Discovered on gastrointestinal stromal tumor 1, a keystone in the diagnosis of extraintestinal gastrointestinal stromal tumors

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT) but have a low incidence. Arising from the interstitial cells of Cajal, GISTs occur at different sites in the GIT with stomach being the most common. They can rarely be seen at sites outside the GIT such as omentum, retroperitoneum and are called as extraintestinal GISTs (EGIST). They have a spindle or epithelioid cell morphology and show positivity by immunohistochemistry (IHC) for CD117. Our aim was to study the clinicopathological and immunohistochemical profile of our cases of EGISTs. Materials and Methods: A cross-sectional study of EGISTs received from 2010 to 2015 was done. IHC with CD117 and discovered on GIST1 (DOG1) was performed and tumors were scored based on the percentage of cells that stained positive. Thirteen abdominal non-GIST spindle cell tumors were included in the study as controls. Results: Seven cases of EGIST were included (four-omental, three-retroperitoneal). All cases stained positive for CD117 and DOG1. One case of epithelioid EGIST scored 4 + with DOG1 and 2 + with CD117. Another case with mixed morphology scored 2 + with DOG1 and 4 + with CD117. All controls were negative for both markers. Conclusion: EGISTs are one of the rare differentials for spindle cell lesions outside the GIT. Although both markers stain positive, DOG1 showed higher score with epithelioid GISTs

Double non coronary aortic sinuses: an autopsy case finding showing the arterial variation / Senos aórticos dobles, no coronarios: un caso de autopsia que demuestra la variación arterial

We report a case of variant origin of the right coronary artery from the left posterior aortic sinus. This was observed routinely during a medico legal autopsy of a 58 year old male who died in a road traffic accident. Initially it was believed that the right coronary artery was absent since there was no obvious right coronary artery ostium from the anterior aortic sinus. However it was found later that the right coronary ostium was present just beside the left coronary ostium in the left posterior aortic sinus and the right coronary artery was arising from the left posterior aortic sinus. The right coronary artery had an intramural course between the aorta and pulmonary trunk, which is considered as very dangerous and life threatening. We believe that the present case report will be enlightening to the cardiologist and cardiothoracic surgeon. It is also true that the conduction of medico legal autopsies of coronary arteries is important for the medico legal resolution.

Se presenta un caso de variación de origen de la arteria coronaria derecha desde el seno aórtico posterior izquierdo. Esto se observó de forma rutinaria durante una autopsia médico-legal de un hombre de 58 años que murió en un accidente de tránsito. Inicialmente se creía que la arteria coronaria derecha estaba ausente ya que no había un ostium observable desde el seno aórtico anterior. Sin embargo, se descubrió más tarde que el ostium de la arteria coronaria derecha estaba presente justo al lado del ostium de la arteria coronaria izquierda en el seno aórtico posterior izquierdo y la arteria coronaria derecha se originaba del seno aórtico posterior izquierdo. La arteria coronaria derecha presentó un recorrido intramural entre la aorta y el tronco pulmonar, que se considera como muy peligroso y potencialmente mortal. Creemos que el presente trabajo será esclarecedor para el cardiólogo y el cirujano cardiotorácico. También consideramos que el conocimiento de la anatomía de las arterias coronarias es importante durante el desarrollo de la autopsia médico-legal para lograr alcanzar una correcta resolución del proceso medicolegal.

A study of high-sensitivity c-reactive protein in bronchial asthma.

Background. Relevance of C-reactive protein an acute phase reactant and a sensitive marker of low-grade systemic inflammation in bronchial asthma has not been fully studied. Objective. To evaluate the significance of high-sensitivity C-reactive protein (hs-CRP) in atopic and non-atopic asthma using an ultra sensitive assay. Methods. The levels of hs-CRP of 200 patients with bronchial asthma and 50 non-asthmatic control subjects were measured using a Latex enhanced immunoturbidimetric test. Spirometry with reversibility study, serum immunoglobulin-E (IgE) measurement and skin test for allergy was done in all the patients. Results. There was a significant increase in hs-CRP levels with age in atopic asthmatics but no such association was observed in the non-atopic asthmatics and control subjects. The hs-CRP levels were not influenced by sex in any group. Smokers in all the three groups had a significantly higher hs-CRP levels as compared to non-smokers. Patients with asthma had higher hs-CRP values as compared to controls. Patients with non-allergic asthma had higher mean hs-CRP as compared to atopic asthmatics and control subjects. Conclusions. The study suggests that there exists a certain degree of low-grade systemic inflammation in addition to the local bronchial inflammation in non-atopic asthmatics. Hence, hs-CRP may be used as a surrogate marker for the airway inflammation in non-atopic asthma patients.

Giant cystic thymoma with haemorrhage and necrosis: An unusual case.

Extreme degree of cystic, haemorrhagic and necrotic changes in a thymoma is rare. A 22-year-old male presented with cough, grade 2 dyspnoea, and occasional chest pain for the past six months. Radiological investigations revealed a large cystic lesion in the anterior mediastinum. A benign cystic tumour was suspected. Surgical resection of the tumour was done. Grossly, the almost entirely cystic and haemorrhagic dumb-bell shaped encapsulated tumour showed a subcapsular residual nodule. Histopathological examination was suggestive diagnosis of benign thymoma (World Health Organization [WHO] Type A, medullary type) associated with the rare features of cells with dendritic processes containing melanin pigment seen singly scattered throughout the tumour.

Pancreatic epidermoid cyst.

Epidermoid cyst of intrapancreatic spleen is described but epidermoid cyst occurring in the pancreas itself is not documented. We report a 36-year-old man who presented with abdominal pain radiating to the back. On ultrasonography, a multilocular cyst was seen in the head of the pancreas. Fine-needle aspiration cytology suggested a diagnosis of epidermoid cyst, which was confirmed on histology of the resected specimen.

Myxoid liposarcoma of the breast--report of a rare case.

Breast sarcomas are very rare. A 40 year old lady presented with a well-defined hard lump, 6 cm in size, in the left breast. Patient underwent simple mastectomy with axillary clearance following a diagnosis of phylloides tumour on fine needle aspiration cytology. Grossly, it was a circumscribed myxoid tumour. Histopathologically, it fulfilled all the criteria for a diagnosis of myxoid liposarcoma. The absence of epithelial component excluded phylloides tumour.

Case reports of basaloid squamous cell carcinoma--an aggressive variant of squamous cell carcinoma.

Basaloid squamous cell carcinoma (BSCC) is a high grade variant of Squamous Cell Carcinoma with a predilection for the aero-digestive tract. The typical microscopic features of carcinoma with a basaloid pattern in intimate association with a squamous component helps in diagnosis of this tumour. There are few reports in the Indian literature and we report three cases, including one in the sinonasal region. This study discusses the differential diagnosis of BSCC, as recognition of this tumour may have therapeutic implications.