Retiform Hemangioendothelioma of the Gluteal Region: A Case Report.

Retiform hemangioendothelioma is a locally aggressive, rarely metastasizing, low-grade angiosarcoma characterized by intercommunicating vascular channels lined by hobnail or cuboidal endothelial cells, flanked by lymphocyte and hyaline sclerosis. Neoplastic endothelial cells usually express von Willebrand factor, CD31 and CD34, while the lymphocytic infiltrate shows a mixture of CD3+, T and CD20+ B cells. The authors describe a case of a 76-year-old female who presented with a soft, painless, ill-defined mass measuring 9 cm in her right gluteal region for the past 15 years, clinically suggestive of a lipoma. There was no regional lymphadenopathy. The mass was resected and sent for histopathological examination. The slow-growing lesion and the typical histomorphology led to the diagnosis of retiform hemangioendothelioma. The diagnosis was confirmed by immunohistochemistry using CD34 antibody, which strongly stained the endothelial cells. The patient was followed up for 6 months after the surgery and no recurrence was noted.

A Community Based Study on Pelvic Inflammatory Disease in Postmenopausal Females: Microbiological Spectrum and Socio-Demographic Correlates.

INTRODUCTION: Pelvic Inflammatory Disease (PID) is a common and serious complication of sexually transmitted diseases in young women but is rarely diagnosed in the postmenopausal women. Very few studies have been done regarding post-menopausal PID. AIM: To determine the burden of PID, associated micro-organisms, pathophysiology and risk factors among post-menopausal women of the community. MATERIALS AND METHODS: A cross-sectional study was conducted among 530 post-menopausal women in the registered field practice areas of the JN Medical College and Hospital, Aligarh, Uttar Pradesh, India. A pre designed and pre tested proforma was used to obtain data regarding socio-demographic details and factors associated with PID. Clinical and laboratory examinations were done to confirm the diagnosis of PID. Data was analyzed using SPSS 23.0. Association between categorical variables was tested with chi-square test and logistic regression analysis was used to find independent risk factors. The value of p<0.05 was considered as significant. RESULTS: About 11.55% of the study subjects were diagnosed with PID (12.5% in rural areas and 10.6% in urban areas). Bacterial vaginosis followed by Trichomonas vaginalis were most common. Among the important risk factors, significant association was found with occupation of the women, increasing parity, multiple sexual contacts, and associated pelvic organ prolapse. Association with smoking, chronic illnesses, diabetes mellitus and hypertension, and associated urinary tract infection were not found to be significant. CONCLUSION: The study shows the hidden burden of the disease in the community and the associated risk factors, which can be prevented by life style and cultural changes if incorporated earlier in the lives.

Disseminated cysticercosis incidentally diagnosed in a patient of fracture shaft of femur.

Cysticercosis is caused by the larval form of Taenia solium tape worm, cysticercus cellulose. The life cycle of T. solium consists of 2 host, the definite host is a man who harbours the adult forms of the worm in the intestine, while the intermediate host is the pig, where the larval form (cysticercus cellulose) is found in the skeletal muscle. Cysticercosis develops when human beings incidentally become the intermediate host and the eggs mature within their small intestine. The route of entry of the eggs into the human intestine may occur through autoinfection or by ingestion of contaminated food or water. Further, these eggs develop into the larval form which spread throughout the intestinal wall and are disseminated by the blood stream to brain, muscles, subcutaneous tissues or any other organ. Until now, only 50 cases of disseminated forms have been reported in the literature, with the majority of the cases being from Indian subcontinent. Regarding the clinical presentations, symptoms usually depend on the location, size and number of cysts in the involved lesion. However, it may present occasionally with dementia, muscular hypertrophy or subcutaneous nodules with relative absence of focal neurological signs or raised intracranial pressure. We, here, report a case of disseminated cysticercosis, detected incidentally in a man aged 52 years who presented with an open fracture of the right femur.

Myopericytoma of lip: a rare lesion in an unusual location.

Myopericytoma is a rare benign tumor with perivascular myoid differentiation. It shares histomorpholoic features with the so-called hemangiopericytoma, myofibroma and glomus tumor. We hereby report the case of a 14-year-old boy who presented with a slowly growing, painless, firm mass on upper lip, diagnosed as myopericytoma on the basis of histopathology and immunohistochemistry. To the best of our knowledge, this is only the second such reported case.

Schwannoma of the scrotum: case report and review of the literature.

Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering the peripheral nerves. Common locations include the head, neck, mediastinum, and retroperitoneum. These tumors are usually asymptomatic until they become large and compress the surrounding tissues. Most schwannomas occur during the third and fourth decades of life, with an equal gender distribution. We present the case of a schwannoma that originated in the scrotum.

Metastasis to left scapula with unknown primary: Approach to pathological diagnosis.

Bony metastasis is a frequent occurrence in malignancy. However, the clinical presentation and pathological findings may sometimes be more in favor of a primary bone lesion. In such cases, immunochemistry has a very important role to play in reaching a final diagnosis. We present the case of a 35 year male patient who was investigated for a lytic lesion in the left scapula and was finally diagnosed with metastatic adenocarcinoma with the help of immunostaining.

A comparison of cytological and histopathological findings and role of immunostains in the diagnosis of soft tissue tumors.

BACKGROUND: Fine needle aspiration cytology (FNAC) has been employed as a useful technique for the initial diagnosis of soft tissue tumors (STT) as well for the identification of recurrent and metastatic cases. AIM: We conducted this study on soft tissue tumors to find the efficacy of FNAC and to finalize the histological diagnosis with immunostains. MATERIALS AND METHODS: The present study was conducted on 126 patients of soft tissue tumors. FNAC and histopathology was performed in all the cases. RESULTS: Hundred and five cases (83.3%) were diagnosed as benign and 21 cases (16.7%) as malignant. On FNAC, tumors were divided into six cytomorphological categories i.e. lipomatous, spindle cell, round cell, myxoid, pleomorphic and vascular tumors. Seventeen cases were inconclusive on cytology. In five cases, the type of malignancy was changed on histological examination. There were three false positive and two false negative cases giving a positive predictive value of 97.2 % in terms of malignancy, a sensitivity of 98.1% and a specificity of 96.7%. CONCLUSIONS: FNAC has a definite role in forming the initial diagnosis of STT, while histopathology with the aid of immunomarkers provides the final diagnosis.

A study on antioxidant and apoptotic effect of Azadirachta Indica (neem) in cases of cervical cancer.

PURPOSE: To study the anti-oxidant properties of neem (Azadirachta indica) in inducing apoptosis of cervical cancer cells and estimation of caspase activity and TNF-α and IFN-γ levels in monocytes of cervical cancer patients and controls. METHODS: Monocytes were cultured from blood samples of 65 study cases and 30 controls for the estimation of caspase 3, 8 and 9 with specific inhibitors and TNF-α and IFN-γ levels in culture supernatant of monocytes. Two cervical biopsies were taken from 18 cases of moderately differentiated SCC. One biopsy was formalin fixed for histopathology and the other for tissue culture was kept in RPMI-1640 medium to evaluate the apoptotic effect of neem extract on malignant cells. RESULTS: Neem-treated monocytes from cervical cancer patients showed high activity levels of caspase 3, 8, and 9. A decrease in TNF-α and an increase in IFN-γ levels was seen in culture supernatant of monocytes. Cyto- and histomorphology of neem-treated cervical cancer cells exhibited increased apoptosis. CONCLUSION: Neem is a potent inducer of apoptosis in biopsies of cervical cancer patients.

Endometrial adenocarcinoma with osteoclastic giant cells in stroma: a case report and review of literature.

It is rare to find osteoclastic giant cells (OGCs) as a stromal reaction in uterine adenocarcinoma of endometrium. Here, we report a case of a 60-year-old female diagnosed with adenocarcinoma of endometrium. Total hysterectomy with bilateral salpingo-oopherectomy and removal of pelvic lymphnodes was performed. Histologically, the tumour showed adenocarcinoma of the endometrium with mucin secretion. The stroma showed some plump reactive pleomorphic cells, resembling stromal cells, infiltrated uniformly with OGCs and mononuclear cells (MNCs). The epithelial cells of adenocarcinoma stained positive for cytokeratin (CK 7) (CAM 5.2). The osteoclastic giant cells and mononuclear cells stained positive with CD68 and negative with cytokeratin and vimentin. We conclude that the osteoclastic giant cells originated from reactive histiocytes/monocytes as a stromal reaction to malignancy.

Spindle cell lipoma breast.

Spindle cell lipoma, which usually arises in the soft tissues, is rare in breast and is difficult to differentiate from primary mammary spindle cell tumor. Here, we present the case of a 48-year-old woman with a 3-cm, solitary, well-circumscribed and nontethered mass lying deep within the tissue of left breast, incidentally detected on routine mammography. The spindle cells proved to be immunoreactive to CD 34, but nonreactive to desmin and smooth muscle actin.

Significance of AgNOR score in benign and malignant soft tissue tumours.

AgNOR staining was employed on FNAC and histopathological sections obtained from patients with soft tissue tumours. The study comprised of 20 normal appearing soft tissues, 74 benign and 36 malignant soft tissue tumours. The slides were stained with AgNOR in order to differentiate between benign and malignant soft tissue tumours. The mean AgNOR count in normal appearing soft tissues, benign lesions and malignant lesions was 1.04+/-0.10 (0.94-1.14), 1.51+/-0.21 (1.1-2.1) and 4.96+/-1.33 (2.57-7.21) respectively. The mean AgNOR count was found to be higher in benign soft tissue tumours as compared to normal appearing soft tissues and the difference was found to be statistically significant. The mean AgNOR count in soft tissue sarcomas was found to be higher as compared to both normal appearing soft tissues and benign soft tissue tumours and the results were found to be statistically significant. The increased AgNOR score in both benign and malignant soft tissue tumours as compared to normal appearing soft tissues indicates high proliferative activity. Thus AgNOR staining is a simple and useful method for estimating tumour cell proliferation thereby differentiating normal appearing soft tissues from benign and malignant soft tissue tumours.

Glyceryl trinitrate, a nitric oxide donor, abrogates ferric nitrilotriacetate-induced oxidative stress and renal damage.

Ferric nitrilotriacetate (Fe-NTA), a common water pollutant and a known renal carcinogen, acts through the generation of oxidative stress and hyperproliferative response. In the present study, we show that the nitric oxide (NO) generated by the administration of glyceryl trinitrate (GTN) affords protection against Fe-NTA-induced oxidative stress and proliferative response. Administration of Fe-NTA resulted in a significant (P<0.001) depletion of renal glutathione (GSH) content with concomitant increase in lipid peroxidation and elevated tissue damage marker release in serum. Parallel to these changes, Fe-NTA also caused down-regulation of GSH metabolizing enzymes including glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione-S-transferase and several fold induction in ornithine decarboxylase (ODC) activity and rate of DNA synthesis. Subsequent exogenous administration of GTN at doses of 3 and 6mg/kg body weight resulted in significant (P<0.001) recovery of GSH metabolizing enzymes and amelioration of tissue GSH content, in a dose-dependent manner. GTN administration also inhibited malondialdehyde (MDA) formation, induction of ODC activity, enhanced rate of DNA synthesis, and pathological deterioration in a dose-dependent fashion. Further, administration of NO inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), exacerbated Fe-NTA-induced oxidative tissue injury, hyperproliferative response, and pathological damage. Overall, the study suggests that NO administration subsequent to Fe-NTA affords protection against ROS-mediated damage induced by Fe-NTA.

Role of FNAC and antithyroid antibodies in the diagnosis of thyroid disorders.

Multiple parameters are needed to diagnose thyroid disorders. 100 cases of thyroid swellings were studied by clinical assessment, hormonal assay, fine needle aspiration cytology (FNAC), antithyroglobulin (Tg) and antimicrosomal (Tm) antibodies and histopathology. The cases were divided into four groups. Cases of thyroiditis on FNAC showed predominance of lymphocytes (76%), hurthle cells (77%), epithelioid cells and giant cells (31%) and high titres of Tg (66%) and Tm (92%). Non toxic goitre was characterized by colloid and foam cells (100%) and low positivity for Tg and Tm (25%). Toxic goitre showed colloid (30%). Hurthle cells, anisonucleosis of acinar cells (38%), fire flare (62%) and high positivity for Tg and Tm (73%). Neoplasia was diagnosed mainly by cell morphology on FNAC and a low positivity for Tg and Tm (30%). FNAC in correlation with thyroid antibodies is useful in diagnosing autoimmune thyroiditis, goitre, Grave's disease and malignancy of thyroid. Antibodies have a specific role in the diagnosis of early stage of thyroiditis.