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Metastatic ameloblastoma to a cervical lymph node: a case report and review of literature
ABSTRACTS
include bacterial, viral, fungal and parasites. Dengue infection is a mosquito-borne viral disease causing acute febrile illness that may be complicated by dengue haemorrhagic fever and shock syndrome. Dengue associated AGN in humans, however, has not been reported. Case report: A 36-year-old man presented with oedema and frothy urine for 3 days. He had proteinuria of nephrotic range with microscopic haematuria. Renal function was normal and investigations: ASOT, ANA, VDRL and hepatitis screen were non-reactive. Renal biopsy showed acute proliferative glomerulonephritis with hump-like fuchsinophilic deposits at the subepithelial location along the glomerular capillaries. There were associated IgG and C3 immune deposits. Three weeks prior to this presentation, he was admitted for dengue with positive serology NS-1, which he recovered uneventfully. Discussion: The latent interval between the preceding infection and onset of renal symptoms of AGN can range from 1 to 6 weeks. AGN is immunologically mediated disease and requires development of antibodies after an infection. It has been hypothesised that dengue virus infection elicits an immune response to the viral antigens. Immune-complex deposition and proliferative lesions were demonstrated in glomeruli of experimental mouse models infected with dengue infection.
S67
Herpes simplex lymphadenitis is a rare condition that is most commonly seen in immunocompromised patients. To date, less than 30 cases have been reported in the literature. It is most commonly seen in patients with haematological malignancy, especially with chronic lymphocytic leukaemia. However, it can be associated with other neoplasms such as Hodgkin lymphoma, mantle and marginal zone B-cell lymphoma, acute and chronic myeloid leukaemia. Presentation can be varied from localised lymphadenopathy, generalised lymphadenopathy with or without a rash, and disseminated HSV infection with multiple organ involvement. Histologically, it shows areas of coalescing necrosis and inflammatory cell infiltrates including histiocytes and neutrophils. Multinucleate cells with ground glass nuclei and Cowdry type A intranuclear inclusions are diagnostic; the diagnosis can be confirmed with herpes simplex virus in-situ hybridisation or immunohistochemistry. Differential diagnoses to consider include cat scratch lymphadenitis, mycobacterial tuberculosis lymphadenitis, Kikuchi-Fujimoto lymphadenitis, systemic lupus erythematosus, Hodgkin lymphoma and large cell non-Hodgkin lymphoma. Herpes simplex lymphadenitis is an important diagnosis which can mimic transformation of an underlying haematological malignancy. We present a case of a 68-year-old male with localised lymphadenopathy and history of chronic lymphocytic leukaemia.
AN INTERESTING CASE OF A SCHNEIDERIAN CARCINOMA Louise Killen and Andrew Parker Sydpath, St Vincent’s Hospital, Sydney, NSW, Australia We present a case report of an unusual tumour, a Schneiderian carcinoma [also known as a cylindrical cell carcinoma, transitional (cell) carcinoma, Ringertz carcinoma or respiratory epithelial carcinoma] which is classified by the WHO as a sinonasal nonkeratinising squamous cell carcinoma (SCC). The patient is a 72-year-old lady who was initially diagnosed with poorly-differentiated SCC of the left nasopharynx in 2003. She has had surprisingly slow disease progression with late recurrences and cervical nodal metastases without systemic dissemination. The tumour has been diagnosed as a poorly-differentiated, nonkeratinising SCC (positive CK5/6, p63, p40, and negative for neuroendocrine, melanocytic and lymphoid markers). However, morphologically this tumour is unusual, as it displays no features of keratinisation and has a distinctive ribbon-like architecture, resembling urothelium, and a striking abundance of admixed neutrophils including microabscesses (identical to Schneiderian papilloma). Recent literature has suggested that Schneiderian carcinomas, although classified under the umbrella of ‘sinonasal SCC’, display a distinctive morphology, clinical course and appear to have a strong aetiological relationship with high-risk human papilloma virus. We highlight the importance of recognising these tumours and distinguishing them from differential diagnoses such as Schneiderian papillomas and typical SCC.
HERPES SIMPLEX LYMPHADENITIS IN ASSOCIATION WITH CHRONIC LYMPHOCYTIC LEUKAEMIA Lauren Kim, Andrew Parker and Lianne Lee Sydpath, St Vincent’s Hospital, Darlinghurst, NSW, Australia
METASTATIC AMELOBLASTOMA TO A CERVICAL LYMPH NODE: A CASE REPORT AND REVIEW OF LITERATURE Sevastjan Kranz Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Vic, Australia Case presentation: A 54-year-old man, who 3 years prior had undergone successful surgical treatment of a left mandibular ameloblastoma, presented with a left submandibular swelling. Radiology confirmed a heterogenous solid nodule close to the previous mandibular resection site and the soft tissue nodule was resected. Histology revealed a lymph node containing a deposit of tumour with features typical of ameloblastoma. These included anastomosing strands of cells, peripheral palisading with reverse nuclear polarity and a dense fibrotic stroma. A further radical left neck dissection had 21 lymph nodes, none of which contained metastatic tumour. Discussion: Ameloblastoma is a rare benign odontogenic tumour with locally aggressive behaviour and a high recurrence rate. Despite its benign histological appearance, ameloblastoma has the ability to metastasise, which occurs in less than 1% of cases. Most metastatic deposits are seen in the lung with few reported cases of lymph node metastases. Due to the rarity of cases, treatment of ameloblastoma with metastases to lymph nodes is controversial. Some recommend radical neck dissection, while others have proposed simple excision with close follow up in cases with a single node metastasis. References 1. Barnes L, Eveson JW, Reichart P, et al. World Health Organisation Classification of Tumours: Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press, 2005; 287–9. 2. Kim Y, Choi SW, Lee JH, et al. A single cervical lymph node metastasis of malignant ameloblastoma. J Craniomaxillofac Surg 2014; 42: (in press). 3. Jayaraj G, Sherlin HJ, Ramani P, et al. Metastasizing ameloblastoma – A perennial pathological enigma? Report of a case and review of literature. J Craniomaxillofac Surg 2014; 42: 772–9.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
include bacterial, viral, fungal and parasites. Dengue infection is a mosquito-borne viral disease causing acute febrile illness that may be complicated by dengue haemorrhagic fever and shock syndrome. Dengue associated AGN in humans, however, has not been reported. Case report: A 36-year-old man presented with oedema and frothy urine for 3 days. He had proteinuria of nephrotic range with microscopic haematuria. Renal function was normal and investigations: ASOT, ANA, VDRL and hepatitis screen were non-reactive. Renal biopsy showed acute proliferative glomerulonephritis with hump-like fuchsinophilic deposits at the subepithelial location along the glomerular capillaries. There were associated IgG and C3 immune deposits. Three weeks prior to this presentation, he was admitted for dengue with positive serology NS-1, which he recovered uneventfully. Discussion: The latent interval between the preceding infection and onset of renal symptoms of AGN can range from 1 to 6 weeks. AGN is immunologically mediated disease and requires development of antibodies after an infection. It has been hypothesised that dengue virus infection elicits an immune response to the viral antigens. Immune-complex deposition and proliferative lesions were demonstrated in glomeruli of experimental mouse models infected with dengue infection.
S67
Herpes simplex lymphadenitis is a rare condition that is most commonly seen in immunocompromised patients. To date, less than 30 cases have been reported in the literature. It is most commonly seen in patients with haematological malignancy, especially with chronic lymphocytic leukaemia. However, it can be associated with other neoplasms such as Hodgkin lymphoma, mantle and marginal zone B-cell lymphoma, acute and chronic myeloid leukaemia. Presentation can be varied from localised lymphadenopathy, generalised lymphadenopathy with or without a rash, and disseminated HSV infection with multiple organ involvement. Histologically, it shows areas of coalescing necrosis and inflammatory cell infiltrates including histiocytes and neutrophils. Multinucleate cells with ground glass nuclei and Cowdry type A intranuclear inclusions are diagnostic; the diagnosis can be confirmed with herpes simplex virus in-situ hybridisation or immunohistochemistry. Differential diagnoses to consider include cat scratch lymphadenitis, mycobacterial tuberculosis lymphadenitis, Kikuchi-Fujimoto lymphadenitis, systemic lupus erythematosus, Hodgkin lymphoma and large cell non-Hodgkin lymphoma. Herpes simplex lymphadenitis is an important diagnosis which can mimic transformation of an underlying haematological malignancy. We present a case of a 68-year-old male with localised lymphadenopathy and history of chronic lymphocytic leukaemia.
AN INTERESTING CASE OF A SCHNEIDERIAN CARCINOMA Louise Killen and Andrew Parker Sydpath, St Vincent’s Hospital, Sydney, NSW, Australia We present a case report of an unusual tumour, a Schneiderian carcinoma [also known as a cylindrical cell carcinoma, transitional (cell) carcinoma, Ringertz carcinoma or respiratory epithelial carcinoma] which is classified by the WHO as a sinonasal nonkeratinising squamous cell carcinoma (SCC). The patient is a 72-year-old lady who was initially diagnosed with poorly-differentiated SCC of the left nasopharynx in 2003. She has had surprisingly slow disease progression with late recurrences and cervical nodal metastases without systemic dissemination. The tumour has been diagnosed as a poorly-differentiated, nonkeratinising SCC (positive CK5/6, p63, p40, and negative for neuroendocrine, melanocytic and lymphoid markers). However, morphologically this tumour is unusual, as it displays no features of keratinisation and has a distinctive ribbon-like architecture, resembling urothelium, and a striking abundance of admixed neutrophils including microabscesses (identical to Schneiderian papilloma). Recent literature has suggested that Schneiderian carcinomas, although classified under the umbrella of ‘sinonasal SCC’, display a distinctive morphology, clinical course and appear to have a strong aetiological relationship with high-risk human papilloma virus. We highlight the importance of recognising these tumours and distinguishing them from differential diagnoses such as Schneiderian papillomas and typical SCC.
HERPES SIMPLEX LYMPHADENITIS IN ASSOCIATION WITH CHRONIC LYMPHOCYTIC LEUKAEMIA Lauren Kim, Andrew Parker and Lianne Lee Sydpath, St Vincent’s Hospital, Darlinghurst, NSW, Australia
METASTATIC AMELOBLASTOMA TO A CERVICAL LYMPH NODE: A CASE REPORT AND REVIEW OF LITERATURE Sevastjan Kranz Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Vic, Australia Case presentation: A 54-year-old man, who 3 years prior had undergone successful surgical treatment of a left mandibular ameloblastoma, presented with a left submandibular swelling. Radiology confirmed a heterogenous solid nodule close to the previous mandibular resection site and the soft tissue nodule was resected. Histology revealed a lymph node containing a deposit of tumour with features typical of ameloblastoma. These included anastomosing strands of cells, peripheral palisading with reverse nuclear polarity and a dense fibrotic stroma. A further radical left neck dissection had 21 lymph nodes, none of which contained metastatic tumour. Discussion: Ameloblastoma is a rare benign odontogenic tumour with locally aggressive behaviour and a high recurrence rate. Despite its benign histological appearance, ameloblastoma has the ability to metastasise, which occurs in less than 1% of cases. Most metastatic deposits are seen in the lung with few reported cases of lymph node metastases. Due to the rarity of cases, treatment of ameloblastoma with metastases to lymph nodes is controversial. Some recommend radical neck dissection, while others have proposed simple excision with close follow up in cases with a single node metastasis. References 1. Barnes L, Eveson JW, Reichart P, et al. World Health Organisation Classification of Tumours: Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press, 2005; 287–9. 2. Kim Y, Choi SW, Lee JH, et al. A single cervical lymph node metastasis of malignant ameloblastoma. J Craniomaxillofac Surg 2014; 42: (in press). 3. Jayaraj G, Sherlin HJ, Ramani P, et al. Metastasizing ameloblastoma – A perennial pathological enigma? Report of a case and review of literature. J Craniomaxillofac Surg 2014; 42: 772–9.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.