Spectrum of vulvar lesions: patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge

Background: A wide variety of inflammatory, premalignant and malignant lesions can occur on the vulva. Some of the lesions are limited to the vulva, while some also involve other parts of the body. Although vulvar diseases can cause a significant issue in the patients, they are less commonly discussed than those of cervix, uterus and ovary. Most of the asymptomatic lesions remain un-noticed, and are seen during routine gynecological checkups. Common complaints in symptomatic lesions are lumps, discomfort, itching and pain. Since the symptoms are nonspecific; determining the location of the lesion can assist with the diagnosis. Being a genital part with skin covering on outer aspect and mucosal lining inside, it is associated with various dermatological, nutritional, and hormonal as well as sexually transmitted diseases. The present study thus was conducted to categorize vulvar lesions based on their histological diagnosis and also to study the morphological spectrum of precursor lesions for malignancy.Methods: Present study includes all types of vulvar lesions sent for pathological study in the Department of pathology, at GMC Nagpur over the period of one year.Results: Total 34 lesions were studied including a wide diagnostic range from inflammatory, dermatological to benign, premalignant and malignant. Inflammatory lesions including various infections and LSA (Lichen sclerosus atrophicus) were the most commonly seen lesions along with collection of neoplastic lesions.Conclusions: Proper diagnostic categorization of the lesions is essential for initiating therapy and reducing patient’s anxiety. Morphology of these lesions along with their diagnostic significance is discussed.

Sclerosing angiomatoid nodular transformation of spleen masquerading as carcinoma breast metastasis: Importance of splenic biopsy in obviating splenectomy.

Metastasis to spleen is rare and usually occurs in the setting of extensive multivisceral metastatic disease. A 60‑year‑old lady with appropriately managed early breast cancer (breast conservative surgery for Grade‑2 infiltrative ductal carcinoma [0.7 cm × 0.5 cm diameter]) in 2006, was detected to have splenic incidentaloma (1.4 cm × 0.8 cm) in November 2012, which was fluoro‑deoxy‑glucose (FDG) avid on positron emission tomography. Fine needle spiration cytology (FNAC) was normal. More than doubling of lesion size by March 2015 (3.83 cm × 3.03 cm diameter) with persistent FDG positivity lead to Tru‑Cut biopsy of spleen, which revealed multiple nodular areas of congestion and hemorrhage, composed of sinusoids (CD31+, CD8+, and CD34−), capillaries (CD31+, CD8−, and CD34+), and small veins (CD31+, CD8−, and CD34−), fibrosis, around these nodular areas along with numerous histiocytes (CD68+) consistent with diagnosis of sclerosing angiomatoid nodular transformation (SANT) of spleen. SANT is a benign, reactive vascular transformation of spleen, notorious to mimic metastasis, the cause of its 18FDG avidity due to its rich content of macrophages and myofibroblasts, usually diagnosed postsplenectomy. This report highlights the importance of splenic biopsy over FNAC is diagnosing splenic incidentalomas, which can help prevent splenectomy, and hence the associated morbidity. This is the first report of SANT in carcinoma breast mimicking metastasis

Inflammatory Pseudotumor of Maxilla: Masquerading as Aggressive Malignancy.

Inflammatory pseudotumor is a chronic inflammatory lesion of unknown origin with highly aggressive course. The disease even being benign in nature spreads aggressively, giving a false clinical impression of malignancy. A knowledge of the clinical entity is essential when considering a diagnosis of malignancy.