scholarly journals Clinicopathological Study of Subcutaneous Heminthicnodules : Unusual Sites and Diagnostic Dilemmas

2021 ◽  
Vol 14 (02) ◽  
pp. 1039-1046
Author(s):  
Varun Kumar Singh ◽  
Koushiki Bhattacharjee ◽  
Padmapriya Jaiprakash
Keyword(s):  
Hydatid Cyst ◽  
Imaging Techniques ◽  
Case Reports ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Needle Aspiration ◽  
Zoonotic Infection ◽  
Tissue Eosinophilia ◽  
Characteristic Features ◽  
Infective Etiology

Introduction: Superficial palpable swellings with helmintic infection as an underlying etiology is usually an accidental finding in the surgically excised specimens. Somatic nematodes and cestodes are the commonly implicated organisms, and the zoonotic nematodes show an emerging trend. The present study aims to reappraise the histopathological findings of helminthic etiology in superficial swellings which were clinically suspected to be of neoplastic/non neoplastic nature. Materials and methods: Thirty six cases of palpable superficial nodules with infective etiology over a period of five years were reviewed. 19/36 were of helminthic etiology were included in the present study. Pertinent demographic and clinical data were retrieved from the medical archives. Results: Amongst the 19 cases, 8 were males and 11 females. Chest wall (4/19), and eyelids (3/19) were the most common sites involved. The size ranged from 0.8-15 cm in greatest dimension. Presence of histiocytes (13/19), granulomas (11/19), eosinophils (10/19), and giant cells (9/19) were the most consistent histological findings. 14 cases had discernible parasite morphology with diagnosis of filarial worms (7/19), Dirofilaria (3/19), cysticercosis (4/19), and hydatid cyst (1/19). Four cases had dead and calcified parasites with no discernible morphology. Conclusion: Granulomatous inflammation and tissue eosinophilia are strong indicators of a parasitic etiology. Subcutaneous and intramuscular filariasis, cysticercosis and hydatid cyst are well documented etoiologies whereas Dirofilariasis is an emerging zoonotic infection with worldwide case reports. Imaging techniques and fine needle aspiration can point towards the diagnosis; however in the absence of characteristic features, histopathology can be relied upon to diagnose a helminthicetiology.

scholarly journals Tuberculosis of the Thyroid

2017 ◽  
Vol 32 (1) ◽  
pp. 47-50
Author(s):  
Elmer F. Fabito ◽  
Mary Jane Tipayno-Lubos ◽  
Felixberto D. Ayahao
Keyword(s):  
Thyroid Gland ◽  
Granulomatous Inflammation ◽  
Inflammatory Cells ◽  
Final Diagnosis ◽  
Giant Cells ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Tumor Formation ◽  
Multiple Drug ◽  
Epitheloid Cells

Objectives: To present a case of thyroid tuberculosis and to discuss its clinical presentation, differential diagnoses and management. Methods:                         Design: Case Report                         Setting:  Tertiary Government Hospital                         Patient: One Results: A 55-year-old farmer presented with an 8-month progressively enlarging anterior neck mass, and fine needle aspiration biopsy yielded grossly turbid straw-colored aspirate admixed with blood with microscopy showing scattered inflammatory cells and macrophages set against a colloid background. After total thyroidectomy, hispathology revealed parenchymal infiltration by multiple aggregates of plump spindled to epitheloid cells forming granulomas with interspersed multinucleated giant cells, central caseation necrosis and surrounding fibrosis with chronic inflammatory infiltrates. The nodal masses also showed prominent germinal centers with interspersed epitheloid cells and foamy macrophages. Final diagnosis was chronic granulomatous inflammation consistent with tuberculosis. Conclusion: Tuberculosis (TB) of the thyroid is a rare occurrence that can present as inflammation, infection or tumor formation of the thyroid gland. Diagnosis depends on identification of the tubercle from tissues and aspirates by acid fast staining and TB culture. Treatment consists of multiple drug therapy for tuberculosis but thyroidectomy may be an option if the thyroid gland is severely diseased. Keywords: tuberculosis, endocrine; thyroid disease

scholarly journals Subcutaneous Granulomatous Inflammation due to Basidiobolomycosis: Case Reports of 3 Patients in Buruli Ulcer Endemic Areas in Benin

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Luc V. C. Brun ◽  
Jean Jacques Roux ◽  
Ghislain E. Sopoh ◽  
Julia Aguiar ◽  
Miriam Eddyani ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antifungal Therapy ◽  
Early Recognition ◽  
Case Reports ◽  
Buruli Ulcer ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Soft Tissue Tumors ◽  
Endemic Areas ◽  
Case Presentations

Background. Basidiobolomycosis is a rare subcutaneous mycosis, which can be mistaken for several other diseases, such as soft tissue tumors, lymphoma, or Buruli ulcer in the preulcerative stage. Microbiological confirmation by PCR for Basidiobolus ranarum and culture yield the most specific diagnosis, yet they are not widely available in endemic areas and with varying sensitivity. A combination of histopathological findings, namely, granulomatous inflammation with giant cells, septate hyphal fragments, and the Splendore-Hoeppli phenomenon, can confirm basidiobolomycosis in patients presenting with painless, hard induration of soft tissue. Case Presentations. We report on three patients misdiagnosed as suffering from Buruli ulcer, who did not respond to Buruli treatment. Histopathological review of the tissue sections from these patients suggests basidiobolomycosis. All patients had been lost to follow-up, and none received antifungal therapy. On visiting the patients at their homes, two were reported to have died of unknown causes. The third patient was found alive and well and had experienced local spontaneous healing. Conclusion. Basidiobolomycosis is a rare subcutaneous fungal disease mimicking preulcerative Buruli ulcer. We stress the importance of the early recognition by clinicians and pathologists of this treatable disease, so patients can timely receive antifungal therapy.

Cytomorphology of Hydatid Cyst: Two Case Reports

2021 ◽  
Vol 8 (2) ◽  
pp. 34-36
Author(s):  
Monica Sarohi ◽  
Shobha Mohindroo ◽  
Manju Rao
Keyword(s):  
Hydatid Cyst ◽  
Hydatid Disease ◽  
Case Reports ◽  
Needle Aspiration ◽  
The Body ◽  
Parasitic Disease ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Needle Aspiration Cytology ◽  
Cyst Hydatid

Hydatid disease is a parasitic disease caused by larvae of Echinococcus. The disease is distributed worldwide. However there are very few reports on cytology findings of hydatid disease as FNA in such cases is contraindicated. Usually hydatid disease is diagnosed on histopathology, but recently fine needle aspiration cytology of hydatid cyst is emerging and is still an issue of debate that whether it can cause dissemination of parasite in the body or not . Due to fewer studies on cytology it poses a problem in diagnosing hydatid disease on cytology. We present two case reports of hydatid cyst on cytology. Keywords: Hydatid cyst, Hydatid disease, Echinococcus larvae.

scholarly journals Tubercular lymphadenopathy with duodenal fistula

2016 ◽  
Vol 07 (02) ◽  
pp. 074-076
Author(s):  
Mukesh Nasa ◽  
Zubin Sharma ◽  
Neeraj Saraf ◽  
Rajesh Puri
Keyword(s):  
Coming Out ◽  
Case Reports ◽  
Giant Cells ◽  
Needle Aspiration ◽  
Alcoholic Patient ◽  
Duodenal Fistula ◽  
Aspiration Cytology ◽  
Chronic Alcoholic ◽  
Granulomatous Lymphadenitis ◽  
Needle Aspiration Cytology

AbstractTuberculosis, both pulmonary and extrapulmonary, is one of the leading causes of significant morbidity and mortality in developing countries. A 29-year-old chronic alcoholic patient presented to gastroenterology outpatient department with complaints of decreased appetite, weight loss, and generalized weakness. On endoscopy, the second part of duodenum appeared edematous with some luminal compromise. There was also presence of an opening in the inferolateral wall of the second part of duodenum, through which milky white caseous material was coming out. Computed tomography demonstrated large conglomerate of paraduodenal, celiac, para-aortic, peripancreatic, and retrocaval nodes with central necrosis. Endoscopic ultrasound showed hypoechoic lymph nodes in paraduodenal, parapancreatic, and celiac axis. Fine needle aspiration cytology showed epithelioid granuloma with Langerhans giant cells suggestive of granulomatous lymphadenitis of tubercular etiology. Tubercular lymphadenopathy eroding into duodenum has been very rarely reported in literature. This case reports the rare possibility of extrinsic tubercular lymphadenopathy eroding into duodenum.

scholarly journals Evaluation of polymerase chain reaction in space-occupying lesions of liver reported as granulomatous inflammation/tuberculosis on fine-needle aspiration cytology

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 1 ◽  
Author(s):  
Kusum Sharma ◽  
Nalini Gupta ◽  
Kapil Goyal ◽  
Ajay Kumar Duseja ◽  
Aman Sharma ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Needle Aspiration ◽  
Insertion Element ◽  
Chain Reaction ◽  
Granulomatous Lesions ◽  
Polymerase Chain ◽  
Needle Aspiration Cytology

Background: Tubercular involvement of the liver is uncommon, but is a serious consideration in differential diagnosis of granulomatous conditions, especially in endemic regions like India. Objective: To assess the role of polymerase chain reaction (PCR) done on archival cytological material in diagnosing tuberculosis (TB) in cases reported as granulomatous inflammation/TB in liver lesions. Materials and Methods: This was a retrospective study including a total of 17 cases of liver space-occupying lesions (SOLs) reported as granulomatous inflammation (n = 12) and TB (n = 5). The smears were retrieved from the archives of the department and were reviewed for the cytomorphologic features. Air-dried smears stained with May–Grünwald–Giemsa (MGG) stain were assessed for the representative material in the form of epithelioid granulomas and giant cells. One/two MGG smears from each case were destained and the material was used for performing PCR for Mycobacterium tuberculosis by amplification of 123 bp fragment of the IS6110 insertion element. Results: The age of the patients ranged from 3 to 61 years. There were 12 females and 5 males. The patients presented with solitary/multiple liver SOLs. DNA could be extracted from 10/17 cases from archival MGG smears. PCR positivity was noted in 8/10 cases (including four acid-fast bacilli smear-positive cases), confirming a diagnosis of TB. Conclusion: Cytomorphology alone may not be sufficient for differentiating various granulomatous lesions reported in liver SOLs. DNA can be extracted from the archival cytological MGG-stained smears. PCR should be carried out if Ziehl–Neelsen staining is negative in granulomatous lesions, especially when material has not been submitted for culture.

Liver rheumatoid nodules imitating liver malignancy: a rare occurrence

2020 ◽  
Vol 13 (12) ◽  
pp. e234366
Author(s):  
Jason Wee ◽  
Salar Sobhi ◽  
Bastiaan De Boer ◽  
Dan Xu
Keyword(s):  
Histological Analysis ◽  
Granulomatous Inflammation ◽  
Needle Aspiration ◽  
Upper Respiratory Tract ◽  
Positron Emission Tomography Scan ◽  
Liver Malignancy ◽  
Positron Emission ◽  
Right Lobe ◽  
Upper Respiratory ◽  
Tomography Scan

We describe a case of a 61-year-old man with a background of rheumatoid arthritis who presented to the emergency department with a single-reported episode of haemoptysis on the background of an upper respiratory tract infection. A CT scan revealed an incidental 40 mm mass in upper right lobe of the liver abutting the diaphragmatic surface. A subsequent positron emission tomography scan confirmed the mass and raised the possibility of another lesion in the liver raising the suspicion of malignancy. The case was complicated by the inability to perform a fine needle aspiration biopsy due to the mass’ proximity to the diaphragm. After discussion with the patient, it was decided to resect the affected liver segment. Histological analysis of the mass revealed localised necrotising granulomatous inflammation suggestive of a rheumatoid nodule, which is seldom reported in the literature.

scholarly journals An overlooked situation in the interpretation of serum thyroglobulin level in a papillary thyroid cancer patient

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Fevziye Burcu Sirin ◽  
Hakan Korkmaz
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Serum Sample ◽  
Imaging Techniques ◽  
Needle Aspiration ◽  
Papillary Thyroid ◽  
Serum Samples ◽  
Serum Thyroglobulin ◽  
Thyroid Cancer Patient ◽  
Serial Dilutions

AbstractIn the present study we report a case of thyroglobulin (TGB) measurement interference in a total thyroidectomized and radio-ablated 61-year old woman with papillary thyroid cancer. We investigated possible interference in the measurement of TGB due to discordant TGB in relation to clinical condition during the follow-up period. Serum TGB was measured with the chemiluminescence method using Beckman Coulter Unicel DxI 800 instrument. To investigate possible interference in TGB measurement serial dilutions, polyethylene glycol precipitation (PEG), treatment with heterophile blocking tube (HBT), rheumatoid factor level determination and retesting of TGB with an alternative method were performed. Serial dilutions of the serum sample revealed linearity but a remarkable decrease in TGB in the patient’s serum samples post PEG and post HBT treatments. Also, TGB results under functional sensitivity level obtained with a different method suggested that TGB interference developed due to heterophile antibody presence in the serum sample. The patient had unnecessarily undergone expensive imaging techniques, and invasive procedures such as lymph node fine needle aspiration biopsy, before the analytical interference was suspected by the clinician. This report illustrates the importance of early communication and close collaboration between clinicians and laboratorians in order to avoid unnecessary clinical intervention.

scholarly journals A Fatal and Rare Case of Hydatid Cyst in the Pouch of Douglas

2021 ◽  
Author(s):  
Ritu Asnani ◽  
Sunil Kumar Yeshvanth ◽  
Lancelot Lobo ◽  
Shipra Sonkusare
Keyword(s):  
Hydatid Cyst ◽  
Rare Case ◽  
Frozen Section ◽  
Public Health Problem ◽  
Zoonotic Infection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Significant Public Health Problem ◽  
Significant Public Health ◽  
Pouch Of Douglas

Abstract Hydatid cyst is a zoonotic infection and a significant public health problem in low- and middle-income countries. A 79-year-old female patient was presented to the gynecology outpatient department with complaints of pain in the abdomen and difficulty in micturition, with a mass palpable per speculum. The ultrasound was suggestive of an ovarian cystadenocarcinoma, whereas computed tomography of the abdomen favored hydatid cyst with adnexal neoplasm as a differential diagnosis. Considering the contradictory findings, a frozen section was sent to confirm the diagnosis, which showed hooklets of Echinococcus granulosus/hydatid cyst under the microscope. This was a rare case of pelvic hydatid cyst mimicking ovarian malignancy and was associated with a less-preferred mode of investigation (frozen section). This article focuses on how a frozen section, despite its limitations and being expensive, can still be considered for accurate patient management.

scholarly journals Mesenteric Cysts: A Retrospective Review. Its Not All That Simple

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S117-S118
Author(s):  
M Bourgeau ◽  
V Avadhani
Keyword(s):  
Cyst Wall ◽  
Imaging Techniques ◽  
Case Reports ◽  
Lymphatic Vessels ◽  
Mucinous Cystadenoma ◽  
Final Diagnosis ◽  
Cystic Mass ◽  
Pathological Examination ◽  
Urachal Cyst ◽  
Mesenteric Cysts

Abstract Introduction/Objective Mesenteric cysts are rare intra-abdominal lesions in adults. However, with the advanced imaging techniques and laparoscopic techniques, they are more often being identified and resected when clinically significant. There is a lack of detailed information in histopathology (except as case reports) since mesentery is generally neglected in our organ-based textbooks. The aim of our study is to highlight the importance of identifying and classifying mesenteric cystic lesions; they are not all that simple. Methods We performed a retrospective search on all mesenteric cysts submitted as excisions in our electronic database from 2013-2019. We classified them as per the de Perrot (PMID: 11053936) classification with modification. Results Our search showed: A. Lymphatic origin-11 (lymphangioma-10, Lymphangioma hamartomatous-1, associated with LAM-0), B. Mesothelial origin-68 (Benign mesothelial cysts-57, multilocular mesothelial cyst-11), C. Enteric origin- 3, D. Urogenital origin (Urachal cyst, mullerian inclusion cyst)-9, E. Mature cystic teratom-2, F. Pseudocyst-12, G. Epithelial cyst (not urogenital)- 11 (a/w LAMN-3, MCN-4, Mucinous cystadenoma-4), H. Associated with carcinoma-2. Case illustration: A 61-year-old male presented with worsening dysphagia, emesis and hiccups. A CT scan showed a 21.2 cm cystic mass with at least one septation (Fig 1). The cyst was resected. On gross pathological examination, the cyst measured 18 cm in greatest dimension with a thick, rough, tan-brown capsule. Microscopic examination showed a fibrous capsule, and cyst wall composed of numerous lymphatic vessels (CD31 positive) and prominent smooth muscle proliferation (Desmin positive). Scattered lymphoid aggregates were also present throughout the cyst wall. No definite epithelial lining was identified and was suspected to have been denuded. HMB-45 immunostain was negative, ruling out association with LAM. The final diagnosis of a Lymphangiomyoma, hamartomatous was rendered. Conclusion Though most of the mesenteric cysts are benign, some of them are significantly important such as Lymphangiomyoma (esp secondary to LAM), MCN, those associated with LAMN etc. and identifying and differentiating from their mimics has distinct clinical implications.

scholarly journals Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tomoko Mizota ◽  
Masato Suzuoki ◽  
Saya Kaku ◽  
Kenichi Mizunuma ◽  
Kazuto Ohtaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Imaging Modalities ◽  
Hepatoduodenal Ligament ◽  
Regional Lymph Nodes ◽  
Multiple Imaging

Abstract Background Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. Case presentation A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. Conclusions SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.

Sign in / Sign up

Export Citation Format

Share Document