Secretory meningioma: A diagnostic pitfall.

Context: Secretory meningioma is a rare subtype of meningiomas, displaying epithelial and secretory differentiation of meningothelial cells. It has unique radiological, morphological, and immunohistochemical features, but runs a benign course. Radiological picture because of the variable degrees of peritumoral edema can be confused with aggressive neoplasms. Morphologically, it is diffi cult to distinguish secretory meningioma from other tumors having a clear cell appearance and aggressive clinical behavior. Materials and Methods: Retrospective analysis over a period of 16 years (1997-2012) brought out fi ve cases diagnosed as secretory meningioma. The slides were restained and subject to special stains and immunohistochemistry and the clinical details were retrieved. Results: On histopathology, the tumors showed a characteristic vacuolated appearance due to the presence of variably sized intracytoplasmic lumina. Another unique feature was the presence of hyaline inclusions within these intracytoplasmic lumina and in the intercellular spaces. These inclusions were periodic acid-Schiff positive diastase-resistant, yellowish-orange on Elastic Van Giesson stain and strongly carcinoembryonic antigen positive. Conclusion: Owing to its rarity and unique morphology secretory meningioma poses a diagnostic challenge to the pathologists. As this tumor follows a benign course, it is crucial to correctly diagnose this entity to avoid unnecessary over treatment.

The absence of JC virus antigens in Indian children with medulloblastomas.

BACKGROUND: The human polyoma virus, also known as the JC virus (JCV), replicates predominantly in the oligodendrocytes, the myelin producing cells in the central nervous system and results in the fatal demyelinating disease progressive multifocal leukoencephalopathy (PML) especially in immunosuppressed patients with AIDS. Several investigators have also documented the presence of the viral genome and early and late antigens in a variety of brain tumors particularly in medulloblastomas, gliomas and ependymomas. Reports also indicate the presence of JCV in patients with colon cancer. The T antigen of JCV has been postulated to have oncogenic potential as substantiated by animal experiments. Although JCV infects 80% of the population, there are scant epidemiological studies regarding JCV from India. There are also reports of the low prevalence of PML in patients with AIDS from India and Africa. AIM: This study was undertaken to investigate if Indian children with medulloblastomas also show evidence of JCV. METHODS: Twenty-two consecutive cases of medulloblastomas were investigated for the presence of T antigen and agnoprotein of JCV in biopsy specimens by immunohistochemistry. Antibodies to the agnoprotein antigen raised in rabbits and a monoclonal antibody against SV40 T antigen raised in mice that cross-reacts with JCV T antigen were used. RESULTS: Out of 22 patients, 4 had desmoplastic tumors while the rest had classical tumors. All children were below the age of 10. Results indicate that while PML tissues showed consistent immunostaining both with antibody to T antigen and agnoprotein antibody, none of the tumors showed any positive staining for JC viral antigens. CONCLUSION: JCV antigens could not be detected by immunohistochemistry in the tumor tissues of Indian children with medulloblastomas.

Pattern of fibronectin in hepatocellular carcinoma and its significance.

Fibronectin is a multifunctional large molecular weight glycoprotein that can bind extra-cellular and cellular components. The aim of the present study was to evaluate expression of fibronectin and its significance in cases of hepatocellular carcinoma (HCC). A few previous studies have shown abnormal over- expression of fibronectin in cases of HCC. Expression of the fibronectin protein was studied in eleven cases of HCC by immunohistochemical method. Fibronectin was seen to localize predominantly in perisinusoidal region and strong positivity was noted in other fibrotic areas. Positivity around nests of cells and tumor nodules was noted in 8/11 cases of HCC and faint cytoplasmic positivity in tumor cells was seen in 5/11 cases. Staining pattern of fibronectin in HCC was definitely abnormal but decreased in the present study. The controversial results as seen in few previous studies also have been partially explained in the present article and further studies using larger sample size is suggested to clarify the issue.

Intracavitary metastatic non-Hodgkin's lymphoma simulating an atrial myxoma.

We describe a case of intracavitary metastasis of Mantle Cell Lymphoma of gastrointestinal tract, which mimicked an atrial myxoma. The gastrointestinal lymphoma led to widespread metastasis and a large metastatic tumor deposit at the hilum of the right lung caught up the hilar vessels. This led to infiltration into the pulmonary veins and intracavitary metastatis to the left side of the heart.