Diagnostic dilemma of a subcutaneous nodule following a trauma in a child: immunohistochemical examination put the final diagnosis of deep granuloma annulare

Six to eight percent of granular cell tumors are seen in the breast. Although mostly benign, they rarely have malignant features clinically and radiologically reminding of breast cancer. This may lead to a potential misdiagnosis of breast carcinoma and overtreatment of patients. The final diagnosis is made by immunohistochemical examination. We performed excisional biopsy on a patient who was diagnosed to have a breast mass. The histopathological examination of the mass revealed granular cell tumor.

Download Full-text

Neurosurgical management of a giant colloid cyst with atypical clinical and radiological presentation

Journal of Neurosurgery ◽

10.3171/2014.7.jns14242 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1185-1188 ◽

Cited By ~ 5

Author(s):

Joel Woodley-Cook ◽

Jaime L. Martinez ◽

Anish Kapadia ◽

David G. Munoz ◽

Aditya Bharatha ◽

...

Keyword(s):

Vision Loss ◽

Obstructive Hydrocephalus ◽

Memory Loss ◽

Final Diagnosis ◽

Colloid Cyst ◽

Ct Scans ◽

Mr Images ◽

Diagnostic Dilemma ◽

Foramen Of Monro ◽

Histopathological Investigation

The finding of a colloid cyst on neuroimaging is often incidental. These lesions are usually located at the foramen of Monro, are hyperdense on CT scans, and generally demonstrate signal intensity of water on MR images, although this depends on their content. When symptomatic, they frequently present with headaches and nausea due to an obstructive hydrocephalus. The authors describe a case of a giant colloid cyst in a patient presenting with complete left-sided vision loss and progressive memory loss, two very atypical findings in colloid cyst presentation. Imaging findings were also atypical, and this case proved to be a diagnostic dilemma because of its clinical and radiological presentation. Histopathological investigation was of utmost importance in the final diagnosis of a colloid cyst. To the authors' knowledge this colloid cyst is larger than any other described in the literature.

Download Full-text

Tuberculous brain abscesses: Case series and review of literature

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.83581 ◽

2011 ◽

Vol 02 (02) ◽

pp. 153-157 ◽

Cited By ~ 11

Author(s):

Sarala Menon ◽

Renu Bharadwaj ◽

A.S. Chowdhary ◽

D.V. Kaundinya ◽

D.A. Palande

Keyword(s):

Brain Abscess ◽

Mr Spectroscopy ◽

Case Series ◽

Final Diagnosis ◽

Diagnostic Dilemma ◽

Proton Mr Spectroscopy ◽

Microbiological Culture ◽

Brain Abscesses ◽

Tuberculous Brain Abscess

ABSTRACT Introduction: Tuberculous brain abscess (TBA) is a rare but serious condition. It resembles a pyogenic brain abscess clinically and radiologically and poses a problem in diagnosis and treatment. A final diagnosis is established by smear or culture demonstration of acid fast bacilli (AFB) within the abscess. Here, we report four such cases in our fiveyear study on brain abscesses, along with the different diagnostic modalities used. Materials and Methods: A total of 75 brain abscess pus specimens were collected during neurosurgery, either by burr hole or by craniotomy. These specimens were further subjected to Gram stain, Ziehl-Neelsen (ZN) stain, and conventional microbiological culture. Only those cases which showed presence of AFB on ZN stain along with the growth of Mycobacterium tuberculosis were considered as TBAs. Such TBA cases were further presented along with their In vitro Proton Magnetic Resonance (MR) Spectroscopic findings. Results: Of these four patients, three were males. Though this condition is more commonly seen in immunocompromised patients, three of the patients in this study were immunocompetent. All the four pus specimens showed presence of AFB in the ZN stain. Three of them grew M. tuberculosis as sole isolate. The fourth case was of concomitant tuberculous and pyogenic brain abscess. In vitro Proton MR spectroscopy of the pus specimens showed absence of multiple amino acids at 0.9 ppm, which was found to be hallmark of TBA. One patient died of four. Conclusions: TBA always poses a diagnostic dilemma. ZN stain and conventional microbiological culture for Mycobacteria always help to solve this dilemma. In vitro Proton MR Spectroscopy also seems to have the diagnostic utility.

Download Full-text

Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration

CytoJournal ◽

10.4103/1742-6413.64385 ◽

2010 ◽

Vol 7 ◽

pp. 9 ◽

Cited By ~ 36

Author(s):

Sara E. Monaco* ◽

Matthew J. Schuchert ◽

Walid E. Khalbuss

Keyword(s):

Fine Needle Aspiration ◽

Final Diagnosis ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Diagnostic Dilemma ◽

Fine Needle ◽

Preliminary Diagnosis ◽

Diagnostic Difficulties ◽

Site Evaluation ◽

Background Material

Background: One of the novel techniques utilizing fine needle aspiration (FNA) in the diagnosis of mediastinal and lung lesions is the endobronchial ultrasound (EBUS)-guided FNA. In this study, we describe five cases which had a discrepancy between on-site evaluation and final diagnosis, or a diagnostic dilemma when rendering the preliminary diagnosis, in order to illustrate some of the diagnostic difficulties and pitfalls that can occur in EBUS FNA. Methods: A total of five EBUS FNA cases from five patients were identified in our records with a discrepancy between the rapid on-site evaluation (ROSE) and final diagnosis, or that addressed a diagnostic dilemma. All of the cases had histological confirmation or follow-up. The cytomorphology in the direct smears, cell block, and immunohistochemical stains were reviewed, along with the clinical history and other available information. Results: Two cases were identified with a nondefinitive diagnosis at ROSE that were later diagnosed as malignant (metastatic signet-ring cell adenocarcinoma and metastatic renal cell carcinoma (RCC)) on the final cytological diagnosis. Three additional cases were identified with a ROSE and final diagnosis of malignant (large cell neuroendocrine carcinoma (LCNEC) and two squamous cell carcinomas), but raised important diagnostic dilemmas. These cases highlight the importance of recognizing discohesive malignant cells and bland neoplasms on EBUS FNA, which may lead to a negative or a nondefinitive preliminary diagnosis. Neuroendocrine tumors can also be difficult due to the wide range of entities in the differential diagnosis, including benign lymphocytes, lymphomas, small and nonsmall cell carcinomas, and the lack of immunohistochemical stains at the time of ROSE. Finally, the background material in EBUS FNAs may be misleading and unrelated to the cells of interest. Conclusions: This study illustrates the cytomorphology of five EBUS FNA cases that address some of the diagnostic challenges witnessed while examining these specimens during ROSE. Many of the difficulties faced can be attributed to the baseline cellularity of the aspirates, the bronchial contamination, the difficulty identifying neoplasms with bland cytology, the wide spectrum of diseases that can occur in the mediastinum with overlapping cytomorphologic features, the mismatch between the background material and the cell populations present, and the overall unfamiliarity with these types of specimens.

Download Full-text

Odontogenic myxofibroma- Report of a rare entity

Journal of Pathology of Nepal ◽

10.3126/jpn.v6i12.16262 ◽

2016 ◽

Vol 6 (12) ◽

pp. 1043-1045

Author(s):

P Poudel ◽

B Bajracharya ◽

S Bhattacharya ◽

D Bajracharya ◽

S Singh ◽

...

Keyword(s):

Female Patient ◽

Recurrence Rate ◽

Rare Case ◽

Benign Tumor ◽

Final Diagnosis ◽

High Recurrence Rate ◽

Rare Entity ◽

Odontogenic Myxoma ◽

Immunohistochemical Examination ◽

Rare Benign Tumor

Odontogenic myxofibroma is a rare, benign tumor, which is considered to be the variant of odontogenic myxoma. It is locally infiltrative, aggressive and has high recurrence rate. Only 24 specific cases of myxofibroma have been reported since 1950 and only two cases have been reported with excessive calcifications till 2012. Here, we report a rare case of Odontogenic myxofibroma with calcifications in 53 years old female patient who presented with the chief complain of swelling. The final diagnosis of Odontogenic myxofibroma was established after histopathological and immunohistochemical examination.

Download Full-text

Retroperitoneal Lymphangioma in an Adult: A Case Report of a Rare Clinical Entity

Case Reports in Surgery ◽

10.1155/2015/732531 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Mayank Tripathi ◽

Sanjeev Parshad ◽

Rajender Kumar Karwasra ◽

Ashish Gupta ◽

Saket Srivastva ◽

...

Keyword(s):

Abdominal Distension ◽

Final Diagnosis ◽

Definitive Diagnosis ◽

Rare Entity ◽

Imaging Studies ◽

Diagnostic Challenge ◽

Diagnostic Dilemma ◽

Case Presentation ◽

Cystic Lymphangiomas ◽

Retroperitoneal Lymphangioma

Background. Retroperitoneal lymphangioma is a rare, benign mesodermal tumor arising from the retroperitoneal lymphatics which usually presents in infancy and it is worthy to report a case when it has presented in an adult. After a thorough literature search in English we concluded that less than 200 cases of adult retroperitoneal lymphangioma have been reported so far. Apart from being a rare entity it also presents as a diagnostic dilemma and final diagnosis is often made on surgical exploration.Case Presentation. We report a case of retroperitoneal lymphangioma in a 55-year-old male who presented with abdominal distension and dull aching abdominal pain.Conclusion. Retroperitoneal lymphangiomas are rare tumors of infancy but may also present in adults where they are a diagnostic challenge. Differentiating cystic lymphangiomas from other cystic growths by imaging studies alone are often inconclusive and surgery is frequently required for definitive diagnosis and to ameliorate the symptoms.

Download Full-text

The epidemiological and clinicopathological study of benign breast disease with special reference to treatment regimen

International Surgery Journal ◽

10.18203/2349-2902.isj20174144 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3317

Author(s):

Anand Kumar Jaiswal ◽

Rakesh Saxena ◽

Shesh Kumar

Keyword(s):

Benign Breast Disease ◽

Ductal Carcinoma ◽

Lobular Carcinoma ◽

Final Diagnosis ◽

Breast Disease ◽

Breast Diseases ◽

Diagnostic Dilemma ◽

Medical College ◽

Benign Breast Diseases ◽

Ductal Hyperplasia

Background: Benign breast disease can be defined to include all those breast diseases which are not malignant. The diagnostic dilemma is for the disease like atypical ductal hyperplasia, mammary intra epithelial neoplasia, ductal carcinoma in situ and lobular carcinoma in situ.Methods: An epidemiological study of 78 patients of benign breast diseases who attend the surgery OPD or admitted as indoor patients in the department of general surgery, B.R.D. Medical College Gorakhpur during a period of one year.Results: Benign breast diseases were most common in third decade (51.28%) following fourth decade (23.07%) of life. Most of the patients belongs to middle (37.1%) and higher (32.5%) socioeconomic status. Fibroadenosis (34.61%) was found to be commonest lesion followed by fibroadenoma (26.92%) and mastitis (24.35%).Conclusions: In our study of benign breast disease, breast pain was the commonest presenting symptom (64.01%) followed by lump in the breast (42.3%). The final diagnosis of benign breast lesion in descending order was fibroadenosis (34.6%), fibroadenoma (26.9%), mastitis (24.4%), duct ectasia (3.8%) and dermatitis of nipple, gynaecomastia 2.56% each. Only one case each (1.2%) of cystosarcoma phyllode, duct papilloma, tuberculosis and galactocele was seen.

Download Full-text

A study of clinicopathologic spectrum of vesicobullous disorders

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20173203 ◽

2017 ◽

Vol 3 (3) ◽

pp. 355

Author(s):

Heena Mittal ◽

Sukhjot Kaur ◽

Bhavna Garg ◽

Neena Sood ◽

Sunil Kumar Gupta ◽

...

Keyword(s):

Pemphigus Vulgaris ◽

Clinical History ◽

Final Diagnosis ◽

Stevens Johnson Syndrome ◽

Direct Immunofluorescence ◽

Diagnostic Dilemma ◽

Dermoepidermal Junction ◽

Female Ratio ◽

Male Female Ratio ◽

Detailed Clinical History

Background: Blistering diseases are alarming skin conditions. Autoimmune blistering diseases are a group of bullous disorders characterized by pathogenic antibodies directed at the target antigens in the epidermis or dermoepidermal junction.The objectives were to study the spectrum of histopathological changes by light microscopy, to evaluate the pattern of direct immunofluorescence (DIF) and to correlate clinical, histopathological features and DIF findings of vesiculobullous lesions of the skin or/and mucosa.Methods: The present study was carried out on 110 skin and/or mucosal biopsies with vesicobullous disorders from July 2013 to June 2016. Detailed clinical history, morphology of lesions, site of involvement and other findings were recorded as per proforma. These cases were analysed clinically, histopathologically and on immunofluorescence.Results: Majority of the patients presented in the age group of 41-50 years (30.9%). The male: female ratio was 1:1.15. Pemphigus vulgaris was the most common vesiculobullous disorder constituting 48.2%, followed by Bullous Pemphigoid constituting 27.3%. Dermatitis herpetiformis constituted 8.3%; Pemphigus foliaceous 3.6%, varicella and Stevens Johnson Syndrome both were observed in 2.7% each. DIF was performed in 81 cases out of which only 72 cases (92.6%) showed positivity. Conclusions: DIF is a sensitive tool for distinguishing immune mediated bullous diseases from other vesiculobullous disorders especially in cases which pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on correlation of clinical, histopathological and immunoflourescence findings.

Download Full-text

Clinical utility of linear endosonography in patients with unexplained biliary dilatation and negative MRCP, with predictors for detection of neoplastic lesions

Egyptian Liver Journal ◽

10.1186/s43066-021-00164-x ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Hassan Atalla ◽

Ayman Menessy ◽

Hazem Hakim ◽

Hideyuki Shiomi ◽

Yuzo Kodama ◽

...

Keyword(s):

Invasive Procedure ◽

Magnetic Resonance Cholangiopancreatography ◽

Abdominal Ultrasound ◽

Final Diagnosis ◽

Multivariate Regression Analysis ◽

Diagnostic Dilemma ◽

Predictive Values ◽

Biliary Dilatation ◽

Asymptomatic Patients ◽

Neoplastic Lesions

Abstract Background and study aims Unexplained biliary dilatation (UBD) frequently represents a diagnostic dilemma. Linear endosonography (EUS), with its close proximity to the pancreaticobiliary system and the ability for tissue acquisition, could have a role in revealing etiologies of UBD particularly in the context of negative other non-invasive modalities. However, in such patients, the decision for this semi-invasive procedure is usually debatable and often needs justification. Thus, we aimed to evaluate the diagnostic utility of linear EUS in patients with UBD after negative magnetic resonance cholangiopancreatography (MRCP) and to delineate predictors for EUS ability to detect neoplastic lesions. Patients and methods This was a prospective diagnostic observational study between 2018 and 2021. Included patients with evidence of biliary dilatation on abdominal ultrasound and negative MRCP underwent linear EUS examination. Results were compared to the final diagnosis relied on histopathology after EUS-guided biopsy or surgery for neoplastic lesions, while ERCP, diagnostic EUS criteria plus histopathology for autoimmune pancreatitis, Rosemont criteria for chronic pancreatitis, and/or follow-up for 6 months were the gold standard tests for non-neoplastic etiologies. Logistic regression was conducted to reveal predictors of neoplasm detection by EUS. Results Sixty-one patients (mean age 60 years, 32 females) were enrolled; 13.1% of them were asymptomatic. The final diagnosis was categorized into 29 patients with and 32 without neoplasms. Sensitivity, specificity, positive, negative predictive values (PPV, NPV), and accuracy of EUS-positive findings were 98.3%, 100%, 100%, 66.7%, and 98.3%, respectively. Corresponding results for neoplasm identification were 100%, 93.8%, 93.5%, 100%, and 96.7%, respectively. The most common neoplastic etiologies were small pancreatic and ampullary masses. Common bile duct (CBD) diameter > 12.9mm and CA19-9 > 37.1 u/ML were independent predictors for pancreaticobiliary neoplasm at multivariate regression analysis. Conclusion Linear EUS appears to have a high accuracy in detecting etiologies of UBD, with higher sensitivity for small pancreatic, ampullary lesions, and CBD stones. CBD diameter > 12.9 mm and elevated CA19-9 > 37.1 u/ML should raise a concern about the presence of occult pancreaticobiliary neoplasm, and then, EUS may be warranted even in asymptomatic patients.

Download Full-text

Recurrent perineal aggressive angiomyxoma: dilemma in diagnosis and outcome of this rare disease

BMJ Case Reports ◽

10.1136/bcr-2020-238722 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238722

Author(s):

Nitin Paul Ambrose ◽

Victor Vijay Coelho ◽

Beulah Roopavathana ◽

Suchita Chase

Keyword(s):

Surgical Excision ◽

Perineal Hernia ◽

Complete Resection ◽

Aggressive Angiomyxoma ◽

Immunohistochemical Examination ◽

Male Population ◽

Mesenchymal Tumour ◽

Diagnostic Dilemma ◽

Perineal Region ◽

High Chance

Aggressive angiomyxoma (AAM) is a very rare, benign, locally infiltrative mesenchymal tumour with a high chance of recurrence following surgical excision. In the male population, it is so rare that less than only 50 cases have been reported so far. We present a case of a large recurrent perineal AAM in a man who presented with swelling in the perineal region following surgical excision 3 years ago. After evaluation, the diagnostic dilemma of a possible perineal hernia or recurrence remained. Surgical exploration ruled out hernia and the tumour was excised with difficulty. Immunohistochemical examination showed tumour cells with diffuse nuclear positivity for oestrogen receptor and patchy cytoplasmic positivity for desmin (A2). Histological and immunohistochemical features confirmed the diagnosis. Being very rare, AAMs need to be considered as a differential diagnosis of pelvic/perineal tumours among males. With no standardised therapy for AAM, complete resection would be the goal of therapy.

Download Full-text