Localized tenosynovial giant cell tumor of tendon sheath. A case report.

BACKGROUND: Localized tenosynovial giant cell tumor of tendon sheath (TGCT-L) is a benign, slowly growing lesion with a peak incidence in the third to fifth decade of life. It is thought to arise from the synovium of tendon sheaths, frequently affecting interphalangeal joints of the hands, feet, ankles and knees. Although the histopathologic appearances are well established, only a few reports describe the cytomorphology of this lesion. CASE: A 37-year-old female presented with a slowly growing, nontender mass located near the left ankle joint. The cytologic features of localized tenosynovial giant cell tumor of tendon sheath (TGCT-L) include abundant mononuclear histiocytic cells occurring singly and in three-dimensional tissue fragments, hemosiderin within histiocytes and a few multinucleated giant cells. Subsequently, the histopathologic examination of the surgical specimen was proven to be TGCT-L. CONCLUSION: Fine needle aspiration cytology can be used as a diagnostic tool for early and accurate detection of TGCT-L since the cytologic features combined with clinical details are sufficiently distinctive.

Diagnostic stromal histomorphology in fibroepithelial breast lesions: a fresh perspective.

Histopathologic parameters were studied in fibroepithelial breast lesions comprising of Fibroadenomas (FAs), Juvenile cellular fibroadenomas (JCFs) as well as benign, borderline and malignant phyllodes tumours (B/Bo/MPTs). H & E stained sections of 67 cases (25 ICFA, 5 Mixed FA, 10 PCFA, 12 JCF and 15 PT) were retrieved from archival material and the microscopic features of each lesion, reviewed by two independent observers. A diagnosis was arrived at by consensus. Diagnostic criteria were laid down for each of the above lesions based on a statistical analysis of data obtained from a previously drawn up semiquantitative grading system for various stromal histomorphologic parameters. An increasing grade of stromal cellularity, pleomorphism, overgrowth and mitotic index was observed, from the benign to the borderline and overtly malignant lesions included in the spectrum. A semiquantitative grading of relevant stromal histomorphologic variables was found to be of immense diagnostic significance in fibroepithelial breast lesions and served to elucidate cases falling into the diagnostic grey zones of the spectrum.

An immunopathological study of lichen planus.

Twenty-five patients with clinically diagnosed lichen planus were examined for direct immunofluorescence patterns in biopsies. The male to female ratio was 1:1.77. The peak incidence was observed in 11-20 years age group. Most (96%) of the patients presented with moderate to severe itching within two months of onset of symptoms. Sixty percent of the patients had violaceous papules; 20% had both papules and plaques. Simultaneous oral involvement was seen in 4% of cases; 8% showed nail changes. Thirteen patients had classical LP, 9 had lichen planus hypertrophicus, 2 had lichen planus actinicus, and one had lichen planopilaris. Direct immunofluorescence revealed fibrin deposition in 64% of cases as a linear pattern at dermo-epidermal junction, as coarse granular deposits of IgM sub-epidermally in 24 of cases and at the dermo-epidermal junction as C 3 in20% of cases. Civatte bodies were seen in 5 cases with H&E staining, but direct immunofluorescence for IgM, fibrin and C 3 was observed only in two cases. This suggests activation of complement and fibrinogen cascade. Whether this is the cause or effect of pathological processes in lichen planus remains to be determined.

Lichen Planus-a Clinico-histopathological.

The clinico-histopathological features of 75 patients of lichen planus were studied. The male to female ratio was 1:13. The largest number of patients (30.6%) fell into the 31-40 year age group. Two patients had systemic hypertension. There was no history of lichen planus in the family. All patients presented with severe itching within 1-2 months of onset. Papular lesions were seen in 72% and papules with plaques were seen 16%. Lower limbs were involved in 38% of cases. Mucosal involvement was seen in 24% in addition to skin involvement ; nail involvement hypertrophicus (17.3%). Lichen planopilaris and oral lichen planus were uncommon. Clinico-histopathological discrepancies were observed in 7 patients. Civatte bodies were seen in only 37% of cases.

Cytological diagnosis of adenoid cystic carcinoma breast--a case report.

The cytologic features of a case of adenoid cystic carcinoma of breast diagnosed on fine needle aspiration cytology (FNAC) in a 52 years old female are described. FNAC was carried out on outer quadrant of breast. The characteristic cytological features were numerous single to branching small round to Avoid cells at places forming microacini. Numerous pink hyaline globules of variable sizes were seen along with finger like projections containing basement membrane material.

Study of diagnostic modalities and pathology of Helicobacter pylori infection in children.

To evaluate various diagnostic tests for Helicobacter pylori (Hp) in children, and to study the spectrum of endoscopic and histological changes in the stomach and duodenum of children with gastroduodenal disorders, associated with Hp infection Children below 12 years of age with various gastroduodenal disorders requiring upper gastrointestinal endoscopy were studied. Endoscopic biopsy specimens were collected from duodenum and antrum. Apart from histopathological examination of biopsy material, rapid urease test (RUT) of the antral biopsy specimen and blood examination to estimate specific IgG antibodies to Hp by Indirect Solid Phase Enzyme Immunoassay was performed. Forty seven children were included. Nine (19.1%) of them were positive both by serology and RUT. Seven (14.9%) were positive by histology. A significant correlation of Hp was noticed with chronic antral gastritis (p = 0.002) and chronic duodenitis (p = 0.006). Age equal to or more than 10 years was found to be significant risk factor for acquiring Hp infection. Prevalence of Hp in children with gastroduodenal complaints was found to be 19%. Both RUT and serology were found to be reliable diagnostic tests for Hp as compared with histology. Antral gastritis and chronic duodenitis had a significant correlation with Hp colonization.

Adenomyosis: diagnosis by hysteroscopic endomyometrial biopsy, correlation of incidence and severity with menorrhagia.

OBJECTIVE: To assess the possibility of diagnosing adenomyosis by hysteroscopic endomyometrial biopsy in patients with menorrhagia and to compare the incidence and depth of penetration in patients who did not have menorrhagia. STUDY DESIGN: The study group included 53 patients who had menorrhagia and the control group included patients who were to have hysterectomy for conditions like prolapse uterus. Hysteroscopic endomyometrial biopsy was done in the menorrhagia group. The incidence and depth of penetration of adenomyosis were compared in both the groups using Kruskal Wallis H test. For correlation of severity of menorrhagia with depth of adenomyosis: Student's t-test and ANOVA were used. RESULT: The incidence of adenomyosis was 60% (18 patients) by endomyometrial biopsy in the menorrhagia group as compared to 33.3% in the control group. The mean depth of invasion of myometrium was 4.103 mm in the menorrhagia group and 2.03 mm in the control group. CONCLUSION: There is a definite correlation between menorrhagia and adenomyosis both in incidence and depth of penetration.

Precursor lesions of Wilms' tumor in Indian children: a multiinstitutional study.

BACKGROUND: Studies regarding different ethnic populations of children with Wilms' tumor (WT) in the U. S. have shown differences between age and gender incidence and the type of its precursor lesions (nephrogenic rests). To the authors' knowledge there are few reports in the literature regarding nephrogenic rests in a large number of cases from other parts of the world. METHODS: In this study, histopathology sections from 127 WTs were pooled from the archives of 4 institutions in northern India and studied for the incidence of nephrogenic rests. Their incidence also was cross-correlated with patient age gender, and tumor morphology. RESULTS: Significantly, the complete absence of perilobar nephrogenic rests was observed in all cases. Intralobar rests were associated with 45.3% of WTs and were observed predominantly with a triphasic histologic pattern and a relatively lower incidence of anaplasia compared with reports in the Western literature (1.5% vs. 4.5%). A lower median age of 2.5 years with a peak in the first 2 years of life was consistent with reported studies in Asian children. The male gender preponderance was in contrast to the equal male to female ratio reported in Western cases. CONCLUSIONS: The type of nephrogenic rests present in Indian children was noted to be different from that in children reported in the Western literature. Differences also existed with regard to the age and gender incidence of children with WT and its morphologic pattern, possibly due to the different genetic nature of the tumor. However, this theory requires confirmation by large epidemiologic and genetic studies.

Multiple primary visceral malignancy--a review with report of two cases.

Multiple primary cancers are being reported with increasing frequency in recent years, the frequency varying from 0.3 to 4.3% in different studies. A combination of primary cancer of larynx and lung is the most common followed by malignant neoplasm involving lip-larynx, skin-larynx, skin-lung, breast-ovary and breast-endometrium. Two interesting cases of rare combinations of primary cancers are being presented. In the first case primary adenocarcinoma of the gall bladder was associated with appendiceal adenocarcinoma. In the second case primary malignant papillary serous cystadenocarcinoma of right ovary and squamous cell carcinoma of cervix uteri were found.