Cytologic findings in the sarcomatoid variant of large cell anaplastic (Ki-1) lymphoma. A case report

Anaplastic large cell (Ki-1) lymphomas are a recently described subtype of non-Hodgkin's lymphoma. A single case of the sarcomatoid variant has recently been reported. Below we report the fine needle aspiration findings in an additional case of the sarcomatoid variant of Ki-1 lymphoma. The diagnosis was made only in retrospect with the aid of immunostains because the cytologic findings were more in keeping with a sarcoma. Striking vascular structures in the smears suggested angiosarcoma or liposarcoma. Additional features were pleomorphic cells with eccentric nuclei and abundant, tapering cytoplasm; spindle cells; multinucleation; cytoplasmic vacuolization; and prominent nucleoli. The smear pattern was composed of dispersed cells with some cohesive groups within an acute inflammatory background with a virtual absence of lymphoglandular bodies. These findings, atypical of lymphoma, broaden the spectrum of possible cytologic findings in lymphoid malignancies and highlight the possible utility of immunostaining. The distinction of lymphoma from sarcoma or carcinoma is of therapeutic importance.     

Surgery of the anterior skull base

Inflammatory disease of the frontal, ethmoid, and sphenoid paranasal sinuses may extend to the adjacent anterior skull base and then intracranially. The potential for this serious complication of sinus disease must be recognized by the primary otolaryngologist-head and neck surgeon, and alternative management strategies must be taken once it is diagnosed. Topics discussed in this article include cranial anatomy, surgical techniques and variations, complications, and special considerations.     

Chordomas of the skull base. Radiologic and clinical evaluation

Chordomas are uncommon skull base tumors, which are locally agressive and are usually not amenable to complete surgical resection. Proton beam irradiation, following surgery, is the preferred treatment modality. For diagnosis and determination of tumor site and extension, CT and MR imaging are the imaging modalities of choice. CT delineates bone destruction and the presence of calcifications and destroyed bone optimally. MR imaging is the modality of choice for better definition of the tumor margin from brain and other soft tissue structures (pharynx) and visualization of blood vessels. The signal intensities and enhancement pattern fail to differentiate chordoma from chondroid chordoma or chondrosarcoma. Chordomas arise from the clivus and therefore are located more centrally, whereas the majority of chondrosarcomas originate in the petroclival fissure and occur more laterally, although occasional overlap occurs in about one third of cases. Immunohistochemical methods allow differentiation of pure chordoma from chondroid chordoma and chondrosarcoma. Chordomas have a lower local control rate than chondrosarcomas.     

Surgery of the base of the skull

To treat pathological processes, primarily tumors, in the base of the skull is one of the most intricate neurosurgical problems. In the past decade, interest in this problem has greatly increased due to the advent of new methods of diagnosis, up-to-date neurosurgical equipment and to a greater cooperation of physicians of related disciplines: ophthalmologists, otosurgeons, plastic surgeons. The authors present and summarize the experience accumulated by the researchers of the N. N. Burdenko Institute of Neurosurgery in the past 10 years in treating basal tumors. Based on a great deal of clinical findings, approaches are proposed in treating some groups of basal tumors, such and pituitary adenomas, craniopharyngiomas, meningiomas at various sites, trigeminal and acoustic neurinomas, and malignant neoplasms of the base of the skull. The conditions required for successful surgical treatment of the processes in the base of the skull are described in detail. One of them is a correct determination of a surgical approach.     

Benign fibroosseous lesions involving the skull base, paranasal sinuses, and nasal cavity. Report of two cases

We report a case of a basilar artery migraine in a 17-year-old boy with transient CT and MR abnormalities after each of two migraine episodes. A repeat MR study 6 months after the last event showed complete resolution of the lesion. Transient abnormalities on brain images similar to those shown in our case have been reported in patients with migraine and other neurologic conditions and are most likely related to cerebral vasogenic edema.     

Congenital encephalocele of the medial skull base

Intensive case management for severely psychiatrically ill patients is a relatively new phenomenon in the private sector. The authors describe a comprehensive case management program designed at Blue Cross Blue Shield of Massachusetts to meet the needs of the most severely ill psychiatric patients in a private managed care environment. The case management program emphasizes involvement of patients in creating comprehensive treatment plans; development of a relationship between case managers, patients and their families, and providers; and clinical coordination between the public and private sectors to create individualized treatment plans. The program's case managers are able to flex the benefit limitations of a managed care or indemnity plan to integrate public and private services and can enlist providers outside a managed care network. The paper describes service utilization by the first 33 patients who participated in the program for one year.     

Injuries of the central base of the skull

In different types of lesions, especially in frontobasal and laterobasal ones, the central base of the skull is injured, too (in about 20% of severe frontabasal lesions). Surgical treatment is necessary. Examination of intra- and infrabasal structures and localized intracranial operations may be performed by transthemoidal-transphenoidal or transpyramidal approaches. Main problems are the treatment of dura lesions, the control of hemorrhages, the examination of the optic nerve, and the compensation of disturbances of central regulation. The above experiences we gathered from patients in the ORL Clinic of Jena University.     

Cytology of cervical chordoma in cerebrospinal fluid from a child. A case report

The cytologic findings on cerebrospinal fluid examination of cervical chordoma in a 2-year-old girl are presented. The major cell type was a small, isolated, hyperchromatic cell with sharply defined nuclear membrane and granular cytoplasm. However, the characteristic cell of this neoplasm, the so-called physaliferous cell with typical bubbly cytoplasm, was also noted. Cytologic findings were compared to biopsy findings, with a good correlation of tumor morphology. Clinical follow-up revealed unusually aggressive tumor behavior, and the patient died a year later despite intensive chemotherapy. The differential diagnosis of the condition is also discussed.     

Report of a case of maxillo-nasal dysplasia (Binder syndrome)

The case of a girl with Binder syndrome (maxillonasal-dysplasia) is reported. The girl has a peculiar face due to severely depressed nasal bridge, the nasofrontal angle is absent and the nose is hypoplastic with flattened alae and nasal tip; the upper lip has a convex contour with poorly developed philtrum. The premaxillary is hypoplastic. Lateral and postero-anterior cephalometric findings are presented.     

Chordomas of the skull base: dynamic MRI

OBJECTIVE: To investigate the role of dynamic MRI in the diagnosis of chordomas at the skull base. MATERIALS AND METHODS: Six patients with surgically proven chordomas of the skull base were examined with spin-echo technique (repetition time/echo time 200 ms/15 ms). Serial imaging was performed every 30 s for 240 s after a rapid injection of gadopenetate dimeglumine (0.1 mmol/kg). The contrast material enhancement ratio (CER) was analyzed. The CER was obtained for each region of interest as follows (Sn - So) x 100/Smax - So, where Sn indicates signal intensity at each dynamic phase; So, signal intensity on the image obtained before administration of contrast material; and Smax, maximum signal intensity of all dynamic imaging. RESULTS: All chordomas showed very slow but steady increase of contrast enhancement with no peak within 240 s. The CERs of six cases at 30 s are 13 to 40 (mean value +/- standard deviation: 22.8 +/- 10.2). CONCLUSION: Dynamic MRI may be helpful in differentiating between chordomas and other tumors of the skull base.     

Sparganosis in the United States. Report of a case

A 20-year-old Philadelphia woman (recently moved from South Carolina) had sparganosis of her lower anterior abdominal wall. In the United States sparganosis occurs when man enters the life cycle of dog or cat tapeworms of the genus Spirometra. Most of the American cases have been reported from the southeastern United States, and the most probable source of infection is contaminated drinking water. Sporadic cases have also been seen in other parts of the country. If the pathologist is familiar with the morphology of spargana, the gross and histologic features are sufficient for identification of genus Spirometra.     

Dislocations of the face and skull. Report of 20 cases

The authors present a serie of 20 cases of craniofacial injuries with or without CSF leakage. They propose a simple classification in 2 groups following the impact: braniofacial injury or orbitofacial injury. For their, craniofacial or orbitofacial injuries are to be operated in one stage by an neurosurgical and maxillofacial team. The best time for operation is approximately around the 10th day following trauma.     

Fibroadenoma of the vulva. Report of a case

A case of fibroadenoma occurring in the vulva of a 24 year old woman is presented. This rare benign tumor appears as dermal or subcutaneous well circumscribed nodule. Histologically the fibroadenoma is characterized by epithelial and stromal proliferation. Two different concepts concerning histogenesis are cited; the authors believe that this tumor arises in ectopic mammary tissue.     

Retroperitoneal ganglioneuroma. Report of a case

OBJECTIVE: To report an additional case of retroperitoneal ganglioneuroma. METHODS/RESULTS: A case of retroperitoneal ganglioneuroma that had been incidentally discovered in a 27-year-old male during abdominal US evaluation is described. The diagnosis was based on the histopathological findings after US-guided biopsy. The clinical features and the findings of the complementary tests, which included radiological assessment, intravenous urography, CT and cavography are presented, as well as the pathology findings. Treatment was by complete surgical excision of the tumor. CONCLUSION: Treatment of ganglioneuroma is by surgery, since the diagnosis is generally based on the histopathological analysis of the surgical specimen. For those cases with a preoperative diagnosis, some authors advocate surgery for patients with clinical evidence of neuroblastoma or another pathology arising from this disease. Although infrequent, ganglioneuroma coexisting with neuroblastoma can occur. For this reason, complete excision of the tumor is preferred.     

Renal endometriosis. Report of a case

In the light of a personal case and a review of the literature, the authors recall the specific features of renal endometriosis. This rare lesion, with a favourable prognosis, is difficult to diagnose and is rarely diagnosed preoperatively. Medical treatment by LHRH agonists is discussed and has been used exceptionally.