Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor?

Background: Opinion remains divided as to whether excision of needle biopsy tract is beneficial and affect the prognosis. The aim of the study was to compare the outcomes in patients of primary malignant bone tumor who had undergone surgery with or without biopsy tract excision. Methods: From January 2017 to June 2020, 240 patients with primary malignant bone tumors who underwent percutaneous needle biopsy followed by surgery were included. We categorized patients into Biopsy tract excision (Group1:185 patients) and Non Biopsy tract excision (Group 2:55 patients). Median follow-up of patients was 58.6 months (range; 12-61.8months). Results: Demographics, histopathological type, tumor location, type of surgery were similar in biopsy tract excision and non excision group. We found biopsy tract seeding in two cases out of 185 (1.1 %). Local recurrence in biopsy tract excision and non excision group was observed in 3.2 % and 1.8 % respectively with p value 0.58. The mean local recurrence free survival rate in group 1 and 2 was 60 and 44 months respectively. Limb salvage was performed in 71.6 % and in amputation in 28.3 % cases. The local recurrence in limb-salvage and amputation group was observed in 3.4 % (6/172) and 1.4 % (1/68) respectively. Conclusion: There was no significant difference in the rate of local recurrence between patients who were treated by biopsy tract excision or non tract excision. Percutenous needle bone biopsy tract leads to minimal risk of tumor seeding during surgical resection of primary bone tumors.We recommend the further multi centre studies with more number of patients to reach a consensus on resection of needle biopsy tract during surgical management of primary bone tumors.

Comparison of pathological response of standard chemoradiotherapy versus short course radiotherapy in rectal carcinoma: A pilot study.

Introduction: Neoadjuvant chemoradiation (CRT) is standard of care for locally advanced rectal cancer. However short course radiotherapy (SCRT) was developed for the benefit of a shorter treatment duration and early surgical intervention which also helped in reducing the case burden to the hospital. SCRT is routinely practised in European countries, Indian experience with the SCRT is limited and hence a pilot study was conducted to compare the morphological difference and pathological response between SCRT and CRT. Objectives: A) Evaluate the morphological changes and pathological response between SCRT and CRT. B) Compare the pathologic response with outcome between SCRT and CRT. Materials and Methods: All rectal cancer patients in clinical stage II and III diagnosed during 2016 to 2020, who underwent SCRT or CRT were selected. Altered histopathologic findings due to therapy such as tumor cell morphology, necrosis and stromal response along with pathological response between the study groups were compared along with the outcome. Results: Ten (12.6%) patients were subjected to SCRT and 69 (87.4%) patients underwent CRT. Morphological changes such as necrosis was noted in nine (90%) and eight (11.5%) cases in SCRT and CRT group respectively. Pathologic complete response (pCR) was noted in 12 (17.5%) cases of CRT only. Near complete response was seen in one (10%) and 14 (20.5%) cases of SCRT and CRT respectively. Despite lower rates of pCR in SCRT, no difference in survival or outcome was noted between the two study groups. Conclusion: pCR as expected is less in patients who received SCRT, despite this the outcome during follow up was similar in both the groups. Indian data is very limited and large multi-centre studies should be carried as SCRT offers an advantage of early definitive surgical intervention in addition to shorter duration of hospitalisation when compared with CRT.

Ewing Sarcoma with Ganglion Cells Post-Chemotherapy: A Case Report with Review of Literature.

Karthik DhandapaniEwing sarcoma arises in both bones (most common) and soft tissues and it commonly affects young adults. The tumor is composed of small round cells showing positivity for CD99 and FLI1 on immunohistochemistry (IHC). We describe ganglion cell differentiation post-chemotherapy in Ewing sarcoma which is a rare phenomenon. A 13-year-old girl presented with a chest wall mass. On biopsy correlating with IHC, the diagnosis was rendered as Ewing sarcoma. She underwent neoadjuvant chemotherapy followed by resection of the tumor. On microscopic evaluation, the tumor showed prominent ganglionic differentiation with expression of neuronal markers. Although maturation post-chemotherapy is an established finding with better prognosis in other primitive pediatric tumors, such neural differentiation is rare with only a few case reports in Ewing sarcoma both post- and pre-chemotherapy. Clinical significance and prognosis of such differentiation which appear to be better are not yet established and needs to be elucidated.

Clinico-Pathological Spectrum of Alveolar Soft Part Sarcoma: Case Series from a Tertiary Care Cancer Referral Centre in India with a Focus on Unusual Clinical and Histological Features.

OBJECTIVE: Alveolar soft part sarcoma (ASPS) is characterized by distinctive histomorphology of variably discohesive epithelioid cells arranged in nests and translocation of t(x;17) (p11.2;q25) resulting in ASPSCR1-TFE3 fusion. The aim of the present study is to review the clinical, histopathological, and immunohistochemical profile of ASPS with a focus on unusual histological features. MATERIAL AND METHOD: The present study is retrospective and descriptive. All cases with a diagnosis of ASPS were retrieved with clinical and radiology details. RESULTS: 22 patients of ASPS were identified. The most common site was the lower extremity and the size range was 3-22 cm. 54.5% of the patients had metastasis, with the lung as the most common site. Metastasis preceded detection of primary tumour in two cases. All cases showed similar histopathology of monomorphic epithelioid cells arranged in nests encircled by sinusoidal vasculature. Architecturally, the organoid pattern (81.8%) was followed by the alveolar pattern. 68.2% of the cases showed apple bite nuclei as the predominant nuclear feature. Rare nuclear features included binucleation (n=13), multinucleation (n=8), pleomorphism (n=4), nuclear grooves in three cases and intranuclear inclusion in one case, mitosis (n=5), and focal necrosis (n=6). All cases were positive for TFE3 and negative for AE1/AE3, EMA, HMB45, PAX8, MyoD1, SMA, synaptophysin, and chromogranin. Only two cases showed focal S100 positivity while one showed focal desmin positivity. CONCLUSION: Diffuse strong nuclear TFE3 positivity is sensitive for ASPS in an appropriate clinicoradiological context. Due to the high propensity for early metastasis, complete metastatic work-up and long term follow up is recommended.

Extra-adrenal peripheral neuroblastic tumors: A clinicopathological study of 18 cases.

Background: Peripheral neuroblastic tumors arise from the sympathoadrenal lineage of the neural crest. They have been classified according to the International Neuroblastoma Pathology Committee (INPC) into Four categories according to International Neuroblastoma Pathology Committee (INPC): a) Neuroblastoma (NB) b) Ganglioneuroblastoma (GNB), nodular c) Ganglioneuroblastoma, intermixed, and d) Ganglioneuroma (GN). Because of the rarity of extra-adrenal peripheral neuroblastic tumors, limited information is available regarding the chemotherapy of NB and GNB. A few case reports or case series with a small number of patients have been documented in the literature. Aim: To describe the clinicopathological characteristics of extra-adrenal peripheral neuroblastic tumors. Materials and. Methods: Clinical, histopathological, and immunohistochemistry (IHC) findings of 18 cases were retrieved. Immunohistochemistry at the time of diagnosis was performed using Ventana Benchmark XT. The mean value was calculated using the Microsoft Office Excel 2019 software. Results: The posterior mediastinum was the most commonly affected extra-adrenal site in our study. Neuroblastoma consisted of eight cases (six in children, two in adults), of which four cases were poorly differentiated and the other four cases were differentiating. Two cases had favorable histology. The bone marrow and cervical lymph node metastasis were documented. Of the four GNB cases, one patient developed bone metastasis. All patients of NB and GNB received combination chemotherapy. One out of six GN patients presented with a large retroperitoneal mass encasing the aorta and renal vessels, mimicking a sarcoma. Conclusion: Extra-adrenal peripheral neuroblastic tumors do not pose any diagnostic issue in adequate tissue sampling. In limited material, immunohistochemistry is needed. The chemotherapy regimen has not been standardized due to rarity. Further molecular testing and targeted therapy may be of help in the future.

Ossifying fibromyxoid tumor: A rare case report with review of literature and its differential diagnosis.

ABSTRACT: Ossifying fibromyxoid tumor (OFMT) is a rare mesenchymal tumor of uncertain histogenesis with intermediate malignant potential presenting commonly in the fifth to sixth decade in the proximal limb and limb girdle. A 65-year-old male patient presented with a slow-growing gluteal mass. Wide local excision performed showed a well-defined tumor in the subcutaneous plane with a partially hard outer shell. Microscopy showed a moderately cellular tumor having cords and nests of round to ovoid cells with moderate cytoplasm and bland nuclei embedded in a myxo-hyaline matrix. An incomplete peripheral rim of ossification was seen. Pleomorphism/high cellularity was not seen. Mitosis was <2/50 high-power field. On immunohistochemistry, both S100 and desmin were positive. A diagnosis of typical OFMT was rendered. Even though rare with many morphological mimics, OFMT should be diagnosed with precision as most of these tumors are low-grade tumors that require only wide local excision and close follow-up without any adjuvant therapy.

Tumor budding as a prognostic indicator in colorectal carcinoma: a retrospective study of primary colorectal carcinoma cases in a tertiary care center.

Colorectal carcinoma (CRC) is the third most common cancer worldwide. Along with many established prognostic factors, tumor budding is emerging as a valuable marker of prognosis. Tumor budding is not yet universally reported but it has recently been suggested in guidelines by ITBCC (International Tumor Budding Consensus Conference). Our aim is to study prognostic implications of tumor budding in CRC. Hundred cases of primary CRC specimens were retrospectively studied from January, 2016, to February, 2017. Tumor bud count and other histopathological parameters were evaluated from hematoxyline and eosin (H & E) stained slides. Survival analysis was done using Cox proportional hazards model. Association of tumor budding and cancer-specific survival was found to be statistically significant (P = 0.018 for average tumor budding and P = 0.035 for highest tumor budding) Tumor budding was found to be significantly associated with other clinicopathological parameters such as T stage, N stage, TNM stage, and lymphovascular invasion with p value < 0.05. Tumor budding is a valuable prognostic indictor for primary CRC and also significantly associated with other prognostic parameters. It should be reported routinely as a guide to prognosis and further management of patients.

Thigh mass in a patient with malignant pleural mesothelioma: Metastasis at an unusual site.

Soft tissue tumors are a highly heterogeneous group of lesions with varied clinical presentation. The majority is primary tumors and metastatic tumors are very rare. Malignant pleural mesothelioma presenting as a soft tissue mass at a distant site is even rarer and can cause diagnostic challenges both clinically and pathologically. We report a case of malignant pleural mesothelioma presenting as a soft tissue mass in the left thigh. A 59-year-old man, non-smoker, working in a cement factory since 30 years presented with complains of difficulty in walking since 1½ months. Review of his previous medical records revealed malignant pleural mesothelioma, which was diagnosed 9 months before. He had denied chemotherapy and was on Ayurvedic medication. The lesion involved the adjacent intercostal muscles. Few enlarged lymph nodes were noted in mediastinal and cervical regions. Biopsy of left supraclavicular and right cervical lymph nodes showed metastases. Metastasis from malignant pleural mesothelioma to the thigh was confirmed by immunohistochemistry. The tumor was positive for CK5/6, CK7, Calretinin and vimentin and immunonegative for CEA, Napsin A and TTF 1.

Metastasis of soft tissue sarcomas in lymph node: A cytomorphological study.

BACKGROUND: Soft-tissue sarcoma (STS) rarely metastasizes to lymph node compared to carcinoma. Fine-needle aspiration cytology (FNAC) carries a pivotal role in diagnosis of metastatic tumor to lymph node. This study highlights the role of FNAC in diagnosis of STS metastasis to lymph node. METHOD: A retrospective study over a period by 4 years carried out. FNAC of enlarged lymph node was performed in patients with STS. Cytology smears were examined in conjunction with clinical details. Histopathology and Immunohistochemistry (IHC) were correlated in synchronous cases. RESULTS: Out of 326 patients, 21 with STS had enlarged lymph nodes, of which 19 cases showed involvement (5.8%). Sixteen cases were metachronous and 3 cases showed synchronous involvement. Fifteen cases had regional lymph nodes while 4 cases had distal lymph node involvement. Head and neck and lower extremities were the most common primary sites of STS. Rhabdomyosarcoma was the most common sarcoma metastasing to the lymph nodes followed by synovial sarcoma, malignant peripheral nerve sheath tumor, and clear cell sarcoma. Other rare tumors included leiomyosarcoma, epitheloid sarcoma, liposarcoma, malignant fibrous histiocytoma, and Ewing's sarcoma/peripheral neuroectodermal tumor. We had a case of dermatofibrosarcoma protuberance (DFSP) of scalp with cervical lymph node metastasis. Very unusual about this case was its rare primary site and the rarer lymph node metastasis. CONCLUSION: FNAC plays an important role in the diagnosis of lymph node metastasis in cases of STS.

Primary hepatic lymphoma: A case report.

Primary non-Hodgkin lymphoma of the liver is a very rare malignancy. In this case report, we describe a case of primary hepatic lymphoma (PHL) in a 60-year-old man who presented with lump and pain in the abdomen of 2 months' duration. The patient had altered liver function, normal serum alfa fetoprotein level (AFP), normal hemogram and bone marrow. A computed tomography scan of the abdomen and pelvis showed an ill-defined hypodense mass with specks of calcification involving the liver, suggestive of primary malignant mass of liver. Diagnosis of PHL was established on the cytology smear and confirmed by immunohistochemistry on tissue biopsy. This case demonstrates that PHL should be considered in the differential diagnosis of space-occupying liver lesions in the presence of a normal level of AFP. Fine needle aspiration cytology is a faster and safer diagnostic modality even in such a rare case. The case has many unique features like negative serology for viruses, no type B symptom and normal lactate dehydrogenase level.

Small cell variant of renal oncocytoma with liver metastases: a case report.

Renal oncocytoma is a renal neoplasm considered to be benign. A small cell variant comprising predominantly of oncoblasts is rare. Metastases from a renal oncocytoma are extremely rare. A case of small cell variant of renal oncocytoma with liver metastases is described.