Adenoid cystic carcinoma of breast: clinicopathologic study of seven cases

Adenoid cystic carcinoma [ACC] of the breast is a rare type of tumor. Our objective was to determine the clinicopathologic features of breast ACC. We reviewed slides of breast ACC reported during 12 years. Seven cases were identified. Age ranged from 38 to 59 years [mean = 47 years]. Mean tumor size was 2.3 cm [range 1.2 to 4 cm]. Histologically, dominant cribriform pattern was seen in 4 cases, solid in 2 and tubular in one case. Mitotic figures ranged from 2 to 22/10 HPFs. Grades I and II were seen in 3 cases each while 1 was grade III. Post-surgical tamoxifen given in 3 cases, chemotherapy and radiotherapy in 2 and 1 case, respectively. Follow-up ranged from 12.5 - 138.5 months [mean = 61. 25 months]. One patient developed vertebral metastasis. Consistent with published data, this series indicated that ACC-breast has a good prognosis

Lymphangioma circumscriptum: clinicopathological spectrum of 29 cases

To describe the clinicopathological spectrum of Lymphangioma Circumscriptum [LC]. Observational case series. Department of Pathology and Microbiology, AKUH, Karachi, from 2002 to 2012. All reported cases of LC were retrieved from medical record. Clinical and pathological features were noted. Frequency percentages were determined. There were 29 cases of LC predominantly males [62%]. The mean age was 27.17 +/- 15.5 years. The commonest sites was anal/perianal region [24%] followed by extremities [17%] and tongue, [14%]. Vulval LC was seen in 3 patients. Two cases were described on scrotum. The lesions were most commonly suspected as viral warts, mole or polyp [in anal Region]. Vesicles with erosions and bleeding and localized growth were the usual clinical presentations. Four of the patients presented with swelling since birth. All were treated with surgical excision. Microscopic examination revealed acanthotic squamous epithelium with papillomatosis. The subepithelial region had collections of lymphatic channels composed of ectatic dilated vessels with serum and inflammatory cells in their lumina. The lymphatic channels were seen in deeper layers along with lymphocytic aggregates. Lymphangioma circumscriptum is a malformation of abnormal lymphatic channels with feeding cisterns in subcutaneous tissue. It is a benign lesion usually occurring in anal/perianal region and confused with warts. Surgical excision is preferred mode of treatment

Spectrum of histopathological findings in Postmenopausal Bleeding

Objective: To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding [PMB]

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013

Methodology: A total of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05

Results: One hundred and twenty-one [77.1%] specimens showed benign pathologies while 36 [22.9%] were malignant. Endometrial polyp was seen in 67 [42.7%] cases followed by endometrial carcinomas in 25 [15.9%], endometrial hyperplasia in 21 [13.4%], cervical carcinoma in 12 [7.6%] and cervical polyps in 9 [5.7%] cases. A highly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group [p < 0.001]. Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed [70.2 +/- 6.5 vs. 61.8 +/- 9.1 years respectively, p=0.069]

Conclusion: Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment

Chondroblastoma: a clinico-pathological analysis

To determine the clinico-pathological and histological features of Chondroblastoma [CB]. Case series. The Aga Khan University Hospital, Karachi, from 2000 to 2013. The histological slides of all reported cases of CB were retrieved and reviewed for morphological features. Clinical features were noted from surgical pathology reports. Frequency of features was noted. Sixty one cases of CB were identified. Pain was the most common presenting symptom. The age ranged from 10 to 38 years [mean 20 +/- 1.98 years; M: F 2.5:1] with 61% patients in the second decade of life. Forty six cases occurred in long tubular bones; distal femur being most common site. Metaphysis, clavicle, temporal bone and metacarpal were also involved. Histologically, all CBs were composed of round to polygonal cells and scattered osteoclast-type multinucleated giant cells and majority had hemosiderin pigment. Chicken-wire calcifications and coarse calcifications were seen in 85% and 26% of cases respectively. A spindle cell component was seen in 54% of cases. ABC-like areas were seen in 10 cases. Mitosis ranged from 1 to 6/10 HPFs. Recurrence was seen in 2 cases. Recurrent tumor showed similar morphology when compared with the initial tumor. CB is a benign tumor but has potential for recurrence. Males are more affected, second decade is more common and distal femur is most common site. Metaphysis, clavicle, temporal bone and metacarpal were the rare sites of CB. Histological features predictive of recurrence were not separately identified

Nipple adenoma of breast: a masquerader of malignancy

Nipple adenoma is a benign condition simulating malignancy such as breast carcinoma and/or Paget's disease clinically. In this study 19 cases diagnosed as nipple adenoma over a period of 14 years are described. The diagnosis was confirmed by histology alone. All patients were females with age ranging from 23 to 63 years. Most of the cases presented clinically with in duration and ulceration accompanied by pain and itching. The diagnosis was clinically suspected in only 3 cases. This highlights the importance of histological diagnosis in all suspicious breast lesions. In one case, the clinical and histological diagnosis was incorrect leading to mastectomy. Complete local excision with clear margins is curative

Rhinosporidiosis presenting as an urethral polyp

Rhinosporidiosis is an inflammatory disease caused by Rhinosporidium seeberi, a protoctistan mesomycetozoa, member of a group of novel aquatic parasites, characterized by hyperplastic polypoid lesions of the nasal cavity and rarely other mucous membranes. We report an unusual presentation of rhinosporidiosis as an urethral polyp, which is only the second case of rhinosporidiosis reported from Pakistan

Infiltrating syringomatous adenoma of nipple

Infiltrating syringomatous adenoma of the nipple is a rare, benign lesion with distinct clinical and histological features. Origin from ducts of dermal sweat glands has been postulated. Important differential diagnosis include nipple adenoma, tubular carcinoma and adenosquamous carcinoma. Appropriate local management includes accurate diagnosis and complete excision to avoid local recurrences. This report describes the condition in a 39-year-old parous lady

Work flow analysis: audit of the turn around time in chemical pathology in a tertiary care hospital

A retrospective analysis of the laboratory results was performed to explore the turnaround time [TAT] for the laboratory services. The TAT for specimens arriving at the main laboratory from wards, main laboratory and critical care areas was noted and compared with the standard set for reporting. Median TAT for results of 169 blood samples was on average 195 min [n=170], 172 min [n=169], 121 min [n=167] from main lab, wards and for STAT samples from critical care areas respectively. Median analytical time was 170 min, 105 min, and 72 min from main lab, from wards and for STAT samples respectively. This TAT is within acceptable limits according to the standard sets. However, high transport time from critical care areas [median 49 min] was noted, which can be further improved if the portering and transport arrangements of the specimens are made more effective

Frequency of primary solid malignant neoplasms in both sexes, as seen in our practice

To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopsies. A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital [AKU], Karachi, in 2004. Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin's lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. Out of 20,000 biopsies, there were 4616 [23.08%] malignant neoplasms. Carcinoma of oral cavity is very common in our population in both sexes

Frequency of primary solid malignant neoplasms in different age groups as seen in our practice

To determine in a large series of surgical biopsies, the frequency of various histologic types of primary solid malignant neoplasms in males and females in different age groups. A retrospective study of 20,000 consecutive surgical biopsies reposted in the section of histopathology, AKU in 2004. Malignant neoplasms are commonest in the fifth and sixth decades of life. The commonest malignant neoplasms in the first decade were Hodgkin's lymphoma and Wilm's tumor in males and females respectively. In the second decade, osteosarcoma in males and Ewing's sarcoma/PNET in females. In the third decade, colorectal adenocarcinoma in males and infiltrating Ductal carcinoma of breast in females. In the fourth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In the fifth decade squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In sixth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females and in the seventh decade, prostatic adenocarcinoma in males and infiltrating ductal carcinoma of the breast in females. Above age of 70 years, the commonest malignant were again prostatic adenocarcinoma in males and infiltrating ductal carcinoma of breast in females. Malignant neoplasms are commonest in the fourth, fifth and sixth decades of life

Significance of immunohistochemistry in accurate characterization of malignant tumors

To determine in a large series of surgical biopsies the role and significance of immunohistochemistry in the adequate and accurate characterization of malignant tumors. A retrospective study of 20,000 consecutive surgical biopsies reported in the Section of Histopathology, AKU in 2003. Data was obtained by retrieving the filed surgical biopsy reports in the section. Out of the 20,000 biopsies, 6534 [32.67%] were neoplastic. 4726 neoplasms [72.33%] were malignant, and 1808 [27.67%] were benign. Immunohistochemistry was performed on 29.49% of malignant tumors, and 4.97% of benign tumors. Immunos were performed on only 2.82% of routine squamous cell carcinomas and adenocarcinomas of various organs, and in only 1.9% of infiltrating breast carcinomas, the commonest malignant tumors in females. In contrast, immunos were performed on 97.12% of non-Hodgkin's lymphomas, 97.94% of Hodgkin's lymphomas, 98.09% of malignant spindle cell neoplasms, 87.96% of small round blue cell tumors of childhood, 87.30% of neuroendocrine neoplasms, and 84.37% cases of malignant melanomas. In addition, immunos were performed on all cases of malignant undifferentiated neoplasms and were able to resolve the issue in over 89% of such cases. Immunos were also performed on 54.74% of metastatic tumors. Lymph nodes were the commonest organs on which immunos were performed i.e. 96.50% of lymph node tumors, followed by CNS and renal neoplasms with 33.01% and 25.92% respectively

Frequency and characteristics of breast lymphomas presenting to a tertiary care hospital Pakistan

To assess the relative frequency of [primary and secondary] mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms. All NHLs [nodal and extra nodal] diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients [n=30] diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information. A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total number of NHLs [Nodal and extra Nodal] was 2632. Thirty [n=30] patients accounting for 1.13% were diagnosed to have lymphomatous involvement of the breast. The Female to Male ratio was13.5:1; age range was 12-92 years with a median age of 43 years [Mean age 46.5 years and Standard deviation of age was 16.88 years]. The sites of the lesions were the right breast in 11 cases [37.93%], left breast in 9 cases [31.03%] and both breasts in 2 cases [6.89%], while the location of 8 masses [27.58%] was unknown. Immunohistochemical studies were negative for cytokeratins [MNF and Cam 5.2] in all cases. All cases of DLBCL expressed B cell lineage antigens and were positive for LCA and Pan B [CD20 and 79a]. We concluded that breast lymphomas represent 1.13% of all NHL and 0.5% of all breast malignancies in this study. The most frequent morphologic type was diffuse large B-cell lymphoma. As patients with primary breast lymphoma have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when needed would result in a more favourable outcome

Uterine perivascular epithelioid cell tumour presenting as a cervical mass

Perivascular Epithelioid Cell Tumour [PEComa] also known as myelomelanocytic tumours are uncommon, recently described mesenchymal tumours that include angiomyolipoma, clear cell "sugar" tumour of the lung, lymphangioleiomyoma and tumours composed predominantly of epithelioid cell morphology. A predilection for uterus has been described. However up till now only 14 cases of uterine PEComas have been described. All of these were seen in adult females in the peri and post menopausal age group [from 40-75years], and almost all were located in the region of body of uterus. A single case in the upper cervical region has been reported with uterine PEComatoses. We report an unusual presentation of this rare tumour presenting as a polypoidal cervical mass in a young female. Occurrence of this tumor in a young female as seen in our case warrants inclusion of PEComa in the diferential diagnosis of all epithelioid and clear cell neoplasms of uterus irrespective of age

Colorectal carcinoma, extent and spread in our population. Resection specimens give valuable information

To acquire information about the extent and spread of colorectal carcinomas in our population by examining colon and colorectum resection specimens received. All colon and colorectum resection specimens received in the section of Histopathology, Aga Khan University Hospital, Karachi from January 1, 2003 to July 31, 2003 were included in the study. Eighty five resection specimens were received during the study period, 69.41% patients were males, and 30.59% were females. The mean age for males was 49 years and for females 48 years. Tumor location was in left colon [58.82%], and in right colon [41.18%]. The average size of the lesions in largest dimension was 5.5cms. Majority [83.53%] were colorectal adenocarcinomas, 71.76% cases were grade II, 16.47% were grade I, and 11.76% were grade III. Most cases [85.88%] infiltrated full thickness of the bowel wall extending into the pericolonic fat. Vascular invasion was seen in 16.47% cases. Radial margin was positive in 23.08% of rectal carcinomas and 57.65% cases showed lymph node metastases. The findings in our study demonstrate that the disease is usually very advanced with extension into pericolonic fat and positive lymph nodes. Thus, the early detection and resection [while the disease is still in an early stage] are essential in our population using better surgical techniques, for proper staging of these tumors

Metanephric adenoma: a rare benign renal tumor

Metanephric adenoma is a rare benign renal tumour. We are reporting one histologically proven such case in a 23 year old male from Afghanistan. He presented with severe right flank pain since 3 weeks. Nephrectomy was done and histopathology was consistent with the diagnosis of metanephric adenoma. This novel renal mass has been reported to have benign clinical course despite its symptomatic presentation and large tumour size. There is no distinguishing radiological feature with can differentiate it from malignant tumours. So far, a uniformly benign clinical course has been associated with Metanephric adenoma, but given its relatively recent identification and rarity and the lack of clinical, radiographic, or cytologic means to establish a definite diagnosis, Metanephric adenoma remains primarily a pathologic diagnosis

Validity of frozen section in the diagnosis of of breast lumps: 5 years experience at the Aga Khan University Hospital

To determine the accuracy of frozen section in the diagnosis of breast lump. Frozen section diagnosis given in consecutive breast biopsies performed in 5 years in our laboratory was evaluated against the final pathology report of permanent sections. The Aga Khan University Hospital Lab receives more than 400 cases per year for frozen section. Three hundred and nineteen consecutive frozen sections of breast lumps examined from 1999-2003 were considered for analysis. Age of patients ranged between 22 and 90 years [mean age 49 years]. In 316 cases [99%] there was no difference between the frozen section diagnosis and the final diagnosis. Three cases [0.94%] were incorrect; 2 cases [0.62%] were false positive. One case was false negative [0.31%]. In 7 cases [2.19%], frozen section diagnosis was deferred to permanent sections. Frozen section diagnostic accuracy was 99%. Sensitivity and specificity was 99.3% and 93% respectively. Positive predictive value and negative predictive values of frozen section were 96.6% and 99.3% respectively. High accuracy of the frozen-section diagnosis in the breast lumps was confirmed in our study

Ovarian primary neuroendocrine carcinoma of non - small cell type: Report of an exremely rare Neoplasm

Paraffin block sections of a uterus and ovarian mass from a 31 year old female were sent for second opinion to the Pathology Laboratory of Aga Khan University. Histologic examination and immunohistochemical features gave a diagnosis of primary neuroendocrine carcinoma of non-small cell type admixed with benign mucinous cystadenoma. This is a rare tumour with only eight being reported in literature