Synchronous occurrence of lobular breast carcinoma and granulosa cell tumor of ovary mimicking metastatic lobular breast carcinoma

Breast cancer is one of the main sources of ovarian metastasis. Diffuse sheet of lobular carcinoma cells can strongly mimic granulosa cell tumor (GCT) which itself is a rare ovarian neoplasm constituting <5% of all the ovarian neoplasms. A 55-year-old female presented with a painful lump in the right breast associated with nipple discharge for 4 months, which on radiological and cytological findings was suspicious of an epithelial malignancy. During routine work-up, a solid-cystic lesion in the left ovarian adnexa was identified. The patient underwent right modified radical mastectomy along with left salpingo-oophorectomy. Histopathological and immunohistochemical features confirmed the diagnosis of a synchronous lobular carcinoma breast with GCT ovary. Simultaneous occurrence of Lobular carcinoma breast (LCB) and GCT ovary is extremely rare. Morphologically, these can look similar, raising a suspicion of LCB metastasis to ovary. This is important to differentiate the two for a proper patient management and prognosis

Computed tomography- guided percutaneous core needle biopsy for diagnosis of intathoracic mass lesions: experience at a tertiary care centre of North India

Background: CT guided core needle biopsy is a less invasive method for initial diagnostic workup in the assessment of intrathoracic masses. This study was conducted to evaluate the diagnostic yield of the procedure as well as to demonstrate the spectrum of various disease in our population.Methods: Present study was conducted in a tertiary care hospital for a study period of two years. Patients with intrathoracic mass were included and CT guided biopsies were performed following a protocol. The CT guided biopsies received were examined for histological diagnosis. Immunohistochemistry was carried out where ever routine histopathology was not sufficient for diagnosis. Relevant immunohistochemical panels were applied for lung, mediastinal and pleural tumours according to the histological differential diagnosis. Detailed demographic and clinical profiles along with radiological findings were noted.Results: Total of 138 cases were taken for CT guided FNAC procedure and 123 (89.1%) cases yielded diagnostic biopsy. Lung was the most commonly involved organ followed by mediastinum. Bronchogenic carcinoma was the most common lesion reported in lung and Non-Hodgkin Lymphoma was the most common mediastinal lesion. Lung collapse was most common radiological feature.Conclusions: CT guided percutaneous biopsy is a valuable diagnostic technique providing for early accurate diagnosis and being minimally invasive procedure. Care should be taken while tissue processing and section cutting of intrathoracic biopsies as the biopsies are small and tissue loss should be prevented so that sufficient material is available for immunohistochemistry.

Clinicopathological and immunohistochemical analysis of Sarcomatoid carcinoma of head and neck mucosal region: a retrospective analysis

Background: Sarcomatoid carcinoma is a biphasic tumour comprising both of malignant epithelial and mesenchymal elements derived monoclonally from same stem cells. These are unusual variants of squamous cell carcinoma and constitute less than 1% of the head and neck mucosal tumors. Only few studies have been published and needs more understanding to establish treatment guidelines. The aim of this study was to review the cases of carcinosarcoma arising from mucosal sites of head and neck and study their clinical, histological and Immunohistochemical features.Methods: Retrospective data and slides of histologically proven sarcomatoid carcinoma over a period of thirty -four months between January 2016 - October 2018 were retrieved and evaluated for various clinical and histopathological parameters.Results: Total of 22 cases were included in the study and the mean age of presentation was 58years with male: female ration 2:1. Most of the patients (81.8%) presented with a mass lesion of less than 6 months duration. The most common site was oral cavity (68.1%) followed by larynx (22.7%). Clinical stage was known in eleven cases. One case presented with pulmonary metastasis. Histopathologically, epithelial differentiation was identified in nine cases (41%) on morphology and in thirteen cases could be highlighted by cytokeratin positivity. The Mesenchymal component was arranged in sheets (63.7%) and fascicles (31.8%). Marked anaplasia and brisk mitosis wereseen in 54.5% and 19.3% respectively.  On immunohistochemistry all 22 cases were positive for Vimentin, twenty cases were positive for cytokeratin/EMA and aberrant mesenchymal markers were expressed in 10% of cases.  Follow up was available in eighteen cases out of which fourteen cases died within one year of diagnosis.Conclusions: Diagnosis of sarcomatoid carcinoma is challenging especially on small biopsy because of overlapping features with other spindle cell tumors. Understanding the clinicopathological features facilitates their diagnosis and effective clinical management.

Blastic plasmacytoid dendritic cell neoplasm presenting as leukemia without cutaneous involvement in a 25 years male patient: Unusual presentation of a rare entity.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive neoplasm classifi ed under “acute myeloid leukemia (AML) and related precursor neoplasm” by current WHO classifi cation. Elderly male are commonly affected with cutaneous lesion being the hallmark of disease presentation. The disease progresses rapidly and sooner or later involves bone marrow and peripheral blood. Cases presenting primarily as leukemia without cutaneous involvement is a rarity with about 29 cases reported in literature till date. Characteristic immunophenotype of CD4+/CD56+/− cells expressing antigens associated with plasmacytoid dendritic cells like CD123, TCL1, BDCA2/CD303, cutaneous lymphocyte-associated and interferon dependent molecule MxA, in absence of any other lineage specifi c marker confi rms the diagnosis. The disease has a poor survival and no standardized therapeutic strategy in the current scenario. A case of 25-year-male presenting with leukemic BPDCN without cutaneous involvement is presented here, who was treated with AML like protocol followed by hematopoietic stem cell transplantation, but succumbed to the disease within 8 months of diagnosis. The present case is being fi rst to be reported from India.