Irregular Nuclear Membranes Research Articles

Protective effect of propolis on manganese chloride neurotoxicity of olfactory bulb in adult male albino rat.

Manganese (Mn) is widely used for industrial purposes and exposure to high levels of Mn may cause an irreversible brain disease. Propolis is a natural plant product; it acts as a powerful reactive oxygen species scavenger and improves the neurodegeneration process. In this study 40 adult male albino rats were divided randomly into four groups 10 rats each: group I (control group), group II manganese chloride (MnCl2) received 10 mg/kg/day/orally for 4 weeks by intra-gastric tube, group III (propolis group) received 50 mg/kg/day/orally for 4 weeks by intra-gastric tube, and group IV (MnCl2 + propolis group) received the same doses with the same duration and route as in groups II and III. Rats were sacrificed after 24 h of last dose. The olfactory bulbs removed, the right bulb cut to be processed for haematoxylin and eosin, immunohistochemical staining and the left cut for electron microscopic studies. Results revealed that rat olfactory bulb from MnCl2 group showed darkly stained mitral cells with dark pyknotic nuclei, some show pericellular spaces and vacuolation, dark apoptotic cells in granular cells, neuropil vacuolation and pyknotic astrocyte. Electron microscopic examination showed abnormal granular cell with irregular damaged nuclear membrane, rupture of myelin fibre. Mitral nerve cell with destructed nucleus, many cytoplasmic vacuoles, swollen rough endoplasmic reticulum, vacuolated mitochondria and neuropil were observed. Manganese chloride + propolis group showed improvement compared to MnCl2 group. It was concluded that propolis can ameliorate the toxic changes of manganese chloride on rat olfactory bulb.

Thyroid paraganglioma: A diagnostic pitfall in thyroid FNA.

Thyroid paragangliomas are extremely rare and often are misdiagnosed by preoperative fine-needle aspiration (FNA) because their cytologic features overlap with those of other thyroid neoplasms. The objective of this study was to review the cytomorphology in a series of thyroid paragangliomas and correlate the findings with histopathology. Five thyroid paraganglioma cases that underwent FNA were reviewed. Their clinical presentation, radiology features, cytomorphology, ancillary tests, and histopathology were analyzed. All patients were women with an average age of 49 years (age range, 35-61 years) and presented with an asymptomatic, solitary thyroid nodule. Radiologically, these nodules (size range, 1.8-3.0 cm) were well circumscribed, hypoechoic, and hypervascular. FNA smears showed clusters of loosely cohesive, medium-to-large epithelioid cells with clear-to-eosinophilic and occasionally foamy cytoplasm that had indistinct cytoplasmic borders. The nuclei were round to oval with focal nuclear membrane irregularities, inconspicuous nucleoli, focal marked anisonucleosis, and occasional intranuclear pseudoinclusions. Naked nuclei, variable numbers of plasmacytoid cells, multinucleated giant cells, and sustentacular cells were present in the background along with blood vessels and lymphocytes. Cytology diagnoses were incorrect and included follicular neoplasm (n = 4) and follicular lesion of undetermined significance (n = 1). Final histopathology with immunohistochemistry revealed conventional paraganglioma (n = 3) or sclerosing paraganglioma with invasive features (n = 2). All thyroid paragangliomas were misdiagnosed on FNA as follicular neoplasms, in part because of the rarity of these tumors in this location and cytomorphology mimicking follicles. The absence of colloid, the presence of naked nuclei, focal marked anisonucleosis, and the presence of sustentacular cells are important cytology clues.

Assessment of cytological features of glandular lesions of the cervix on conventional smear preparations-a comprehensive study from a tertiary care hospital.

Atypical glandular cells (AGC) as a diagnostic category in cervicovaginal cytology remains as a challenge to cytopathologists. The aim of the present study is to identify the cytological features helpful in categorizing AGC as reactive or neoplastic upon correlation with histology. The study was a retrospective review of cervical smears, with histopathological follow up, reported as glandular lesions for a period of 9 years. The architectural and nuclear features studied were adapted from The Bethesda System (TBS) to stratify the lesions as AGC, AGC-FN (atypical glandular cells favour neoplasia) and adenocarcinoma. The cytological categories were correlated with histology. A total of 89 cases of which 67 (AGC NOS = 34, AGC FN = 19, adenocarcinoma = 14) with histology were reviewed. Neoplastic lesions were encountered in 14 cases (34.6%). Of the cases diagnosed as AGC-NOS, AGC-FN and adenocarcinoma, 26.5%, 68.4% and 100% respectively were neoplastic on histopathology. Squamous lesions accounted for 14.9% of all the glandular lesions. Rosette or acinar formation and loss of polarity frequently observed in neoplastic lesions as compared to reactive changes (p = 0.0004, p = 0.001). Of the nuclear features, nuclear hyperchromasia or coarse clumping of chromatin along with nuclear membrane irregularity and nuclear pleomorphism was frequently associated with neoplastic lesions as compared to reactive conditions (p = 0.007, p = 0.001, p = 0.0002). A diagnosis of AGC at cytology harbors significant number of malignant lesions when confirmed on biopsy. Architectural features complemented with nuclear characteristics helps in differentiating between reactive and neoplastic conditions. Hence stratifying glandular lesions at cytology according to TBS helps in the management.

Cytological features and nuclear scores: Diagnostic tools in preoperative fine needle aspiration of indeterminate thyroid nodules with RAS or BRAF K601E mutations?

The cytological diagnosis of follicular-patterned thyroid lesions is challenging, especially since the World Health Organisation classification has recognised non-invasive follicular thyroid neoplasm with papillary-like features. These entities are often classified as indeterminate on cytology. Molecular testing has been proposed to help classify indeterminate nodules. RAS and K601E BRAF mutations are mostly encountered in follicular-patterned lesions, but their diagnostic value is not well established. Nuclear scores have also been proposed to help classify indeterminate lesions. To investigate the correlation between cytological features and histology and to assess nuclear scores in a series of indeterminate RAS or BRAF K601E positive thyroid nodules. The cytological parameters of 69 indeterminate RAS or BRAF K601E-positive thyroid nodules were evaluated. The Strickland and Maletta scores and a new nuclear score were assessed. Diagnosis of malignant, benign or indolent neoplasms was confirmed in each case by histology. Malignant and indolent nodules were considered surgical nodules, and adenomas non-surgical nodule. Surgical nodules were associated with the presence of ground glass nuclei (P=.001), grooves (P<.001) or irregular nuclear membranes (P=.01) on cytology. Nuclear scores were more often ≥2 in surgical nodules compared to benign ones (P<.001), with high sensitivity, but a low negative predictive value. Analysis of nuclear features is useful to distinguish non-surgical from surgical nodules in indeterminate FNAs. Although nuclear scores are not ideal rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they seem useful to screen non-molecular tested or non-mutated indeterminate FNAs. This work shows that meticulous analysis of nuclear features on cytological specimens can be useful to distinguish non-surgical nodules (adenoma) from surgical nodules in indeterminate FNAs. Although nuclear scores are not rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they are useful in screening non-molecular tested or non-mutated indeterminate FNAs for surgery.

Apoptosis of germ cells in the normal testis of the Japanese quail (Coturnix coturnix japonica)

It has been established that excess germ cells in normal and in pathological conditions are removed from testicular tissue by the mechanism of apoptosis. Studies on germ cell apoptosis in avian species are grossly lacking, and there are only a few reports on induced germ cell degenerations in the testis tissue of birds. This study was designed to investigate the process of apoptosis of germ cells in the Japanese quail (Coturnix coturnix japonica). Germ cell degenerations were investigated in birds of all age groups, namely pre-pubertal, pubertal, adult, and aged. Apoptosis of germ cells in the quails, as shown by hematoxylin & eosin (H&E), TdT dUTP Nick End Labeling (TUNEL) assay and electron microscopy, was similar to that observed in previous studies of germ cells and somatic cells of mammalian species. The observed morphological features of these apoptotic cells ranged from irregular plasma and nuclear membranes in the early stage of apoptosis to rupture of the nuclear membrane, condensation of nuclear material, as well as fragments of apoptotic bodies, in later stages of apoptosis. In the TUNEL-positive cell counts, there was a significant difference between the mean cell counts for the four age groups (P < 0.05). Post hoc analysis revealed a highly significant difference in the aged group relative to the pubertal and adult age groups, while the cell counts of the pre-pubertal group were significantly higher than those of the pubertal group. However, there was no significant difference between cell counts of the pre-pubertal and the adult, and between the pre-pubertal and the aged groups.

High-grade urothelial carcinoma with hypochromatic chromatin in urine cytology

Some high-grade urothelial carcinomas (UCs) in urine cytology have hypochromatic chromatin, but the incidence and criteria for diagnosis are not well described. Urine cytology cases with biopsy follow up were reviewed. Cytospin preparations from 331 cases with biopsy follow up (230 benign/low-grade UC, 101 malignant) were reviewed. There were no false-positive cases. Cases with malignant cells with hypochromatic chromatin were identified in a total of 17 cases (16.8% of all malignancies). These comprised 2 carcinoma in situ, 11 high-grade papillary UC, 3 invasive UC, and 1 adenocarcinoma. Sixteen of 93 high-grade UCs (17.2%) had cells with hypochromatic chromatin. These cells were the only type of malignant cell in 4 of 101 cases (4.0%). All cases had cells with high nuclear-to-cytoplasmic ratios and markedly indented and irregular nuclear membranes that could be identified on both cytology and subsequent histology. Malignant urothelial cells in urine cytology with hypochromatic chromatin can be present in 17% of cases and can be diagnosed as "positive for malignancy" based on their high nuclear-to-cytoplasmic ratio, and markedly indented and irregular nuclear membranes.

Gastric-type endocervical adenocarcinoma and cervical cytology: Experience at a general hospital and review of the literature.

Gastric-type endocervical adenocarcinoma (GAS) is an uncommon type of endocervical adenocarcinoma that is not associated with human papillomavirus infection. This diagnosis is relatively rare and may portend a worse prognosis than usual-type endocervical adenocarcinoma. Subtle morphological features make it an under-recognised diagnostic challenge. Study of the cytological features of individual cases is valuable in order to increase awareness of this entity. The pathology database of our institution was searched for the diagnosis of GAS and all cytological and surgical specimens for each patient were reviewed. The original cytological interpretation was compared to a retrospective central review interpretation. Clinical history and follow-up results were obtained from the electronic medical record. Four cases of GAS were identified. The findings on initial cervical cytology varied, with GAS found in both patients with negative cervical cytology and those with atypical glandular cells. Cytological findings included endocervical cells arranged in three-dimensional clusters and honeycomb sheets with abundant vacuolar cytoplasm, and in two patients, moderate nuclear atypia with irregular nuclear membranes, coarse chromatin, hyperchromatic nuclei, and prominent nucleoli. In one patient, GAS was incidentally discovered via thorough sampling of a cystic lesion in the superior portion of the endocervical canal. GAS is an aggressive human papillomavirus-independent type of endocervical adenocarcinoma with subtle morphological features and, as our study shows, varying clinical presentation. Given the aggressive nature of GAS and the difficulties in initial diagnosis, increased awareness of this entity among pathologists is crucial.

Fine-needle aspiration cytomorphology of papillary thyroid carcinoma with NTRK gene rearrangement from a case series with predominantly indeterminate cytology.

Neurotrophic tyrosine kinase receptor (NTRK) rearrangement has been reported in a subset of papillary thyroid carcinoma (PTC) cases. Little is known about the cytomorphologic features of NTRK-rearranged PTC. We report an institutional series of 13 fine-needle aspiration (FNA) specimens of NTRK-rearranged PTC with a predominantly indeterminate cytology diagnosis. NTRK3 or NTRK1 rearrangements were detected on FNA or surgical specimens by next-generation sequencing. The 13 patients had a median age of 18 years; 10 patients were female and 3 patients were male. In 10 (77%) cases, cytology was indeterminate, and histopathologic follow-up was predominantly the follicular variant of PTC (n=8 [62%]), mostly infiltrative subtype. Of 12 FNA specimens available for review, a predominant loosely cohesive group pattern was the most commonly encountered architectural pattern (n=5 [41%]), followed by single cell (n=3 [25%]), thick cord (n=2 [17%]), and microfollicular pattern (n=2 [17%]). Background lymphocytic thyroiditis was observed in 9 cases. At the cellular level, the cytoplasm was moderate and granular, occasionally vacuolated. Classic PTC nuclear features (eg, nuclear enlargement, elongation, grooves, and nuclear membrane irregularity) were present but were often focal and subtle. Chromatin was often granular. Intranuclear pseudoinclusions were absent or rare. Our study demonstrates that most cases of NTRK rearrangement lack classic PTC cytomorphologic characteristics. Loosely cohesive groups and single cells with granular, sometimes vacuolated cytoplasm and subtle nuclear features are often seen on FNA specimens. Recognizing these characteristics may be helpful to preoperatively prompt molecular testing, including NTRK rearrangement analysis.

Cytologic studies of in vivo fallopian tube specimens in patients undergoing salpingo-oophorectomy.

Objectives:Recent research shows that most high grade ovarian cancer (OC) originates from the fallopian tube (FT). Cytologic evaluation of FT cells may enable early detection of OC.Material and Methods:This was a prospective study with patients enrolled from 3 centers (October 2016– August 2017). Forty-two women undergoing salpingo-oophorectomy for a pelvic mass suspicious for malignancy or undergoing risk-reducing surgery for BRCA mutations were included in the study. At the time of scheduled surgery, a novel catheter was used to collect FT cells through hysteroscopy. A pathologist blinded to surgical or pathologic findings evaluated FT cytology, and results were compared to pathology.Results:Of the 61 samples collected, 72% (44/61) met the adequacy criteria (≥5 clusters of cells with 20 cells in each cluster). Cytology classification criteria were established and applied to adequate samples. Forty-four samples were benign with mixed population of cells with round, oval, and spindled nuclei; 2-dimensional clusters; columnar cell configuration; flat sheets; cilia presence; no/mild nuclear pleomorphism; no nuclear membrane irregularities; and no nucleoli. Five samples had benign features with reactive nuclear and cytoplasmic changes and/or background inflammation, which were categorized as “reactive atypia.” Two malignant samples had features of 3-dimensional (3D) clusters, loss of mixed population of cells; increased nuclear/cytoplasmic ratio; nuclear membrane irregularity and nucleoli presence. Three samples with some but not all of malignant features were categorized as “neoplastic” (anisonucleosis; small nucleoli and features suggestive of 3D clusters). Malignant/ neoplastic samples were labeled as “Positive” (n = 5) while benign/reactive samples were labeled as “Negative” (n = 39). A high concordance rate (95%, 42/44) was observed between cytology results and histology.Conclusions:We characterized cytologic features for pathologically distinct FT samples collected in vivo using a novel catheter and demonstrated its value in detecting OC.

Cyto-histo correlations of plasmacytoid and micropapillary variants of high-grade urothelial carcinoma: do they fit well in The Paris System for reporting urinary cytology?

Plasmacytoid and micropapillary variants of high-grade urothelial carcinoma (HGUC) exhibit unique histologic morphology and very aggressive clinical behavior. However, the morphology of these 2 variants in urinary cytology is not well studied and evaluated using The Paris System for reporting urinary cytology. A database search was performed in all patients with the diagnosis of plasmacytoid or micropapillary HGUC. A total of 5 patients with positive urinary cytology cases were identified. The cytomorphology of every urinary cytology case was correlated with the histologic features in the surgical specimens from the same patient. One urine and 4 bladder washings were evaluated. Cytologically, plasmacytoid HGUCs are characterized by single, large tumor cells with hyperchromasia, irregular nuclear membranes, and vacuolated cytoplasm. The nuclear-to-cytoplasmic (N:C) ratio was less than 0.5 in many of the malignant cells due to the abundant cytoplasm. The cytology features of micropapillary HGUC include the presence of micropapillae of tumor cells with no fibrovascular core. Individual high-grade urothelial cells were also identified in all 4 cases, but 1 (25%) of these had only rare cells meeting The Paris System criteria for HGUC due to abundant cytoplasm and lack of hyperchromasia in most malignant cells. Plasmacytoid and micropapillary variants of HGUC have unique cytomorphologic features in urinary cytology specimens, which are reflective of the corresponding histological findings. These 2 clinically aggressive variants of HGUC may not be as readily interpreted as malignant using The Paris System for reporting urinary cytology, creating potential diagnostic pitfalls.

Renal medullary carcinoma involving serous cavity fluids: a cytomorphologic study of 12 cases

Renal medullary carcinoma (RMC) is a highly lethal adenocarcinoma with a propensity for widespread metastatic disease in young patients. It is strongly associated with sickle cell trait and shows the loss of SMARCB1 (also known as INI1 or BAF47) protein expression. In the present study, we reviewed a series of 12 patients for whom the cytology specimens played a significant role in patient treatment. We performed a retrospective case review of patients with a history of RMC from 3 large tertiary care pathology practices. A total of 12 patients were identified with histologically confirmed RMC who had had pleural, pericardial, or urine specimens involved by their disease or had undergone initial kidney fine needle aspiration. Patient age ranged from 13 to 37 years (median, 21.5 years). All 12 patients were black or of African descent, and 10 had a confirmed history of sickle cell trait. Of the 12 patients, 11 (92%) had fluid specimens involved by metastatic tumor at some point in their clinical course, and 4 (33%) had initially presented with pericardial and/or pleural effusions or urine specimens that were positive for malignancy. Cytologic examination predominantly showed fragments of 3-dimensional "tumor balls" with smooth borders, fine pale cytoplasm with vacuolization, and highly pleomorphic nuclei with irregular nuclear membranes and coarse to vesicular chromatin and single prominent nucleoli. The cytomorphology of RMC involving serous fluids is nonspecific and in keeping with metastatic high-grade adenocarcinoma. In a young patient presenting with no history of malignancy and a pleural or pericardial effusion, triaging the material for ancillary studies and a nuanced assessment of patient history and radiologic findings will be critical.

The Paris System “atypical urothelial cells” category: can the current criteria be improved?

The Paris System (TPS) for reporting urine cytology was developed for standardization of diagnosis focusing on the detection of high-grade urothelial carcinoma (HGUC). Probably the most challenging task for TPS is to provide criteria for the atypical urothelial cell (AUC) category. The TPS criteria for AUC include increased nuclear/cytoplasmic (N/C) ratio (>0.5) and 1 of the 3 minor criteria including nuclear hyperchromasia (NH), coarse chromatin (CC) and irregular nuclear membrane (INM). We evaluated TPS-AUC diagnostic value and investigated whether other morphologic parameters can improve its criteria. Urine samples with diagnoses of AUC collected during a 6-month period were re-reviewed. Data captured included N/C ratio >0.5, NH, CC, INM, and 2 additional criteria including enlarged nuclear size (ENS) and the presence of nucleolus (N). ENS was considered when the nucleus was 2 times larger than the urothelial cell or 3 times larger than lymphocyte. By applying the TPS-AUC criteria, the rate of atypia diagnosis reduced in comparison to Pre-TPS (9% versus 13%, P = 0.02). Among the AUC minor criteria, NH was the best criterion with the highest interobserver agreement (IOA) and correlation with HGUC (k = 0.342, r = 0.61, P < 0.001) and strong PPV (93.6%). ENS had the highest PPV (95.8%) and, after NH, had the highest IOA and correlation with HGUC (k = 0.29, r = 0.52, P < 0.001). TPS improves the diagnostic value of urine cytology, particularly in cases with atypia. ENS is a strong criterion for increasing the diagnostic value of AUC and potentially can improve TPS performance as a minor criterion.

Cytomorphologic findings of low-grade fibromyxoid sarcoma

Low-grade fibromyxoid sarcoma (LGFMS) is a rare fibroblastic tumor characterized by a prolonged clinical course and malignant biological behavior. Given its deceptively bland cytomorphology, a diagnosis can be quite challenging notably on fine-needle aspiration (FNA). In an attempt to shed light on some of the distinctive cytomorphologic characteristics, this study was conducted to review all cases of LGFMS in our database, correlating available clinical data, immunohistochemical findings, and molecular analysis. This series included 20 FNAs from 18 patients with a histologically confirmed LGFMS diagnosis from 3 large academic institutions. Detailed cytomorphologic analysis for each case was documented in conjunction with corresponding clinical characteristics and provided ancillary testing. Out of 14 adequate FNA samples, 9 (64.2%) demonstrated a mixture of fibrous and myxoid pattern; the majority of cases were composed of deceptively bland tumor cells with rare nuclear pleomorphism and nuclear membrane irregularities. A MUC4 immunostain was performed on 5 specimens; all tested positive (100%). FUS rearrangement was detected in 4 out of 5 cases (80%). Follow-up information revealed 5-year recurrence in 1 case and metastatic disease in 2 cases, to the lung/pleura (8 years) and fourth rib (1 year), respectively. The presence of bland spindle cells and associated with myxoid matrix material, in the appropriate clinical setting, can suggest LGFMS and direct additional confirmatory testing. A definitive diagnosis of LGFMS on FNA requires adequate sampling, familiarity with key cytomorphologic features, acquisition of diagnostic material for a cell block preparation and ancillary testing, and clinicoradiologic correlation.

The Possible Protective Effect of Apple Cider Vinegar on Mercuric Chloride-Induced Changes on Rat Hepatocytes: Immunohistochemical and Ultrastructure Study.

Introduction:Mercuric chloride is a toxic form of mercury capable for induction of oxidative liver damage. Apple cider vinegar (ACV) is a powerful antioxidant agent being used in salad dressings. Our study aimed to assess the beneficial effect of ACV against mercuric chloride-induced hepatic cell damage through an ultrastructural and immunohistochemical study.Materials and Methods:Forty Wistar rats used divided into four groups (10 rats each); control; Group A (ACV): Rats received 2 ml/kg ACV; Group B (HgCl2): Rats received 1 mg/kg HgCl2, and Group C (ACV + HgCl2): Rats received 2 ml/kg ACV 30 min before giving 1 mg/kg HgCl2. Doses given orally by intragastric tube for 30 days.Results:Toluidine blue results of HgCl2 group revealed hepatocytes with irregular boundaries, eccentric deeply stained nuclei, and large cytoplasmic vacuoles. Electron microscopic results showed dilated rough endoplasmic reticulum, and smooth endoplasmic reticulum, cytoplasmic vacuolations, areas of cytoplasmic rarefaction, degenerated mitochondria, nuclear membrane irregularities, and dilated bile canaliculi with lost microvilli. Moreover, there was significantly increased expression of HSP60 and number of hepatocytes with proliferating cell nuclear antigen-positive nuclei. ACV + HgCl2 group showed improvement of the previous changes.Conclusion:ACV could be promising for attenuation of liver cell damages induced by several toxins through its powerful antioxidant properties.

Atypical Mesonephric Hyperplasia of the Uterus Harbors Pathogenic Mutation of Kirsten Rat Sarcoma 2 Viral Oncogene Homolog (KRAS) and Gain of Chromosome 1q.

Mesonephric carcinoma (MNC) is a rare but notable entity of the female genital tract. While many researchers have acknowledged and studied MNC, much remains unknown on the characteristics of mesonephric remnant (MNR) or hyperplasia (MNH). There has not been any study examining the molecular features of MNR and MNH so far. The aim of this study was to investigate the clinicopathological and molecular characteristics of ten uterine mesonephric lesions, including two MNRs without atypia, four MNHs without atypia, and three MNHs with atypia. We reviewed the electronic medical records and all available slides of ten cases from multiple institutions. Targeted sequencing and array comparative genomic hybridization were performed. Three atypical MNHs displayed nuclear enlargement, mild-to-moderate nuclear pleomorphism, and nuclear membrane irregularity, and harbored pathogenic Kirsten rat sarcoma 2 viral oncogene homolograt sarcoma 2 viral oncogene homolog (KRAS) mutation. Two of those that co-existed with MNC harbored the same sequence alterations as each of their adjacent MNC. One of the three atypical MNHs harbored chromosome 1q gain. Atypical MNH is a potential premalignant lesion in which KRAS mutation and chromosome 1q gain play an important role in the early stage of mesonephric carcinogenesis.

Malignant Melanoma: Skin Cancer-Diagnosis, Prevention, and Treatment.

Melanoma is a skin cancer caused by a malignancy of melanocytes. Incidence of melanoma is rapidly increasing worldwide, which results in public health problems. Primary extracutaneous melanomas can be ocular, gastrointestinal, mucosal, leptomeningeal, genitourinary, and lymphatic. The relationship between exposure to ultraviolet (UV) light and development of melanoma is intensively acute and complex, and intermittent sun exposure greatly increases the risk of melanoma. It is the fifth most common type of cancer in men number and the sixth most common in women. The diagnosis of melanoma is made through clinical assessment of the pigmented by health care professionals. Architectural features of malignant melanoma including asymmetry, confluence of growth, marked cellularity, and poor circumscription. The cytological feature of malignant melanoma include an irregular and thick nuclear membrane and prominent nucleoli. The preventive measures include reducing exposure to UV light and the sun. The early detection of skin cancer greatly reduces both short- and long-term morbidity and mortality. The treatment and follow-up with the doctor for melanoma patients may differ because of the stage of the tumor and the primary lesion. The typical therapy for malignant melanoma is surgical excision, immunotherapy such as interleukin 2 (IL-2), gene therapy, and biochemotherapy.

Anti-diabetic effect of moringa oleifera extract on parotid gland of albino rats

Aim: to investigate the antidiabetic effect of moringa oleifera on parotid gland.Materials and methods: 45 adult male albino rats weighing from 150-200 gm were used in this study. The rats were divided into three equal groups (15 rats each) as follow: Group I: The animals served as control group. Group II: The animals subjected to diabetic induction and did not receive any treatment. Group III: The animals subjected to diabetic induction, soon after blood analysis, animals of this group were given 200 mg/kg body wt. /day of moringa oleifera extract by gastric tube for 3 weeks. At the end of the moringa treatment, the rats were euthanized with over dose halothane and parotid glands were rapidly excised, then processed for: histological examination using heamatoxylin and eosin stain, transmission electron microscope and comet assay.Results: the examination with light microscope showed group I with normal architecture of the glandular tissue, the parotid gland sections showing densely packed acinar cells with large basally located nuclei while in group II parotid gland sections showed loss of acinar outlines with intracellular vacuolization and pyknotic nuclei. In-group III the acinar cells begin to regain their symmetrical shape and size. Ultrastructurely the serous cell of group I showed euchromatic nuclei, parallel cisternae rough endoplasmic reticulum, homogenous secretory granules and intact desmosomal attachments between cells. The serous cell of group II showing irregular nuclear membrane with predominant heterochromatin, dilated and irregular arrangements of rough endoplasmic reticulum and multiple vacuoles. In-group III the serous acini appeared with less number of vacuoles and numerous parallel cisternae of rough endoplasmic reticulum. The Comet assay results: In the control parotid glands, the majority of the cells appeared as homologous discs with a very low tail moment, very low percentage of tail length and tail DNA %. In group II tail formation was different from the normal gland cells in the number of tailed cells and the tail length. In group III the tail moment was found to be significantly decreased than that found in the group II.Conclusion: These results help to increase information about the usefulness of M. oleifera and its safety.

Células del cuello uterino con atipias que no descartan una lesión de alto grado (ASC-H) con premalignidad

Introducción: la presencia de células escamosas con atipias que no descartan una lesión intraepitelial escamosa de alto grado (ASC-H) es significativa, pues cerca de 50% podrían corresponder a una lesión premaligna del cérvix uterino. Objetivo: describir las alteraciones citomorfológicas más frecuentes en los extendidos citológicos categorizados como células escamosas con atipias que no descartan una lesión intraepitelial escamosa de alto grado (ASC-H), con existencia de lesión clínicamente significativa en el resultado histopatológico. Metodología: estudio retrospectivo en el laboratorio de citología de la Facultad de Farmacia y Bioanálisis, Universidad de Los Andes y Clínica de Prevención del Cáncer de la Sociedad Anticancerosa, Mérida-venezuela, de los casos analizados entre enero 2010 y diciembre 2016 con resultados citológicos cervicales ASC-H. Resultados: 35,8% (19/53) de los casos presentaron un resultado histopatológico anormal: 22,6% solo infección por HPV y 13,2% una lesión premaligna (CIN) combinada con infección por HPV. El 73,7% con CIN y/o HPV presentó células metaplásicas inmaduras atípicas con hipercromasia (78,6%), anisocariosis (100%), cromatina y membrana irregular (92,9%), sobre fondo de frotis no inflamatorio. Conclusiones: las alteraciones citomorfológicas más frecuentes en los extendidos citológicos de cuello uterino categorizadas como ASC-H y significativamente asociadas con lesión en el resultado histopatológico fueron: anisocariosis, hipercromasia, cromatina y membrana nuclear irregular, sobre un fondo de frotis limpio. Las mismas atipias fueron comunes en los grupos con CIN 1, 2 o 3 y/o HPV, con diferencias estadísticas significativas (p&lt;0,05).

1416 Rare Presentation of Large Pancreatic Mass With Chylous Ascites

INTRODUCTION: Primary pancreatic lymphomas (PPL) are very rare and mimic pancreatic head cancer. We present a case of a man who presented with a pancreatic mass and chylous ascites, and was found to have PPL. CASE DESCRIPTION/METHODS: A 69-year-old man presented with 2 months of anorexia, abdominal pain and distension. He denied fever, chills or weight loss. Abdomen was distended, soft, non-tender with shifting dullness and fluid thrill. Laboratory tests were noncontributory except for mildly elevated LDH 254 U/L. Abdominal computed tomography (CT) showed a 20 × 10 × 17 cm soft tissue mass impinging the distal duodenum, replacing the proximal pancreatic parenchyma, encasing the celiac and superior mesenteric arteries; ascites, lymphadenopathy and multiple omental nodules were seen. No cirrhosis or hepatomegaly noted. 2.5 L of grossly chylous fluid was drained with lymphocytic predominance, high triglycerides 980 mg/dL and negative cytology. Endoscopic ultrasound (EUS) showed an irregular hypoechoic mass. Fine needle aspiration (FNA) showed lymphoid cells with irregular nuclear membrane contours strongly positive for CD20, consistent with B cell lymphoma. PET-CT scan confirmed a metabolically active pancreatic mass with inguinal, aortocaval, juxtadiaphrgamatic and inframammary lymphadenopathy. Diagnostic laparoscopic biopsy confirmed diffuse B-cell lymphoma of germinal center origin positive for CD10, BCL6, BCL2 and CD45. Patient received 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) which he tolerated well. Follow-up PET CT scan showed reduction in size of pancreatic mass and lymph nodes without areas of new/worsening lymphoma. DISCUSSION: PPLs comprise 0.5% of all pancreatic masses. Diagnostic criteria include dominant pancreatic mass, without superficial or mediastinal lymphadenopathy, absent hepatosplenic involvement and a normal blood leukocyte count. Clinical presentation is non-specific without classic symptoms of nodal lymphoma. Abdominal pain is the most common symptom (83%), followed by abdominal mass and weight loss. High tumor burden, β2-microglobulin levels &gt;2 mg/l and high LDH levels are poor prognostic markers. Definitive diagnosis requires histologic confirmation, EUS-guided sampling is highly accurate. Treatment options include surgery, chemotherapy, radiation, alone or in combination. Cure rates upto 30% have been reported. Long term remission can be obtained with CHOP chemotherapy alone in majority of patients. Addition of rituximab results in overall improvement in patient survival.

Diffuse Large B-Cell Lymphoma of the Cervix Diagnosed on Cervical Screening Cytology

Abstract Case Presentation Primary lymphoma of the cervix is an uncommon entity and far more rarely diagnosed on routine screening cervical cytology. We present a case of a 38-year-old female with a 1-year history of heavy cyclical menstrual bleeding and interval spotting. She had no other significant past medical or obstetric history. On cervical exam, obscuring blood was noted without distinct abnormalities of the visualized cervix. Pathologic Findings Cervical cytology by ThinPrep (Hologic, Marlborough, MA) liquid-based cytology preparation demonstrated atypical squamous cells of undetermined significance as well as an abundant population of atypical lymphoid-appearing cells. Morphology of this second population was characterized by large cells (2-3 times the size of background inflammatory cells) with high nuclear-to-cytoplasm ratio, vesicular chromatin, occasional nucleoli, marked nuclear membrane irregularities, and scant cytoplasm. A cell block of the specimen was performed and demonstrated a mature but cytologically large and atypical lymphoid population. Immunohistochemistry on the cell block specimen was consistent with a B-cell immunophenotype with strong CD45 and CD20 immunolabeling. Subsequent radiologic workup showed a diffusely enlarged cervix with increased metabolic uptake, as well as bilateral metabolically active pelvic lymph nodes. Conclusion Cervical and endometrial curettings obtained at an outside facility confirmed the diagnosis of lymphoma that was further categorized as diffuse large B-cell lymphoma, germinal center B-cell type. This case highlights an uncommon diagnosis found on screening cervical cytology. It reinforces awareness of the potential for lymphoid neoplasms on cervical cytology and the differential diagnosis associated with such cases.