Was it Ewing's? A Diagnostic and Therapeutic Dilemma.

We present an atypical case of histopathology suggesting hemangioendothelioma and immunohistochemistry-proven Ewing's sarcoma in a 39-year-old lady who presented with multiple stony hard swellings involving the occipital region of the scalp, right cervical lymph node, right scapular region, left infraclavicular region of the chest, right anterior abdominal wall swelling, and inner aspect of right thigh. She underwent left-sided below-knee amputation for parosteal osteosarcoma in the left distal tibia 3 years back. Palliative radiotherapy with dose of 30 Gy in 10 fractions over 2 weeks was administered to the right neck and right upper back following which she attained moderate pain relief but no reduction in swellings as was expected had it been a case of hemangioendothelioma or Ewing's sarcoma..

Inflammatory myofibroblastic tumor of maxillary sinus successfully treated with radiotherapy and corticosteroid: report of a rare case.

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) is a mesenchymal tumor mainly found in lung or retroperitoneum and rarely affects head and neck region. Extensive English literature search reveals that less than fifty cases of head and neck IMT have been reported so far, maxillary sinus being fewer. CASE PRESENTATION: We present a case of IMT involving maxillary sinus in a 48-year-old gentleman who attained complete clinico-radiologic response after treatment with radiotherapy (RT) and concurrent oral prednisolone. CONCLUSIONS: This is the first report where such magnificent response was attained in primary setting treated with RT and steroids as opposed to surgery which used to be considered as standard of care till now.

Hamartoma of Palatine Tonsil: A Rare Case.

Hamartomas are disorganized but benign masses composed of cells indigenous to the involved site. They have been reported in almost all organs but are rare in the head and neck region, especially the pharynx. We describe the case of a six-month-old male infant who presented with acute respiratory symptoms due to a pedunculated polypoid mass arising from his left palatine tonsil. He underwent a tonsillectomy and removal of the polyp after initial stabilization. Histopathological examination showed features consistent with hamartoma. The child had an uneventful recovery and follow-up after one year showed no evidence of recurrence. Our case highlights that rare benign lesions like hamartoma originating in the oral cavity, even in infants, can have such an acute presentation and should be considered in differential diagnosis.

Fine needle aspiration cytology of non-hematological neoplasms in pediatric age group: Our experience.

BACKGROUND: The role of aspiration cytology has largely been ignored in pediatric population. The present study was undertaken to evaluate the role of fine needle aspiration cytology (FNAC) in non-hematological neoplasms in children in our institution, which is a rural tertiary care center. MATERIALS AND METHODS: A total of 88 cases of non-hematological pediatric mass lesions were studied in which cytopathological diagnosis could be corroborated with histopathology. RESULTS: Out of all the cases, 70 (80%) cases were benign tumors and 18 (20%) were malignant tumors. Fibroadenoma (37.9%) comprised the majority of cases in the benign category while small round cell tumors (SRCTs) (44.4%) comprised the majority of cases in the malignant category. Definite diagnosis could be offered based on the cytomorphology in 79.5% cases, while in 20.5% of cases only a broad cytological classification could be offered. Among the malignant lesions, FNAC showed 100% sensitivity while a specific diagnosis was made in 90% of cases. CONCLUSION: FNAC proved to be a rapid and fairly accurate tool in diagnosing non-hematological tumors in the pediatric age group.

Cutaneous Chromoblastomycosis Mimicking Tuberculosis Verrucosa Cutis: Look for Copper Pennies!

Chromoblastomycosis is a rare chronic fungal infection of skin and subcutaneous tissue. It is primarily a disease of tropical and subtropical regions and affects mainly the agricultural workers following trauma with vegetable matter. Cutaneous Chromoblastomycosis may clinically mimic cutaneous tuberculosis as both the condition usually presents with hyper pigmented verrucous lesion of skin. Here in we report a case of chronic cutaneous Chromoblastomycosis in a middle aged woman from north eastern part of India, who was initially misdiagnosed as Tuberculosis verrucosa cutis. In histopathology characteristic brown colored spores of the fungus (also known as copper pennies) were seen within dermal abscess. The organism isolated from culture of the biopsy material was Fonsecaea pedrosoi thus confirming our diagnosis of cutaneous chromoblastomycosis. The patient responded well to oral Itraconazole. The dermatologists and pathologists should be aware of this condition especially when dealing with verrucous lesion of the skin. The pathologists should search for fungal spores in cutaneous lesion with pseudoepitheliomatous hyperplasia and dermal abscess.

Invasive primary aspergillosis of the larynx presenting as hoarseness and a chronic nonhealing laryngeal ulcer in an immunocompetent host: a rare entity.

Primary aspergillosis usually affects the paranasal sinuses, orbit, ear, and lower respiratory tract. Laryngeal aspergillosis usually occurs as a result of secondary invasion from the tracheobronchial tree, more commonly in immunocompromised hosts. Primary laryngeal localization of Aspergillus infection is seldom encountered. We report the case of an immunocompetent 42-year-old man who presented with hoarseness and a laryngeal ulcer of fairly long duration. A malignancy was initially suspected clinically, but a laryngoscopic biopsy led to a diagnosis of invasive primary laryngeal aspergillosis. No other focus of aspergillosis was found on x-ray and computed tomography. After identification of Aspergillus niger on culture, inquiries revealed no exposure to steroids, cytotoxic drugs, or irradiation, and workups for malignancy, human immunodeficiency virus infection, tuberculosis, and diabetes were negative. Although isolated laryngeal involvement is rare, aspergillosis may be considered in the differential diagnosis of a chronic nonhealing laryngeal ulcer that is clinically suggestive of a malignancy, even in an immunocompetent host.

USG guided FNAC of ovarian mass lesions: A cyto-histopathological correlation, with emphasis on its role in pre-operative management guidelines.

OBJECTIVE: Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of ovarian masses is an efficient diagnostic modality for accurately diagnosing ovarian tumours prior to surgery. The main aim of this study was to assess the sensitivity, specificity and accuracy of FNAC in diagnosing ovarian masses. MATERIAL AND METHODS: Eighty-three patients with ovarian masses were recruited and correlation of USG-guided FNAC was made with histopathology in all but 6 cases, where surgery was not indicated. RESULTS: Cytological diagnosis was obtained in all 83 ovarian lesions: 56 cases were benign, 6 possibly benign, 3 suspicious of malignancy and 18 cases as malignant. Out of 77 cases where histology was available, the 12 non-neoplastic cysts were endometriotic cysts and follicular cysts. The majority of neoplastic lesions were surface epithelial tumours. Out of 12 non-neoplastic cysts and 43 benign tumours, all but two were diagnosed as benign or possibly benign on cytology; of the 22 histologically malignant or borderline tumours, 18 were malignant or suspicious of malignancy on cytology, while four were false negative (three of these were borderline tumours). Thus, the sensitivity of cytological diagnosis was 83%, specificity was 97% and accuracy was 93%. CONCLUSION: USG-guided FNAC seems to be a relatively safe, simple, fast and cost-effective procedure where most ovarian malignancies either present late in their course or no screening method is available. In addition, cyto-radiological correlation through this procedure may be useful in deciding management guidelines prior to any surgical intervention.

A rare case of gangrenous appendicitis by eggs of Taenia species.

Cysticercosis and Taeniasis continue to be a major public health burden in the developing countries like India. Humans are the only definitive hosts infected by ingestion of eggs of Taenia species. Appendicular Taeniasis is rare with few isolated case reports during the past 30 years. Here, we report the case of a 38-year-old female patient from Nepal who presented with acute pain abdomen, was operated and diagnosed as suffering from gangrenous appendicitis caused by eggs of Taenia species.

Fine-needle sampling provides appreciable diagnostic yield in lesions of post kala azar dermal leishmaniasis: analysis of four cases from North Eastern India.

Post-kala-azar dermal leishmaniasis (PKDL) is a sequel of visceral leishmaniasis (VL), usually occurring 6 months to 3 years after VL. Spectrum of cutaneous lesions in PKDL can be hypopigmented macules, nodules, plaques, or erythema. It is usually diagnosed clinically, supplemented by ancillary techniques like skin smear examination, histopathology, polymerase chain reaction, and monoclonal antibody test. Literature on the role of cytology in the diagnosis of PKDL is extremely limited. Here we highlight the appreciable yield of fine-needle sampling in four cases of PKDL, which may be considered as a useful diagnostic aid.

Primary bilateral small lymphocytic lymphoma of ocular adnexal origin: Imprint cytology suggests the intraoperative diagnosis.

Ocular adnexal lymphomas (OAL) involve the peri-global soft tissues like orbit, eyelid, conjunctiva, lacrimal gland. We describe a rare case of primary bilateral OAL, histomorphologically small lymphocytic lymphoma, B cell phenotype of lacrimal gland origin. Rapid intraoperative diagnosis can be suggested on imprint cytology; subsequent histology and immunohistochemistry are helpful for confirmation and further line of management. Since no preformed lymphoid structures are expected within the orbit or lacrimal gland, any lymphoid mass here should be critically evaluated as a lymphoproliferative lesion.

Clinicopathologic study of parapharyngeal tumors.

BACKGROUND: Parapharyngeal space (PPS) tumors are rare. Three main groups are identified, namely those of salivary origin, neurogenic tumors and paragangliomas. Early pathological classification of PPS tumors is important for pin point diagnosis and timely management. AIMS: The PPS is a complex anatomical potential space and poses high risk of per and postoperative complication. This study was done to perform optimum preoperative evaluation by clinicoradiologic correlation and guided fine needle aspiration cytology (FNAC) which is essential to minimize intraoperative risk. MATERIALS AND METHODS: Guided FNAC was carried out to diagnose parapharyngeal tumors in 48 patients from January 2008 to January 2010. The inflammatory lesions were excluded in the present study. Correlation with histopathology was done in all the cases. RESULTS: The mean age for all the patients was 38.2 years. There were 23 male and 25 female subjects. Seventy nine percent of the lesions were benign with pleomorphic salivary adenoma being the commonest, while only 20.8% of the lesions were malignant. All the patients presented with neck swelling. No complication was encountered in the present study. CONCLUSION: FNAC can replace incisional biopsy which may be hazardous in this area. Immediate treatment can be planned based on the FNAC report.

Secondary signet ring cell carcinoma of prostate.

True metastases to prostate from solid tumors are reported only in 0.2% of all surgical prostatic specimens and 2.9% of all male postmortems. Clinical context, morphological features, and immunohistochemical localization of prostate specific antigen (PSA) are supposed to clarify the differential diagnosis between a secondary and a primary tumor. We report an unusual and rare case of secondary signet ring cell carcinoma (SRCC) of prostate in which the clinical data and signet ring cell morphology pointed toward the diagnosis of a primary SRCC. Immunohistochemistry (IHC) for PSA not only proved the case to be a secondary SRCC but also initiated the process for diagnosis of the occult primary malignancy in the patient's stomach.

Juvenile xanthogranuloma-diagnostic challenge on fine-needle aspiration cytology.

Juvenile xanthogranuloma (JXG) is a rare cutaneous lesion with paucity of literature on its cytological features. We report one such case which on fine-needle aspiration cytology yielded a mixed population of foamy histiocytes, multinucleated giant cells and variable admixture of lymphocytes and eosinophils causing diagnostic dilemma with other differentials, especially Langerhans cell histiocytosis. However, clinical correlation followed by histopathology confirmed the diagnosis. Hence, JXG has characteristic and diagnostic cytologic features.

Cytopathological dilemma of anaplastic sacral chordoma with radiological and histological corroboration.

Chordoma is a relatively rare locally invasive and potentially malignant tumor of fetal notochord origin, affecting the axial skeleton. Cytopathological diagnosis of chordoma is favored by the presence of characteristic physaliphorous cells, bearing abundant foamy cytoplasm dispersed in a myxoid matrix. Anaplastic chordoma or dedifferentiated chordoma, an even rarer variant, can cause a diagnostic confusion with chondrosarcoma from the cytopathological point of view, with similar chondromyxoid matrix and atypical cells. Hence, chordoma bearing anaplastic features needs to be identified and should be distinguished from chondrosarcoma on aspiration cytopathology. We present a case of anaplastic sacral chordoma in a man 59 years of age, causing extensive destruction of sacrum and invading the paravertebral tissues as evidenced by radiology. Fine needle aspiration cytopathology revealed few large pleomorphic hyperchromatic cells, admixed with characteristic physaliphorous cells and myxoid matrix. The cytopathological diagnosis has been confirmed by histopathology and immunohistochemistry. Since anaplastic chordoma bears an unfavorable prognosis, it should be suspected on preoperative aspiration cytopathology. Clinicoradiological correlation along with histopathological and immunohistochemical confirmation is necessary subsequently.

Guided fine needle aspiration cytology of retroperitoneal masses - Our experience.

BACKGROUND: Early pathological classification of retroperitoneal masses is important for pin-point diagnosis and timely management. AIMS: This study was done to evaluate the usefulness and drawbacks of guided fine needle aspiration cytology (FNAC) of retroperitoneal masses covering a period of two years with an intention to distinguish between neoplastic and non-neoplastic lesions and to correlate with histologic findings. MATERIALS AND METHODS: FNAC was done under radiological guidance in all cases using long needle fitted with disposable syringe. Appropriate staining was done and cytology was correlated with histology which was taken as the gold standard for comparison. RESULTS: Fifty-one patients who presented with retroperitoneal masses were studied. Forty-four lesions were malignant cytologically and 7 were inflammatory (tuberculous). According to radiological and cytologic findings, we classified our cases into four groups: renal tumors, retroperitoneal lymphadenopathy, germ cell tumors, soft tissue tumors. Except for cases of non-Hodgkin lymphoma (NHL) and metastatic lesions, we had sensitivity and specificity of 100%. In NHL the sensitivity and specificity were both 50%. In cases of metastatic adenocarcinoma, the sensitivity and specificity were 84.6% and 81.8%, respectively. CONCLUSIONS: Ignoring the pitfalls, guided FNAC is still an inexpensive and reliable method of early diagnosis of retroperitoneal lesions.

Cytological diagnosis of adamantinoma of long bone in a 78-year-old man.

A clinicohistopathological study of a rare case of adamantinoma of long bone in a 78-year-old patient is presented. The cytological features when evaluated in conjunction with clinical and radiologic features are sufficiently diagnostic. The primary knowledge of its existence and knowledge of its cytological features are important for a correct preoperative cytological diagnosis.

Calcaneal intraosseous lipoma: a case report and review of the literature.

Intraosseous lipomas are rare benign bone tumors. This benign neoplasm has been reported to occur in the calcaneus as well as the proximal femur. In the past, the relative absence of symptoms and radiographic similarity to a bone cyst has accounted for underdiagnosis of intraosseous lipoma. The case presented in this article was diagnosed with the help of computerized tomography and histopathologic analysis, after which the patient was treated by means of curettage and packing with calcium phosphate bone graft substitute. The purpose of this article is to increase awareness among clinicians of the existence of this unusual lesion.

Computed tomography guided fine needle aspiration cytology of mass lesions of lung: Our experience.

CONTEXT: Computerized tomography (CT) guided fine needle aspiration cytology (FNAC) of lung lesions has rapidly emerged as a less-invasive, cheap, rapid and fairly accurate diagnostic aid in lung lesions. AIMS: The purpose of this present study was to evaluate the effectiveness of CT-guided FNAC in the diagnosis of pulmonary mass lesions (both benign and malignant) and to determine the complication rate of this procedure. SETTINGS AND DESIGN: We conducted an institution-based, prospective study on 127 patients who presented with pulmonary mass lesions. MATERIALS AND METHODS: After proper consent was obtained, CT-guided transthoracic fine needle aspiration was done and their diagnoses were confirmed by appropriate methods. The results were analyzed statistically. RESULTS: Out of 127 cases selected for the study, 59.8% were males while the rest were females. Cough was the most common symptom present in 71.2% cases, followed by weight loss (62.4%). 21.2% cases were cytologically benign. Adenocarcinoma (54.2%) was the commonest malignant tumor. FNAC provided at least 96% sensitivity and 100% specificity in diagnosing lung tumors. Among the benign lesions, specific diagnoses were obtained in 48.1% cases. Thus, altogether a specific diagnosis was obtained in 109 of 127 cases, i.e. 85.8%. No major complication was noted. CONCLUSIONS: CT-guided FNAC is an extremely valuable and fairly accurate diagnostic aid of intrathoracic mass lesions, with a reasonable rate of complication.

Hydatid cyst of ovary- a rare entity.

Hydatid disease is a zoonosis caused by the larval stage of Echinococcus granulosus. It is prevalent in areas where livestock is raised in association with dogs. Humans are the accidental intermediate host. Primary peritoneal echinococcosis is a rarely observed clinical condition. We report a case of peritoneal hydatid cyst diagnosed incidentally during an operation performed for suspected ovarian cyst.