citološka punkcija pod kontrolom ultrazvuka i citološka analiza je upućivala na papilarni karcinom čvora desnog režnja štitnjače. Učinjen je operativni zahvat. Histopatološka analiza potvrdila je citološku dijagnozu, i završne histološke dijagnoze bile su Warthin-varijanta papilarnog karcinoma štitnjače s limfocitnim tireoiditisom uz intraglandularno širenje tumora. Isključene su metastaze u limfne čvorove kao i vaskularna invazija i devet mjeseci nakon operacije pacijentica je dobro i bez znakova bolesti. Tumor je lako zamijeniti s Hurthle staničnim karcinomom, varijantom visokih stanica papilarnog karcinoma i to icitološki i histološki, ali limfocitni infi ltrat unutar stapki papila tumora u histološkim preparatima jasan je faktor njegove dijagnoze. Limfocitna infi ltracija u ovoj varijanti papilarnog karcinoma i povezanost s limfocitnim tireoiditisom sugerira ulogu imunoloških mehanizama u njegovoj patogenezi i prognozi. U budućnosti, biti će potrebno još studija za bolje razumijevanje njegovog biološkog ponašanja