Gamna-Gandy Bodies in Surgical Neuropathology Specimens: Observations and a Historical Note

Cutaneous Gamna-Gandy Bodies: An Unusual Case of Dystrophic Calcification

Dystrophic calcification is a common histopathologic finding that can be concomitant with a plethora of diseases, ranging from self-limited infections to insidious malignancies. Gamna-Gandy bodies (GGBs) are a form of dystrophic calcification associated with chronic hemolysis and are typically observed in the spleen. In this report, we present a case of a 92-year-old man who presented with a four-millimeter blue papule that was biopsied given the concern for a blue nevus. The subsequent histopathological examination of the biopsy specimen showed a dermal organizing hematoma adjacent to pale yellow to brown, refractile material within fibrotic collagen consistent with GGBs. Scanning electron microscopy with energy dispersive x-ray analysis (SEM/EDXA) revealed that the structures were composed of carbon (39%), oxygen (32%), iron (16%), phosphorus (7%), calcium (5%), and sodium (1%). Fourier transform infrared spectroscopy (FTIR) identified amorphous calcium phosphate. GGBs have not been previously described in the skin and have been rarely characterized with SEM/EDXA in other sites. This article is protected by copyright. All rights reserved.

Mineralizing Pulmonary Elastosis in a Cat

Mineralizing pulmonary elastosis (MPE) is a rare and unique phenomenon that has been reported in humans, typically secondary to recurrent pulmonary haemorrhage. MPE has a complex histopathological appearance, often containing iron-calcium deposits that can be mistaken as fungal organisms or other inorganic material. This report documents the first case of MPE in an animal species. A 10-year-old female domestic cat with respiratory failure was submitted for necropsy. The lungs were consolidated with severe pulmonary haemosiderosis, and widely disseminated granulomas surrounded large aggregates of hyphae-like structures. The pulmonary vasculature and airway smooth muscle were partially mineralized and fragmented. Histochemical stains revealed that the fungus-like material stained strongly with Prussian blue and alizarin red but only sparingly with von Kossa and negative with Gomori's methenamine silver stain. These findings are similar to those of MPE in humans. As most veterinary pathologists may not be familiar with MPE, it is important to avoid possible misinterpretation by recognizing its distinct features and the ancillary testing that may be required.

Gamna-Gandy bodies in fine-needle aspiration from abdominal splenosis: A clue to underlying portal hypertension

A 40-year-old woman presented with abdominal pain and jaundice. Past medical history was significant only for splenectomy following a motor vehicle accident. Owing to presence of multiple peritoneal nodules on computerized tomography (CT) and elevated serum CA-125, ovarian peritoneal carcinomatosis was suspected. Ultrasound-guided fine-needle aspiration (FNA) revealed presence of abundant hemosiderin, leukocytes, endothelial cells, and fungal hypha-like structures. No evidence of neoplasia was found. Findings were consistent with Gamna-Gandy bodies (GGBS) within splenic tissue. Based on history of splenectomy and FNA findings, a diagnosis of abdominal splenosis with presence of GGBS was made. Workup for hepatic cirrhosis and portal hypertension was recommended. Liver biopsy confirmed presence of cirrhosis. To our knowledge, this is the first report of GGBS identified within abdominal splenosis. It is important for pathologists to be able to recognize GGBS and to be aware of their relationship to portal hypertension and other conditions associated with severe vascular congestion or hemorrhage. History and pathogenesis of GGBS, their diagnostic morphologic features and a review of cases of GGBS diagnosed via cytology are given.

Metastatic lesions of atrial myxoma. A pathologist can clinch them all

Atrial myxomas are the most common primary benign cardiac tumors. The embolization of tumor particles is not infrequent, and in nearly half of them, the cerebral arteries are affected, usually leading to embolic ischemic stroke. Formation of intracranial aneurysms, development of parenchymal brain metastasis, and intracerebral hemorrhage due to ruptured aneurysms are rarer. Diagnosis of such lesions in a previously undiagnosed case of myxoma may be challenging for a pathologist. Herein, we present two patients of cardiac myxoma with varied neurological manifestations and their pathological findings.

Gamna-Gandy bodies in a solid pseudopapillary tumor of the pancreas

Gamna gandy bodies are sclerosiderotic granules composed of various amounts of calcium and hemosiderin in hyalinised fibrous tissue. We report a case of an 18 year old girl with solid pseudopapillary tumor of the pancreas in which numerous gamna gandy bodies were present. The pathogenesis of such a finding is unclear. To the best of our knowledge, this is the first report of Gamna Gandy bodies occurring in a solid pesudopapillary tumor of the pancreas.

Cytologic features and staining characteristics of Gamna-Gandy bodies from seven canine fine-needle aspirate preparations

Gamna-Gandy (GG) bodies are non-infectious, hyphal-like structures associated with siderotic nodules in lymphoid tissue; GG bodies are very rarely reported in veterinary cytologic samples. Cytologically, GG bodies can be misidentified as hyphae or plant material. Seven canine lymphoid tissue aspiration cases that contained GG bodies were investigated for morphologic variability and staining characteristics. Available archived cytology slides containing GG bodies were stained with reagents known to show positive results (Prussian blue, Alizarin red S, Von Kossa) and negative results (Gomori methenamine silver) in histologic samples. Calcofluor white staining was also performed. GG bodies in Wright-Giemsa-stained cytology samples displayed considerable variability but were generally 2-5 µm diameter, 10-35 µm long, refractile, clear, pale-tan or pale-yellow, wavy or straight, tubular structures. Six cases allowed for cytochemical staining; staining properties were similar to histology samples. The bodies did not stain with calcofluor white; this stain may be helpful in distinguishing GG bodes from fungal hyphae.

Pseudofungi: A Diagnostic Pitfall

Pseudofungi are septate hyphae-like structures very similar morphologically to true fungal elements. Histologically their presence poses a diagnostic challenge as they mimic fungal infection. Accurate identification of pseudofungi is required to avoid unnecessary treatment, and this can be accomplished by careful morphologic analysis with the use of appropriate histochemical stains. We report a patient with pseudofungi within a paratracheal lymph node, describe the morphologic findings, and discuss the differential diagnosis.

The wonderful colors of the hematoxylin-eosin stain in diagnostic surgical pathology

The hematoxylin-eosin (H&E) stain has stood the test of time as the standard stain for histologic examination of human tissues. This simple dye combination is capable of highlighting the fine structures of cells and tissues. Most cellular organelles and extracellular matrix are eosinophilic, while the nucleus, rough endoplasmic reticulum, and ribosomes are basophilic. This review discusses the spectrum, intensity, and texture of colors observed in H&E-stained slides to illustrate their value in surgical pathology diagnosis. Changes in color of the nuclei occur in the presence of nuclear pseudoinclusions (such as papillary thyroid carcinoma) or inclusions (such as viral infection, surfactant, immunoglobulin, and biotin). The color of the cytoplasm of spindly cells can provide clues to their nature, such as basophilic (fibroblast), eosinophilic (smooth muscle and others), and amphophilic (myofibroblast). Eosinophilic globules have diagnostic value for sclerosing polycystic adenosis of salivary gland, low-grade B-cell lymphoma, solid pseudopapillary tumor of pancreas, and inclusion body fibromatosis. Eosinophilic granules are characteristic of granular cells (lysosome-rich), oncocytic cells (mitochondria-rich), and cells with secretory products (including neuroendocrine cells). Eosinophilic crystals can be diagnostic of lymphoma/plasmacytoma and crystal-storing histiocytosis. Basophilic granules or inclusions are diagnostic of acinic cell carcinoma and malakoplakia (Michaelis-Gutmann bodies). Yellow or brown inclusions are characteristic of hyalinizing trabecular adenoma of thyroid (yellow bodies), brown bowel syndrome, and malignant melanoma. Extracellular eosinophilic deposits can be produced by many conditions, but amyloid and monoclonal immunoglobulin deposition disease are important considerations. Extracellular basophilic deposits may be seen in small cell carcinoma and systemic lupus erythematosus, but they differ in that the former is blue (nuclear material) while the latter is purple (nuclear material plus immunoglobulin).

Clinical and molecular characteristics of congenital glioblastoma

Congenital glioblastoma (cGBM) is an uncommon tumor of infancy with a reported variable but often poor cure rate, even with intensive therapy. Five patients with cGBMs, arising de novo and not in familial tumor predisposition kindreds, were studied for histological and biological features, using Affymetrix microarray. Tumors were large, often associated with hemorrhage, extended into the thalamus, and often bulged into the ventricles. One patient died acutely from bleeding at the time of operation. The 4 surviving patients underwent surgery (1 gross total resection, 3 subtotal resections or biopsies) and moderate intensity chemotherapy without radiation, and remain progression-free at a median time of 36 months (range, 30-110 months). Affymetrix microarrays measured gene expression on the 3 cGBMs from which frozen tissue was available. Unsupervised hierarchical clustering of cGBMs versus 168 other central nervous system tumors demonstrated that cGBMs clustered most closely with other high-grade gliomas. Gene expression profiles of cGBMs were compared with non-congenital pediatric and adult GBMs. cGBMs demonstrated marked similarity to both pediatric and adult GBMs, with only 31 differentially expressed genes identified (false discovery rate, <0.05). Unique molecular features of cGBMs included over-expression of multiple genes involved in glucose metabolism and tissue hypoxia. cGBMs show histological and biological overlap with pediatric and adult GBMs but appear to have a more favorable outcome, with good response to moderate intensity chemotherapy with only subtotal resection or biopsy. Further study may determine whether identified gene expression differences contribute to the improved survival seen in these tumors.

[Gamna Gandy bodies: Features mimicking a mycotic disease. Two cases in the spleen]

We report the clinical and histopathological features of 2 cases of Gamna-Gandy bodies located in the spleen. The diagnosis was made by the presence of circumscribed nodules containing dark brown rod-shaped and "bamboo-shaped" fibrotic structures. These structures were positive with Perls and von Kossa staining. Differential diagnosis includes filamentous mycoses such as mucormycosis and phaeohyphomycosis. Gamna-Gandy nodules can be isolated or these bodies can be observed associated with another lesion, particularly, a tumor.