Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation.

Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. Wuchereria bancrofti is the most common filarial infection. In some cases, microfilariae and adult filarial worm have been incidentally detected in fine-needle aspirates of various lesions; detection of microfilaria from subcutaneous site or from abscess site is even rarer. We here report an unusual case of Bancroftian microfilariasis in a 68-year-old female coming from endemic area presenting with right submandibular abscess. Our aim is to highlight the chances of finding microfilaria and adult worm in cytology of an unsuspected case at an unusual site.

Recurrent angio-fibroma of breast masquerading as phyllodes tumor.

A young Indian female presented with a recurring tumor in the right breast masquerading as phyllodes tumor. Patient had history of five times excision and recurrences of the tumor, diagnosed as fibrous phyllodes of the breast. Presently, a well-circumscribed tumor of about 10 cm size, comprising of benign fibrous-angiomatous tissue with evidence of foci of pyogenic vasculitis was observed. Immuno-histochemical markers for the myo-epithelial and epithelial elements excluded the possibility of fibrous phyllodes, inflammatory myofibroblastic tumor, desmoid fibromatosis, and metaplastic carcinoma. The present findings were diagnostic of an inflammatory angio-fibroma of the right breast, not reported in the earlier literature. The observations indicated that the female breast may be susceptible to spontaneous productive and common-antibiotic-resistant focal septic vascular inflammation giving rise to angio-fibromatous proliferation producing a well-defined tumor mass in the breast, distinguishable from the other breast lesions by the connective tissue stains and immuno-histochemical markers.

Effect of short term zinc supplementation on iron status of children with acute diarrhea.

OBJECTIVE: To study the effect of short term (2 wk) zinc supplementation on hemoglobin and iron status of children with acute diarrhea. METHODS: This study was a prospective, open label, single arm interventional trial conducted from June 2008 through October 2009 in a teaching hospital of North India. Three to sixty months old children presenting with acute diarrhea participated in the study. Subjects were supplemented with recommended doses of oral zinc gluconate for 2 wk. Changes in levels of hemoglobin, serum iron, total iron binding capacity, and serum ferritin were the main outcome measures. RESULTS: Sixty-two patients completed the study successfully. The prevalence of anemia before and after 2 wk of zinc supplementation remained unchanged. However, a small decline (p > 0.05) was observed in mean hemoglobin (from 8.95 ± 1.4 to 8.73 ± 1.43 g/dL), serum iron (79.56 ± 45.81 to 78.61 ± 44.41 µg/dL) and ferritin (84.77 ± 45.35 to 83.55 ± 44.10 ng/mL) levels. Total iron binding capacity increased from 331.60 ± 109.72 to 341.30 ± 119.90 µg/dL post supplementation (p > 0.05). CONCLUSIONS: Even though statistically insignificant, the small change observed in the levels of hemoglobin, and indicators of iron status following short term zinc supplementation might assume significance in some settings in developing countries where children receive short courses of zinc repeatedly for frequent diarrheal episodes.

Sclerosing stromal tumour of the ovary presenting as precocious puberty: a rare neoplasm.

A 7-year-old Indian girl presented with symptoms of excessive development of breasts, early menarche, growth of pubic hairs, accelerated growth and abdominal distension. On clinical examination, a large right abdominopelvic mass was palpable. MRI revealed a large, heterogeneous, solid and cystic tumour in the right adnexal region, suggestive of an ovarian neoplasm. The hormonal profile showed markedly elevated oestradiol and low follicle-stimulating hormone levels. Clinical diagnosis of precocious puberty with right ovarian mass was concluded. Right-sided salpingo-oophorectomy was performed. Histopathology showed features consistent with sclerosing stromal tumour of the ovary. Postoperatively, signs and symptoms of precocity gradually regressed and her serum oestradiol level came down to normal. This is the first reported case from India.

Reticular schwannoma mimicking myxoid sarcoma.

Reticular/microcystic schwannoma is a recently described rare distinctive variant of schwannoma with a predilection for gastrointestinal tract. Its occurrence in soft tissue is extremely rare. We report a case of reticular/microcystic variant of schwannoma in a 55-year-old Indian woman who presented with a painless slow-growing swelling in the right forearm for the past 6 months. MRI findings suggested myxoid sarcoma. However, histological and immunohistochemical findings in the excised specimen were consistent with reticular/microcystic variant of schwannoma. This case report emphasises that the diagnosis of reticular/microcystic schwannoma should always be considered in cases where myxoid sarcomas are suspected as it can mimic malignant myxoid sarcomas, clinically and radiologically, thereby avoiding aggressive intervention and overtreatment.

Tubercular thyroiditis with multinodular goitre with adenomatous hyperplasia: a rare coexistence.

A 32-year-old Indian woman presented with swelling in the anterior part of the neck for the last 3 years. Clinical and radiological examination and fine needle aspiration cytology suggested the diagnosis of multinodular goitre. A subtotal thyroidectomy was performed by the surgeon and the specimen was submitted for the final diagnosis. Histological examination of the specimen revealed multiple caseating tubercular granulomas coexistent with multinodular goitre and adenomatous hyperplasia. The sections demonstrated acid-fast tubercle bacteria, confirming the diagnosis of tubercular thyroiditis. This case emphasises that tubercular thyroiditis should always be considered in patients with thyroid swelling or nodule, in countries where the prevalence of tuberculosis is high.

White-blue pyelocalyceal cyst with hydrotic glomerulonephritis.

A 5-month-old male infant presented with a 15 day history of distension of abdomen. On clinical examination, a soft lump was palpable in the left lumbar region. Radiological findings suggested an enlarged non-functional left kidney with ureteropelvic adhesive obstruction. The left renal mass was excised and submitted for histopathological examination. The excised renal mass was cystic with its wall partly white and partly blue. Gross and histopathological findings were diagnostic of a white-blue pyelocalyceal cyst with hydrotic glomerulonephritis. This entity needs to be differentiated from a large number of other cystic diseases of the kidney. Intrauterine screening and diagnosis may be significant for a possible early intrauterine uro-laparoscopic recanalisation of the pyeloureteral obstruction to save the affected kidney.

Apoptotic effect of green tea polyphenol (EGCG) on cervical carcinoma cells.

The objective of this study was to probe the apoptotic effect of green tea polyphenol epigallocatechin-3-gallate (EGCG) on cervical carcinoma cells. This study was conducted in Departments of Pathology and Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India over a span of one and half years from January 2005 to August 2006. Caspase-3 assay was performed on monocytes isolated from cervical carcinoma patients and cultured with EGCG; cytosmears and sections from cervical carcinoma tissue cultured with EGCG were prepared for the morphological evidence of apoptosis. EGCG in a dose of 5 µg/ml and 10 µg/ml increased the caspase-3 levels in human cells. Cytosmears and sections from cervical carcinoma tissue cultured with EGCG showed better differentiation and increased number of apoptotic cells as compared to non EGCG controls. The number of such cells was increased more in 48 hours than in 24 hours. EGCG in a dose of 5 µg/ml and 10 µg/ml promoted apoptotic preparedness of human cells and induced apoptotic change in cervical carcinoma cells.

Mature embryoid teratoma in the wall of a mucinous cyst adenoma of ovary in multiparous female.

A collision tumour in ovary comprising a small ovoid embryoid mature teratoma in the surface wall of large mucinous cyst adenoma is reported in a 36-year-old female and its pathogenesis is discussed. The oval teratoid mass externally to the mucinous cyst lining did not show any columnar epithelial or mucin-secreting cyst. Findings suggested that the mature embryoid teratoma originated from ovarian germ cell rest in the surface wall of the cyst adenomatous neoplasm. Another possibility could be that the mature embryoid teratoma resulted from parthenogenesis of ovum together with the mucinous adenoma cysts by epithelial metaplasia of the follicular lining.

Pyelocalyceal cysts with hydrotic nephritis of the kidney: case of a unilateral congenital developmental anomaly.

This report describes the diagnostic, morbid, anatomical and histopathological features of pyelocalyceal cysts with hydrotic nephritis of the kidney in a 3-year-old boy, and discusses the pathogenesis. Calyceal cysts gave rise to a 'large blue cystic lobulated kidney' with microscopic changes in nephrons identifiable as 'hydrotic nephritic glomerulosclerosis'. Pelvic and calyceal cysts were identifiable by location, number, arrangement, and morbid anatomical and microscopic features of their lining walls. Such cysts may develop due to partial or complete obliterate adhesions at the uretero-pelvic and pyelocalyceal junctions. Patent calyceo-tubulonephric junctions in such cases may give rise to hydrotic nephritis. Pyelocalyceal cystic disease with hydrotic nephritis of the kidney needs to be distinguished from megacalycosis and hydronephrosis and deserves recognition. Observations in this case may provide the basis for future classifications of cystic renal diseases.

Septic disruption of lactiferous ducts with heterogeneous carcinoma of the breast in a lactating woman.

This report documents the diagnostic histopathological features of heterogeneous breast carcinoma following sepsis and disruption of the lactiferous ducts in a lactating woman and discusses the pathogenesis. Sections from the nipple revealed disrupted collecting lactiferous ducts presenting with intraduct precarcinoma and carcinoma of the epidermoid type, and attached reparative sprouts lined by lactiferous cells. Breast lobules showed generalised benign adenotic change with various foci of carcinoma microscopically identifiable as intraduct primitive lactiferal ectodermal carcinoma, lactating carcinoma, primitive neuroendocrine carcinoma and myoepithelioid granulomatous carcinoma. The findings led to the conclusion that the lactiferous ducts are susceptible to sepsis and disruption, which may predispose a patient to breast carcinoma. The pattern of carcinoma suggested that lactiferous epithelial cells behaved colonially, with different metaplastic changes, precarcinoma and carcinoma.

Pattern of oestrogen, progesterone and Her2neu receptors expression in a heterogeneous carcinoma of the breast in a lactating woman.

Oestrogen-progestrone-Her2neu receptor status was studied in various loci/foci of heterogeneous carcinoma of the breast and its metastatic secretory component in the lymph node in a lactating woman. All the carcinoma variants were negative for the trio markers except tumour components evolved to secretory or lactating carcinoma, which showed focal positivity. Findings showed that oestrogenic receptors, progesterone receptors and Her2neu negative primitive carcinoma in a heterogenous breast cancer may evolve into oestrogen receptor, progesterone receptor and Her2neu positive secretory/lactating carcinoma alongside other receptor negative carcinoma variants. Focal marker positivity/negativity underlined the fact that a diagnostic/prognostic marker status report may account for the tumour area included in the section/sample only. Study of the immune marker expression/status in various loci may help identification of the components, morphogenesis and dynamics of heterogeneous carcinoma of the breast.

Immature embryoid teratoma of the gall bladder: case of a primary primitive neoplasm.

This study presents diagnostic histopathological features of a primary embryoid teratomatous neoplasm in the gall bladder of a 60-year-old woman, and also discusses its pathogenesis. Sections revealed immature and typical embryoid bodies and dispersed syncytial trophoblasts along with mature and immature neuroectodermal and mesodermal elements. The residual endothelial lining of the gall bladder showed in situ and proliferative changes characteristic of an endodermal tumour. Ultrasonographic and magnetic resonance imaging findings of the rest of the abdominal and pelvic organs appeared normal. Results show that the mature adult gall bladder is susceptible to primary neoplasms of a primitive nature ranging from immature embryoma and teratoma to neuroectodermal tumour. Such primitive neoplasms in adult organs where benign neuroectodermal elements are present may evolve from a constituent cell of an adult organ acquired during embryogenesis from a morula that differentiated into trophoblastic (outer) and embryoblastic (inner) cells, and existing dormant cells at rest until reactivation during oncogenesis.