Primary Squamous Cell Carcinoma of Pleura Masquerading as Tuberculous Abscess: A Rare Case Report and Review of Literature

Primary pleural SCC is a rare pleural malignancy which has seldom been reported. Here we report a case of a 47 year male who presented with low grade fever, persistent chest pain and loss of appetite for 3 months along with a positive history of contact. CECT thorax demonstrated   fluid collection in the pleural space along with fibrotic patch and cytology revealed extensive necrosis. Based on above findings   provisional diagnosis of tuberculous abscess was made and subsequently anti- tuberculous treatment   was started. Later on after 3 months patient again presented with similar complaints and physical examination revealed a bulging mass on back which was aspirated and sent for cytology which revealed features consistent with the diagnosis of   poorly differentiated squamous cell carcinoma. This was later confirmed by CECT thorax, showing heterogeneous mass with pleural thickening and invasion. Histopathology eventually confirmed the diagnosis of primary pleural squamous cell carcinoma.

Spindle-cell ameloblastic carcinoma of the maxilla with adenoid cystic carcinoma-like areas: A new variant.

Ameloblastic carcinoma is a rare aggressive malignancy of odontogenic epithelial origin. The disease has been reported to afflict people over a wide range of age group without any sex predilection. It is characterized by rapid growth and destruction of overlying bones along with involvement of adjacent soft tissues. The overall prognosis of this cancer is poor despite radical surgery and radiotherapy. Owing to the rarity of this lesion, complete data on the biological behavior and response to different treatment modalities are still lacking. The authors hereby report a case of this uncommon tumor arising from left maxilla in a 60-year-old Indian male. Histopathological examination of the tumor showed foci of spindling intermixed with large areas of tumor cells arranged in cribriform pattern and having luminal eosinophilic material which was reminiscent of adenoid cystic carcinoma. A final diagnosis was achieved after immunohistochemical study. These unusual findings prompted this case report.

Assessment of Various Cytological Changes For Predicting Radiosensitivity of Oral Cavity Cancer by Serial Cytology.

A prospective, non-randomized study was carried to assess the role of serial cytological assay in predicting radiosensitivity of squamous cell cancer of oral cavity in patients on fractionated radiotherapy (RT) and to evaluate the relationship of radiosensitivity with the histological grade of oral cancer. We studied 54 histologically proven cases of squamous cell carcinoma on cyclical radiotherapy treatment. Radiosensitivity was assessed using serial scrape smears taken before, during and after treatment with radiotherapy (4 & 8 weeks). Depending on the observed cytological change, patients were grouped in those showing good radiation response (sensitive) and those with poor radiation response (resistant) and their relation to cumulative dose of radiotherapy was analyzed for statistical significance. The changes such as multinucleation, micronucleation, karyorrhexis and cytoplasmic vacuolation occurring in irradiated cancer cells, had a statistically significant dose related increase with radiotherapy (P < 0.05). Less differentiated tumors were less radiosensitive and exhibited increased rate of persistence of dysplastic cells and a higher rate of recurrence (33%) after completion of radiotherapy as compared to well differentiated tumors. We recommend regular use of serial cytological assay as it provides valuable evidence of radiosensitivity and persistence of tumor/dysplastic cells at 8 weeks post-radiotherapy.

Pindborg Tumor in an Adolescent- An Atypical Presentation.

Calcifying epithelial odontogenic tumor (Pindborg tumor), is a rare benign odontogenic neoplasm representing about 0.4-3% of all odontogenic tumors. This tumor more frequently affects adults in an age range of 20- 60 years, with a peak incidence in the 5th decade of life. Calcifying epithelial odontogenic tumour has a much lower recurrence rate than ameloblastoma and malignant transformation with metastasis is rare.

Actinomycosis - Left Post Chest Wall.

A forty year old female of weak body built presented with recurring small hard lumps in let posterior chest wall for 3 years and discharging ulcers for 3 months duration. Clinically, the provisional diagnosis was malignancy with secondary infection. FNAC showed features suggestive of dysplasia but histopathology confirmed the diagnosis as actinomycosis. The present case is reported due to rare incidence of actinomycosis at post chest wall with muscle involvement.

Giant primary mesenteric liposarcoma: a rare case report.

Primary mesenteric liposarcoma is a rare malignant tumor of mesenchymal origin. These tumors are often found to be of substantial size upon first clinical presentation. We report a case of primary mesenteric liposarcoma in a 55 year old man who underwent laparotomy for the clinical/radiological impression of a mesenteric cyst. FNAC was inconclusive due to suboptimal cellularity. On laparotomy there were 2 masses (diameter- 19 and 14 cms) weighing approximately 8.5 kilograms together. Histopathology showed features of atypical lipomatous tumor / well differentiated liposarcoma (ALT/WDLS) with mixed histological pattern (e.g. lipoma like, sclerosing and myxoid areas) varying from area to area. Prognosis of ALT/WD liposarcoma depends upon its anatomic location and most aggressive histological subtype. This case is being presented because of its huge dimensions, rarity of the site and mixed histological pattern.

Cytohistomorphological grading of breast carcinoma with special reference to apoptotic rates and lymph node metastasis.

To analyze the significance of comparative evaluation of cytohistomorphological grading of infiltrating ductal carcinoma with specific reference to lymphnode metastasis status and apoptotic index. 50 patients who underwent FNAC and mastectomy for infiltrating ductal carcinoma were included in the study. Concordance between cytological and histological grades was calculated. Cytological smears were also evaluated for apoptotic rates and lymph node metastasis and then compared with the histological grades using regression analysis. Histological and cytological grades were comparable and statistically significant difference was found in the lymphnode metastasis rate and apoptotic index in the three cytological grades of the tumor. Moreover, by considering the apoptotic rates, the sensitivity of cytological grading significantly rose in relation to histological grade. With histological grade taken as the standard, cytology was found to be comparable but less sensitive for grading infiltrating ductal carcinoma. However, by considering lymphnode status and apoptotic rates as calculated on cytology, the sensitivity of cytological grading rose significantly in relation to histological grade. Therefore, apoptotic index incorporated with cytological grade may provide relevant information on the aggressiveness of invasive ductal carcinoma of breast and could be a useful parameter to take into consideration when selecting neo-adjuvant therapy.

Significance of AgNOR score in benign and malignant soft tissue tumours.

AgNOR staining was employed on FNAC and histopathological sections obtained from patients with soft tissue tumours. The study comprised of 20 normal appearing soft tissues, 74 benign and 36 malignant soft tissue tumours. The slides were stained with AgNOR in order to differentiate between benign and malignant soft tissue tumours. The mean AgNOR count in normal appearing soft tissues, benign lesions and malignant lesions was 1.04+/-0.10 (0.94-1.14), 1.51+/-0.21 (1.1-2.1) and 4.96+/-1.33 (2.57-7.21) respectively. The mean AgNOR count was found to be higher in benign soft tissue tumours as compared to normal appearing soft tissues and the difference was found to be statistically significant. The mean AgNOR count in soft tissue sarcomas was found to be higher as compared to both normal appearing soft tissues and benign soft tissue tumours and the results were found to be statistically significant. The increased AgNOR score in both benign and malignant soft tissue tumours as compared to normal appearing soft tissues indicates high proliferative activity. Thus AgNOR staining is a simple and useful method for estimating tumour cell proliferation thereby differentiating normal appearing soft tissues from benign and malignant soft tissue tumours.

Significance of apoptosis in prostatic intraepithelial neoplasia and carcinoma.

This study was carried out to assess the significance of apoptosis in prostatic intraepithelial neoplasia (PIN) and prostate cancer. A total of 120 prostatic specimens were studied in the department of Pathology [corrected] JNMC, Aligarh. The rate of apoptosis in PIN and prostate cancer was examined by quantifying the number of apoptotic bodies per hundred cells (apoptotic index) on haematoxylin and eosin stained histological sections [corrected] A significant correlation was noted between increasing apoptotic indices and increasing Gleason grades within a cancer.

Cytodiagnosis of yolk sac tumor.

To analyze cytomorphologic features of yolk sac tumors of childhood. Four cases of pediatric yolk sac tumor (YST), diagnosed by fine needle aspiration cytology were reviewed (1998-2002). Age of patients ranged from 1(1/2) to 5 years. Three cases presented clinically with an intra-abdominal mass while one case presented with a testicular mass. Fine needle aspirates had been obtained directly as well as under radiologic (USG/CT) guidance. Smears were stained with H & E and Papanicolaou stain. In all cases values of serum alpha-fetoprotein and hCG were available preoperatively. Histopathologic diagnosis was correlated with cytologic findings in all the cases. Cytologic examination showed richly cellular smears with a combination of morphological patterns. Characteristically, tumor cells were arranged in papillary groups, tight cell clusters and formed acinar structures. Cells showed enlarged, moderately pleomorphic, hyperchromatic nuclei and moderate amount of cytoplasm, some of which displayed cytoplasmic vacuolation, displacing the nuclei eccentrically. Preoperatively, serum alpha-fetoprotein level was raised in all cases. Histopathology confirmed the cytologic diagnosis. Yolk sac tumor is common among the germ cell tumors of pediatric age group which presents a spectrum of cytomorphologic features having important differences with other germ cell neoplasm, e.g. embryonal carcinoma. Clinicoradiologic features and tumor markers are additionally helpful for an accurate cytologic diagnosis.