Mohammad Jaseem Hassan

An Incidental Primary Papillary Carcinoma Arising in a Thyroglossal Duct Cyst: Report of a Rare Finding.

The thyroglossal duct cysts (TGDCs) are the most common congenital anomaly of the thyroid, usually manifested as painless midline neck mass. Malignancy is very rare and is reported in around 1% of cases as an incidental finding after histopathological evaluation of resected cyst. Papillary carcinoma is the most common carcinoma reported in TGDC. Here, we report a case of 17-year-old-female, who presented with a gradually increasing midline neck mass which moves with swallowing. On imaging a diagnosis of infected TGDC was made. The Sistrunk operation was done and a diagnosis of primary papillary carcinoma arising in a TGDC was rendered histopathologically. The contemporary appearance of papillary carcinoma thyroid was reported in about 20% cases of TGDC carcinoma, thus it is essential to differentiate primary papillary carcinoma arising in a TGDC from those of metastatic papillary carcinoma thyroid by strict diagnostic criteria.

Atypical fibroxanthoma in a young female misdiagnosed clinically as a malignant melanoma- An unusual presentation

Atypical fibroxanthoma (AFX) is an uncommon spindle cell tumor with intermediate or borderline malignant potential. Clinically, it may be misdiagnosed as a squamous cell carcinoma (SCC) or malignant melanoma. Solar irradiation has been implicated in its pathogenesis. The diagnosis of AFX rests on a combination of histopathological features and a negative immunohistochemical profile. AFX is a rare tumor usually found in sun exposed skin of head and neck region in elderly Caucasian men. Rarely, it has a second peak in young adults, where it is found in trunk and extremities. The present case is reported as AFX is quite unusual in a young female with a nodule in the leg which was clinically diagnosed as a malignant melanoma. Only a few cases of AFX have been reported in young women. This case highlights the fact that accurate diagnosis of atypical fibroxanthoma is very crucial so as to avoid overenthusiastic and overzealous treatment as required for a malignant tumor.

Coexistent axillary hydatid disease and tuberculosis: Case report of an extremely rare occurrence.

Tuberculous infection is highly prevalent in India, however, hydatid disease is relatively uncommon. Frequent sites of predilection of hydatid disease are the liver and lungs. Other unusual sites of infliction are the peritoneum, thyroid, breast, pancreas, and mediastinum. Hydatid disease in the axilla is quite uncommon. We hereby report a case of coexistent axillary hydatid disease with tuberculous lymphadenitis. To the best of our knowledge, even after extensive search of the literature we did not come across any such case. Fine needle aspiration cytology (FNAC) is a cost-effective procedure performed on an outpatient basis and helped clinch a prompt diagnosis, with minimum discomfort or complications. The role of FNAC in early diagnosis cannot be overemphasized.

Primary Endometrial Squamous Cell Carcinoma In Situ: Report of a rare disease.

Squamous cell carcinoma (SCC) of the endometrium, whether primary or secondary to cervical cancer, is a rare entity. Primary endometrial squamous cell carcinoma in situ is even more uncommon; it usually occurs in postmenopausal women and has a strong association with pyometra. We report a 60-year-old multiparous postmenopausal woman who presented to the Hakeem Abdul Hameed Centenary Hospital, New Delhi, India, in May 2014 with a lower abdominal swelling corresponding in size to a pregnancy of 26 gestational weeks and vaginal discharge of one years duration. A total abdominal hysterectomy with a bilateral salpingooophorectomy was performed, which revealed an enlarged uterus with pyometra. Histopathology showed that the entire endometrial lining had been replaced with malignant squamous cells without invasion of the myometrium. Immunohistochemistry revealed that the tumour cells were positive for p63 with a high Ki-67 labelling index. No adjuvant therapy was required and the patient was disease-free at a seven-month follow-up.

Extramedullary plasmacytoma of the thyroid: report of a rare case

TO THE EDITOR: Extramedullary or extra-osseous plasmacytomas (EMP/EOP) are localized plasma cell neoplasms that arise in tissues other than bone. EMP comprises 3-5% of all plasma cell neoplasms. The upper respiratory tract and the oral cavity are the most common sites for EMP [1], and the thyroid gland is one of the rare sites for this neoplasm. Here, we report a case of EMP of the thyroid in a 53-year-old male who presented to the surgery outpatient department (OPD) with a left-sided thyroid swelling of six months duration.

Atypical Leiomyoma: a rare histologic variant - A Diagnostic Challenge

Bizarre or atypical leiomyoma (LM) is defined as “leiomyoma containing giant cells with pleomorphic nuclei and little or no mitotic activity.” Due to the ominous and worrisome microscopic appearance (many large giant cells with hyperchromatic, pleomorphic, malignant looking nuclei), this variant maybe misdiagnosed as a sarcoma. It, therefore presents a diagnostic challenge to the pathologist to accurately diagnose such a tumor while ensuring that a true malignancy is not overlooked. We report a case of a atypical leiomyoma of the uterus in a 40 year old female presenting with irregular menstrual bleeding. This highlights the need for extensive tissue sampling in such dubious cases to help arrive at a correct diagnosis. Bangladesh Journal of Medical Science Vol.17(3) 2018 p.511-514

Cytological diagnosis of crystallizing galactocele – report of an unusual case

Crystallizing galactocele is a very rare entity which yields a viscous, chalky material on Fine Needle Aspiration Cytology (FNAC). FNAC is used both for diagnosis as well as treatment of this condition. We present here a case of 26 years old lactating female who presented with swelling in the right breast for 8 months. The swelling was firm, discrete, non-tender and mobile involving the upper inner quadrant of right breast. A diagnosis of benign breast disease, possibly fibroadenoma was made clinically. FNAC of the lesion yielded thick, milky and chalky material. Cytological smears showed numerous semitransparent crystals of varying size and shapes with angulated borders in a background of granular and amorphous debris along with frothy appearing micelles. These crystals show positive birefringence. Based on clinical history of lactation and typical cytological findings, a diagnosis of crystallizing galactocele was made. We report this case because of rarity of this condition and to the best of our knowledge, till date only five cases of crystallizing galactocele has been reported in medical literature.

Inflammatory Pseudotumor of the Spleen Masquerading as Splenic Malignancy

Inflammatory pseudotumors (IPTs) of the spleen are extremely rare, benign tumors of unknown etiology, and are most frequently detected incidentally. We report a case of IPT of the spleen in a 19-year-old male, who presented to the Hamdard Institute of Medical Sciences and Research, New Delhi, with a history of pain and heaviness in the left hypochondrium. On clinical examination, splenomegaly was detected. Ultrasonography and contrast-enhanced computed tomography of the abdomen revealed an enlarged spleen with a mass lesion completely occupying the lower pole of the spleen. Therefore, a diagnosis of splenomegaly with a malignant splenic lesion was suggested. Open splenectomy was performed. On gross examination, a well-circumscribed nodular growth measuring 9 × 8 × 5 cm in diameter was seen on the lower pole of the spleen, which on cut section appeared tan white with foci of yellowish discoloration. Microscopic examination of the nodular growth revealed spindle cells in a hyalinized stroma with inflammatory infiltration of predominantly plasma cells and lymphocytes. On immunohistochemistry, the spindle cells were positive for smooth muscle actin. A diagnosis of IPT of the spleen was rendered following histopathology testing. Splenectomy is both diagnostic and curative for this rare entity, and prognosis is usually favorable following the procedure.

Role of fine needle aspiration cytology in diagnosis of various giant cell lesions of bone and its Histopathological correlation

Introduction: Correct diagnosis is a matter of supreme importance because the treatment varies in different types of musculoskeletal tumors and in conditions simulating these tumors. Because of limited presence of literature for cytological diagnosis of giant cell lesions of the bone, we conducted this study to assess the reliability of Fine needle aspiration cytology in diagnosis of giant cell lesion of the bone and correlating our findings with final histopathological diagnosis. Method: The superficial and deeply located bone lesions were localized with the help of radiographs. For aspiration of superficial lesions 22-23 gauge needles was used along with 10 ml disposable syringe, while for deeply located lesion 20 gauge needles was used. The cytological smears were then stained by May Grunwald Giemsa and Hematoxylin and eosin stain. Result: During the period of one and half years, cytological diagnosis of giant cell lesions was made in 27 cases on FNAC. The mean age of the patient was 21.7 years with male to female ratio of 1.25:1. Maximum number of cases (18/27 cases) was encountered in 11-30 year age group. Tibia was the most common bone involved (12 cases) followed by femur and humerus (5 cases each). On final histopathological evaluation various giant cell lesions consist of 16 cases of Giant cell tumor, 5 cases of aneurysmal bone cyst and 3 cases each of Fibrous dysplasia and Chondromyxoid fibroma. Conclusion: Despite limited literature we wish to recommend fine needle aspiration cytology as initial tool for differentiation of various giant cell lesions especially in conjunction with clinical and radiological findings.

Hepatic tuberculosis mimicking metastasis in a case of carcinoma sigmoid colon

Tuberculosis (TB) presenting as isolated liver mass without clinical evidence of TB is difficult to diagnose preoperatively and is usually mimicked by primary or metastatic carcinoma of the liver. Hepatic TB associated with carcinoma colon is a rare association which has very rarely been reported in the literature. This case illustrates the diagnostic difficulties of hepatic TB and the need to consider it in the differential diagnosis of hepatic nodular lesions in carcinoma colon patients. Here, we report a case of 48-year-old female who presented in the casualty with features of acute intestinal obstruction. Preoperatively a mass was seen at the hepatic flexure along with three lesions in the liver presumed to be metastatic in origin. However, histopathology of the mass revealed adenocarcinoma colon and the liver lesion proved to be hepatic TB. We wish to highlight that on encountering a hepatic lesion in a carcinoma colon patient the possibility of hepatic TB should also be kept in mind apart from the obvious possibility of metastasis especially in an endemic country like India.