Clinicopathological analysis of extracranial head and neck schwannoma: A case series

Background: Extracranial head and neck schwannomas are rare tumors which are often clinically misdiagnosed. Preoperative diagnosis of these tumors is challenging but imperative for surgeons so as to avoid nerve damage during excision. Materials and Methods: Sixteen patients diagnosed with extracranial head and neck schwannomas over a period of 2 years were retrospectively analyzed. Clinical details including preoperative fine-needle aspiration cytology (FNAC) and/or computed tomography (CT)/magnetic resonance imaging (MRI) findings were retrieved. FNAC smears and formalin-fixed paraffin-embedded sections were evaluated. Results: Among these 16 tumors, 6 (37.5%) were located in the lateral aspect of neck, 4 (25%) in scalp, 2 (12.5%) in orbit, and one each (6.25%) in palate, tongue, submandibular gland and parotid gland. The mean patient age was 31.3 years. FNAC was performed in 14 cases, of which 8 cases (58.3%) showed features of benign nerve sheath tumor (BNST), two cases (14.2%) were inconclusive with possibility of mesenchymal lesion, two cases (14.2%) were inadequate, one case (8.3%) showed features suggestive of schwannoma, and a diagnosis of nerve sheath tumor inconclusive for malignancy was rendered in a single case. The sensitivity of FNAC in diagnosis of BNST was 71.4%. CT or MRI was performed in five cases, of which an accurate diagnosis was rendered only in one case of orbital schwannoma. Conclusion: Imaging has a limited role in the preoperative diagnosis of head and neck schwannomas owing to nonspecific radiological features. Cellular aspirate smears are helpful in accurate diagnosis even at unusual locations

Pleomorphic rhabdomyosarcoma of the left atrium mimicking myxoma.

Primary rhabdomyosarcoma (RMS) of the heart is a rare malignant tumor which has poor prognosis and survival despite surgery and adjuvant chemotherapy. The preoperative diagnosis is often difficult in view of nonspecific clinicoradiological findings. This report describes a case of a 60‑year‑old woman who was clinically diagnosed as left atrial myxoma. A diagnosis of pleomorphic RMS was made on histopathology after excision. Our case discusses the clinicopathological features and treatment options of cardiac RMS emphasizing the fact that histopathology and immunohistochemistry are essential to confirm the diagnosis of such an aggressive malignant tumor.

Gingival Granular Cell Lesion-Congenital Epulis.

Gingival granular cell tumour or congenital epulis is a rare benign soft tissue tumour that occurs mostly over lateral alveolar ridge of maxilla. The lesion behaves in a benign manner with spontaneous regression and without any recurrence or metastasis. We hereby report a case of congenital epulis in a 5 weeks old, baby girl who presented with single sessile mass over right side of maxillary alveolar ridge since birth; and want to emphasize that although rare this entity should always be considered in differential diagnosis of neonatal lesions of the oral cavity.

Pindborg Tumor in an Adolescent- An Atypical Presentation.

Calcifying epithelial odontogenic tumor (Pindborg tumor), is a rare benign odontogenic neoplasm representing about 0.4-3% of all odontogenic tumors. This tumor more frequently affects adults in an age range of 20- 60 years, with a peak incidence in the 5th decade of life. Calcifying epithelial odontogenic tumour has a much lower recurrence rate than ameloblastoma and malignant transformation with metastasis is rare.

Primary neuroendocrine carcinoma of the breast.

Primary neuroendocrine carcinoma of the breast is rare-only about 30 cases have been reported in literature. Immunohistochemical examination showing expression of chromogranin and/or synaptophysin confirms evidence of neuroendocrine differentiation. Usually foci of neuroendocrine differentiation can be seen in breast carcinoma and are reported to be present in about 2-5% of breast cancer cases. Here, we report a case of breast carcinoma in which most of the areas studied on the tissue section showed neuroendocrine differentiation.

Spindle cell lipoma breast.

Spindle cell lipoma, which usually arises in the soft tissues, is rare in breast and is difficult to differentiate from primary mammary spindle cell tumor. Here, we present the case of a 48-year-old woman with a 3-cm, solitary, well-circumscribed and nontethered mass lying deep within the tissue of left breast, incidentally detected on routine mammography. The spindle cells proved to be immunoreactive to CD 34, but nonreactive to desmin and smooth muscle actin.

Fine Needle Aspiration Cytology in the Management of Tumors and Tumor like Lesions of Bone

FNAC should be considered as the part of routine preliminary investigation of orthopaedic patients presenting with musculoskeletal tumorous lesions. A total of 110 cases were screened cytologically in the background of clinical, radiological findings and biochemical tests. Primary malignant tumor formed the major entity accounting for 56% of the cases, while benign tumors comprised 8% only. Overall success rate of needle aspiration cytology in diagnosing tumors and tumor like lesions was 92%. Giant cell tumors of bone was the most common malignant lesion observed in 15 cases (30%), followed by Ewing's Sarcoma in 5 cases (10%). Cytologic diagnosis was completely compatible with the final histopathologic diagnosis in 82.3% of cases.

Malignant glomus tumour--a case report.

Glomus tumours are usually benign neoplasms of glomus bodies. Here we report a rare case of malignant glomus tumour of soft tissue. The tumour was 8 cm in size, infiltrating deep tissue, with nuclear atypia, high mitotic activity (6/HPF), atypical mitosis and showed recurrence, thus fulfilling all the criteria of malignancy.

Bilateral lower zone shadows on chest radiograph - A clinicopathological profile.

Background: The initial suspected diagnosis in bilateral lower zone lung involvement made clinically can be compared and correlated with the final diagnosis obtained after percutaneous FNA cytology, BAL fluid examination and transbronchial biopsy. Aim: To study diseases presenting with bilateral lower zone shadow on chest radiograph and compare the initial clinical diagnosis to the final diagnosis. Methods: Fifty six patients were studied by routine hematological, sputum and pleural fluid examination along with PCNA and TBNA cytology, bronchial aspirate/ BAL fluid examination and transbronchial biopsy after a detailed clinical history and thorough physical examination. Results: Initially suspected diagnosis included tuberculosis in 32.1% cases, pneumonia in 30.4%, malignancy in 10.7%, pulmonary oedema in 5.4%, bronchiectasis in 8.9%, ILD in 7.1%, TPE in 3.6% and bilateral hydatid disease of lung in 1.7% of cases. The final diagnosis revealed tuberculosis in 25.0% cases, pneumonia in 23.2%, malignancy in 16.1%, bronchiectasis in 8.9%, pulmonary oedema and ILD in 7.1% each, sarcoidosis and TPE in 3.6% each, while pulmonary candidiasis, pulmonary alveolar proteinosis and bilateral hydatid disease of the lung in 1.7% case each respectively. Conclusion: Majority of cases can be diagnosed by a detailed clinical profile along with a chest radiograph. However, FNAC and fibreoptic bronchoscopy are of high value for pathological and microbiological confirmation of the diagnosis and provides a significant yield.