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.

Liquid-based cytology versus conventional cytology in fine-needle aspirates of salivary gland neoplasms.

BACKGROUND: Liquid-based cytology (LBC) is a method of retrieving and processing of cytological material for the assessment of both gynecological and nongynecological cases introduced in 1996. Mostly conventional smears (CS) are prepared in Indian scenario; however, due to increasing popularity of LBC in nongynecology specimens, LBC is also used in few centers for diagnosing salivary gland neoplasm. AIM: The aim of this study is to compare CS and LBC in fine-needle aspiration cytology (FNAC) of the salivary gland neoplasms in terms of cytomorphological details, adequacy, ease of interpretation, pitfalls, and diagnostic efficiency. MATERIALS AND METHODS: We conducted a prospective, observational, comparative study which included 64 salivary gland neoplasms. Both CS and LBC (SurePath) were prepared as per standard protocols and examined. RESULTS AND CONCLUSION: In our study, specificity and positive predictive value of both the techniques (conventional and LBC) were found to be 100%. Sensitivity of both the techniques was found to be similar (66.7%). Negative predictive value and diagnostic accuracy of conventional technique were found to be almost similar to that of LBC technique (97.6% vs. 97.2% and 97.7% vs. 97.4%). In terms of adequacy and cellularity, CSs were better than LBC. Ease of interpretation was better with CSs due to abundant chondromyxoid stroma, an important clue in the diagnosis of pleomorphic adenoma. Nuclear details and background were better in LBC as compared to CS. Hence, we conclude that in salivary gland FNAC, both CS and LBC have similar diagnostic efficiency. however, interpretation of conventional smears is easier than Liquid Based Cytology especially in cases of pleomorphic adenoma. However, some advantages of LBC in respect to conventional cytology, with better-preserved morphology obtained from LBC becomes furthermore obligatory.

An Immunohistochemical Study of Anaplastic Lymphoma Kinase and Epidermal Growth Factor Receptor Mutation in Non-Small Cell Lung Carcinoma.

INTRODUCTION: Lung cancer is one of the leading causes of cancer related death. Targeted treatment for specific markers may help in reducing the cancer related morbidity and mortality. AIM: To study expression of Anaplastic Lymphoma Kinase (ALK)and Epidermal Growth Factor Receptor (EGFR) mutations in patients of Non-Small Cell Lung Cancer NSCLC, that are the targets for specific ALK inhibitors and EGFR tyrosine kinase inhibitors. MATERIALS AND METHODS: Total 69 cases of histologically diagnosed NSCLC were examined retrospectively for immunohistochemical expression of EGFR and ALK, along with positive control of normal placental tissue and anaplastic large cell lymphoma respectively. RESULTS: Of the NSCLC, Squamous Cell Carcinoma (SCC) accounted for 71.0% and adenocarcinoma was 26.1%. ALK expression was seen in single case of 60-year-old female, non-smoker with adenocarcinoma histology. EGFR expression was seen in both SCC (59.18%) and adenocarcinoma in (77.78%) accounting for 63.77% of all cases. Both ALK and EGFR mutation were mutually exclusive. CONCLUSION: EGFR expression was seen in 63.77% of cases, highlighting the importance of its use in routine analysis, for targeted therapy and better treatment results. Although, ALK expression was seen in 1.45% of all cases, it is an important biomarker in targeted cancer therapy. Also, the mutually exclusive expression of these two markers need further studies to develop a diagnostic algorithm for NSCLC patients.

Symptomatic sclerosing haemangioma: a rare case of solitary pulmonary nodule in a young girl.

Sclerosing haemangioma (SH) is a rare benign lung tumour with distinctive variety of histological patterns. SH typically presents as asymptomatic peripheral, solitary well-circumscribed lesion in women with median age at diagnosis in the fifth decade. Preoperative diagnosis of this tumour is difficult, and sometimes even intraoperative frozen sections cannot differentiate it from malignant tumours. Here, we present our experiences in investigating its characteristics. We report a case of a 19-year-old girl who presented with chest pain, cough and sputum and off and on haemoptysis for 6 months. Anti-tubercular treatment was given but provided no relief. CT chest showed a well-defined hypodense solid mass lesion with a soft tissue alternation. Lobectomy was performed. Microscopy revealed a tumour comprising of two distinct populations of cells surface and stromal cells which disposed in papillary, solid, sclerotic and haemorrhagic growth patterns. Histology and immunohistochemistry confirmed the diagnosis of SH of the lung.

Invasive intestinal myiasis in a young male presenting as fungating rectal mass: an unusual presentation.

Intestinal myiasis is usually an accidental phenomenon which is transient and asymptomatic. It occurs due to intake of contaminated food or water containing fly larvae or eggs. We report a case of invasive intestinal myiasis presenting with complaint of pain, blood-mixed mucous discharge per rectum along with passage of maggots in stool. On proctoscopy an irregular fungating rectal growth with maggots was detected in rectum and anal canal. Excision of growth with diversion colostomy was done. On histopathology numerous variable-sized larvae in different stages of development were detected throughout the inflamed and necrosed bowel wall. No tumor was seen. With maintenance of proper hygiene, vermicide anti inflammatory and purgatives were given. Patient became alright after colostomy closure. The symptomatic presentation as a mass lesion and necessity for surgical intervention prompted us to report this rare case.

Tumor irrigation fluid enhances diagnostic efficacy in endoscopic biopsies of intracranial space-occupying lesions.

PURPOSE: Intraventricular neuroendoscopic CNS biopsiesare small, fragmented, and tissue is frequently inadequate for diagnosis. We have attempted to increase cellular yield using tumor irrigation fluid (TIF) and a cyto-histological approach for diagnosis of intracranial tumors, cysts, and infections. METHODS: A retrospective group of 147 cases, where only endoscopic biopsies were obtained, was compared with a prospective group of 31 cases where along with the endoscopic biopsies, tumor irrigation fluid (TIF) was collected. Tumor cyst fluid was obtained from cystic tumors (n=6). Small tumor fragments in the TIF were utilized to make squash smears (n=31). Clotted fragments were processed for sections in (n=3). Centrifuged deposit smears were prepared from tumor irrigation fluid and tumor cyst fluid. RESULTS: Conclusive pathological diagnosis in endoscopic biopsies could be arrived at in 77.4% (24/31) prospective cases and 80.3% (118/147) in retrospective cases. Collection of TIF with a cyto-histological diagnostic approach gave a significantly higher rate of conclusive pathological diagnosis in 93.5% (29/31) cases in the prospective group. CONCLUSIONS: Additional tissue from TIF preserves the original biopsy, provides more material for diagnosis and gives a better morphological picture in smears. Hence diagnosis of endoscopic CNS biopsies can be rendered in more cases and with greater degree of confidence.