A case of recurrent esthesioneuroblastoma was diagnosed by fine-needle aspiration of a midcervical mass. The cytologic features that characterize this uncommon neoplasm include uniform, small, round-to-oval cells with coarsely granular chromatin, multiple small nucleoli, prominent nuclear membranes, and scant cytoplasm. Morphologically and ultrastructurally, esthesioneuroblastoma cells resemble those of sympathetic neuroblastomas. Both tumors show rosette formation and minimal cellular pleomorphism, and, by electron microscopy, dense-core cytoplasmic granules can be identified. The cytologic recognition of esthesioneuroblastoma is important since it metastasizes to cervical lymph nodes accessible to fine-needle aspiration biopsy. In addition, the histogenesis of this unusual neuroectodermal tumor and its behavior are discussed.
We would like to report on a case of mesothelioma in a patient with a wellknown source of asbestos exposure, as well as an unusual exposure source.IM was a 72-year-old white male with a 60 pack-year smoking history, and multiple medical problems including diabetes, hypertension, renal insufficiency, coronary artery disease, and peripheral vascular disease. He was referred to our hospital in early 1991 with a 2-month history of progressive dyspnea, night sweats, fever, cough, and pleuritic chest pain. This referral followed unsuccessful treatment for decompensated congestive heart failure and diagnostic aspiration of both cytology and culture negative, serosanguinous pleural fluid.Review of the chest radiograph confirmed the presence of previously noted calcified pleural plaques on the left and diffuse pleural thickening with effusion on the right. These findings were also noted on subsequent computerized tomography scan. The latter was suggestive of parenchymal asbestos-related fibrosis as well. Repeat thoracentesis produced cytology suspicious for adenocarcinoma. The patient was deemed high risk for thoracotomy and for open lung biopsy due to his multiple medical problems. He died soon thereafter and a diagnosis of mesothelioma was made.Review of his occupational history revealed probable asbestos exposure as a shipyard welder during World War 11. However, further investigation disclosed daily washing machine maintenance activities as an operator of a laundromat from 1966 through 198 1. He would disassemble and sand the clutch lining on these units in order to "keep the tub from spinning out of sequence." Actual availability of one of these clutch assembly linings resulted in analysis confirming the presence of 10-12% chrysotile asbestos. The washer manufacturer later confirmed use of asbestos for this purpose until 1980.Although the patient's shipyard exposure most likely explains the findings in this case, daily exposure from the washer clutch assemblies cannot be overlooked.Address reprint requests to Dr.
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