Coexistent struma ovarii and serous cystadenofibroma in the same ovary.

Struma ovarii is a highly specialized and rare form of mature teratomas constituting 2% of all teratomas although small foci of thyroid tissue may be found in 5% to 15% of teratomas. Coexistence of this unusual germ cell tumor with ovarian epithelial tumors has been reported rarely; however, concomitant struma ovarii and serous cystadenofibroma has been mentioned in only 1 case report in the extensively searched medical literature. We report a rare occurrence of struma ovarii along with a serous cystadenofibroma in a 47-year-old woman.

Langerhans cell histiocytosis masquerading as tuberculosis: a diagnostic dilemma resulting in inappropriate anti-tubercular therapy.

Langerhans cell histiocytosis is known to mimic many other conditions. We present two patients where anti-tubercular therapy was instituted when clinical and radiological features suggested tuberculosis. The correct diagnosis of histiocytosis was reached only on further work-up including immunohistochemistry following un-responsiveness to treatment. In retrospect it was felt that an inordinately high index of suspicion for tuberculosis, clinical and radiological overlap between the two entities, an urgency to start empirical therapy in a rapidly deteriorating patient and pathological similarities between epithelioid histiocytes and pathologic Langerhans cells led to the diagnostic and therapeutic errors.

An acute myeloid leukemia M6b blast crisis with giant proerythroblasts in chronic myeloid leukemia.

The case of a 12 yr old female with bcr-abl positive chronic myeloid leukemia who subsequently developed a fatal AML-M6b (pure erythroleukemia) blast crisis is presented. The case is unique for its rarity of occurrence and for the striking resemblance that the circulating proerythroblasts showed to the giant cells characteristically seen in Parvovirus B19-induced acute pure red cell aplasia. This is, to the best of our knowledge, the first description of such cells in a blast crisis of chronic myeloid leukemia.

Metastasis of cervical carcinoma to endometrial polyp: an interesting case report.

A metastatic focus of small circumscribed carcinoma in an endometrial polyp is extremely rare. Most of these reported cases have a primary carcinoma of the breast. We report a circumscribed metastatic squamous cell carcinoma in an endometrial polyp. This, to the best of our knowledge, is the first case report of metastasis of cervical carcinoma to a benign endometrial polyp.

Unsuspected multiples myeloma presenting as bilateral pleural effusion - a cytological diagnosis.

BACKGROUND: Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis. CASE PRESENTATION: A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin's Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type). CONCLUSION: Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age.

Malignant peripheral nerve sheath tumor of the breast: case report.

BACKGROUND: Malignant peripheral nerve sheath tumor is a rare soft tissue sarcoma of ectomesenchymal origin. It is the malignant counterpart of benign soft tissue tumors like neurofibromas and schwannomas and may often follow them. Common sites include deeper soft tissues, usually in the proximity of a nerve trunk. Breast is an extremely rare location of this lesion and presentation as a breast lump in the absence of pain or previous benign neural tumor is even rarer. CASE PRESENTATION: A 38-year-old female presented with complaints of painless, hard breast lump for three months which was clinically suspected to be a ductal carcinoma with inconclusive fine needle aspiration cytology. Histopathology revealed a malignant spindle cell tumor which was confirmed to be malignant peripheral nerve sheath tumor on the basis of immunopositivity for vimentin, neurone specific enolase and S-100. CONCLUSION: To the best of our knowledge only six such case reports have been published in literature. The differential diagnosis of malignant peripheral nerve sheath tumor should be considered by the clinician as well as the pathologists in the work-up of a breast neoplasm as treatment and prognosis of this rare malignancy is different.

Rare coexistence of keratinizing squamous metaplasia with xanthogranulomatous pyelonephritis. Report of a case with the role of immunocytochemistry in the differential diagnosis.

BACKGROUND: Xanthogranulomatous pyelonephritis (XPN), a rare form ofchronicpyelonephritis, is commonly associated with lithiasis and rarely leads to keratinizing squamous metaplasia. Its manifestations closely mimic those of a renal neoplasm, leading to misdiagnosis of malignancy, often resulting in radical nephrectomy. The role of immunocytochemistry in the preoperative cytologic diagnosis is assessed in the present case report. CASE: A 20-year-old male presented with fever and an enlarging mass in the right renal angle. Ultrasonography revealed a heterogeneous mass in the renal pelvis. Fine needle aspiration cytology was advised to rule out malignancy. Aspiration smears from the mass showed many dissociated cells and clusters of them with abundant vacuolated cytoplasm, vesicular nuclei and prominent nucleoli in some cells. Many desquamated metaplastic squamous cells were also seen. The background was predominantly necrotic, with inflammatory cells. The cytologic possibility of XPN with squamous metaplasia vs. renal cell carcinoma was considered. Immunocytochemical markers, epithelial membrane antigen (EMA) and CD68 (histiocytic marker) were used to determine the nature of the suspicious vacuolated cells; these cells were immunoreactive for CD68 and negative for EMA, thus confirming the cytologic diagnosis of XPN with keratinizing squamous metaplasia. CONCLUSION: The case highlights the presence of metaplastic squamous cells in XPN in smears for the first time. Immunocytochemistry is an essential tool in the preoperative cytologic diagnosis of XPN. The patient can be managed conservatively with antibiotics.

A rare case of congenital nasopharyngeal teratoma presenting with respiratory distress.

Teratomas of the head and neck are rare, benign neoplasms, usually presenting in the neonatal period and are often malignant with regard to their location. Teratomas occur with a frequency of one in 4,000 live births with head and neck teratomas accounting for <5% of the total. Extensive literature search has shown that there are only two cases congenital nasopharyngeal teratoma reported in India, and we report the third such case.

Lipomatous Polyp Presenting With Intestinal Intussusception in Adults: Report of Four Cases.

Intussusception is a relatively common cause of intestinal obstruction in children but a rare, and uncommon clinical entity in adults accounting for 1%. Lipoma accounts for 4% of all benign tumors of the gut. Most of these are seen in the large intestine, usually submucosal and around ileocecal valve. These are often asymptomatic. Though these lesions are benign, it continues to present difficulties in the preoperative differentiation between malignant and benign colonic neoplasm.

Morphological findings in bone marrow biopsy and aspirate smears of visceral Kala Azar: a review.

CONTEXT: Visceral leishmaniasis (VL) is endemic in India and may simulate and cause many hematological disorders like pancytopenia, myelofibrosis, myelodysplasia and hemophagocytosis. AIMS: The study aims to investigate the hematological manifestation of Visceral Leishmaniasis and associated changes that may be observed in bone marrow aspirate smears and biopsy which may warn a pathologist of possible infections. SETTINGS AND DESIGN: This is a retrospective study of 18 VL cases on B (b) one marrow aspirate and biopsy in the department of Pathology in a tertiary care teaching hospital in New Delhi. METHODS AND MATERIAL: Giemsa stained slides of bone marrow aspirates and hematoxylin and Eosin stained biopsy slides were reviewed in detail by two competent pathologists. All the findings were tabulated and discussed and comparisons made with the previous similar studies. RESULTS: Hyper cellular marrow, increased lymphocytes and plasma cells, marrow granulomas, hemophagocytosis, myelofibrosis, myelodysplasia and gelatinous transformation of the marrow were notable features the presence of which together or individually should caution a pathologist to search for Leishman Donovan (LD) bodies in patients especially in a non-endemic zone in a tropical country.

Demodex-associated dermatologic conditions--A coincidence or an etiological correlate. Review with a report of a rare case of sebaceous adenoma.

Demodex folliculorum is a saprophytic mite of the human pilosebaceous unit with a prelidiction for facial skin and eyelashes. Infestation occurs frequently without symptoms; however, suppurative or granulomatous inflammation may be seen with high mite density. Skin lesions, such as rosacea, pityriasis, and blepharitis, have been attributed to Demodex; however, its role in sebaceous adenoma (SA) has not been reported in extensively searched medical literature. We report this rare case and review the skin lesions associated with Demodex folliculorum.

Bone marrow angiogenesis in aplastic anemia--a study of CD 34 and VEGF expression in bone marrow biopsies.

INTRODUCTION: Bone marrow function and the growth of hemopoietic cells depends on an intact microvasculature. A pivotal regulator of angiogenesis is vascular endothelial growth factor (VEGF). Our study assesses VEGF expression and microvessel density (MVD) in the bone marrow of patients with aplastic anemia (AA). MATERIALS AND METHOD: Bone marrow specimens from 25 patients with AA and 15 controls were studied. MVD was calculated on sections stained immunohistochemically for CD34. Subsequently, all the cases were studied for VEGF expression. RESULTS: Bone marrow MVD in patients with AA was significantly lower than that in controls (p < 0.01). There was a significant MVD difference between severe AA and moderate AA (p < 0.05). VEGF expression was also significantly lower in AA cases compared to controls (p < 0.05). CONCLUSION: Our data show that AA is associated with reduced angiogenesis and reduced VEGF expression. Defective angiogenesis may result in or aggravate bone marrow aplasia in AA patients. There are limited studies on this aspect. More studies to confirm the present hypothesis might pave the way for new treatment options in AA.

A rare coexistence of concurrent breast hemangioma with fibroadenoma: a case report.

We report the case of a 38-year-old Asian, Indian female with capillary hemangioma breast in coexistence with the commonly occurring fibroadenoma. Clinical examination of the breast revealed a 4 cm diameter lump. Mammography revealed a well defined slightly hypoechoic lesion with smooth contours. A lumpectomy was performed. Histopathology confirmed the diagnosis of a completely encapsulated fibroadenoma coexistent with a capillary hemangioma in the adjacent breast tissue. The rarity of literature on breast hemangioma especially capillary type with coexisting fibroadenoma deserves mention.

Acinic cell carcinoma with extensive neuroendocrine differentiation: a diagnostic challenge.

Primary salivary gland carcinoma with neuroendocrine differentiation is of rare occurrence, especially so in the parotid gland. Amongst the various reported primary tumors with neuroendocrine differentiation, acinic cell carcinoma (ACC) one such tumor. A 48 year old lady presented with a gradually increasing right infra-auricular swelling for a period of 1 year which enlarged suddenly in a short period. Contrast Enhanced Computed Tomography (CECT) suggested diagnosis of Pleomorphic Adenoma. Fine Needle Aspiration Cytology (FANC) yielded a cystic fluid suggesting a possibility of Warthin's tumor or Oncocytic lesion. Intraoperative findings were suggestive of a Warthin's tumor. Initial histopathological examination of the tumor was suggestive of neuroendocrine carcinoma. However, extensive sectioning revealed peripheral islands of ACC. Immunoexpression of S-100, Neuron specific Enolase (NSE), Chromogranin A and Synaptophysin confirmed the diagnosis. The possibility of neuroendocrine differentiation in a primary salivary gland tumor should be kept in mind whenever a salivary gland tumor shows only neuroendocrine histology.

Evans syndrome: a study of six cases with review of literature.

Evans syndrome is an uncommon condition characterised by simultaneous or sequential development of immune thrombocytopenia (ITP) and autoimmune haemolytic anaemia (AIHA) with a positive direct antiglobulin test (DAT) in the absence of a known underlying aetiology. The great majority of patients with Evans syndrome have a chronic relapsing course despite treatment, which is associated with significant morbidity and mortality. We reviewed the clinical and laboratory features of six patients with Evans syndrome. All patients had thrombocytopenia, bleeding symptoms and haemolytic anaemia with positive direct Coombs test at presentation. We discuss the aetiopathogenic, clinical, therapeutic and natural history of Evans syndrome.

Ectomesenchymal chondromyxoid tumor of the hard palate--a case report.

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare tumor. Only 26 cases of ECMT have been reported, all occurred in the anterior tongue. We present a case of a 30-year-old male with a nodule in the hard palate, which was reported as ECMT on histopathology. The differential diagnosis considered included are extraskeletal myxoid chondroma, ECMT, pleomorphic adenoma, oral focal mucinosis, chondroid choristoma, and ossifying fibromyxoid tumor. After serial sections no other component was observed and a diagnosis of ECMT was made by exclusion. The patient is asymptomatic on follow up. A review of existing literature is also presented here.