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PubMed1996

[Simultaneous pulmonary tuberculosis and bronchial cancer. A diagnostic pitfall].

Simultaneous development of unsuspected primary cancer in close vicinity to an active tuberculous process of the lung can seriously complicate diagnosis. In most reported cases, a long interval had elapsed before carcinoma was suspected. Such a case is described. Initially a 72-year-old man with carvernous tuberculosis was successfully treated with adequate antituberculous drugs. After 18 weeks of treatment, the patient's pulmonary parenchymal status showed no further improvement, and after 25 weeks the lung infiltration was seen to be slowly increasing. Thoracotomy performed after 40 weeks of treatment revealed inoperable squamous cell carcinoma and apparently healed tuberculosis.

Aged↗
PubMed1996

Congenitally absent pulmonary veins--diagnostic pitfalls. Two case reports.

Two patients with partial absence of the right and left pulmonary veins respectively are described. Congenitally absent pulmonary veins are a rare phenomenon and the diagnosis is often missed or delayed. When children present with haemoptysis and/or recurrent respiratory infections with no obvious underlying cause, absence of the pulmonary veins must be part of the differential diagnosis. Special investigations to be done in these patients are chest roentgenograph to compare the lung volumes, radio-isotope scan, echocardiography and cardiac catheterisation. Magnetic resonance imaging may be helpful in defining the cause and site of obstruction of the pulmonary veins. Depending on the cause, surgery might be considered.

Child↗
PubMed1997

Intratumoral necrosis of lung carcinoma: a potential diagnostic pitfall in incremental dynamic computed tomography analysis of solitary pulmonary nodules?

The authors determined the pattern and enhancement range of necrotic lung carcinoma using incremental dynamic computed tomography (CT). Thirty-seven pathologically proven lung cancers (range, 8-57 mm in diameter) were evaluated using incremental dynamic CT. Scans were obtained before and 30 seconds, 2 minutes, and 5 minutes after the onset of contrast material injection. Computed tomography numbers in circular regions of interest (60% of tumor diameter) were calculated, and the difference in CT number between nonenhanced and the scan showing maximum attenuation was determined. In cavitary necrotic carcinomas, regions of interest were established excluding areas of cavitation. Nine (24%) of 37 lung carcinomas had intratumoral necrosis; four (11%) had noncavitary necrosis, and five (14%) had cavitary necrosis. Maximum attenuation of four noncavitary necrotic carcinomas (mean 31 +/- standard deviation 25 HU; range, -3-56 HU) was lower than cavitary necrotic carcinomas (42 +/- 8 HU; range, 35-51 HU; p = 0.36) and non-necrotic carcinomas (48 +/- 17 HU; range, 25-91 HU; p = 0.07). All carcinomas showed maximum attenuation > or = 25 HU except for one noncavitary necrotic carcinoma (maximum attenuation = -3 HU; 36 mm in diameter). Noncavitary necrosis was recognized as low attenuation on noncontrast scan in two of four cases and as an unenhanced area on enhanced scan in four of four cases. Although noncavitary necrotic lung carcinoma may rarely show maximum attenuation < or = 15 HU, necrotic material is recognized as unenhanced area on enhanced scan.

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PubMed1997

Ovarian metastatic melanoma. A diagnostic pitfall in histopathologic examination.

Malignant melanoma metastasis to the ovary is exceptional. This observation relates the case of a 33 year-old woman who presented with a voluminous unilateral, histologically poorly differentiated, ovarian mass, and discusses the differential diagnosis. Immunohistochemical studies demonstrated strong positivity for S-100 protein, HMB-45 and vimentin. We emphasize the unpredictable clinical and biologic behavior of malignant melanomas and the necessity to perform immunohistochemical study by S-100 protein and HMB-45 in a poorly differentiated metastasis to the ovary, histologically compatible with malignant melanoma; even in the absence of intracytoplasmic pigment and clinical antecedent of cutaneous malignant melanoma.

Adult↗
PubMedDate not supplied

Cystic gastric leiomyoma--a diagnostic pitfall.

A case of a 74-year-old woman with a cystic calcified leiomyoma of the stomach is presented. The cyst was initially interpreted and treated as a pancreatic pseudocyst with repeated punctures and cystogastrostomy. Due to failure of elimination of the cyst, and because of infection, the patient underwent surgery. A discussion of the differential diagnoses and treatment is presented.

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PubMed1997

Diagnostic pitfalls of aspiration cytology of salivary duct carcinoma.

BACKGROUND: Salivary duct carcinoma (SDC) is a highly aggressive primary salivary gland neoplasm that resembles intraductal and infiltrating breast carcinoma histologically. The purpose of this study was to review the cytologic features of histologically proven salivary duct carcinomas and to identify the potential pitfalls in cytologic diagnosis. METHODS: Fine-needle aspiration cytology of nine histologically proven salivary duct carcinomas was reviewed. RESULTS: The patients' age ranged from 62 to 89 years (median, 69 years). There were eight males and one female. The cytologic diagnoses of these cases were as follows: pleomorphic adenoma (PA) (three cases), high grade carcinoma, not otherwise specified (three cases), mucoepidermoid carcinoma (MEC) (two cases), and atypical cytology with differential diagnosis including MEC, oncocytoma, and acinic cell carcinoma (one case). The spectrum of cytologic findings included broad flat sheets and three-dimensional clusters. There was mild to severe cellular pleomorphism and nuclear atypia. Papillary clusters and cribriforming occasionally were identified. Bland cytologic features and prominent hyaline stroma, shown to represent the dense fibrosis on histologic sections, were identified in three cases cytologically interpreted as PA. CONCLUSIONS: Fine-needle aspiration of SDC may be difficult to interpret accurately, and bland cytomorphologic features in some cases may lead to a false-negative interpretation; several clinically important pitfalls are demonstrated in our series.

Adenoma↗
PubMed1997

Giant cell epulis with unusual clinical and radiological features--a diagnostic pitfall in FNAC material. Report of a case with differential diagnosis.

Giant cell epulis (peripheral giant cell granuloma) is a tumorlike condition of the gingiva found predominantly in elderly women. A case of peripheral giant cell granuloma of the mandibular gingiva, examined by fine needle aspiration biopsy, is herein reported. A 51-year-old woman presented with a three week history of bleeding from a six cm tumor located in the central part of the mandible. On radiography, an osteolytic lesion was present, suspicious of malignancy. An aspiration biopsy revealed microscopic features suggesting the diagnosis of a giant cell lesion of possibly malignant nature. Surgical resection was performed. Histological examination showed giant cell epulis destroying the mandibular bone. Differential diagnosis of this lesion is widely discussed.

Biopsy, Needle↗
PubMed1994

Elastofibroma dorsi: diagnostic problems and pitfalls.

The diagnostic cytomorphologic findings in a case of elastofibroma dorsi are described in this report. The correct diagnosis was initially overlooked on fine-needle aspiration, and was subsequently made by open biopsy. Review of the FNA material, however, demonstrated scanty but diagnostic material. Cytologic examination revealed a mixture of fibroblasts, adipose tissue, and swollen lightly staining cyanophilic elastic fibers in a background of collagenous matrix. Cross sections of the elastic fibers had the typical serrated and globular appearance. These fibers stained positive with elastin stains. The cytomorphology of elastofibroma dorsi with diagnostic pitfalls and differential diagnostic dilemmas are discussed in this article.

Aged↗
PubMed1989

[Primary hyperparathyroidism. Apropos of 102 recent exploratory cervicotomies: diagnostic and clinical pitfalls].

The authors report on various diagnostic pitfalls on 102 patients having undergone exploratory cervicotomy for primary hyperparathyroidism. A false positive diagnostic error was made on 2% of the cases, bringing to 100 the number of patients with a confirmed diagnosis of primary hyperparathyroidism. False negative diagnosis was made on 4% of the patients: two late diagnoses leading to an acute toxic state and death postoperatively in both cases; two pure psychiatric variants leading to repetitive hospitalizations in psychiatry. Error in diagnosis because of a masking effect was made in 4% of the cases:--one association with a clear cell nephro--epithelioma--one association with a multiple myeloma--two associations with a benign monoclonal gammapathy. The absence of hypercalcemia, a diagnostic pitfall in the modern form of this disease was found in 7% of the cases. PTH hypersecretion which is virtually a constant finding in the normocalcemic form of the disease obviates in most cases the need of a bone biopsy and quantitative histomorphometric analysis. The association with another endocrinopathy was found in 12% of the cases (2 MEN I, 1 MEN II, 9 hyperthyroidism). Because of its high frequency in the aged (22% greater than 75 years) the diagnosis of this disease is difficult for its signs are mimicked as well by the aging process. The preoperative topographic diagnostic error is avoided since there doesn't seem to be any test which would preclude the normal surgical procedure of carefully exploring all 4 topographic sites of the parathyroid. Surgical errors can be numerous but minimized with the increasing experience of the operator. Histological errors are seen mainly in the normocalcemic variety where only electron microscopy can detect the typical signs of cellular hyperactivity.

Aged↗
PubMed1996

Diagnosis of osteoarthritis. Guidelines and current pitfalls.

Diagnostic and classification guidelines for osteoarthritis based on clinical and radiographic signs for the most frequently involved joints (knee, hip and hand) have been developed by the American College of Rheumatology. Excellent, new 'high tech' biochemical and imaging methods and guidelines for clinical evaluation of the condition and its therapy have recently been developed and validated. Accordingly, we have consistent and reliable methods for assessing the established condition, but they provide little help in making an early and correct diagnosis for the different forms of osteoarthritis. Both the diagnostic process and the differential diagnosis consist of careful history taking and detailed analysis of the complaints (especially pain), with proper physical examination including a search for the source of pain and tenderness. Not all deformities and pain in and around the joints are signs and symptoms of osteoarthritis, even if the patient is of 'osteoarthritis age' and the joint shows 'osteoarthritis signs' on the x-ray. On the other hand, even if the underlying disease is osteoarthritis, the symptoms and signs may be due to disorders secondary to the basic disease (e.g. enthesopathy or tendinopathy) and the patient's complaints can be helped more easily by physiotherapy and local injections. The course of the disease and close follow-up yield diagnostic clues in cases where the cross-sectional diagnostic measures fail to provide them. Analysis of serum, joint fluid and x-ray films can be of diagnostic value, and other imaging methods (ultrasound, radioisotope scanning, computerised tomography, magnetic resonance imaging, arthroscopy) are also useful tools. Differential diagnosis is not only of theoretical value; misdiagnosis of osteoarthritis leads to either omitted or unnecessary treatment, and causes psychological stress to the patient.

Diagnosis, Differential↗
PubMed2000

Principles and pitfalls of diagnostic test development: implications for spectroscopic tissue diagnosis.

Diagnostic spectroscopy has the potential to supplant the time-honored "gold standard" of light microscopy and herald an era of in vivo tissue diagnosis. However, the lessons in disease diagnosis learned by pathologists over the years should not be forgotten. This discussion will focus on the basis principles and pitfalls of diagnostic test development, and how they apply to optical spectroscopy tissue diagnosis.

Diagnosis, Differential↗
PubMed1997

Retrieved endogenous biotin: a novel marker and a potential pitfall in diagnostic immunohistochemistry.

AIM: Antigen retrieval (AR) procedures are based on the effect of heating (by either microwave or pressure cooking treatments) on routinely fixed and paraffin embedded tissues. We observed that AR procedures restore the reactivity of endogenous biotin (EB) and report on the distribution of EB following AR in a series of routinely fixed and embedded tissues. METHODS AND RESULTS: Following pressure cooking or microwave treatments, a simple streptavidin-peroxidase staining revealed retrieved endogenous biotin (REB) in normal tissues (such as liver, kidney and adrenal cortex), in oxyphylic cells and in some tumours, especially in carcinomas of the kidney and of the adrenal cortex. In formalin-fixed (but not in alcohol-fixed) tissue sections, the heating procedures caused an intense and finely granular cytoplasmic reaction, following a routine streptavidin-conjugated peroxidase treatment. The staining was prevented by blocking of EB by a sequential avidin-biotin treatment. CONCLUSIONS: Retrieval of EB reactivity can cause pitfalls in diagnostic immunohistochemistry but, alternatively, it might also constitute a useful and novel diagnostic marker.

Antigens↗
PubMed1997

Thymoma mimicking thyroid papillary carcinoma: another pitfall in fine-needle aspiration.

Thymomas are composed of a mixture of epithelial and lymphoid cells. When the lymphoid cells predominate, the possibility of malignant lymphoma must be considered. Recently, a thymoma mimicking lymphoblastic lymphoma was reported in this journal as a diagnostic pitfall in a mediastinal aspiration. We encountered another diagnostic pitfall at the other end of the spectrum: a thymoma with a dominant epithelial component in which a papillary carcinoma of thyroid had to be considered in the differential diagnosis.

Aged↗