Gastrointestinal basidiobolomycosis: Beware of the great masquerade a case report.

Basidiobolomycosis is rare infection caused by the saprophytic fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis is an infrequent, albeit, increasingly reported, emerging form of the disease and typically affects immunocompetent individuals with potentially grave sequelae if unrecognized. Acquaintance with this exceptionally rare fungus and its potential for presenting as gastrointestinal mass masquerading as colonic malignancy is critical for timely diagnosis, appropriate treatment and successful clinical outcome. We report a case of gastrointestinal basidiobolomycosis masquerading as colonic malignancy in a 29-year-old Omani patient successfully treated with combination of surgery and prolonged azole antifungal therapy.

Neuroprotective Effects of a Variety of Pomegranate Juice Extracts (PJE) Against the Excitotoxin Quinolinic Acid in Human Primary Neurons.

BACKGROUND: Quinolinic acid (QUIN) excitotoxicity is mediated by elevated intracellular Ca2+ levels, and nitric oxide (NO•) mediated oxidative stress leading to DNA damage, and cell death due to energy restriction. METHODS: We evaluated the effect of a series of pomegranate juice extracts (PJE), Helow, Malasi, Qusum, and Hamedh, with antioxidant properties on QUIN induced excitotoxicity on primary cultures of human neurons. RESULTS: We showed that Helow and Malasi can attenuate QUIN-induced excitotoxicity to a greater extent than Qusum and Hamedh from Oman. Similarly, both Helow and Malasi were able to attenuate QUIN-induced Ca2+ influx and nNOS activity to a greater extent compared to Qusum, and Hamedh. All extracts reduced the oxidative effects of increased NO• production, and hence preventing NAD+ depletion and cell death. CONCLUSION: In addition to the well-known antioxidant properties of these natural phytochemicals, the inhibitory effect of some of these compounds on specific excitotoxic processes such as calcium influx provides additional evidence for the beneficial health effects of PJE in excitable tissue, particularly within the CNS.

Value of ancillary studies in the evaluation of fine-needle aspiration specimens: Our experience.

BACKGROUND: The cytological diagnosis of poorly differentiated tumors is challenging because the tumor cells may have morphologically difficult presentations in materials obtained by fine-needle aspiration cytology (FNAC). With the application of FNAC in primary diagnosis of malignant lesions, there has been a significant increase in the use of ancillary studies in the aspirated material. AIMS: We evaluated the value of ancillary studies, namely cell blocks, immunocytochemistry (ICC) and electron microscopy (EM), in the final interpretation of FNAC smears. MATERIALS AND METHODS: Sixty-nine cases of neoplastic swellings were subjected to FNAC. Material acquired was divided for ICC, consisting of immunoperoxidase staining of direct smears, and/or cellblocks and EM, in addition to routine light microscopy (LM). Correlation with the available histological material with immunohistochemistry and/or pertinent clinical information was used as a "gold" standard. RESULTS: Five (7.2%) cases were excluded from the study, the material being necrotic or insufficient. Cell blocks were available in 46/64 (71.8%) cases, ICC evaluation was performed in 41/64 cases (64%) and EM studies were done in 57/64 cases (89%). Diagnostic accuracy of LM alone was 32/64 (50%). Cell blocks improved the diagnoses in 8/46 (17%) cases. The ICC data were diagnostic in 18/41 (43.9%) cases, helpful in 8/41 (19.6%) cases and non-helpful in 15/41 (36.5%) cases. EM studies were diagnostic in 22/57 (38.5%) cases, helpful in 18/57 (31.5%) cases and non-helpful in 17/57 (30%) cases. In 34/64 (53.1%) cases, all ancillary techniques (cell blocks, ICC and EM) were applied and their diagnostic accuracy was compared. CONCLUSIONS: With appropriate case selection, ancillary studies performed on aspirated material can provide useful information in FNAC.

Immunophenotyping of Tumours.

BACKGROUND: Immunophenotyping has added a new dimension to improve the diagnostic accuracy of malignant diseases. The emphasis is on its usefulness in planning and institution of specific therapy besides helping in prognostication. METHODS: The study included 83/1385 biopsies of cancer patients over an 18 month period on which immunohistochemical staining (IHC) with monoclonal antibodies were performed. The technique was used to establish the histogenetic origins/expression of the tumours. The study excluded haematolymphoid malignancies. RESULT: Eighty three cases on whom IHC was performed included poorly differentiated tumours (15), metastatic tumours (16), soft tissue tumours (35), central nervous system tumours (9) and miscellaneous (6). Two cases could not be typed. The clinicopathological correlation in terms of the management and the problems related to its misinterpretation are discussed. CONCLUSION: Immunophenotyping of tumours in an oncology set up is significant in the 'Final Diagnosis'.

Immunophenotypic Characterization of Benign and Malignant Prostatic Lesions.

BACKGROUND: Biopsy diagnosis is the gold standard for differentiating benign and malignant prostatic enlargements. This study was aimed at supplementing biopsy diagnosis with immunophenotypic characters of prostatic lesions. METHODS: Twenty five cases each of nodular hyperplasia and adenocarcinoma prostate were compared for their morphologic appearances and immunophenotyping, by studying antibodies to prostate specific antigen (PSA), transglutaminase, chromogranin and high molecular weight keratin, proliferating cell nuclear antigen, cell death (apoptosis) and neovascularisation (CD 34). RESULTS: Markers of differentiation (PSA and transglutaminase) aided recognition of higher-grade tumours. PSA negativity avoided metaplasia being overcalled as carcinoma. Loss of basal cells around malignant prostatic acini as determined by high molecular weight keratin (HMWK), was useful in foci of atypical small acinar proliferation and in prostatic intraepithelial neoplasia. Assessment of proliferation indices identified subsets of tumours, within conventional morphologic Gleason's grades, with a higher growth fraction. Cell death determination and study of tumour vessels did not offer any improvement on morphology. CONCLUSION: Immunophenotypic assessment helps in refining morphologic diagnosis of prostatic lesions. Differentiation and proliferation markers objectively assess tumour characteristics with their biologic growth potential and are recommended for diagnostic use. They also help in assessement of response to therapy.

Solitary myofibroma of the breast: a case report.

Solitary myofibromas are relatively rare neoplasms but one of the most common fibrous neoplasms occurring in infancy and childhood. Adult cases have also been reported in the literature. We describe here a case report of an eighteen-month-old child who presented with a gradually enlarging nodule in the right breast. The case is presented for an insight into contemporary knowledge about its histogenetic origin, behaviour and prognosis.

Chronic subdural haematoma and the enigmatic eosinophil.

The membranes from 50 cases of chronic subdural haematomas were examined histologically and correlated with the duration of the lesion. Cases were divided into three groups based on duration from time of trauma and/or onset of clinical symptoms to date of surgery - Group I: 1 to 30 days, Group II: 31 to 90 days and Group III: >90 days. Infiltration with eosinophils was observed in the vascularised and hyalinised granulation tissue of the subdural membrane in 30 of the 50 cases (60%). There was a trend to correlation both of the frequency and the extent of eosinophilic infiltration with duration of haematoma. Thus, eosinophils were encountered in about half the cases with duration up to 3 months which increased to 80% in cases with duration more than 3 months. The extent of eosinophilic infiltration (mild, moderate or severe) also appeared to correlate with duration of haematoma in that mild infiltration was more common in Group I cases while moderate to severe infiltration were more frequently observed in Group II and III cases. No correlation was observed of the eosinophilic infiltrate with age and sex of the patients or with presence of other cellular inflammatory components of the membrane. Interestingly, a finding hitherto unreported in English literature was the demonstration of mast cells in 7 of 16 membranes (44%) which had been stained using toluidine blue. It is possible that the eosinophils appear at this unusual site due to chemotactic stimulus abetted by these mast cells as well as lymphocytes and haemosiderin pigment. The eosinophils may have an important role in the repair and healing process of these membranes.

Villoglandular papillary adenocarcinoma of the cervix: case report.

The incidence of cervical adenocarcinoma is on the rise over the last several decades. It generally carries a worse prognosis than squamous carcinoma. Villoglandular papillary adenocarcinoma (VGA) of the cervix has been identified as a distinct subset of cervical adenocarcinoma that occurs in young women and supposedly carries an excellent prognosis. We report a case of adenocarcinoma of the cervix in a young woman that had classical histological features of VGA but at operation showed presence of tumor cells in the peritoneal wash. A review of world literature on the 56 cases reported so far is presented where occasional cases showing disease spread have been reported, suggesting caution in the management and follow-up of this clinicopathologic entity.

Ependymoma with extensive lipidization mimicking adipose tissue: a report of five cases.

Lipomatous ependymoma is a recently described entity and only 3 cases of this variant have been reported in the literature. We report 5 cases of this rare variant of ependymoma. Patients age ranged from 4 years to 45 years and, interestingly, all of them were males. Two tumors were supratentorial in location, 2 in the fourth ventricle and 1 was intramedullary. Microscopically all of them showed the classical histology of ependymoma along with lipomatous differentiation. The lipomatous component was composed of cells with a large clear vacuole pushing the nucleus to the periphery and giving a signet ring cell appearance. This component demonstrated positivity for GFAP and S-100 protein thereby confirming its glial lineage. Three of the 5 tumors were high grade (WHO-grade III), had a high MIB-1 labelling index (MIB-1 LI) and showed recurrence on follow-up. However, 2 were low grade (WHO grade II) and patients are free of disease till the last follow up.

Adult Wilms' tumour (report of two cases).

Wilms' tumour, an embryonic neoplasm, the most common renal tumour in childhood, had occasionally been reported in adults. Authors report two such cases and have reviewed the relevant literature. While Wilm's tumour in children classically demonstrates the curative potential of combined modality treatment, no such clear guide lines are available for those occurring during adulthood. Pathologic diagnosis of adult Wilm's tumour is difficult because of the multiplicity of undifferentiated adult tumours that must be considered in the differential diagnosis. As no predictive parameters for optimal therapy exist, a combination of surgery, irradiation and chemotherapy probably is indicated for all stages of disease.