13 December 2007 – Case of the Week #104
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This Case is sponsored by Milestone Medical, the technological leader in Microwave Accelerated Tissue Processing. Milestone manufactures instrumentation and accessories that enable Histologists and Pathologists to achieve the highest level of productivity, while maintaining their flexibility and safety.
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We have updated the Stains Chapter with extensive information,
references and images for the various actins, caldesmon and calponin.
We thank Dr. R. F. Chinoy, Tata Memorial Hospital, Parel, Mumbai (India) for contributing this case. To contribute a
Case of the Week, please email info@PathologyOutlines.com
with the clinical history, your diagnosis and microscopic images in JPG, GIF or
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we send out the case. Please only send cases with a definitive diagnosis, and
preferably cases that are out of the ordinary. Case of the Week #104 Clinical
History FNA of a neck nodule from a 22 year
old man. The requisition form indicated that this was a thyroid mass. Cytology images: image
#1; #2;
#3;
#4 Micro images: frozen section;
permanent
sections #1; #2;
#3 What is your diagnosis? Diagnosis: Meningioma Discussion The fine needle aspirate shows
sheets of bland, round to oval cells with a suggestion of whorling. The cells
have abundant cytoplasm, indistinct cell borders and nuclei with finely
granular chromatin and small nucleoli. Intranuclear inclusions are common, and
occasional nuclear grooves are seen. These features are suggestive of
meningioma (Diagn Cytopathol
1999;21:402), although the location is not typical. Subsequently,
it was learned that the actual tumor location was the base of the skull. Nuclear
grooves are also uncommon in meningioma, although they have been described (Acta
Cytol 1991;35:501). The frozen section
and permanent sections show features more typical of meningioma, including
meningothelial cells in syncytial sheets and whorls with psammoma bodies. The most important differential
diagnosis of the fine needle aspirate is papillary thyroid carcinoma, in part because
the requisition indicated (incorrectly) that this was a thyroid mass. In
addition, both tumors have nuclear pseudoinclusions, nuclear grooves and
psammoma bodies. Diagnosis may require frozen section or radiologic
correlation to determine the precise location of the mass (Acta
Cytol 2001;45:1053). Immunostaining for EMA (positive in meningiomas)
or keratin (weak/negative in meningioma) may be helpful. Nat Pernick, M.D., President 30100 Telegraph Road, Suite 404 Telephone: 248/646-0325
PathologyOutlines.com, Inc.
Bingham Farms, Michigan (USA) 48025
Fax: 248/646-1736
Email: NPernick@PathologyOutlines.com
