Acute promyelocytic leukemia‐associated Sweet's syndrome mimicking an axillary abscess: A case report with review of literature

A subcutaneous painful left axillary nodule was clinically diagnosed as abscess. Fine‐needle aspiration biopsy (FNAB) revealed smears full of mature neutrophils. Background was free of fibrinous necrotic material and degenerating and necrotic neutrophils, which is characteristic of abscess. No organisms were detectable on special staining, and culture was sterile. A cytological differential diagnosis of abscess or Sweet's syndrome (SS) was offered, and the latter was confirmed. SS, also known as acute febrile neutrophilic dermatosis, shows diffuse dermal neutrophilic infiltrate without vasculitis on biopsy. Our case is probably the first where SS was diagnosed on FNAB. SS is a differential diagnosis for painful skin nodules. FNAB smears of painful skin nodules that yield abundant neutrophils should be carefully evaluated for necrosis, fibrin and degenerated neutrophils. The absence of these in an appropriate clinical setting points towards a neutrophilic dermatosis like SS. Diagn. Cytopathol. 2015;43:1007–1010. © 2015 Wiley Periodicals, Inc.     

Serous effusions in malignant lymphomas: a review

Serous effusions are a common complication of lymphomas. Although the frequency of pleural effusion is 20-30% in non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), the involvement of peritoneal and pericardial cavities is uncommon. Among lymphoma subtypes, T-cell neoplasms, especially the lymphoblastic lymphomas, more frequently involve the serous fluids. The thoracic duct obstruction and impaired lymphatic drainage appear to be the primary mechanism for pathogenesis of pleural effusion in HD and direct pleural infiltration is the predominant cause in NHL. There is wide variation in rate of positive cytologic findings of NHL in pleural effusion (22.2-94.1%). Cytologic features of specific lymphoma subtypes such as lymphoblastic lymphoma, follicular center cell lymphoma, including Burkitt-type lymphoma, marginal zone lymphoma, MALT lymphoma, and anaplastic large-cell lymphoma, etc., have been described in the literature. The differential diagnostic problems of lymphomas in serous effusions include reactive lymphocytoses, early involvement by lymphomatous process, small round-cell tumors (SRCT), and presence of look-alike of Reed-Sternberg cells. To overcome these difficulties, various ancillary studies, including immunocytochemistry (ICC), morphometry, flow cytometry (FCM), and cytogenetics/molecular genetics (PCR, in-situ hybridization, and Southern blotting), have been performed on effusion specimens. ICC not only distinguishes lymphomas from reactive lymphocytoses and SRCTs, it significantly modifies the morphologic diagnosis to achieve a better classification of lymphomas. Combined morphology and immunophenotyping by FCM, has a sensitivity as well as specificity of 100%. Morphometry also distinguishes reactive lymphocytoses from malignant lymphoma with a high degree of sensitivity (>85%) and specificity (>95%). Limitations of individual ancillary techniques can be overcome by using multiple parameters. Although lymphomas rarely present as serous effusions without the involvement of other thoracic and extrathoracic sites, a small group of lymphomas called primary effusion lymphomas (PEL) exhibit exclusive or dominant involvement of serous cavities, without a detectable solid tumor mass. This body cavity based lymphoma (BCBL) is a distinct clinicopathologic entity and is found predominantly in AIDS patients with preexisting Kaposi sarcoma. In the absence of obstructive or infiltrative tumor mass, its pathogenesis has been attributed to stimulation by vascular endothelial growth factor (VEGF)/vascular permeability factor (VPF), leading to vascular leakage. Cytomorphologically, PEL is usually a large-cell lymphoma, which appears to bridge features of large-cell immunoblastic and anaplastic large-cell lymphoma (ALCL). Most of these cases comprise a unique subgroup of B-cell lymphoma, with features of both high-grade anaplastic and B-immunoblastic lymphoma, but T-cell and/or natural killer cell immunophenotypes are described. Its association with various viral DNAs has been studied in detail by molecular techniques. Pleural effusion due to lymphomas, either primary or otherwise, is considered as one of the factors adversely influencing overall survival. The presence of pleural effusion at the time of presentation is not only associated with extremely poor outcome of lymphomas, it is also a predictor of disease relapse after chemotherapy and decreased survival. When the patients of lymphomatous pleural effusions with and without mediastinal mass present in respiratory distress, thoracocentesis is the initial diagnostic and therapeutic choice in these patients. In such situations, cytology along with ancillary studies not only gives a quick diagnosis of lymphoma, but also offers prognostically significant information such as classification of lymphomas, its grade and immunophenotype, and presence/absence of viral DNAs and tumor lysis syndrome.     

Difficulties in diagnosis of Riedel's thyroiditis on aspiration cytology: A case report and brief review of the literature

Riedel's thyroiditis (RT) is a rare disorder characterized by extensive fibrosis extending to the extrathyroidal tissues. An elderly male presented with diffuse moderate thyromegaly and hoarseness of voice for two years. Radiology showed extrathyroidal extension around trachea with compression and deviation suggestive of malignancy. Thyroid was hard and non tender. Ultrasound guided Fine Needle Aspiration (FNA) from multiple foci on both sides using thinner needle yielded moderately cellularity showing follicular cells, lymphoplasmacytic infiltrate, scant colloid and fibrous tissue fragments. Hurthle cells were absent. Adiagnosis of chronic thyroiditis was given with possibility of RT in view of clinical and radiological findings. A core biopsy showed similar picture as cytology. Guided FNA from multiple foci using thinner needle helped to obtain adequate material allowing a confident diagnosis. This case adds to the meagre literature available on the cytologic diagnosis of RT and highlights the diagnostic challenge due to suspicious radiology findings.     

Morphometry of the midfacial complex in subjects with class III malocclusions: Procrustes,euclidean, and cephalometric analyses

The purpose of this study was to determine whether the morphology of the midface differed in subjects with a retrognathic midfacial appearance (Class III malocclusions) using a combination of morphometric and cephalometric analyses. After obtaining appropriate consent, lateral cephalographs of 133 children of European-American descent, ages 5–11 years, were compared: 73 had Class III malocclusion, 60 had normal (Class I) occlusion. The cephalographs were traced and subdivided into seven age- and sex-matched groups. Average geometries based upon seven nodes (pterygoid point, PTS; rhinion, RO; posterior nasal spine, PNS; midpalatal point, MPP; anterior nasal spine, ANS; subspinale, A; prosthion, Pr), scaled to an equivalent size, were compared using a Procrustes routine. Euclidean distance matrix analysis (EDMA) was employed to localize differences in morphology. Bivariate analyses on unscaled data utilizing nine linear and six angular measurements were also undertaken. Results from Procrustes and EDMA analyses indicated that although the overall midfacial configurations differed statistically (P < 0.05), only about half of the seven age sub-groups maintained significance. Similarly, only four of the nine linear measures (PNS-MPP, MPP-ANS, A-Pr and PTS-RO) and two of the six angular parameters (PTS-RO-ANS and ANS-A-Pr) tested were significantly different (P < 0.05). Therefore, midfacial morphometric variability and morphological diversity may mask statistical differences. It is concluded that the midface may be the defining craniofacial component in the final appearance of Class III malocclusions compared to other craniofacial components, including the cranial base and mandible. Clin. Anat. 11:162–170, 1998. © 1998 Wiley-Liss, Inc.     

Localisation of deformations of the midfacial complex in subjects with class III malocclusions employing thin-plate spline analysis

This study determines deformations of the midface that contribute to a class III appearance, employing thin-plate spline analysis. A total of 135 lateral cephalographs of prepubertal children of European-American descent with either class III malocclusions or a class I molar occlusion were compared. The cephalographs were traced and checked, and 7 homologous landmarks of the midface were identified and digitised. The data sets were scaled to an equivalent size and subjected to Procrustes analysis. These statistical tests indicated significant differences ( P <0.05) between the averaged class I and class III morphologies. Thin-plate spline analysis indicated that both affine and nonaffine transformations contribute towards the total spline for the averaged midfacial configuration. For nonaffine transformations, partial warp 3 had the highest magnitude, indicating the large scale deformations of the midfacial configuration. These deformations affected the palatal landmarks, and were associated with compression of the midfacial complex in the anteroposterior plane predominantly. Partial warp 4 produced some vertical compression of the posterior aspect of the midfacial complex whereas partial warps 1 and 2 indicated localised shape changes of the maxillary alveolus region. Large spatial-scale deformations therefore affect the midfacial complex in an anteroposterior axis, in combination with vertical compression and localised distortions. These deformations may represent a developmental diminution of the palatal complex anteroposteriorly that, allied with vertical shortening of midfacial height posteriorly, results in class III malocclusions with a retrusive midfacial profile.     

Morphologic variations of the dorsal tarsometatarsal ligaments of the foot

This study investigated the anatomical features of the dorsal tarsometatarsal ligaments of the foot for the purpose of analyzing the ligamentous components and classifying their types. Fifty embalmed cadaveric feet from 27 adult cadavers were dissected in this study. The dorsal tarsometatarsal ligaments comprised nine components (first cuneiform‐first metatarsal, dCn1‐M1; first cuneiform‐second metatarsal, dCn1‐M2; second cuneiform‐second metatarsal, dCn2‐M2; third cuneiform‐second metatarsal, dCn3‐M2; third cuneiform‐third metatarsal, dCn3‐M3; third cuneiform‐fourth metatarsal, dCn3‐M4; cuboid‐third metatarsal, dCb‐M3; cuboid‐fourth metatarsal, dCb‐M4; cuboid‐fifth metatarsal, dCb‐M5). The dCn3‐M4 and dCb‐M3 had not been previously reported. The dCn1‐M1, dCn1‐M2, dCn3‐M2, dCn3‐M4, and dCb‐M3 had only one band, the dCn2‐M2 had two bands, and the others had one or two bands. The ligaments originating from Cb attached simultaneously to M3 and M4 (4/50), M4 and M5 (7/50), or M3 and M5 (5/50), which were Y‐shaped (dCb‐M3, 4 and dCb‐M3, 5), or V‐shaped (dCb‐M4, 5). The dorsal tarsometatarsal ligaments were classified into four types according to the presence of each component. In Type I (52%), Type II (36%), Type III (10%), and Type IV (2%), all components were observed except for one, two, three, and four components, respectively. The dimensions of each component were measured, and as a result the dCn1‐M1 was found to be the widest and longest of the dorsal ligaments while the dCn1‐M2 was found to be the thickest. The dorsal tarsometatarsal ligaments comprised nine components and were classified into four types. Clin. Anat. 32:212–217, 2019. © 2018 Wiley Periodicals, Inc.     

Benefits of Tai Chi Quan on neurodegenerative diseases: A systematic review

BackgroundNeurodegenerative diseases have become an important concern with the accelerated aging process. Tai Chi Quan (TCQ) has positive benefits for brain health and chronic diseases. The aim of this study was to summarize the protective effects of TCQ for motor function, cognition, quality of life, and mood in patients with neurodegenerative diseases.MethodsA systematic search was conducted via PubMed database and the Web of Science core collection database until August 20, 2021. The available English systematic reviews, meta-analyses, and clinical trials were included. Two reviewers completed the screening and assessment process independently.ResultsA total of 28 studies on Parkinson's disease, 21 on cognitive impairment, and 9 on multiple sclerosis met the included criteria. The study found that TCQ remarkably improved general motor function and balance, and prevented falls for Parkinson's disease. TCQ significantly improved global cognitive function for cognitive impairment. TCQ was likely safe and beneficial for multiple sclerosis as result of heterogeneous outcomes and small samples.ConclusionTCQ exercise can effectively improve the motor function, global cognitive function, and falls in patients with neurodegenerative diseases. However, the positive effects of TCQ on the quality of life and mood of patients with neurodegenerative diseases need further evidence.     

Correlation between C9ORF72 mutation and neurodegenerative diseases: A comprehensive review of the literature

Chromosome 9 open reading frame 72 (C9ORF72) encodes a 54-kDa protein with unknown function that is expressed at high levels in the central nervous system. The C9ORF72 hexanucleotide amplification is one of the most recently discovered repetitive amplification diseases related to neurodegeneration. Its association with amyotrophic lateral sclerosis/frontotemporal dementia (ALS/FTD) spectrum diseases has been fully established, although a causative role for C9ORF72 in Alzheimer''s disease (AD) and Parkinson''s disease (PD) remains to be established. Therefore, in this article, we will review the evidence for C9ORF72 as a causative factor in neurodegenerative diseases, the underlying mechanisms, and the potential for targeting C9ORF72 as a strategy to alleviate neurodegenerative disease progression.     

Expression of interleukin‐17 in primary Sjögren's syndrome and the correlation with disease severity: A systematic review and meta‐analysis

The aberrant expression of interleukin‐17 (IL‐17) has been reported in primary Sjögren's syndrome (pSS). Abnormalities in IL‐17 can promote the production of pro‐inflammatory cytokines and aggravate autoimmune disorders. The aim of this study was to investigate alterations of IL‐17 in patients with pSS and explore the correlation between IL‐17 and disease severity. Eight databases were searched for original studies reporting the expression of IL‐17 in patients with pSS and controls. Eligible reports were included in the pooled analysis, and subgroup evaluations were performed according to different types of controls and IL‐17 measurement methods. Newcastle‐Ottawa Scale criteria were used to assess the risk of bias of the included studies. In total, 45 articles are included in the meta‐analysis. The expression of IL‐17 is significantly increased in patients with pSS compared to controls. Furthermore, patients with pSS without immunosuppressive treatment show markedly higher IL‐17 levels. In addition, patients with pSS with positive rheumatoid factors tend to express a higher level of IL‐17 than patients with negative rheumatoid factors. Negative correlations between IL‐17 levels and ocular parameters are also found in patients with pSS. The results are similar after adjustment by “trim and fill” methods. In conclusion, the expression of IL‐17 is obviously increased in patients with pSS, especially among those without immunosuppressive treatment. In addition, IL‐17 level correlates with the disease severity of pSS. These findings demonstrate the significance of IL‐17 overexpression in patients with pSS and may provide insights for the development of therapeutic interventions targeting IL‐17 for pSS.     

High-Altitude-Induced alterations in Gut-Immune Axis: A review

High-altitude sojourn above 8000 ft is increasing day by day either for pilgrimage, mountaineering, holidaying or for strategic reasons. In India, soldiers are deployed to these high mountains for their duty or pilgrims visit to the holy places, which are located at very high altitude. A large population also resides permanently in high altitude regions. Every year thousands of pilgrims visit Holy cave of Shri Amarnath ji, which is above 15 000 ft. The poor acclimatization to high altitude may cause alteration in immunity. The low oxygen partial pressure may cause alterations in gut microbiota, which may cause changes in gut immunity. Effect of high altitude on gut-associated mucosal system is new area of research. Many studies have been carried out to understand the physiology and immunology behind the high-altitude-induced gut problems. Few interventions have also been discovered to circumvent the problems caused due to high-altitude conditions. In this review, we have discussed the effects of high-altitude-induced changes in gut immunity particularly peyer's patches, NK cells and inflammatory cytokines, secretary immunoglobulins and gut microbiota. The published articles from PubMed and Google scholar from year 1975 to 2017 on high-altitude hypoxia and gut immunity are cited in this review.     

Fine‐needle aspiration biopsy of alveolar rhabdomyosarcoma of stensen's duct: A case report and review of the literature

The cytologic features of an alveolar rhabdomyosarcoma arising within Stensen's duct of the parotid gland are described. These malignancies and sarcomas in general are not usually included in the differential diagnosis of a parotid lesion as they rarely present as primary parotid malignancies. In addition, these neoplasms are even rarer outside of the pediatric and adolescent populations. Due to the difficulty of this diagnosis, we present this case to increase awareness of the diagnosis in the salivary glands and to highlight the cytomorphologic features that can aid in the correct diagnosis. Diagn. Cytopathol. 2014;42:1069–1074. © 2014 Wiley Periodicals, Inc.     

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.     

Kaposi's sarcoma of the gastrointestinal tract: report of two cases and review of the literature

Involvement of Kaposi's sarcoma in the gastrointestinal tract is common in AIDS patients and can also occur in non-AIDS patients. However, the disease is usually asymptomatic and, due to tumor growth primarily in the submucosa, biopsy diagnosis is possible in less than 25%. In the present study, we describe two cases of Kaposi's sarcoma that were first diagnosed in the gastrointestinal tract of a 74-year-old patient who presented to the clinic with nausea and vomiting. On esophagogastroduodenoscopy, a lesion 0.7 cm in size was found. Histology revealed a Kaposi's sarcoma of the stomach with existing HHV8 infection, and there were negative tests for HIV. The second case is a 39-year-old patient with multiple lesions in the stomach and in the small and large intestine. The histology verified multiple Kaposi's sarcomas that were HHV 8-positive. Afterwards, the diagnosis of an HIV infection was made. Primary diagnosis of Kaposi's sarcoma of the gastrointestinal tract in HIV-negative patients is certainly rare and more frequently made in HIV patients. Nevertheless, Kaposi's sarcoma must always be considered in lesions of the gastrointestinal tract or in gastrointestinal bleeding and should lead to further elucidation of the causes.     

Primary diagnosis and REAL/WHO classification of non-Hodgkin's lymphoma by fine-needle aspiration: cytomorphologic and immunophenotypic approach

The Revised European American lymphoma (REAL) and World Health Organization (WHO) classification of non-Hodgkin's lymphoma (NHL) relies on the constellation of cytologic, phenotypic, genotypic, and clinical characteristics of NHL. For the most part, the classification does not rely on architectural pattern for classification of neoplasms. This classification makes it possible to diagnose and classify lymphomas by fine-needle aspiration (FNA). In this study, we attempted to evaluate the accuracy of FNA in diagnosing and classifying NHL within the context of the REAL/WHO classifications. Cases included only those in which FNA was the primary diagnosis, followed by a surgical biopsy for confirmation. Flow cytometry (FCM) for phenotyping was carried out whenever material was available. Two groups of pathologists were identified. Group A consisted of pathologists with background training in cytopathology and/or hematopathology (three pathologists). Group B consisted of experienced surgical pathologists with no training in cytopathology and/or hematopathology (four pathologists). Seventy-four cases were included in the study. FCM phenotyping was performed in 53 cases (71%). Large cell lymphoma constituted 63% of the cases. The remaining lymphomas included Burkitt's, small lymphocytic, lymphoblastic, follicle center cell, Ki-1, mantle cell, marginal zone, and natural killer cell lymphoma. The diagnosis of lymphoma was rendered for all cases. The correct classification was seen in 63% of the cases. Classification was more accurate in immunophenotyped than in nonimmunophenotyped cases (84% vs 33%; P = 0.00004). Group A pathologists showed higher incidence of proper classification than group B (80% vs 56%; P = 0.046). The diagnosis and classification of NHL can be achieved in a large number of cases on FNA material. This accuracy can be increased if cytomorphologic criteria are established for different entities of NHL aided by FCM for phenotyping.     

Fine-needle aspiration of Riedel's disease: report of a case and review of the literature

The cytomorphological features of a case of Riedel's thyroiditis (Riedel's disease) in a 37-yr-old woman are reviewed. The patient presented with a diffusely enlarged thyroid gland with extension to carotid and jugular vessels bilaterally. A fine-needle aspiration of the right lobe of the thyroid demonstrated moderate cellularity with fragments of fibrous tissue with bland spindle-shaped cells and myofibroblasts. The patient subsequently underwent a bilateral subtotal thyroidectomy with removal of two-thirds of both lobes of the thyroid. A frozen section diagnosis of Riedel's disease was later confirmed on paraffin sections. Here we describe the cytological findings of a case of Riedel's disease and provide some helpful clues in distinguishing it from other forms of thyroiditis such as fibrosing variant of Hashimoto's thyroiditis, subacute thyroiditis, or granulomatous thyroiditis and from malignancy with which it can be confused both clinically and cytologically.     

Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother’s schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother''s prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.     

Thyroid cancer and thyroid autoimmune disease: A review of molecular aspects and clinical outcomes

Thyroid cancer (TC) is the most prevalent malignant neoplasm that affects the endocrine system. Hashimoto's thyroiditis (HT), also known as chronic lymphocytic thyroiditis, is the most common autoimmune thyroid disease (AITD) that, together with Graves' disease (GD), represent the main autoimmune diseases that affect the thyroid gland. Some studies suggest a greater risk of AITD and the development of TC, while others, investigate its relationship with TC progression and patient prognosis. In this review, we have analyzed published data on the molecular aspects related to the association between AITD and TC, addressing their influence on TC progression, diagnosis, and prognosis of the patients. MEDLINE database (PubMed) platform was used as a search engine and the original articles related to the topic were selected using the keywords combination “thyroid cancer and Hashimoto thyroiditis” or “thyroid carcinoma and thyroid autoimmune disease”. After the selection, we categorized the main findings of the papers into four topics: antitumor immunity, tumor progression, diagnosis, and prognosis. Although most of the studies have pointed out the presence of AITD as a factor that increases the risk of TC, few molecular mechanisms to support this conclusion have been described. Additionally, little information is available to explain, pathophysiologically, the effects of autoimmunity in TC diagnosis, progression, and prognosis.     

The orbit: A re‐appraisal of the surgical landmarks of the medial and lateral walls

The anterior ethmoidal foramen (AEF) and posterior ethmoidal foramina (AEF and PEF, respectively) on the medial wall and the cranio‐orbital foramen (COF) on the lateral wall are used as landmarks in orbital surgeries. In surgery these foramina, the neurovascular structures they transmit and other orbital structures in close proximity need to be identified to minimise their risk of damage. Despite the clinical importance, the current understandings lack consistency in the precise location, microanatomy and morphology of the foramina. This study therefore aimed to document and analyze the microanatomy, location, and morphometric relations of the EF and COF to determine a standardized guideline to accessing the foramina. One hundred dry orbits were morphometrically analyzed, and a further six orbits were micro‐dissected to determine the locations of the EF and COF. The orbital size dimensions were measured for each dry orbit and correlated with the morphometric distances. A complete morphometric and quantitative analysis showed the distances of the EF and COF to be variable, with greater variations observed in the incidence of the accessory EF and PEF distances in the medial wall, and in the presence of the COF and the accessory COF in the lateral orbital wall. Significant correlations were observed between the length of the medial orbital wall and some EF distances. This study is the first to suggest a standardized method of locating these foramina in the orbit irrespective of population and sex differences, in order to help improve clinical applications in crucial orbital surgeries. Clin. Anat. 29:998–1010, 2016. © 2016 Wiley Periodicals, Inc.