Clinico-Pathological Profile of Patients with Spinal Cord Lesions.

Background: Spinal cord is the site of variety of lesions and includes both non neoplastic and neoplastic lesions. Common non neoplastic lesions include meningomyeloceles, dermoid cysts, epidermoid cysts, arachnoid cysts and neurenteric cysts whereas neoplastic lesions include astrocytomas, ependymomas, schwannomas, neurofibromas and meningiomas. The aim is to study clinico-pathological profile of patients with spinal cord lesions. Methods: This was a prospective study conducted at Department of Pathology, Osmania General Hospital, Secunderabad from June 2010 to May 2013. All specimens received during study period. Only samples related to spinal cord were included. Results: Of all, non-neoplastic were 28 cases [43%] and neoplastic were 37 cases [57%]. Males were 30 cases [46%] and females were 35 cases [54%] with slight predominance in females. Of all most common were Meningomyelocele [23%] followed by Schwannomas [19%], Neurofibromas [12%], Lipomeningomyelocele [9%], Ependymomas [6%], Meningiomas [6%], Astrocytomas [5%], Dermoid cyst [5%], Arachnoid cyst [3%], Neurenteric cyst [3%], Teratoma [3%] and others include Paraganglioma, PNET, Oligodendroglioma, Metastatic deposits. Intramedullary lesions constitute 10 cases [19%] with [3 non neoplastic and 7 neoplastic], Intradural extramedullary lesions constitute 24 cases [54%] with [4 non neoplastic and 20 neoplastic], Extradural lesions constitute 31 cases [27%] with [21 non neoplastic and 10 neoplastic]. Conclusion: Most non neoplastic lesions in the spinal cord were due to developmental defects and present in younger age group whereas most neoplastic were acquired and occur in adults.

Sclerosing adenosis clinically feigning as carcinoma breast: A case report.

Sclerosing Adenosis (SA) is a lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast suggesting benignity. The disease has an increased incidence among reproductive-age and perimenopausal women, especially between 35 and 50 years of age. The clinical, radiological, and histopathological properties of sclerosing adenosis may resemble malignancy, which is the factor responsible for the clinical significance of the disease. Early diagnosis of sclerosing adenosis (SA) is very important as it is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be controversial and unclear. The main histopathological alterations of the terminal ductal lobular unit (TDLU) present as a widening and distortion of lobules with an increased number of acini and stromal fibrosis. The lesion is also called an “adenosis tumor of the breast” or “nodular sclerosing adenosis” if it presents as a palpable mass. Sclerosing adenosis is present in 12% of benign proliferative lesions and 20-25% of malignant lesions on histopathological examination. On mammography (MG), it can present as opacity, focal asymmetry, architectural distortion, or micro calcifications, mimicking a carcinoma. We have presented a case of 42 year old female who was diagnosed as carcinoma breast clinically and on radiology. Mammography showed a fibrosed lesion of size 4.5x3 cm with focal specks of microcalcification and irregular borders. But repeated fine needle aspiration cytology (FNAC) smears revealed small and large clusters of ductal epithelial cells with minimal anisonucleosis with background showing amorphous crystalline material and stromal fragments. Basing on FNAC, plan of surgery changed and a wide local excision with 2 cm normal margins was done and the specimen sent for histopathological examination (HPE), which revealed the lesion as sclerosing adenosis (SA).

Pediatric caecal lymphoma involving ovary in a 12 year old girl – A bad prognostic sign: A rarity.

Primary caecal lymphoma or the colonic lymphoma is a rare tumor of the gastrointestinal (GIT) tract and comprises only 0.2-1.2% of all colonic malignancies, both in adults and pediatric age group. The most common variety of colonic or caecal lymphoma is a on-Hodgkin’s Lymphoma (NHL) which arises from the lymphoid elements of the intestine. GIT is the most frequently involved site, accounting for 50-60% of all extra nodal lymphomas, and most of them are NHL. In adults, the stomach is the most common location of GIT lymphomas, followed by the small intestine, but the most common GI site of NHL in children is the terminal ileum and the ileo-caecal region. Diagnosis is difficult since lymphoma presents with vague abdominal pain with loss of weight and appetite. It may present as lump abdomen with complications such as intestinal obstruction, bleeding, perforation and peritonitis and intussusseption. Histologically it is B or T cell type with small or large cell variation, but frequently encountered is diffuse large B-cell cell lymphoma (DLBCL). DLBCL has low incidence but favorable outcome in young adults, lesions localized to one area or organ and children below 5 years of age, but has an aggressive course in children between 10-15 years of age and also in adults above 55 years of age. DLBCL or GIT Lymphomas in general have male preponderance. We present a rare case of caecal lymphoma (DLBCL) involving appendix and right ovary in a 12 year old girl who presented with vague symptoms of abdominal pain and abdominal mass. Clinically and radiologically, provisional diagnosis of Ileo-caecal tuberculosis with possibility of adhesions leading to a mass lesion was considered. Histopaththological examination (HPE) revealed the diagnosis and prognosis of the case.

Kikuchi-Fujimoto disease in inguinal lymph node – A rare site of occurrence.

Kikuchi-Fujimoto disease (KFD) is also known as histiocytic necrotizing lymphadenitis It is a benign, systemic lymphadenitis, self limiting disease first described independently by Japanese Pathologists Kikuchi and Fujimoto in Japan in 1972. The incidence of KFD is unknown. KFD is up to 4 times commoner in women. It presents as lymphadenopathy mainly involving the posterior cervical region, but can occur in any lymph node and even in extra nodal sites. Fever is associated with lymph node enlargement in half of the cases. Though viral and autoimmune cause is suggested by some studies, the exact etiology remains uncertain. There have also been reports of a relation between KFD and systemic lupus erythematosus. Most of the preoperative diagnostic tests are inconclusive. Definitive diagnosis depends on the histopathological examination of the lymph node biopsy. Clinically it has to be differentiated from other lesions like malignant lymphoma, mononucleosis tuberculosis and SLE as treatment and prognosis differs. Here we submit a case of Kikuchi-Fujimoto disease in an inguinal lymph node in a young adult auto driver.