Papillary cystadenocarcinoma of the parotid gland: a rare sub-variant of salivary gland adenocarcinoma

Papillary cystadenocarcinoma of the salivary gland is a very rare malignant neoplasm accounting for only 2% of all salivary gland lesions. In 1991 it was first included as a separate entity in the World Health Organization (WHO) classification of salivary gland tumors and in 2017 WHO Classification, the tumor was clubbed as a sub-variant of adenocarcinoma, not otherwise specified. It most commonly occurs in the major salivary glands. Herein we report a case of salivary papillary cystadenocarcinoma in a 54-year-old female, who presented with rapid enlargement of the right parotid swelling. Based on radiology and fine-needle aspiration cytology, a working diagnosis of the malignant tumor involving the superficial lobe of the right parotid gland was made. In view of the malignant nature of the swelling, superficial parotidectomy was done. The histopathology and immunohistochemistry of the mass confirmed the diagnosis of papillary cystadenocarcinoma of the right parotid. With the revised 2017 WHO classification of salivary gland tumors, it is important to report all rare subtypes in order to understand their biology and behavior.

Pediatric Granular Cell Tumor of the Breast: An uncommon neoplasm in an uncommon site and age group

Granular cell tumor (GCT) is a rare soft tissue neoplasm of Schwann cell origin. Most cases occur in adults; however, the precise incidence is unknown in children. GCT is usually a slow-growing, painless tumor involving the skin and soft tissues that is mostly located in the head and neck region, especially the tongue. The breast is one of the least common sites involved by GCT. This paper presents a 3-year-old girl who presented with a soft to firm, ill-defined swelling on the right breast with painful ulceration of the overlying skin. Fine needle aspiration rendered an initial diagnosis of fibrocystic change accompanied by apocrine metaplasia. Histologic evaluation of the excised breast mass revealed a benign granular cell tumor. Although rare, GCT of the breast should be included in the differential diagnosis for breast masses in pediatric patients. Proper diagnosis and timely management of this tumor are essential because of its malignant potential (<2% of cases) and high rate of local recurrence if not properly excised.

Circle Of Willis: Variant Forms and their Embryology Using Gross Dissection and Magnetic Resonance Angiography.

Background: The circle of Willis is a large arterial anastomotic ring present at the base of the brain uniting the internal carotid and the vertebrobasilar systems. Branches from the internal carotid and vertebral arteries anastomose to form an arterial circle in the basal cisterns and then distribute to supply the brain. The anatomy of the circle is known to vary significantly; the vessels may be absent or sufficiently narrowed altering the hemodynamics of the circle of Willis and affecting its role as a collateral route. These variant forms can be correlated to their phylogeny and embryology. Prior knowledge of these variant forms is important in pathologies and treatment (e.g. parent artery occlusion for carotid aneurysms) resulting occlusion of carotid and vertebral arteries. Context and purpose: Our study was undertaken to observe and compare the morphology of circle of Willis using two entirely different methods; gross dissection (GD) and Magnetic resonance angiography (MRA) and to correlate the variant patterns encountered with the possible underlying developmental events. Gross dissection was carried out in 70 human cadavers and equal numbers of MRA’s of healthy individuals were studied retrospectively. Results: Only 31 cases (22.14%) presented with a complete circle of Willis, out of which 14 (20%) were cadaveric specimen and 17 (24.18%) were in MRA group. Unilateral hypoplastic posterior communicating artery was the most common variation observed in our study (19.28%). Conclusions: The wide variation in completeness of the circle of Willis in general population is similar to earlier observations. Review of phylogeny and embryology makes us familiar with variant forms which would be otherwise difficult to recognize and may be misinterpreted. MRA and gross dissection findings despite certain variations are comparable.