Fine Nuclear Chromatin Research Articles

Malignant Glomus Tumor of the Kidney: A Case Report and Review of the Literature

Abstract Introduction/Objective Glomus tumors are rare neoplasms arising from the glomus body which is a specialized arteriovenous anastomosis that has a role in temperature regulation of the skin. They account for less than 2% of soft tissue tumors and typically manifest as painful nodules in the extremities, most commonly in the subungual region of the fingers and dermis of the wrist, forearm, and foot. They rarely arise in visceral organs as they lack glomus bodies. There are rare case reports of benign glomus tumors arising in the kidney, and malignant renal glomus tumors are exceedingly rare. Methods/Case Report We present a case of a 32-year-old man who was found to have a right renal mass incidentally after being involved in a motor vehicle accident. Computed tomography of the abdomen revealed a 5.3 cm enhancing mass in the posterior aspect of the inferior pole of the right kidney. Histological examination revealed a solid neoplasm composed of a pleomorphic population of cells with densely eosinophilic to pale cytoplasm, centrally located round to oval nuclei with fine nuclear chromatin and relatively inconspicuous nucleoli. Prominent lymphovascular invasion and 1 mitotic figure per 10 high power fields were also present. Areas composed of necrosis, sclerosis, hemosiderin deposition and calcification were identified. Immunohistochemical stains revealed the neoplastic cells to be positive for CD34, vimentin, smooth muscle actin, caldesmon, with focal reticulin staining around the tumor cells. Cells were negative for desmin, high and low molecular weight cytokeratins, synaptophysin, chromogranin, PAX8, and GATA3. The morphology and immunoprofile of the mass are consistent with the diagnosis of glomus tumor. Results (if a Case Study enter NA) NA Conclusion Although very rare, the presence of prominent vascular invasion, increased mitotic activity as well as necrosis are consistent with malignant behavior and support the classification as a malignant glomus tumor.

Cytology of peritoneal implants of borderline serous tumor of ovaries in ascitic fluid.

Objectives:Peritoneal fluid cytology is done routinely in cases with serous carcinoma of ovary. However, morphologic features of borderline serous tumors (BSTs) of ovary in ascitic fluid have been rarely described. The aim of our study was to evaluate the morphologic features of BST with and without ascitic fluid involvement (BST+ and BST-, respectively) and compare with those of serous carcinomas, both in conventional and liquid-based cytology (LBC) smears.Material and Methods:Out of 30 BST cases reported in 3 years, seven cases had BST+. We compared the cytomorphology of seven cases of BST+, seven cases of BST-, and seven cases of serous adenocarcinoma with positive ascitic fluid cytology. Both conventional and LBC smears were studied in all cases and compared. Histopathology of omentum in these cases was also studied.Results:Most cases with BST+ had regular papillary fragment borders with nuclei showing mild-to-moderate pleomorphism, fine nuclear chromatin with small nucleoli as compared with serous carcinomas all of which had irregular borders with moderate-to-severe nuclear pleomorphism, coarse chromatin, and macronucleoli.Conclusion:A combination of cytoarchitectural and nuclear features can help in suspecting BST in ascitic fluid. Ascitic fluid cytology together with tissue histology can increase the rate of the detection of peritoneal implants.

Conventional Direct Smear Yields Diagnostic Indicators of Gastric-Type Mucinous Carcinoma Compared with Cytomorphological Features Identified by Liquid-Based Cervical Cytology

Introduction: Gastric-type mucinous carcinoma (GAS) of the uterine cervix is an adenocarcinoma subtype with a gastric phenotype that poses diagnostic pitfalls in cervical screening cytology because of its blunt morphologic atypia and the limited utility of human papillomavirus testing and ancillary immunochemical staining. Despite the recent widespread uptake of liquid-based cytology (LBC) systems, the cytomorphological features of GAS in LBC samples and the differential features between GAS and usual-type endocervical adenocarcinoma (UEA) remain unclear. Methods: Eight GAS cases, all of which were surgically treated following histological confirmation, were examined. Direct Papanicolaou-stained smears and LBC samples were reviewed and compared with 10 UEA cases as controls. Featured cytomorphological findings were as follows: background (mucinous, inflammatory, or necrotic), cell crowding (size of neoplastic cell clusters), cytoplasm (golden mucin and cell border), and nuclei (nuclear chromatin and nucleoli). Results: Of 18 adenocarcinomas, 16 were detected against a non-mucinous background in LBC samples, most of which were accompanied by mild to moderate inflammation. Clusters comprising >300 neoplastic cells were identified in both GAS and UEA in conventional smears (CSs), while no LBC samples harboured clusters as large as these. Cell borders of GAS were more distinct than those of UEA in CSs (p < 0.001), although fewer populations of neoplastic clusters revealed distinct cell borders in both GAS and UEA in LBC samples. Three of 8 and 2 of 8 GAS cases had golden mucin in CSs and in LBC samples, respectively, which was not detected in UEA at all. Nucleoli against fine nuclear chromatin were more pronounced in GAS than in UEA on CS (p = 0.03), although the difference between GAS and UEA was not apparent in LBC samples. Discussion/Conclusion: This study demonstrated that the diagnostic clues to detect GAS using the conventional approach, namely distinct cell borders and prominent nucleoli, are not useful for excluding UEA in LBC samples. Conventional cervical smears may indicate a diagnosis of GAS; however, specific high-risk HPV detection approaches, such as HPV test or immunocytochemical p16/Ki-67 dual staining, are desirable to differentiate GAS from UEA in the setting of LBC with ambiguous cytomorphological features.

Primary Meningioma of the Middle Ear - A Rare Presentation

Abstract Introduction/Objective Meningiomas are the benign intracranial neoplasm, most commonly occurring in the third and sixth decade of life. The most common intracranial locations for meningiomas are parasagittal sinuses and large dural sinuses. Very rarely extracranial meningiomas can also be observed. We present a case of fibrous meningioma presenting as middle ear mass, in which a 13 years old female was presented with drainage from the left ear. Biopsy showed fibromyxomatous tissue. CT scan of the head showed soft tissue filling the middle ear and extending into the mastoid. Methods The mass was resected and sent to pathology, where H&amp;E staining and immunohistochemistry was done for diagnosis. Results The H&amp;E stained section showed a spindle-shaped neoplasm with areas of sheet-like growth interspersed with areas showing tumor cell growth in short fascicles, and some areas of decreased cellularity. Tumor cells have moderate cytoplasm, fine nuclear chromatin and inconspicuous nucleoli. The tumor cells were positive for EMA, PR(nuclear staining) and pan-TRK and negative for D-240, SOX-10, S-100 and desmin. These histological features alone with immunohistochemistry profile were consistent with meningioma WHO grade 1. Conclusion Primary middle ear meningioma although a rare diagnosis, but should be considered while dealing with middle ear pathologies. Histomorphology and immunohistochemistry play an important role in making diagnosis.

MG-122 Atypical fish pattern consistent with insertion of 5’ CBFB into 16p13 in a case of therapy-related acute myeloid leukaemia

Background The inv (16) and related t (16;16) resulting in fusion of CBFB gene (16q22) to MYH11 (16p13) are not commonly observed in therapy-related AML (t-AML). Objective To present a case of t-AML with CBFB/MYH11 fusion and rearrangement of chromosome 16 other than the commonly described inv (16) and related t (16;16). Case report A 46-year-old woman presented with t-AML 1.25 years after adjuvant radiation and chemotherapy for rectal carcinoma. Peripheral blood showed marked reduction in neutrophils, 24% blasts and increased lymphocytes and monocytes. Bone marrow aspirates revealed large blasts with abundant cytoplasm, fine nuclear chromatin, occasional deep nuclear folds and prominent nucleoli. Bone core biopsy mainly consisted of blasts and was remarkable for numerous eosinophilic myelocytes and metamyelocytes. Cytogenetic analysis of bone marrow aspirate was interpreted as 46,XX,inv (16)(p13.3q22)[6]/47,idem,+8[14]/48,idem,+6,+8[2]. Interphase FISH analysis using the CBFB break-apart probe showed an atypical abnormal signal pattern of two CBFB fusion signals and one 5’ CBFB probe signal. Metaphase FISH analysis showed an abnormal chromosome 16 with a CBFB fusion signal on one arm and a 5’ CBFB signal on the other arm. The normal 16 homologue showed the expected one CBFB fusion signal. The CBFB/MYH11 fusion transcript type A was detected by RT-PCR. Conclusion The abnormal CBFB pattern observed in this case differs from what is expected for an inv (16) or t (16:16), but can be explained by an insertion of 5’ CBFB into 16p13. This case demonstrates that insertion of 5’ CBFB into 16p13 is another mechanism of producing a CBFB /MYH11 fusion.

Clinicopathologic analysis of 3 patients with metaplastic thymoma

Objective To investigate the clinicopathologic characteristics of metaplastic thymoma. Methods The histological features and immunophenotype of three cases with metaplastic thymoma were studied, and the literatures were reviewed. Results There were 2 females and 1 male of 3 patients with 45, 52 and 40 years old, respectively. All tumors were characterized by a biphasic pattern composed of epithelial components and spindle cells. The epithelial areas consisted of anastomosing cords and islands or broad trabeculae of cohesive neoplasia cells. Some epithelial cells showed mild cytologic atypia, the presence of prominent nuclear grooves or pseudoinclusion body, and very low mitotic activity. The cells appeared bland and a fine nuclear chromatin pattern, and the mitoses were not found. The epithelial cells were diffusely and strongly positive for AE1/AE3. The spindle cells were diffusely positive for Vimentin. The Ki-67 fraction was low (< 5 %) in both components. Conclusions Metaplastic thymoma is a rare primary thymic epithelial tumor, and its biologic behavior is likely benign or lowly malignant process. Occasionally, the tumor invades adjacent tissue or recurrence. With complete tumor resection, the patients have good prognosis. The diagnosis of metaplastic thymoma mainly relies on its morphologic features and immunohistochemical profiles. Key words: Metaplasia; Thymoma; Immunohistochemically

Extraosseous plasmacytoma of the stomach

A 70-year-old man with a history of coronary artery disease and bladder cancer presented with generalized weakness, a 1-week history of melena, and anemia (hematocrit 26.8%, normal range: 40%-54%). EGD revealed a 7-cm mass in the gastric fundus and proximal greater curvature, with central clean-based ulceration (A and B). Multiple biopsy specimens were obtained. Histopathologic examination revealed sheets of atypical plasma cells displaying increased cell size, fine nuclear chromatin, prominent nucleoli, and occasional multinucleation (C).

Metastatic paraganglioma presenting as a primary shoulder mass

Paragangliomas uncommonly metastasize, including to the bones, wherein these tumors are designated as malignant paragangliomas. A 56-year-old man presented with pain and immobility in his right arm for 1year. He had a history of controlled hypertension and diabetes mellitus for 2years. He had also been taking anti-anxiety medications for 25years. His shoulder imaging revealed an expansile, lytic, destructive lesion in the glenoid cavity, measuring 4.6 × 3.9 × 3.2cm, involving the adjacent bones and soft tissues. A whole-body PET-CT scan revealed a hypermetabolic destructive mass in the right glenoid cavity and another lesion in his abdomen in the aortocaval region. Initial biopsy and subsequent scapular resection microscopically revealed a multinodular tumor with polygonal cells arranged in a nesting and diffuse pattern, in a vascularized and sclerotic stroma. Tumor cells displayed moderate to abundant, eosinophilic to clear cytoplasm, fine nuclear chromatin, focal intranuclear inclusions, and scattered mitotic figures. Immunohistochemically, tumor cells were positive for vimentin, synaptophysin, chromogranin, and CD56 and negative for AE1/AE3, CK, EMA, CD10, SMA, Melan A, HMB-45, desmin, and S100-P. Biopsy of the abdominal mass revealed foci of tumor cells resembling the scapular tumor. Diagnosis of a malignant paraganglioma was finally offered. The patient's post-operative blood pressure is controlled. Currently, his urinary vanillylmandelic acid and metanephrine levels are normal. He is asymptomatic 11months post-surgery and is on follow-up. This unusual case is presented to increase a diagnostic index of suspicion for a malignant paraganglioma, including at unconventional musculoskeletal sites. The diagnostic challenge and therapeutic implications are discussed herewith.

Acute Myeloid Leukemia with t(2;6)(q12;q12) Reveals Dysmegakaryopoietic Finding and Poor Prognosis

We present a case of acute myeloid leukemia (AML) with a balanced translocation between chromosomes 2q12 and 6q12, t(2;6)(q12;q12). This abnormality was defined by conventional cytogenetics and multicolor banding techniques using specific probes for chromosome 2. Blasts accounted for 2% of white blood cells in peripheral blood and approximately 30% of all nucleated cells in marrow aspirates. They were medium-to-large cells with fine nuclear chromatin, indistinct nucleoli and basophilic cytoplasm. Immunophenotyping indicated the blasts were of myeloid lineage with aberrant CD7 expression. Therefore, the patient was diagnosed as ‘Acute myeloid leukemia, NOS, AML with maturation’ according to the WHO classifications. In literature review, this case should be considered as the first report of AML with t(2;6)(q12;q12). Interestingly, a bone marrow smear showed dysmegakaryopoietic findings, such as multinucleated or mononucleated megakaryocytes and micromegakaryocytes. After diagnosis, the induction chemotherapy was given with idarubicin and cytosine arabinoside according to the protocol of intermediate-prognostic AML. After chemotherapy, the patient had been in remission for 13 months but relapsed with 54% blasts in marrow aspirates. The cytogenetic analysis revealed t(2;6)(q12;q12), which is same with karyotype shown at diagnosis. In this case report, the pathologic and clinical findings of AML with t(2;6)(q12;q12) were described, which are severe dysmegakaryopoiesis and poor prognosis. This report may be helpful for clinician to have a similar case treated

Ocular palsy associated with aggressive NK-cell leukemia

A 22-year-old woman was referred to our hospital with a 1-month history of recurrent fever, subacute onset of bilateral orbital pain, and diplopia. Physical examination revealed the limits of supraduction of her right eye and infraduction of her left eye. A bone marrow aspirate from the ilium showed scattered large immature-looking lymphocytes (15.8%) with pale cytoplasm, fine nuclear chromatin, and nucleoli (Fig. 1). These cells were stained positively with CD56, TIA-1, granzyme, and perforin, and were stained negatively with CD3. In situ hybridization for EBER demonstrated that the cells were EBV-positive. A diagnosis of aggressive NK-cell leukemia was made. Magnetic resonance imaging of orbital cavity showed marked enlargement, and diffuse high intensity signals in the right superior rectus muscle and left inferior rectus muscle on fat-saturated T2-weighted image (Fig. 1). These lesions were diffusely contrast-enhanced on fat-saturated T1-weighted image (Fig. 2). After two courses of dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide chemotherapy,

Acute erythroid leukaemias

Note Criteria for diagnosis of acute erythroid leukaemia. Erythroleukaemia Historically, AML with erythroid features has been designated M6 by the French-American-British (FAB) group. The FAB criteria for M6 diagnosis are: bone marrow erythroblasts equal to or greater than 50% and blasts equal to or greater than 30% of the non-erythroid cells. The World Health Organization (WHO) have recently recommended that the requisite blast percentage for a diagnosis of AML be 20% or greater, and this includes erythroid leukaemia. AML M6 would equate to the new WHO definition of erythroleukaemia (erythroid/ myeloid). If there are less than 20% blasts, the diagnosis is refractory anaemia with an excess of blasts (RAEB). Trilineage dysplasia is common but is not a prerequisite for diagnosis. Erythroid dysplasia may manifest as binuclearity, nucleo-cytoplasmic asynchrony and vacuolation. The morphological appearance of the myeloblasts is not characteristic and they may contain Auer rods. Myeloperoxidase and Sudan black B stains may be positive in the myeloblasts. The iron stain may show ringed sideroblasts and PAS may be positive in the erythroid precursors in a block or diffuse pattern. Pure erythoid leukaemia In addition to the typical AML M6 (erythroleukaemia), there is a second subtype of acute erythoid leukaemia where there is a neoplastic proliferation of immature cells entirely committed to the erythroid series (>80% of marrow cells) without evidence of a myeloid component. This is termed pure erythroid leukaemia by the WHO. Morphology is characterised by medium sized erythroblasts with fine nuclear chromatin, distinct nucleoli and deeply basophilic cytoplasm that often have vacuoles. Occasionally the blasts can resemble acute lymphoblastic leukaemia, distinction can be made by immunophenotyping. The erythroid nature of the blasts can be shown by electron microscopy demonstrating free ferritin particles. The blasts are negative for Sudan black B and myeloperoxidase (MPO), but positive for PAS in a block pattern.

Aspectos morfológicos de células da série eritrocítica de Caiman crocodilus yacare (Daudin, 1802; Reptilia, crocodilia)

Com o objetivo de estudar o sistema hematopoético do réptil Caiman crocodilus yacare, foram utilizados cinco exemplares hígidos e jovens (aproximadamente um ano de idade), provenientes de São Paulo e de Mato Grosso do Sul. Amostras de sangue periférico foram colhidas em EDTA, através da punção do seio venoso cervical, e da medula óssea por punção aspirativa do osso femural. Estudo histológico da medula óssea femural foi realizado através da coloração por HE, Giemsa e técnica de Gomori para fibras reticulínicas. Os esfregaços de sangue e de medula foram processados para coloração panótica (Leishman ou Rosenfeld). A presença de sítios hematopoéticos ativos foi demonstrada histologicamente nos cortes transversais do fêmur, principalmente no terço distal. As células da linhagem eritrocítica foram encontradas dentro dos vasos capilares sinusóides medulares, na região central do osso. As células precursoras desta linhagem estavam aderidas à parede do vaso, e suas sucessoras distribuídas em direção ao centro do sinusóide à medida que amadureciam. Nos esfregaços de medula, as células imaturas da linhagem eritrocítica mostraram-se arredondadas e com núcleo predominantemente frouxo, em contraposição às células maduras, de núcleo condensado e forma em geral elíptica. Foram vistos pró-eritroblastos, eritroblastos basofílicos, policromáticos e ortocromáticos, e finalmente eritrócitos.

Consultation with the Specialist: Childhood Leukemia

1. Jennifer M. Pearce, MD* 2. Richard H. Sills, MD* 1. *Department of Pediatrics, Albany Medical College, Albany, NY Author Disclosure Drs Pearce and Sills did not disclose any financial relationships relevant to this article. After completing this article, readers should be able to: 1. Understand the similarities in presentation of aplastic anemia and childhood leukemia. 2. Know that the absence of blasts in the peripheral blood of a patient who has pancytopenia does not rule out the diagnosis of leukemia. 3. Recognize bone pain as a symptom of leukemia. 4. Delineate the percentage of patients who have standard-risk acute lymphoblastic leukemia and enter remission with initial treatment. 5. Identify the important sites of relapse of acute lymphoblastic leukemia. 6. Identify the relationship of Down syndrome and leukemia. 7. Recognize the potential for a second malignancy following acute lymphoblastic leukemia. A 3-year-old boy develops pallor, bruising, and intermittent fever over 3 weeks. Laboratory findings include: hemoglobin, 6.8 g/dL (68 g/L); white blood cell (WBC) count, 1.8×10 3 /mcL (1.8×10 9 /L) with 2% neutrophils and 98% lymphocytes; platelet count, 25×10 3 /mcL (25×10 9 /L); mature lymphocytes on blood smear; and normal prothrombin and partial thromboplastin times. He is referred to a pediatric hematologist with the concern of aplastic anemia. The bone marrow is hypercellular and replaced with large blasts; immunophenotyping is consistent with acute myeloid leukemia (AML) (Figs. 1and 2). Figure 1. Photomicrograph of bone marrow aspirate smear from Case 1, showing marrow replaced completely with myeloblasts. Identifying features include the very fine nuclear chromatin, large distinct nucleoli, an irregular nuclear shape, and relatively abundant cytoplasm with red granules. Flow cytometry demonstrates that these cells are myeloid in origin because they are positive for the immunophenotypic markers CD13 and CD33. Figure 2. A. Normal section of bone marrow biopsy with the typical heterogenous appearance due to the presence of the different hematopoietic precursors. The clear areas represent the expected amount of fat. B. Biopsy from Case 1, …

Natural killer-cell lymphoma involving the gynecologic tract.

Non-Hodgkin lymphomas (NHL) can involve the gynecologic tract, most often as a manifestation of systemic involvement, and most cases reported have been of B-cell lineage. We describe 2 women with natural killer (NK)-cell lymphoma involving the gynecologic tract that initially presented with vaginal bleeding. In case 1, the patient had a stage IE nasal-type NK-cell lymphoma involving the cervix. The tumor was composed of medium-sized, irregular lymphoid cells with angioinvasion and necrosis. In case 2, the patient had a stage IV blastoid NK-cell lymphoma/leukemia infiltrating all organs in a hysterectomy and bilateral salpingo-oophorectomy specimen. Subsequent biopsy specimens revealed that the bone marrow and lymph nodes were also involved. The neoplasm was composed of small to medium lymphoid cells with fine nuclear chromatin. Case 1 was assessed immunohistochemically and the neoplastic cells were positive for CD3, CD56, and TIA-1. Case 2 was analyzed using both immunohistochemical and flow cytometry methods. The neoplastic cells were positive for cytoplasmic CD3, CD4, CD7, CD43, CD45, and CD56 and were negative for surface CD3. Both cases were negative for Epstein-Barr virus (EBV) ribonucleic acid (RNA) and molecular studies showed no evidence of T-cell receptor gamma chain gene rearrangements. The immunophenotype and absence of T-cell receptor gene rearrangements support NK-cell origin. We report these cases to illustrate that NK-cell lymphomas can involve, and rarely arise in, the gynecologic tract.

Novel B-Cell Precursor Leukemia Sister Cell Lines, NALM-33 and NALM-34, Established from a Patient with Acute Lymphoblastic Leukemia

Two novel B-cell precursor (BCP) acute lymphoblastic leukemia (ALL) cell lines, designated NALM-33 and NALM-34, were established from a 72-year-old male patient with ALL at relapse. Subcultures of each initial flask were first made after eight weeks of continuous incubation; thus, the two cell lines are simultaneous sister cell lines. The cells proliferate consistently singly and free-floating in suspension. They are negative for Epstein-Barr virus (EBV) infection by polymerase chain reaction (PCR) and are negative for mycoplasma infection. They have the morphological appearance of lymphoblasts with a scanty rim of cytoplasm, fine nuclear chromatin and distinct nucleoli. The primary leukemic blasts showed a common ALL phenotype with CD19+, CD10+, CD13—, HLA-DR+ and Igs—; the cell lines NALM-33/-34 display an identical immunophenotype. They fulfill “European Group for the Immunological Characterization of Leukemias (EGIL)” criteria as BCP leukemia B-II type. While the immunoglobulin heavy chain genes were found uniquely to be in their germline configuration, rearrangement of both κ and λ light chain genes was noted by Southern blot analysis. CDR-III detection by reverse transcriptase-PCR was also not detected. NALM-33/-34 did not respond significantly to the proliferative stimuli of various hematopoietic cytokines. In the cytogenetic analysis, they revealed the t(8;14)(q24.1;q32) with additional numerical and structural chromosomal abnormalities. The extensive immunological, cytogenetic and functional characterization of NALM-33/-34 suggests that these two novel cell lines may represent unique and relevant in vitro model systems for BCP-type leukemia cells.

A Variant Burkitt-Type Translocation (8;22)(q24;q11) in Multiple Myeloma: Report of a New Case and Review of the Literature

We report here a new case of multiple myeloma (IgG, κ, stage IIIA) with a variant Burkitt-type translocation (8;22)(q24;q11). Bone marrow plasma cells were morphologically immature with fine nuclear chromatin and nucleoli. Chromosome analysis showed complex aberrations; that is, 53,XX,der(1)add(1)(p11)dup(1)(q12q32),+3,+5,t(8;22)(q24;q11),+9,add(10)(p13),+11,+15,add(19)(q13),+21. Fluorescence in situ hybridization analysis with the yeast artificial chromosome (YAC) clone I2 containing the C- MYC gene at 8q24 and the chromosome-22-specific DNA library pBS22 revealed that I2 was located on the der(8)t(8;22). A fusion signal derived from I2 and the YAC clone B99E1 containing the BCR gene at 22q11 was also observed on the der(8)t(8;22). Our results indicate that the breakpoint at 8q24 in this patient was located far downstream of the C- MYC gene. This breakpoint site is similar to Burkitt lymphoma with t(8;22)(q24;q11). A review of eight cases in the literature and the present case of multiple myeloma with t(8;22)(q24;q11) showed that most of them were of advanced stage and had an immature phenotype. It is suggested that the C- MYC gene may be activated by t(8;22)(q24;q11) and implicated in disease progression in multiple myeloma.

TUMORLIKE CLUSTERS OF IMMATURE CELLS IN CEREBROSPINAL FLUID OF INFANTS

Cerebrospinal fluid (CSF) samples from four infants 3 days to 4 months of age with a history of prematurity or birth trauma were found to contain clusters of immature cells. These cells were arranged in groups or syncytia, sometimes with nuclear molding, and were cytologically characterized by scant basophilic cytoplasm, nuclei with fine nuclear chromatin, and small nucleoli. The picture simulated the appearance of metastatic tumor admixed with hemosiderin-laden macrophages, erythrocytes, and leukocytes. Because of the low numbers of cells or aggregates present in CSF samples and the relatively small quantity of CSF obtained, immunohistochemical and flow cytometric evaluations were not performed. Prior studies have designated these immature cells as undifferentiated leptomeningeal cells or cells from, the subependymal germinal matrix and have associated their presence with intraventricular hemorrhage (IVH) in premature newborns. Three of our patients had a history of prematurity; the fourth patient suffered a traumatic birth but was not premature. In long-term follow-up, the patients have not shown progression of neurologic deficits or evidence of malignancy. Thus, it is important to recognize that in infants with a history of IVH, subarachnoid hemorrhage, or ventricular drainage devices, the presence of tumorlike clumps of cells associated with hemosiderin-laden macrophages most likely does not represent metastatic tumor.

Tumorlike Clusters of Immature Cells in Cerebrospinal Fluid of Infants

Cerebrospinal fluid (CSF) samples from four infants 3 days to 4 months of age with a history of prematurity or birth trauma were found to contain clusters of immature cells. These cells were arranged in groups or syncytia, sometimes with nuclear molding, and were cytologically characterized by scant basophilic cytoplasm, nuclei with fine nuclear chromatin, and small nucleoli. The picture simulated the appearance of metastatic tumor admixed with hemosiderin-laden macrophages, erythrocytes, and leukocytes. Because of the low numbers of cells or aggregates present in CSF samples and the relatively small quantity of CSF obtained, immunohistochemical and flow cytometric evaluations were not performed. Prior studies have designated these immature cells as undifferentiated leptomeningeal cells or cells from the subependymal germinal matrix and have associated their presence with intraventricular hemorrhage (IVH) in premature newborns. Three of our patients had a history of prematurity; the fourth patient suffered a traumatic birth but was not premature. In long-term follow-up, the patients have not shown progression of neurologic deficits or evidence of malignancy. Thus, it is important to recognize that in infants with a history of IVH, subarachnoid hemorrhage, or ventricular drainage devices, the presence of tumorlike clumps of cells associated with hemosiderin-laden macrophages most likely does not represent metastatic tumor.

Spermatocytic seminoma in the rat.

During the necropsy of a 2-yr-old untreated control rat from a carcinogenicity study, a tan brown nodular mass was observed within the tunica albuginea of one testis. Both testes were processed for light and transmission electron microscopy. Histologically, the testicular mass was composed of round to polyhedral cells with distinct cell boundaries, amphophilic cytoplasm, fine nuclear chromatin, and a delicate fibrovascular supporting stroma. Ultrastructurally, the tumor cells displayed features associated with spermatocytic differentiation. Based on the light microscopic and the ultrastructural features, the tumor was considered a spermatocytic seminoma of the testis, a rare tumor in the rat.