Melanotic Neuroectodermal Tumor of Infancy of Jaws: A Case Report and Review of Literature.

Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon pigmented neural crest tumor primarily found in infants. We presented a case report of successful surgical management of MNTI in an 11-month-old female. A total of 178 articles discussing 249 cases of MNTI were identified through literature search. Literature review of 250 cases of MNTI including the current case report was conducted considering study parameters such as age and gender of the patient, location of the lesion, levels of vanillylmandelic acid, management options, and outcome after treatment. Statistical review of the data showed that MNTI predominantly affects the anterior maxilla in infants less than six months of age. Recurrence of the lesion shows a significant association with age of the individual and treatment method employed. This study reports a 2.4% mortality rate, 2% malignancy rate, and a recurrence rate of 15.2%, with recurrence times ranging from 15 days to 20 months. We advocate a minimum follow-up of four months to two years to monitor recurrence.

Expression of immune checkpoint protein in oral squamous cell carcinoma and its clinicopathological correlation: A tertiary care center cross-sectional study.

Background: Recent evidence suggests that oral squamous cell carcinoma (OSCC) patients who exhibit the immunohistochemical expression of immune checkpoint protein programmed cell death ligand 1 (PD-L1) are more likely to have a poor clinical outcome and may serve as an independent prognostic marker. Aims and Objectives: This study aimed to assess the immunohistochemical expression of immune checkpoint protein PD-L1 in OSCC and its clinicopathological correlation. Materials and Methods: OSCC cases were included in the study. This was a tertiary care center cross-sectional one-year duration study. Histomorphological diagnosis and immunohistochemical expression of PD-L1 were performed after taking ethical clearance. The statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0 statistical analysis software. Results: A total of 106 cases of OSCC were included in the study. Histologically, the majority of cases (58.5%) were graded as well differentiated, followed by moderately differentiated (58.5%) and poorly differentiated (4.7%), respectively. In PD-L1 immunohistochemical expression, score 1+ was accorded to 37 (34.9%), 2+ was accorded to 31 (29.2%), and score 3+ was accorded to 33 (31.1%) cases. Tumor size, pattern, depth of invasion lymphovascular invasion (LVI), and perineural invasion (PNI) were found to be significantly associated with PD-L1 immunohistochemical scores. Conclusions: We concluded that the immunohistochemical expression of immune checkpoint protein PD-L1 positivity in tumor cells was seen in the majority of the cases (60.37%) in our patient. This suggests that the PD-1 or PD-L1 pathway plays a significant role in tumor immune evasion in OSCC.

Solitary superficial angiomyxoma of the ear pinna: a diagnostic dilemma with a review of literature.

Superficial angiomyxoma is an extremely rare subcutaneously placed myxoid soft tissue neoplasm. There are few case reports with fine needle aspiration cytological and histopathological findings available for this tumor because of its rarity. Here, we describe a case of superficial angiomyxoma in a 24-year-old girl who had a solitary left ear pinna mass without a Carney's complex at the time of presentation or at the end of two years of follow-up next to the surgical removal of the tumor. The clinical, cytomorphological, and histological findings, together with the immunohistochemical markers, in a case of superficial angiomyxoma are described in this rare case report for the first time in the English literature.

Immunohistochemical Expression of p16 and CDK4 in Soft Tissue Tumors.

BACKGROUND AND OBJECTIVES:  The aim of this study was to determine the immunohistochemical expression of p16 (p16INK4a) and cyclin-dependent kinase 4 (CDK4) and CDK4 markers in various lineages of soft tissue tumors and to evaluate their role in differentiating atypical lipomatous tumors/well-differentiated liposarcomas from benign lipomas. MATERIAL AND METHODS: A total of 70 cases of both excisional and incisional biopsies of soft tissue tumors were included in this study. Histopathological examination was done by using formalin-fixed, paraffin-embedded tissue samples. After that, we performed IHC expressions of p16 and CDK4 markers on the unstained slides of these soft tissue tumors.  Results: Immunohistochemical study showed that positive expressions of p16, CDK4, and combined (p16+CDK4) markers were 51.4%, 10.0%, and 12.9%, respectively in soft tissue tumors. Positive p16 expression was observed among a higher proportion of malignant cases (66.7%) as compared to benign (20.0%) and intermediate (50.0%) cases. This difference was found to be statistically significant (p=0.009). Negative expression of only CDK4 and combined (p16 and CDK4) were observed among a higher proportion of benign as compared to malignant and intermediate cases (90.0% vs. 78.6% & 75.0%, p=0.393 and 65.0% vs. 26.2% & 37.5%, p=0.028, respectively). This difference was not found to be statistically significant. For adipocytic tumors, the majority of malignant and intermediate tumors had positive p16 (7/7; 100%) and CDK4 (6/7; 85.7%) immunohistochemical expression. These differences were found to be statistically significant. CONCLUSION: Immunohistochemical marker p16 can be used to differentiate between malignant and benign soft tissue tumors. Amongst adipocytic tumors, combination of p16 and CDK4 immunohistochemical expression can be used to differentiate liposarcomas from benign ones.

Lower lip cysticercosis: An unusual case report.

Cysticercosis is a disease that occurs when humans are infected with Taenia solium larvae. The parasitic illness cysticercosis, which is common in impoverished nations, hardly ever affects the mouth. Oral cysticercosis is rare that might be challenging to diagnose clinically. This rare case report documents an oral cysticercosis case in a 38-year-old male patient who had an asymptomatic lesion in the buccal mucosa of his lower lip. A T. solium larva was identified on histopathological examination in a cystic cavity after an excisional biopsy.

A malignant transformation of borderline phyllodes tumor to fibrosarcoma breast: A rare case report.

ABSTRACT: Phyllodes tumor of the breast with malignant transformation to fibrosarcoma of the breast is a rare entity. Breast fibrosarcoma is uncommon, accounting for less than 1% of all breast tumors. Prognosis of fibrosarcoma of the breast is poor. Due to its rarity, survival rates are not defined. A 23-year-old woman presented with a mass in the left breast, and another 48-year-old woman presented with right breast mass. Both patients underwent for surgery. The histological & immunohistochemical examination confirms the diagnosis of a malignant transformation from borderline phyllodes tumor to fibrosarcoma. We concluded that the phyllodes tumor is mostly benign but local recurrence is common. As the tumor progresses toward malignancy, due to the difficulty in the diagnosis of borderline phyllodes tumors, total mastectomy with axillary resection must be recommended.

Prostate Tuberculosis Masquerading as Prostate Carcinoma: A Rare Case Report.

Genitourinary tuberculosis (GUTB), the second most frequent type of extrapulmonary tuberculosis (TB) in endemic regions, was initially described by Wildbolz in 1973. The prostate and epididymis are the first sites of male genital tuberculosis, followed by the seminal vesicles and the testicles. Here, we describe a case of a 65-year-old male who presented with obstructive lower urinary tract symptoms (LUTS) for the previous six weeks. The digital rectal examination revealed prostatic enlargement with a firm and nodular surface. A high prostate-specific antigen level (88 ng/ml) was found in serum analysis. There was a suspicion of prostate cancer on the basis of clinical, radiological, and serological examination. In view of the suspicion of carcinoma, a prostate biopsy was performed, which revealed the proliferation of prostatic glandular and stromal elements with interspersed granulomas, necrosis, and aggregates of mature lymphoid cells. The histopathology findings were indicative of benign prostatic hyperplasia with granulomatous prostatitis. Ziehl-Neelsen (ZN) stain was negative for acid-fast bacilli. The cartridge-based nucleic acid amplification test (CBNAAT) for Mycobacterium tuberculosis was ordered on the prostate biopsy tissue bits, which showed positive results. On the basis of histopathology and nucleic acid amplification test, the diagnosis of prostate tuberculosis was considered. There are no specific clinical and radiological findings related to prostate tuberculosis; hence, the diagnosis can be established only after histopathological examination and tissue-based cartridge-based nucleic acid amplification test. Clinicians should have a high index of suspicion for tuberculosis, especially in patients from endemic countries who present with symptoms of the lower urinary tract, especially if there is granulomatous inflammation coupled with necrosis.

Expression of aldehyde dehydrogenase 1A1 in oral squamous cell carcinoma and its correlation with clinicopathological parameters.

Background: Aldehyde dehydrogenase 1A1 (ALDH1A1) is a key aldehyde dehydrogenase (ALDH) isozyme, related to the cancer stem cells which are responsible for initiating tumor growth, progression, and recurrence. High expression of ALDH1A1 has been reported in several tumor types in humans and its expression is associated with poor prognosis. The aim of this study was to assess the expression of the ALDH1A1 in oral squamous cell carcinoma (SCC) and its correlation with various clinicopathological parameters. Materials and Methods: ALDH1A1 expression was analyzed by using immunohistochemistry on paraffin blocks of 112 cases of primary oral SCC and their corresponding 68 lymph nodes with metastatic deposits. ALDH1A1 expression was also correlated with various clinicopathological parameters. Statistical analysis was done with statistical analysis software, the Statistical Package for the Social Sciences version 21.0. Results: High ALDH1A1 expression was observed in 31.2% of cases of primary oral SCC as compared to 73.5% in lymph node metastasis. A statistically significant difference (P = 0.04) was observed in high TNM stages (68.6%) of the tumor as compared to low TNM stages (31.4%). However, histopathological grades of tumor showed nonsignificant correlation with ALDH1A1 expression (P = 0.093). 40.2% of patients were expired at the end of the study, and the rate of mortality was significantly higher (P = 0.01) in patients with high ALDH1A1 expression as compared to low expression (60.0% vs. 31.2%). Conclusion: High ALDH1A1 expression was associated with higher TNM tumor stage and high nodal stage. It was also associated with high mortality rate which validates it as a marker of invasiveness and poor prognosis in oral SCC.

Comparison of Different Histological Staining Methods for Detection of Helicobacter pylori Infection in Gastric Biopsy.

BACKGROUND: Helicobacter pylori gastritis affects two-thirds of the world's human population. Among various invasive and non-invasive tests, histology play a very important role in detecting H. pylori in gastric biopsies. In histology, for detection of H. pylori, we use different histological staining techniques like routine haematoxylin & eosin (H&E) stain, Giemsa stain, Gimenez stain, and periodic acid Schiff - Alcian blue (PAS-AB) stain. OBJECTIVE: Aim of our study was to evaluate these different histopathological staining techniques for detecting H. pylori in gastric mucosal biopsies and to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H&E stain, Gemenez stain and PAS-AB in the detection of H. pylori in gastric biopsies using Giemsa stain as the reference standard. MATERIALS AND METHODS: It was a prospective descriptive study design of 45 gastric biopsies of patients having gastritis. This study was conducted at Vivekananda Polyclinic and Institute of Medical Sciences over a period of one year, from March 2021 to February 2022. From each formalin-fixed paraffin-embedded block, four glass slides were prepared and stained with H&E stain, Giemsa stains, Gemenez stain, and PAS-AB stain to detect the presence/absence of H. pylori in gastric biopsies. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were assessed. RESULTS: Various staining techniques for detecting H. pylori in gastric mucosal biopsies were compared. In reference to Giemsa stain results, statistical analysis indicates that the diagnostic accuracy of the Gimenez stain, H&E stain, and PAS-AB stain were 95.6%, 91.1%, and 84.4% respectively. Gimenez stain is confirmed to be better than H&E stain and PAS-AB stain to detect H. pylori in 45 gastric biopsies of patients having gastritis. PAS-AB stain is the worst stain to detect H. pylori in gastric biopsies. CONCLUSION: Gimenez stain has higher diagnostic accuracy than PAS-AB stain in the detection of H. pylori in gastric biopsy. In fact, Gimenez stain has high sensitivity, specificity and diagnostic accuracy as compared to traditional H&E stain while PAS-AB stain has lower sensitivity, specificity and diagnostic accuracy. Thus, Gimenez stain is also recommended for the detection of H. pylori in gastric biopsy.

Primary Spinal Intradural Ewing's Sarcoma: Hemorrhagic Presentation with Acute Neurological Deterioration in Two Pediatric Patients.

Extraosseous primary spinal intradural Ewing's sarcoma (ES) is an unusual entity. Bleed within such tumors with acute neurological worsening is extremely rare, especially in the pediatric age. In this article, we present two children with intradural-extramedullary ES who had sudden decline in their neurological status consequent to an intratumoral hemorrhage. We discuss their clinical course and also briefly review the pertinent literature. Spinal intradural Ewing's sarcomas possibly have a tendency to bleed. A short clinical symptomatology along with an acute neurological deterioration and radiologic evidence of intratumoral hemorrhage in a spinal intradural tumor should raise the suspicion of an ES.

Incidental Gallbladder Carcinoma in North Indian Population: Importance of Routine Histopathological Examination of All Benign Gallbladder Specimens.

AIM: To evaluate the incidence of incidental gallbladder carcinoma in specimens of cholecystectomy performed for benign gallbladder diseases and to establish the utility of routine histopathological examination of all gallbladder specimens obtained following cholecystectomy done for benign diseases. MATERIAL AND METHODS:  This was a hospital-based three years prospective and retrospective study done at a tertiary care centre in North India. Gallbladder specimens from laparoscopic and open cholecystectomies done for benign gallbladder diseases without any clinico-radiological evidence of malignancy were included in the study. Routine histopathological evaluation of 1,268 such gallbladder specimens was carried out to get the incidence of incidental gallbladder carcinoma and pathological staging of carcinoma was done according to American Joint Committee recommendations for cancer staging (AJCC). All the diagnosed cases of Incidental gallbladder carcinoma (IGBC) were analysed in terms of demographics, radiology findings, and gross and microscopic pathology findings. RESULTS: Out of 1,268 gallbladder specimens of clinically benign diseases, 16 cases (1.26%) were diagnosed as cases of IGBC with female predominance with a male to female ratio of 1:7. Mean gallbladder thickness in these cases was 0.77±0.20 cm, and 98.30% cases of IGBC were associated with gall stone disease. However, no correlation was observed between the age, gallbladder thickness and pathological stages of these IGBC. CONCLUSION:  IGBC is an occult disastrous malignancy of the gallbladder, which can be missed in the pre and intraoperative periods despite careful clinical and radiological evaluation and comes as a surprise for pathologists the first time. We recommend that all specimens of gallbladder obtained from its surgical resection for benign diseases should be subjected to histopathological examination.

Nodular Hidradenocarcinoma, Trichelemmal Carcinoma and Squamous Cell Carcinoma with Clear Cell Changes: Pitfalls of Biopsy Diagnosis of Skin and Adnexal Tumours.

Skin and Adnexal tumours are a group of benign and malignant tumours whose basic diagnosis relies on histopathology. A single tumour may show more than 1 appendageal differentiation. Morphologic distinction between benign and its malignant counterpart is of utmost importance as it affects the treatment and prognosis of patient. We have described 3 cases who presented in our university hospital, in which final resection pathological diagnosis differed from initial core biopsy interpretation. The authors have made an attempt to provide a brief overview of diagnostic overlap existing between nodular hidradenocarcinoma and tumours of clear cell histology. Salient morphologic features differentiating cylindroma or trichilemmal carcinoma from squamous cell carcinoma have also been discussed. Final diagnosis is paramount for adjuvant management and prognostication of the patient in a clinical setting.

A rare case report of transitional urothelial carcinoma metastasizing to isolated upper cervical lymph node diagnosed on cytology.

Transitional urothelial carcinoma frequently metastasizes to pelvic and retroperitoneal lymph nodes usually within 2 years of primary diagnosis but isolated metastasis to upper cervical lymph node after 5 years of primary diagnosis is extremely rare. We report here a case of a 53-year-old male who presented with Level II cervical node enlargement after 5 years of being diagnosed and treated for urothelial carcinoma. The diagnosis of cervical metastasis from urothelial carcinoma was suggested by fine-needle aspiration cytology and confirmed by immunocytochemistry.

Head and Neck Sarcomas-clinicopathological Findings, Treatment Modalities and Its Outcome - A Retrospective Study.

Introduction: Sarcomas are malignant neoplasms constituting an important group of tumours due to their high morbidity and mortality. They can arise either from soft tissue or bone. Soft tissue sarcomas are common, but bone sarcomas are rare. The aims and objective of this study are to carry out the study of head-and-neck sarcomas between January 2006 and May 2020. Materials and Methods: Eighty-two patients of head-and-neck sarcoma were included. Study of demographic and clinicopathological characteristics including age, sex, gender, presenting symptoms, origin, primary anatomical location, size, tumour grade, staging, treatment modality, recurrence, metastasis, and patient status during the recent visit. Results: Fifty-six (68.3%) were males and 26 (31.7%) were females. The male/female ratio was 2.28:1. The most affected age group was 0-19 years. Tumour size of >5 cm in greatest dimension was seen in 67.1% cases and tumour size of <5 cm in 32.9%. Chemotherapy + radiotherapy (CT + RT) was given in 23.8% followed by surgery in 13.9%. Recurrence was seen in 19.5% and metastasis in 18.3%. Discussion: Rhabdomyosarcoma was the most predominant histological type. Maximum patients reported in late stage. The most commonly used treatment was the combination of CT and RT. Recurrence was seen in 19.5% and distant metastasis in 18.3% patients. Head-and-neck sarcomas are rare so epidemiological studies involving more cases must be carried out for better understanding and better outcome.

Liquid-based cytology versus conventional cytology in fine-needle aspirates of salivary gland neoplasms.

BACKGROUND: Liquid-based cytology (LBC) is a method of retrieving and processing of cytological material for the assessment of both gynecological and nongynecological cases introduced in 1996. Mostly conventional smears (CS) are prepared in Indian scenario; however, due to increasing popularity of LBC in nongynecology specimens, LBC is also used in few centers for diagnosing salivary gland neoplasm. AIM: The aim of this study is to compare CS and LBC in fine-needle aspiration cytology (FNAC) of the salivary gland neoplasms in terms of cytomorphological details, adequacy, ease of interpretation, pitfalls, and diagnostic efficiency. MATERIALS AND METHODS: We conducted a prospective, observational, comparative study which included 64 salivary gland neoplasms. Both CS and LBC (SurePath) were prepared as per standard protocols and examined. RESULTS AND CONCLUSION: In our study, specificity and positive predictive value of both the techniques (conventional and LBC) were found to be 100%. Sensitivity of both the techniques was found to be similar (66.7%). Negative predictive value and diagnostic accuracy of conventional technique were found to be almost similar to that of LBC technique (97.6% vs. 97.2% and 97.7% vs. 97.4%). In terms of adequacy and cellularity, CSs were better than LBC. Ease of interpretation was better with CSs due to abundant chondromyxoid stroma, an important clue in the diagnosis of pleomorphic adenoma. Nuclear details and background were better in LBC as compared to CS. Hence, we conclude that in salivary gland FNAC, both CS and LBC have similar diagnostic efficiency. however, interpretation of conventional smears is easier than Liquid Based Cytology especially in cases of pleomorphic adenoma. However, some advantages of LBC in respect to conventional cytology, with better-preserved morphology obtained from LBC becomes furthermore obligatory.

A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion.

BACKGROUND: The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB). MATERIALS AND METHODS: This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope's biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB. RESULTS: 46 Patients underwent this study. In all 46 patients both CPB and TPB were performed. TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular. CONCLUSIONS: TPB has much greater diagnostic efficacy than CPB.

Extra-axial primary non-Hodgkin's CNS lymphoma mimicking meningioma, in a 5-year-old immunocompetent child: a rare entity.

We describe a case of a 5-year-old immunocompetent girl who presented with features of raised intracranial pressure with left eye ptosis of 1-month duration. CT scan and MRI of the brain showed an extra-axial, intensely contrast enhancing lesion in the left temporoparieto-occipital region, consistent with meningioma. On open tissue biopsy and immunohistochemistry staining, a diagnosis of B cell non-Hodgkin's lymphoma was made. Six cycles of chemotherapy with cyclophosphamide, adriamycin, vincristine and prednisolone regimen were given and showed a good clinical outcome without any recurrence during follow-up of 5 months.

Expression of GLUT-1 in oral squamous cell carcinoma in tobacco and non-tobacco users.

BACKGROUND: GLUTs are a family of proteins that mediate glucose transport through the membrane, expressed in head and neck squamous cell carcinoma. GLUT-1 positivity in malignant cells indicates increased proliferative activity, energy requirements, aggressive behaviour and poor radiation response. AIM: To observe the expression of GLUT-1 protein in oral squamous cell carcinoma in tobacco and non-tobacco users and to correlate the expression with histopathological grading and pathological staging. METHODS: 50 cases (25 tobacco and 25 non-tobacco) of oral squamous cell carcinoma, selected during period of August 2014 to July 2015. Histopathological grading, TNM and staging were done. Immunohistochemical staining was performed using standard protocol for paraffin embedded sections. Analysis was performed on SPSS software (Windows version 17.0). RESULTS: Significant association of GLUT-1 expression was found with history of tobacco (p < 0.001), Bryne's grade (p < 0.001), tumour size (p = 0.001), nodal metastasis (p = 0.022) and stage (p < 0.001). Higher GLUT-1 expression in stage II, stage III and stage IV was found as compared to stage I. GLUT-1 immunoexpression also shows progressive switch from membranous to cytoplasmic to combined location correlating with histopathologic grade and pTNM stage. CONCLUSION: GLUT-1 expression correlates significantly with histological grade and pTNM staging of oral squamous cell carcinoma. It also significantly correlates with tobacco addiction. Thus, GLUT-1 expression may serve as a biomarker for patients of oral squamous cell carcinoma.