Isolated ureteric endometriosis presenting as a ureteric tumor

A 32 year old lady presented with recurrent left flank pain for 4 weeks and chronic lower back pain. CT without contrast showed no stones and mild left hydronephrosis. CT of the spine suggested an inflammatory process at L5-S1 vertebra. The diagnosis was supported by a bone scan. Incidentally, the scan showed nonfunctioning left kidney. Diuretic renography confirmed poor perfusion and no excretion. A retrograde study showed narrowing of the ureter at the pelvic brim. Ureteroscopy showed a papillary mass in the lumen of the ureter from which multiple cold cup biopsies were taken. The pathology however was not conclusive. A robotic nephroureterectomy was carried out. Definitive pathology showed intrinsic endometriosis of the ureter. We conclude that endometriosis should be considered in the differential diagnosis of unexplained ureteric obstruction and ureteric lumen filling defects in young women

Clinicopathologic features of hepatic neoplasms in explanted livers: a single institution experience

Hepatic neoplasms can be the primary indication for hepatic transplantation. The tumors can also be incidentally identified in explanted livers. We explored the clinicopathologic features of hepatic neoplasms identified in explanted livers. All explanted livers resected between 2001 and 2006 were evaluated for the presence of neoplasms and their clinicopathologic features were examined. In 98 liver transplants, 15 neoplasms [15.3%] were identified. Patient ages ranged from 5 to 63 years [median, 56 years]. The primary etiology of hepatic disease was hepatitis C virus in 12 cases, hepatitis B virus in 1 case, cryptigenic cirrhosis in 1 case and congenital hepatic fibrosis in 1 case. Serum alpha-fetoprotein was significantly elevated [>400 U/L] in only 2 cases. CA19-9 was not elevated in any of the cases. The tumors included hepatocellular carcinoma [HCC] in 13 cases, 1 case of choloangiocarcinoma and 1 case of combined HCC and hepatoblastoma. The tumors in size from 0.5 to 5 cm [median 1.4 cm] and were multifocal in 5 of the cases [33%]. Tissue alpha-fetoprotein expression was only seen in the cases associated with elevated serum levels. In our institution hepatic neoplasms are seen in more than 15% explanted livers. They can be incidentally indentified, are frequently not associated with elevated serum levels of alpha-fetoprotein and CA19-9, are commonly multifocal but small, and are associated with good prgonosis. Elevated serum alpha-fetoprotein, albeit specific, is not a very sensitive marker in the detection of hepatic neoplasms

Grading of follicular lymphoma using flow cytometry

The treatment and prognosis of follicular lymphoma [FL] is dependant on the grade of the disease. In the World Health Organization classification of lymphoma, grading of FL into low grade [1 and 2] and high grade [3] is recommended. Grading of FL is possible in excision biopsy; histological grading is subjective and inconsistent Grading is extremely difficult in needle core biopsies and fine needle aspirates. We attempted to grade FL using flow cytometry [FCM] and CD 19/forward scatter. Cases of FL seen in our institution and submitted for FCM were evaluated for the percentage of cells detected beyond the 500-channel mark [on a 1024 scale] on a CD19/forward scatter dot plot. We hypothesized that these cells most likely represent centroblasts and their percentage would reflect the grade of the disease. Histological grading of the lymphoma on the open biopsies constituted the reference for FL grade. Thirty-six cases of FL, including 22 males and 14 females, ranging in age from 19 to 92 years [median, 42 years], were studied. There were 17 cases of low grade [grade 1; n=10 and grade 2; n=7] and 19 cases of high grade [grade 3] FL The percentage of cells identified beyond the 500-channel mark on CD19/forward scatter dot plot ranged from 0.12% to 12.55% [median, 4.9%] in low grade [grade 1 and 2] whereas the percentage of those cells in high grade FL ranged from 6.22% to 51.95% [median, 21%; p=0.00001]. Our findings suggest that using a CD19/forward scatter dot plot can help identify centroblasts in FL making grading possible on FCM, especially in small biopsies and fine needle aspirates