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Background: Objectives: Uterine smooth muscle tumours are diagnostically challenging as well as scientifically intriguing with leiomyoma being the most common. On review of literature there are numerous studies on audit of hysterectomy specimens worldwide, however, studies focusing on detailed histopathologi cal analysis of leiomyomas are limited. Thereby, this study was conducted to identify the secondary changes as well as histological variants of leiomyoma, their frequency of occurrence and other associated clinicopathological factors Methods: A retrospecti ve audit of all the hysterectomy and myomectomy specimens was conducted over a period of 3 years (Jan 2016 to Dec 2018) comprising of a total of 155 cases with 388 leiomyomas (LM). The clinical details were retrieved, and histopathological slides reviewed for cellularity, mitosis, atypia, necrosis, any secondary changes or specific variants. Results: On histopathology, 19.1% LM showed degenerative changes and histologic variants were observed in 6.18% LM. Hyaline change was the most frequent degenerative ph enomenon in 82.43% (60/74) while cellular leiomyoma was the most common variant in 37.5% (9/24) LM. Conclusion: Certain histological variants make the differentiation from malignant tumors challenging. A thorough tissue sampling and strict adherence to histologic criteria coupled with a ncillary techniques like immunohistochemistry can help in excluding malignancy in most of the cases. Awareness regarding these is very important amongst youn g pathologists to avoid misdiagnosis and overtreatment leading to unwarranted stress to the patient.
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Teratoma is a germ cell tumor seen mainly in neonates and young adults; it contains elements derived from all three germinal layers, with its usual site of occurrence being the ovary and testis and less common sites being several extragonadal locations. This case is of a 10-year-old boy who presented with an asymptomatic mass, heterogenous on ultrasonography and showing enhanced solid areas along with nonenhancing cystic areas on contrast enhanced computed tomography. Cytological diagnosis of malignant mesenchymal tumor was made; however, exact categorization could not be done. After surgical excision, histological and immunohistochemical studies yielded the diagnosis of immature teratoma with somatic malignancy – sarcoma. Teratomas with malignant transformation refer to a form of germ cell tumor in which a somatic teratomatous component becomes morphologically malignant and develops aggressively. These are associated with chromosomal abnormalities i (12p) reflecting germ cell tumor clonality. The occurrence of an identifiable sarcomatous component is a well recognized but distinctly uncommon phenomenon.
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Introduction: The intraoperative diagnostic accuracy of a tumor is an essential part in patients’ work-up. If the surgeon finds it malignant during surgery, widespread dissection including lymph nodes can be done simultaneously and thus preventing the need of second surgery. Objective: The aim of this study is to determine the accuracy of imprint cytology (IC) for the intraoperative diagnosis in patients with tumor and its usefulness in low facility set up. The diagnostic accuracy of IC has been compared with histopathological examination (HPE), the gold standard diagnostic. Material and methods: This study included 55 patients presenting as a tumor mass of different organs with clinically diagnosed as malignant. In the operation theater, smears for IC were made from cut surfaces of tumors. These ware stained with Papanicolaou stain and hematoxylin and eosin (H&E) stain. The results of IC were compared with HPE using H&E staining. Results: This study included tumor specimens of five from lymph nodes, three from cervix, 31 from breast, four from gastrointestinal tract (GIT), three from parotid gland, five from ovary, one from uterine corpus and three from skin. Table 3 shows categorization of benign and malignant tumors. Locally infiltrative tumors have been shown in benign tumor list. The result of my study is as follows: IC for benign and locally infiltrative tumors gave 100% accuracy and that for malignant tumor it was 34/35 (97%) accuracy. The only case which was misdiagnosed as reactive lymph node (LN), which was turned out to be as Hodgkin’s lymphoma. Conclusion: Intraoperative IC is a useful method for evaluating tumors. The simplicity of technique can be used at small centers with low facility set-up.
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Introduction: Myeloid sarcoma (MS) is a rare localized extramedullary tumor of myeloid precursor cells. Short clinical history: An 11-year-old male presented with nasal bleed, two days; breathlessness and loss of appetite, one month and bilateral nasal blockade for two months. There was no fever. On clinical examination, bilateral cervical lymphadenopathy and hepatosplenomegaly was found. On opening mouth, a pink mass hanging behind the soft palate was noted. Magnetic resonance imaging of head and neck revealed a nasopharyngeal mass in maxillo-ethmoidal sinus. Gross pathology: Excised mass was greenish pink, measuring 2 × 2 × 2 cm. Microscopic examination: Hemogram revealed total leukocyte count 1.2 lac/mm3, hemoglobin 10.1 g/dl, and platelet count 41,000/mm3. Differential count showed 24% blasts with marked left shift. Bone marrow aspirate revealed 27% blasts. No auer rod seen. Cytochemistry showed myeloperoxidase (MPO) positivity. Trephine biopsy showed myeloid hyperplasia with excess blasts. Histopathological examination of lymph nodes and soft tissues showed leukemic infiltration. Immunohistochemistry showed blasts positive for MPO and negative for CD3. On multicolor flow cytometry blasts were positive for MPO, CD34 and CD45, and negative for CD3 and CD79a. A diagnosis of MS with acute myeloid leukemia (AML) was made. Discussion: It is rare in children (1 month-89 years). Any site of body, most commonly skin, lymph node, bone, etc. are affected. Prediction of first appearance of MS or AML was difficult in this case. MS may progress to AML simultaneously or may remain localized, never progressing to AML. Conclusion: Any extramedullary tumor showing myeloid precursor cells, should be investigated for MS, easily misdiagnosed as solid tumors.