Papillary meningioma with prominent flow voids.

This report presents an extremely rare case of papillary meningioma with prominent flow voids and increased perfusion parameters on MRI in a 28-year-old male presenting with headache. This knowledge helped the neurosurgeon to minimise intra-operative blood loss and achieve a favourable post-surgical outcome. Contribution: A rare case of papillary meningioma and its differentiating features from typical meningiomas have been discussed considering its implications for management as well as prognostication to reduce morbidity and mortality.

Epithelial-Myoepithelial Carcinoma of Nasal Cavity at an Unusual Age: A Case Report and Review of Literature.

Introduction: Epithelial-myoepithelial carcinoma (EMC) was recognised as a distinct pathologic entity in World Health Organisation classification. It is an extremely rare low grade carcinoma of salivary gland, with characteristic biphasic tubular structures. It predominantly occurs in Parotid gland but can also be seen in nasopharynx, lacrimal gland, paranasal sinuses, larynx, lung. Nasal EMC (excluding the paranasal sinuses as primary tumour site) are very rare with only 13 cases reported till date. In this case report, we described a case of nasal EMC extending into nasopharynx, its clinical features and management. We have also done a literature review of all the relevant cases of nasal EMC. Material and Methods: We searched the PubMed database for articles between January 1950 and December 2022 for nasal EMC for this review. Results: We found 13 relevant case reports of nasal EMC and median age was 58 years with female preponderance. We found that our patient was the youngest to be reported till date. Two cases, including the current study, showed epicentre of the tumour in posterior nasal cavity, extending to choana and nasopharynx. Most common presentation was epistaxis, followed by nasal obstruction. Only 4 out of 14 cases had information on surgical margin status, out of which only one has positive surgical margin. Five patients (including the patient in the current study) received adjuvant radiotherapy; however 6 patients (42.8%) did not receive any adjuvant radiotherapy.

Primary Cutaneous Adenoid Cystic Carcinoma Of The Chest Wall With Axillary Lymph Node Metastases And Its Management: A Case Report.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of adenoid cystic carcinoma (ACC) arising commonly from the salivary gland. Less often they originate outside the head and neck region, with the scalp being the commonest cutaneous site in 40% of the cases. The presentation on the chest wall is rare, with no reports to date on axillary lymph node metastases. Here we report a case of a 65-year-old female with previously operated PCACC of the chest wall at a different center, showing uptake on positron emission tomography imaging at the site of surgical scar that w as inconclusive on needle biopsy metastasized to the axillary lymph node confirmed by needle biopsy managed with wide local excision, axillary lymph node dissection, and chest wall reconstruction with keystone island flap. The postoperative outcome was uneventful with no recurrence or axillary complications at one year's follow-up. She was advised to receive adjuvant radiotherapy; however, she refused. To conclude, though PCACC is rare, they can have an aggressive presentation, and a multidisciplinary approach is necessary for a better outcome.

Rare Presentation of Tuberculous Osteomyelitis of Mandibular Condyle Mimicking as Parotid Tumor: A Case Report.

Tuberculosis (TB) is a significant health problem and mortality in most developing countries. It is a chronic granulomatous disease caused by Mycobacterium tuberculosis and M. tuberculosis complex. It can be pulmonary form or Extra pulmonary form. Extrapulmonary tuberculosis involving temporomandibular joint is infrequent presentation of Skeletal TB. Here we present a rare case of extrapulmonary tuberculosis that was initially misdiagnosed as a parotid lesion due to atypical signs and symptoms and multiple in-conclusive FNAC reports. The final diagnosis was established by histopathological report.

The immunohistochemical biomarker B-cell lymphoma-2 expression in malignant and premalignant lesions of the uterine cervix and its association with human papillomavirus infection.

Introduction: Cervical cancer is one of the leading causes of cancer deaths among women. It results due to human papillomavirus (HPV) infection. Cervical intraepithelial neoplasia (CIN) is the preinvasive condition of cervical cancer. Various objective immunohistochemical (IHC) markers have been studied for cervical cancer. This study is aimed at studying the expression of B-cell lymphoma-2 (Bcl-2) IHC marker among preinvasive and invasive lesions of cervical cancer and its association with HPV infection. Methodology: This prospective study was conducted over a period of 1 year in a tertiary care hospital in central India, included 73 women suffering from CIN and cancer cervix. The expression of Bcl-2 and the presence of HPV genotypes were studied. Results: Out of 73 patients, 34 had cancer cervix, out of which 15 (44%) had Bcl-2 positivity, 24 had CIN 1, out of which 13 (54%) had Bcl-2 positivity, 10 had CIN 2, out of which 4 (40%) had Bcl-2 positivity and 5 had CIN 3, out of which 3 (60%) had Bcl-2 positivity. No significant difference was found in Bcl-2 positivity among CIN-1, CIN-2, CIN-3, and cancer cervix cases with a Chi-square value of 1.116 and P = 0.77. HPV positivity was found in 41 (56%) out of 73 patients where HPV 16 subtype was the most common (31.5%), followed by HPV 18 (13.7%). No significant association between HPV positivity and Bcl-2 positivity was found with P = 0.34. Conclusion: Bcl-2 IHC seems to have variable expression among CIN cases. Although its expression is low among invasive cancer cases when compared with preinvasive lesions, the difference is not significant. Similarly, no significant association was found between Bcl-2 expression and HPV infections.

Juvenile Psammomatoid Cemeto-ossifying Fibroma of Mandible: a Diagnostic dilemma.

Psammomatoid Juvenile ossifying fibroma (PsJOF) is a rare benign fibro-osseous lesion characterised to grow to unusually large size very rapidly. Its usual presentation is in younger age group mostly children and predominately involving the Sino-Naso-Orbital region. Its aggressive nature gimmicks a malignant lesion but it is rather a benign lesion with a higher recurrence rate than the conventional ossifying fibroma but lacking metastatic potential. The high recurrence rate makes it essential that the lesion is not reconstructed immediately and thorough monitoring in the follow-up period. Lesion of such clinical importance needs to be diagnosed preoperatively to provide a better and radical surgical treatment option, but the variability in its presentation as seen in this case makes it even harder to diagnose. We aim to draw attention to the rare phenomena that PsJOF presents to help readers broaden their purview in diagnosis and thereby manage them accordingly.

FNAC of Breast Lesions with Special Reference to IAC Standardized Reporting and Comparative Study of Cytohistological Grading of Breast Carcinoma.

BACKGROUND: International Academy of Cytology (IAC) has established a process to produce comprehensive and standardized approach to fine-needle aspiration cytology (FNAC) reporting. They have categorized the breast lesions in C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant). AIMS AND OBJECTIVES: The aim of study is to classify various breast lesions (C1 to C5) and to grade breast carcinoma on FNAC using Robinson's grading system which is then correlated with modified Bloom-Richardson grading. MATERIALS AND METHODS: All routine FNAC for breast lump were included in the study during the period from Jan 2016 to Jan 2017. The study was conducted in the Department of pathology and lab medicine of a tertiary care hospital in central India. RESULTS: A total 225 female patients were included in the study, with an age group ranging from 15 - 79 years, with lesions in breast were taken. C1 lesions were found in 3 cases, C2 in 186 cases, C3 in 13 cases, C4 in 4 cases, and C5 in 19 cases. Correlation of cytohistological grading was obtained in 108 cases. CONCLUSION: Cytological categorization based on IAC structured reporting will enhance the reproducibility of reports among pathologist & clinicians. With the comparison between cytohistological nuclear grading, the cytoprognostic scores will help in evaluating the aggressiveness of tumor, predicts histological grade and prognosis. It could be a useful parameter for selecting neo-adjuvant chemotherapy.

Disseminated Cutaneous Rhinosporidiosis.

A 41-year-old man from the state of Chhattisgarh, India, had a previous history of nasopharyngeal rhinosporidosis for 27 years, for which he had surgical intervention seven times, most recently endoscopically 2 months earlier. For the last 8 months, he had noticed skin lesions on the shoulders and forehead. Of interest was a history of bathing in ponds as a child. Examination revealed a soft, skin-colored, strawberry-shaped papule on the forehead (Figure 1A), a papule with a hemorrhagic crust on the left shoulder (Figure 1B), and a crusted friable plaque on the right shoulder (Figure 1C). Endoscopy revealed a 1 cm × 1 cm red polypoidal mass on the lateral wall of the nasopharynx. A diagnosis of disseminated cutaneous rhinosporidiosis with nasal-nasopharyngeal rhinosporidiosis was considered.

Protective effect of Zizyphus spinachristi on MPP+-induced oxidative stress.

Oxidative stress and mitochondrial dysfunction mediated neuro apoptosis is reported to play a major role in the pathology of Parkinson's disease. Zizyphus spina-christi fruits (ZSCF) are used as traditional medicines that are well-known for their high antioxidant properties. In the present study, we investigated the protective effects of ZSCF extract against 1-methyl-4-phenylpyridinium (MPP+) induced neurotoxicity in SH-SY5Y cell lines. The effect of ZCSF on MPP+ induced cell viability (MTT - 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide assay), membrane damage - (lactate dehydrogenase (LDH),  oxidative stress  (levels of ROS, nitric oxide and GSH and activities of SOD and catalase),  mitochondrial membrane potential and apoptosis (activity of caspase 3 and protein expressions of cyto c, Bax and Bcl-2) were measured. Our results showed that ZSCF could be able to reduce the neurotoxicity of MPP+ and offer neuroprotection in vitro. This protective effect of ZCF might be mediated by its potent antioxidant properties. However, further research is necessary to isolate active compounds and performing preclinical and clinical studies to confirm the neuro-protective effects of ZSCF in PD.

Late onset angioma serpiginosum of the breast with co-existing cherry angioma.

Angioma serpiginosum is a cutaneous vascular nevoid disorder that presents as red, nonblanchable and grouped macules distributed in a serpiginous pattern and resembles purpura. It usually begins in childhood and commonly affects the lower limbs and the buttocks. Late onset of the lesions is unusual. We report a 46-year-old female who presented with progressively extending lesions on her breast since preceding four years. She also had a cherry angioma overlying the lesions, an observation hitherto not reported so far.

Fluorescence in situ hybridization for 1p, 19q status in a cohort of glial neoplasms.

OBJECTIVE: The objective of the following study is to determine 1p, 19q status in a cohort of glial neoplasms. materials and methods: Fluorescence in situ hybridization for determination of 1p, 19q deletions in 100 glial neoplasms diagnosed between January 2007 and March 2011, was performed using Vysis dual color probes localizing to 1p36/1q25; 19q13/19p13. RESULTS: Out of the 100 tumors, 78 tumors were either pure oligodendroglial (OD) neoplasms or had an OD component. 1p and 19q codeletions were seen in 72.7% of oligodendrogliomas (World Health Organization [WHO] Grade II), 90.9% of anaplastic oligodendrogliomas (WHO Grade III), 22.2% of mixed oligoastrocytomas (WHO Grade II) and 42.9% of the anaplastic oligoastrocytomas (WHO Grade III). Of the 29 tumors that were diagnosed as glioblastoma multiforme (GBM), 11 had an OD component of which four showed codeletions of 1p and 19q (36.4%) and two tumors showed epidermal growth factor receptor (EGFR) amplification (20%) without 1p19q codeletions. Amongst the remaining 18 GBMs without an OD component, three cases showed EGFR amplification (16.7%), one case showed isolated deletion of 1p and none showed 1p19q codeletions. Polysomies involving 1p and/or 19q with or without deletions were seen in 76.9% of mixed oligoastrocytic tumors, 7.7% of pure OD tumors and one glioblastoma. CONCLUSIONS: 1p19q codeletion is an early molecular change in the genesis of OD tumors, which is retained at the time of progression. Mixed tumors more frequently show polysomies of 1p and 19q. The presence of codeletion in a third of the GBMs with an OD component with its absence in GBMs without an OD component, justifies categorization of these tumors as a separate entity.

Nabag (Zizyphus spina-christi) extract prevents aberrant crypt foci development in colons of azoxymethane-treated rats by abrogating oxidative stress and inducing apoptosis.

Zizyphus spina-christi (ZSC) fruit is a rich source of bioactive compounds but any medicinal properties in chemoprevention of colon cancer have hitherto not been studied. The aim of the present study was to examine in vivo protective effects of ZSC water extract on colon carcinogenesis in azoxymethane (AOM)-treated rats. Our results showed that ZSC significantly reduced AOM-induced colonic aberrant crypt foci development and AOM-induced oxidative stress as indicated by restoration of endogenous glutathione depletion and abrogating the impairment of total antioxidant capacity. Caspase-3 cleavage, which has been considered as an apoptotic index, was almost undetectable in AOM-treated rats and ZSC exhibited pro-apoptotic effects evidenced by increased levels of cleaved caspase-3. In the studied model, our findings provide the first in vivo evidence that ZSC extract could inhibit the early stage of colon carcinogenesis by preventing oxidative stress and inducing apoptosis.

Primary telangiectatic osteosarcoma of the cervical spine.

Telangiectatic osteosarcoma (TOS) is one of the 8 subtypes of osteosarcoma that infrequently affects the spine. The radiopathological features of TOS overlap with those of more benign entities, most commonly the aneurysmal bone cyst), and therefore is a significant diagnostic challenge. It is a rare but well-described entity in the thoracolumbar and sacral spine, and to the authors' knowledge has not been previously reported in the cervical spine. The authors report the case of a 15-year-old boy who presented with a 6-month history of neck pain and torticollis. He underwent preoperative glue embolization followed by a staged subtotal C-5 spondylectomy and posterior fusion for a C-5 vertebral body lytic expansile lesion. Histopathological examination showed the lesion to be TOS. The surgery was followed by adjuvant radiation and chemotherapy with a favorable outcome at the 1-year follow-up. This report reiterates that TOS is an important differential diagnosis for aneurysmal bone cyst and giant-cell tumor of the spine, as its biological behavior and clinical outcome differ from those of these more benign lesions, which it mimics.