Jayasree Kattoor

Malignant Phyllodes Tumor

The study aims to evaluate the survival and prognosis of patients with malignant phyllodes tumor. Between 1982 and 1998, 37 women with malignant phyllodes tumor were treated at the Regional Cancer Center, Trivandrum. Twelve patients were recurrent. Survival was estimated using the Kaplan‐Meier method. Patient, disease, and treatment factors were compared using log‐rank test. The Cox‐proportional hazard model was employed to identify the prognostic factors. Thirty‐six patients had surgery. Twenty‐five patients received postoperative radiotherapy, and 2 received chemotherapy in addition. The median follow‐up was 43 months (range 1–170 months). Eight patients failed locally, and 7 of these were successfully salvaged by surgery. The 5‐year overall survival was 74.2% (95% CI, 0.44 to 0.89), whereas 5‐year disease‐free survival was 59.6% (95% CI, 0.39 to 0.7). The margin of surgical excision was found to be the only independent prognostic factor (p = 0.003). However, patients with tumor size more than 5 cm (hazard ratio 2.9) were found to have increased hazard, whereas those receiving adjuvant radiotherapy (hazard ratio 0.6), married women (hazard ratio 0.4), and those women over the age of 35 years (hazard ratio 0.7) showed a decreased hazards. Cystosarcoma phyllodes is a rare malignancy of the female breast. Surgery with adequate margins is the primary treatment. Adjuvant radiotherapy appears to improve the disease‐free survival.

Meningioma presenting as temporal region swelling: Diagnosis by cytopathology and immunohistochemical confirmation on cell block preparation.

Meningiomas are common intracranial neoplasms. Meningomas are rarely subjected to fine-needle aspiration (FNA) studies. However, intraoperative squash preparations are commonly done. FNA of meningiomas are usually performed incidentally for cases with a clinical suspicion of some other disease such as metastatic carcinoma. We are reporting two cases, which were referred to our center with a diagnosis of metastatic carcinoma on FNA from swelling of the temporal region. We are discussing the characteristic cytomorphological features, which help in diagnosing meningiomas, the common cytological differentials, and the utility of immunohistochemistry (IHC) on cell block preparations in confirming the diagnosis, especially when there is a clinical differential diagnosis.

Malignant melanoma of breast: A unique case with diagnostic dilemmas

Melanomas arising in the skin, mucous membranes, and eye are encountered commonly than melanomas involving the breast. Melanomas in the breast are usually metastatic. Primary melanoma of the breast is extremely rare. We report a case of malignant melanoma of breast (primary/metastatic) that presented as a breast lump in a patient with no detectable cutaneous, mucosal or ocular lesion and who is a known case of squamous cell carcinoma of the oral cavity and had relapsed twice. The unexpected challenges faced during the diagnosis prompted us to report this case.

Odontogenic ghost cell carcinoma with pulmonary metastasis

Odontogenic ghost cell carcinoma (OGCC) is an exceptionally rare malignant odontogenic epithelial tumor. It is characterized by ameloblastic-like islands of epithelial cells with aberrant keratinization in the form of ghost cells with varying amounts of dysplastic dentin. Malignant histological characteristics include infiltration, cellular pleomorphism, numerous mitosis and necrosis. Its biological behavior varies from slow-growing locally invasive lesions to rapidly growing highly aggressive tumors. OGCC metastasizing to distant sites is extremely rare. Only three cases of metastasis have been reported in literature. We are reporting the case of a 54-year-old male patient who presented with tender swelling in the malar region. Histopathological examination revealed OGCC and he received postoperative radiotherapy. Two years later, he presented with a lung mass. Biopsy from the lung lesion showed the same morphology as that of maxillary tumor with scattered ghost cells. This case points to the aggressive behavior of OGCC and its metastatic potential. It also highlights the need for long-term follow-up of these patients.

Chondroblastoma: Report of two cases diagnosed by cytology

Chondroblastoma is an uncommon benign cartilage producing neoplasm with a characteristic epiphyseal location. This report documents the cytological features of two cases of chondroblastomas diagnosed by cytology. One of the two cases had an unusual location in the temporomandibular region and the other was located in the epi-metaphyseal region of the right humerus. Smears characteristically revealed chondroblasts and osteoclast-like giant cells. The cytologic diagnosis of chondroblastoma was confirmed on both cases by histopathology. The radiologic appearance and differential diagnosis in both cases are discussed.

Primary systemic amyloidosis of tongue with chondroid metaplasia

Amyloid is a pathologic proteinaceous substance deposited between cells in various tissues in a variety of clinical conditions. We report a case of amyloidosis of tongue with extensive chondroid metaplasia diagnosed on incisional biopsy in a multiple myeloma patient, who underwent autologous peripheral blood stem cell transplant for the same in 2010 and now presented with disease relapse after 2 years.

Renal cell carcinoma metastasizing to adenocarcinoma of esophagogastric junction: A rare case of tumor-to-tumor metastasis

The simultaneous occurrence of two primary tumors in one patient is not uncommon, but one tumor metastasizing to another malignancy is a rare phenomenon. Tumor-to-tumor metastasis was first described by Berent in 1902. Since then fewer than 200 cases have been reported in the literature. In most of these cases renal cell carcinoma acted as a recipient tumor. In tumor-to-tumor metastasis renal cell carcinoma acting as a donor is exceedingly rare and there are no reported cases of adenocarcinoma of the esophagogastric junction acting as a recipient. We present a case of renal cell carcinoma metastasizing to an adenocarcinoma of esophagogastric junction. To our knowledge, this is the first reported case of such a combination.