Myxoid Liposarcoma with Cartilagenous Differentiation.

Myxoid liposarcoma (MLPS) is an adipocytic tumour and second commonest among the types of liposarcoma. It exhibits a wide histological spectrum. It is important to be aware of this diversity of morphology in this tumour to prevent a wrong diagnosis. Heterologous differentiation in myxoid liposarcoma is reported; however, this is rare. To date, seven cases of MLPS with cartilaginous differentiation have been reported. Only five of these were further confirmed by cytogenetic analysis. We are reporting the 8th case of MLPS with cartilaginous differentiation. A 66-year female presented with posterior left thigh mass. Excision was done. Microscopic examination showed sheets of bland spindle cells containing round to oval nuclei and fine, delicate chicken-wire vessels. The firm blue appearing areas, which accounted for about 20% of the tumor volume, were characterised by mature hyaline cartilage. The final diagnosis was MLPS, showing prominent cartilaginous differentiation. Anterior and lateral margins were involved. Tumour was very close to the rest of the resection margins. FNCLCC grade was 1. Provisional pathological stage, as per staging system of the Union for International Cancer Control for extremity, was pT2. Patient was examined by oncologists. Wide local excision is in plan as two margins were involved by the tumour, while rest of the margins were very close to tumour. Key Words: Liposarcoma, Myxoid, Cartilaginous differentiation.

Malignant Acanthosis Nigricans: An Indicator of Internal Malignancy.

Acanthosis nigricans is a skin disease characterised by symmetric velvety hyperpigmented, verrucous plaques of the intertriginous surfaces of the axilla, neck, inframammary, and mucocutaneous regions. Malignant acanthosis nigricans is a paraneoplastic phenomenon most commonly associated with gastric adenocarcinoma. Tripe palms, florid cutaneous papillomatosis and oral involvement along with generalised acanthosis nigricans are the features which are highly suggestive of internal malignancy. This case report describes a rare case of a patient who presented with combination of malignant acanthosis nigricans, tripe palms, florid cutaneous papillomatosis and oral involvement associated with undifferentiated malignant neoplasm of hepatic bile ducts.

Evaluation of histo-pathogical patterns of ovarian masses in relation to age in Rawalpindi-Islamabad region - Lab Research.

OBJECTIVE: To evaluate the histopathological patterns of ovarian tumours in relation to age in Rawalpindi-Islamabad region of Pakistan. METHODS: The retrospective study was conducted at the Army Medical College, Rawalpindi, Pakistan, and comprised data related to ovarian tumour cases from 2013 to 2017). Tumour type, tumour subtype, tumour size, cancer staging and age of patients were noted from the medical records. Ovarian tumours were broadly classified in accordance with the World Health Organisation system for ovarian neoplasms. RESULTS: Out of 420 ovarian tumour cases, 250 (59.5%) were benign, 24 (5.7%) were borderline, and 146 (34.8%) were malignant. In terms of classification, 268 (63.8%) were surface epithelial tumours, 100 (23.8%) germ cell tumours, 29 (6.9%) sex cord stromal tumours, 12 (2.9%) metastatic tumours, n= and 11(1.2%) were miscellaneous.. Of the malignant tumours, 146(61.6%) were found in patients aged over 40 years. Serous cystadenoma was the most common 82(32.8%) benign tumour, while serous cyst-adenocarcinoma constituted the main bulk 48(32.9%) of malignant tumours.. CONCLUSIONS: The frequency of ovarian tumours was found to be quite high among women of Rawalpindi-Islamabad region..

Expression of Estrogen Receptors (ER), Progesterone Receptors (PR) and HER-2/neu receptors in Endometrial Carcinoma and their associations with histological types, grades and stages of the tumor.

OBJECTIVE: To study and detect immunohistochemical expression of Estrogen Receptors, Progestrone Receptors and HER-2/neu Receptors in Endometrial Carcinoma (EC) and to find their associations with histological types, grades and stages of the tumor. METHODS: A cross sectional study of one year duration from January 2016 to January 2017 was conducted at Histopathology department of Army Medical College, Rawalpindi. A non-probability purposive sampling technique was used to include 56 cases of EC. The specimens were tested for ER, PR and HER-2/neu expression using immunohistochemical analysis. Data was analyzed in SPSS and the significance of association of expression of the receptors with histological types, grades and stages of the tumor was assessed. RESULTS: Significant association of Her-2/neu overexpression with histological types and grades of EC was seen, whereas the association of ER and PR expression with histological types, grades and stage of EC was statistically insignificant. CONCLUSION: It is suggested that EC showing over expression of HER2/neu with immunohistochemistry may be treated with anti HER-2/neu treatment with better chances of survival and decreased post-treatment morbidity.

Unusual skin mass (primary cutaneous mucinous carcinoma).

Primary mucinous carcinoma of the skin is a rare malignant tumour of sweat gland origin. Diagnostic concerns include its deceptively benign appearance in some cases and the difficulty in differentiating it from secondary mucinous carcinoma of skin metastasising from a primary source elsewhere. A case of a 75-year-old man is reported who presented with a slowly growing painless mass near the lateral canthus of the right eye for about 2 years. Clinically, a diagnosis of basal cell carcinoma was made whereas histopathology revealed mucinous carcinoma of the skin. The primary source of the tumour could not be found on detailed physical examination and laboratory investigations. Immunohistochemistry, performed later, was consistent with primary cutaneous mucinous carcinoma.

Hepatitis B Leading to Megaloblastic Anemia and Catastrophic Peripheral Thrombocytopenia.

Hepatitis B virus (HBV) typically causes chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is associated with a variety of extrahepatic complications. We herein, present a rare extrahepatic complication of HBV infection. A 32-year man presented with melena, bleeding from gums and fever. Peripheral blood examination revealed anemia, macrocytosis and severe thrombocytopenia. His hepatitis B surface antigen (HBsAg) was positive but deoxyribonucleic acid (HBV DNA) by polymerase chain reaction (PCR) was negative. Other hepatitis, human immune deficiency virus (HIV), dengue, and autoimmune serology were negative. Bone marrow examination revealed megaloblastic erythropoiesis. There was mild to moderate reduction of megakaryocytes in bone marrow, which was not compatible with severe peripheral thrombocytopenia. His response to cyanocobalamin and folic acid was remarkable for myeloid cell lines and moderate for erythroid cell lines, but poor to platelet counts. Platelet counts gradually improved to safe limits with eltrombopag, likely reflecting autoimmune pathogenesis for thrombocytopenia. This case report highlights multiple targets of HBV infection with associated multiple pathogenetic mechanisms.

PREGNANCY, THYROTOXICOSIS AND POLYMYOSITIS.

A young pregnant lady of 26 years age, presented with recent onset weaKness of legs. On examination, she was only able to move legs from side to side and lift the arms with difficulty. Rest of neurological and systemic examination did not reveal any abnormality. On investigations, there were raised serum muscle enzyme levels, hyperthyroid hormone profile, myopathy on electromyography and myositis on muscle biopsy. Common conditions of myositis were excluded. She was given glucocorticoids and methimazole to which she responded well.

Diagnostic challenges and role of immunohistochemistry in metastatic liver disease.

OBJECTIVE: To evaluate the role of Immunohistochemistry (IHC) in the diagnosis of metastatic liver disease, with a descriptive, cross-sectional study at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Rawalpindi. MATERIAL AND METHODS: A total of 130 cases of metastatic liver disease were retrieved from the tumor registry data. Eosin-haematoxylin stained sections and Immunohistochemistry panels applied to ascertain the site of primary tumor were evaluated. The panels of detailed immunohistochemical markers were applied. Frequency and percentages were calculated for qualitative variables. Mean and standard deviations were calculated for quantitative variables. RESULTS: Males were 87 (67%) and were females 43 (33.07%). The most common site of primary was in GIT (45%), followed by neuroendocrine carcinoma and gall bladder. The other less common sites were lung, breast, ovary and thyroid. CONCLUSION: There is no specific singular panel of immunohistochemistry markers which can be used in all cases of metastatic liver tumors. The best use and selection of IHC markers depend upon morphological features, clinical history and results of other relevant investigations.

Gastrointestinal stromal tumors-a morphological and immunohistochemical study.

PURPOSE: The rationale of this study was to assess the morphological and immunohistochemical characteristics of gastrointestinal stromal tumor (GIST) along with their risk stratification. METHODS: Record of 36 cases diagnosed as GIST over a period of 2 years (January 2007 to December 2008) was retrieved. Slides were reviewed for histological typing, immunohistochemical staining, and mitotic count. Cases were divided into very low, low, intermediate, and high-risk groups according to the Fletcher method of risk stratification (Table 1; Fletcher et al. (Int J Surg Pathol 10:81-89, 2002)). Mean, median, and mode were calculated for quantitative variables like age, tumor size, and mitotic count by using SPSS version 14. Frequencies and percentages were also calculated for qualitative variables like results of immunohistochemistry, tumor site, and histological subtypes. RESULTS: Out of 36 patients, 14 patients were male, and 22 were female. A total of 14 (39%) patients had tumor size between 2 and 5 cm, 13 (36%) patients had size between 5 and 10 cm, and 9 (25%) patients had size >10 cm. There was no tumor less than 2 cm in size. Twenty-one patients (58%) had mitoses <5/50 high power fields (HPF) while seven (20%) had mitoses between 5 and 10/50 HPF and eight (22%) >10/50 HPF. Thirty-one (86%) of cases were strongly positive for CD117 while CD34 was positive in 81% of the cases. Most frequent histological type was hypercellular spindle cell type, and most frequent site of presentation was stomach. Seven patients fell into low risk, ten patients intermediate risk, and 19 patients in high risk groups. There were no patients in very low risk group. CONCLUSION: By using microscopy and immunohistochemical techniques, GISTs can be diagnosed accurately and treated efficiently. Risk stratification and histological subtyping have emerged as efficient tools to predict malignant behavior.