HER 2 Expression in Gastric and Gastro-esophageal Junction (GEJ) Adenocarcinomas.

INTRODUCTION: Gastric cancer is one of the leading causes of cancer mortality in the world/India with majority being diagnosed at an advanced stage. Various chemotherapeutic regimens have modestly improved overall survival leading to quest for novel therapeutic agents. Overexpression of HER2 in many gastric cancers has lead to the advent of targeted therapy with anti HER2 antibody like Trastusumab which has improved the overall survival. MATERIALS AND METHODS: Sixty cases of gastric adenocarcinomas (44 biopsies and 16 gastrectomies) over the past five years ( June 2009 to June 2014),were included in the study. Diagnosis was confirmed by review of slides and IHC with anti HER2 antibodies was performed using Dako Real Envision Detection system and scoring was done by Hoffmann et al., scoring system. RESULTS: Of the 60 cases, majority were males (60%),with a mean age of 65.65 yrs. Tumours in antrum (76.7%) formed the major bulk. HER2 expression was observed in 26.7% of Tumours, predominantly in males (p=0.006) and intestinal type (p= 0.054). HER2 expression correlated with Tumour grade (moderately differentiated and well differentiated, p= 0.042). Tumours of gastro-esophageal junction (GEJ) showed HER2 expression in 45.5% as opposed to 22.4% in gastric location. Poorly differentiated and diffuse type of adenocarcinomas did not express HER2. Two of three Tumours from patients in the age group 31-40 y expressed HER2. CONCLUSION: Male gender, intestinal-type and moderately differentiated gastric cancers may be the ones that can be targeted for therapy using Herceptin. Though trastusumab is approved for advanced gastric and GEJ cancers, it's role in adjuvant / neo-adjuvant setting in early stages needs to be evaluated with newer agents like Pertuzumab, Bevacizumab, especially in young patients.

Benign epithelioid peripheral nerve sheath tumour resembling schwannoma.

Peripheral nerve sheath tumours (PNST) with epithelial appearing cells compromise a heterogeneous group of neoplasms that are rare and diagnostically challenging. Of these, malignant PNSTs with epithelioid features (epithelioid MPNST) are commonly described in literature. However benign epithelioid PNSTs are rare and till date about 38 cases have been described in the literature. We report a benign epithelioid PNST with light microscopical and immunohistochemical features suggestive of schwannoma, presenting as a thigh mass in a 23-year-old female. The tumour was encapsulated, showed epithelioid cells in aggregates, and expressed vimentin and S-100 positivity. There was no expression of CD34, CK, EMA, CD99, p63 and HMB 45. Typical Antoni A and Antoni B areas were absent. At 18 months follow-up, the patient was well.

Generalized eruptive histiocytosis mimicking leprosy.

Generalized eruptive histiocytosis (GEH) is a rare cutaneous histiocytosis that mainly affects adults and presents with multiple symmetric papules on face, trunk, and proximal extremities. GEH is included in type IIa (histiocytes involving cells of dermal dendrocyte lineage) of histiocytic disorders. Clinical and pathological correlations are required for differentiating GEH from other histiocytic disorders and from lepromatous leprosy which clinically mimic GEH and is prevalent in India. We report a case of a middle-aged woman who presented with generalized asymptomatic papules and nodules and was treated for leprosy but was finally diagnosed to have GEH after clinical, histopathological, and immunohistochemical correlation. Furthermore, the newer lesions also showed features of progressive nodular histiocytosis.

Malignant myoepithelioma of the breast: case report with review of literature.

Myoepithelial lesions of the breast are extremely rare and can present with a diverse morphology. We report a case of malignant myoepithelioma characterized by proliferation of atypical oval to polygonal cells expressing typical myoepithelial markers. A 45-year-old lady presented with a mass in the left breast. Fine needle aspiration yielded a cellular smear with large papillae-like clusters of monomorphic cells with naked nuclei in the background. A diagnosis of sub-areolar sclerosing duct hyperplasia was made on cytology and the patient underwent excision. The surgical specimen showed a grey-white 5x3 cm mass on cut surface. Histopathology revealed mitotically active (5-6 per 10hpf) oval to polygonal cells tumor cells with clear to eosinophilic cytoplasm arranged in the form of nodules separated by dense sclerotic stroma mimicking clear cell or adenoid-cystic carcinoma. A diagnosis of malignant myoepithelioma was made as the cells were CK14 and SMA positive, and negative for ER and PR on immunohistochemistry. We discuss the unusual morphological features of malignant myoepithelioma, cytological findings and the important differential diagnoses of malignant myoepthelial lesions. A high degree of suspicion with a keen eye for morphological details coupled with relevant immunohistochemistry will aid in arriving at the diagnosis.

Primary leiomyosarcoma of the kidney.

Primary leiomyosarcoma of the kidney is a rare tumor with an aggressive behaviour. A 55-year-old woman presented with a left sided abdominal mass in our outpatient department. Radiologic investigations revealed the mass to be renal in origin with colonic adhesions for which radical nephrectomy and hemicolectomy were done. The tumor completely appeared to replace the left kidney and had a whorled character focally on cut section. Microscopically, spindle cells having malignant features with cigar shaped nuclei were seen. The smooth muscle origin of the cells was confirmed by immunohistochemical positivity for smooth muscle actin. Sarcomatoid variant of the renal cell carcinoma was ruled out as the tumor was negative for cytokeratin. Tumors with spindle cell morphology in the kidney should not always be taken for a sarcomatoid variant of renal cell carcinoma and should be investigated thoroughly.

Cytological diagnosis of actinomycosis and eumycetoma: a report of two cases.

Mycetoma and actinomycosis are common in tropical countries and are increasingly diagnosed in other parts of the world due to rapid mobilization of the population. They are usually diagnosed on histopathology. There is very limited data on the role of fine-needle aspiration cytology (FNAC) in diagnosing these lesions. We report here two cases: one of eumycetoma and the other of an actinomycosis that were reliably diagnosed with FNAC. The cytological features were similar to histopathology features and differentiated eumycetoma and actinomycosis. FNAC is a rapid, simple and inexpensive outpatient procedure that helps in rapid diagnosis.

Epididymo-testicular malacoplakia--a case report.

Malacoplakia is one of the rare, chronic inflammatory disorders affecting the epididymis and testis. Diagnosis of the same is important as the treatment differs from the other granulomatous lesions in this area. We present a case of malacoplakia involving both the epididymis and testis with a brief review of literature.

Macrofollicular encapsulated papillary thyroid carcinoma--a case report.

Macrofollicular encapsulated papillary thyroid carcinoma (MEPC) is a rare variant of papillary carcinoma of thyroid with a favourable clinical course. It could be mistaken for a follicular neoplasm or a hyperplastic nodule. We report cytological and histopathological features of this rare variant of papillary carcinoma in a 22 year old female with brief review of literature.

Schwannoma of the palatine tonsil.

Schwannoma is a solitary, benign tumour arising from the neural sheath Schwann cells of the peripheral, cranial or autonomic nerves. In the head and neck region, it occurs most commonly in association with the acoustic nerve within the skull and is rarely found in oral structures. When it is found in oral structures, the tongue is reported to be the favoured site. Schwannoma of the tonsil is extremely rare, with only two cases reported in the literature. We report what is, to our knowledge, the third case of schwannoma of the tonsil, diagnosed by histopathology.

Congenital transient myeloproliferative disorder progressing to acute myeloid leukemia in Down's syndrome: a case report.

Chromosomal abnormalities like monosomies and trisomies predispose to various malignancies, hematopoietic or non hematopoietic. Patients with Trisomy 21(Down's syndrome) are prone to acute leukemias during childhood, but congenital leukemia in such children is rare (17%) and should be differentiated from a similar condition -Transient Myeloproliferative Disorder (TMD) which does not necessitate any treatment other than follow up. We report a patient of Down's syndrome with TMD in neonatal period which had spontaneous remission at 3 weeks but later died of acute myeloid leukemia at 6 months. The blasts in our case during the TMD episode were Myeloperoxidase(MPO) positive unlike other cases of TMD reported in literature. To the best of our knowledge we have not come across a case of TMD (MPO positive) later progressing to leukemia in Indian literature. Hence we report this case.

Mammary hamartoma--a case report.

Mammary hamartoma is a rare lesion commonly associated with Cowden syndrome. It presents clinically as a fibroadenoma. The nonspecific cytological findings makes the pre-operative diagnosis of this lesion difficult. Though hamartomas of the breast are predominantly benign, co-existent malignancies within them have been reported. These lesions also have a tendency to recur; hence a correct diagnosis and extensive sampling of hamartoma is essential. We report a case of mammary hamartoma with a brief review of literature.

Vimentin expression in breast carcinomas.

Epithelial malignancies expressing mesenchymal markers and their prognostic implications have been studied by various authors. In view of this, we studied fifty cases of breast carcinomas for vimentin expression and correlated the various clinical and histopathological parameters. Eighteen percent (9/50) of all breast carcinomas expressed vimentin. Vimentin positive tumours were predominantly larger in size (mean greatest diameter 5.43 cm), of higher TNM stage, node negative (55.56%), poorly differentiated (66.66%, p=0.0458) with high mitotic rate (>10/hpf, p=0.0000), Estrogen (88.88%) and Progesterone (77.77%) receptor negative thus pointing towards aggressive biological behavior. Interestingly 20% of well differentiated and 9.09% of moderately differentiated tumours also expressed vimentin. One vimentin positive case had pulmonary metastases despite being node negative while another well differentiated vimentin positive tumour showed skeletal muscle infiltration. Hence, we conclude that vimentin expression is an indicator of biologically aggressive tumours.

Squamous metaplasia in a multinodular goiter: a case report.

Squamous epithelium in thyroid is an unusual finding. It is seen in a variety of inflammatory and neoplastic conditions. It's presence has been attributed to metaplastic change of follicular epithelium by some authors and to the persistence of ultimobranchial body by others. We encountered a case of multinodular goiter with groups of squamous cells lining a cystic cavity. We report it because of it's rarity with a brief review of literature.

Leiomyosarcoma arising from tunica vaginalis testis: a case report.

Benign and malignant soft tissue tumors of the paratesticular region i.e. those arising from the testicular tunics, epididymis and spermatic cord are uncommon. Of these, leiomyosarcoma arising from the tunica vaginalis is extremely rare. On extensive computerised search, a single case has been reported till date in the literature. We hereby report one such case because of its rarity.

Collagenous spherulosis of breast: diagnosis by FNAB with review of literature.

Collagenous Spherulosis (CS) of breast is an innocuous but interesting uncommon morphological feature observed with a variety of benign and malignant breast lesions. We report a case of collagenous shperulosis associated with nodular sclerosing adenosis (Adenosis tumor) on fine needle aspiration (FNA) smears confirmed later by biopsy. The differential diagnosis of collagenous spherulosis is discussed.

Leiomyosarcoma of the mesocolon--a case report.

Retroperitoneal leiomyosarcomas including those arising from the mesentery are rare. These account for 5.8% of all soft tissue sarcomas. Most of these tumors present in late life with female preponderance. Diagnosing these tumors at an early stage is difficult due to their location. Hence, most of them attain large sizes with metastases to distant sites at the time of diagnosis. We report a case of leiomyosarcoma arising from the sigmoid mesocolon due to it's rarity and unusual clinical presentation.