Solid variant of papillary carcinoma of nipple: An under recognized entity.

Papillary lesions of the breast represent a heterogeneous group with differing biological behavior. Solid papillary carcinomas are uncommon tumors composed of circumscribed large cellular nodules separated by bands of fibrosis. Correct diagnosis is crucial but may be difficult, as many other benign and malignant lesions have similar histological appearances. Immunohistochemistry plays a useful role in their differentiation. We describe one such case of a solid variant of papillary carcinoma of the left nipple in a 75-year-old woman, who had no other palpable mass in rest of the breast tissue. The case is documented for the rarity of its occurrence and significance of recognition of this lesion.

Coronary atherosclerosis in sudden cardiac death: An autopsy study.

Background: The incidence of ischemic heart disease (IHD) has markedly increased in India over the past few years. Considering the variations in racial, dietary and lifestyle patterns in our population, it is essential to study the biology of coronary atherosclerosis in our patients. Vulnerable plaques have a large number of foam cells, extracellular lipid, thin fibrous caps and clusters of inflammatory cells and are more prone to rupture. These plaques are nourished by the microvessels arising from the vasa vasorum of the blood vessels and by lumen-derived microvessels through the fibrous cap. This autopsy study was designed to analyse the coronary arterial tree in cases of sudden cardiac death, classify coronary atherosclerotic plaques and to assess the factors contributing to vulnerability of the plaques including inflammation, calcification and microvascular density. Materials and Methods: Seven cases of sudden cardiac death were included in the study. The hearts were perfusion-fixed and the coronary arteries along with their main branches were dissected and studied. The location of the plaques, type of plaques, presence of inflammation and calcification were assessed. The cap thickness and microvessel density per 1000um 2 were assessed. The statistical significance was estimated. Results and Conclusions: Extensive high-grade coronary atherosclerotic disease was seen in all sudden cardiac death cases. Majority of the plaques were vulnerable. High-grade inflammation was seen in most of the vulnerable and ruptured plaques. All the ruptured plaques were uncalcified indicating that calcification probably stabilizes the plaques and protects against rupture. Increased microvessel density was noted in ruptured plaques compared to vulnerable plaques. However, it was not statistically significant.

Autofluorescence: a screening test for mycotic infection in tissues.

Fungal infection is a major health concern as the clinical features are not very distinctive. Lack of rapid diagnostic techniques results in delay in diagnosis, which may even culminate in a fatal outcome. The fact that many pathogenic fungal organisms autofluoresce in hematoxylin and eosin (H and E)-stained sections under ultraviolet illumination led us to evaluate the role of autofluorescence as a rapid screening technique for fungal infections. The aim of the present study was to assess the value of autofluorescence as a screening method for detecting fungi on tissue sections and to compare the results of autofluorescence with conventional histochemical stains for fungi. Hematoxylin and eosin-stained slides of mycotic lesions were examined under fluorescent microscope and the findings were compared with results of Gomori's methenamine silver and periodic acid-Schiff stains. We found fungal autofluorescence in 63 out of 64 cases studied, with a sensitivity of 97.8% and specificity of 100% in comparison with fungal stains. This was statistically significant (P < 0.05). We conclude that autofluorescence can be used as a rapid screening method for identification of fungi in tissue sections as it does not require any other specialized staining procedure.

Disseminated malignant fibrous histiocytoma (giant cell rich): a case report.

Giant cell rich malignant fibrous histiocytoma accounts for 3 -15% of all malignant fibrous histiocytomas. Currently, the nomenclature giant cell malignant fibrous histiocytoma is reserved for undifferentiated pleomorphic sarcomas with prominent osteoclastic giant cells. It is considered to be synonymous with malignant giant cell tumor of soft parts. We report a case of disseminated giant cell malignant fibrous histiocytoma involving the scalp, cervical node, lungs, spine, abdominal wall, base of penis, gluteal cleft, paraspinal region and back. The diagnosis was established after staining for a panel of immunohistochemical markers namely cytokeratin, vimentin, S100, desmin, CD68 and smooth muscle actin. CD68 positivity in tumor cells helped in arriving at the final diagnosis. It is essential to recognize this tumor as a giant cell rich distinct entity and differentiate from other giant cell rich pleomorphic sarcomas since therapeutic and prognostic differences are being appreciated currently.

Morphological and morphometric analysis of coronary atherosclerosis--an autopsy study.

Coronary atherosclerosis is the most frequent cause of ischemic heart disease. The composition and vulnerability of the atherosclerotic plaque determines the development of acute coronary syndromes. In this study, 224 advanced atherosclerotic plaques were identified from the main coronary arterial branches of 10 autopsy heart specimens. The plaques were classified by American heart association (AHA) and modified American heart association classification. Vulnerability of the plaques and factors influencing vulnerability were assessed. Vulnerable plaques were mostly of Type IV category of AHA classification and of thin cap fibroatheroma type by modified American heart association classification. Inflammation was more frequent and was of a higher grade in vulnerable plaques. Calcification was predominantly of mild grade.

Subcutaneous panniculitis-like T cell lymphoma in a HIV positive patient.

Immunocompromised patients are at increased risk for developing certain malignant tumors, particularly aggressive B cell lymphomas and extranodal lymphomas like primary central nervous system lymphoma and primary effusion lymphoma. T cell lymphomas are uncommon in these patients. We report a rare case of subcutaneous panniculitis-like T cell lymphoma in a HIV positive patient who presented with multiple subcutaneous nodules.

Value of AgNORS in premalignant and malignant lesions of the cervix.

Study of the argyrophilic nucleolar organizer regions (AGNORS), which was used extensively in cytogenetics, has been identified as a reliable indicator of cell proliferation and in turn, the malignant potential of a lesion. Premalignant and malignant lesions of the cervix are analysed for their AGNOR counts in this study. Statistically significant difference in AGNOR counts was noted in different sets of lesions. This technique can serve as a useful adjunct to routine histopathology.

Histological and functional correlation of thyroid carcinoma by immunohistochemistry.

40 cases of thyroid carcinoma comprising of 22 follicular, 11 papillary, 4 medullary, 2 anaplastic and 1 medullary carcinoma with focal areas of papillary differentiation were selected for this immunohistochemical study for the presence of thyroglobulin, calcitonin and somatostatin. As per the functional classification recommended by Otto L Jungberg, 22 cases were well differentiated, 13 were of intermediate differentiation with 3 poorly differentiated cases. 2 cases of anaplastic carcinoma were negative for all the 3 markers. Correlation between functional classification and histological pattern show 77% of the well differentiated type to be of follicular pattern with the rest consisting of papillary carcinoma. In the intermediate type 38.4% were follicular carcinoma, 15.3% medullary carcinoma and the rest, papillary carcinoma. Poorly differentiated type consisted of 2 medullary carcinomas. Contrary to previous reports, functional differentiation did not always correlate with histological pattern.