Granular cell tumor (GCT) is a rare benign neoplasm of Schwannian origin which accounts of 0.5% of soft tissue tumors. Although the most common site for GCT is tongue, it can occur at any site. GCT presenting as cutaneous nodule is rare, however cases have been reported in literature. We hereby document a case of 30 year female with a hyper‐pigmented cutaneous nodule of anterior chest wall on the milk‐line mimicking as an ectopic breast, diagnosed as GCT on fine needle aspiration cytology. We also add a note on the differential diagnoses of GCT with differentiating cytological features to emphasize on the correct diagnosis of GCT pre‐operatively.
Extramedullary haematopoiesis (EMH) is a compensatory mechanism that occurs when there is deficient bone marrow haematopoiesis secondary to either peripheral red cell destruction or marrow replacement. 1 EMH is the appearance of haematopoietic tissue outside of the bone marrow, which may be composed of two or three haematopoietic cell lineages. 2 In routine cytology practice, it is unusual to encounter extramedullary proliferations of bone marrow elements. EMH is a rare complication of chronic myeloid leukaemia (CML) which can be encountered in the liver, spleen and, rarely, in the lymph nodes. The development of EMH in CML does not usually affect the prognosis of patients; however, the presence of a marrow proliferation in a lymph node would indicate an immediate search for an underlying bone marrow neoplasm and prompt a haematological evaluation, including review of haemogram, peripheral blood smear, and possibly a bone marrow aspiration and biopsy. 3 Here, we report a case of EMH in the axillary lymph node of 67-year-old man with CML in chronic phase which was diagnosed on cytology based on the identification of all the three lineages of haematopoietic cells with a background of reactive lymphoid cells. | C A S E REP ORTA 67-year-old man presented to medicine outpatient department with easy fatigability, early satiety, dyspnoea on exertion and weight loss for 2 months. He had no complaints of fever and bleeding manifestations or any history of hospitalisation. On physical examination, he had pallor, left axillary lymphadenopathy and splenomegaly.The axillary lymph node which measured 2 × 2 cm was firm, mobile and non-tender. The patient was subjected to fine needle aspiration (FNA) cytology from the axillary node with a clinical possibility of tuberculosis. May-Grünwald Giemsa-and Papanicolaou stained smears revealed a polymorphous population of reactive lymphoid cells admixed with few neutrophils, eosinophils, occasional basophils and tingible body macrophages. In addition, there were scattered large giant cells with lobulated nuclei and some giant cells with large round nuclei, simulating the morphology of large and small megakaryocytes, respectively. Furthermore, we could appreciate a few precursor forms of myeloid and erythroid lineage cells. There was no granuloma or malignancy. Hence, we reported the smears as suggestive of extramedullary haematopoiesis with a note for detailed haematological evaluation (Figures 1A-D and 2A).On haematological evaluation, he was found to have a total leucocyte count of 369.57 × 10 9 /L, haemoglobin 55 g/L and platelets 161 × 10 9 /L. A peripheral blood smear showed hyper-leucocytosis with myeloid bulge and blast accounting for less than 2% with basophilia ( Figure 2B). The haematological diagnosis was CML-chronic phase (BCR-ABL1 positive proven on peripheral blood). Later, bone marrow examination revealed 100% cellularity and myeloid hyperplasia with a full range of maturation. The blast cells constituted <5% on morphology as well as on immunohistochemistry for CD34 and C...
An intraosseous ganglion is a rare lesion which can be confused clinically and radiologically with bony neoplasms. This lesion can be accurately diagnosed on FNAC when biopsy may not be very useful.
Filariasis and Strongyloidiasis are two endemic parasitic infections seen in any tropical country. Filariasis, commonly caused by Wuchereria bancrofti, Brugia malayi, and Brugia timori is seen often in peripheral blood and lymphoid tissue. But it can be isolated from wide variety of soft tissue sites in the body like soft tissue lumps, breast, thyroid, body fluids. Strongyloides stercoralis, a helminthic infection, usually affects the respiratory and gastrointestinal (GI) tract, and frequently picked up in GI biopsies. However, in cases of hyper infection and patients with altered immunity, it can be isolated from other rare sites like body fluid samples. Accurate morphological Identification and confirmation are important for specific management. We report a case of microfilaria isolated from cerebrospinal fluid and a case of Strongyloides larva isolated from ascitic fluid in clinically unsuspected cases of these two parasitic infestations. We have also added a brief discussion on morphological differences between the two larval forms.
Background Lymphatic malformations are the second most common vascular malformations after venous malformations. These slow-flow lesions occur most often in the paediatric population and seldom in the extremities. We report a case of lymphangioma at the popliteal fossa in an adult who underwent complete surgical resection. Case presentation A 30-year-old male presented to the department of orthopaedics with a swelling in the right calf region. Clinically, it was suspected to be a Baker’s cyst. Ultrasound showed a multiloculated anechoic cystic lesion in the inferior aspect of popliteal fossa along the intermuscular plane with multiple internal septations. Infected Baker’s cyst was considered, and MRI was suggested for further evaluation. On MRI, the lesion measured 7.2 × 4.6 × 5.8 cm, appeared as a low signal on T1 and high signal on STIR and T2, with multiple internal septations and was situated in the inferior aspect of the right popliteal fossa along the intermuscular plane between the lateral head of gastrocnemius and soleus muscles. No obvious synovial extension. A post-contrast study showed minimal peripheral and septal enhancement. Neither internal enhancing solid components nor significant internal derangement of the knee was observed. Diagnosis of lymphangioma was considered based on the imaging features and ruling out the common differentials for cystic lesions around the knee. Wide local excision was performed. Histopathological evaluation showed multiple irregularly dilated lymphatic channels lined by flatted epithelium. The lymphatic channels were seen to be surrounded by thick fibro collagenous cyst wall with scattered congested blood vessels, skeletal muscle fibre and chronic inflammatory cells. Conclusion Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative. At the popliteal fossa, it presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee.
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