Kiran Mishra

Low‐dose mifepristone in treatment of uterine leiomyoma: A randomised double‐blind placebo‐controlled clinical trial

Aims: To evaluate the effect of low‐dose mifepristone on leiomyoma‐related symptoms, uterine and leiomyoma in women with symptomatic leiomyomata.

Solid tumors of childhood.

Objective : Cancer is one of the leading causes of death in children. There is the need to have the histologic review of malignancies in children from the Indian sub–continent.Methods : In the present study, malignant tumors received over 12 years were reviewed and re–classified according to classifications based on prognosis.Results : A total of 472 tumors were received over 12 years. Of these 318 were benign and 154 malignant. The commonest malignant solid tumor was lymphoma followed by pediatric renal tumors. The sarcomas included bone tumors, Rhabdomyosarcoma and synovial sarcoma. There were 13 germ cell tumors, 10 retinoblastomas and six neuroblastomas.Conclusion: The review revealed that a definite diagnosis or classification was not assigned in 21 cases in the original reporting. Of these 14 could be assigned a definite category on review and immuno-staining. These included five non-Wilms sarcomas, four Rhabdomyosarcomas, three Ewing’s sarcoma/ PNETs and two Synovial sarcomas. The study also revealed an unexpected high percentage (11%) of epithelial malignancies in children

Malignant chondroid syringoma.

Malignant chondroid syringoma (MCS) is a rare tumor, of the sweat gland; only a few hundred such cases are reported in literature. A female presented with a subcutaneous swelling on the scalp with repeated recurrence and positive regional lymph nodes. Adequate planning for the treatment of this case was possible as preoperative diagnosis of MCS was documented by fine needle aspiration cytology (FNAC). The case was successfully managed with a multimodal approach, which included radical surgery and subsequent radiotherapy. The patient is symptom free after 25 months. The possibility of this type tumor should be entertained when multiple recurrences occur following adequate excision. FNAC has a definitive role in planning rational therapy.

Evaluation of endometrial steroid receptors and cell mitotic activity in women using copper intrauterine device: Can Cu-T prevent endometrial cancer?

Aims: To study changes in endometrial proliferative indices (i.e. cell mitosis and Ki67), endometrial steroid (estrogen and progesterone) receptors, and serum estradiol and progesterone level in women using copper intrauterine device (IUD) after 6 months of use.

Pheohyphomycosis caused by Exophiala spinifera: a rare occurrence

A 10‐year‐old immunocompetent boy presented with multiple, verrucous, disseminated pheohyphomycotic lesions caused by Exophiala spinifera. The patient was not responsive to combination antifungal therapy (itraconazole, terbinafine, fluconazole) and cryotherapy. As antifungal susceptibility is known to be variable for Exophiala spinifera, in vitro sensitivity testing is recommended before medical treatment. This article reviews, in brief, all cases documented so far in the English literature.

Fibromatosis Colli in Infants

OBJECTIVE To review eight cases of fibromatosis colli and assess their cytomorphologic features. STUDY DESIGN Cytologic smears from eight patients diagnosed as having fibromatosis colli on fine needle aspiration cytology were reviewed. RESULTS Cytologic features of fibromatosis colli are bland-appearing fibroblasts and degenerative atrophic skeletal muscle in a clean background. Besides these, we found a large number of muscle giant cells; numerous bland, bare nuclei; and parallel clusters of fibroblasts. Collagen was seen in all cases. CONCLUSION A confirmatory, noninvasive diagnosis of fibromatosis colli can be made by fine needle aspiration cytology alone; invasive diagnostic and therapeutic measures are best avoided. Excision biopsy may not be necessary and should be reserved for cases with a strong clinicopathologic suspicion of malignancy.

Comparison of the radiometric BACTEC 460 TB culture system and Löwenstein–Jensen medium for the isolation of mycobacteria in cutaneous tuberculosis and their drug susceptibility pattern

Background  Mycobacterial isolation from cutaneous tuberculosis on Löwenstein–Jensen (L–J) medium has been reported to be low. The radiometric BACTEC 460 TB culture system (BACTEC system) has shown better isolation rates in pulmonary tuberculosis. There has been a progressive increase in the prevalence of multidrug resistance in pulmonary tuberculosis, but similar studies are lacking for cutaneous tuberculosis. Therefore, this study was undertaken to compare mycobacterial isolation on conventional L–J medium vs. the BACTEC system, and to determine the prevalence of multidrug resistance in cutaneous tuberculosis.

Fine Needle Aspiration Cytology of Malignant Chondroid Syringoma

BACKGROUND: Chondroid syringoma, a tumor of the eccrine glands, was previously called mixed tumor of skin as it has both mesenchymal and epithelial elements. Malignancy in this tumor is extremely rare. Although there are a few reports describing the cytomorphologic features of chondroid syringoma, the cytologic findings of its malignant counterpart have not been described. CASE: A 40-year-old female presented with a recurrent swelling on the scalp of one years duration. Fine needle aspiration yielded blood-mixed gelatinous material. May-Grunwald-Giemsa-stained smears showed epithelial cells arranged in cordlike structures and ill-formed glands against a myxomatous background. The epithelial cells had scanty cytoplasm and markedly pleomorphic nuclei with prominent nucleoli. Afew cells in the stroma had a halo around them and a resemblance to cartilage cells. A preoperative diagnosis of malignant chondroid syringoma was made. The tumor was excised, and the cytologic diagnosis was confirmed on histopathology. CONCLUSION: Cytomorphologic features of a rare case of malignant chondroid syringoma are reported for the first time. The presence of malignant epithelial cells against a myxoid background with a few chondroid foci helped in making a correct preoperative diagnosis.

Syringomatous adenoma of the nipple: a case report

Sir, Nipple tumours are uncommon lesions of the breast. Adenoma of the nipple, syringomatous adenoma and papilloma are the limited tumours involving the nipple and areolar region. Syringomatous adenoma of the nipple is a rare neoplasm, first described by Rosen in 1983. To date, less than 25 cases have been reported in the English literature. It differs from other tumours of the nipple and areolar region in being of skin appendageal origin and differentiation. Incomplete excision of this locally infiltrative tumour is associated with a high rate of recurrence. Nipple sacrifice may be necessary for achieving complete excision and histologically negative margins. To the best of our knowledge, this is the first case to be reported from India. A 20-year-old female presented with a 2-month history of an itchy nipple lump in her right breast. She also complained of one episode of serous nipple discharge. There was no history of bleeding from the nipple, anorexia or weight loss. On examination, the lump was causing nipple enlargement. The overlying skin was ulcerated. The ipsilateral axilla, contralateral breast and axilla were unremarkable. The mass was excised completely with wide margins, including the overlying skin. The surgical specimen was fixed in 10% neutral buffered formalin and paraffin embedded. Four-mm thick sections were cut and stained with H&E. Immunohistochemical staining for epithelial membrane antigen (M 0613, dilution 1:100; Dako, Sweden) and S100 (N 1573, Dako) was performed using the streptavidin–biotin–peroxidase technique. Appropriate positive and negative controls were prepared simultaneously. The gross specimen consisted of a skin-covered nodular soft tissue piece measuring 1 cm in maximum dimension. The surface showed foci of ulceration. Microscopically, a connection between the tumour and overlying skin was present. The epidermis was slightly hyperplastic. An area of ulceration was also seen. Keratotic cysts containing amorphous pink material were present in the superficial portion of the tumour (Fig. 1). The tumour was composed of ducts and tubules scattered in a fibrous stroma. Characteristic commaor tadpole-shaped ducts were seen. The majority of the ducts were lined with doublelayered epithelial cells. A few areas showed epithelial hyperplasia in the form of multilayering and micropapillae. Some ducts were slightly dilated and contained eosinophilic secretions and foamy cells. Lining cells were small, cuboidal, and contained a moderate amount of eosinophilic cytoplasm and central nuclei. Mitotic figures (five to six per 10 high power fields) were seen. Myoepithelial cells were inconspicuous. The stroma was fibrous and unremarkable. Lymphocytes and plasma cells were present in the stroma. There were no areas of haemorrhage or necrosis. At the periphery, the tumour infiltrated into the surrounding smooth muscle of the nipple and underlying breast parenchyma. In the deeper portion, tumour ducts surrounded lactiferous ducts (Fig. 2). The deep resected margin was free of tumour. Staining for epithelial membrane antigen showed positivity limited to the luminal border of epithelial cells. S100 stained tumour-infiltrating Langerhans cells, leaving epithelial cells unstained (Fig. 3). Myoepithelial cells were conspicuously absent. Syringomatous adenoma of the nipple is a rare neoplasm. Its morphological features, namely tadpoleshaped ducts embedded in a fibrous stroma and keratotic cysts, are strikingly similar to syringoma of the skin. However, syringomatous adenoma of the nipple is a locally infiltrating neoplasm, often involving the smooth muscle of the nipple, underlying breast parenchyma and even nerves. Our case showed all the typical morphological features of syringomatous adenoma of the nipple, including origin from overlying epidermis, keratotic cysts and local infiltration. In addition, our case showed uncommon features like epithelial hyperplasia and Fig. 1 Scanner view of tumour showing connection between the tumour and overlying skin. Keratotic cysts are seen in the upper left quadrant (H&E, original magnification, 640).

ER, PR and Ki-67 expression status in granulomatous and chronic non-specific endometritis

Aim:  To study the changes in the histological pattern, distribution and intensity of sex steroid receptors (estrogen and progesterone) and cell proliferation by Ki‐67 expression by semi‐quantitative scores in granulomatous and chronic non‐specific endometritis in the premenstrual phase.