Subcutaneous metastases of sarcomatoid mesothelioma with its differential diagnosis on fine needle aspiration--a case report.

Metastasis of mesothelioma of the pleura, to the skin and subcutis is an extremely rare occurrence. A 25 year old woman, who had undergone chemotherapy, partial excision of tumor followed by radiotherapy of sarcomatoid mesothelioma of the pleura, presented three months later with painless widespread subcutaneous nodules. FNAC of these nodules reveled pleomorphic malignant spindle shaped cell with epithelioid morphology. The subcutis is a particularly rare site of metastatic sarcomatoid mesothelioma. It is essential to differentiate neoplasm metastatic to the skin and subcutis from primary and benign lesions of the same region. FNAC is accurate and efficient, in conjugation with clinical history, and it also prevents surgical biopsy in the diagnosis of metastatic subcutaneous lesion. To our knowledge, this is the first case, reported till date, in which the sarcomatoid mesothelioma metastasized to the subcutaneous tissue and was diagnosed by fine needle aspiration cytology (FNAC).

Clinicopathological prognostic factors of adult granulosa cell tumor of the ovary--a study of 37 cases.

Adult granulosa cell tumor (GCT) of the ovary is the most common malignancy amongst the sex cord stromal tumors. Clinical stage, age, tumor size, residual disease and several histologic factors have been reported to be of prognostic significance. There were 839 ovarian malignancies at our institute during the period from 1998 to 2002. Out of 54 granulosa cell tumors, 40 cases were evaluable which includes 37 cases of adult GCT and 3 cases of juvenile GCT. They were studied retrospectively. Majority of patients presented with abdominal symptoms and FIGO stage I. All patients were treated surgically and 62.1% of adult GCTs were given post-operative chemotherapy. Clinical stage, presence of residual disease and tumor volume were the most important prognostic factors. Age of patient, menstrual status, post-operative chemotherapy, mitosis or histological patterns were of little significance in our study.

Fine needle aspiration cytology of hepatoblastoma: a study of 20 cases.

Hepatoblastoma (HBL) is the most common primary malignant hepatic tumor in children. The aim of the present study is to describe cytological findings of HBL, to subclassify it, and to discuss differential diagnoses. Twenty cases were taken from records of Cytopathology department, Gujarat Cancer and Research Institute, Ahmedabad. The aspiration smears were stained with Papanicolaou stain andlor Giemsa stain. Cytological and architectural criteria were applied to aspiration smears. Fifteen cases (75%) of HBL were diagnosed in the patients below the age of two years. The commonest presentation was found to be lump in abdomen. On the basis of cytoarchitectural features, HBL was classified in two groups undifferentiated and differentiated. Morphologically, the tumor cells were commonly arranged in acinar pattern, papillary pattern, or in sheets. FNA cytology alone had some limitations in the diagnosis of HBL. Hence, cytoarchitecture in combination with clinicalfeatures, imaging techniques and serum a-fetoprotein levels were helpful for specific diagnosis of HBL and to rule out various others differential diagnosis of small round cell tumor. The cytological differential diagnosis between differentiated HBL and Hepatocellular carcinoma (HCC) was found to be very difficult.

Role of mitotic counts in the grading and prognosis of the breast cancer.

100 Cases of invasive breast cancer were studied for Tumor type, Tumor site, Nodal Status, Mitotic counts, Nuclear pleomorphism, Tubule formation and Nottingham modification of Bloom Richardson Grading. The follow up of the 82 patients treated with surgery and adjuvant treatment was available. Mitotic activity index (MAI) counted with strict criteria of elston CW, emerged as one of the most significant prognostic parameter followed by overall grade in predicting Tumor free survival (TFS) for the patients. Mitotic count also correlated well with overall Grade and lymph node status in predicting the TFS. This parameter is very useful where advanced studies like flowcytometry and immunohistochemical studies of the cell proliferation marker are not available.

Efficacy and safety of carvedilol in infants with dilated cardiomyopathy: a preliminary report.

BACKGROUND: Carvedilol has proven to be beneficial in a majority of adult patients with congestive heart failure. Although the experience from adult patients may be extrapolated to older children, symptomatic infants remain a subset for whom dosage, safety and efficacy need to be established. The purpose of this study was to assess whether treatment with carvedilol is efficacious and safe for infants with dilated cardiomyopathy who do not show satisfactory clinical improvement despite treatment with conventional medications. METHODS AND RESULTS: Eight infants with dilated cardiomyopathy (ejection fraction <30%) who were symptomatic despite tailored treatment with decongestive medications, were enrolled in the study. Echocardiographic findings and heart failure symptom scores were analyzed before and after starting carvedilol. Patients were hospitalized and monitored for side-effects during up-titration of carvedilol. At a follow-up of 4.5+/-2.2 months, patients receiving carvedilol showed a significant improvement in the left ventricular ejection fraction (38.5+/-11% v. 24.4+/-5%), and heart failure symptom score (p<0.05). No adverse events related to carvedilol administration occurred. There were no deaths. CONCLUSIONS: Carvedilol is well tolerated in infants with dilated cardiomyopathy and there is significant improvement in their functional status. Optimal timing of starting therapy, dosage and long-term effects need to be investigated with multi-institutional trials.