Primary Transitional Cell Carcinoma Of Bulbar Urethra

Primary urethral carcinoma (UC) is a rare entity, and bulbar UCs of transitional cell origin are even rarer. Primary presentation as a scrotal abscess and urethrocutaneous fistula is rarely documented in UC patients. We present a case of a 66-year-old male presenting to emergency department with a scrotal abscess. Following blind incision and drainage, the urethral injury was suspected, and biopsy of suspicious lesion was taken from scrotum which came out to be invasive transitional cell carcinoma. A wide local excision of the tumor was done after workup. Hence, all patients with scrotal abscess and urethrocutaneous fistula should be investigated before performing any blind procedure.

Histopathological study of adrenocortical masses with special references to Weiss score, Ki-67 index and p53 status.

Background: Adrenal mass present with wide morphological spectrum and clinical manifestation, which can give rise to diagnostic confusion. Proper categorization is essential for individualized treatment. Aim and Objective: (1) Application of Weiss criteria to differentiate between benign and malignant adrenocortical neoplasm (2) co-relation of Ki-67 and p53 expression with the Weiss score. Materials and Methods: A prospective, observational study was conducted in the Department of Pathology in collaboration with department of Endocrinology and Urology of a tertiary care hospital including 19 patients presented with clinically symptomatic or radiologically detected adrenocortical mass. Tissue for histopathological study was obtained in the form of the postoperative material. Histopathological categorization was done, and Weiss score was calculated in all tumors. Ki-67 and p53 immunohistochemistry were performed. Result: A total 19 cases of adrenal mass lesions were included. Cushing syndrome was the presenting symptoms in 26.3% adrenocortical masses. All patients with tumors with Weiss’s score <3 (Group 1) were alive after 24 months of followup compared to 20% of those with Weiss’s score >3 (Group 2). Statistically signifi cance difference was noted in average weights and size of the tumors. Distribution of Ki-67 and p53 expression between Group 1 and Group 2 were compared and found statistically highly signifi cant with Fisher’s two-tailed P < 0.001. Conclusion: The combination of the meticulous evaluation of clinical, morphological and immunohistochemical profi le helps in proper categorization of adrenocortical mass.

Expression of CDX-2 and Ki-67 in different grades of colorectal adenocarcinomas.

Background: CDX2 is a caudal homeobox gene essential for intestinal differentiation and is specifi cally expressed in colorectal adenocarcinomas. Its role in colorectal carcinogenesis is not fully elucidated. Aims and Objectives: To study the expression pattern of CDX2 and Ki-67 in different grades of colorectal adenocarcinomas and to observe the relationship of their staining patterns in various tumor stages and to look for correlation if any, between Ki-67 labeling index (Ki-67 LI) and CDX2 expression. Materials and Methods: A total of 74 cases were enrolled. Detailed clinical profi le, peroperative fi ndings, histological grading and staging were noted. Immunohistochemistry for CDX2 and Ki-67 was done, and Ki-67 LI was calculated. CDX2 staining was graded semiquantitatively, and statistical analysis was done. Result: Age of presentation ranged from 20 to 75 years, and the male:female ratio was 1.83:1. There were 8, 47 and 13 cases of well, moderate and poorly differentiated adenocarcinomas, respectively. The mean Ki-67 LI of well, moderate and poorly differentiated adenocarcinomas were 14.25, 31.34 and 43.08 respectively, and their difference was statistically signifi cant, correlation was also noted with stage. CDX2 expression appeared to be stronger in poorly differentiated cases, but there was no signifi cant difference in its expression in the different grades and stages. There was no correlation between Ki-67 LI and CDX2 immunostaining pattern. The lymph node metastasis showed CDX2 positivity in all the cases. Conclusion: Expression of CDX2 does not signifi cantly change with the grade of colorectal adenocarcinomas. However, it is an important diagnostic marker in metastatic colonic lesions. The Ki-67 LI, on the other hand, showed a strong correlation with histopathological grades.

Potter’s sequence: A story of the rare, rarer and the rarest.

Potter’s syndrome is a rare condition affecting one in 2000-5000. We present here two autopsy cases of Potter’s syndrome, with the rare fi nding of discoid adrenals and the even rarer fi nding of in situ neuroblastoma in one of the cases.

Central nervous system teratomas in infants: A report of two cases.

Intracranial teratomas are uncommon neoplasms with most of them being encountered in the pediatric age group. Teratomas are composed of derivatives of all the three germ cell layers and are classifi ed into mature, immature and teratoma with malignant transformation. Two cases of intracranial teratomas in infants are presented here with the idea of highlighting this relatively uncommon condition in an uncommon age.

Metastatic ganglioneuroma: A misnomer.

Neuroblastoma, ganglioneuroblastoma and ganglioneuroma atumors arising from the neural crest cells. Ganglioneuroma is considered as the most mature amongst the three and usually has no metastatic potential. Spontaneous maturation of neuroblastoma into ganglioneuroma is, however, quite well-known. Here, we present a case of an 8-year-old girl child with evidence of metastasis of ganglioneuroma into a lymph node.

A histopathological study of liver and biliary remnants in the long-term survivors (>10 years) of cases of biliary atresia.

Context: Biliary atresia (BA) is a destructive process affecting both extraand intra-hepatic bile ducts leading to fibrosis and obliteration of the biliary tree and cirrhosis usually within 2 years. Factors influencing the outcome of portoenterostomy (PE) have not been clearly defined. Aims: Our aim was to identify children with no evidence of liver disease 10 years or more after PE and to compare the pathology of liver and biliary remnants in this group with those associated with poor outcome. Settings and Design: Prospective observational study. Materials and Methods: Wedge biopsies of liver and portal remnants, taken at the time of PE, where available, were reviewed. The parameters studied were - presence of large bile ducts (>150 μ), degree of fibrosis and bile duct proliferation (BDP), presence of ductal plate malformation (DPM) and age at operation. Statistical Analysis Used: Fisher’s exact test with Freeman Halton extension for univariate analysis and Logistic regression analysis as multivariate analysis. Results: Of 68 cases operated between 1995 and 2001, 14 patients survived >10 years and 54 were associated with poor outcome. Large ducts were significantly more in survivors (70% vs. 26%, P = 0.02). DPM was not seen in any of the survivors and was present in 24% of poor outcome group. Fibrosis and BDP were also significantly less among the survivors (P < 0.001, P = 0.03, respectively). The mean ages at operation in the two groups were 66.8 and 89.6 days, respectively. Conclusion: From this study, we feel that lower degree of fibrosis and BDP, absence of DPM, presence of large ducts and younger age at operation were associated with better long-term outcome. Of these, degree of fibrosis was the most significant factor.

Dedifferentiated papillary carcinoma of thyroid in an adolescent girl--a case report.

Dedifferentiated papillary carcinoma of thyroid shows combined histopathological features of classical papillary carcinoma and anaplastic carcinoma. This is a very rare tumour in adolescence. This prompted the authors to report this case.