Superficial CD34-positive fibroblastic tumor: A new entity; case report and review of literature.

Earlier, categorized under low grade malignant fibrous histiocytoma and low grade sarcomas, 'superficial CD34 positive fibroblastic tumor', a newly proposed entity, is a low grade mesenchymal tumor of intermediate malignant potential. Morphological features include monomorphic neoplastic spindle cells arranged in a fascicular to storiform pattern along with sheets of pleomorphic epithelioid cells, and multinucleated giant cells with glassy cytoplasm. Diffuse vimentin and characteristic diffuse CD34 positivity is seen in all cases with few showing focal cytokeratin expression. Rest of the melanocytic and mesenchymal markers are negative. Herein, we present a case of superficial CD34-positive fibroblastic tumor in arm swelling of a 16-year-old female. Differential diagnosis of the same on the basis of morphology as well as immunohistochemistry has also been discussed. This is the first case reported from India to the best of our knowledge.

A Case Report of a Giant Cholesteatoma.

Cholesteatoma is a well demarcated, non-neoplastic, temporal bone cystic lesion with extensive keratinisation. Keratoma and epidermoid cyst are other possibly more accurate names suggested to describe the same. It can be classified as congenital or acquired. Its management is often complicated by its tendency to recidivism/recurrence. Long standing cholesteatomas can be a precursor for squamous cell carcinoma. We hereby present a case of giant cholesteatoma in a 45-year-old female with radiological involvement of the left temporal region, periauricular region and infratemporal fossa with lytic destruction of left middle ear ossicles, mastoid and squamous part of temporal bone with intracranial extension. The enormity of the present lesion along with its bony erosions raised the strong clinical suspicion of malignancy. The underlying case report highlights the relevance of exhaustive sectioning and immunohistochemistry to reach the diagnosis.

The Prognostic Significance of Neuroendocrine Differentiation in Colorectal Carcinomas: Our Experience.

INTRODUCTION: Neuroendocrine differentiation in colorectal carcinomas, detected using immunohistochemistry and ultrastructural techniques, has been studied as a prognostic marker for invention of targeted therapy. There are a few studies done on this aspect which have shown conflicting results ranging from poor prognosis to no prognostic significance. AIM: The aim of the study was to determine the clinical significance of neuroendocrine differentiation in colorectal carcinomas using immunohistochemical stains such as chromogranin A & synaptophysin in relation to its prognostic significance. MATERIALS AND METHODS: A retrospective study was conducted wherein all the colorectal carcinomas, received in the Department of Pathology, over a period of 3 years, were reviewed. Neuroendocrine markers were done on 53 cases of moderately, poorly and undifferentiated adenocarcinomas. Based on the degree of immunoreactivity for these markers, tumours were divided into group 0, group 1, group 2, group 3 & group 4. Group 0 & 1 were categorized as neuroendocrine differentiation absent & group 2, 3 & 4 as present. Neuroendocrine differentiation was correlated with age, sex, grade, stage, diagnosis & survival. Follow up data of the cases was recorded. RESULTS: Neuroendocrine differentiation was present in 18 cases (33.9%). The degree of immunoreactivity for neuroendocrine markers in present study were; group 0- 58%, 1- 7.5%, 2- 9%, 3- 13% & 4- 11%. The mean age of patients was 54 years with a slight male preponderance {M:F::1.6:1}. Most of the carcinomas with neuroendocrine differentiation belonged to Grade II (61%) & Stage II & III (83%). Neuroendocrine differentiation did not show any significant association with age, sex, location, histological type, grade, stage & survival. CONCLUSION: The above results indicate that the presence of neuroendocrine differentiation cannot be recommended as a prognostic marker in colorectal carcinomas.