Primary gallbladder lymphoma presenting with perforated cholecystitis and hyperamylasaemia.

Primary gallbladder lymphoma is rare. Perforated cholecystitis due to primary gallbladder lymphoma and not related to chemotherapy has been unreported. We report the case of an 80-year-old woman presenting with an acute abdomen and clinical peritonitis. Her serum amylase was raised to 878 iu/l. Urgent computed tomography revealed generalised free fluid with a normal pancreas and was non-diagnostic as to the underlying pathology. An emergency laparotomy revealed bilious peritonitis with a necrotic patch on a distended gallbladder. A cholecystectomy was carried out and histology of the gallbladder revealed a marginal zone lymphoma.

Tumour-infiltrating lymphocytes predict for outcome in HPV-positive oropharyngeal cancer.

BACKGROUND: Human papillomavirus (HPV)-positive oropharyngeal cancer (OPSCC) is associated with improved survival compared with HPV-negative disease. However, a minority of HPV-positive patients have poor prognosis. Currently, there is no generally accepted strategy for identifying these patients. METHODS: We retrospectively analysed 270 consecutively treated OPSCC patients from three centres for effects of clinical, pathological, immunological, and molecular features on disease mortality. We used Cox regression to examine associations between factors and OPSCC death, and developed a prognostic model for 3-year mortality using logistic regression analysis. RESULTS: Patients with HPV-positive tumours showed improved survival (hazard ratio (HR), 0.33 (0.21-0.53)). High levels of tumour-infiltrating lymphocytes (TILs) stratified HPV-positive patients into high-risk and low-risk groups (3-year survival; HPV-positive/TIL(high)=96%, HPV-positive/TIL(low)=59%). Survival of HPV-positive/TIL(low) patients did not differ from HPV-negative patients (HR, 1.01; P=0.98). We developed a prognostic model for HPV-positive tumours using a 'training' cohort from one centre; the combination of TIL levels, heavy smoking, and T-stage were significant (AUROC=0·87). This model was validated on patients from the other centres (detection rate 67%; false-positive rate 5.6%; AUROC=0·82). INTERPRETATION: Our data suggest that an immune response, reflected by TIL levels in the primary tumour, has an important role in the improved survival seen in most HPV-positive patients, and is relevant for the clinical evaluation of HPV-positive OPSCC.

Solitary extra-skeletal sinonasal metastasis from a primary skeletal Ewing's sarcoma.

INTRODUCTION: Ewing's sarcoma is a rare, malignant tumour predominantly affecting young adolescent males. We describe a unique case of an isolated extra-skeletal metastasis from a skeletal Ewing's sarcoma primary, arising in the right sinonasal cavity of a young man who presented with severe epistaxis and periorbital cellulitis. RESULTS: Histologically, the lesion comprised closely packed, slightly diffuse, atypical cells with round, hyperchromatic nuclei, scant cytoplasm and occasional mitotic figures, arranged in a sheet-like pattern. Immunohistochemical analysis showed positive staining only for cluster of differentiation 99 glycoprotein. Fluorescent in situ hybridisation identified the Ewing's sarcoma gene, confirming the diagnosis. MANAGEMENT: Complete surgical resection was achieved via a minimally invasive endoscopic transnasal approach; post-operative radiotherapy. Ten months post-operatively, there were no endoscopic or radiological signs of disease. CONCLUSION: Metastatic Ewing's sarcoma within the head and neck is incredibly rare and can pose significant diagnostic and therapeutic challenges. An awareness of different clinical presentations and distinct histopathological features is important to enable early diagnosis. This case illustrates one potential management strategy, and reinforces the evolving role of endoscopic transnasal approaches in managing sinonasal cavity and anterior skull base tumours.

Follicular variant of papillary thyroid carcinoma -- a cytological study.

The cytological diagnosis of classical papillary carcinoma is easily established based on the characteristic architectural and nuclear features. However, the follicular variant of papillary thyroid carcinoma(FVPTC) poses a diagnostic challenge. In this study we analysed the cytological features of 14 histopathologically proven cases of FVPTC. We inferred that a combination of architectural features such as follicles and syncytial clusters and nuclear features, viz grooves, pseudoinclusions and enlarged nuclei with fine chromatin, were helpful in establishing the diagnosis. It is hence suggested that based on the combination of the aforesaid features a diagnosis of FVPTC be offered whenever it is possible. This helps in patient management, obviating the need for a second surgical intervention.

Rabies viral antigen in extracranial organs: a post-mortem study.

Rabies is a communicable disease and a significant health hazard. Histopathological confirmation of the diagnosis depends on the demonstration of Negri bodies - characteristic intracytoplasmic inclusions. In cases where these are not seen, immunohistochemistry serves as a useful adjunct. After its establishment in the central nervous system, the rabies virus is known to reach peripheral organs by a centrifugal spread. The present study was undertaken with the aim of demonstrating rabies viral antigen (RVAg) in the extracranial organs. Eleven confirmed cases of rabies were analysed and RVAg was found in the adrenal glands, heart, gastrointestinal tract and pancreas, confirming the centrifugal spread of the virus. The detection of RVAg in the extracranial sites may serve as a useful tool in the ante-mortem diagnosis by subjecting the extracranial tissue to biopsy and subsequent immunohistochemistry.

Epithelioid sarcoma. Report of a case with fine needle aspiration diagnosis.

BACKGROUND: Epithelioid sarcoma is a rare type of soft tissue sarcoma affecting the extremities, particularly the hands and fingers. Though it is well described histopathologically, publications regarding its cytologic findings are limited. CASE: A 52-year-old woman presented with swelling of the left middle finger. Fine needle aspiration was performed. Smears showed oval to polygonal cells with epithelioid features. A diagnosis of soft tissue sarcoma with a possibility of epithelioid sarcoma was suggested. Histopathologic examination and immunohistochemistry confirmed the diagnosis. CONCLUSION: In the presence of classic cytologic findings, the diagnosis of epithelioid sarcoma can be suggested. Subsequent histologic examination and immunohistochemistry can confirm the diagnosis.

Osteosarcoma of the bladder--a case report.

A 25-year old man with hematuria had a polypoid tumor of the urinary bladder which was diagnosed as transitional cell carcinoma (TCC) on transurethral resection with partial cystectomy. One year following post-operative radiotherapy, he had to undergo surgery for intestinal perforation. On laparotomy the recurrent tumor had involved pelvic organs and sigmoid colon. It now showed predominantly osteogenic sarcoma on histopathologic examination. The case is reported in view of rarity of primary osteogenic sarcoma in the urinary bladder.

Acute erythroleukemia (AML-M6)--a study of clinicohematological, morphological and dysplastic features in 10 cases.

Acute erythroleukemia is a relatively rare form of acute myelogenous leukemia. In the present study we analysed ten cases of acute erythroleukemia. All the patients were anemic and nine were thrombocytopenic at the time of diagnosis. Peripheral blood showed blasts in nine cases. Dyserythropoiesis was seen in all the cases whereas dysmegakaryopoiesis was seen in five cases. Dysplasia in the granulocytic series was seen in five cases. Based on the overall features this study concludes that acute erythroleukemia is associated with dysplasia of variable degree.

Epithelioid haemangioendothelioma of the rib--a case report.

Epithelioid haemangioendothelioma is a rare primary malignant tumour of the bone that accounts for less than 1% of all primary bone malignancies. The case discussed here is of a 35 years old male who presented with gradually increasing left infrascapular mass attached to 10th rib. X-ray showed an expansile lytic lesion in 10th rib. On FNA the diagnOsis of fibrous dysplasia or fibrous-histiocytic lesions was suggested. The lesion was excised along with adjacent rib. Histopathological examination showed features of epithelioid haemangioendothelioma. Immunohistochemistry revealed focal factor VIII related antigen positivity.

Immunohistochemical study of human rabies.

Rabies is a communicable disease that is almost always fatal. In its classic form, rabies is well recognized, but cases presenting with a paralytic illness mimic Landre's Guillain-Barre syndrome and in such cases the diagnosis remains in doubt. This problem is further compounded when the history of dogbite is not forthcoming. At autopsy rabies can be diagnosed by subjecting fresh tissue to virologic investigations or examining formalin-fixed paraffin-embedded tissue sections for the presence of characteristic inclusions; that is, the Negri bodies. However, these inclusions are not present in all cases. Hence, the need arises for a better method for diagnosis. The present study utilized immunohistochemistry as a diagnostic tool using both monoclonal and polyclonal antirabies antibodies in 20 cases of rabies encephalomyelitis. The diagnosis of rabies could be confirmed in 17 cases (85%) based on neuropathologic findings alone. In contrast, immunohistochemistry yielded positive results in all cases. Moreover, the amount of rabies viral antigen was much more abundant than could be expected from the histopathologic findings. Thus immunohistochemistry is a rapid, safe, sensitive and specific technique for the diagnosis of rabies.