BACKGROUND:B‐cell lymphomas with concurrent IGH‐BCL2 and c‐MYC rearrangements (so‐called “double‐hit lymphomas” [DHL]) are a relatively rare, recently described category in the 2008 World Health Organization classification of hematopoietic neoplasms. Response to chemotherapy and survival are poor.METHODS:The authors reviewed files of cytogenetically documented DHL to identify cytologic features that would allow its possible recognition.RESULTS:Twelve fine‐needle aspirates (FNAs), 2 pleural fluids, and 1 touch imprint of cytogenetically proven DHL were uncovered. Primary DHL was correctly recognized in 3 of 12 FNA cases using Ki‐67 staining coupled with a positive bcl‐2 result as the basis for performing fluorescence in situ hybridization (FISH) analysis of c‐MYC and IGH‐BCL2 rearrangements. Remaining FNAs and non‐FNA cases were diagnosed as non‐Hodgkin lymphoma, B‐cell lymphoma, or atypical lymphocytosis. Ten cases had cell block material available. All cases had high cellularity with a dissociated smear pattern and background lymphoglandular bodies. Cell size ranged from intermediate to large. Nuclei were predominantly rounded or slightly irregular in contour; 4 FNAs had markedly cleaved nuclei. Some nuclei harbored discrete but small nucleoli, whereas in others coarse chromatin and indistinct or multiple small nucleoli existed. A variable number of mitotic figures, tingible body macrophages, and background apoptotic cells were also present.CONCLUSIONS:No specific cytomorphologic feature(s) were found to reliably identify DHL using FNA or exfoliative cytology. A high Ki‐67 proliferation index and positive bcl‐2 staining (on cytospin slides or cell block material) of cases not conforming to typical Burkitt lymphoma morphology should prompt FISH analysis for c‐MYC and/or IGH‐BCL2 rearrangements to identify DHL, particularly if tissue biopsy is not expected. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society
Cupriavidus pauculus is a water microorganism rarely isolated from clinical specimens. We describe a pseudo-outbreak in which multiple strains that were associated with moistening of culturette swabs with tap water were isolated from a single clinic before collecting the patient specimen. CASE REPORTIn a period of 6 weeks, 27 skin and superficial site swab specimens were submitted from an outpatient clinic to the clinical microbiology laboratory for bacterial culture. The specimens were plated onto blood agar (BA; Becton Dickinson, MD), MacConkey (Becton Dickinson, MD), and chocolate agar (CA; Becton Dickinson, MD) per routine procedure. Eleven of the clinical specimens grew an unusual bacterium. After 24 h, the colonies were smooth, round, and colorless on BA and CA and nonfermentative on MacConkey agar. The cultures were negative for common skin flora, such as coagulase negative Staphylococcus or Corynebacterium spp., and other commonly isolated wound pathogens, such as Staphylococcus aureus or Pseudomonas aeruginosa (6). The organisms were found to be Gram negative and catalase and oxidase positive and were reported as "Pseudomonas-like" nonfermenting bacilli by the MicroScan WalkAway system (Siemens Healthcare Diagnostics, IL).Because of the uncommon nature and the presence of this bacterium in multiple specimens in a short span of time, further investigation was undertaken. All the specimens originated from a single hospital-affiliated outpatient clinic and were submitted by the same physician's office. The swab specimens had been collected with double culturette swabs (BBL CultureSwab; BD Diagnostics, Sparks, MD) from various skin and wound sites from patients with various comorbidities and of different age groups. The clinic was contacted, and unopened culturette swabs of the same lot number were requested to rule out contamination. The uninoculated culturettes plated onto BA, CA, MacConkey, and colistin nalidixic acid (CNA; Remel, KS) plates did not yield any growth, thereby ruling out contamination. The clinic was contacted again for a detailed account of specimen collection methods. Upon further inquiries, it was discovered that the culturette swabs were moistened with tap water before collecting the patient specimen. A tap water sample from the clinic sink was requested and plated onto BA, CA, MacConkey, and CNA plates by using a swab, and it grew a "Pseudomonas-like" nonfermenting bacilli morphologically similar to the patient isolates.A total of six isolates and the water isolate were separately referred to the Ohio Department of Health Laboratory and to the Centers for Disease Control and Prevention (CDC) reference laboratories for further identification. The isolates were identified as Cupriavidus (Ralstonia, Wautersia) pauculus based on morphology and biochemical tests. The following tests were reported positive: oxidase, catalase, citrate, and urea. The following were negative: indole, nitrate, methyl red-VogesProskauer, gelatin, and esculin. There was no acid production from glucose, xylose, ma...
A tumoral mass of amyloid (amyloidoma) arising in the soft tissues of the distal extremities is exceedingly unusual, and applying the fine-needle aspiration (FNA) biopsy technique to specifically diagnose this condition is even more infrequent. Herein, we report an example of two separate amyloidomas arising in the right calf of an otherwise asymptomatic elderly man who was referred to the sarcoma clinic because these masses clinically and radiographically simulated a malignant neoplasm. The fine-needle aspirate yielded amorphous, acellular, dense blue material on Romanowsky-stained smears and smudgy acellular cyanophilic material on Papanicolaou-stained smears. The aspirate procured cell-block contained hyalinized eosinophilic acellular material on H&E stain that was Congo-red positive and displayed yellow-green birefringence with polarization. Unlike prior assertions to the contrary, a diagnosis of amyloidoma is possible using FNA cytopathology even in patients without a known underlying amyloidogenic disorder.
Background. The increasing incidence of primary cutaneous B-cell lymphomas (PCBCLs) presents new challenges for clinicians. Despite advances in the clinical and pathologic characterization of PCBCL, the significance of the current staging approach as a risk profiling tool and the effect of various treatments on outcome remain unclear. Materials and Methods. We retrospectively reviewed patients who presented with a diagnosis of PCBCL seen at The Ohio State University between 1998 and 2012. We reviewed the initial presentation and treatment modality.We then assessed whether the treatment modality (conservative skin-directed vs. definitive radiation with or without systemic therapy), stage (T1 or $T2), or histologic subtype (primary cutaneous follicle center lymphoma [PCFCL] vs. primary cutaneous marginal zone B-cell lymphoma [PCMZL]) affected the riskof recurrence. Results. We identified 67 patients referred with an initial diagnosis of PCBCL. After imaging, 12 did not meet the criteria
Sclerosing epithelioid fibrosarcoma (SEF) rarely occurs outside the somatic soft tissue. Until recently no consistently specific genetic alteration had been associated with SEF. Molecular testing of the FUS gene rearrangement involving chromosome 16 [at one time considered specific for low-grade fibromyxoid sarcoma (LGFMS) and its variant, LGFMS with giant collagen rosettes), may be a nonrandom abnormality in some cases of SEF.We present an example of a rare FUS-positive SEF that arose in the floor of mouth of a 56 year old male. Light microscopy, exhaustive immunohistology, and FISH examination showing chromosome rearrangement using the FUS break-apart probe led to an erroneous diagnosis of LGFMS with giant collagen rosettes. An outside expert agreed with that diagnosis citing the FISH results as confirmatory. Upon review almost 2 years later after local recurrence, the classic histopathologic features of SEF were noted instead. This example suggests that at least a subset if not most examples of SEF are part of the LGFMS ''family'' of neoplasms, and reiterates the value of careful histologic examination in an age of increasingly sophisticated and presumably specific molecular results.
The performance of the Hybrid Capture 2 (HC2) test for human papilloma virus (HPV) detection depends on the prevalence of infection. However, the current HC2 manufacturer recommended interpretative algorithm is the same for all women. This test, which may be particularly useful in perimenopausal and postmenopausal women given the morphologic complexity of their Pap tests, could be affected by the overall lower prevalence of HPV infection in this age group. We investigated HC2 equivocal and weakly positive HPV tests in women 50 years and older and the detection of high-grade dysplasia (CIN2+) on their follow-up specimens. All HC2 test data from 1,067 consecutive specimens and 85 additional specimens from women ≥ 50-years-old with equivocal and weakly positive HC2 were analyzed. Follow-up specimens from women with HC2 tests within these ranges were reviewed. No CIN2+ was found on follow-up of 49 cases of women ≥ 50 with equivocal or weakly positive HC2 results. The current HC2 algorithm resulted in “positive” reports in 63% of specimens with initial equivocal HC2 due to retests mostly within the equivocal range. These results suggest that women 50 years and older may benefit from higher HC2 thresholds. The test could also be reported as HC2 values (RLU/CO) to be interpreted in view of risk factors.
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