Angiomatoid Fibrous Histiocytoma in an Elderly Male: An Unusual Presentation of a Rare Case.

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue neoplasm of low malignant potential often misdiagnosed clinically. It typically occurs in the superficial soft tissues of the extremities in children and young adults. It is characterized by recurrences and rarely metastases. Surgery remains the mainstay of management. Here, we present a rare case report of AFH in a 65-year-old male diagnosed using fine needle aspiration as spindle cell sarcoma. The patient underwent wide local excision. The patient is under follow-up. There is no evidence of metastases, and the patient is disease free three-years post-excision.

Hyperthermia: A Potential Game-Changer in the Management of Cancers in Low-Middle-Income Group Countries.

Loco-regional hyperthermia at 40-44 °C is a multifaceted therapeutic modality with the distinct triple advantage of being a potent radiosensitizer, a chemosensitizer and an immunomodulator. Risk difference estimates from pairwise meta-analysis have shown that the local tumour control could be improved by 22.3% (p < 0.001), 22.1% (p < 0.001) and 25.5% (p < 0.001) in recurrent breast cancers, locally advanced cervix cancer (LACC) and locally advanced head and neck cancers, respectively by adding hyperthermia to radiotherapy over radiotherapy alone. Furthermore, thermochemoradiotherapy in LACC have shown to reduce the local failure rates by 10.1% (p = 0.03) and decrease deaths by 5.6% (95% CI: 0.6-11.8%) over chemoradiotherapy alone. As around one-third of the cancer cases in low-middle-income group countries belong to breast, cervix and head and neck regions, hyperthermia could be a potential game-changer and expected to augment the clinical outcomes of these patients in conjunction with radiotherapy and/or chemotherapy. Further, hyperthermia could also be a cost-effective therapeutic modality as the capital costs for setting up a hyperthermia facility is relatively low. Thus, the positive outcomes evident from various phase III randomized trials and meta-analysis with thermoradiotherapy or thermochemoradiotherapy justifies the integration of hyperthermia in the therapeutic armamentarium of clinical management of cancer, especially in low-middle-income group countries.

A Rare Case of Primary Malignant Mesenchymoma Arising from Submandibular Salivary Gland.

Malignant mesenchymoma is a rare tumor in which there are two or more distinct mesenchymal components. These are generally considered as high-grade neoplasms and are usually associated with a poor prognosis. Here, we report a case of malignant mesenchymoma containing undifferentiated spindle cell sarcoma, leiomyosarcoma, chondrosarcoma, osteosarcoma, and areas with rhabdoid differentiation in a 54-year-old male. The primary tumor measured 5.5 × 4 × 3 cm and weighed 135 g arising from the left submandibular salivary gland. Fine-needle aspiration cytology showed the presence of pleomorphic spindle cell clusters with atypia and myxoid stroma. An impression of malignant salivary gland neoplasm was given. Diagnosis of malignant mesenchymoma was made on histopathological examination supported by immunohistochemistry showing strong positivity with p53, Ki-67, and focal positivity for smooth muscle actin, S-100, desmin, and negativity for cytokeratins. The exact histogenesis of malignant mesenchymoma and the optimal management strategy to decide the prognosis remains uncertain as it is a rare tumor.

Utility of MOC-31 monoclonal antibody in differentiating metastatic adenocarcinoma cells and reactive mesothelial cells in effusion cytology.

In effusion cytology, a clear distinction between reactive mesothelial cells and metastatic adenocarcinoma cells is sometimes challenging mainly due to similarities in the cytomorphological features. In such cases for definitive diagnosis, paraffin-embedded cell block examination and immunohistochemistry are helpful in making this distinction. MOC-31 is one of the proposed immunomarker for adenocarcinoma cells. We undertook to evaluate the role of MOC-31 as a marker for identifying adenocarcinoma cells in effusion specimen. A total of 185 paraffin-embedded cell blocks of effusion samples were identified, of these 111 cases were of metastatic adenocarcinoma. MOC-31 was positive in 101 of the 111 cases of metastatic adenocarcinoma. Minimal focal cytoplasmic staining was also seen in 7 of the 74 cases of reactive mesothelial cells, but these were taken negative as they did not show membrane positivity. The sensitivity and specificity of MOC-31 for metastatic adenocarcinoma cells were 92.5%, and 100% respectively, positive and negative predictive value (NPV) was 100% and 91.14%, respectively. MOC-31 can be used as a reliable marker in effusions for distinguishing metastatic adenocarcinoma from reactive mesothelial cases.

Cytomorphologic diagnosis of basaloid squamous cell carcinoma: a case report.

BACKGROUND: Basaloid squamous cell carcinoma is a high-grade variant of squamous cell carcinoma that most commonly occurs in the upper aerodigestive tract. There are limited case reports of this entity in the cytology literature. The authors describe the cytologic features of a histologically confirmed case of basaloid squamous cell carcinoma arising in the floor of the mouth. CASE: A 51-year-old woman presented with a swelling in the floor of the mouth. Fine needle aspiration was performed; the aspirate comprised groups, sheets and a dispersed population of small to medium-sized cells with hyperchromatic nuclei and scant cytoplasm. Extracellular basement membrane-like material was also noted, which led to the erroneous diagnosis of adenoid cystic carcinoma. Histopathology characteristically revealed the presence of squamoid nests between malignant basaloid cells, and the tumor was finally diagnosed as basaloid squamous cell carcinoma. Occasional groups of squamoid cells were observed in the aspirate on retrospective evaluation. CONCLUSION: Basaloid squamous cell carcinoma should be considered in the differential diagnosis of tumors arising in oral cavity. Cytologic diagnosis may be difficult, but careful search for a second cell population of squamoid cells in addition to small basaloid cells may aid in rendering the correct diagnosis.

Bone metastases of clear cell sarcoma of the kidney diagnosed by fine needle aspiration cytology. A case report.

BACKGROUND: Clear cell sarcoma of the kidney (CCSK) was first recognized from its predilection to metastasize to bone. While there are many case reports in documenting the diagnosis of CCSK by fine needle aspiration cytology (FNAC), this is the first case in which FNAC was instrumental in diagnosing the condition from a metastatic site. CASE: A 2-year-old presented with multiple bone lesions. Fine needle aspirates from these lesions showed a polygonal cell population with eccentrically diagnose both pri placed, lobulated nuclei. The diagnosis of metastatic clear cell sarcoma offered on FNAC prompted a search for the primary renal lesion. CONCLUSION: FNAC is a rapid, cost-effective technique and must be used to type pediatric tumors so that an appropriate chemotherapeutic regimen can be commenced promptly.

Cytodiagnosis of hepatic amyloidosis by fine needle aspiration cytology: a case report.

BACKGROUND: Amyloid in fine needle aspirates tends to be overlooked due to its rarity. It may appear at virtually any site and can be identified by special stains. CASE: In a case of amyloidosis of the liver, where fine needle aspiration cytology was instrumental in making the primary diagnosis. Smears revealed normal hepatocytes and chronic inflammatory cells. Amorphous material (amyloid) was extensively present between compressed hepatocytic clusters. It stained pale green in Papanicolaou-stained preparations and reddish purple with Giemsa stain. This material was initially thought to be hyalinized granulomas. However, it was later confirmed to be amyloid by using Congo Red stain. CONCLUSION: Whenever amorphous material is present in smears, a high index of suspicion for amyloid needs to be maintained.