Primary cutaneous amyloidosis: A clinico-pathological study with emphasis on polarized microscopy.

Background: Primary localized cutaneous amyloidosis (PCA) is a relatively rare condition characterized by amyloid deposition in dermis without systemic involvement. Although, histopathological examination of the lesion reveals amorphous eosinophilic deposits in papillary dermis examination of congo red stained slides under polarized light will give definitive diagnosis Aims: To study the clinicopathological features of cutaneous amyloidosis emphasizing the utility of polarized light in diagnosis. Materials and Methods : A clinicopathological study of primary cutaneous amyloidosis over a period of 8 years was undertaken. All the cases, clinically diagnosed and histopathologically proven as cutaneous amyloidosis were stained with congo red and studied under polarized light. Results and Conclusions: Of the 45 cases of clinically suspected amyloidosis, 32 cases were proven histopathologically as primary cutaneous amyloidosis and confirmed by congo red stain under polarized light which showed apple green birefringence. Among the two types of PCA, lichen amyloidosis was the most common variant accounting to 65.63% with pure cases of macular amyloidosis accounting for only 15.63%. Biphasic amyloidosis was seen in 18.75%. Knee was the commonest site of involvement with pruritis being the most common symptom. Histopathologically, the most common findings were hyperkeratosis, irregular acanthosis and expansion of dermal papillae by amyloid deposits showing apple green birefringence under polarized microscope with congo red staining. Although, H and E stain gives a clue for the diagnosis of amyloid nevertheless congo red staining under polarized light forms a very sensitive and definitive method for confirmation.

Erythematous nodules of the hand: A rare site of metastatic breast carcinoma.

Acral cutaneous metastasis is a rare phenomenon. A 38-year-old woman presented with painful lesions in the left hand since 1 month. On examination, multiple painful, erythematous, lobulated plaques and nodules were present over the palmar aspect of the finger tips and thenar eminence. Biopsy of the nodule revealed lobules of small pleomorphic epithelial cells arranged in singles, small nests, cords and small abortive luminal pattern in an abundant mucoid matrix, suggestive of metastatic mucinous carcinoma. Past history revealed that the patient had undergone bilateral mastectomy for carcinoma breast. Diagnosis of cutaneous metastases is based on clinical history and histopathological examination. Identification of the primary tumor is very important for prompt treatment and prognosis. The rarity of pure acral cutaneous metastasis and its possible pathogenetic mechanisms are discussed.

Evaluation of scoring system in cytological diagnosis and management of breast lesion with review of literature.

Background: Fine needle aspiration cytology (FNAC) breast is generally considered as a rapid, reliable, and safe diagnostic tool to distinguish non-neoplastic from neoplastic breast lesions. Masood's Scoring Index has been proposed to help in sub-grouping of breast lesions so as to help in surgical management. Aims: To assess the accuracy of Modified Masood's Scoring Index (MMSI) in the diagnosis of benign and malignant breast lesions in patients with palpable breast lump, and review of literature. Settings and Design: A prospective study from a tertiary care center. Material and Methods: This prospective study included a total of 100 cases, both females and males, with palpable breast lump, in the age range of 10-80 years, over a period of 2 years from January 2007 to 2009, who underwent FNAC. They were cytologically grouped into five categories as suggested by Masood et al, and confirmed by histopathology. Results: Evaluation of Masood Scoring Index led to modification (Modified Masood Scoring Index; MMSI) by shifting score 9 from Group I to Group II, thus increasing the diagnostic accuracy of the breast lesions. Conclusions: MMSI was found to be a useful, easily reproducible scoring method of breast lesions to improve diagnostic accuracy of nonproliferative breast disease and proliferative breast disease without atypia cases, as the prognosis and treatment of these cases varies.

Subcutaneous Panniculitic-Like T-Cell Lymphoma: A red alert! The role of a vigilant histopathologist.

Subcutaneous panniculitic-like T-cell lymphoma constitutes a distinctive clinicopathologic entity derived from cytotoxic T lymphocytes. A 25-year-old female presented with fever and skin lesions over the upper limb, lower limb and trunk since 2 years. On examination, there were multiple subcutaneous, tender, erythematous, poorly circumscribed indurated plaques and nodules on the upper limbs and lower limbs. Histopathological examination revealed subcutaneous fat displaying a predominantly lobular infiltration of atypical lymphoid cells. Characteristically, there was rimming of individual fat cells by the surrounding neoplastic lymphocytes. Immunohistochemical evaluation of the neoplastic lymphocytes showed CD3 and CD5 immunoreactivity and CD30 and CD20 negativity. A diagnosis of subcutaneous panniculitic T-cell lymphoma was made. SPTCL is a rare cytotoxic lymphoma that can be misdiagnosed as benign panniculitis due to similarities in clinical and histological features between the two entities and thus cause a diagnostic hindrance.

BCG induced mycobacterial spindle cell pseudotumor in an infant.

Mycobacterial Spindle cell Pseudotumor (MSP) is a rare complication of mycobacterial infection, especially the atypical variety. It is characterized by an exuberant spindle cell proliferation. This has been reported in the lymph nodes, skin, spleen, lungs, brain, etc. The incidence is higher in immuno-compromised patients, especially those with acquired immunodeficiency syndrome. It is rare to encounter this lesion in infants. We report a case of MSP in the axillary lymph node of a 7-month-old infant, following Bacillus Calmette Guerin (BCG) vaccination due to Mycobacterium tuberculosis complex, which was proved by PCR.

Fine needle aspiration cytology of adenomatoid tumour--a case report with review of literature.

Adenomatoid tumours are neoplasms of male and female genital tract with the epididymis being the most common site. They also occur in uterus, fallopian tube, and ovary. These benign tumours are asymptomatic or cause mild symptoms and a palpable mass. Fine needle aspiration of these tumours is very useful to differentiate malignant from benign lesions and helps to avoid unnecessary aggressive surgical procedures. FNAC of these benign epididymal tumours is diagnostic, rapid, reliable, conclusive and cost effective. We are reporting a case of adenomatoid tumour of epididymis in a 41 year old male patient, diagnosed by FNAC and confirmed by histopathology.