- Email: [email protected]
Multiple pilomatrixoma, diagnosed on fine needle aspiration cytology: a case report
S78
Pathology (2011), 43(S1)
PATHOLOGY 2011 ABSTRACT SUPPLEMENT
routine H&E stains revealed reactive appearing follicles, with well defined mantle zone. Immunohistochemical analysis showed a subtle increase in CD5 and cyclin D1 staining in the mantle zone. Flow cytometry results were suggestive of mantle cell lymphoma (MCL). The results of morphology, immunohistochemistry and flow cytometry were correlated and the lesion was best regarded as in situ mantle cell lymphoma. The genetic hallmark of MCL is the balanced translocation, t(11;14)(q13;q32) involving cyclin D1 and immunoglobulin heavy chain which results in over- expression of cyclin D1. Classical mantle cell lymphoma is characterised by a diffuse, nodular or mantle zone growth pattern. However, it begins in or initially localises to the mantle zones of otherwise normal lymph nodes. Hence in situ MCL can be easily missed which again stresses the significance of flow cytometric analysis and use of cyclin D1. References Swerdlow SH, Campo E, Harris NL, et al., editors. World Health Organization Classification of Tumours. Pathology and Genetics: Tumors of Haematopoietic and Lymphoid Tissues. Lyon, IARC Press, 2008. Aqel N, Barker F, Patel K, et al. In situ mantle cell lymphoma - a report of two cases. Histopathology 2008; 52: 256-60. Richard P, Vassallo J, Valmary S, et al. ‘In situ-like’ mantle cell lymphoma: a report of two cases. J Clin Pathol 2006; 59: 995–6.
LYMPHOPROLIFERATIVE DISORDER OF NATURAL KILLER CELLS WITH SPLENIC INVOLVEMENT – AN UNUSUAL CASE Lianne Lee, Andrew Parker Sydpath, St Vincent’s Hospital, Darlinghurst, NSW, Australia Chronic lymphoproliferative disorders of natural killer (NK) cells is a recently described provisional entity in the World Health Organization (WHO) classification. It is characterised by a persistent increase in peripheral blood NK cells without a definite cause, often with bone marrow involvement. It occurs in adults with a median age of 60 years, has no association with Epstein-Barr virus (EBV) and tends to follow a chronic clinical course. In contrast, aggressive NK-cell leukaemia has a median age of 42, is EBV related, more prevalent amongst Asians and other ethnic populations, and has a rapidly progressive course irrespective of treatment. We present an unusual case of a 47-year-old male with chronic lymphoproliferative disorder of NK cells with splenic involvement. The spleen showed prominent red pulp expansion by bland cytotoxic lymphocytes of NK-cell lineage which were EBV negative. Our case is within the spectrum of NK-cell lymphoproliferative disorder and appears to be intermediate between the two well defined WHO entities. The patient is alive and asymptomatic 10 months after diagnosis having been treated with splenectomy only. However, his haemoglobin has steadily fallen to 95 g/L (130–180 g/L) and treatment with methotrexate and prednisone is being planned. OVARIAN ENDOMETRIOID ADENOFIBROMATOUS TUMOUR: PRESENTATION OF AN INTERESTING CASE Lianne Lee, Trent Davidson, Lyndal Edwards Prince of Wales Hospital, Randwick, NSW, Australia Ovarian endometrioid tumours represent 2–4% of all ovarian tumours. Endometrioid adenofibromas are a rare subtype of endometrioid ovarian tumours. Although most of these tumours are benign, in some cases, the epithelial component shows a spectrum
of cytological and/or architectural atypia. These cases may be classified as borderline/proliferating through to malignant endometrioid adenofibromatous tumours. However, although histological criteria for the classification of these tumours have been described, in practice, definitive classification of these tumours may be difficult. Furthermore, although benign and (most) borderline tumours tend to have an indolent natural history, the clinical behaviour of borderline tumours with in situ or early invasive carcinoma remains uncertain. We present the case of a 77-year-old female with an ovarian endometrioid adenofibroma with benign, borderline and malignant epithelial components (Grade 1 endometrioid adenocarcinoma) without convincing destructive stromal invasion or desmoplasia. MULTIPLE PILOMATRIXOMA, DIAGNOSED ON FINE NEEDLE ASPIRATION CYTOLOGY: A CASE REPORT Lisa L. Lin1, Abha Malik2 Department of Tissue Pathology, ICPMR, Westmead Hospital and 2 Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, NSW, Australia
1
Pilomatrixoma is a benign skin appendage tumour often misdiagnosed clinically and on fine needle aspirate cytology. This is in part due to this lesion sharing some similar cytological features with other more common entities. The cytological features of this entity and its association with various syndromes are described. We present a case where fine needle aspiration cytology and subsequent histology were used to diagnose one of several pilomatrixomas in a 42-year-old man. The cytology findings included a predominant population of uniform basaloid cells arranged in irregular groups, sheets of ghost cells (keratinised anucleate cells), presence of refractile keratin pearls, and an isolated cluster of nucleated squamoid cells on a background of abundant keratinous and granular debris. Subsequent histology showed a cystic structure lined by sheets of uniform basophilic cells with central ghost cells and keratin debris, confirming the presence of a pilomatrixoma. Through presenting this case, we highlight the cytological features of this uncommonly biopsied entity, and alert to the possible association of multiple pilomatrixomas with various syndromes. AN INTERNAL CONTROL FOR MONITORING DNA EXTRACTION AND PCR INHIBITION IN REAL-TIME PCR ASSAYS T. Lin, L. Yang, C. Denver, L. Lavulo Bioline Australia, Eveleigh, NSW, Australia Real-Time PCR (qPCR) has become more prominent in research and diagnostics due to its high sensitivity, accuracy, and reliability, over a broad range of applications. These attributes are heavily dependent on template quality and the presence of inhibitory components. Subsequently, these factors impact the sensitivity, robustness of the assay, and can also result in false-negative results. A common practice to control for these factors in qPCR utilises a known amount of control DNA added either before or after DNA extraction. However, this approach can either result in degradation/ loss of control DNA (pre-extraction), or enables monitoring of inhibition within the assay (post-extraction), but has no value as an extraction control. Ideally, the test sample and internal control undergo the same processing prior to qPCR. We have developed a platform whereby the internal control (a living target) more closely
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2011), 43(S1)
PATHOLOGY 2011 ABSTRACT SUPPLEMENT
routine H&E stains revealed reactive appearing follicles, with well defined mantle zone. Immunohistochemical analysis showed a subtle increase in CD5 and cyclin D1 staining in the mantle zone. Flow cytometry results were suggestive of mantle cell lymphoma (MCL). The results of morphology, immunohistochemistry and flow cytometry were correlated and the lesion was best regarded as in situ mantle cell lymphoma. The genetic hallmark of MCL is the balanced translocation, t(11;14)(q13;q32) involving cyclin D1 and immunoglobulin heavy chain which results in over- expression of cyclin D1. Classical mantle cell lymphoma is characterised by a diffuse, nodular or mantle zone growth pattern. However, it begins in or initially localises to the mantle zones of otherwise normal lymph nodes. Hence in situ MCL can be easily missed which again stresses the significance of flow cytometric analysis and use of cyclin D1. References Swerdlow SH, Campo E, Harris NL, et al., editors. World Health Organization Classification of Tumours. Pathology and Genetics: Tumors of Haematopoietic and Lymphoid Tissues. Lyon, IARC Press, 2008. Aqel N, Barker F, Patel K, et al. In situ mantle cell lymphoma - a report of two cases. Histopathology 2008; 52: 256-60. Richard P, Vassallo J, Valmary S, et al. ‘In situ-like’ mantle cell lymphoma: a report of two cases. J Clin Pathol 2006; 59: 995–6.
LYMPHOPROLIFERATIVE DISORDER OF NATURAL KILLER CELLS WITH SPLENIC INVOLVEMENT – AN UNUSUAL CASE Lianne Lee, Andrew Parker Sydpath, St Vincent’s Hospital, Darlinghurst, NSW, Australia Chronic lymphoproliferative disorders of natural killer (NK) cells is a recently described provisional entity in the World Health Organization (WHO) classification. It is characterised by a persistent increase in peripheral blood NK cells without a definite cause, often with bone marrow involvement. It occurs in adults with a median age of 60 years, has no association with Epstein-Barr virus (EBV) and tends to follow a chronic clinical course. In contrast, aggressive NK-cell leukaemia has a median age of 42, is EBV related, more prevalent amongst Asians and other ethnic populations, and has a rapidly progressive course irrespective of treatment. We present an unusual case of a 47-year-old male with chronic lymphoproliferative disorder of NK cells with splenic involvement. The spleen showed prominent red pulp expansion by bland cytotoxic lymphocytes of NK-cell lineage which were EBV negative. Our case is within the spectrum of NK-cell lymphoproliferative disorder and appears to be intermediate between the two well defined WHO entities. The patient is alive and asymptomatic 10 months after diagnosis having been treated with splenectomy only. However, his haemoglobin has steadily fallen to 95 g/L (130–180 g/L) and treatment with methotrexate and prednisone is being planned. OVARIAN ENDOMETRIOID ADENOFIBROMATOUS TUMOUR: PRESENTATION OF AN INTERESTING CASE Lianne Lee, Trent Davidson, Lyndal Edwards Prince of Wales Hospital, Randwick, NSW, Australia Ovarian endometrioid tumours represent 2–4% of all ovarian tumours. Endometrioid adenofibromas are a rare subtype of endometrioid ovarian tumours. Although most of these tumours are benign, in some cases, the epithelial component shows a spectrum
of cytological and/or architectural atypia. These cases may be classified as borderline/proliferating through to malignant endometrioid adenofibromatous tumours. However, although histological criteria for the classification of these tumours have been described, in practice, definitive classification of these tumours may be difficult. Furthermore, although benign and (most) borderline tumours tend to have an indolent natural history, the clinical behaviour of borderline tumours with in situ or early invasive carcinoma remains uncertain. We present the case of a 77-year-old female with an ovarian endometrioid adenofibroma with benign, borderline and malignant epithelial components (Grade 1 endometrioid adenocarcinoma) without convincing destructive stromal invasion or desmoplasia. MULTIPLE PILOMATRIXOMA, DIAGNOSED ON FINE NEEDLE ASPIRATION CYTOLOGY: A CASE REPORT Lisa L. Lin1, Abha Malik2 Department of Tissue Pathology, ICPMR, Westmead Hospital and 2 Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, NSW, Australia
1
Pilomatrixoma is a benign skin appendage tumour often misdiagnosed clinically and on fine needle aspirate cytology. This is in part due to this lesion sharing some similar cytological features with other more common entities. The cytological features of this entity and its association with various syndromes are described. We present a case where fine needle aspiration cytology and subsequent histology were used to diagnose one of several pilomatrixomas in a 42-year-old man. The cytology findings included a predominant population of uniform basaloid cells arranged in irregular groups, sheets of ghost cells (keratinised anucleate cells), presence of refractile keratin pearls, and an isolated cluster of nucleated squamoid cells on a background of abundant keratinous and granular debris. Subsequent histology showed a cystic structure lined by sheets of uniform basophilic cells with central ghost cells and keratin debris, confirming the presence of a pilomatrixoma. Through presenting this case, we highlight the cytological features of this uncommonly biopsied entity, and alert to the possible association of multiple pilomatrixomas with various syndromes. AN INTERNAL CONTROL FOR MONITORING DNA EXTRACTION AND PCR INHIBITION IN REAL-TIME PCR ASSAYS T. Lin, L. Yang, C. Denver, L. Lavulo Bioline Australia, Eveleigh, NSW, Australia Real-Time PCR (qPCR) has become more prominent in research and diagnostics due to its high sensitivity, accuracy, and reliability, over a broad range of applications. These attributes are heavily dependent on template quality and the presence of inhibitory components. Subsequently, these factors impact the sensitivity, robustness of the assay, and can also result in false-negative results. A common practice to control for these factors in qPCR utilises a known amount of control DNA added either before or after DNA extraction. However, this approach can either result in degradation/ loss of control DNA (pre-extraction), or enables monitoring of inhibition within the assay (post-extraction), but has no value as an extraction control. Ideally, the test sample and internal control undergo the same processing prior to qPCR. We have developed a platform whereby the internal control (a living target) more closely
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.