Fallopian tube prolapse through the vaginal vault after hysterectomy is a rare complication. The clinical diagnosis is difficult and the patient may undergo unnecessary treatment. A cytological diagnosis of tubal prolapse is rare. There are very few descriptions of the cytological appearances of prolapsed fallopian tube and to our knowledge, they have not been described in liquid based cytology preparations. The presence of classic columnar cells with cilia and sheets of cells with small granular uniform nuclei in an orderly arrangement are the diagnostic appearances of cells originating from the fallopian tube. We describe a case in which the cells had undergone squamous metaplasia with nuclear enlargement and increased nuclear to cytoplasmic ratios corresponding to reactive atypia but with fine and evenly distributed chromatin and smooth nuclear contours, which indicated their benign nature. In addition, in this case intracytoplasmic polymorphs and associated extracellular infiltrates of inflammatory cells are noted. The description of this case may help others to consider a cytological diagnosis of prolapsed fallopian tube, thus preventing repeated cauterisations of vault granulation tissue on one hand, and possibly excessive surgical treatment of a mistaken malignant lesion on the other.

Aberrant adrenal tissue near the adrenal gland is common, but the finding of ectopic adrenal tissue in structures around the spermatic cord and testis is rare. We describe a case of concomitant seminoma and ectopic adrenal tissue of the spermatic cord occurring in an adult patient who had undergone orchidopexy as a child. IntroductionAberrant adrenal tissue near the adrenal gland is common, but the finding of ectopic adrenal tissue in structures around the spermatic cord and testis remains rare. 1 In 1740, Morgagni first described ectopic adrenal tissue in the vicinity of the adrenal gland, 2 and in 1885 Dagonest noted the presence of adrenocortical tissue in the spermatic cord of an infant.3 Other non-adrenal sites include the coeliac axis, renal parenchyma, broad ligament and ovary; the placenta, hepatic, pulmonary and intracranial lesions, including eleventh cranial deposits, have also been described. 4,5 Case reportA 45-year-old male was referred to the outpatient department with a 3-month history of a painless right testicular mass. There was no history of trauma, recent infection, systemic upset or weight loss. His history was remarkable for essential hypertension and an inguinal orchidopexy at age 13 for an undescended right testicle. He had fathered 6 children.Physical examination revealed a soft non-tender abdomen with a right inguinal scar. There was a discreet mass in the upper pole of his right testicle, a right scrotal scar consistent with his orchidopexy and a normal left hemiscrotum. Tumour markers (alpha fetoprotein, beta human chorionic gonadotrophin and lactate dehydrogenase) were normal. Scrotal ultrasound demonstrated a 9-mm mass in the upper pole of the right testicle and a nodule in the right spermatic cord (Fig. 1). He underwent a right radical orchidectomy via his old inguinal scar. Final histopathological analysis revealed a classic seminoma, which stained positive for placental alkaline phosphatase (PLAP), but negative for Ber-H21, inhibin and Alphafeto protein (Fig. 2). No lymphovascular invasion was noted and it was staged as a pT1 lesion. The nodule in the spermatic cord contained morphological features consistent with an adrenal rest (Fig. 3). DiscussionIn the pediatric population, ectopic adrenal tissue found during inguinoscrotal procedures has been extensively documented 1,5 with a right-sided preponderance. There is an increased incidence of ectopic adrenal tissue within the spermatic cord of males with undescended testes, 5 ranging from 1.6% to 5.1%. 3,6 Autopsy series have shown an incidence of ectopic adrenal tissue adjacent to the native adrenal of up to 32% in adults.7 However, the incidence of ectopic adrenal tissue in the spermatic cord of adults is significantly lower at 1%. 8 Macroscopically, the appearance of ectopic adrenal tissue is characteristic (a round, yellow nodule, firm in consistency, embedded in the cremasteric fibres, resembling a fat lobule).1 Adrenal rests situated far from the original gland are composed entirely of cortical adrenal tissue with n...

Small cell carcinoma (SCC) is an aggressive malignancy most commonly described in the lung. We present a case of a 61-year-old male who presented with a neck swelling and was subsequently found to have metastatic SCC of the prostate. Clinicians should be aware that it metastasizes early. Unlike conventional prostate adenocarcinoma, it is not a prostate-specific antigen (PSA) secreting tumor hence serum levels do not correlate with disease severity, and a low PSA reading may give false reassurance. In the future, further studies on genomic typing and novel targeted therapies may achieve better clinical outcomes for patients with this aggressive type of prostate cancer.

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