Mycobacterium tuberculosis diagnosed promptly by bronchial brushing cytology in an immunocompetent patient

Respiratory cytology plays an important role in the diagnosis of lower respiratory tract infection. The timely diagnosis of pulmonary tuberculosis (TB) can be very challenging due to the nonspecific cytomorphologic features and limited number of organisms, especially in the immunocompetent patients. Here, we reported a case of TB diagnosed promptly by bronchial brushing cytology in a 51‐year‐old immunocompetent patient. She presented with a 4 cm fungating lesion involving right lower lobe of the lung and mediastinal lymphadenopathy with an initial concern for malignancy. Bronchial brushing showed scattered acute inflammatory cells in the background of necrosis. A cell block was prepared and acid‐fast bacilli (AFB)‐positive organisms were identified. Subsequent polymerase chain reaction (PCR) performed on the sputum detected Mycobacterium tuberculosis. This case highlights the importance of recognizing the cytomorphology of TB from a bronchial brushing specimen; and also emphasizes the potential utility of the cell block from respiratory cytology in the diagnosis of TB.     

Cutaneous granular cell tumor clinically mimicking ectopic breast diagnosed on fine needle aspiration cytology

Granular cell tumor (GCT) is a rare benign neoplasm of Schwannian origin which accounts of 0.5% of soft tissue tumors. Although the most common site for GCT is tongue, it can occur at any site. GCT presenting as cutaneous nodule is rare, however cases have been reported in literature. We hereby document a case of 30 year female with a hyper‐pigmented cutaneous nodule of anterior chest wall on the milk‐line mimicking as an ectopic breast, diagnosed as GCT on fine needle aspiration cytology. We also add a note on the differential diagnoses of GCT with differentiating cytological features to emphasize on the correct diagnosis of GCT pre‐operatively.     

SLE pericardial effusion clinically mimicking hypothyroidism and tuberculosis diagnosed on cytology with LE cells

The occurrence of lupus erythematosus cells (LE cells) in serous body fluids is extremely uncommon but, when present, is highly specific for systemic lupus erythematosus (SLE). LE cells are commonly reported in pleural and peritoneal effusions but very rarely documented in pericardial effusion. Here, we report a case in which pericardial fluid examination clinched the diagnosis of SLE which was clinically suspected of tuberculosis/hypothyroid effusion by striking presence of LE cells on May‐Grünwald Giemsa‐stained and Papanicolaou stained smears. Subsequent serologic studies revealed high titers of anti‐nuclear antibodies and anti‐ds‐DNA confirming the diagnosis of SLE. This case highlights the importance of careful examination of pericardial fluid or pleural or peritoneal fluid in the diagnosis of unsuspected cases of SLE in an era wherein “LE cell detection” is considered to be of historic interest.     

Role of fine‐needle aspiration cytology and fluid cytology in extra‐pulmonary tuberculosis

Extra‐pulmonary tuberculosis is the presence of disease in an organ without obvious involvement of the lungs (World Health Organization, Tuberculosis Fact sheet, 2006). The present article focuses on the incidence of extra‐pulmonary tuberculosis as an emerging and clinically significant disease to be reckoned with in the present era. It also highlights fine‐needle aspiration cytology (FNAC) as an inexpensive, less invasive procedure for early diagnosis of such tuberculosis and timely initiation of specific therapy. All cases of proved tuberculosis presenting to the M.V.J. Medical College and Research Hospital were recorded over a period of two years (2008–2010); and categorized as pulmonary and extra‐pulmonary cases. A total of 96 cases of tuberculosis were observed; extra‐pulmonary tuberculosis was seen in 64 cases. Of these 56 cases were from lymphnodes and 8 from extra‐nodal sites which included tuberculous dactylitis (two cases), tuberculous mastitis (two cases), tuberculous synovial effusion (one case), pericardial effusion (one case), epididymo‐orchitis (one case), and cold abscess (one case). The cytology patterns observed included granulomatous inflammation and necrosis with or without acid fast bacilli. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Cutaneous metastasis of hepatocellular carcinoma diagnosed by fine needle aspiration cytology and Hep Par 1 immunopositivity

Cutaneous metastasis of hepatocellular carcinoma (HCC) is very rare, accounting for less than 0.8% of all known cutaneous metastases and occurring in 2.7–3.4% of HCCs. With less than 50 such cases reported worldwide, most of which were diagnosed histologically on excised lesions, it can only be expected that diagnosis made on cytological features alone would be challenging. We report a case of cutaneous metastasis of HCC diagnosed based on cytological features and confirmed by Hep Par 1 immunopositivity of the cell block material. An 81‐year‐old man, who was known to have unresectable HCC, presented with a 1‐month history of painless, left nasal alae mass. The mass measured 1.5 cm in diameter, and was multilobulated with a central necrosis. Fine needle aspiration of the mass was done. Smears were cellular, comprising of malignant cells in loose clusters and aggregates as well as singly dispersed. The malignant cells displayed moderate nuclear pleomorphism, occasional prominent nucleoli, and intranuclear pseudoinclusion. Cell block material demonstrated the trabeculae pattern of the malignant cells and Hep Par 1 immunopositivity. The final diagnosis of a metastatic cutaneous HCC was made. In conclusion, cutaneous HCC metastasis is rare and should be considered in the differential diagnosis in patients with a history of HCC presenting with suspicious skin lesion. In the right clinical setting, a confident diagnosis can be made in such cases by using the fine needle aspiration technique aided with immunopositivity for Hep Par 1 antibody of the aspirated material. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.     

Two cases of nocardiosis diagnosed by fine‐needle aspiration cytology: Role of special stains

Nocardiosis, a suppurative disease caused by aerobic actinomycetes, is a common opportunistic infection in immunocompromised patients. Unless, the infection is suspected, the diagnosis of Nocardia is tedious and difficult, as these are thin filamentous bacilli, which stain negatively on routine cytological stains. We present two such cases diagnosed on fine‐needle aspiration cytology and discuss the importance of performing the modified Ziehl–Neelsen stain in such cases. Diagn. Cytopathol. 2011. © 2010 Wiley‐Liss, Inc.     

Respiratory sinus arrhythmia and serotonin transporter promoter gene polymorphisms: Taking a triallelic approach makes a difference

It has been recently reported in Psychophysiology that carriers of the short allele of an insertion/deletion (ins/del) functional polymorphism in the promoter region (5‐HTTLPR) of the serotonin transporter gene may display decreased resting respiratory sinus arrhythmia (RSA). However, this region hosts another functionally connected single‐nucleotide polymorphism (rs25531), which should also be genotyped in order to correctly categorize the low‐ and high‐expressing alleles of 5‐HTTLPR. The present study investigated resting RSA in an ethnically homogenous sample (N = 143) of participants genotyped for both the ins/del and rs25531 polymorphisms in 5‐HTTLPR. In contrast with the biallelic genotypes, based only on the ins/del alleles, the triallelic 5‐HTTLPR genotypes (i.e., including rs25531) showed no association with resting RSA. Taking a triallelic approach to 5‐HTTLPR is thus necessary in order to avoid false positive results.     

Diagnosis of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) by fine needle aspiration cytology

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a rare benign disease of unknown etiology presenting with massive lymphadenopathy. We report four cases of this disease retrieved from the archives of cytopathology laboratory, BPKIHS, Dharan, Nepal, during the period of January 2002 to October 2007. The cytologic morphology revealed lymphocytes, plasma cells, and single to multinucleated histiocytes with well preserved lymphocytes in their cytoplasm (emperipolesis or lymphophagocytosis). It is concluded that FNAC is a useful and reliable tool for the diagnosis of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and biopsy can be avoided in these patients, thereby reducing patient inconvenience and health care cost.     

Leishmania donovani and Pneumocystis jirovecii (carinii) diagnosed on bronchoalveolar lavage cytology in a liver transplant recipient with Cytomegalovirus infection

Liver transplant recipients are prone to several infections, including lung infections, which can lead to substantial morbidity and mortality. Bronchoalveolar lavage (BAL) cytology is a rapid and sensitive diagnostic tool to identify the etiologic agents. We report a rare case of a 24‐year‐old male, post Live donor liver transplantation for autoimmune chronic liver disease, who presented with cough, fever, weight loss, and cavitatory lesion in lung. BAL cytology revealed Leishmania donovani (LD) and Pneumocystis jirovecii/carinii (PCP). Cytomegalovirus deoxyribonucleic acid polymerase chain reaction (CMV DNA PCR) test showed markedly raised levels. Patient was put on treatment for these multiple infections and showed significant improvement. Thus, rapid diagnosis of infections through BAL cytology is crucial in transplant recipients to institute timely therapy and avoid undesirable empirical treatments. Moreover, this case highlights a rare finding of LD bodies along with PCP in BAL cytology.     

Duplex detection of the Mycobacterium tuberculosis complex and medically important non‐tuberculosis mycobacteria by real‐time PCR based on the rnpB gene

A duplex real‐time PCR based on the rnpB gene was developed for Mycobacterium spp. The assay was specific for the Mycobacterium tuberculosis complex (MTB) and also detected all 19 tested species of non‐tuberculous mycobacteria (NTM). The assay was evaluated on 404 clinical samples: 290 respiratory samples and 114 from tissue and other non‐respiratory body sites. M. tuberculosis was detected by culture in 40 samples and in 30 samples by the assay. The MTB assay showed a sensitivity similar to Roche Cobas Amplicor MTB‐PCR (Roche Molecular Systems, Pleasanton, CA, USA). There were only nine samples with non‐tuberculous mycobacteria detected by culture. Six of them were detected by the PCR assay.     

Large cell neuroendocrine carcinoma of the maxillary sinus on fine needle aspiration cytology: Report of a rare case with a focus on pitfalls in diagnosis

Head and neck large cell neuroendocrine carcinoma (LCNEC) is a rare high‐grade malignant tumor with neuroendocrine differentiation. We report a case of LCNEC causing difficulty in cytological diagnosis. A 60‐year‐old man with right‐sided face pain presented with a swelling at the right cheek, and he complained of right nasal obstruction and lacrimation. Preoperative fine‐needle aspiration cytology (FNAC) showed high cellularity, with a moderate number of clusters of tumor cells on an abundant necrotic background. The clusters were arranged in sheet structures with palisading, and were cohesive with overlapping. The tumor cells had comparatively abundant cytoplasm, with conspicuous large, irregular nucleoli with a fine granular chromatin pattern. Mitotic figures were observed easily. On immunocytochemistry using LBC smear, tumor cells were negative for p40. High‐grade carcinoma other than non‐keratinizing squamous cell carcinoma was suggested from these findings on FNAC. The pretreatment histological biopsy sample revealed tumor cells with solid growth pattern, necrotic materials and large polygonal cells with abundant cytoplasm, fine granular chromatin, and conspicuous nucleoli. Head and neck LCNEC with abundant cytoplasm, fine granular chromatin patterns, prominent nucleoli, and necrotic background were very characteristic of LCNEC. If considered carefully, these findings can enable us to exclude the majority of non‐keratinizing squamous cell carcinomas, and FNAC using ancillary technique can be very useful for proper diagnosis.     

Intracytoplasmic and intranuclear Reinke's crystals in a testicular Leydig-cell tumor diagnosed by fine-needle aspiration cytology: a case report with review of the literature

We report on the cytopathologic findings of a Leydig-cell tumor of the testis in a young adult male with no evidence of endocrine dysfunction. The preoperative diagnosis was based on fine-needle aspiration cytology (FNAC) alone, which was subsequently confirmed on histopathology. The present case was of interest on account of the paucity of literature regarding the cytodiagnosis of this lesion. In addition, the finding of intracytoplasmic lipofuscin pigment and several intracytoplasmic as well as intranuclear Reinke's crystals served to clinch the diagnosis on FNA. Therefore, the use of FNAC, especially in the presence of diagnostic Reinke's crystals, may vitiate the need for more invasive biopsy procedures in the preoperative diagnosis of testicular Leydig-cell tumors.     

Enhanced protective efficacy against Mycobacterium tuberculosis afforded by BCG prime‐DNA boost regimen in an early challenge mouse model is associated with increased splenic interleukin‐2‐producing CD4 T‐cell frequency post‐vaccination

The development of improved vaccines and vaccination strategies against Mycobacterium tuberculosis has been hindered by a limited understanding of the immune correlates of anti‐tuberculosis protective immunity. Simple measurement of interferon‐γ frequency or production per se does not provide adequate prediction of immune protection. In this study, we examined the relationship between T‐cell immune responses and protective efficacy conferred by the heterologous vaccination strategy, bacillus Calmette–Guérin (BCG) prime‐Ag85A DNA boost (B/D), in an early challenge mouse model of pulmonary tuberculosis. The results demonstrated that mice vaccinated with the B/D regimen had a significantly reduced bacillary load compared with BCG‐vaccinated mice, and the reduction in colony‐forming units was associated with decreased pathology and lower levels of inflammatory cytokines in the infected lungs. Further analysis of immunogenicity showed that the superior protection afforded by the B/D regimen was associated with significantly increased frequency of splenic interleukin‐2 (IL‐2) ‐producing CD4 T cells and increased IL‐2 production when measured as integrated mean fluorescence intensity post‐vaccination as well. These data suggest that measurement of elevated frequency of IL‐2‐producing CD4 T cells or IL‐2 production in the spleens of vaccinated mice can predict vaccine efficacy, at least in the B/D strategy, and add to the accumulating body of evidence suggesting that BCG prime‐boost strategies may be a useful approach to the control of M. tuberclosis infection.     

Superhydrophobic Porous PLLA Sponges with Hierarchical Micro‐/Nano‐Structures for High‐Efficiency Self‐Cleaning

Porous poly (l ‐lactic acid) (PLLA) sponges have received rapid development in the materials science and energy fields due to their good biocompatibility and degradability. Herein, hierarchical micro‐/nano‐structures of PLLA sponges are successfully prepared by the microphase separation method to investigate the influence of non‐solvents on PLLA microtopography. The interaction ability between PLLA and various alcohol non‐solvents is precisely calculated by using the Flory–Huggins equation. SEM results show that the porosity of PLLA surfaces increases with increasing non‐solvent solubility parameters at a certain range. When the solubility parameters of alcohol non‐solvents are much higher than that of PLLA, PLLA bulks accumulate on the surfaces, mainly caused by its insolubility. DSC curves disclose that the crystallinity has a positive relationship with contents and solubility parameters of alcohol non‐solvents. Furthermore, these porous PLLA surfaces show strong water repellency and self‐cleaning ability so that the contaminant can be quickly cleared away from the PLLA surfaces. This study provides a new insight into understanding the formation process of PLLA porous materials and the wetting variation for high‐efficiency self‐cleaning.     

Sclerosing polycystic adenosis of the parotid gland: Report of one case diagnosed by fine‐needle cytology with in situ malignant transformation

Sclerosing polycystic adenosis (SPA) is a rare pathological condition affecting the salivary glands, first described by Smith etal. in 1996. Even though this lesion is being increasingly diagnosed, less than 50 cases have been published in the world literature to date. In line with numerous other pathological analogies between breast and salivary gland lesions, SPA shares with fibrocystic disease of the breast many histopathological features, i.e., fibrosis, oncocytic (apocrine) changes, hyperplasia of ductal and acinar epithelium, cystic dilation of ducts, and, often, atypical epithelial changes. Most of the described cases have followed a benign clinical course, despite the frequent possibility of atypical hyperplasia in more than 50% of the cases and of the more than occasional in situ malignant transformation. In this article, we introduce a new case occurring in the parotid gland of a 57‐year‐old male showing atypical epithelial hyperplasia and low‐grade in situ mucoepidermoid carcinoma. Fine‐needle cytology (FNC) was performed on the lesion and, when a diagnosis of SPA was prospected, the variegated cytological features of the obtained sample posed several differential diagnostic problems. The spectrum of pathological lesions entering differential diagnosis comprised sebaceous adenoma, Warthin's tumors with presence of sebaceous remnants, and low‐grade mucoepidermoid carcinoma. Histopathological examination disclosed SCA with intraductal neoplastic transformation resembling noninvasive low‐grade mucoepidermoid carcinoma. The cytological diagnosis of SPA should be entertained whenever a polymorphous picture is found on FNC samples comprising oncocytic/apocrine changes, sebaceous cells, cystic background, and epithelial hyperplasia with low‐grade cytological atypias. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Induction of specific cell‐mediated immune responses and protection in BALB/c mice by vaccination with outer membrane vesicles from a Brucella melitensis human isolate

Brucellosis is a worldwide bacterial zoonosis caused by Brucella spp. No approved vaccine is available for human use against the disease. In this study, outer membrane vesicles (OMVs) from a Brucella melitensis biovar 1 human isolate obtained in Iran were used to immunize BALB/c mice (n = 12) by 2 intramuscular injections with a 2‐week interval. Another group of 12 mice was used as non‐vaccinated controls. Two weeks after the last vaccination, six mice of each group were sacrificed, and proliferation and interferon gamma (IFNγ) production responses of their splenocytes were evaluated following in vitro stimulation with killed Brucella cells. The other mice were challenged with the virulent B. melitensis isolate. Two weeks later, mice were killed and spleens were cultured to determine the number of the challenge strain. The results showed proliferative response and IFNγ production of splenocytes from vaccinated mice (stimulation index: 2.18 ± 0.57, and 1519.35 ± 10.70 pg/mL, respectively) were significantly higher than those of control mice (stimulation index: 1.02 ± 0.02, and 210.01 ± 17.58 pg/mL, respectively). Numbers of the challenge strain in spleens of vaccinated mice were also significantly less than those in the controls with 1.6 units of protection. Our study revealed vaccination with OMVs of the B. melitensis isolate could induce specific immune responses and protection against infection in the mouse model suggesting their potential application for active immunization against brucellosis.