Histomorphological study of prostatic adenocarcinoma and its mimics.

CONTEXT: Prostate adenocarcinoma (PC) is one of the common cancers in India and world over. Numerous prostatic, nonprostatic lesions, and normal structures can be very similar to adenocarcinoma. A pathologist's awareness of the benign mimics is important for the diagnosis of PC. AIM: The aim of this study was to determine the prevalence, clinical, and histopathological features of PC, and its common mimics, and to study the criteria for their distinction from PC. MATERIALS AND METHODS: A prospective study of histopathological features of radical prostatectomy and transurethral resection of the prostate specimens, sent to the department of pathology in a medical college, for a period of 2 years was done. A brief clinical history followed by a clinical examination, including per-rectal findings and serum prostate-specific antigen (PSA) levels, was noted. RESULTS: After excluding all the cases of benign hyperplasia of prostate without any associated findings, 50 cases of operated surgical specimens of prostate were studied. PC was the most frequent diagnosis in 28 patients of 50 cases (56.0%). Basal cell hyperplasia formed the predominant mimic (26.0%), followed by prostatic intraepithelial neoplasia (8%), prostate atrophy (4%), clear-cell cribriform hyperplasia(4%),, and one case of atypical adenomatous hyperplasia (2%). Serum PSA was >4 ng/mL in all the cases of PC. In three of the mimics, PSA was >4 ng/mL and in the rest it was <4 ng/mL. Immunohistochemistry (IHC) was not applied in our study. CONCLUSION: Biopsy still remains a gold standard for diagnosis of PC and its mimics. All the lesions in the above study were diagnosed on routine hematoxylin and eosin staining. IHC is useful especially for lesions in the grey zone but not in routine histopathological study and should not be used as a screening test but should be applied in specific selected cases only.

Intravascular papillary endothelial hyperplasia: An unusual histopathological entity.

Intravascular papillary endothelial hyperplasia (Masson's tumor) is a benign lesion of the skin and subcutaneous tissue consisting of a reactive proliferation of endothelial cells with papillary formations related to a thrombus. It poses a diagnostic challenge as the clinical signs and symptoms are nonspecific and may mimic a soft tissue sarcoma. The diagnosis is based on histopathology. Here we report two cases of Masson's hemangioma occurring on the upper lip and on the left hand.

Pulmonary sarcoidosis: An important differential diagnosis in transbronchial lung biopsies.

BACKGROUND: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Lungs and lymphatics are the principal sites affected by this disease. The disorder is often not suspected by physicians. MATERIALS AND METHODS: This was a retrospective study done on 140 transbronchial lung biopsies received for histopathological examination in the Department of Pathology for 1 year in a multispeciality tertiary care hospital, in Delhi. RESULTS: Out of 140 transbronchial lung biopsies studied, 13 cases of sarcoidosis were diagnosed histopathologically. In these patients a clinical, pathological, and radiological corelation was done. And a final diagnosis of sarcoidosis was given after excluding other granulomatous lesions. CONCLUSION: Transbronchial lung biopsies have become an important tool in the diagnosis of sarcoidosis in present time. Hence sarcoidosis should be considered as a differential diagnosis when dealing with granulomatous lesions in lung biopsies.

Role of argyrophilic nucleolar organizer region staining in identification of malignant cells in effusion.

BACKGROUND: Cytological examination of effusions helps to differentiate between benign and malignant effusions, but fails a definitive diagnosis in a number of cases. The main problem here is to distinguish reactive mesothelial cells from neoplastic cells. AIM: In the present study, we used argyrophilic nucleolar organizer region (AgNOR) staining for diagnosis of benign and malignant effusions. MATERIALS AND METHODS: In this study, 100 cases of effusion samples were taken and centrifuged. Four smears were prepared from sediment, one each for Leishman, hematoxylin and eosin (H and E) staining and two for AgNOR staining. AgNORs were counted as black dots in the nuclei of all abnormal cells using ×100 oil immersion objective. Their dispersion and shape was compared in benign, malignant and atypical cases. RESULTS: Out of 50 pleural effusion samples, 29 were benign, 10 were malignant and 11 atypical. Among the 47 peritoneal effusion samples, 27 were benign, 16 were malignant and 4 atypical. Out of three cases of pericardial effusion samples, one was benign and two were malignant. All effusions were subjected to AgNOR staining. The benign group consisted of cells showing 1 to 2 dots of regular size and shape. In malignant group, 3 to 5 dots of variable size, shape and irregular contours were observed per cell. In atypical group, the reactive mesothelial cells showed 1 to 2 dots, malignant cells showed 3 to 4 irregular dots. Thus, a differentiation was noted between activated mesothelial cells and malignant cells, which was not possible in Leishman and H and E-stained smears alone. CONCLUSION: Therefore, AgNOR can be branded as an extremely useful additional diagnostic tool for cytodiagnosis of effusions.