Diagnostic utility of CD10 immunohistochemical staining on cellblock in differentiating hepatocellular carcinoma from secondary malignancies of liver.

BACKGROUND: Differentiation of hepatocellular carcinoma (HCC) from metastatic malignancy in liver may be difficult at times on fine-needle aspiration cytology, especially in case of moderate-to-poorly differentiated tumors. The benefit of cell-block technique is the recognition of histologic pattern of diseases along with application of a wide variety of immunohistochemical (IHC) stains to differentiate hepatic malignancies. In this study, CD10 IHC staining was done on cellblocks prepared from aspirates of clinicoradiologically/cytologically suspected malignant liver neoplasms to differentiate HCC from malignancies metastasizing to liver. OBJECTIVE: The objective of the study was to assess the diagnostic utility of CD10 IHC stain on cell-block preparation for differentiating primary from Secondary malignancies of liver. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded cellblocks of 61 cases (25 cases of HCC and 36 cases of metastatic carcinoma) were prepared from a fine-needle aspirate of the suspected malignant liver neoplasm and immunostained using monoclonal antibody against CD10. RESULTS: Twenty-two (88%) of 25 cases of HCC were positive for CD10 with a canalicular staining pattern. Two (8%) were positive for CD10 with membranous and one (4%) with cytoplasmic staining pattern. CONCLUSION: CD10 immunostaining on cellblock is useful in discriminating HCC and metastatic carcinoma of the liver with a diagnostic accuracy of 88.52%.

Well differentiated papillary mesothelioma of abdomen- a rare case with diagnostic dilemma.

Well-differentiated papillary mesothelioma is a rare tumor occurring predominantly in the peritoneum of young women, a few with history of asbestos exposure. A 28-year-old woman presented with ascites and pain abdomen. Ultrasonography and computed tomography scan of the abdomen revealed a mass in the retroperitoneum measuring 15 cm × 12 cm. Histopathological examination along with immunohistochemistry (IHC) confirmed it to be a papillary mesothelioma in the peritoneum. It is difficult to differentiate from more common malignant mesothelioma and papillary adenocarcinoma, which also have poorer prognosis. The difficulty can be resolved by clinico-radiological correlation along with histopathological examination and IHC.

Pitfalls in the cytological diagnosis of tenosynovial giant cell tumor: An illustration of eight discordant cases.

Tenosynovial giant cell tumor (TSGCT) is a highly recurrent benign tumor of the extremities. Wide local excision is usually sufficient to achieve its recurrence-free outcome. However, that needs a confident pre-operative cytological diagnosis as TSGCT. Aspirates from this tumor express the characteristic polymorphic cytological pattern, enough to impose a definite diagnosis. However rarely so, inadequate sampling from smaller tumors or due to faulty techniques, and selective sampling from topographic clusters of any individual component may lead to wrong interpretation. An unorthodox location near the larger limb joints further complicates the diagnostic misery on occasions. Such tumors are amenable to incomplete removal and risk for future recurrence. In this report, we describe eight cases of TSGCTs that were cytologically diagnosed otherwise. The cytological features of these discrepant tumors and the factors attributable to such dilemma are elaborated. Finally, a possible remedy has been proposed at conclusion in order to avoid future inconveniences.

Root Cause Analysis (RCA) of Prolonged Laboratory Turnaround Time in a Tertiary Care Set up.

INTRODUCTION: Among the multitude of daily administrative problems which are faced by the modern hospitals today, prolonged Turnaround Time (TAT) of laboratory investigations is a crucial one, which affects patient care as well as patient satisfaction adversely. AIMS AND OBJECTIVES: The specific objectives were to observe the TAT of common laboratory investigations, to identify cause of increased turnaround time and to formulate action plans to rectify increased TAT. METHODOLOGY: An observational, RCA study was performed on 100 randomly selected patients. A separate group of 50 patients were assisted to get their investigations done and to reduce the time intervals without actively interfering with the steps. The results which were obtained were accepted as standards. Root cause analysis of the delays which were detected in TAT was done. Time intervals of TAT in the two groups were compared by 2 tailed t-tests done for equality of means. Result and Analysis: All time intervals were high in the study group and they were found to be statistically significant (p<0.05) within a 95% confidence interval of the difference. The maximum time which was needed in the control group was within the interval between the prescription of the investigation by the doctor and writing of the requisition by the Out-patient Department (OPD) staff. For the study population, it was the interval between the writing of the requisition by the OPD staff and the reaching of the patient at the central Laboratory. The standard deviation (27.665) and range (102) were also exceptionally high for this interval in the study group. CONCLUSION: This study revealed that easy to implement administrative steps would help in reducing the TAT significantly and in improving the quality of services of the central laboratory. These include the setting up of sample collection counters at the outpatient department (OPD) and inpatient department (IPD), employment of minor methods like printing the directions for reaching the laboratory on the OPD ticket, the start of a single prick policy, declaring central laboratory as a separate department and integration of the administrative control under one authority.

Disseminated Cutaneous Histoplasmosis, an Initial Manifestation of HIV, Diagnosed with Fine Needle Aspiration Cytology.

Acute progressive disseminated histoplasmosis (PDH) may be the initial manifestation of human immunodeficiency virus (HIV). However, cutaneous involvement is very rare. We present an unusual case of acute PDH with multiple diffuse cutaneous papulonodular lesions predominantly on the face, trunk, and upper extremities, diagnosed initially with fine needle aspiration cytology (FNAC). Subsequent serological tests revealed positivity for antibodies for HIV 1 and 2. The cytomorphological features were further confirmed by biopsy and histochemical stains. FNAC is a rapid, cost-effective tool that may be utilized in the diagnosis of papulonodular forms of PDH and for initiating prompt therapy. We discuss the clinical features, clinical differentials, and treatment of the condition.

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.

Chondroid syringoma: a case with unusual cytological findings.

Chondroid syringoma is a rare benign skin adnexal tumor, the cytological features of which have been published very rarely in the literature. A mucoid aspirate, abundant chondromyxoid matrix material, and epithelial components were suggested as diagnostic criteria. The reported case is one of chondroid syringoma confirmed by histopathology, the fine needle aspiration cytology of which yielded thin fluid-like material and microscopy revealed epithelial clusters with admixed smaller myoepithelial cells, background cyst macrophages, and only scanty chondromyxoid stromal elements. Including these cytological features of the present case among the diagnostic criteria for cytodiagnosis of chondroid syringomas might increase the chances of a definitive preoperative diagnosis and help in planning the extent of surgery.

A Study on the Correlation between Cord Blood Glucose Level and the Apgar Score.

INTRODUCTION: The study of the biochemical parameters of cord blood acts as a mirror, which usually reflects the neonatal status. The widely used system for the evaluation of a neonate is the Apgar score. There is no comprehensive published data which has established the association between the cord blood glucose level and the Apgar score. Similarly, there is also no well accepted reference range of the cord blood glucose level. OBJECTIVES: The main objectives of the present study was to ascertain any adverse effects of an abnormal cord blood glucose level on the neonatal status and to find out a standard reference level of glucose in cord blood. METHODS: The cord blood glucose estimation was done by using the glucose oxidase peroxidase method and the statistical analysis was performed by using the SPSS, version 16 software. RESULTS AND CONCLUSIONS: In the present study, the cord blood glucose level was found to have no correlation with the Apgar scores which were calculated at both one minute and five minutes after birth. It was also found that for the foetus to be free from any obvious complication, the cord blood glucose level had to be around 87 mg/dl. The fluctuations in the maternal glucose levels are weakly associated with the glucose level in the cord blood.

A rare case of chondromyxoid fibroma mimicking spina ventosa.

Chondromyxoid fibroma (CMF) is perhaps the rarest of all bone tumors. Classically it occurs in the metaphyseal region of the long bones surrounding the knee. The small bones of the feet are also commonly involved. But CMF occurring in small bones of the hand, however, is very uncommon. Tuberculous dactylitis is referred to as spina ventosa. The bones of the hands are more frequently affected than bones of the feet. We present a rare case of CMF occurring in the middle phalanx of the left middle finger which was misdiagnosed as spina ventosa clinicoradiologically. It can be a common mistake especially in areas where prevalence of tuberculosis is still high. This case once again stresses the need for biopsy and to consider CMF as a rare differential diagnosis in all suspected cases of spina ventosa.

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.

Squamous cell carcinoma arising in a testicular teratoma and presenting as sister Mary joseph nodule.

The most common somatic type malignancy arising in patients with testicular germ cell tumors (GCTs) is sarcoma. Development of carcinomas, especially squamous cell carcinoma is an extremely rare event. Most cases of metastatic umbilical nodules (Sister Mary Joseph nodule) develop from adenocarcinomas. Fifteen percent of such cases have unknown origin; but development from a testicular squamous cell carcinoma has not yet been reported in the literature. We report a rare case of somatic type squamous cell carcinoma arising in a testicular teratoma. It is also possibly the first reported case of its kind which presented with a metastatic umbilical nodule. This possibility should be kept in mind while evaluating metastatic umbilical nodules in young male patients.

Morphological predictors of nipple areola involvement in malignant breast tumors.

CONTEXT: Nipple areola (NA) sparing mastectomy has an acceptable complication rate, is oncologically safe and facilitates an improved cosmetic result, aiding greatly in reducing psychological trauma associated with breast loss. Questions regarding preoperative case selection for NA sparing mastectomy are pertinent. AIMS: The principle objective was to develop a simple model based on correlation of malignant involvement of NA with morphological factors in breast cancer cases to accurately predict the cancerous involvement of nipple areola preoperatively. SETTINGS AND DESIGN: The present cross-sectional study was carried out on 136 patients of breast cancer. The period of study spanned 3 years from 2004 to 2007. MATERIALS AND METHODS: We evaluated 17 different morphological parameters which had proven prognostic significance in breast cancer cases for their relationship with NA involvement. Data regarding cytological parameters were available in 120 cases out of the total number of 136 cases. Simple and conventional methods appropriate for any under-resourced set-up were employed to enhance the economic viability and acceptability of the project. STATISTICAL ANALYSIS USED: Statistical analysis in this study was mostly done using SPSS version: 14 software. P-value < 0.05 was considered significant when assessing correlation between two parameters. RESULTS: The frequency of NA involvement detected in this study was 19.1%. In univariate analysis, 13 of the 17 morphological parameters were found to have strong statistical association (P < 0.05) with NA involvement. In multivariate analysis, only four parameters-macroscopic NA changes, tumor-NA distance ( < 1.5cm), histological lymph node grade and extra capsular extension in lymph node were found to have independent role for NA involvement prediction. This multivariate Cox and Snell Regression model with Cox and Snell Regression Square of 0.551 can predict accurately 98.5% cases of nipple involvement using the 4 parameters as variables. CONCLUSIONS: By application of this simple multivariate model, accurate prediction of NA involvement would be possible preoperatively. NA sparing mastectomy may be performed on those cases predicted to have no NA involvement thus substantially reducing the burden of psychological morbidity.