Xanthogranulomatous Cholecystitis with Florid Ducts of Luschka: Double Trouble Mimicking Malignancy.

Xanthogranulomatous Cholecystitis (XGC) is an uncommon inflammatory condition of gall bladder, which is often misdiagnosed as malignancy preoperatively, leading to extensive surgical resections which may not be necessary for the patient. Ducts of Luschka are a rare developmental variant of the biliary tree, which are prone to injury and bile leak during cholecystectomy. We report a case of a 52-year-old male patient who was taken up for surgery with a provisional diagnosis of chronic calculous cholecystitis. Intraoperative finding of dense adhesions, made the surgeons suspect malignancy. On histopathological examination, it was not only diagnosed as a case of XCG, but it also had florid ducts of Luschka, another rare variant needing documentation as it is a close mimicker of malignancy.

Bilateral Primary Papillary Serous Carcinoma of the Fallopian Tube.

Primary fallopian tube carcinoma is considered one of the rarest female genital cancers, and its bilateral occurrence is even rarer. Because of the rarity of fallopian tube carcinomas as well as the clinical presentation which simulates an ovarian cancer, a correct preoperative diagnosis of fallopian tube carcinoma is seen only in 4% of cases, and is usually first appreciated by Pathologists. We are reporting our experience of a case of bilateral primary serous carcinoma of the fallopian tube in a 36-year-old female.

Role of fine-needle aspiration cytology in the diagnosis of major salivary gland tumors: A study with histological and clinical correlation.

INTRODUCTION: Neoplastic lesions of salivary glands present an interesting subject because of their histologic diversification. Complex features exhibited by them have aroused considerable speculations concerning their histogenesis and continues to hold the interest of clinicians and pathologists. Major salivary glands are superficial and have easy accessibility for fine-needle aspiration cytology (FNAC). These glands are generally not subjected to incisional or core needle biopsy, because of the possible risks of fistula formation and tumor seedling. FNAC diagnosis of major salivary gland neoplasms aids in proper planning of required surgery and avoidance of the same in cases of non-neoplastic lesions. MATERIALS AND METHODS: Cytological features of major salivary gland tumors diagnosed on FNAC were studied over a period of one and a half years. Cytological and architectural patterns in smears were compared with histopathological features in cases where the specimens were available with a note on the age, sex and presenting complaints. STATISTICAL ANALYSIS: Analysis of variance (ANOVA) was used to find the significance of study parameters. Chi-square/Fisher Exact was used to find the significance of study parameters on categorical scale between two or more groups. P value of <0.05 was considered to be significant. RESULTS: A total of 114 salivary gland FNACs were done, 75 patients were clinically suspected to be neoplasms. The peak incidence was in the third to fourth decade of life with a female preponderance. Parotid was the most commonly affected gland (80%) with pleomorphic adenoma and mucoepidermoid carcinoma (10.7%) being the most common benign and malignant tumors respectively. The diagnostic accuracy of FNAC was 97.6%. Warthins tumor was misdiagnosed and was associated with a strong smoking history. CONCLUSION: Salivary gland neoplasms constitute a small but significant percentage of head and neck tumors. FNAC is inexpensive, quick, and aids in the preoperative diagnosis and planning of surgery.

Basal cell adenoma of the parotid gland: Cytological diagnosis of an uncommon tumor.

Basal cell adenoma (BCA) is a rare benign epithelial tumor of the salivary gland, displaying monomorphic basaloid cells without a myxochondroid component, representing 1-3% of all salivary gland neoplasms seen predominantly in women over 50 years of age. It is uncommon in young adults. Cytodiagnosis of basaloid tumors chiefly basal cell adenoma of the salivary gland, is extremely challenging. The cytological differential diagnoses range from benign to malignant, neoplastic to non- neoplastic lesions. Histopathological examination is a must for definitive diagnosis, as these entities differ in prognosis and therapeutic aspects. We present a 22-years-old male with this uncommon diagnosis with a discussion on the role of cytological diagnosis. Fine needle aspiration cytology is a simple, minimally invasive method for the preoperative diagnosis of various types of neoplastic and non-neoplastic lesions. The knowledge of its pitfalls and limitations contributes to a more effective approach to treatment.

Isolated intracranial rosai-dorfman disease involving the meninges: report of a rare case.

Sinus histiocytosis with massive lymphadenopathy or Rosai-Dorfman disease (RDD) is a reactive condition of unknown etiology, characterised by a proliferation of histiocytes exhibiting emperipolesis of lymphocytes and plasma cells. It usually presents as bilateral painless cervical lymphadenopathy. Extranodal RDD without nodal disease is seen in 23% of the cases. Intracranial RDD occurs in less than 5% of the total number of patients with extranodal disease. Isolated intracranial RDD in the absence of nodal disease is exceptional. We report a case of Rosai-Dorfman disease with isolated intracranial involvement. A 38-year-old man came with long-standing headache and the magnetic resonance imaging (MRI) scan showed features of meningioma. The histopathology revealed sheets of histiocytes displaying emperipolesis. These histiocytes were S100 positive but CD1a and epithelial membrane antigen negative.

Amelanotic melanoma masquerading as a superficial small round cell tumor: a diagnostic challenge.

Malignant melanoma poses a remarkable capacity for morphological diversity and often presents as a diagnostic challenge due to its wide clinical presentation. We present a case of a 73-year-old lady, with a large superficial ulcerative nodular mass on the flexor aspect of the right upper arm. On fine needle aspiration poorly differentiated round cell tumor was suggested, with histopathology also supporting the same diagnosis. A final diagnosis of amelanotic melanoma was given following immunohistochemical work-up using a panel of relevant markers. We are presenting this case, not only for its rare clinical presentation, but also for the diagnostic difficulties encountered by us in cytology and histopathology to reach the final diagnosis.

Aggressive Digital Papillary Adenocarcinoma-A rare Entity Posing a Diagnostic Challenge.

Aggressive digital papillary adenocarcinoma (ADPCA) is rare tumor of the sweat glands, which is characterised by lesions on the fingers, toes and the digits. The lesion is serious but often overlooked because it is confused clinically with benign and non-tumorous entities. In this paper, we present an interesting case of ADPCA in a 40-year-old lady, suspected clinically as pyogenic granuloma, with the initial excision biopsy indicating a malignant tumor in the sweat gland. Ray amputation of the affected finger was done followed by a thorough work up to rule out metastasis. Histopathological features were studied in detail, along with required markers. We present this case as the documentation of this malignant tumor is limited in literature and also it requires a high index of suspicion when dealing with all masses arising on the digits.

Emphysematous pyelonephritis in a diabetic leading to renal destruction: pathological aspects of a rare case.

Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority of cases occur in diabetics with poor glycemic control, while a small percentage may be due to urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment, presenting with left flank pain and poor stream of urine since one week. Laboratory tests revealed that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal parenchymal destruction. The nephrectomy specimen was studied in detail to know the histopathological findings in a case of diabetic patient with emphysematous pyelonephritis. We present this case not only because of it being a rare complication of diabetes, but also to focus on the histopathological findings of the same, documentation of which is limited in literature.

Isolated primary renal echinococcosis: a rare entity.

Primary renal echinococcosis, a rare entity in diseases involving the kidney, accounts for 2-3 % of all cases. We present a case of 37-year-old female presenting with pain in the right iliac fossa. Radiologically, both ultrasound abdomen and CECT diagnosed as hydatid cyst, mild to moderate hydronephrosis, proximal hydroureterosis, and a possibility of rupturing into the pelvicalyceal system. Renal sparing surgery is the treatment of choice in most cases (75 %) with nephrectomy being reserved for non-functioning kidney as in our case. Histopathological examination of the nephrectomy specimen confirmed the diagnosis.

Malignant myoepithelioma of the breast: case report with review of literature.

Myoepithelial lesions of the breast are extremely rare and can present with a diverse morphology. We report a case of malignant myoepithelioma characterized by proliferation of atypical oval to polygonal cells expressing typical myoepithelial markers. A 45-year-old lady presented with a mass in the left breast. Fine needle aspiration yielded a cellular smear with large papillae-like clusters of monomorphic cells with naked nuclei in the background. A diagnosis of sub-areolar sclerosing duct hyperplasia was made on cytology and the patient underwent excision. The surgical specimen showed a grey-white 5x3 cm mass on cut surface. Histopathology revealed mitotically active (5-6 per 10hpf) oval to polygonal cells tumor cells with clear to eosinophilic cytoplasm arranged in the form of nodules separated by dense sclerotic stroma mimicking clear cell or adenoid-cystic carcinoma. A diagnosis of malignant myoepithelioma was made as the cells were CK14 and SMA positive, and negative for ER and PR on immunohistochemistry. We discuss the unusual morphological features of malignant myoepithelioma, cytological findings and the important differential diagnoses of malignant myoepthelial lesions. A high degree of suspicion with a keen eye for morphological details coupled with relevant immunohistochemistry will aid in arriving at the diagnosis.

Type II First Branchial Cleft Cyst: A Case Report with Review of Literature.

We report a rare case of type II first branchial cleft cyst that presented as an intraparotid cyst. Rarity and varied presentations of the first branchial cleft cysts have led to frequent misdiagnosis. High index of suspicion is required. Complete excision is the main treatment.

Cytomorphology of dedifferentiated liposarcoma of the subcutis of the upper back with axillary lymph node metastasis: a case report.

BACKGROUND: Liposarcoma in subcutaneous location is rare, and dedifferentiation is extremely rare. CASE: A 65-year-old woman presented with a mass in the upper back of 13 years' duration with a recent history of increase in size. Fine needle aspiration cytology of the mass and axillary lymph nodes showed pleomorphic cells and lipoblasts. Cytologic diagnosis of dedifferentiated liposarcoma was done and was later confirmed on histopathology. CONCLUSION: Diagnosis of dedifferentiated liposarcoma can be attempted on fine needle aspiration cytology smears.

Fine needle aspiration cytology of juvenile hyaline fibromatosis: a case report.

BACKGROUND: Juvenile hyaline fibromatosis (YHF) is a rare inherited disorder characterized by tumorous growth of hyalinized fibrous tissue. No report on cytomorphology of this condition is available in English on MEDLINE. CASE REPORT: A 6-year-old girl had multiple nontender nodules on both ear lobes, nose and scalp. Fine needle aspiration of the nodule on the left ear revealed benign, spindle-shaped cells with an eosinophilic ground substance in the background. The diagnosis of JHF was made following cytologic and histopathologic studies. CONCLUSION: Fine needle aspiration cytology is reliable for the diagnosis of JHF.

Adult Wilms' tumour: a case report with review of literature.

BACKGROUND: Wilms' tumor is the commonest primary malignant renal tumor in childhood. Rarely, it may present in the adult age group. CASE PRESENTATION: We report a 48-year-old male presenting with flank pain and haematuria. Abdominal ultrasound revealed a right renal mass measuring 11 x 10 cms, and a clinical diagnosis of renal cell carcinoma was made. Nephrectomy was performed, and a final diagnosis of adult Wilms' tumor was made based on the criteria proposed by Kilton et al. CONCLUSION: The possibility of an adult Wilms' tumor should be considered when a patient presents with pain in the flank and a renal mass. Rarity of the tumor favors documentation in literature.

Macrofollicular encapsulated papillary thyroid carcinoma--a case report.

Macrofollicular encapsulated papillary thyroid carcinoma (MEPC) is a rare variant of papillary carcinoma of thyroid with a favourable clinical course. It could be mistaken for a follicular neoplasm or a hyperplastic nodule. We report cytological and histopathological features of this rare variant of papillary carcinoma in a 22 year old female with brief review of literature.

Mammary hamartoma--a case report.

Mammary hamartoma is a rare lesion commonly associated with Cowden syndrome. It presents clinically as a fibroadenoma. The nonspecific cytological findings makes the pre-operative diagnosis of this lesion difficult. Though hamartomas of the breast are predominantly benign, co-existent malignancies within them have been reported. These lesions also have a tendency to recur; hence a correct diagnosis and extensive sampling of hamartoma is essential. We report a case of mammary hamartoma with a brief review of literature.

Squamous metaplasia in a multinodular goiter: a case report.

Squamous epithelium in thyroid is an unusual finding. It is seen in a variety of inflammatory and neoplastic conditions. It's presence has been attributed to metaplastic change of follicular epithelium by some authors and to the persistence of ultimobranchial body by others. We encountered a case of multinodular goiter with groups of squamous cells lining a cystic cavity. We report it because of it's rarity with a brief review of literature.