Intravascular and Extravascular Migratory, Metastatic Melanoma of the Great Saphenous Vein

Melanoma blood vessel metastases are very uncommon. Wereport this very rare case of metastatic melanoma along thewall of great saphenous vein (GSV), showing intra and extravascular metastasis. By far only a single case of intravascularmetastatic melanoma (IVMM) of GSV and thirty six cases ofextravascular migratory metastatic melanoma (EVMM) ofGSV have been reported. In our case melanoma cells wereseen both inside and outside of the wall of GSV, and in thedermis. A 60 years old male presented with multiple swellingsupper left thigh since one and a half year. Patient wasoperated. All swellings, along with, part of saphenous vein tillthe knee, and small part of skin were excised under GA.Microscopically, hematoxylin and eosin sections given fromvarious sites showed features of malignant melanoma. Tumorcells were seen in the dermis, and the lumen, as well asoutside the wall of saphenous vein, but not in the epidermis.Only very few melanocytic granules were seen in a singlearea of a section. On Immunohistochemistry –, MarkersHMB45, S100 and Vimentin are strong immunoreactive. CKPAN was focal immunoreactive.In our case the melanoma spread along the wall of the GSV.This pericytic angiotropism of melanoma cells, also showingsigns of intravasation, which suggests that melanomacells may migrate along the external surface of vessels, amechanism termed ‘EVMM and also by invading the bloodvessels ‘IVMM’.

Histopathological Patterns of the Testicular Biopsies and its Role in the Evaluation of Infertility Among Azoospermic Male Patients: A Hospital Based Study From Northern India

To identify and categorize various pathological patterns seen in testicular biopsies of azoospermic males along with their Johnson’s score and to evaluate the importance of the histological examination of testicular biopsies for further clinical planning. Methods: The study was conducted in the Department of Pathology of Mahatma Gandhi Medical College and Hospital, Jaipur, India. Slides prepared from testicular biopsies either unilateral or bilateral (received between January 2003 to December 2012), of 135 patients who had azoospermia on routine semen analysis were retrospectively retrieved and reviewed. Various histopathological patterns were evaluated and categorized and were graded according to the Johnson’s scoring. If more than one histological pattern was noted in the same testicular biopsy it was called as ‘Mixed pattern’ whereas if the right and left testes showed different histological pattern it was called as ‘Discordant pattern’. Results: A total of 152 testicular biopsies were collected from 135 patients (118 patients with unilateral and 17 patients with bilateral testicular biopsies). All the patients had azoospermia on routine semen analysis. The age of the patients ranged from 20 to 51 years. The most common histological pattern observed was Normal spermatogenesis (35.56%) followed by Sertoli cell only syndrome (23.70%) and Germ cell maturation arrest (20%). Hypospermatogenesis and Seminiferous tubule hyalinization was seen only in 2.96% and 2.22% of the cases respectively. Conclusion: This study has shed some light on the possible underlying etiologies of primary male infertility and emphasizes the need for bilateral testicular biopsies and on meticulous pathological examination of all seminiferous tubules in order to identify mixed and discordant patterns. The data extrapolated from our study can serve as a template for better management of primary male infertility and will optimize the advanced therapeutic modalities for the infertile couples.

A comparative and evaluative study of cytological and histological grading system profile in malignant neoplasm of breast--an important prognostic factor.

Breast carcinoma is one of the leading causes of malignancy in females. Diagnosis of breast carcinoma is often made by fine needle aspiration biopsy. Nuclear grading is the most important prognostic factor. It is important to grade the breast carcinoma which will provide valuable information to the treating oncologist to plan the management. The purpose of the study is to compare the cytological grading with histological grading and to assess the prognosis according to the grade. 100 cases of breast carcinoma were graded cytologically by Robinson Grading system and 71 cases were graded histologically by modified Bloom-Richardson system and results of both were compared and statistical correlation was done. In the present study sensitivity and specificity of cytological grading system were 90.77% and 84.42% respectively.

Asymptomatic lymphangitis carcinomatosis due to squamous cell lung carcinoma.

Lymphangitis carcinomatosa most commonly due to primary malignancy originating in the breast, stomach, pleura and prostate but may also originate from the lung itself. It is clinically characterised by progressing dyspnoea with or without cough even at an early stage. We report the case of a patient with squamous cell lung cancer presenting with asymptomatic lymphangitis carcinomatosa.

Chylothorax in a patient with ovarian tumour.

A rare case of chylothorax complicating sex cord tumour of ovary in a young girl is being reported here. It was successfully managed by using a multipronged strategy consisting of chemotherapy, total parentral nutrition and bleomycin pleurodesis.