Nasopharyngeal carcinoma with unusual metastasis to urinary bladder.

Nasopharyngeal carcinoma (NPC) metastasizing to urinary bladder is an uncommon site. We report an interesting case of NPC, on follow-up, presenting with unusual urinary symptoms and mimicking a primary bladder cancer. Subsequent bladder cold cup biopsy and immunohistochemistry unfolded a metastasis of NPC, highlighting unexpected and a rare presentation.

Clinical Impact of Mismatch Repair Protein Testing on Outcome of Early Staged Colorectal Carcinomas.

INTRODUCTION: Colorectal cancer is the third most common cancer in men and second most common in women globally. In the present study, we aimed to analyse the proportion of patients with loss of immunostaining for mismatch repair (MMR) proteins in all newly diagnosed stage II cases of colorectal cancer for the purpose of prognostication, for determination of further chemotherapeutic strategy and for familial screening. METHOD: From January 2014 to December 2015, 62 consecutive newly diagnosed cases of stage II colorectal cancer were included in the study. Details of each patient related to their demographic profile and tumour profile were recorded. All the cases were grossed and staged according to College of American Pathologist (CAP) guidelines. The expression of MMR proteins (which was earlier validated on normal as well as tumour tissue) in FFPE tumour tissue using IHC for mut L homologue 1 (MLH1), mut S homologue 2 (MSH2), mut S homologue 6 (MSH6) and post-meiotic segregation increased 2 (PMS2) was studied. Information regarding stage, treatment, clinical outcome and overall survival was retrieved when available. RESULTS: Out of a total of 371 cases, 62 (16.7%) cases were of stage II CRC, out of which 43 (12%) were treatment naive. Among the selected 62 cases, 26 (41.9%) demonstrated loss of MMR proteins and 36 (58.0%) cases had intact nuclear expression. Out of the cases with MMR loss, 38.4% showed loss of MLH1 and PMS2, 30.7% showed loss of MSH2 and MSH6, 26.9% showed isolated loss of PMS2 and 3.8% showed isolated loss of MSH6. Right-sided location (57.6%) was more common than left-sided (19.2%) and transverse colon (23.0%). Majority of the cases were moderately differentiated (65.3%) in morphology. There was no intratumoural infiltrate in most of the cases (53.8%), and only 3.8% cases showed marked intratumoural infiltrate. Also, peritumoural lymphocytic infiltrate was mild to moderate in most of the cases (26.9%) and marked Crohn's-like infiltrate was seen in only 7.6% cases. CONCLUSION: Our study shows that the routine evaluation of MMR proteins is achievable and essential for the purpose of prognostication, planning of treatment strategies and ascertaining a hereditary basis of CRC. The incidence of MMR protein loss was quite high in our study compared to other studies probably due to a difference in ethnicity. Though a right-sided predominance was supported, none of the typical morphological features of microsatellite instability (MSI) tumours were substantiated by our study, highlighting the lack of importance of histology for predicting MSI, and emphasising the point that MSI testing should be done as a routine procedure in all stage II CRC. A short follow-up was done for all our cases and comparison between the survival of the chemotherapy treated MSI cases versus those which were treatment naïve was performed and revealed that chemotherapy (CT) did not provide additional benefit to survival; MSI tumours in general are a better prognostic category and do not require additional chemotherapy.

Neuroendocrine Carcinoma of Gall Bladder: A Series of 19 Cases with Review of Literature.

BACKGROUND: Neuroendocrine neoplasms of the gall bladder (GB) are rare tumors classified as grade 1 and 2 neuroendocrine tumor (NET), neuroendocrine carcinoma (large cell or small cell type), and mixed adeno-neuroendocrine carcinoma (MANEC). Primary neuroendocrine carcinomas (NEC) of GB are rare with grave prognosis not withstanding radical surgical treatment. Chemotherapy forms the primary management due to the advanced stage at presentation, as complete surgical resection is generally not possible. The overall median survival is 4-6 months despite aggressive management. Only 73 cases of small cell carcinoma (SCC) and 10 cases of large cell neuroendocrine carcinoma (LCNEC) have been reported in English literature till now. We present a series of 19 cases of NEC of GB with their pathological and clinical features and response to treatment. OBJECTIVE: The objective of this study was to evaluate NECs of the GB for their clinical behavior, prognosis, and treatment outcome in terms of survival and to segregate NECs into further subcategories, that is 20-50 % and >50 %, based on MIB-1 index. METHODS: We retrospectively searched the clinical and pathological database over 2.5 years (January 2012 to June 2014) through existing electronic hospital medical records to collect cases of NEC arising in GB. A total of 447 cases of gall bladder pathologies were analyzed, of which 19 cases were diagnosed as NEC. All relevant investigations were documented and response to treatment/therapy was evaluated clinically and radiologically. Tumor specimen was obtained by fine-needle aspiration cytology and/or biopsy and classified using the latest World Health Organisation (WHO) classification (2010) via cytopathologic, histopathologic, and immunohistochemical visage. RESULTS: Nineteen patients diagnosed as NEC of GB were evaluated in the study, with 16 having SCC, 2 having LCNEC, and 1 with MANEC. All patients presented in advanced clinical stage III or IV, along with distant metastasis and showed progressive disease during therapy. Ki67 index was between 20 and 50 % in 5 cases and >50 % in 8 cases. Follow-up was available in 14 cases with a median survival of 3 months, and 2 of these patients capitulated to their illness, before commencement of treatment. The remaining 5 cases were lost to follow-up. Out of these, 2 had deranged liver function test and no chemotherapy could be administered, and the other 3 refused treatment. CONCLUSIONS: NECs are aggressive with generally poor prognosis, characterized by insidious onset and advanced clinical stage of presentation. A radical approach to treatment with chemotherapy is the best form of palliation. Role of radiotherapy remains undefined due to paucity of data.

Unusual presentations of intracranial meningiomas: Report of two cases and review of the literature.

Meningiomas at extracranial sites are uncommon clinical presentations. They may present in the form of benign, slow.growing masses or may exhibit aggressive malignant behavior. We report two cases of intracranial meningiomas presenting at extracranial sites that are, at the sinonasal tract/external auditory canal and as a neck mass. The clinical presentations, histopathological features and appropriate management are discussed.