Xanthogranulomatous Change in a Leiomyoma: First Report of an Extremely Rare Variant/Degenerative Change.

Xanthogranulomatous inflammation, a specific form of chronic inflammation, is marked by parenchymal destruction, proliferative fibrosis, and infiltration of typical foamy histiocytes admixed with hemosiderin-laden macrophages and foreign-body giant cells. Myometrial xanthomatosis, a term designated for nodular or diffuse histiocytic hyperplasia of the myometrium, has been reported in association with pregnancy-related procedures. Moreover, a 2-3-fold increase in histiocytic counts has been observed in leiomyomatous areas than in adjacent normal myometrium. The first evidence of collections of lipid-laden macrophages was documented in the form of yellowish degeneration of uterine leiomyomas. We report a case of xanthogranulomatous change in a leiomyoma in a 47-year-old female who presented with abnormal uterine bleeding. To the best of our knowledge, this is the first report of xanthogranulomatous variant/degenerative change in a leiomyoma. This case highlights a new variant of leiomyoma which both gynecologists and pathologists should be aware of as it may pose a diagnostic challenge both clinically as well as pathologically.

Congenital Unilateral Hypoplasia of Kidney with Mesonephric Remnants in the Ureter: A Case Report.

Mesonephric remnants persist as an appendix of epididymis and paradidymis in efferent ductules in males and skene's glands and Gartner's ducts in females. The mesonephric remnant in the renal parenchyma is extremely rare and only a few cases have been reported in the literature. We present a case with a non-functioning atrophic left kidney. Histopathology showed variable-sized ducts filled with colloid-like material surrounded by collagenized stroma. The ureter showed hypertrophied muscle and a few ducts lined by flattened and a few by columnar epithelium resembling epididymis suggestive of mesonephric remnants. IHC for CD10, PAX 8, and GATA3 was positive. A diagnosis of congenital unilateral hypoplasia of kidneys and ureter with mesonephric remnants was given.

Xanthogranulomatous change in a pleomorphic adenoma: An extremely rare variant/degenerative change. Is it fine needle aspiration induced?

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor characterized by morphological diversity, metaplastic changes, degeneration, cystic change, altered differentiation, and rarely malignant transformation, thereby may create a diagnostic dilemma on cytology. Xanthogranulomatous (XG) inflammation within a PA could be due to XG sialadenitis coexistent with PA or preoperative fine-needle aspiration cytology (FNAC) induced histologic alteration. The argument in favor of this hypothesis is that the changes seen in the histopathology would not be present in the cytology, implying that the alterations were most likely due to the traumatic injury of needling rather than spontaneous change of the lesions themselves. These FNAC induced changes are focal in most of the cases, so the underlying lesion is readily identifiable, but on rare occasions they are so extensive that it can masquerade as a malignancy. We report a case of XG change in a PA in a 39-year-old male of 8 years standing. Through this case we wish to emphasize that knowledge of a previous FNAC and its potential effects on histology of the subsequent surgical specimen is necessary to avoid potential misdiagnosis.

Granular Cell Tumor Breast Masquerading as a Malignancy Cytologically: a Rare Case Presenting a Diagnostic Dilemma.

Granular cell tumor (GCT) also known as Abrikossoff's tumor is an uncommon soft tissue tumor of neurogenic origin. GCT of the breast accounts for < 0.1% of breast tumors and 6% of all reported cases of granular cell tumor. Although GCT is a benign tumor, malignant GCT can be seen in 1% v of the cases. GCT of the breast is diagnostically challenging as it can imitate carcinoma clinically and radiologically but need to be differentiated from breast malignancy since they have totally different approach in treatment and prognosis. GCT has a great ability to mimic a variety of lesions from benign histiocytic to malignant epithelial/mesenchymal lesions, thereby presenting a diagnostic challenge to the practicing cytopathologist. We report a case of GCT of breast cytologically masquerading as a malignancy in a 45-year-old female. Although, fine needle aspiration (FNA) is a first-line diagnostic tool, the present case reemphasizes the role of histopathology as the gold standard for a definite diagnosis clubbed with ancillary techniques like immunohistochemistry and special stains.

IAC standardized reporting of breast fine-needle aspiration cytology, Yokohama 2016: A critical appraisal over a 2 year period.

BACKGROUND: Breast cytology is a significant component of the "Triple approach" for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision.AIMS \& OBJECTIVES:The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned. MATERIALS AND METHODS: All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible. RESULTS: Out of 468 breast lesions reported on FNAC, the category wise distribution was - Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively. CONCLUSION: FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC.

Benign mesenchymoma of bone: A rare case report.

Benign mesenchymomas, exceptionally rare tumors, composed of two or more nonepithelial mesenchymal elements are not usually found together in a tumor. We report herein a rare case of benign mesenchymoma in the lower end of tibia in a 36-year-old female showing fibrous, fatty, and osseous elements.