Idiopathic granulomatous hypophysitis: A report of an uncommon disorder.

Hypophysitis of the pituitary gland is a rare inflammatory disorder and broadly classified as primary and secondary hypophysitis. Primary hypophysitis is mainly of lymphocytic, granulomatous, and xanthomatous types. Among the various primary hypophysitis, granulomatous hypophysitis is rare type with an incidence of 1 in 10 million. The various forms of hypophysitis are misdiagnosed as pituitary adenoma in 40% cases. Idiopathic granulomatous hypophysitis is even rarer inflammatory disorder accounting for <1% of cases involving panhypopituitarism with headache and visual disturbances. We report idiopathic granulomatous hypophysitis in a 28-year-old female presenting with blurring of vision and headache.

Clinico-Histopathological Spectrum of Infectious Granulomatous Dermatoses in Western India- A Representative Study from Mumbai.

INTRODUCTION: Infectious Granulomatous Dermatoses (IGDS) have various aetiological factors with a considerable overlap in the histopathological and clinical features, thus posing a diagnostic dilemma for dermatologists and pathologists. AIM: We aimed at determining the histopathological profile of IGDS correlating it with clinical features with an attempt to find the aetiology. MATERIALS AND METHODS: In a cross-sectional study conducted in a tertiary referral center of Mumbai over two years, out of 1872 skin biopsies received, 239 histopathologically diagnosed cases of IGDS were studied for histopathological features of granuloma. A clinico-histopathological correlation was attempted. Chi-square test was used for comparison of proportions of different groups. RESULTS: Leprosy (211 cases) and tuberculosis (28 cases) were the commonest histopathologically diagnosed IGDS. Leprosy spectrum included BT (30.33% cases), followed by TT (21.32%), BL and LL and 21.79% cases of lepra reactions. Skin TB biopsies on histopathology showed lupus vulgaris (53.85% cases), scrofuloderma (15.38%), TBVC and papulonecrotic tuberculid (11.54% each). In leprosy maximum clinico-pathological agreement was seen at tuberculoid pole (TT 72.7% and BT 56.6%). Among tuberculosis cases, scrofuloderma (100%) and lupus vulgaris (53.8%) showed maximum agreement. CONCLUSION: Leprosy and skin TB are the commonest IGDS in Mumbai region though difficult to diagnose and subcategorize with certainty during initial stages. Histopathology plays the important role to elucidate the dilemma. This being a single center study, more such studies with a larger sample size are recommended to get more elaborate data and regional prevalence of these IGDS for a better overall approach to prevention, treatment and control.

An abnormally large prostatic utricle cyst associated with unilateral renal agenesis.

Prostatic utricle cyst is an uncommon congenital disorder associated with urogenital anomalies. We present a case of an abnormally large prostatic utricle cyst filling the whole of the abdominal cavity with unilateral renal agenesis in an 8-year-old male child.

Childhood actinic keratosis in an albino transforming into squamous cell carcinoma.

Actinic keratosis is a scaly, cutaneous lesion that is often seen in elderly patients. It is almost never seen in children and young adults. It develops on areas such as the face, ears and dorsa of the hands with chronic sun exposure. Actinic keratosis is a premalignant lesion, since histological changes in the epidermis may progress to squamous cell carcinoma if left untreated. There are roughly 70,000 people with albinism in India. These patients are prone to develop actinic keratosis which may undergo spontaneous remission or develop into invasive squamous cell carcinoma, basal cell carcinoma and malignant melanoma.We present an unusual case of a 35 year old albino who developed actinic keratosis at the age 15 years which progressed to squamous cell carcinoma.

Spectrum of non-infectious erythematous, papular and squamous lesions of the skin.

BACKGROUND: Dermatopathologists base their diagnostic approach on the tissue reaction pattern. This study mainly includes the interpretation of two major tissue reaction patterns, the psoriasiform and the lichenoid reactions, with clinicopathological correlation. AIMS: To analyze the spectrum of non-infectious erythematous papular and squamous lesions of the skin at our institute, study the age, sex and anatomic distribution pattern and classify the lesions into major categories; determine the incidence of each subcategory. STUDY PERIOD: two years; prospective, sample size: 161 cases, proforma filled. RESULTS: The lesions comprised 15.80% of the total load of surgical pathology and 30.99% of total number of skin biopsies. The highest percentage was in the 30-40 year age group (28.6%) with a male preponderance of 60.25%. The extremities were most frequently involved (67.79%). Lichenoid lesions were the commonest (46.57%) with lichen planus 26.7% and psoriasis vulgaris-19.88% being the most frequent. There were 5.6% seropositive cases. Correlation with the histopathological diagnosis was positive in 97.52% cases and negative in 2.48% cases. CONCLUSION: The contribution of histopathology to the final diagnosis was significant. It confirmed the diagnosis in 92.55% and gave the diagnosis in 4.97% cases.

Primary non-Hodgkin's lymphoma of the salivary gland: a spectrum of lymphoepithelial sialadenitis, low-grade B-cell lymphoma of mucosa-associated lymphoid tissue with transformation to high-grade lymphoma.

Lymphoid infiltrates of the salivary gland can be either reactive or neoplastic. The reactive lesion, lymphoepithelial sialadenitis (LESA) may be associated with Sjogren's syndrome (SS) or may occur as an isolated salivary gland enlargement. Patients with LESA/SS have a particularly high risk of subsequently developing lymphoma, which is a low-grade mucosa-associated lymphoid tissue (MALT) type lymphoma of the salivary gland. We document a rare case of primary non-Hodgkin's lymphoma of the parotid gland arising in the background of LESA and with a rare example of transformation from low grade to high-grade B cell lymphoma of MALT type.

Self inflicted, bilateral oleogranuloma of the breast: report of a bizarre case.

A 30-year-old male was admitted with bilateral painful breast enlargement of 6 months duration. There was a past history of surgery for similar bilateral swellings, which was then diagnosed as fibrocystic disease. On examination both breasts were firm to hard, tender & adherent to deeper structures. A single axillary lymph node was palpable on each side. The clinical diagnosis was sarcoma of the breast. After initial denial, the patient confessed to having injected gear oil into both the breasts,for the purpose of augmentation. He was a homosexual.

Pathology of placenta in HIV infection.

The spectrum of HIV pathological lesions encountered in the placenta has not been well documented in the literature. To address this issue, we examined 51 placentae of HIV positive mothers, prospectively over a one year period and compared the pathology of the cases treated with zidovudine (AZT) or nevirapine (NVP) with untreated cases. We also correlated the placental pathology with the HIV status of the neonates. The maternal to child transmission rate was 4.44%. A lower fetal / placental weight ratio was seen in normal birth weight neonates compared to low birth weight neonates. No significant gross lesions were encountered and the placental disc did not show any significant decrease in dimensions. The commonest inflammatory lesion seen was chorio-amnionitis 31.37% and the commonest non-inflammatory lesion was cytotrophoblastic hyperplasia 76.47%. There was no significant decrease in the incidence of the lesions following anti-retroviral therapy in our study, and we did not find any correlation between the incidence of placental lesions and the HIV status of the newborn.

Macrodystrophia lipomatosa: a case report.

Macrodystrophia lipomatosa is a rare congenital form of localized gigantism, characterized by an increase in all mesenchymal elements, particularly fibroadipose tissue. The areas of predilection are segments supplied by the median or plantar nerves. We report such a rare case in a thirty four year old male patient, who presented with a swelling of the right upper limb and a marked increase in the size of the right thumb, index finger and radial half of the right hand, present since birth, with progressive increase to the present size. Amputation of the right thumb and debulking of the palm was done. The specimen measured 26 x 18 x 12 cms. and the thumb alone measured 13 x 7 x 7 cm. histology revealed hypertrophy of adipose tissue in the subcutaneous compartment and infiltration into the nerve sheaths and muscles.

Granulocytic sarcoma of breast: an aleukemic presentation.

Granulocytic sarcoma is a rare extramedullary tumor composed of immature myeloid cells. It is usually associated with leukemia or other myeloproliferative disorders but can also occur without overt hematologic diseases. The breast is an uncommon site of presentation and requires a high index of suspicion for diagnosis. We report such a case in a 45-year-old female, who presented with nontender left breast lump of 6 months' duration. A peripheral smear and bone marrow examination at that time was normal. A lumpectomy was done. An H and E diagnosis of lobular carcinoma vs. non-Hodgkin's lymphoma was entertained. Immunostains, however, revealed myeloperoxidase, naphthol AS-D chloroacetate esterase and CD43 positivity, indicating a diagnosis of granulocytic sarcoma. It appears that early initiation of systemic AML-type chemotherapy is beneficial and may delay or avert the development of AML in bone marrow and blood. Eight months later, the patient presented with an orbital mass; bone marrow and peripheral smear involvement by AML.

Peutz-Jegher's syndrome with ovarian serous cystadenoma: an unusual association.

A 29 year female presented with epigastric pain with bilious vomiting since 1 1/2 years. This patient was diagnosed as a case of Peutz-Jegher's syndrome based on evidence of the characteristic mucocutaneous pigmentation which was present since birth and intestinal hamartomatous polyposis. There was an associated unilateral ovarian cystadenoma which is a rare association and which highlights the importance of a gynaecologic examination in female patients with Peutz-Jegher's syndrome.

Primary aneurysmal cyst: bone type in the breast.

A 60-year-old women presented with one month's history of a large breast lump. On examination she had irregular hard mass occupying the central and outer quadrants of the right breast with no palpable lymph nodes. Fine needle aspiration cytology (FNAC) diagnosis was a benign stromal lesion. In view of the large size, a simple mastectomy was performed. We are reporting this case of primary extrasseous aneurysmal cyst of the bone in the breast as the first case described in the literature.