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Trabzonlu L, McDermott S, Pitman MB, Chebib I. Pulmonary Kaposi sarcoma in a patient with bilateral lung transplant: An unexpected diagnosis on transbronchial fine needle aspiration and core biopsy. Diagn Cytopathol 2024; 52:E215-E221. [PMID: 38860692 DOI: 10.1002/dc.25368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024]
Abstract
Kaposi sarcoma (KS) is a low-grade vascular neoplasm that can be seen in various sites, most commonly seen in skin and mucosal tissues. Cytologic features of KS have been well-documented in the literature, however, since it is rarely seen in visceral organs, it could pose significant diagnostic challenges on fine needle aspiration (FNA) biopsies. We present a case of pulmonary KS diagnosed on transbronchial FNA biopsy in a 70-year-old female bilateral lung allograft recipient 11 months after transplantation. The aspirate smears showed a moderately cellular specimen containing a mixture of small, tightly cohesive clusters and loosely clustered groups of monomorphic, ovoid to spindled cells with moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel on the concurrent core biopsy showed the tumor cells to be positive for ERG, KIT, and HHV8, confirming the diagnosis. We compared our case to previously published reports of confirmed pulmonary KS in lung allograft recipients.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Carrilho C, Ismail M, Lorenzoni C, Fernandes F, Alberto M, Akrami K, Funzamo C, Lunet N, Schmitt F. Fine needle aspiration cytology in Mozambique: Report of a 15-year experience. Diagn Cytopathol 2018; 47:166-171. [PMID: 30478961 DOI: 10.1002/dc.24062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is an important diagnostic tool in a range of medical settings. It is fast, quick and a highly accurate diagnostic method and can be used, in settings with minimal laboratory infrastructures. METHODS In this report, we describe the experience in the use of FNAC since it is introduction in 1996 in the Anatomical Pathology Service of the Maputo Central Hospital (MCH), along with more detailed data referring to 2009-2010. RESULTS The number of FNAC analyses increased gradually from 269 (4.1% of all pathologic tests of the Service) in 1996, when it was introduced in Mozambique, to 3234 (17% of all tests) in 2010. Lymph nodes were the organs most frequently biopsied, followed by breast and soft tissues. Inflammatory conditions, especially tuberculosis, were the most frequent diagnoses (22.2% of the cases), followed by hyperplastic conditions (20.6%), benign tumors (13.4%) and malignant tumors (12.3%). CONCLUSION Our results clearly demonstrate that even in an environment with poor laboratory resources, it is possible to establish a FNAC clinic that can provide a quick and precise diagnosis for clinicians to aid in early treatment interventions, especially in inflammatory diseases which were the majority of our cases.
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Affiliation(s)
- Carla Carrilho
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Mamudo Ismail
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Cesaltina Lorenzoni
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique.,National Cancer Control Program Ministry of Health, Maputo, Mozambique
| | - Fabíola Fernandes
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Matos Alberto
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique
| | - Kevan Akrami
- Department of Infectious Disease, University of California, San Diego, San Diego, California
| | - Carlos Funzamo
- National Cancer Control Program Ministry of Health, Maputo, Mozambique
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Fernando Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto, IPATIMUP, Porto, Portugal.,Departamento de Patologia da Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Muthu V, Sehgal IS, Dhooria S, Agarwal R. Clinical significance and epidemiological evolution of epitrochlear lymphadenopathy in pre- and post-highly active antiretroviral therapy era: A systematic review of the literature. Lung India 2018; 35:150-153. [PMID: 29487251 PMCID: PMC5846265 DOI: 10.4103/lungindia.lungindia_13_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Epitrochlear lymphadenopathy is believed to be associated with distinct etiologies, however the evidence for the same is lacking. We systematically reviewed the reported causes of an enlarged epitrochlear lymph node and compared them over different time periods. Epitrochlear lymphadenopathy was encountered in a wide range of diseases, and we found no association with any particular disease.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Duduyemi BM, Owusu-Afriyie O, Danquah KO, Osakunor DN. Cytopathology practice in Kumasi: A 2-year retrospective audit. J Cytol 2017; 34:22-26. [PMID: 28182080 PMCID: PMC5259925 DOI: 10.4103/0970-9371.197593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Surgical pathology service is generally unavailable in most developing countries and comes with challenges. Cytopathology is a reliable, inexpensive adjunct to surgical histopathology. We present a retrospective review of the various cytopathology cases received at the department. Materials and Methods: A retrospective review of 836 cytopathology cases from January 2010 to December 2011 at the Department of Pathology of our hospital was conducted. All cytopathology reports and records from the department were retrieved and analyzed using the Statistical Package for the Social Sciences version 16 for windows. Results: A total of 836 (mean age 38.18 ± 22.18) cases were reviewed, at an average of approximately 418 cases performed a year (5.7% of the total workload). More than half (58.0%) of the cases received had no clinical diagnosis indicated on request forms. Seventy-seven percent (77%) of the cases were diagnosed as either definite or nondefinite. The breast was the most aspirated specimen site (20.2%). Benign cases formed 45.0% of all the cases and 29.0% were malignant. There were more benign than malignant cases with respect to all sites aspirated except the breast (18.3%), lymph nodes (35.0%), and soft tissues (11.7%) where the reverse occurred. Conclusion: Patronage of cytopathology in Kumasi is increasing and serves as a quick, cheap, and effective alternate means for diagnosis. Improving and expanding on the current practice will ensure that pathologists in practice sustain and improve diagnostic cytopathology and provide material for training young pathologists.
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Affiliation(s)
- Babatunde M Duduyemi
- Department of Pathology, Kwame Nkrumah University of Science and Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana, Africa
| | - Osei Owusu-Afriyie
- Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Africa
| | - Kwabena O Danquah
- Department of Medical Laboratory Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Africa
| | - Derick Na Osakunor
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Africa
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Yergiyev O, Mohanty A, Curran-Melendez S, Latona CR, Bhagavatula R, Greenberg L, Silverman JF. Fine-needle aspiration cytology of disseminated Kaposi sarcoma of the bone in an AIDS patient. Acta Cytol 2014; 59:113-7. [PMID: 25547261 DOI: 10.1159/000369855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) is a vascular neoplasm associated with human herpesvirus 8 (HHV-8). Skin and mucous membranes are the most common sites, but other organs may be involved. Skeletal KS is rare and occurs either by direct spread of mucocutaneous lesions or through dissemination. Patients present with bone pain and lytic lesions for which they may undergo fine-needle aspiration (FNA). While there are about 70 published case reports of skeletal KS, there is limited literature specifically describing its cytomorphology. Our literature search yielded only a single prior reported case of FNA biopsy of skeletal KS in a Nigerian AIDS patient. CASE We present a case of disseminated KS of the axial skeleton in a 45-year-old African-American man with AIDS which was diagnosed on FNA cytologic examination. The patient presented with multiple lytic lesions in the axial skeleton. The aspirate, core-needle biopsy and touch imprint cytology of a bone lesion demonstrated clusters of spindle and epithelioid cells in radial and streaming arrangement with indistinct intercytoplasmic borders, elongated nuclei, fine chromatin and inconspicuous nucleoli. Immunohistochemical studies revealed positivity for HHV-8 and vascular markers. The cytomorphologic and ancillary features of the case are presented and discussed.
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Affiliation(s)
- Oleksandr Yergiyev
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, Pa., USA
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Alikhan MB, Tretiakova M, Khan G, Hyjek E, Antic T. Cytopathologic diagnosis of Kaposi sarcoma in unusual clinical settings. J Am Soc Cytopathol 2014; 3:244-249. [PMID: 31051677 DOI: 10.1016/j.jasc.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Kaposi sarcoma (KS) is a rare disease that presents as 1 of 4 distinct clinicopathologic subtypes; however, it may present in populations outside those normally encountered. In such cases, it will be important to consider KS in the differential diagnosis, as it may mimic other neoplastic and non-neoplastic entities. MATERIALS AND METHODS We describe 2 cases of KS, 1 in a patient not clinically fitting any of the 4 subtypes and the other in a patient with atypical presentation in human immunodeficiency virus (HIV)-associated disease. The first is an 81-year-old African American (AA) woman with a history of KS of the leg, who presented with groin lymphadenopathy and the second is a 42-year-old AA man with a known history of HIV infection, no skin lesions, and new axillary lymphadenopathy. RESULTS Fine-needle aspiration of the groin and axillary lymph node, respectively, showed atypical spindle cells in a lymphoplasmacytic background. The spindle cells were positive for human herpesvirus-8 on the cell block and subsequent lymph node excision. In patients with HIV infection, in addition to reactive and lymphoproliferative processes, KS should be considered. In the former case, the demographic of an elderly AA woman without immunosuppression would not cause concern for systemic KS, but for a metastatic tumor or lymphoma. CONCLUSIONS Cytology is a helpful tool in narrowing the differential diagnosis for spindle cell lesions. With a diagnosis of KS, clinicians would be able to query the clinical history for a possible etiology, such as HIV, and exclude the possibility of metastatic disease.
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Affiliation(s)
- Mir B Alikhan
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois
| | - Maria Tretiakova
- Department of Pathology, University of Washington, Seattle, Washington
| | - Ghazal Khan
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois
| | - Elizabeth Hyjek
- Department of Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois.
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Fulciniti F, De Chiara A, Apice G, Petrillo A, Botti G, Feroce F, Mozzillo N. Fine-needle cytology of Kaposi's sarcoma in an intramammary lymphnode: report of one case. Diagn Cytopathol 2012; 40 Suppl 2:E149-52. [PMID: 22454222 DOI: 10.1002/dc.21783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 06/22/2011] [Indexed: 12/12/2022]
Abstract
Kaposi's sarcoma (KS) is the most common human immunodeficiency virus (HIV) infection disease-associated malignancy. It consists of an angiosarcomatous change of the epithelial and mucous membrane-associated connective tissue not only in various sites, for example, skin, gastrointestinal system, lungs, and so on, but may also involve nonepithelial organs, such as lymphnodes. An unusual localization of KS to an intramammary lymphnode is reported here. The patient, an HIV-negative 69-year-old woman with a clinical history of rheumatoid arthritis treated with hydrocortisone, had an 8-month pathological history of biopsy-proven Kaposi sarcoma of the skin with visceral extension (stomach and duodenum). The appearance of a well-defined 23 × 20 mm(2) breast nodule during chemotherapy elicited fine-needle cytology to exclude breast carcinoma. Surgical excision confirmed the cytopathological diagnosis of Kaposis's sarcoma.
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Affiliation(s)
- Franco Fulciniti
- S.S.D. di Citopatologia, A.F. di Anatomia Patologica e Citopatologia, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy.
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Lang TU, Khalbuss WE, Monaco SE, Michelow P, Pantanowitz L. Review of HIV-Related Cytopathology. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:256083. [PMID: 21559199 PMCID: PMC3090088 DOI: 10.4061/2011/256083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/15/2011] [Indexed: 11/28/2022]
Abstract
Exfoliative and aspiration cytologies play a major role in the management of patients with human immunodeficiency virus infection. Common cytology samples include cervicovaginal and anal Papanicolaou tests, fine needle aspirations, respiratory specimens, body fluids, Tzanck preparations, and touch preparations from brain specimens. While the cytopathologists need to be aware of specific infections and neoplasms likely to be encountered in this setting, they should be aware of the current shift in the pattern of human immunodeficiency virus-related diseases, as human immunodeficiency virus patients are living longer with highly active antiretroviral therapy and suffering fewer opportunistic infections with better antimicrobial prophylaxis. There is a rise in nonhuman immunodeficiency virus-defining cancers (e.g., anal cancer, Hodgkin's lymphoma) and entities (e.g., gynecomastia) from drug-related side effects. Given that fine needle aspiration is a valuable, noninvasive, and cost-effective tool, it is frequently employed in the evaluation and diagnosis of human immunodeficiency virus-related diseases. Anal Papanicolaou tests are also increasing as a result of enhanced screening of human immunodeficiency virus-positive patients for cancer. This paper covers the broad spectrum of disease entities likely to be encountered with human immunodeficiency virus-related cytopathology.
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Affiliation(s)
- Tee U. Lang
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
| | - Walid E. Khalbuss
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
| | - Sara E. Monaco
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
| | - Pam Michelow
- Cytology Unit, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg 2192, South Africa
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
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Guggisberg K, Okorie C, Khalil M. Cytopathology including fine-needle aspiration in sub-Saharan Africa: a Cameroon experience. Arch Pathol Lab Med 2011; 135:200-6. [PMID: 21284438 DOI: 10.5858/135.2.200] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Surgical pathology is unavailable in most of sub-Saharan Africa because of equipment costs and lack of expertise. Cytopathology is an inexpensive and reliable alternative. OBJECTIVE To explore the utility of cytopathology in a rural hospital setting in Africa. DESIGN A cytopathologist and a pathology resident from Calgary, Alberta, Canada, went to Cameroon to provide a cytopathology service at the Banso Baptist Hospital. Both performed the fine-needle aspiration procedures. Direct smears were fixed in alcohol and stained with hematoxylin-eosin. Surgical specimens subsequently obtained from the patients were processed and reported at Calgary Laboratory Services, Canada. The histopathologic diagnoses were the gold standard for determining the accuracy of the cytologic diagnoses. RESULTS Fifty-nine patients were examined during a 5-week period, 33 females (56%) and 26 males (44%). Sixteen (27%) were known to be HIV positive. Forty-four fine-needle aspiration procedures were performed for 43 patients (73%). The cost of each procedure was approximately US $10. Head and neck and breast were the sites most frequently sampled for aspirates. Cervical smears from 5 patients were also assessed, as were 8 fluid specimens and 2 touch preparations of prostatic core biopsies. The most frequent diagnoses for malignancy were carcinoma and lymphoma. Tuberculous lymphadenitis was diagnosed in 6 patients, 4 of whom were HIV positive. Surgical specimens were received from 18 patients (30%). Cytohistologic and clinicopathologic correlation revealed 1 false-positive (1.6%) and 1 false-negative (1.6%) diagnosis. CONCLUSION Cytopathology is a reliable alternative for tissue diagnosis in low-resource settings.
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Affiliation(s)
- Kelly Guggisberg
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Alberta, Canada
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Pantanowitz L, Kuperman M, Goulart RA. Clinical history of HIV infection may be misleading in cytopathology. Cytojournal 2010; 7:7. [PMID: 20607096 PMCID: PMC2895884 DOI: 10.4103/1742-6413.64375] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 01/19/2010] [Indexed: 11/22/2022] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients are at an increased risk for developing opportunistic infections, reactive conditions and neoplasms. As a result, a broad range of conditions are frequently included in the differential diagnosis of HIV-related lesions. The clinical history of HIV infection may, however, be misleading in some cases. Illustrative cases are presented in which knowledge of a patient's HIV status proved to be misleading and increased the degree of complexity of the cytologic evaluation. Case 1 involved the fine needle aspiration (FNA) of a painful 3 cm unilateral neck mass in a 38-year-old female with generalized lymphadenopathy. Her aspirate revealed a spindle cell proliferation devoid of mycobacteria that was immunoreactive for S-100 and macrophage markers (KP-1, PGM1). Multiple noncontributory repeat procedures were performed until a final excision revealed a schwannoma. Case 2 was a CT-guided FNA of a positron emission tomography positive lung mass in a 53-year-old man. The acellular aspirate in this case contained structures resembling fungal spore forms that were negative for mucicarmine and GMS stains, as well as cryptococcal antigen immunocytochemistry. A Von Kossa stain confirmed that these pseudo-fungal structures were calcified debris. Follow up revealed multiple calcified lung and hilar node based granulomata. Case 3 involved the cytologic evaluation of pleural fluid from a 47-year-old man with Kaposi sarcoma and recurrent chylous pleural effusions. Large atypical cells identified in his effusion were concerning for primary effusion lymphoma. Subsequent pleural biopsy revealed extramedullary hematopoiesis, documenting these atypical cells as megakaryocytes. These cases demonstrate that knowledge of a patient's HIV status can be misleading in the evaluation of cytology specimens, with potential for misdiagnosis and/or multiple procedures. To avoid this pitfall in the setting of HIV infection, common entities unrelated to HIV infection and artifacts should always be included in the differential diagnosis.
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Affiliation(s)
- Liron Pantanowitz
- Address: Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Bofin AM, Christensen E. Skin. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chen X, Remotti F, Tong GX, Gorczyca E, Hamele-Bena D. Fine-needle aspiration cytology of subcutaneous toxoplasmosis: A case report. Diagn Cytopathol 2009; 38:716-20. [PMID: 20014129 DOI: 10.1002/dc.21281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Toxoplasmosis is a common opportunistic infection in patients with AIDS in whom it typically presents as encephalitis, pneumonia, lymphadenitis, and myocarditis. Skin involvement is very rare and, to our best knowledge, Toxoplasma gondii forming a subcutaneous mass has not been reported. Here, we report the findings of an interesting case of subcutaneous toxoplasmosis with the cytological appearance of an inflammatory fibrovascular lesion in a HIV-positive patient and discuss the differential diagnosis.
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Affiliation(s)
- Xiaowei Chen
- Department of Pathology, Columbia University Medical Centre, New York, NY 10032, USA.
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Fine-needle aspiration, an efficient sampling technique for bacteriological diagnosis of nonulcerative Buruli ulcer. J Clin Microbiol 2009; 47:1700-4. [PMID: 19386847 DOI: 10.1128/jcm.00197-09] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Invasive punch or incisional skin biopsy specimens are currently employed for the bacteriological confirmation of the clinical diagnosis of Buruli ulcer (BU), a cutaneous infectious disease caused by Mycobacterium ulcerans. The efficacy of fine-needle aspirates (FNA) using fine-gauge needles (23G by 25 mm) for the laboratory confirmation of BU was compared with that of skin tissue fragments obtained in parallel by excision or punch biopsy. In three BU treatment centers in Benin, both types of diagnostic material were obtained from 33 clinically suspected cases of BU and subjected to the same laboratory analyses: i.e., direct smear examination, IS2404 PCR, and in vitro culture. Twenty-three patients, demonstrating 17 ulcerative and 6 nonulcerative lesions, were positive by at least two tests and were therefore confirmed to have active BU. A total of 68 aspirates and 68 parallel tissue specimens were available from these confirmed patients. When comparing the sensitivities of the three confirmation tests between FNA and tissue specimens, the latter yielded more positive results, but only for PCR was this significant. When only nonulcerative BU lesions were considered, however, the sensitivities of the confirmation tests using FNA and tissue specimens were not significantly different. Our results show that the minimally invasive FNA technique offers enough sensitivity to be used for the diagnosis of BU in nonulcerative lesions.
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Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations. BMC Cancer 2008; 8:190. [PMID: 18605999 PMCID: PMC2464778 DOI: 10.1186/1471-2407-8-190] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 07/07/2008] [Indexed: 11/10/2022] Open
Abstract
Kaposi sarcoma (KS) is a multifocal, vascular lesion of low-grade malignant potential that presents most frequently in mucocutaneous sites. KS also commonly involves lymph nodes and visceral organs. This article deals with the manifestation of KS in unusual anatomic regions. Unusual locations of KS involvement include the musculoskeletal system, central and peripheral nervous system, larynx, eye, major salivary glands, endocrine organs, heart, thoracic duct, urinary system and breast. The development of KS within wounds and blood clots is also presented. KS in these atypical sites may prove difficult to diagnose, resulting in patient mismanagement. Theories to explain the rarity and development of KS in these unusual sites are discussed.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
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Von Roenn JH. Clinical presentations and standard therapy of AIDS-associated Kaposi's sarcoma. Hematol Oncol Clin North Am 2003; 17:747-62. [PMID: 12852654 DOI: 10.1016/s0889-8588(03)00043-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The treatment plan for a patient with AIDS-related KS should be based on tumor characteristics, control of HIV infection, comorbidities, and patient treatment goals (see Table 1). Institution of optimal antiretroviral therapy is an essential component of KS therapy. When available, enrollment in a clinical trial should be considered, except for patients who are naive to chemotherapy with symptomatic or life-threatening KS. For a patient with minimal, indolent cutaneous disease, after optimal control of HIV replication, local treatment, investigational treatment, or interferon are reasonable considerations. For the patient with rapidly progressive, cutaneous disease, tumor-related symptoms, or visceral disease, cytotoxic chemotherapy in combination with antiretroviral therapy is the first consideration. Future advances undoubtedly will include pathogenesis-based agents, either alone or in combination with currently available cytotoxic therapy.
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Affiliation(s)
- Jamie H Von Roenn
- Department of Medicine, Division of Hematology/Oncology, The Feinberg School of Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 North St. Clair Street, Suite 850, Chicago, IL 60611, USA.
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