Mary Theresa Sylvia

The expression of immunohistochemical markers estrogen receptor, progesterone receptor, Her-2-neu, p53 and Ki-67 in epithelial ovarian tumors and its correlation with clinicopathologic variables.

BACKGROUND This study aims to evaluate the expression of estrogen receptor alpha (ER α), progesterone receptor A (PRA), Her-2-neu, p53, and Ki-67 in epithelial ovarian tumors and their correlation with various clinicopathologic variables. MATERIALS AND METHODS This study included 60 consecutive cases of epithelial ovarian tumors. Sections of 4 μm were taken from paraffin embedded tissue blocks for immunohistochemistry (IHC). Statistical analysis was done using Chi square test, ANOVA. RESULTS ER α had lower expression in benign (29%) and PRA higher expression in malignant (63.6%) tumors. ERα, PRA had higher expression in serous (72.72%, 57.14%), postmenopausal (81.8%, 71.42%), advanced stage (63.63%, 52.38%), grade 3 (45.45%, 38.09%), and tumors with ascites (90.90%, 85.7%). Her-2-neu, p53 were negative in benign and higher in malignant (21%, 57.6%), serous (71.42%, 57.89%), grade 3 (57.14%, 31.57%), and tumors with ascites (85.7%, 84.21%). Ki-67 had a significant higher expression in malignant (48.6 ± 26.76), serous (55.43 ± 27.85), and grade 3 tumors (68 ± 22). CA-125 levels were significantly higher in malignant, serous, advanced stage, grade 3 and ER α, Her-2-neu and p53 positive tumors. CONCLUSION ERα, PRA expression in tumors with adverse prognostic factors support the mitogenic role of estrogen and estrogenic regulation of PR. Her-2-neu and p53 expression only in malignant tumors suggest their carcinogenic role and aid in the differentiation of borderline and malignant tumors. Higher Ki-67 in tumors with adverse prognostic factors would help in prognostication and differentiation. Lack of co-expression of markers proves the extreme heterogeneity of ovarian tumors. These markers may aid in differentiation and prognostication of ovarian tumors.

Verocay bodies and myxoid change in fibrosarcomatous variant of dermatofibrosarcoma protuberans: A case report and review of literature

Dermatofibrosarcoma protuberans (DFSP) is a fibro-histiocytic tumor of intermediate malignant potential. Unusual morphologic patterns can be misleading. Sarcomatous change in DFSP is a rare occurrence. Presence of Verocay bodies and myxoid change in DFSP is uncommon. We report a case where the trucut biopsy was initially reported as neurogenic tumor based on prominent Verocay bodies, myxoid change and increased mitoses. Resection specimen had classic areas of DFSP with foci of Verocay bodies, prominent myxoid change, myofibroblastic differentiation, sarcomatous transformation and a satellite nodule. We also briefly discuss the relevant literature.

Multiple myeloma with crystalline and Auer rod-like inclusions

A 50-year-old male presented with fatigability. A peripheral blood film showed marked rouleaux formation (top left). A bone marrow aspirate showed 74% plasma cells (top right), many of which had intracytoplasmic inclusions; some of these were empty spaces in the shape of crystals (bottom left) while others were azurophilic and needle-shaped, resembling Auer rods (bottom right). A few of the crystalline inclusions were extracellular. Serum immunoelectrophoresis showed a monoclonal M protein, immunoglobulin (Ig)G, with kappa light chain restriction. Crystalline cytoplasmic inclusions are a rare finding, seen in 1% of multiple myeloma cases, and result from the crystallisation of immunoglobulin. This phenomenon was first described by Steinmann in 1940. Crystals may be Auer rod-like (needle-shaped) or rhomboid/rectangular: usually only one form is found in an individual case. Our patient is unusual in having both types of inclusion. Earlier reports of cases with inclusions were IgA secreting but there are also reports of crystals associated with IgG secretion, as in our patient. There is no known prognostic significance.

Cutaneous lupus erythematosus of elbows: A distinct entity?

The elbow is not recognized as common site for cutaneous lupus erythematosus (CLE) lesions. Twelve cases of CLE over the elbows were evaluated for systemic involvement and Cutaneous Lupus Disease Area and Severity Index activity and damage scores and Systemic Lupus Erythematosus Disease Activity Index scoring was done. Histopathological examination of the affected skin was performed in doubtful cases. Most of the patients were women (10, 83.3%) with mean age of 28.75 years. Three patients had only elbow lesions and the remaining nine patients had CLE lesions at sites other than the elbows, of which five had elbow lesions preceding skin lesions elsewhere over the body and three patients were not aware of whether elbow lesions preceded or succeeded CLE lesions at other sites, and one patient had noticed malar rash 9 months prior to elbow lesions. All the patients antinuclear antibody positivity, systemic involvement, and fulfilled criteria for systemic lupus erythematosus. This peculiar localization of CLE to the elbows may be associated with a greater risk of systemic involvement and may be an predictor of flare of LE.

Neurotized congenital melanocytic nevus resembling a pigmented neurofibroma.

Neurotized congenital melanocytic nevus and pigmented neurofibroma (PNF) are close mimics and pose a clinicopathological challenge. We present a case of pigmented hypertrichotic plaque over lumbosacral region and discuss the differential diagnosis and its clinical, histopathological and immunohistochemistry features which may aid in differentiation. We highlight the difficulties faced in differentiating neurotized congenital melanocytic nevus from pigmented neurofibroma.

Reactive eccrine syringofibroadenomatosis presenting as bilateral plantar hyperkeratosis

Eccrine syringofibroadenoma (ESFA) is a rare cutaneous tumor with eccrine differentiation with varied clinical manifestations. We report a case of reactive eccrine syringofibroadenomatosis associated with chronic bilateral plantar ulcers in a patient with diabetes mellitus presenting as plantar hyperkeratosis and verrucous growth at margins.

Ochronosis masquerading as pigmented villonodular synovitis: a case report

Alkaptonuria is an autosomal recessive disorder of tyrosine metabolism with a Mendelian pattern of inheritance. We present a unique, clinically asymptomatic case of ochronosis, first diagnosed on histopathological examination. This case is presented for its rarity. The knowledge of the histopathological changes would help to clinch the diagnosis even when it is not suspected clinically or radiologically, as in our case. An early and appropriate diagnosis would direct conservative therapy rather than major surgeries and would also help in preventing the development of fatal complications.