Synchronous high-grade bladder carcinoma associated with chronic lymphocytic leukemia: A rare entity in Indian literature

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) is one of the common lymphoproliferative disorders with an increased risk of developing subsequent neoplasms of epithelial and mesenchymal origin. The decreased immunity and B-cell dysfunction in CLL probably accounts for this emergence of secondary malignancy. Breast, brain, skin and prostate tumors have been reported as usual coincident malignancies of CLL, while in occasional cases CLL may occur with malignancies of other solid organs, such as skin, lung, heart, and prostate. Synchronous CLL with urothelial carcinoma (UC) is an infrequent occurrence. We report this case because of its rarity in Indian literature and interesting hematological, immunophenotypic, histopathological, and cytopathological features of metastatic high-grade UC in a 61-year-old male with CLL

Cytomorphological Spectrum of Hepatic Nodular Lesions A Tertiary Care Centre Experience.

Background: FNAC is a very useful procedure for the diagnosis of various hepatic lesions. USG-guided FNAC offers good accuracy without major complications and minimal intervention at less cost, the only major contraindication being severe hemorrhage & vascular lesion. Although imaging techniques have helped greatly with the early and accurate diagnosis of liver abscess, the appearances are often non-specific. There is some overlap between the radiologic features of liver abscesses, HCC and metastases too. Tumors, primary or secondary, may undergo extensive necrosis, with the resultant radiologic image of the cavitatory neoplasm mimicking abscesses; abscesses are accompanied by proliferative reactive changes, making radiologic differentiation from a neoplastic process almost impossible. In these situations, FNAC plays an essential complementary role. Material and Methods: All patients, irrespective of age and sex, who presented to the hospital from January 2011 to June 2013 with nodular liver lesions diagnosed clinically or radiologically, with normal range of prothrombin time (International normalized ratio- INR) were subjected to fine needle aspiration under radiological guidance. Smears made were stained with toluidine blue for rapid onsite evaluation (ROSE) for adequacy of diagnostic material. Hematoxylin and Eosin (H&E), Giemsa stain and Papanicolaou stain were done as per protocol. Results: Of the total aspirates, 22.5% (36 cases) were benign, 63.75%(102) were malignant, 13.75% (22) non-representative as they contained only few scattered hepatocytes and blood, which was inadequate for final opinion. FNAC was of help in diagnosing liver lesions successfully in 86.25% of cases. Conclusion: USG guided FNAC has proved to be a fairly precise & minimally invasive technique in diagnosis of hepatic lesions as the procedure is simple, economical and easily available. The results are obtained quickly without serious complications related to the procedure. In a nutshell, FNAC is a highly accurate diagnostic tool with high sensitivity & specificity.

Paratesticular papillary serous cystadenocarcinoma: A rare entity in Indian population.

Ovarian-type surface epithelial carcinomas of testis and paratestis are very rare. These tumors develop from mesothelial inclusions or abnormalities in the development of coelomic epithelium. The diagnosis of these lesions can be difficult, both clinically and radiologically, as morphological, immunohistochemical and ultrastructural features overlap with serous tumors arising in the female genital tract. The pathologist should be aware of the histopathological features and immunostains which help in reaching defi nite diagnosis. To the best of our knowledge only one such case has been reported in Indian literature. We hereby report a case of young male with this unusual lesion diagnosed on histopathology.

Multifocal hemangioendotheliomas of bone mimicking metastases.

Hemangioendotheliomas are rare vascular tumors that can arise from soft tissue or bone. The former comprises hemangioma, epithelioidhemangioma, hemangiomatosis and massiveosteolysis or Gorham’s disease (which mimics malignantneoplasm due to aggressive osteolytic destruction). The rarer malignant counterparts are epithelioidhemangioendothelioma, hemangioendothelioma and angiosarcoma in increasing order of malignancy. The diagnosis of these lesions is diffi cult both clinically and radiologically. Hereby we report an unusual case which was mistaken for metastasis and was diagnosed with the help of histopathology.