Arpita Saha

Primary aspergillosis of vocal cord: Long-term inhalational steroid use can be the miscreant

Primary laryngeal aspergillosis is extremely rare, especially in an immunocompetent host. It is commonly found as a part of systemic infection in immunocompromised patients. A case of vocal cord aspergillosis with no systemic extension in an immunocompetent patient on long-term steroid metered dose inhaler (MDI) is presented here, because of its rarity. The present case is a 28-year-old asthmatic female who was on inhalational steroid for 8 years, presented with sudden onset of severe dysphonia for 5 days. Fiberoptic laryngoscopy demonstrated whitish plaque involving right vocal cord, clinically suggestive of fungal laryngitis. Microlaryngeal laser surgery was performed with stripping of the plaque. Histopathology demonstrated ulcerated hyperplastic squamous epithelium with masses of fungal hyphae, which was confirmed to be Aspergillus species on fungal culture. This rare but serious adverse effect of long-term steroid MDI use must be kept in mind while treating an asthmatic patient. We also present a brief review of literature of laryngeal aspergillosis.

Fine needle aspiration cytology of dermatopathic lymphadenitis in an asymptomatic female: A case report.

Dermatopathic lymphadenopathy usually presents as enlarged superficial lymph nodes, most often involving the axillary or inguinal regions. Most patients have a chronic dermatopathy that precedes the development of dermatopathic lymphadenopathy. This condition can be confused with lymphoma in adults. There are very few case reports on cytological features of this disease in literature. We describe a case of dermatopathic lymphadenopathy in a 50-year-old female without any skin disease.

Lipoleiomyoma of the left broad ligament with dermoid cyst in ipsilateral ovary and synchronous multiple benign lesions of female genital tract: An unusual association

Lipoleiomyoma of the uterus is a rare variant of leiomyoma, and lipoleiomyoma of the broad ligament is still rarer, with only a handful of cases being reported. The present case was a perimenopausal woman who presented with a huge lower abdominal mass. Ultrasonography and computed tomography showed a heterogeneous solid mass in the left adnexa. The histopathological findings confirmed the nature of the lesions as a benign lipoleiomyoma with dermoid cyst of the left ovary and its other associated benign lesions, were the interesting features seen in this case which were not suspected clinically and radiologically.

Phlebolith in arteriovenous malformation in buccal fat pad masquerading sialolith: A rare case report.

Arteriovenous malformations (AVMs) are rare vascular lesion in the buccal fat pad (BFP). One of the important complications associated with these lesions is phlebolith formation within it. To the best of authors′ knowledge, there is no medical literature on AVM with phlebolith formation in BFP till date. The present case is a 12-year-old boy who presented with a swelling in the right side of the face, clinically diagnosed to be sialocele with sialolith. Excision of the mass was done, and histopathology revealed AVM with the formation of phlebolith. This rare entity needs to be kept in mind while evaluating a case of calcification in BFP. The first case of AVM with phlebolith formation in BFP is reported here along with brief review of literature.

Inflammatory Myofibroblastic Tumor of the Mid Common Bile Duct Masquerading as Cholangiocarcinoma

A 24-year-old female presented with yellowish eyes and urine for 1 month. She also complained of fever with chills and rigor and abdominal pain. She had associated loss of appetite and significant weight loss. There was no history of abdominal swelling, pedal edema, hematemesis, or encephalopathy. She had past history of recurrent episodes of obstructive jaundice for last 9 years. Her examination revealed scleral icterus, pruritus and a palpable, firm, non-tender gall bladder. There was no evidence of any other oraganomegaly or lymphadenopathy. Her investigations at the admission revealed mild leukocytosis, total bilirubin 5.8 mg/dL (0.1–1.3), direct bilirubin 2.9 mg/dL (0–0.4) and alkaline phosphatase 204 U/L (35–150), ALT 86 U/L (5–40) and AST 71 U/L (5–40). Viral serology for hepatitis A, B, and C and HIV were negative. Ultrasonography (USG) and computed tomography (CT) abdomen revealed a mass in the hepatic hilum extending up to the mid common bile duct (CBD) and bilateral intrahepatic biliary radicle dilatation (IHBRD) with no ascites or lymphadenopathy. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) also revealed well defined, asymmetrical, circumferential obstructing mass in the h i lum-mid CBD wi th un invo lved intrapancreatic part of CBD. Patient was suspected as a case of type IV cholangiocarcinoma. Palliative stenting was done to accomplish free flow of bile. Patient underwent exploratory laparotomy and a large mass measuring 10 × 6 cm, arising from bilateral hepatic ducts and extending up to mid CBD was seen adhering to the duodenum and colon. Debulking of the tumor was done and biliary-enteric continuity was restored with Roux-en-Y hepaticojejunostomy. The distal end of CBD was free from tumor. Enlarged regional lymph nodes were excised as well. Grossly the lesion was grayish-white, firm, and nodular. Attached gall bladder with cystic duct was unremarkable with cystic duct entering the mass. The proximal resection margin was involved by the tumor. Histopathology revealed a tumor disposed in short fascicular and vague storiform pattern with variable collagenous stroma. The bland tumor cells were plump, spindle with oval to elongated nuclei, minimal nuclear pleomorphism, inconspicuous nucleoli and pale eosinophilic cytoplasm. The spindle cells were intimately mixed with dense inflammatory infiltrate comprising predominantly of mature plasma cells. At places, nonneoplastic glands lined by biliary type columnar epithelium were seen entrapped within the tumor (Fig. 1). On immunohistochemistry, the tumor cells were immunoreactive for vimentin, smooth muscle actin (SMA), and negative for cytokeratin (CK), CD34, CD117, DOG1, and ALK1 (Fig. 2). A final diagnosis of IMT was made. The enlarged lymph nodes revealed reactive lymphoid hyperplasia. The postoperative course was uneventful and the patient was discharged on Etoricoxib. * Ritu Verma dr_rituverma@rediffmail.com

Does desmin immunohistochemistry have a role in assessing stage of urothelial carcinoma in transurethral resection of bladder tumor specimens

Context: Pathological stage is the most important determinant of clinical outcome of bladder carcinoma patients. pT 1 carcinoma is defined by invasion into lamina propria, including muscularis mucosae (MM), but not into muscularis propria (MP) (pT 2 ). However, pathological staging of the tumor is a complicated task for pathologists. Splitting of MP or hypertrophy of MM caused by tumor invasion are important causes of interpretation subjectivity leading to intra-pathologist variation and disagreement. The aim of the study was to prospectively evaluate the utility of desmin immunohistochemical expression for evaluation of muscle invasion in transurethral resection of bladder tumor (TURBT) specimens. Materials and Methods: A total of 40 TURBT cases was taken. Specimens were processed, stained with H and E, graded and evaluated to determine whether MP invasion was present. Desmin immunohistochemistry (IHC) was used to assess muscle invasion and compare the result with H and E stained sections. Tumors with radiological evidence of gross invasion and those of stage T is were excluded. Results: Among 40 TURBT cases, there were 37 cases of transitional cell carcinoma. Among them, 17 were high grade and 20 were low grade. On H and E, 17/37 cases showed MP invasion, 8/37 cases showed no MP invasion and the rest 12/37 had questionable MP invasion. Desmin staining intensity was graded from 0 to 3+. MM showed negative (0) and moderate (2+) staining in one case each, mainly (35/37) showed mild (1+) staining intensity. MP showed moderate (2+) (3/37) to strong (3+) (34/37) staining intensity. Among 12/37 questionable cases (on H and E) desmin staining showed definite MP invasion in eight cases. Conclusions: Although morphology remains the gold standard, desmin IHC has diagnostic utility in the evaluation of questionable MP invasion and hence in staging of urothelial carcinoma.