A Rare Case of Epididymal Cyst Due to Schistosomiasis.

Schistosomal epididymitis is a very rare condition. Worldwide, very few cases have been reported, especially in India. Here is a case of schistosomal epididymitis that was found on histopathological examination of an epididymal cyst in a 32-year-old man in India. Patient presented with concerns of a right testicular swelling. Ultrasonography of scrotum showed an ill-defined echogenic lesion just above the head of right epididymis. Excision of epididymal cyst was performed. Histopathological examination showed eggs of schistosoma surrounded by abundant inflammatory infiltrate. Post-operatively, the patient was treated with single dose of praziquantel.

Primary mediastinal lymphomas, their morphological features and comparative evaluation.

BACKGROUND: Primary mediastinal lymphoma is an uncommon tumor. Hodgkin's lymphoma (HL), primary mediastinal B-cell lymphoma (PMBCL), and T-lymphoblastic lymphoma are the most common primary mediastinal lymphomas. Key morphological and immunohistochemistry (IHC) features play a very crucial role in diagnosis as well as further categorization. MATERIALS AND METHODS: In this study, the morphological spectrum and histological features of 32 cases of primary mediastinal lymphomas diagnosed over 5 years were studied and morphological and IHC features of PMBCL versus HL were compared. Features of PMBCL were also compared against a control group of systemic diffuse large B-cell lymphoma. RESULTS: Although PMBCL and HL are known to show overlapping morphological features, it was observed that presence of clear cells and compartmentalizing fibrosis in PMBCL; and classical Reed-Sternberg cells and dense inflammatory background in HL are important morphological clues while evaluating the biopsies. PMBCL showed diffuse, strong and uniform CD20 positivity; whereas CD30 showed focal/patchy, weak to moderate and heterogeneous expression, wherever found positive. As against this, HL showed diffuse, strong and uniform CD30 positivity; and focal/patchy, weak to moderate and heterogeneous CD20 expression, if found positive. CD20, CD3, and CD30 were sufficient in most of the cases while diagnosing PMBCL and HL. CONCLUSION: This study emphasizes the critical examination of IHC markers. Only positive expression in neoplastic cells is not sufficient to make a diagnosis, equal importance should be given to percentage, intensity, pattern, and type of positivity. Apart from basic IHC described above; CD15, leukocyte common antigen and fascin played an important role in differentiating HL and PMBCL in select doubtful cases.

Morphological spectrum of mediastinal lesions with special emphasis on evaluation of needle biopsy: An experience from a tertiary care hospital.

BACKGROUND & OBJECTIVES: Mediastinal lesions are uncommon and are infrequently encountered in routine clinical practice. Hence, there is a need for more elaborate studies of mediastinal lesions to make the pathologists and clinicians aware of the large spectrum of these lesions. The present study describes the histomorphological spectrum of various mediastinal lesions in a tertiary care hospital in India, along with the discussion of some unusual and interesting cases. Considering the limited diagnostic material obtained in guided biopsies, the adequacy of such tissue for providing a definite opinion was also evaluated. METHODS: This was a retrospective study performed on 125 mediastinal masses diagnosed on surgically resected specimens as well as needle biopsies over a period of two years (January 2012-December 2013). A few cases had inadequate diagnostic material, making a total of 116 cases which were further evaluated. RESULTS: A total of 116 patients of mediastinal lesions were included in the study. Most of the lesions were in 21-30 yr age group, with male:female ratio of 1.7:1. Anterior mediastinal compartment was most commonly involved. Majority of the cases (62.1%) were of neoplastic nature, with benign tumours (34.5%) being more common than malignant ones (27.6%). Thymoma followed by lymphoma constituted the most common mediastinal tumours. One-third of the total cases were diagnosed on needle biopsy samples. All cases where needle biopsy was followed by resection specimen showed concordant diagnosis. The percentage adequacy of biopsy was 91.7 per cent and the diagnostic accuracy was 100 per cent. INTERPRETATION & CONCLUSIONS: This study provides the histomorphological spectrum and biological diversity of the mediastinal lesions. It also emphasizes that biopsy is sufficiently adequate, with the help of a comprehensive immunohistochemistry panel, for providing a definite diagnosis in majority of cases.

Coexistence of tuberculosis with histiocytic sarcoma: A rare association.

Histiocytic sarcoma (HS) is an exceedingly rare hematolymphoid neoplasm of histiocytic lineage. We report a case of 25-year-old Woman who presented with generalized lymphadenopathy and ascites. There was no personal or family history of tuberculosis (TB). Histopathological examination of omental and peritoneal biopsy revealed TB while mesenteric lymph node showed HS. This case highlights the fact that a patient may be harboring coexistent malignancy/lymphoma along with TB. Therefore, the clinician should have a high index of suspicion, especially when there is therapeutic failure to antitubercular drugs (ATT) and persistence of fever or generalized lymphadenopathy. Sometimes, there may be surprising presence of uncommon malignancies, like in our case, where we found HS with TB. Since both diseases share similar clinical and radiological features, it is highly possible that one may not look further, once one of these is diagnosed.

Solitary neurofibroma of the adrenal gland not associated with type-1 neurofibromatosis.

Neurofibromas are tumors of neural origin. They can be solitary or may be associated with neurofibromatosis type-1 (NF-1). These are mostly seen in the head and neck region, upper extremities or along the nerves. Visceral neurofibromas are extremely rare. In this paper, we present an unusual case of solitary neurofibroma of the adrenal gland not associated with NF-1.

Primary endobronchial histiocytic sarcoma in a case of papillary carcinoma thyroid: a complex clinical scenario.

Histiocytic sarcoma is a rare malignant neoplasm showing histiocytic differentiation. We document a case of a 55-year-old man presenting with cough and breathlessness following a subtotal thyroidectomy for infiltrating papillary thyroid carcinoma. An endobronchial growth was seen on endoscopy. Histopathologic examination revealed a neoplasm of histiocytic lineage with positivity for leucocyte common antigen, Vimentin, CD68, CD4, and CD45RO. To the best of our knowledge, primary endobronchial histiocytic sarcoma in association with infiltrating papillary thyroid carcinoma has not been reported in the literature so far. Our case emphasizes the importance of clinicopathologic and radiologic correlation in resolving difficult diagnostic dilemmas.

Endobronchial leiomyoma in an immunocompetent four-year-old female child.

Pulmonary leiomyoma are uncommonly encountered benign mesenchymal neoplasms in children, usually found in immunosuppressed individuals in association with human immunodeficiency virus or Ebstein-Barr virus infection. We describe an interesting case of a 4-year-old immunocompetent girl who presented with pleural effusion and lung collapse secondary to endobronchial leiomyoma. She underwent a left thoracotomy and a left pneumonectomy for excision of the bronchial mass.

Rectal cap polyposis masquerading as ulcerative colitis with pseudopolyposis and presenting as chronic anemia: a case study with review of literature.

Cap polyposis (CP) is an under recognized form of non-neoplastic colonic polyps, characterised by the presence of inflammatory polyps with a distinct "cap" of granulation tissue. CP is often seen masquerading as chronic inflammatory bowel disease. The most common symptoms are mucoid diarrhoea, bloody stools, abdominal pain, and tenesmus. In this case report, we present a patient who was diagnosed with CP during the investigation of unexplained chronic long standing anemia secondary to intermittent rectal bleeding. CP, although rare, should be considered in the differential diagnosis of patients presenting with intermittent rectal bleeding and mucoid diarrhoea.