Gliosis of the cervix

Cervical glial polyps or gliosis of uterine cervix are rare. These are rare polypoidal mesenchymal tumours and usually manifest with vaginal bleeding, post-coital bleeding or cervical discharge. Microscopically these polyps show heterotopic glial tissue with varying degree of gliosis. Immunoperoxidase staining with Glial fibrillary acidic protein (GFAP) confirms the glial nature of the polyp. Controversies remain regarding the origin. Some consider them to be foetal implants following termination of pregnancy whilst others consider them to be metaplastic in nature. We report a rare case of cervical gliosis that was diagnosed after histological examination of the resected specimen in a 32-year-old lady who presented with irregular per vagina bleeding.

A holiday bug - Answers

(Refer to page 164) Answer: Giardiasis. The slide shows duodenal biopsy with pear shaped protozoa of Giardia lamblia on the luminal surface of the villi. Giardia lamblia is a pear-shaped, flagellated protozoan that causes a wide variety of gastro-intestinal complaints. Giardia is possibly the most common parasite of humans worldwide and the second most common in the United States after pinworm.

A holiday bug

A 35-middle-aged female with history of recent travel to the Indian Subcontinent, presented with features of malabsorption. Blood chemistry revealed low serum albumin and low serum Vitamin B12 levels. Upper gastrointestinal endoscopy was done and was reported as normal. The duodenal biopsy sent for histopathologic examination and is shown (Panel). What is the diagnosis? Answer: refer to page 186

Lymphangioma of the ovary

Lymphangioma of the ovary is an extremely rare lesion. There are only 19 cases reported in the literature. Lymphangioma is usually unilateral and asymptomatic, presenting as an incidental finding during routine gynaecologic procedures. It is composed of aggregates of lymphatic spaces in ovarian stroma and the endothelial cells lining these spaces stain positively with CD-31 and CD-34 on immunostaining. The main differential diagnosis is an adenomatoid tumour which can be differentiated from the lymphangioma by immunohistochemical studies. We report this rare lesion in a 42-year-old Malay lady diagnosed after total abdominal hysterectomy and right salpingo-oophrectomy. A literature review is presented and the histological and immunohistological findings along with differential diagnosis are discussed.

Cystic carcinoma of the neck

Malignant cystic lesions of the lateral side of the neck are usually due to metastasis and are rarely primary carcinoma. The most common is metastatic cystic squamous cell carcinoma arising from a primary site at the Waldeyer's ring. However, they can arise from papillary carcinoma of thyroid, lung and mediastinum but very rarely from the abdominal and pelvic organs without regional lymph node involvement. Therefore, accurate diagnosis is very important for appropriate management. We report two cases of cystic squamous cell carcinoma of the lateral neck; cystic metastasis from an occult squamous cell carcinoma of the tongue and a primary branchiogenic carcinoma. We emphasize the importance of meticulous search for the primary malignant lesions in cases of cystic carcinoma of the neck.

Disseminated histoplasmosis

The clinical presentation of Disseminated Histoplasmosis is diverse and may simulate hepatic, blood, pulmonary and renal disease. Less commonly it may resemble meningitis endocarditis, adrenal insufficiency, gastro-intestinal disorders and cutaneous disease. Definite diagnosis rests on the demonstration of the fungal bodies in tissues and by isolation of fungus by culture. Two cases of disseminated histoplasmosis confirmed by such methods are reported. These two cases are probably first 2 cases of Histoplasma infection reported from Burma.