Diagnostic Utility of Epithelial Membrane Antigen (EMA) and Calretinin (CAL) in Effusion Cytology.

INTRODUCTION: Fluid cytology and subsequent utilization of immunocytology on cell block is being used commonly for increasing the diagnostic accuracy in effusion cytology. AIM: To do cytological analysis of fluids and evaluate the role of Epithelial Membrane Antigen (EMA) and Calretinin (CAL) to differentiate between reactive and malignant cell in pleural and peritoneal fluids. MATERIALS AND METHODS: This was a prospective study carried out in Department of Pathology, Shri Guru Ram Rai Institue of Medical and Health Science, for a period of 18 months from January 2014 to June 2015. A total of 253 samples of pleural and peritoneal fluid were studied by May-Gruenwald-Giemsa (MGG) stain and Papanicolaou (Pap) staining. In 73 cases which were suspicious for malignancy, cell blocks were prepared and IHC was done using two immunomarkers- EMA and CAL. RESULTS: A total of 253 cases of effusion cytology were studied out of which 73 were found positive for malignant cells. Maximum cases of malignant cells or atypical cells were seen in peritoneal fluid. A total of 34 cases were histologically positive for malignancy. All these cases showed strong membranous and cytoplasmic positivity for EMA. Most of cases also showed 2%-5% positivity for CAL. There were 38 cases categorized as atypical or reactive mesothelial cell hyperplasia. These cases showed nuclear and cytoplasmic staining for calretinin and none of these were positive for EMA, although 5 cases showed score 2-3, which was considered as negative. CONCLUSION: The distinction between reactive and malignant mesothelial cells in cytological specimens can be problematic. A combination of CAL and EMA may help in accurate diagnosis.

Scrotal chondroma in a young male: A rare case report.

Soft tissue chondroma is a rare benign, slow growing tumor usually located in hand and foot. Scrotal chondroma is exceedingly rare; chondromas in the pelvic region have also been reported. However, chondroma occurring in the scrotal wall is extremely rare, and only a few cases have been reported worldwide. They should be differentiated from well-differentiated chondrosarcoma. To the best of our knowledge, this is the first case of scrotal chondroma to be reported from India.

Diffuse intestinal submucosal lipomatosis with incidental epidermal inclusion cyst of caecum clinically masquerading as carcinoma caecum.

Symptomatic diffuse submucosal intestinal lipomatosis is a rare entity. Also few cases of epidermal inclusion cyst of caecum have been reported in literature. Here, we are presenting a rare case of intestinal submucosal lipomatosis with coincidence of epidermal inclusion cyst of caecum and presumptively diagnosed as carcinoma of ileocaecal region during surgery in a 55 years old male. Both are rare entity considering the location even they should be kept as a differential diagnosis in unusual cases of intestinal perforations with inconclusive radiological findings or clinical uncertainity.

Primary MPNST in Childhood- A Rare Case Report.

Malignant peripheral nerve sheath tumour usually occurs between 20-50 years of age, comprising about 5-10% of soft tissue sarcomas. Only 1.7% of them have been reported to occur in children < 5 months of age according to the literature. Here, we are describing 18 mnth old male child presented with a swelling in the lower back. MRI showed a sacrcoccygeal swelling extending to and communicating with CSF at lower sacral level. Birth history of the child was normal with normal apgar score. The histological diagnosis was malignant peripheral nerve sheath tumour. IHC showed focal positivity of GFAP and S100. Primary spinal MPNST in children are rarer. A careful neurological examination is warranted in children. Early diagnosis and referral to multidisciplinary team are important in ensuring the best diagnosis and optimal therapy in this young age.

Carcinoma adenoide quístico de la glándula de Bartolino. Una entidad poco común sujeta a diagnósticos erróneos / Adenoid cystic carcinoma of Bartholin's gland—A rare entity likely to be misdiagnosed

Los carcinomas primarios de la glandula de Bartolino son muy infrecuentes. El carcinoma adenoide quístico, una variante de adenocarcinoma, es todavía más raro que otros tipos histológicos en este órgano. Este tumor maligno es localmente agresivo, ocurre en mujeres postmenopáusica y muy raramente se encuentra en mujeres menores de 40 años. Una mujer de 35 años consultó por dispareunia en el departamento ginecológico del ambulatorio de nuestro Instituto. La lesión había sido diagnosticada previamente como un proceso inflamatorio. El diagnosticó de carcinoma adenoide quístico fue realizado mediante punción aspiración con aguja fina y confirmado histopatológicamente. Comunicamos los rasgos citohistológicos de este raro tumor, diagnosticado en una paciente joven. Realizamos una revisión de la literatura pertinente(AU)

Primary carcinomas of Bartholin's gland are very rare. Adenoid cystic carcinoma, a variant of adenocarcinoma is even rarer than the other histological types at this site. This locally aggressive malignant neoplasm is usually found in postmenopausal females and occurs only very occasionally in women under forty years of age. A 35-year-old patient presenting with dyspareunia was admitted at our gynaecology outpatients department. The lesion had been previously misdiagnosed as an inflammatory lesion. The diagnosis of adenoid cystic carcinoma was made on fine needle aspiration cytology which was confirmed on histopathological examination. We report the cyto- and histopathological features of this rare tumour occurring in a young patient together with a review of the relevant literature(AU)

Pilomyxoid astrocytoma.

Pilomyxoid astrocytoma (PMA) is a recently described brain tumor. PMA shares similar features with pilocytic astrocytoma (PA), the most common central nervous system (CNS) tumor in the pediatric population, yet displays subtle histologic differences. We describe a case of PMA in a six-year-old male involving sellar and suprasellar region presenting with failure to thrive and delayed developmental milestones. The histological findings revealed a tumor composed of a monotonous population of loosely arranged cells with delicate piloid like processes, within a prominent myxoid background. The tumor lacked biphasic appearance, Rosenthal fibers, eosinophilic granular bodies and calcification that are commonly observed in classical PA. Previous studies have shown PMA to behave more aggressively than PA, with shorter progression-free survival as well as a higher rate of recurrence and CNS dissemination. Thus, recognition of PMA and its distinction from classical PA is very important.

A case of carcinoma rete testis: histomorphological, immunohistochemical and ultrastructural findings and review of literature.

A 72-year-old man presenting with a secondary hydrocoel underwent orchidectomy. Gross examination revealed a tumor arising in the region of the rete testis, which on histopathology proved to be a papillary adenocarcinoma. The patient did not have evidence of any other neoplasia elsewhere in the body. The lesion fulfilled the anatomic criteria elucidated by Nochomovitz et al to be labelled as adenocarcinoma of Rete testis. Electron microscopy revealed characteristic nuclear infoldings and microtubules with two different arrangements. The tubules were either seen to form concentric circles or were in irregular groups with filaments interspersed. The lesion on immunohistochemistry was negative for germ cell markers AFP and HCG, and was positive for cytokeratin and epithelial membrane antigen. A review of literature is also presented.