Endocrine mucin-producing sweat gland carcinoma of the eyelid - A diagnostic challenge.

ABSTRACT: Skin adnexal or sweat gland neoplasms are rare adnexal tumors that pose a diagnostic challenge for both ophthalmologists and pathologists. Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is an uncommon low grade carcinoma of eccrine ducts with a predilection to occur in the periocular region in the elderly female. We present a rare case of 65-year-old healthy male who presented with a lobulated mass in the left eye lower lid, clinically suspected as sebaceous gland carcinoma, diagnosed as endocrine mucin-producing sweat gland carcinoma histopathologically.

Multicentric Castleman's disease in India - Does EBV rather than HHV8 play a role?

BACKGROUND AND AIM: Multicentric Castleman's disease (MCD) is a rare lymphoproliferative disorder manifesting as multiple lymphadenopathy, multiorgan involvement, and inflammatory symptoms. This study aims at highlighting some unique features of MCD in Indian patients. MATERIALS AND METHODS: These 17 patients from review of 78 cases of Castleman's disease (CD) diagnosed. Besides routine tissue sections were stained for Human Herpes Virus 8 latency associated nuclear antigen (HHV8-LANA) by immunohistochemistry (IHC) and Epstein Barr virus latent membrane protein (EBV-LMP) or Epstein Barr Virus by in situ hybridization (EBER-ISH). RESULT: The cases included Plasma cell variant (11 cases), mixed MCD (4 cases) and two concurrent MCD with large B cell lymphoma in HIV positive patients. Median age of disease onset was 47 years and female predominance was seen. Out of 15 MCD uncomplicated by lymphoma, 5 had POEMS (Polyneuropathy, organomegaly, endocrinopathy, myeloma protein, skin changes) and one also had TAFRO (Thrombocytopenia, anasarca, fever, marrow reticulin fibrosis, organomegaly, normal or slightly elevated immunoglobulin) syndrome. Out of 10 MCD without lymphoma, 2 cases showed few EBV positive large cells, both have features of POEMS. All 17 MCD cases were negative for HHV8-LANA IHC. Two HIV patients with MCD had large cell lymphoma, intrasinusoidal pattern, of which one was EBV positive. Though four relapses were seen, none died from disease. One of the two patients complicated by lymphoma died from disease. CONCLUSION: Indian patients with MCD show female preponderance and are negative for HHV8 but show EBV positive cells. This makes a case for role of EBV in etiopathogenesis of MCD in India.

Primary peritoneal serous carcinoma: a rare case and palliative approach.

Primary peritoneal serous carcinoma (PPSC) is a rare primary malignancy that diffusely involves the peritoneum, indistinguishable clinically and histopathologically from primary serous ovarian carcinoma. The origin of PPSC has not been well characterized. Here we present a case of PPSC diagnosed in ultrasonography-guided fine needle aspiration cytology (FNAC) in a 76- old female presenting with ascites, abdominal pain, distension and constipation. PPSC is an unusual tumour but cytomorphology is distinctive enough to diagnose preoperatively. In the case report hereby described PPSC is an inoperable malignancy, hence chemotherapy and palliative care are the only offered treatment.

Analysis of diagnostic value of cytological smear method versus cell block method in body fluid cytology: study of 150 cases.

BACKGROUND: Aspiration of serous cavities is a simple and relatively non-invasive technique to achieve diagnosis. Cytologic evaluation of body cavity fluid is diagnostically challenging. METHODS: A total of 150 fluid specimens were examined for conventional cytological smear (CS) and cell block method (CB). Out of 150 fluids, 79 were pleural fluid, 69 were ascitic fluid and 2 pericardial fluid. Each fluid specimen was divided in two equal parts: one part was subjected to conventional smear technique, while the other part was subjected to 10% alcohol-acetic acid-formalin cell block technique. Overall morphological details, cellularity, architecture, nuclear and cytoplasmic details were studied in both CS and CB techniques. RESULTS: In this study, the utility of the CB method in the cytodiagnosis of malignant effusions was found to be highly significant as compared to the CS method. The additional yield of malignancy was 10% more as was obtained by the CB method. CONCLUSION: For the final cytodiagnosis of body fluid, there is statistically significant difference between the two techniques. In other words, CB is superior to CS method.

Study of coronary atherosclerosis by modified american heart association classification of atherosclerosis-an autopsy study.

BACKGROUND: The study was designed to assess the atherosclerotic lesions in coronary arteries in cases subjected to autopsy to grade by applying Modified American Heart Association (AHA) classification, evaluate the atheromatous & vulnerable plaques to find out the to age and sex related prevalence of atherosclerosis in the semi-urban & urban population of Jamnagar, a district in Western India. MATERIAL & METHODS: Autopsy was conducted on 264 cases whose age ranged from 8-79 years, by the conventional technique; heart was removed & dissected along the direction of blood flow. Microscopic assessment of the three main coronary arteries was done. RESULT: According to Modified AHA classification of atherosclerosis, maximum number of cases were in the 40-49 years age group. Intimal xanthoma was the most common type in all three coronary arteries. The number of males was 168(64%) and females was 96(36%). 59% males & 52% female were affected from atherosclerosis. An intermediate lesion was noted commonly in young individuals (10-39 years) and older individuals (40-79 years) were 46% & 41% respectively. Pathological Intimal thickening was more common in left anterior descending coronary artery compared to others. Thin fibrous cap atheroma was more common in Left circumflex artery than compared to Left anterior descending artery & Right coronary artery. CONCLUSION: The study highlights the impact of atherosclerotic lesions in the population of Jamnagar, a district in Gujarat state of Western India. The increased amount of intermediate atherosclerotic lesions found in the young population gives an indication that anti-atherogenic preventive measures and drastic dietary & life style modification need to be implemented in young individuals, this will help to prevent coronary artery disease from causing premature death that lead to huge financial burden on the economy and health sector of India.

Intrascrotal extratesticular schwannoma.

Primary nerve sheath tumors in an intrascrotal and extratesticular location are extremely rare, with only a few cases reported in the literature. We report a fine needle aspiration cytology (FNAC)-diagnosed and histologically confirmed case of paratesticular schwannoma in a 32-year-old male. The patient had no evidence of neurofibromatosis and there was a pre-operative cytologic suspicion of leiomyoma as well. A palpable left-sided inguinal lymph node showed features of reactive lymphoid hyperplasia. This case is documented to highlight the rarity of paratesticular schwannoma and the role of FNAC in its pre-operative interpretation.