Category Archives: Uncategorized

“Towards Curing Incurable Cancer” Amazing lecture by Prof. James Watson, co-discoverer of the structure of DNA, at King Faisal Specialist Hospital and Research Centre.

 

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Never Assume

This is a fine needle aspiration from 50 years old female patient presented with bilateral ovarian masses. She is also known case of breast carcinoma for which she had mastectomy.

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  • Hypercellular smear

  • Monotonous nuclei.

  • Different architectural patterns including trabecular and follicular grouping.

  • Many nuclear grooves.

The following features strongly support the diagnosis of Granulosa Cell Tumor of the ovary. The diagnosis can be confirmed with inhibin immunostain.

Other features not present in this case:

  • Call-Exner bodies, noncellular material that is brightly magenta in color on Diff quick stain surrounded by granulosa cells.

Falling in the trap of assuming this tumor as a metastatic breast adenocarcinoma is easy. follicular grouping might be interpreted as glandular differentiation.

Thigh Mass

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Male patient in his second decade presents with huge thigh mass.

Touch preparations stained with Diff Quick  showed :

  • Fibrillary to myxoid metachromatic stroma. 
  • Hypercellularity. 
  • The cells show plumpy hyperchromatic nuclei with moderate pleomorphism some intranuclear pseudoinclusions are also noted.
  • Nerve sheath differentiation in the form of elongated, slender wavy nuclei. 
  • Scanty cytoplasm.

On Histopathology the case was diagnosed as Malignant Peripheral Nerve Sheath Tumor.

The morphological features of MPNST are very variable. The 2 most common patterns are the spindle cell and  epithelioid cell patterns. Cases showing fibromyxoid like morphology and Hemangiopericytoma like features are reported.

“The majority of MPNST are diagnosed as spindle cell sarcoma or pleomorphic sarcoma with FNA. The cellular features may suggest MPNST but a diagnosis may be difficult, even with the help of adjunctive methods. IC may be of diagnostic help if S-100 protein is positive. The positivity in MPNST is typically focal, extensive staining favours a cellular schwannoma. negative staining with desmin, SMA and muscle-specific actin excludes smooth muscle tumours and negative staining with cytokeratin, EMA and CD99 excludes  synovial sarcoma”.  The Cytology of Soft Tissue Tumours Dr. Mi1ns Akerman Dr. I-Ienryk A. Domanski

Helpful features include sharp radiating pain in FNA aspiration, Relation with major nerve trunk and history of Neurofibromatosis type 1 .

(By courtesy of Dr. Hatim Khoja)

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Adenomatoid Tumor, with Signet Ring like morphology

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Adenomatoid tumors are composed of two major elements the epithelial component and the fibrous stroma. the epithelial component is arranged in tubules, cords and nests withe cells that are flat, cuboidal to low columnar with round or oval nuclei and abundant dense cytoplasm however the cells might contain cytoplasmic vacuols and sometimes it’s so extensive that it results in signet ring like morphology as in the case of this gentle man how presents with painless small 2 cm mass in the epididymis. one should not confuse this with metastasizing signet ring carcinoma as adenomatoid tumors are very common only second to cord lipomas in such locations.  Negative CEA immunostain will rule out adenocarcinoma.

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Rt. Thyroid Nodule FNA

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55 years old female patient with history of breast carcinoma present’s with solitary thyroid nodule, spot diagnosis?

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