A rare case of malignant paraganglioma of urinary bladder.

Paraganglioma of the urinary bladder is a rare pathologic entity with no defi nitive histological, immunohistochemical or molecular features to determine its malignant potential. Malignancy is essentially determined by the presence of deep local invasion, invasion of adjacent structures and lymph node or distant metastases. So far, up to 180 cases of paraganglioma have been reported, with <30 being malignant. A 50-year-old male presented with painless hematuria for 6 months. Cystoscopic biopsy of the bladder mass was given as invasive urothelial carcinoma. Patient underwent radical cystectomy with pelvic lymphadenectomy. The gross morphological brown discoloration of mass on formalin fi xation was suspicious of paraganglioma and was confi rmed on immunohistochemistry. The diagnosis of malignant paraganglioma was made based on regional lymph node metastases. We describe a rare case of a patient with malignant urinary bladder paraganglioma with main differential diagnostic considerations on the histomorphology.

Omental sclerosing extramedullary hematopoietic tumors in Janus kinase-2 negative myelofibrosis: Caveat at frozen section.

Sclerosing extramedullary hematopoietic tumors (SEMHTs) are associated with chronic myeloproliferative neoplasms. These extremely rare mass lesions were first described in kidney and peritoneum. On histopathology, they are characterized by sclerosis, entrapped fat, atypical megakaryocytes with myeloid and erythroid elements. Only approximately ten cases have been subsequently reported in orbit, lacrimal system, liver, omentum, and skin. The authors present a case of SEMHTs as incidentally detected omental nodules, while the patient was undergoing splenectomy for Janus kinase-2 negative myelofibrosis. The authors postulate their origin in omentum-associated lymphoid tissue; and highlight the diagnostic dilemma presented by SEMHTs at frozen section.

Evaluation of non cyanide methods for hemoglobin estimation.

Background: The hemoglobincyanide method (HiCN) method for measuring hemoglobin is used extensively worldwide; its advantages are the ready availability of a stable and internationally accepted reference standard calibrator. However, its use may create a problem, as the waste disposal of large volumes of reagent containing cyanide constitutes a potential toxic hazard. Aims and Objective: As an alternative to drabkin`s method of Hb estimation, we attempted to estimate hemoglobin by other non-cyanide methods: alkaline hematin detergent (AHD-575) using Triton X-100 as lyser and alkaline- borax method using quarternary ammonium detergents as lyser. Materials and Methods: The hemoglobin (Hb) results on 200 samples of varying Hb concentrations obtained by these two cyanide free methods were compared with a cyanmethemoglobin method on a colorimeter which is light emitting diode (LED) based. Hemoglobin was also estimated in one hundred blood donors and 25 blood samples of infants and compared by these methods. Statistical analysis used was Pearson`s correlation coefficient. Results: The response of the non cyanide method is linear for serially diluted blood samples over the Hb concentration range from 3gm/dl -20 gm/dl. The non cyanide methods has a precision of + 0.25g/dl (coefficient of variation= (2.34%) and is suitable for use with fixed wavelength or with colorimeters at wavelength- 530 nm and 580 nm. Correlation of these two methods was excellent (r=0.98). The evaluation has shown it to be as reliable and reproducible as HiCN for measuring hemoglobin at all concentrations. The reagents used in non cyanide methods are non-biohazardous and did not affect the reliability of data determination and also the cost was less than HiCN method. Conclusions: Thus, non cyanide methods of Hb estimation offer possibility of safe and quality Hb estimation and should prove useful for routine laboratory use. Non cyanide methods is easily incorporated in hemobloginometers by using very minute quantities of reagents and test sample; hence, these methods can be used to provide point of care testing in blood banks for hemoglobin (Hb) estimation in blood donors.

Idiopathic renal replacement lipomatosis: A case report and review of literature.

Idiopathic renal replacement lipomatosis is a rare condition in which the renal parenchyma, especially the renal sinus is replaced with adipose tissue with increase in perirenal fat. We report a case of renal replacement lipomatosis presenting as a renal mass clinically. The computed tomography scan revealed low density and nodular masses of adipose tissue within the renal parenchyma. The differential diagnosis before surgery was angiomyolipoma, lipoma, and xanthogranulomatous pyelonephritis. After the histological examination and extensive literature search, the diagnosis of renal replacement lipomatosis was made. It is a rare entity and may be missed if not considered due to lack of experience, so we hope that more urologists, radiologists, and pathologists become aware of this entity and recognize it.

Mucinous adenocarcinoma of the renal pelvis with pseudomyxoma peritonei.

Mucinous adenocarcinoma of the renal pelvis is an extremely rare tumor with very few case reports in literature. Pseudomyxoma peritonei is an uncommon condition characterized by the presence of mucinous gelatinous material in the peritoneal cavity. It occurs secondary to primary mucinous neoplasms of particularly the appendix and the ovary. We present a case of a 35-year-old female who had a history of dull aching pain in the right flank since one and a half years. Upon ultrasonography (USG) and computerized tomography (CT) scan, there was a large cystic mass measuring 15x15x12 cm, extending into the right lumbar region. Grossly, the entire kidney was converted into a cystic mass measuring 15x15x12 cm containing gelatinous mucinous material weighing 1 kg. Histologically, the tumor was composed of simple and complex glandular acini together with a superficial resemblance to colonic mucosa with abundant extracellular mucin. Thus, a diagnosis of mucinous adenocarcinoma of the renal pelvis leading to pseudomyxoma peritonei was made.