Giant cell tumor of the maxilla

@#OBJECTIVE/strong: To present a rare case of maxillary swelling; its investigation and management.br /br /strongMETHODS/strong:br /strongDesign/strong: Case Report br /strongSetting/strong: Tertiary Government Teaching Hospital br /strongPatient/strong: One br /br /strongRESULTS/strong: A 45-year-old female presented with a right maxillary swelling of six months duration. Radiological investigation revealed a radiolucent lesion arising from the inferior aspect of the right maxilla with no areas of calcification. Incisional biopsy report was consistent with giant cell tumor. The mass was excised via a Weber Ferguson incision under general anesthesia.CONCLUSION/strong: Though rare, giant cell tumor should be considered as one of the differential diagnosis in cases of maxillary swelling. Adequate surgical excision with long-term follow-up should be the treatment of choice for managing a giant cell lesion of the maxilla./p

Primary pleomorphic sarcoma of the ovary with rhabdomyosarcomatous differentiation.

A 49-year-old patient presented with a right ovarian mass, which, on microscopy, showed to consist of haphazardly oriented large pleomorphic cells with abundant cytoplasm. Periodic acid Schiff stain was positive but negative with diastase digestion. Immunohistochemical staining with Desmin showed intense cytoplasmic positivity in almost all the cells. Cytokeratin, epithelial membrane antigen, smooth muscle actin, HMB-45, S-100 and neurone-specific enolase were negative. Immunohistochemical staining with Myogenin showed intense nuclear positivity. There was no other primary tumor on extensive search. A diagnosis of primary sarcoma of the ovary with rhabdomyosarcomatous differentiation was made. The incidence of similar tumors of the ovary are low and therefore little data are available on this uniformly lethal tumor. Thus, such cases need to be reported to pool experience so that the tumor can be diagnosed early.

Expression of cytokeratins in gliomas.

Metastatic carcinoma, which is a common malignant tumor seen in the central nervous system is often difficult to distinguish from glioblastoma multiforme. In general, neoplastic cells maintain fidelity in the expression of parent cell intermediate filament and immunohistochemistry remains the mainstay in diagnosis. A panel consisting of GFAP (usually positive for astrocytic tumors) and cytokeratin (usually positive for metastatic carcinomas) is most commonly used for this purpose. However, co-expression of two or more classes of intermediate filament proteins by neoplasms is a widespread phenomenon and there are reports of glial neoplasms expressing keratin markers. Our aims and objectives were to analyse the expression of both cytokeratin and GFAP in different glial tumors and metastatic carcinomas. Cases were collected for a period of two years. All the cases were diagnosed as primary or metastatic intracranial tumors. Formalin-fixed paraffin-embedded thin sections were taken on egg-albumin coated slides and immunostaining with GFAP and polyclonal cytokeratin was done. Forty-five tumors were analysed, including 35 glial neoplasms and 10 metastatic carcinomas of which 7 of the 32 astrocytic neoplasms (22%) showed focal immunoreactivity with pancytokeratin. All of the glial tumors but none of the metastatic carcinomas were positive with GFAP. So our conclusion was that co-expression of GFAP and CK is a fairly common phenomenon, especially in case of undifferentiated and high grade gliomas and this must be kept in mind while differentiating these cases from metastatic carcinoma, as CK positivity does not rule out the diagnosis of a glial neoplasm. Further studies with an expanded panel of CK is most useful for this.

Infantile hemangioendothelioma of liver: report of two cases.

Infantile hemangioendothelioma, the commonest mesenchymal tumour of liver in infancy, though benign in nature, may behave aggressively. Here reports of two such cases are presented. Both were girls and less than 1-year old. Grossly, they presented with nodular hepatic masses with features of heart failure. Histopathology of both liver masses showed intercommunicating bloodvessels, lined by single layer of plump endothelial cells showing CD-34 positivity by immunohistochemistry. Entrapped biliary channels within tumour mass showed cytokeratin positivity.