Origin and survival outcomes of Pseudomyxoma peritonei-A retrospective study.

BACKGROUND: Pseudomyxoma peritonei (PMP) is an unusual clinical condition typically presenting with widespread mucinous neoplastic lesions within the peritoneum resulting in gelatin material-rich ascites. It was first described by Werth in 1884. Ever since, its clinical presentation, definition, site of origin, and prognosis have been a subject of debate. However, many histopathologic, immunohistochemical, and genetic studies have attempted to locate the primary lesion in the appendix in both genders. OBJECTIVES: To analyze the histological origin and survival outcomes of pseudomyxoma peritonei in patients treated at a regional cancer center. MATERIALS AND METHODS: Fifteen cases of PMP were diagnosed during the five-year study period. The demographic and clinicopathological details were retrieved; the slides were reviewed and histological parameters reassessed. Descriptive statistics were used to express proportions. Continuous variables were recorded as mean (SD) or median (IQR). Kaplan-Meier (KM) curve was used to estimate overall survival. RESULTS: Mean age for PMP was found to be 47.5 years for low grade Mucinous Carcinoma Peritonei (MCP), 54.2 years for high grade MCP, and 58 years for high grade MCP with signet ring cells. Most common overall presentation was abdominal distension in 53.3% (8/15) of cases, followed by acute appendicitis in 20% (3/15) cases. PMP was detected synchronous with the primary tumor in 9/15 cases (60%). Primary lesion in the appendix was grossly identified in 7/15 cases, while it was not explored in the remaining eight cases. Yet, by combined clinical, radiological, histopathological, and immunohistochemical analysis, we identified that most of the cases (14/15) had an appendiceal origin (93.3%). The overall survival for 12 months was 50% and for 18 months was 37%. CONCLUSION: The surgeon and radiologist may well bear in mind the most common possibility of an appendiceal origin for PMP and resect the appendix, irrespective of the presence of a grossly or radiologically detectable lesions. We emphasize that immunohistochemistry helped to detect the site of origin even when the primary was occult.

Intracellular Toll-Like Receptors Modulate Adaptive Immune Responses in Head and Neck Cancer.

The percentage of head and neck cancer (HNC) positive for human papillomavirus (HPV) is unknown in most parts of India. How toll-like receptors (TLRs) affect the adaptive immune response in HNC is also mainly unknown. We here assessed the expressions of HPV DNA, p16, inflammation, and TLRs in oral squamous cell carcinoma (OC) and oropharyngeal squamous cell carcinoma (OPC). Patients with OC (n = 31) and OPC (n = 41), diagnosed during 2017-2018 at the Malabar Cancer Centre (tertiary cancer center), Kerala, India, were included in the study. Immunohistochemistry was performed on tumor specimens against p16, TLR3, TLR7, TLR8, TLR9, CD4, and CD8. Quantitate polymerase chain reaction for 14 high-risk HPVs (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68) was performed. Seven out of 31 OC (22.6%) were p16+ but only 3.2% (1/31) of OC were positive for HPV DNA. While 24.4% (10/41) of OPC were p16+, HPV DNA was found in only one P16+ OPC and in no P16- OPC. TLR3, TLR7, TLR8, and TLR9 were expressed both in OC and in OPC. The expression of TLR7 was significantly higher in OPC compared with OC. TLR8 expression was correlated with and TLR7 tended to be correlated with the inflammatory score in OPC (r = 0.56, p < 0.05 and r = 0.52, p = 0.08, respectively). In conclusion, the role of HPV in OC and OPC is minor, and p16 constitutes a poor biomarker for HPV positivity in Kerala, India. Intracellular TLRs are correlated with the degree of inflammation in OPC but not in OC and may potentially constitute a medical target in the therapy of HNC in the future.

Ghost Cell Odontogenic Carcinoma with Sarcomatous Transformation : Report of a Rare Case with Review of Literature.

Ghost Cell Odontogenic Carcinoma is a rare malignant odontogenic tumor that can appear as "de novo " or arises from malignant transformation of preexisting benign calcifying odontogenic cysts or dentinogenic ghost cell tumors after multiple recurrences. Ghost cell odontogenic carcinoma is histopathologically characterized by ameloblast-like islands of epithelial cells with aberrant keratinization, simulating a ghost cell, with varying amounts of dysplastic dentine. This article reports an extremely rare case of ghost cell odontogenic carcinoma with foci of sarcomatous change, involving maxilla andnasal cavity which arose from a previously existing recurrent calcifying odontogenic cysts in a 54-year-old man and reviews the features of this unusual and rare tumor. To the best of our knowledge, this is the first case of ghost cell odontogenic carcinoma with sarcomatous transformation to be reported till date. Owing to its rarity and unpredictability of clinical course, long -term follow up of patients with ghost cell odontogenic carcinoma, is mandatory for observation of recurrence and distant metastasis. Keywords: Ghost cell odontogenic carcinoma, maxilla, sarcoma, calcifying odontogenic cysts, ghost cells, odontogenic tumour.

Frequency of EGFR mutations in lung adenocarcinoma patients - A study from tertiary cancer center of South India.

BACKGROUND AND OBJECTIVES: Epidermal growth factor receptor (EGFR) mutation analysis has become an important part of the initial workup of non-squamous non-small cell lung cancer (NS-NSCLC) patients. This study is attempted as South Indians population is comprised of ethnic groups with diverse genetic makeup and only very limited data on EGFR mutation is available from south India. A detailed understanding of EGFR mutation profile will help in better planning of treatment strategies and resource allocation. METHODS: A retrospective analysis of EGFR mutation frequency in 350 patients diagnosed with adenocarcinoma of lung and its association with pathological characteristics was done. RESULTS: Out of 350 cases of pulmonary adenocarcinoma, within an age group ranging from 30 to 86 years. EGFR mutations were identified in 34.8% (n = 122) cases, out of which 35.24% (n = 43) were in non-smoker females (P = 0.001). Of the 14 cases with resistant type of EGFR mutations, nine were in smoker males and the remaining five in non-smoker females. INTERPRETATION AND CONCLUSION: Overall EGFR mutation frequency observed in our study was similar to other Indian studies. However, in our study, we observed that mutation in exon 21 was less frequent compared to other studies. A similar slightly increased frequency of rare mutations and double mutations were observed in our study. A detailed study of the molecular epidemiology of lung cancer and its association with different geographical zones of India is needed. This understanding will help in better planning of treatment strategies and resource allocation.

Predicting donor-related factors for high platelet yield donations by classification and regression tree analysis

Introduction Collecting high-dose (HD) or double-dose (DD) apheresis platelets units from a single collection offers significant benefit by improving inventory logistics and minimizing the cost per unit produced. Platelet collection yield by apheresis is primarily influenced by donor factors, but the cell separator used also affects the collection yield. Objectives To predict the cutoff in donor factors resulting in HD and DD platelet collections between Trima/Spectra Optia and MCS+ apheresis equipment using Classification and Regression Trees (CART) analysis. Methods High platelet yield collections (target ≥ 4.5 × 1011 platelets) using MCS+, Trima Accel and Spectra Optia were included. Endpoints were ≥ 6 × 1011 platelets for DD and ≥ 4.5 to < 6 × 1011 for HD collections. The CART, a tree building technique, was used to predict the donor factors resulting in high-yield platelet collections in Trima/Spectra Optia and MCS+ equipment by R programming. Results Out of 1,102 donations, the DDs represented 60% and the HDs, 31%. The Trima/Spectra Optia predicted higher success rates when the donor platelet count was set at ≥ 205 × 103/µl and ≥ 237 × 103/µl for HD and DD collections. The MCS+ predicted better success when the donor platelet count was ≥ 286 × 103/µl for HD and ≥ 384 × 103/µl for DD collections. Increased donor weight helped counter the effects of lower donor platelet counts only for HD collections in both the equipment. Conclusions The donor platelet count and weight formed the strongest criteria for predicting high platelet yield donations. Success rates for collecting DD and HD products were higher in the Trima/Spectra Optia, as they require lower donor platelet count and body weight than the MCS+.

The Spectrum of Histomorphological Changes and Pathological Tumor Response following Preoperative Oral Metronomic Chemotherapy in Oral Squamous Cell Carcinoma.

Sithara AravindBackground Oral metronomic chemotherapy (OMCT) represents an emerging concept in cancer treatment involving frequent administration of chemotherapeutic drugs at doses below maximum tolerated doses and with no prolonged drug-free break. OMCT is being tried preoperatively in developing nations with constrained resources to prevent disease progression during the waiting period from diagnosis to surgery (bridge OMCT). The aim of the present study was to assess the spectrum of histomorphological changes and pathological tumor response following bridge OMCT in oral squamous cell carcinoma (OSCC) and to propose a new pathological response scoring system. Materials and Methods A retrospective single-center study comprised of tissue sections of tumor proper and metastatic lymph nodes of 50, locally advanced OSCC patients treated with bridge OMCT, and had completed definitive surgery were analyzed. The present study evaluated the histomorphological features and proposed a new scoring system for pathologic tumor response. The pathologic tumor response was categorized as complete response (pCR), no response (pNR), and partial response (pPR). Results Of the total 50 patients, 2 patients had pCR, 3 had pNR, and 45 patients had pPR as per the new proposed scoring system. Note that 96% of the cases showed no disease progression. Conclusion Bridge OMCT is a novel treatment method that can be used to tide over the waiting period between the diagnosis and surgery in resource-constrained institutions with heavy patient load. This mode of treatment in locally advanced OSCC seems to provide promising results in this setting. Large multicentric trials are warranted to confirm these results.

Testing for Microsatellite Instability in Colorectal Cancer - a Comparative Evaluation of Immunohistochemical and Molecular Methods.

BACKGROUND: Introduction: The majority of colorectal cancers (CRC) develop through the chromosomal instability pathway and approximately 15% display microsatellite instability (MSI) as a carcinogenic event. CRCs with microsatellite instability status have a characteristic phenotype. We aimed to assess the clinico-pathological and MSI profiles of sixty-one cases of CRC through immunohistochemical (IHC) staining for the mismatch repair(MMR) proteins and DNA based Polymerase Chain Reaction (PCR) assay for microsatellite markers. PATIENTS & METHODS: Haematoxylin & Eosin stained sections of the tumor were evaluated for various histopathologic features. Immunohistochemistry was performed for the four MMR proteins, MLH1, MSH2, MSH6 and PMS2. NCI recommended panel of five nucleotide repeat markers was amplified from tumor DNA. RESULTS: The majority of the patients were males above fifty years of age. Around 61% of tumors were in the leftsided colon. Adenocarcinoma NOS (55, 90%) was the most common histological type. A total of 18 (29.5 %) cases showed dMMR by immunohistochemistry. Loss of PMS2 protein and combined loss of MSH2 & MSH6 were the most common findings in low and high MSI respectively. Of the 13 cases selected for PCR analysis, nine cases had high MSI (at least two markers unstable) and four cases had low MSI (one marker unstable) Results of PCR based DNA assay showed good concordance with IHC. No significant statistical association could be identified between the status of MSI by either methods and sociodemographic or clinical features. DISCUSSION: MSI constitutes 12%-20% and 6%-13% of CRCs in Western and Eastern countries respectively. In our series IHC staining revealed that 29.5% of cases showed dMMR. This was similar to other Indian studies which reported a prevalence of 22-27%. The combined loss of MSH2 & MSH6 (78%) was the most common type of dMMR. There was good concordance between IHC and PCR results. The issue of heterogenous or weak staining is a limiting factor in IHC interpretation and few cases of dMMR may be missed. CONCLUSION: To conclude, IHC can be a very useful screening tool to detect microsatellite instability and triage cases of dMMR for MSI biomarker testing. The MSI status also serves as a prognostic and predictive tool. KEY WORDS: Colorectal cancer, microsatellite instability, immunohistochemistry, Polymerase chain reaction.

Determination of mononuclear cell count using peripheral smear and flow cytometry in peripheral blood stem cell products: A retrospective study from an Indian cancer center.

BACKGROUND: Mononuclear cells (MNCs) are considered equivalent to hematopoietic stem cells, and differential count using peripheral smear was routinely practiced to enumerate MNC. Flow cytometry plots used for CD34 enumeration assay can also be used in MNC enumeration as it counts more WBC events than manual methods. The aim was to determine the relationship and degree of agreement between peripheral smear and flow cytometry in MNC enumeration of peripheral blood stem cell (PBSC) products. METHODS: In 63 patients, 73 PBSC products were collected between January 2017 and September 2019. The differences in MNC count estimated by peripheral smear method and from flow cytometry plots used for CD34 enumeration were analyzed using Mann-Whitney test. Agreement between the two methods for MNC enumeration was determined by regression analysis. Receiver operating characteristic curve was performed to determine MNC threshold in peripheral blood and PBSC product for adequate mobilization and harvest. RESULTS: There was no difference in enumeration of median MNC count between peripheral smear and flow cytometry (52% vs. 59%, P = 0.185) in PBSC product. However, regression analysis indicated a constant and proportional difference between the methods with r = 0.52. Cumulative sum test for linearity showed deviation from linearity (P = 0.04). MNC counts in peripheral blood failed to achieve discrimination capacity in predicting adequate CD34+ yield/kg body weight in product. CONCLUSION: Peripheral smear estimated lower MNC counts than flow cytometry with weaker agreements between the two methods. Hence, MNC count derived from flow cytometry plot can substitute peripheral smear method for MNC dose calculations. MNC dose at 3.4 × 108/kg consistently predicted >2 × 106/kg CD34+ cells collected.

Comparison of abo antibody levels in apheresis platelets suspended in platelet additive solution and plasma

ABSTRACT Background Transfusion of platelets (PLTs) with high ABO antibody titres can pose a risk of hemolysis if the unit crosses the ABO type. The PLTs stored in the platelet additive solution (PAS) remove asubstantial fraction of plasma and replace it with an isotonicbuffered solution.We aimed to assess the difference in anti-A/B antibody levels in Groups O, A and B apheresis platelets (APs) suspended in plasma and PAS. Methodology Apheresis donors are categorized into two groups, Plasma (Group I) and PAS (Group II), each blood group (A, B and O) had 20 samples. The anti-A/B(IgM)antibody levels were recorded from the AP donor (Group II) and from the AP units for both groups. The reduction in the anti-A/B(IgM) antibody levels in the APs suspended in the PAS for each blood group was determined. Results The median anti-A titres in blood Groups B (p = 0.009) and O (p = 0.005) was significantly lower in Group II. However, the difference in anti-B levels was not significant in the blood groups A (p = 0.057) and O (p = 0.205). The median level of reduction in IgM antibody titres across donor samples and the PAS-stored platelets was two-fold. The regression showed a level of reduction in antibody titres which can be explained by baseline donor antibody titres in blood groups A and B compared to blood group O. Conclusion The medianABO antibody titres were lower in APs suspended in PAS than in plasma. Addition of the PAS significantly lowered the IgM antibody titres by twofold, compared to plasma.

Recurrent hyperhemolytic transfusion reaction in myelodysplastic syndrome- A case based approach.

We present here a case report of a 27 year old female, with myelodysplatic syndrome suspected to have recurrent hyperhemolytic transfusion reactions (HHTR). Patient was transfusion dependent for ten years and was transfused with leukodepleted and irradiated Packed Red Blood Cells (PRBC). She presented with signs and symptoms of acute intravascular hemolysis, deranged coagulation profile with post transfusion Hb lower than baseline. Post transfusion workup was uneventful. She was managed conservatively with fluid support and methylprednisolone initially. After few uneventful transfusions, patient developed second episode of HHTR with compatible unit.Immunophenotype favored an inflammatory response possibly induced by monocytic lineage. As transfusion dependent, the patient required methylprednisolone as premedication and all subsequent transfusions were uneventful.

Evaluation Of Pathological Response And Its Predictors In Carcinoma Rectum Following Neoadjuvant Chemoradiation.

BACKGROUND: Neoadjuvant chemoradiation followed by surgery is the standard of care in locally advanced rectal tumors. Better pathologic response after chemoradiation is associated with better outcomes. Pathologic response may depend on various, patient and tumor related factors. The aim of our study was to assess the pathological response using a modified Ryan scoring system and to study various factors which influence the response. MATERIALS AND METHODS: This is a retrospective study carried out at a tertiary cancer centre in India. Patient details and histopathology reports of rectal cancer patients who took neoadjuvant chemoradiation from January 2016 to December 2018 were analyzed. Demographic details, pathological response assessed by modified Ryans tumor regression grade (TRG) score and various factors which influence the pathological response were studied. Those with TRG score 0 (complete response) and1(near complete response) were grouped together as good responders and those with score 3 (partial response) and 4 (poor or no response) as poor responders. Univariate and multivariate analyses were performed using logistic regression to determine factors which influence pathologic response. RESULTS: There were a total of 83 patients. Males and females were equally distributed. 43.4%(n=36) of patients had lower rectal tumors,32.5%(n=27) had midrectal tumors and 24.1%(n=20) had upper rectal tumors. 46% of patients were good responders which includes complete responders ,17% (n=14) and those with a near complete response,29% (n=24). 54% of patients were poor responders,which includes those with incomplete response,36% (n=34) and with no or poor response,18% (n=15). Among the upper rectal tumors, only 20% had good response and among the mid and lower rectal tumors 54% had good response.(p value 0.02).63% of males were good responders in comparison to 37% among females (p value 0.05). DISCUSSION: Response to neoadjuvant chemoradiation with capecitabine in locally advanced rectal tumors in our institute is similar to the literature data with a complete response in 16.9%, near complete response in 28.9% partial response in 36.1% and no response in 18.1% of patients, according to modified Ryan score. It was found that upper rectal tumors had a poorer response when compared to mid and lower tumors and females had a poorer response compared to males. CONCLUSION: Even though neoadjuvant chemoradiation remains the standard of care in locally advanced rectal carcinomas, its benefit in upper rectal tumors needs to be validated in larger studies.

Expression of p16INK4a in oropharyngeal squamous cell carcinoma from a tertiary cancer centre of South India: A preliminary study.

Background & objectives: Human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma (OPSCC) are found to be strongly associated with each other with an increase in incidence has been noted globally over the years. A literature search for data depicting the role of HPV in oropharyngeal carcinoma in South India, however, has resulted in little information, thus, the present study was aimed to assess a possible association between the two among OPSCC patients from a tertiary care cancer centre in South India. Methods: One hundred and fourty three OPSCC cases were included in the study and analyzed for age, gender, marital status, habits, clinical TNM staging, site, laterality, symptoms, histological type (keratinizing and non-keratinizing), primary treatment and follow up period. All the cases were subjected to p16INK4a immunostaining. Statistical analysis was done using SPSS software. Results: Of the 143 cases 12 were found to be p16 positive with no significant difference between the study variables among p16 positive and negative cases. Base of the tongue was the most commonly involved site for the p16 positive cases. The p16 positive cases presented at an elderly age, early stage and were mainly the keratinizing type. Interpretation & conclusions: The p16 positive OPSCC cases constituted a small proportion in the present study and behaved similar to p16 negative cases. Usage of tobacco and alcohol appear to be the susceptible factors even in p16 positive cases. More studies from other States would be helpful to determine if HPV-related SCC in the Indian subcontinent behave differently or similarly to cases from Western countries.

Incipient Warthin tumor of intraparotid lymph node in a patient with squamous cell carcinoma of the external auditory canal: An incidental finding.

The occurrence of intranodal salivary gland neoplasm is uncommon; squamous cell carcinoma (SCC) of the external auditory canal (EAC) is another rare occurrence. Clinically, SCC of EAC presents with symptoms similar to other benign otologic conditions. A case of Stage I SCC in EAC region is presented here in a 60-year-old male patient with incidental intranodal Warthin tumor along with the histological differential diagnosis. The patient is being followed up. There is no evidence of recurrence 1 year and 11 months after surgery.

Flow cytometric enumeration of CD34+ hematopoietic stem cells: A comparison between single- versus dual-platform methodology using the International Society of Hematotherapy and Graft Engineering protocol.

BACKGROUND: Flow cytometric enumeration of CD34+ hematopoietic stem cells (HSC) is the reference point for undertaking apheresis and evaluation of adequacy for peripheral blood stem cell (PBSC) engraftment. AIMS: To determine whether single platform correlates with dual platform methods in CD34+ enumeration using ISHAGE protocol. METHODS: Retrospective analysis of CD34 Enumeration assays on both peripheral blood and PBSC product samples using Beckman Coulter FC500 Flow Cytometer. The t test and correlation study was used to study the difference between single and dual platform methods in CD34+ enumeration. RESULTS: We present our data on 152 samples comprising 41 peripheral blood samples collected before apheresis procedure and 111 samples collected from PBSC product. We observed strong positive correlation between single and dual platform methods for CD34+ counts in peripheral blood sample (r = 0.92; P < 0.001) and PBSC product sample (r = 0.85; P < 0.001). CONCLUSION: In our study, both single versus dual platform had similar results in CD34+ cell counts. The single platform provides rapid results with ease of procedure. Errors with dual platforms are relatively common with respect to denominator. We recommend to use mean of total leukocyte count from two different hematology analyzer to minimize variation in dual platform.

Frozen Section Evaluation in Head and Neck Oncosurgery: An Initial Experience in a Tertiary Cancer Center.

OBJECTIVE: Frozen section evaluation is routinely used by oncosurgeons across specialties for rapid assessment of the presence of tumor in any tissue and its most common use is in surgical margins. Today, the use of intraoperative frozen-section evaluation of surgical margins is an accepted and frequent practice in head and neck oncology. This study aims to determine the efficacy and accuracy of frozen sections in head and neck cancer patients and compare the results with the respective paraffin sections and also to analyze the reasons for any disparity between them. MATERIAL AND METHOD: A retrospective study was conducted to evaluate efficacy and accuracy of frozen section in head and neck cancer of 265 patients, treated at a tertiary cancer centre hospital between January 2013 to December 2014. RESULTS: Out of 265 cases, it was found that 12.6% of these sections showed true positivity, 6.3% false positivity, 2.9% false negativity and 78.2% true negativity. The study also shows a sensitivity of 82.05% and specificity of 96.46%. CONCLUSION: Our study shows that intraoperative frozen section reports are specific and highly sensitive. We recommend a minimum of 3-4 sections, optimum cryostat temperature, good section thickness and quality staining for a good concordance rate.

Laryngeal Basaloid Squamous Cell Carcinoma with a Substantial Spindle Cell Component: Case Presentation and Updated Review of Literature.

Basaloid squamous cell carcinoma with spindle cell component is an uncommon aggressive variety of squamous cell carcinoma with only a few reported cases in literature. Histologically a combination of basaloid squamous cell carcinoma and spindle cell squamous cell carcinoma is appreciated and immunohistochemistry serves a role in differentiation from malignant neoplasms of salivary gland or neuro-endocrine origin. Prime treatment modality is combination of surgery and external beam radiotherapy. A case of basaloid squamous cell carcinoma with proliferation of bizarre mesenchymal component is being reported here with an updated literature review.

Clinicopathological Spectrum of Anaplastic Carcinoma of Thyroid - 5 Year Experience from a Tertiary Cancer Centre.

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive and lethal solid tumors known to affect humans. Although ATC accounts for only 1% to 5% of all thyroid tumors, it portends a dismal prognosis with a median survival of 4 to 12 months from the time of diagnosis. In this retrospective review we aim to study the clinical, cytological and histopathological features and management of ATC cases reported in our institution. MATERIALS AND METHODS: Twenty-two patients with ATC were identified from institutional database between January 2012 and December 2016. Clinicopathologic data and survival data was obtained from the medical records. Fine needle aspiration cytology (FNAC) slides and histological slides were reassessed for the predominant morphologic findings. RESULTS: Of the 22 patients, 8 were male and 14 were female. The median age at presentation was 70 years (range 50-85 years) with a median survival of 3 months. A history of pre-existing thyroid disease was present in 32% of the patients. Distant metastases were seen in 41% of patients. FNAC findings noted were pleomorphic vesicular nuclei, multinucleated giant cells, necrotic background, atypical squamoid cells, spindle cells and atypical mitosis. Majority of the patients (59%) received palliative radiotherapy as treatment.14% underwent total thyroidectomy and remaining 27% received best supportive care. CONCLUSION: ATC remains a highly lethal disease with limited survival .FNAC can serve as a reliable tool in the early diagnosis. With several drugs in clinical trial, the therapeutic scenario of ATC might improve in future.

High Grade Serous Cystadenocarcinoma of Testis-Case Report of a Rare Ovarian Epithelial Type Tumour.

Ovarian epithelial type tumour of testis are extremely rare tumours that resemble ovarian surface epithelial tumours. They usually present as testicular or paratesticular tumours and can be serous, mucinous, endometrioid or Brenner tumour. Serous and mucinous types account for the majority of tumours. The tumours are benign, borderline or malignant, commonly borderline. Here, we report a case of high grade serous cyst adenocarcinoma of testis which manifested as extensive metastasis in supraclavicular, mediastinal and abdominopelvic groups of lymph nodes, lung and adrenal gland without clinical evidence of an overt primary tumour. We report this case so as to make clinicians and pathologists aware of this rare entity and to stress on the fact that this rare entity should be kept in mind when evaluating cases of metastatic adenocarcinoma in male patients.