Khalil Baba

Extraventricular neurocytoma of the vermis in a child

Neurocytomas are rare neoplasms, composed of uniform round cells with neuronal differentiation. We report a rare extraventricular neurocytoma (EVN) in a 5-year-old boy who presented with headache and vomiting. His MRI brain showed a vermian mass. The histopathological examination and immunohistochemistry revealed it to be an EVN. We report this patient for the rarity of the condition and the EVN mimicking a medulloblastoma on imaging. This tumor needs to be differentiated from a medulloblastoma as the former has a better prognosis.

HRAS T81C polymorphism modulates risk of urinary bladder cancer and predicts advanced tumors in ethnic Kashmiri population

OBJECTIVE Specific acquired HRAS mutations have been found to predominate in bladder cancer, and HRAS T81C polymorphism has been determined to contribute the risk of various cancers, including bladder cancer. MATERIALS AND METHODS We screened the exon 1and 2 of HRAS and frequently detected polymorphism at nucleotide 81T to C (exon 1). A case-control study was conducted using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to test the genotype distribution of 140 bladder cancer patients in comparison with 160 cancer-free controls from a Kashmiri population. RESULTS In HRAS T81C SNP, frequencies of TT, TC, and CC genotypes among controls were 84.4%, 15.6%, and 0.0%, while in cases allele frequencies were 64.3%, 30%, and 5.7%, respectively. A significant differences was observed between the control and cases with odds ratio (OR) = 3.0 and 95% confidence interval (CI) = 1.74-5.20 (P = 0.000). Interestingly, combined TC and CC genotype abundantly presented in high grade (OR = 5.4 and 95% CI = 2.8-10.2; P < 0.00) and in advanced tumors (OR = 3.3, 95% CI = 1.71-6.30; P < 0.05). A significant association of the variant allele (TC+CC) was found with male subjects (≥50) and ever smokers (P = 0.001). CONCLUSION It is evident from our study that HRAS T81C SNP moderately increases bladder cancer risk, and rare allele is a predictive marker of advanced bladder tumors.

Metastatic lymphadenopathy in Kashmir valley: a clinicopathological study.

BACKGROUND Lymphadenopathy is a common presentation in both benign and malignant diseases which need to be diagnosed without delay. Fine needle aspiration cytology (FNAC) helps us diagnose a disease and follow its course, including the response to therapy. AIM This study aimed to analyze the clinicopathological features of metastatic lymphadenopathy and the diagnostic utility of FNAC in our setting. MATERIALS AND METHODS This two-year prospective study included all the patients with metastatic lymphadenopathy, diagnosed with FNAC. RESULTS A total of 412 cases (male:female ratio, 1.3:1; age range, 3 to 90 years) were studied. Supraclavicular lymph nodes were involved most commonly (50.5%). The commonest metastatic tumor was squamous cell carcinoma in general (30.1%) and in males (37.6%), and infiltrating ductal carcinoma (25.3%) in females. Lung, with 64 (15.5%) cases followed by esophagus, 60 (14.6%) cases; breast, 49 (11.9%) cases; skin, 32 (7.8%) cases; and stomach, 25 (6.1%) cases were the most common primary sites of malignancy. In 69 patients, excision biopsy was performed. Histopathological findings correlated well with that of cytology in all these cases. CONCLUSIONS FNAC is an important tool in the diagnostic work up of metastatic lymphadenopathy, which in the hands of an experienced and skilful cytopathologist can avoid the need for excision biopsy.

Profile of Lymphadenopathy in Kashmir Valley: a Cytological Study

Lymphadenopathy is one of the commonest and significant manifestations of local as well as systemic ailments, especially malignancies. Fine needle aspiration cytology (FNAC) helps in diagnosing the disease itself, in general, but more importantly ruling out malignancy, in particular. Hence it saves much of the cost and use of resources incurred with excision biopsy of such lymph nodes. This prompted us to study the cytologic patterns of lymphadenopathy in our setting and the diagnostic utility of FNAC in the evaluation of lymphadenopathy. In this retrospective observational study, 1,579 patients (953 males and 626 females) with lymphadenopathy who were subjected to FNAC over a period of three years (January 2009 to December 2011) were studied. The cervical region was involved in most of the cases (76%) followed by the axillary region (17.5%). Metastatic malignancy (38.2%) was the commonest cause of lymphadenopathy followed by reactive lymphoid hyperplasia (36.9%), tuberculosis (9.1%) and lymphomas (8.6%). Squamous cell carcinoma (32.2%) followed by adenocarcinoma (21.9%) were the most frequent metastatic tumors. FNAC is a useful diagnostic tool in the management of patients presenting with lymphadenopathy and should be considered before more invasive and costly procedures are performed, particularly in developing countries.

Bilateral Breast Metastasis from Mucinous Adenocarcinoma of the Rectum: A Case Report and Review of the Literature / Rektum Müsinöz Adenokarsinomundan Bilateral Meme Metastazı: Bir Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Abstract Metastatic breast carcinoma is rarely seen in clinical practice. It has been reported that lymphoma-leukemia, melanoma and sarcomas can metastasize to the breast. Bilateral metastases to the breast are rare and commonly have been seen to originate from ovarian carcinoma. Adenocarcinoma of rectum metastasizing to breast is an extremely rare clinico-pathological situation. We report a 28-year-old female who presented with bilateral breast metastasis 9 months after abdomino-perineal resection and total meso-rectal excision for a locally advanced mucinous adenocarcinoma of the rectum. A few case reports of a mucinous adenocarcinoma of rectum presenting with bilateral breast metastasis have been seen in the world literature and we hereby report this case who till now is the youngest patient reported Öz Metastatik meme karsinomuna klinik uygulamada nadiren rastlanır. Lenfoma-lösemi, melanom ve sarkomların memeye metastaz yapabildiği bildirilmiştir. Memeye bilateral metastaz nadirdir ve sıklıkla over karsinomundan köken aldıkları görülmüştür. Memeye metastaz yapan rektum adenokarsinomu son derece nadir bir kliniko-patolojik durumdur. Yerel ilerlemiş rektum müsinöz adenokarsinomu için abdominoperineal rezeksiyon ve total mezorektal eksizyon yapılan ve 9 ay sonra bilateral meme metastazı saptanan (28 yaşında bir kadını) hastayı sunuyoruz. Dünya literatüründe bilateral meme metastazıyla gelen birkaç rektum müsinöz adenokarsinomu olgusu bildirilmiştir ve biz de şimdiye kadar bildirilen en genç hasta olan bu olguyu sunuyoruz.

Clinicopathologic Characteristics of Brain Gliomas: Experience From Culturally and Geographically Distinct Kashmir Valley

Kashmir valley is distinct from rest of India geographically. It has a different climate with people having different social and dietary habits. Cancer pattern in Kashmir is different from rest of India with gastric, esophageal, and skin cancer having a higher prevalence in the valley. No comprehensive study on brain tumors prevalent in the valley is available. To study the pattern of brain tumors, a 3-year retrospective analysis of gliomas was carried out, which are the commonest brain tumors in this population. One hundred and forty gliomas were seen, of which 56 were low grade and 84 were high grade. The clinicopathologic spectrum of gliomas with their outcome was analyzed and it was noted that the spectrum is not different from that reported from rest of India with malignant gliomas as more common and glioblastoma as the commonest tumor accounting for 35% of total gliomas. Among low-grade tumors fibrillary astrocytoma (World Health Organization grade II) accounted for most cases (16.7%). Other tumor types such as oligodendroglioma, oligoastrocytoma, and ependymoma showed a pattern comparable with those occurring in other regions. Radiologic features of gliomas with their outcome were also studied and on analysis these parameters were not different from those reported elsewhere.

An Unusual Case Report - Longest Appendix in India (20.5 cm)

Introduction: The vermiform appendix is an organ that can have variable sizes, locations as well as functional potentials. Appendicitis is the most common surgical emergency, but its diagnosis can be a challenge to the treating surgeon. A 25 years-old male was admitted to the surgical ward with a right sided abdominal pain. The initial clinical presentation was vague. He underwent an appendicectomy which revealed a very long appendix. About half of the adult patients with appendicitis present with the known classical signs and symptoms, but the clinical scenario might be occasionally completely different usually due to varying appendicular tip position. We describe here the longest and largest appendix removed in India to date, measuring about 20.5 cm in length.

Primary gastrointestinal lymphomas in children: An experience of 12 years from a tertiary care center of North India

BACKGROUND AND AIM Lymphomas are among the dominant solid tumors in children and primary gastrointestinal lymphomas (PGILs), although rare, are the most common extranodal lymphomas and the most common malignancies affecting the gastrointestinal tract in children. This study was undertaken to analyze childhood PGIL with reference to clinical presentation, anatomic distribution, histopathologic, and immunohistochemical (IHC) characteristics. MATERIALS AND METHODS In this 12 year combined retrospective and prospective descriptive study, all the cases of PGIL in children were selected according to Dawsons criteria. RESULTS A total of 11 cases were found which included 9 boys and 2 girls (male:female - 4.5:1) ranging in age from 1 to 14 years (mean 6.6 years). Abdominal pain (81.8%) and intestinal obstruction (63.6%) were the most common presenting features. Grossly, most of the lesions were ulcero-infiltrative (72.7%) and involved the terminal part of the ileum (36.4%) and ileocecal region (27.3%) most commonly. Histopathologically and IHC, all the cases were high-grade lymphomas of diffuse large B-cell type except for one case of mucosa-associated lymphoid tissue lymphoma. No case of Burkitts lymphoma was found. CONCLUSION PGILs are an important cause of morbidity and mortality in children worldwide with considerable variation in their clinicopathological features and treatment modalities. Only some studies are available in literature for comparison. Further studies are required to define the genetic and molecular basis of the different histopathological pattern found in our setting.

Synchronous Primary Adenocarcinoma and Gastrointestinal Stromal Tumor of Stomach: A Case Report and Review of Literature

A synchronous occurrence of epithelial and gastrointestinal stromal tumors (GISTs) in the stomach is unusual. The association has often been detected incidentally and it is not known whether such an association is a simple incidental coexistence or there is a causal relationship between the two lesions. We hereby report a 70-year-old male operated for adenocarcinoma of stomach who, besides the primary lesion in the lesser curve, had another lesion i.e., GIST on the serosal aspect of antrum picked up on gross examination of the specimen. The tumor was GIST of low risk category which was positive for tumor markers CD117 (C-kit) and CD34. The case is presented here for its rarity.

Squamous Cell Carcinoma of Lung with Osteo-Cartilaginous Metaplasia: A Case Report and Review of the Literature

Abstract Calcification and ossification are very rare in primary squamous cell carcinoma of the lung. We report a 55-year-old male with primary squamous cell carcinoma of the lung who on histopathological examination was seen to have extensive calcification and ossification. Squamous carcinoma of the lung rarely presents with osteocartilaginous metaplasia. The case is presented here for its unique presentation. ÖZ Akciğerin primer skuamöz hücreli karsinomunda kalsifikasyon ve ossifikasyon çok nadirdir. Histopatolojik incelemede yaygın kalsifikasyon ve ossifikasyon görülen primer skuamöz hücreli akciğer karsinomu bulunan 55 yaşında bir erkek hastayı sunuyoruz. Akciğerin skuamöz hücreli karsinomu nadiren osteokartilajinöz metaplazi gösterir. Vaka bu nadir özelliği nedeniyle sunulmuştur.