Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India.

OBJECTIVE: Paratesticular tumors (PTT) are rare and form a heterogenous group, ranging from benign to malignant high grade sarcomas. This study was undertaken to describe the clinicopathological spectrum of PTTs received over a 20-year period. METHODS: All primary and secondary PTTs diagnosed from 2000 to 2019 in the pathology department of a tertiary care hospital in North India were retrospectively reviewed. Gross, histopathological features and immunohistochemistry (IHC) findings were correlated with clinical details. RESULTS: A total of 169 intra-scrotal tumors were diagnosed during the study period, out of which there were 30 PTTs (in 27 patients) comprising 17.75%. Age range was 4 to 85 years (median 58 years). Benign PTTs were the commonest (n = 21, 70%), followed by metastasis to the paratesticular region (n = 6, 20%) and then primary malignant PTTs (n = 3, 10%). The commonest benign PTT was lipoma (n = 16, 76.19%), followed by adenomatoid tumor (n = 3, 14.28%) with one case each (4.76%) of cellular angiofibroma and hemangioma. Among primary malignant PTT, there were two cases of rhabdomyosarcoma, and one case of biphasic malignant mesothelioma. Metastatic tumors included four cases of prostatic adenocarcinoma, and one case each of pancreatic signet ring cell carcinoma and clear cell renal cell carcinoma. CONCLUSION: PTTs show a wide clinicopathological spectrum. Benign PTTs are commoner than malignant PTTs. Meticulous grossing and histopathological examination supplemented by IHC is essential for an accurate diagnosis of this heterogenous class of tumors, which influences the role of adjuvant therapy and patient prognosis.

Histopathological Spectrum and Immunohistochemical Profile of Lung Carcinomas: A 9-Year Study from a Tertiary Hospital in North India.

BACKGROUND: Lung cancer is the most common cancer worldwide and the leading cause of cancer-related death. Diagnostic bronchoscopic or percutaneous biopsies are usually small. However, judicious use of immunohistochemistry (IHC) helps in accurate subtyping, which forms the basis for molecular tests and treatment. AIM: The aim was to study the role of IHC in the diagnosis of various histological subtypes of lung cancer. METHODS: This 9-year study from 2009 to 2017 included all cases diagnosed as lung carcinoma on tissue biopsies. IHC markers were selected based on histopathology, from a panel comprising CK7, CK20, CK5/6, p63, thyroid transcription factor 1 (TTF-1), napsin A, synaptophysin, chromogranin A, neuron-specific enolase, CD56, and CDX2. Metastatic cancers to the lung were excluded from the study. RESULTS: There were 199 cases of lung carcinoma comprising squamous cell carcinoma (37.7% [n = 75]), adenocarcinoma (26.1% [n = 52]), small cell carcinoma (20.6% [n = 41]), non-small cell lung carcinoma-unclassified (10.1% [n = 20]), adenosquamous carcinoma (2.5% [n = 5]), and others (3% [n = 6]). IHC was done on 47.7% (95/199) of cases. Squamous cell carcinomas showed CK5/6 and p63 positivity in 13/13 (100%) and 12/13 (92.3%) cases, respectively. Adenocarcinomas were positive for napsin A in 12/13 (92.3%) and TTF-1 in 35/41 (85.4%) cases. Neuroendocrine markers were positive in all small cell carcinomas. CONCLUSION: Squamous cell carcinoma was the most common primary lung malignancy in the North Indian population, followed by adenocarcinoma and small cell carcinoma. IHC panel of TTF-1, napsin A, CK5/6, and p63 is very helpful to classify most non-small cell lung carcinomas.

Systemic and primary cutaneous anaplastic large cell lymphoma: Clinical features, morphological spectrum, and immunohistochemical profile.

BACKGROUND: T-cell lymphomas with anaplastic morphology typically comprise of anaplastic lymphoma kinase positive, anaplastic large cell lymphoma (ALK+ ALCL), ALK-negative ALCL (ALK- ALCL), and primary cutaneous ALCL (PC-ALCL). However, other entities such as diffuse large B-cell lymphoma, peripheral T-cell lymphoma, Hodgkin lymphoma, and undifferentiated carcinoma can also show similar anaplastic features. AIMS: To study the clinical features and histological spectrum of ALCL and emphasize the role of immunohistochemistry (IHC) in their diagnosis and categorization. SETTING AND DESIGN: Eight cases of ALCL diagnosed over a period of 4 years were selected for the study. MATERIALS AND METHODS: Histopathological review and IHC was performed on all cases. Two ALK+ ALCL cases were tested by fluorescent in situ hybridization (FISH) for t(2;5)(p23;q35). RESULTS: There were four cases of ALK+ ALCL and two each of ALK- ALCL and PC-ALCL. Histologically, all the subtypes showed pleomorphic and "hallmark" cells with strong CD30 expression and variable loss of T-cell antigens. One case of PC-ALCL was leukocyte common antigen (LCA) negative. Epithelial membrane antigen was positive in all the six systemic ALCL cases. Two cases tested for t(2;5)(p23;q35) by FISH were positive. CONCLUSIONS: Diagnosis of ALCL is based on recognizing the key morphological features, especially the presence of "hallmark" cells. IHC is essential for confirmation of diagnosis and excluding other malignancies with anaplastic morphology. The inclusion of CD30 in the initial IHC panel will help identify LCA negative cases and avoid misdiagnosis.

Comparative analysis of colorectal carcinoma staging using operative, histopathology and computed tomography findings.

BACKGROUND: The staging of colorectal carcinoma using 3 modalities viz operative, histopathology and CT scan has been subject of interest in accurately defining the extent of disease. This retrospective as well as prospective study was carried out at CMC, Ludhiana, Punjab from November 2011 to May 2014. AIM: The objective of this study was to assess the usefulness and accuracy of CT scan findings to state the extent and spread of colorectal malignancy and to correlate these findings with histopathological diagnosis. METHOD: A total of 31 biopsy proven patients showing variable bowel wall thickening involving the colon /rectum on CECT (Contrast Enhanced Computed Tomography) were included in the study. The tumours were staged based on the CT scan findings and were compared with the operative and histopathological findings. OBSERVATIONS: Rectum was the most common site of involvement followed by the recto-sigmoid involvement. Metastasis was observed in 5 cases out of the 31 malignant cases. Five of the 7 cases were correctly staged as T1 & T2 lesions on CT having a sensitivity of 83.3%, specificity of 92%, and positive predictive value of 71.4% and a negative predictive value of 95.8% in the diagnosis of T1 and T2 lesions. 15 of the 16 cases were correctly staged as T3 lesions. CT had a sensitivity of 88.2%, specificity of 93.8%, and positive predictive value of 93.8% and a negative predictive value of 86.7% in the diagnosis of T3 lesions. All the 8 cases were correctly staged as T4 lesions. CT had a sensitivity of 100%, specificity of 100%, and positive predictive value of 100% and a negative predictive value of 100% in the diagnosis of T4 lesions. CONCLUSION: We conclude that CT scan is an excellent modality in diagnosing malignant lesions of the colon and rectum.

Mullerian choristoma in a case of spinal dysraphism.

It is extremely rare to find mullerian choristomas in association with spinal dysraphism, with <10 cases published in English literature. We report a case of heterotopic uterus and fallopian tube-like tissue within a lumbar subcutaneous lipoma associated with spina bifida and tethered cord. A 21-year-old lady presented with lumbar swelling since birth and dull pain in the lower back. Magnetic resonance imaging showed spina bifida at level L3 and L4, tethering of the cord and a subcutaneous lipomatous swelling. Biopsy revealed lobules of fibroadipose tissue embedded in which were seen organoid cystic structures containing prominent smooth muscle coats in their wall. These cystic structures were lined by the endometrium and showed fallopian tube-like papillary infoldings. Immunohistochemistry showed estrogen receptor positivity in the epithelium, stroma, and smooth muscles. The epithelial cells were also positive for cancer antigen 125 and cytokeratin 7 while the stromal cells showed CD10 positivity, supporting mullerian derivation. The pathogenesis and differential diagnosis of such lesions is discussed.

Metastatic squamous cell carcinoma of the lung masquerading as a soft tissue tumor.

Carcinoma of lung can metastasize to any organ system; however, metastasis to skeletal muscles is extremely rare. A 63-year-old man, known case of pulmonary tuberculosis on treatment, presented with a painful swelling in his left leg. Examination revealed a 5.0 cm × 3.0 cm calf swelling, which on imaging was suggestive of a soft tissue tumor. Fine-needle aspiration cytology of the swelling revealed it to be squamous cell carcinoma. Further investigations revealed a mass in the left lower lobe of the lung. Biopsies from both the lung lesion and calf swelling confirmed the diagnosis of squamous cell carcinoma of lung with metastasis to the calf muscle. The case is being presented because of its unusual presentation and rarity.

Nonrejection pathology of renal allograft biopsies: 10 years experience from a tertiary care center in north India.

BACKGROUND: Renal dysfunction in allograft transplant is common and its assessment is done using Revised Banff '97 working classification, which is the accepted formulation for the evaluation of histological appearance of renal allograft biopsies. The nonrejection category under the Banff working classification of renal allograft pathology forms a large group resulting in allograft dysfunction. AIM: To evaluate the spectrum of histopathological changes seen in renal allograft dysfunction. MATERIALS AND METHODS: A total of 119 renal biopsies were studied over 10 years presenting with renal allograft dysfunction from a tertiary center in North India. RESULTS: Majority of the biopsies were in the nonrejection category (47.1%), which included few cases of acute tubular necrosis (25.2%), cyclosporine nephrotoxicity (16%), infections (10.9%), and thrombotic microangiopathy (3.4%). The second largest category in our study was acute/active cellular rejection group (31.9%), which displayed moderate to severe tubulitis, mononuclear cell infiltrate in the interstitium, and vasculitis. Antibody-mediated rejection cases were seen in 28.6% of the renal biopsies followed by chronic allograft nephropathy cases (12.6%) showing features of tubular atrophy and interstitial fibrosis. Borderline changes with features of mild tubulitis contributed to 7.6% of the biopsies. The smallest group comprised of only 4.2%, which were within normal histological limits. CONCLUSION: Timely accurate diagnosis of renal allograft dysfunction is essential for prompt, effective management of renal transplant patients. Thus, nonrejection pathology forms a significant cause of renal dysfunction in patients with renal allograft transplantation.

Spontaneous rupture of tuberculous spleen in a HIV seropositive patient on maintenance hemodialysis.

Spontaneous rupture of the spleen usually occurs secondary to infection, hematological disorders or infiltrative lesions of the spleen. In patients with positive human immunodeficiency virus (HIV) antibodies and the acquired immunodeficiency syndrome (AIDS) who present with acute abdomen, splenic rupture should be considered as a possible cause and should additionally be investigated for co-infection with tuberculosis. Spontaneous rupture of spleen in asymptomatic patients requires a high index of suspicion for diagnosis. We herein report on a HIV-positive patient on maintenance hemodialysis, who presented with spontaneous rupture of a tuberculous spleen.

Wasp sting: an unusual fatal outcome.

Wasp stings are not uncommon especially in populations living in proximity of forested areas all over the world. Local manifestations following stings are common and un-usually life threatening anaphylaxis may occur, requiring prompt treatment. Multi organ failure and acute renal failure following wasp stings are rare and histological evaluation suggest acute tubular necrosis secondary to hemolysis, rhabdomyolysis and direct venom toxicity. A rare com-plication of a patient following multiple wasp stings with disseminated intravascular coagulation, acute renal failure and thrombotic microangiopathy is presented.

Tuberculosis in a renal allograft: a successful outcome.

Tuberculosis is endemic in most South-East Asian countries including India. It causes significant morbidity and mortality in renal transplant recipients and often, it is not diagnosed early, due to its innocuous clinical presentations. A high index of suspicion and proactive management in the early phase of presentation can reduce allograft nephropathy, graft nephrectomy and mortality. A patient with an unusual presentation of tuberculosis localized to the allograft and successful management with anti-tuberculosis medications is described.