Anurag Mehta

Extrauterine adenomyoma with uterus like features: A rare entity presenting 17 years post hysterectomy

We report a case of a 47-year-old female (posthysterectomy) with bleeding per vaginum. Imaging studies showed a large abdomino-pelvic mass diagnosed as extrauterine adenomyoma with uterus-like features. This pathological entity is extremely uncommon with only few case reports available in the reported literature. This case is being highlighted for its rarity and to discuss the possible theories for origin of this uncommon condition.

Comparison of aspiration vs non-aspiration techniques in fine-needle cytology of thyroid lesions.

Aim: To compare the efficacy of fine-needle non-aspiration cytology (FNNAC) with that of fine-needle aspiration cytology (FNAC) of thyroid lesions. Materials and Methods: FNAC and FNNAC techniques were studied in 50 cases of thyroid lesions. All the needle-sampling procedures were done by a single operator. The samples were assessed cytologically and evaluated using five parameters, that is, background blood or clot, amount of cellular material, degree of cellular degeneration, and degree of cellular trauma and retention of appropriate architecture. Statistical Analysis: Wilcoxon signed rank test was performed using SPSS14 software. Differences between all the individual parameters as observed in FNAC and FNNAC smears were insignificant. Results and Conclusion: After evaluation of FNAC and FNNAC on the basis of these scores, greater numbers of diagnostically superior samples were obtained by FNNAC; however, by FNAC more number of diagnostically adequate smears were observed. The numbers of unsuitable smears were also more by FNNAC technique.

Immunohistochemical Profile of Breast Cancer Patients at a Tertiary Care Hospital in New Delhi, India

BACKGROUND To assess the immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor-2 (HER2) neu receptor in breast cancer and their associations with various clinicopathological characteristics. MATERIALS AND METHODS This is a retrospective analysis of women who presented with primary, unilateral breast cancer in the Department of Medical Oncology at Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India during the period from January 2008 to December 2011. Data were retrieved from the medical records of the hospital including both early and locally advanced cancer cases. ER, PgR and HER2neu expression in these patients was assessed and triple negative patients were identified. Associations of triple negative and non-triple negative groups with clinicopathological characteristics were also evaluated. RESULTS A total of 1,284 women (mean age 52.1 years, 41.9% premenopausal) were included in the analysis. Hormone receptor positivity (ER and/or PgR) was seen in 63.4% patients, while 23.8% of tumors were triple negative. Only 23.0% were HER2 positive. Around 10.0% of tumors were both ER and HER2 positive. ER and PgR positivity was significantly associated with negative HER2 status (p-value<0.0001). Younger age, premenopausal status, higher tumor grade, lymph node negativity, advanced cancer stage, and type of tumor were strongly associated with triple negativity. Significantly, a smaller proportion of women had ductal carcinoma in situ in the triple negative group compared with the non-triple negative group (35.6% versus 60.8%, p-value<0.01). CONCLUSIONS The present analysis is one of the largest studies from India. The majority of the Indian breast cancer patients seen in our hospital present with ER and PgR positive tumors. The triple negative patients tended to be younger, premenopausal, and were associated with higher tumor grades, negative lymph nodes status and lower frequency of ductal carcinoma in situ.

Mycosis fungoides/Sezary syndrome: report of an unusual case

Introduction:  Sézary syndrome (SS) is an uncommon form of cutaneous T cell lymphoma (CTCL) with a classical triad of lymphadenopathy, characteristic circulating lymphoma cells (Sézary cells) and erythrodermatous skin involvement with classical mycosis fungoides (MF)‐like histological picture.

Clinicopathological Characteristics of Triple Negative Breast Cancer at a Tertiary Care Hospital in India

BACKGROUND Triple-negative breast cancer (TNBC), characterized by the lack of expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2, is typically associated with a poor prognosis. The majority of TNBCs show the expression of basal markers on gene expression profiling and most authors accept TNBC as basal-like (BL) breast cancer. However, a smaller fraction lacks a BL phenotype despite being TNBC. The literature is silent on non-basal-like (NBL) type of TNBC. The present study was aimed at defining behavioral differences between BL and NBL phenotypes. OBJECTIVES i) Identify the TNBCs and categorize them into BL and NBL breast cancer. ii) Examine the behavioral differences between two subtypes. iii) Observe the pattern of treatment failure among TNBCs. MATERIALS AND METHODS All TNBC cases during January 2009-December 2010 were retrieved. The subjects fitting the inclusion criteria of study were differentiated into BL and NBL phenotypes using surrogate immunohistochemistry with three basal markers 34βE12, c-Kit and EGFR as per the algorithm defined by Nielsen et al. The detailed data of subjects were collated from clinical records. The comparison of clinicopathological features between two subgroups was done using statistical analyses. The pattern of treatment failure along with its association with prognostic factors was assessed. RESULTS TNBC constituted 18% of breast cancer cases considered in the study. The BL and NBL subtypes accounted for 81% and 19% respectively of the TNBC group. No statistically significant association was seen between prognostic parameters and two phenotypes. Among patients with treatment failure, 19% were with BL and 15% were with NBL phenotype. The mean disease free survival (DFS) in groups BL and NBL was 30.0 and 37.9 months respectively, while mean overall survival (OS) was 31.93 and 38.5 months respectively. Treatment failure was significantly associated with stage (p=.023) among prognostic factors. CONCLUSIONS Disease stage at presentation is an important prognostic factor influencing the treatment failure and survival among TNBCs. Increasing tumor size is related to lymph node positivity. BL tumors have a more aggressive clinical course than that of NBL as shown by shorter DFS and OS, despite having no statistically significant difference between prognostic parameters. New therapeutic alternatives should be explored for patients with this subtype of breast cancer.

Clear cell adenocarcinoma of the male urethral tract.

We present a rare case of clear cell adenocarcinoma of the male bulbomembranous urethra. Mostly these tumors have been described in the female urethral tract with its possible origin from mullerian remnants, wolffian remnants or paraurethral glands. Histologically, these tumors have typically tubulocystic pattern comprising of hobnailed cells with clear glycogenated cytoplasm along with well-defined cytoplasmic membranes. This case is being presented due to its rarity, aggressive behavior and to discuss, trauma as its possible etiological factor.

Glomus tumor of the stomach.

Gastric glomus tumors are rare neoplasms. We report here a case of gastric glomus tumor in a 25-year-old female who presented with exsanguinating gastrointestinal hemorrhage. Clinically and on gross examination, the tumor was suspected to be a gastrointestinal stromal tumor (GIST). Histopathological and immunohistochemical evaluation revealed it to be a glomus tumor.

Urothelial carcinoma of bladder having rhabdoid differentiation with isolated scapular metastasis

Sir, Rhabdoid tumor was originally described by Beckwith and Palmer as a highly malignant renal tumor of childhood. Tumors with similar features have been documented in extra renal sites and also in adults. The histogenesis of these tumors is uncertain, however, electron microscopic studies in most cases have revealed cytoplasmic aggregates of intermediate filaments. Tumors with rhabdoid phenotype are associated with an aggressive clinical course. Urothelial carcinomas of bladder with rhabdoid differentiation are very rare and only handful of cases have been described in the literature. We present a case of urothelial carcinoma of bladder with prominent rhabdoid features in adult male with unusual distant bone metastasis to the acromian.

A Report of Sarcomatoid Carcinoma of the Gallbladder Treated with Palliative Deocetaxel and Gemcitabine Chemotherapy

Gallbladder carcinoma (GBC) is a disease common in the northern part of India, Chile, and Japan [1]. The commonest histological type of this neoplasm is adenocarcinoma, while sarcomatoid histology is rare [2]. There are a few reports available in the literature on sarcomatoid GBC where it was detected in a surgically resectable stage [3, 4]. The prognosis of this type of neoplasm is very poor [2]. We report a case of metastatic sarcomatoid carcinoma along with its outcome who received palliative deocetaxel and gemcitabine chemotherapy.

Low to intermediate grade salivary duct carcinoma associated with osteoclast like-giant cell tumor of parotid gland: A rare case with distinct pathological features

Osteoclast like-giant cell tumor of the salivary gland is an extremely rare tumor with distinct pathological features and unknown histogenesis. The neoplastic nature of these tumors in itself is questionable. We present the twentieth case in English literature of primary osteoclast like-giant cell tumor with accompanying low to intermediate grade salivary duct carcinoma of parotid gland, metastasizing to the ipsilateral cervical lymph node. As far as we know this is the second case with lymph node metastasis. Due to the rarity of the tumor its exact biological course is uncertain. We present and discuss this rare case with special emphasis on the histology, immunohistochemistry, and histogenesis.