Evaluation of cervical and anal intraepithelial neoplasia in women attending a sexually transmitted infection clinic.

Background: The incidence of anal and cervical cancers and their precursors have increased in the past decades. Women with HIV and sexually transmitted infections are at a higher risk. Cervical human papilloma virus infection may serve as a reservoir and source of anal infection or vice versa. A higher incidence of anal cytological abnormality has been observed in patients with abnormal cervical cytology. Objectives: This cross sectional study was designed to estimate the prevalence and associations of anal and cervical cytological abnormalities in a cohort of sexually active women using Papanicolaou smears. Methods: We conducted a single centre study of 35 consecutive HIV positive and 40 HIV negative women attending the sexually transmitted infection clinic. Cervical and anal specimens were obtained for cytology after a detailed history and examination. Chi square test and coeffi cient of correlation were used for comparison. Results: Cervical dysplasia was observed in 22.6% (17.3% low-grade squamous intraepithelial lesion and 5.3% high grade squamous intraepithelial lesion) and anal dysplasia in 8% study subjects (6.7% low-grade squamous intraepithelial lesion and 1.3% high grade squamous intraepithelial lesion); no association was observed with HIV infection. A higher number of patients with cervical dysplasia (29.4%) were found to have concomitant anal dysplasia (P = 0.002). History of anal intercourse was reported in all patients with anal dysplasia and was higher (P < 0.037) in patients with cervical dysplasia. Limitations: The limitations included a small sample size, lack of correlation with histological fi ndings and bias due to STI clinic-based recruitment of the study population. Conclusion: Cytology may be used to screen for cervical and anal dysplasia in women irrespective of HIV status. Women with cervical dysplasia may be preferentially screened for anal dysplasia and vice versa. Anal intercourse may be a risk factor for anal and cervical dysplasia.

Diagnostic utility of Wilms’ tumour-1 protein (WT-1) immunostaining in paediatric renal tumours.

Background & objectives: Renal tumours constitute about 7 per cent of all neoplasms in children. It is important to differentiate Wilms’ tumour (commonest tumour) from non-Wilms’ tumours. The aim of this study was to evaluate the immunoexpression and diagnostic role of Wilms’ tumour-1 protein (WT1) in paediatric renal tumours. Methods: A total of 53 cases of renal tumours in children (below 18 yr) who underwent total nephrectomy were included in this retrospective study. WT1 immunostaining was done using mouse monoclonal WT1 antibody (clone: 6F-H2). Results: Of the 53 cases, 38 (72%) were of Wilms’ tumour. Non-Wilms’ group (15) included six cases of mesoblastic nephroma (MN), two each of clear cell sarcoma (CCSK), renal cell carcinoma (RCC) and peripheral neuroectodermal tumour (PNET) and one each of angiomyolipoma (AML), rhabdomyosarcoma (RMS) and malignant rhabdoid tumour (MRT). Proportion of WT1 positivity in Wilms’ tumour was 100 per cent in contrast to 26.7 per cent in non-Wilms’ tumours (P<0.001). Epithelial and blastemal components of Wilms’ tumour showed moderate (2+) nuclear and cytoplasmic staining in 80 (24/30) and 75 per cent (24/32) cases, respectively. MN, PNET, CCSK and AML were negative for WT1. RMS, RCC and MRT showed cytoplasmic staining, strongest in RMS. No significant association was seen between WT1 expression and NWTSG (National Wilms’ Tumor Study Group) stage. Interpretation & conclusions: WT1 helps to differentiate Wilms’ tumour from other paediatric renal tumours. It may help in differentiating the two subgroups of Wilms’ tumour which have distinct molecular pathogenesis and biological behaviour, however, further prospective studies are required for validation of this hypothesis.

Testicular mixed germ cell tumor metastasizing to heart.

A 21 years old male presented with low grade fever, hemoptysis and progressively increasing dyspnoea of four month duration followed by acutely developing dizziness, hypotension, convulsion and altered sensorium. He had been operated (left inguinal orchidectomy) for left testicular swelling two years back with high alpha-fetoprotein and normal beta-human chorionic gonadotropin (beta-hCG). In view of this a possibility of metastasis secondary to a malignant testicular tumor was considered. Echocardiography demonstrated a large intracardiac mass, chest computed tomography (CT) revealed intracardiac mass, mediastinal masses and left sided pleural effusion. The histopathology revealed testicular mixed germ cell tumor (MGCT). This case is presented to demonstrate uncommon cardiac manifestations of secondary spread of testicular malignancy.

Sertoli-Leydig cell tumor of ovary with heterologous element: a case report.

Sertoli-Leydig cell tumors are uncommon tumors of ovary accounting for about 1% of sex cord stromal tumors. They constitute between 0.1% to 0.5% of all the primary ovarian neoplasms. The majority of reported cases are moderately or poorly differentiated combined Sertoli-Leydig cell tumors. A rare case of Sertoli-Leydig cell tumor with heterologous element in a 14 year girl is described. The heterologous component comprised smooth muscle, an uncommon element, that was seen in 60 to 70% of the tumor area. The epithelial element of the tumor consisted of solid, tubular and foci of retiform pattern. Both these features imply a poor prognosis.

Wilms' tumour in adults: a report of three cases.

Wilms' tumour is the most common pediatric renal neoplasm. Its occurrence in adults is rare, less than 1% of all nephroblastomas have been reported after the age of 15 years of age. We report 3 cases of Wilms' tumour in adults, their clinico-pathological profile and review the literature including the cases reported from India. Patients were young adults, their age ranging from 25 to 32 years. The largest tumour dimension was between 11 cm to 17 cm. Two cases were blastema predominant while the third case had typical triphasic histology. All cases were stage II (National Wilms' Tumour Study), favourable histology. Although Wilms' tumour in adults is morphologically similar to its childhood counterpart, it often responds poorly to the combination chemotherapy. The criteria for its diagnosis are strict and should be adhered to for its correct identification.

VACTERL association with Prune-Belly syndrome.

We report a term, small for gestational age neonate having full spectrum of VACTERL association. In addition, the neonate also had triad of signs and symptoms associated with prune belly syndrome. The concurrence of these two syndromes could lie in their common etiology of defect in mesodermal differentiation. Such a combination is extremely rare and is generally incompatible with life.

Aspiration cytology, histology and hormone status in solid and cystic papillary tumor of pancreas--report of three cases.

Solid and cystic papillary tumor of pancreas (SCPT) are rare tumors. Of the well described cases 95% have occurred in women of reproductive age, suggesting a role of hormonal factors in the pathogenesis of this tumor. Only few studies evaluating estrogen and progesterone receptor status have found it to be positive. Cytohistocorrelation and immunohistochemistry for estrogen (ER) and progesterone (PR) receptors of three such cases are reported here. All three were diagnosed by fine needle aspiration cytology (FNAC) and showed cytoplasmic positivity for ER and PR receptors. May-Grunwald Giemsa, Papanicolaou and hematoxylin and eosin stained slides were evaluated for cytology and histopathology. Unstained methanol fixed slides were used for immunohistochemistry. The cytoplasmic staining of ER and PR receptors cannot be underestimated, as shown by Carbone A et al which represents ERII receptors. This study confirms the presence of ER and PR receptors in these tumors and highlights the already established cytological features.

Solid tumors of childhood.

OBJECTIVE: Cancer is one of the leading causes of death in children. There is the need to have the histologic review of malignancies in children from the Indian sub-continent. METHODS: In the present study, malignant tumors received over 12 years were reviewed and re-classified according to classifications based on prognosis. RESULTS: A total of 472 tumors were received over 12 years. Of these 318 were benign and 154 malignant. The commonest malignant solid tumor was lymphoma followed by pediatric renal tumors. The sarcomas included bone tumors, Rhabdomyosarcoma and synovial sarcoma. There were 13 germ cell tumors, 10 retinoblastomas and six neuroblastomas. CONCLUSION: The review revealed that a definite diagnosis or classification was not assigned in 21 cases in the original reporting. Of these 14 could be assigned a definite category on review and immuno-staining. These included five non-Wilms sarcomas, four Rhabdomyosarcomas, three Ewing's sarcoma/PNETs and two Synovial sarcomas. The study also revealed an unexpected high percentage (11%) of epithelial malignancies in children.

Fine needle aspiration cytology of chondroblastoma--a case report.

Chondroblastoma accounts for less than one percent of osseous neoplasms, and is one fifth as common as giant cell tumor, a lesion with which it is very frequently confused. It has a marked predilection for the epiphysis of long bones. Radiologically, these are lytic lesions with a thin margin of increased density. A majority of chondroblastomas have an entirely benign course and are successfully treated by curettage and bony chip grafts. Clinically, chondroblastomas may be confused with other neoplasms, both benign and malignant. Fine needle aspiration is fast gaining acceptance as an accurate and rapid technique for diagnosing osseous neoplasms. The cytological features of chondroblastoma like individually lying chondroblasts, nuclear grooves, chodroid matrix and chicken-wire calcification are diagnostic of this neoplasm and may allow fine needle aspiration to become a valuable pre-operative technique in the management of these patients.

Reappraisal of abdominal tuberculosis.

Tuberculosis, including abdominal tuberculosis, is a common disease responsible for considerable mortality and morbidity. The diagnosis of abdominal tuberculosis requires a high index of suspicion due to its vague symptomatology. This retrospective study (of 3 years duration) was conducted on 84 operated cases in whom a diagnosis of abdominal tuberculosis (excluding genito-urinary) was made on histopathology. These constituted 5.4% of all the surgical material related to gastro-intestinal tract. The mean age of the patient was 23.5 years, with the youngest patient being only 7 months old. No sex predilection was noted (41 males, 43 females). Eighteen patients (21.4%) belonged to the paediatric age group (0-15 years). Majority of patients (92.8%) presented with features of intestinal obstruction. Sixteen patients were already receiving anti-tuberculous treatment. Terminal ileum (49 cases) was the most common site of involvement followed by appendix (9), jejunum (5), anal canal (4), caecum (3) and colon (2). One case of duodenal tuberculosis was also confirmed. The important features noted in this study were high paediatric patient involvement (21.4%), significantly higher incidence of intestinal perforation (69%) and rarity of gastroduodenal tuberculosis (1.2%). Concomitant infections like typhoid and worm infestations were also seen.

Calcifying aponeurotic fibroma: a case report and review of literature.

Calcifying aponeurotic fibroma is a rare soft tissue tumor that primarily occurs in children and adolescents and has a strong predilection for the distal portion of the extremities, especially the hands and feet. This paper presents a case report of calcifying aponeurotic fibroma.