SMARCB1 deficient sinonasal carcinoma: An emerging entity with a diagnostic challenge

SMARCB1 deficient sinonasal carcinomas are rare neoplasms, classified under sinonasal undifferentiated carcinomas by the fourth edition of the World Health Organization (WHO) classification of head and neck tumors. It is characterized immunohistochemically by loss of SMARCB1(INI1) expression. We are reporting the case of a 63-year-old man who was evaluated for nasal stuffiness of 3 months duration in another hospital where a radiological evaluation showed a polypoidal soft tissue lesion in the right maxillary sinus extending to the right nasal cavity and spheno-ethmoidal sinus. He underwent excision biopsy which was reported as non- keratinizing nasopharyngeal carcinoma. He was referred to our center with residual disease in spheno-ethmoidal recess for which radiotherapy was given. After completion of radiotherapy, the primary site had no residual disease, but while on follow-up he developed left sided neck nodes within 4 months of completion of treatment. Excision of the lesion was done and histopathological and immunohistochemical analysis revealed it to be metastasis from SMARCB1 deficient sinonasal carcinoma and not nasopharyngeal carcinoma as diagnosed from the other center. This case is being reported to highlight the diagnostic challenge associated with this rare entity.

Papillary carcinoma thyroid serving as recipient tumor to carcinoma breast: A rare example of tumor-to-tumor metastasis

A 36-year-old female presented with lump in the left breast of 2 months duration. Fine-needle aspiration cytology (FNAC) and trucut biopsy confirmed the diagnosis of carcinoma. Clinically, it was T3N1Mx disease. Computed tomography (CT) of the chest detected bilateral lung metastasis. CT head and neck detected a nodule in the thyroid which on FNAC was suspicious of papillary carcinoma. The patient was started on chemotherapy for breast disease with a good initial response; however, while on-follow up, there was progression of disease at primary site. The patient was taken up for surgery. Radical mastectomy along with total thyroidectomy was performed. Histopathological examination showed infiltrating duct carcinoma, not otherwise specified type and papillary carcinoma thyroid. There was a 0.4 cm × 0.4 cm metastatic focus, from breast carcinoma within the papillary carcinoma thyroid. The metastasis was confirmed by immunohistochemistry. Metastasis to thyroid is rare. However, tumor-to-tumor metastasis with papillary carcinoma serving as recipient to breast carcinoma is exceedingly rare with very few case reports in the literature. We report this case for its rarity and also for highlighting the fact that pathologists should keep in mind the possibility of metastasis also when coming across unusual morphology in thyroid lesions.

Histopathological Study of the Relationship of Columnar Cell Lesions to Carcinoma Breast

Introduction: Columnar cell lesions (CCLs) of the breastcomprise a spectrum of benign to atypical entities that have incommon variably dilated terminal duct lobular units lined bycolumnar epithelial cells with prominent apical cytoplasmicsnouts. They are increasingly being encountered in breastbiopsies because their associated microcalcifications aredetected on mammographic screening. Current study aimed toknow the proportion and significance of columnar cell lesionsseen along with carcinoma breast.Material and methods: Excision biopsy specimens of thebreast which included both lumpectomies and mastectomieswere studied in the department of pathology. Postchemotherapy specimens were excluded from the study.5sections each were taken from adjacent breast tissuesand studied for columnar cell lesions after staining withhematoxylin, and eosin.100 cases were included in this study.Results: Majority of the cases were diagnosed as IDC grade 2.One or the other columnar cell lesions were seen in the majorityof invasive ductal carcinomas. CCLs may be characterized bya single layer of columnar cells (columnar cell change [CCC]),multiple layers with stratification and apical tufting (columnarcell hyperplasia [CCH]), or monomorphic cells with cytologicatypia (flat epithelial atypia [FEA]). The differentiationbetween CCC, CCH, and FEA is clinically significant: CCCand CCH are considered benign lesions, whereas FEA canbe associated with, and even a precursor to, low-grade ductalcarcinoma in situ and atypical ductal hyperplasia. Of the total12 cases of grade 2 IDC, 8 cases (66.6%) showed columnarcell change, 4 of them showed columnar cell hyperplasia(33.3%) and 9 of them showed both flat epithelial atypia andductal carcinoma in-situ changes (75%).Conclusion: A consistent correlation exists between columnarcell lesions and Carcinoma Breast which is evidenced by thepresence of such lesions in diagnosed cases of carcinoma.Since columnar cell lesions represent a significant precursorfor carcinoma breast, a multidisciplinary modality of approachwill help to detect these lesions much earlier and will proveworthwhil

Sclerosing mucoepidermoid carcinoma with eosinophilia of thyroid gland: Not so indolent a neoplasm?

A 58-year-old female, a known diabetic and hypertensive, presented with left-sided swelling on the anterior aspect of the neck of 1-year duration, which was rapidly increasing in size for the past 6 months. She was on Eltroxin for hypothyroidism for the past 1 year. Computed tomography study of the neck showed a nodule in the left lobe of thyroid which on fine-needle aspiration was suspicious for malignancy. Total thyroidectomy with left posterolateral lymph node dissection was done. Histopathological examination showed sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid gland with lymph node metastasis. SMECE of the thyroid was initially thought to be a low-grade malignancy with indolent clinical behavior. However, our case showed extra thyroidal spread with lymph node metastasis, necessitating adjuvant therapy for our patient. Such aggressive behavior has been noted in few earlier case reports also.

Role of frozen section in the intra‑operative margin assessment during breast conserving surgery.

BACKGROUND: Breast conserving surgery (BCS) is increasingly done for early breast cancers in many countries since it has been demonstrated by randomized trials that survival rates after BCS followed by adjuvant therapy are equivalent to those obtained after mastectomy. Frozen section analyses (FSA) is a technique used for intra‑operative assessment of margin status in BCS. The aim of this study was to assess the concordance of margin status assessment by FSA and permanent sections and to assess correlation with local recurrence. MATERIALS AND METHODS: A total of 162 patients underwent BCS for in situ or invasive carcinoma with FSA of margins during the year 2008 at our center. The inclusion criteria in this study were patients with intact tumor at the time of surgery. After application of the inclusion criteria, 60 patients could be included in this study. RESULTS: After frozen section, 20 patients had an initial negative margin. 40 subjects underwent additional excisions at the time of initial surgery because of close or positive margins. Of these 40 patients, in 32 patients a negative margin could be achieved with re‑excisions. Pathological analyses of frozen section showed concordance to permanent sections in all cases. At a median follow‑up of 40 months, there were no local recurrences. CONCLUSION: Intra‑operative FSA allows resection of suspicious margins at the time of primary conservative surgery and results in low rates of local recurrence and second surgeries. There is good concordance between results of FSA and the final paraffin section in assessing margin status.

Comparison of Efficacy of Glutaraldehyde And U.V. Light Disinfection And Their Effect On Dimensional Stability of Polyvinyl Siloxane Impressions - An IN-Vitro Study.

Dental impressions need to be washed and disinfected immediately after making, to control transfer of infectious diseases from saliva and blood of the patient to dentists and technicians. Since sterilization of impressions is not possible because of high temperature and time needed, disinfection is the method of choice. But disinfection process may sometimes affect the properties of impression material. This study has undertaken to evaluate the efficacy and effect of chemical and U.V light disinfection on poly vinyl siloxane impressions.

Decoy cells in the urine cytology of a renal transplant recipient: An immunohistochemical study.

Human polyoma virus causes renal dysfunction and graft loss as a result of tubulo-interstial nephritis in renal transplant recipients after reactivation of latent virus in renal epithelium. The infected cells in the urinary sediments are characterized by large homogenous inclusions, which may cause diagnostic error in urine cytology. The epithelial cells with polyoma viral inclusions in urine cytology specimens are termed Decoy cells to caution pathologists not to misdiagnose these cells as cancer cells. We present a case of polyoma viral changes detected the first time in our laboratory in the urine of a 46year old male who underwent renal transplantation six months back and followed by immunotherapy. Urine cytological examination showed decoy cells and subsequently revealed on histopathology. Immunoperoxidase staining for SV-40 LT antigen (LT ag), expression of proliferating cell nuclear antigen (PCNA), p53 and Rb genes were also studied in the tissue sections for further observation. The expression of SV40 LT ag was negative, while PCNA showed strong positivity; p53 and Rb were expressed moderately in the nuclei of cells in the tubules. The report of a case of decoy cells in the urine of a patient with renal transplantation focuses the importance of cytologic analysis of urine as a diagnostic tool for screening renal transplant recipients at risk of polyoma viral infection.

Granulocyte macrophage--colony stimulating factor (GM-CSF) as adjunct in induction therapy of acute myeloid leukemia.

Use of growth factors (G-CSF/GM-CSF) as adjunct in induction therapy of AML is controversial. Possible stimulation of leukemia cell clones has been the major cause of concern. We treated 50 cases of AML with GM-CSF as an adjunct during induction therapy. 35 patients (70%) achieved complete remission out of which 13 patients relapsed at a median relapse period of 15 months. Average duration of neutropenia was 10.5 days. (15 days in the control) Febrile episodes were fewer and antibiotic support was required for an average period of only 7.6 days (16.9 days in the control). The benefits including the economic analysis of the role of GM-CSF in this setting is discussed.