Multicentric Castleman's disease in two cases.

Castleman's disease is an atypical lymphoproliferative disorder having two types of presentation--the localized and the multicentric form. The localized form presents as a slowly growing mass with a relatively benign course. Multicentric Castleman's disease has a more aggressive clinical course with diffuse lymph node enlargement and systemic illness. It is rarely seen in childhood and only thirteen cases have been reported in literature. This is the first report of 2 cases from the Indian subcontinent with a maximum follow-up of 44 months one of whom had asplenia.

Colonic actinomycosis masquerading as perforated colonic carcinoma.

A case of Actinomycosis affecting the transverse colon masquerading as an abdominal neoplasm with perforation to abdominal parietal wall is presented. Abdominal actinomycosis lesions may present as a perforated abdominal neoplasm requiring emergency laparotomy. This case report highlights the diagnostic dilemma and the management algorithm for such infections.

Angiogenesis in myelodysplastic syndromes (MDS) in Indian patients.

Angiogenesis plays an important role in the pathogenesis of haematological neoplasms and may be correlated with the prognosis. We recently evaluated the microvessel densities in trephine biopsy sections of seventeen patients of myelodysplastic syndromes (MDS). Of the 17 cases, 2 were RAEB-t, 3 were RAEB, one was RARS and 11 were of the subtype RA (FAB subtyping). The microvessel counts were measured in the bone marrow biopsy sections by immunohistochemical staining, using CD34 reactive monoclonal antibodies. MVD was significantly higher in the cases of RAEB and RAEB-t as compared to the cases of RA. The average MVD per x400 in the cases of RA was 5.7 +/- 4.7 with a median value of 4.65 (range 19) whereas it was 45.4 +/- 10.0 and 44.0 (range 27.3) respectively in RAEB and RAEB-t (p <.001), the 95% confidence interval being (2.94, 8.5) and (36.6, 54.3), for the two groups respectively. This finding may imply that subtypes of MDS with a higher tendency for converting to acute leukaemia are associated with increased angiogenesis as compared to other subtypes where the risk of progression to acute leukaemia is much lower.

Childhood primary mesenteric seminoma.

We report an 11-year-old child who presented with an abdominal lump and was diagnosed as having an extragonal primary mesenteric seminoma. Patient was treated with 4 cycles of combination chemotherapy cisplatin, etoposide and bleomycin; he is now disease free for 2 years. We discuss and review extragonadal germ cell tumors arising from the mesentery and their management.

Mycetoma sans sinuses.

Mycetoma is a chronic suppurative infection involving the skin, subcutaneous tissue and bone. The hallmark of mycetoma is tumefaction, draining sinuses and the presence of microcolonies called grains. Sinuses develop in all patients with mycetoma within a year of the appearance of the lesion. The following case is reported as no sinuses had developed despite the presence of the lesion for 9 years, posing a diagnostic dilemma.

Recurrent lymphocytic hypophysitis in a woman 27 years after subtotal adrenalectomy for hypercortisolism possibly of autoimmune origin.

Lymphocytic hypophysitis commonly occurs in females in peripartum period but several unusual presentations have been reported. Here we report a rare case of recurrent lymphocytic hypophysitis in a woman who had subtotal adrenalectomy for hypercortisolism 27 years back. Polyglandular autoimmune endocrinopathy with an uncommon combination of Cushing's syndrome and recurrent hypophysitis is a strong possibility in this case. Treatment with steroids has been found to have beneficial effect.

Bone relapse in acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) can occasionally relapse in unusual extramedullary sites like bone. Here we present a 6.5-year old boy with 'T' cell ALL who developed a swelling in left tibia which was infiltrated with lymphoblasts 7 months after completion of chemotherapy. Bone marrow and cerebrospinal fluid were negative for blasts. This is the first reported case of bone relapse in ALL from India. We discuss the previous cases of isolated bone relapse in ALL reported in English literature.

Plaque form of pretibial myxedema in hypothyroidism.

Pretibial myxoedema presenting as a diffuse plaque form is being reported in a hypothyroid patient.

Laparoscopy assisted hemi-colectomy for ileo-caecal tuberculosis.

Laparoscopy assisted hemicolectomy for ileo-caecal tuberculosis is being evaluated the world over. Several procedures are performed laparoscopically, including the laparoscopic hemicolectomy, for benign and malignant diseases. Abdominal tuberculosis is one of the commonest causes of intestinal obstruction in India. We have evaluated the role of laparoscopic resection of ileocaecal tuberculosis and successfully performed the procedure in five patients. The clinical profiles of patients and operative procedure are discussed in this article with a brief review of the literature.

Fine needle aspiration cytology, histology and MIB-1 proliferative index in a case of dyshormonogenetic goitre.

The fine needle aspiration (FNA) cytologic findings along with histology and MIB-1 proliferative index in a case of dyshormonogenetic goitre is presented. A 12-year old female child from non-endemic zone presented with a isotopically cold solitary thyroid nodule with a history of goitre being present since birth. Past history of any neck irradiation or maternal ingestion of any goitrogen during the antenatal period and family history of goitre were negative. FNA cytology revealed an extremely cellular preparation with predominantly microfollicular pattern without colloid. Nuclei were round to oval, slightly enlarged with evenly distributed chromatin and inconspicuous nucleoli. Larger tissue fragments also showed foci of solid cell groups with nuclear crowding, overlapping and loss of polarity in addition to the prevalent microfollicular pattern. Occasional tissue fragments showed solid groups of trapped follicular epithelial cells in the matrix of fibrocollagenous tissue. Histology showed an intensely hyperplastic follicular cells with nodule formation, irregular fibrosis, pseudo capsular or vascular wall invasion mimicking malignancy. Immunohistochemistry for calcitonin was negative but thyroglobulin was positive. MIB-1 (Ki-67) proliferation index varied from 0.05 to 0.26 (mean 0.13) in the hyperplastic nodules versus 0.9 to 2.1 (mean 1.34) in the hyperplastic solid microfoci scattered amidst the grossly normal appearing thyroid tissue. The possible cytologic diagnostic pitfalls in favor of follicular neoplasm is discussed.

Oesophageal leiomyoma presenting as a mediastinal mass.

A 28 year old male presented with complaints of retrosternal pain, discomfort and dysphagia of 4 years duration. Barium swallow and oesophagoscopy were suggestive of extrinsic compression of thoracic oesophagus. CT scan of chest was suggestive of a large mediastinal lymph node mass. Thoracotomy and open biopsy showed a benign mesenchymal tumor on frozen section. A transthoracic oesophagectomy with gastric pull up and cervical oesophago-gastric anastomosis was performed. The postoperative course was uneventful and the patient discharged on the tenth postoperative day.

Benign cystic peritoneal mesothelioma in a man.

Benign cystic mesothelioma of the peritoneum is uncommon and usually occurs in women. We report this condition in a man, who was treated successfully by surgical excision of the tumor.

Hyalinizing trabecular adenoma--a case report with FNAC histologic, MIB-1 proliferative index and immunohistochemical findings.

Hyalinizing trabecular adenoma is a recently described benign thyroid tumor, almost exclusively occurring in females. The morphological features of this entity overlap with both papillary and medullary carcinoma to varying extent. This, in turn, creates a situation of serious diagnostic pitfall particularly for a false positive diagnosis of papillary carcinoma in fine needle aspiration (FNA) cytology. False consideration of medullary carcinoma is also possible by the unwary especially if staining for Congo red and/or immunostaining for calcitonin is not resorted to. At histologic level, the distinctive architectural pattern is however of great help and thus poses a much lesser danger of misdiagnosis. We relate here our experience in a recently encountered case of hyalinizing trabecular adenoma and describe detailed FNA cytologic and histologic findings along with immunohistochemical profile using a panel of eight monoclonal antibodies. The tumor proliferative potential has also been assessed using MIB-1 (Ki-67) immunostaining. The various pros and cons of diagnostic pitfalls are discussed.

Assessment of proliferative potential of meningiomas using PCNA LI and AgNOR counts.

Seventy-six cases of international meningiomas were studied using staining for Proliferating Cell Nuclear Antigen (PCNA) and silver nucleolar organizer regions (AgNORs) in order to find out any correlation of these parameters to the histological typing of the tumours and their biological behaviour. Histologically, 35 of the 76 cases were benign, 12 atypical and 19 malignant. Ten cases were recurrent. A male preponderance with a male: female ratio of 1.6:1 was noted. Five of 76 cases were in children below 15 years of age. Majority of the tumours were convexity meningiomas. Overall PCNA labeling index (LI) values ranged from 0.1% to 11.0%. Benign group had an LI of 0.9 +/- 1.42 whereas atypical, malignant and recurrent group had LIs of 4.06 +/- 2.33, 2.91 +/- 2.66 and 3.36 +/- 3.76 respectively. One way analysis of variance test showed a significant difference in the distribution of LI between benign versus atypical, malignant and recurrent group (P < 0.05). A highly significant difference was also observed between PCNA LI of recurrent benign group versus non-recurrent benign group (p < 0.01, wilcoxon Rank Sum Test). On further classifying the tumours based on LI values, it was observed that 30 of 41 (73%) cases of combined atypical, malignant and recurrent group (i.e. biologically more aggressive group) had LI of > 1%, whereas 26 of 35 cases (74%) belonging to the benign group had LI of < 1%. Overall AgNOR counts ranged from 1.27 to 3.11. No statistically significant difference was found in AgNOR counts amongst the different groups of meningiomas. There was no correlation between PCNA LI and AgNOR counts. It was thus concluded that PCNA LI but not AgNOR counts in the primary tumour could be of potential value for more accurate assessment of biologic behaviour of meningiomas in conjunction with the conventional A histological parameters.

MIB-1 proliferative index in parathyroid adenoma & hyperplasia.

A retrospective study on 22 cases of parathyroid adenoma, 9 cases of primary parathyroid hyperplasia and 14 specimens of normal suppressed glandular tissue was undertaken to determine the usefulness of proliferative index (PI) for discriminating adenoma from hyperplasia, as an adjunct to the existing histological criteria. PI was determined by avidin-biotin-complex immunostaining after high temperature microwave antigen retrieval in paraffin sections, using monoclonal MIB-1 antibody which detects paraffin resistant analogue of cell cycle-associated Ki-67 antigen. PI expressed as percentage positive cell nuclei, was 1.36 +/- 0.62 (range 0.04-2.72) in adenoma, 1.17 +/- 0.83 (0.02-1.98) in hyperplasia and 0.03 +/- 0.02 (0.00-0.06) in normal suppressed glandular tissue. While the difference between normal suppressed glandular tissue and adenoma and hyperplasia was significant (P < 0.001), that between adenoma and hyperplasia was not. We conclude that although PI could distinguish between normal suppressed glandular tissue versus glands with primary hyperparathyroidism, it failed as an additional useful parameter for discriminating between adenoma and hyperplasia, both of which have low but similar proliferative activity.

Basaloid-squamous carcinoma. A distinct histopathological entity.

Basaloid Squamous Carcinoma (BSC) is an uncommon aggressive neoplasm occurring in the upper aerodigestive tract. Lung as a primary site has only recently been reported. A combination of microscopic features is required to make a diagnosis and to differentiate it from other more common malignancies in these sites. Three cases of BSC including one in the lung are reported. There are no prior published reports of this neoplasms in Indian literature. The study highlights the typical microscopic features and the diagnostic difficulties which may be encountered.