Mondita Borgohain

Pancreatic paraganglioma: An extremely rare entity and crucial role of immunohistochemistry for diagnosis.

Paragangliomas are rare neuroendocrine neoplasms arising in extra-adrenal chromaffin cells of autonomic nervous system and histologically akin to chemodectomas. They are rare, affecting about 1 in 2,000,000 population. It is a generic term applied to tumors of paraganglia regardless of the location. In rare instances, paragangliomas present around and involve the pancreas, thereby mimicking any one of the more common primary pancreatic lesions. Pancreatic paraganglioma is an extremely rare tumor. It grows slowly, so radical resection is recommended to achieve curability with good prognosis. These neoplasms present considerable diagnostic difficulty not only for the clinician and radiologist but also for the pathologist. Here, we report a case of a 55-year-old woman who presented with a left-sided abdominal swelling for 3 months duration, initially having clinical suspicion of an ovarian tumor. The radiological imaging revealed a lesion in the tail of pancreas with a differential diagnosis of pancreatic carcinoma and metastatic tumor. Only after exploratory laparotomy, the diagnosis was made as a rare case of pancreatic paraganglioma on the basis of histological examination and immunohistochemistry.

A Study on Schwannomas: Morphology Alone is Insufficient

Schwannomas constitute one of the most common benign peripheral nerve sheath tumors. Schwannomas can occur anywhere in the body occasionally with unusual presentation. FNB does not appear to provide an accurate preoperative diagnosis. Complete excision of the mass should be the goal of surgical excision. In this case series, we studied various clinicomorphological features of schwannomas for duration of one year. Immunostaining were done using anti-S100 protein and a panel of antibody to confirm the diagnosis cases as well as in cases whose histological picture simulated schwannoma. Out of the 9 cases in our study, two cases showed unusual presentations. Schwannoma often gives a differential diagnosis of similar benign soft tissue tumors. All cases were benign schwannoma except one case with rectal growth turned out to be gastrointestinal stromal tumor on immunohistochemistry. Herein, we are discussing about the various histological pictures of schwannoma, diagnostic difficulties encountered in histopathology and the indispensable role of immunohistochemistry in confirmation. Classic schwannoma picture in histology is insufficient to confirm the diagnosis. Cellular schwannoma often posed a differential diagnosis of other tumors in histology such as spindle cell tumor. Palisading of nuclei is not unique to schwannoma as seen in the case of gastrointestinal stromal tumor. It can also occur in leiomyoma, leiomyosarcoma, gastrointestinal stromal tumor, calcifying aponeurotic fibroma, and even in non-neoplastic smooth muscle lesion. Gastrointestinal stromal tumor may harbor a picture of classic schwannoma and should be careful in gastro intestinal site.

Missing Clinical Work Up Leading to Misdiagnosis of a Case of Germ Cell Tumour

Background: The large majority of primary testicular tumours originate from germ cells. Cryptorchidism remains the most common risk factor for testicular germ cell tumors. Approximately 10% of the cases are associated with past (corrected) or present cryptorchidism. Seminoma is the most frequent GCT and frequently occurs in undescended testes (5% to 8%). Case report: A 30-year male attended surgery OPD with a mass in the right lumbar region. CT scan revealed a small intestinal mass which was also verified by the surgeons intraoperatively. On histopathological examination of the resected specimen a diagnosis of neuroendocrine tumour (Carcinoid) was offered. The patient came to us requesting immunohistochemistry for confirmation but it showed CK and chromogranin negativity. Further marker study showed the tumour to be positive for CD117. Revised histomorphology along with immunohistochemistry favoured the diagnosis of extragonadal germ cell tumour (seminoma). Surgeons later confirmed the soft tissue mass to be that of undescended testis, thereby leading to a final diagnosis of seminoma. Conclusion: Cryptorchid patients have approximately a fourfold elevated risk of testicular germ cell tumors. The histopathological diagnosis at times is sufficient when proper background information is available to the pathologist. In the absence of such information, the use of adjunct studies helps us to arrive at a correct diagnosis.

Invasive lobular carcinoma of male breast: What we don't know-A report of 5 cases

Male breast carcinoma is a very rare malignancy. It mostly has invasive ductal histology while invasive lobular histology is exceptionally uncommon constituting no more than 1–2% of male breast cancer cases. Here we present five cases of invasive lobular breast carcinoma arising in male breasts which were diagnosed by histological examination. Immunohistochemistry was performed to evaluate the hormonal receptor status. Early diagnosis of breast carcinoma in males have prognostic implication in patients’ survival and show better response to hormonal therapy when it is reactive for estrogen and progesterone receptors. Therefore it is mandatory for the pathologists to keep this rare condition in their minds while evaluating any case of male breast lump and to perform a vigorous search for any small focus of this tumour in circumstances of male breast lump including gynaecomastia. Majority of information regarding treatment of male breast cancer is retrospective in nature and is derived mainly from small single-institution series; thus, the choice of treatment modalities is generally guided by extrapolation of data from female breast cancer. Due to paucity of data and the extreme rarity, male breast carcinoma should be considered and managed as a distinct entity. The invasive lobular carcinoma perhaps with an added advantage for being reactive of hormonal receptors, which could be treated by adjuvant Tamoxifen. It is hoped that a long term multicentric studies will help us to know the prognostic implication of uncommon invasive lobular histology, as well as trials could be strategically designed to optimize the treatment.

Sebaceous carcinoma of the scalp: Recurrence after treatment and utility of diagnostic cytology

Sebaceous carcinoma (SC) of the eyelid is an aggressive, rare tumor of epidermal appendages, accounting for <1% of all cutaneous malignancies. We report a histopathologically diagnosed case of SC, who presented with multiple swellings on the scalp and cervical lymphadenopathy after surgery and radiotherapy. Fine needle aspiration revealed clusters and dispersed population of cells with high nucleo-cytoplasmic ratio, round to oval nuclei, prominent nucleoli, with moderate to abundant vacuolated cytoplasm. A diagnosis of sebaceous gland adenocarcinoma was given. Smears from the lymph node showed features of metastatic carcinoma. This case highlights that fine needle aspiration cytology is a simple, cost-effective tool for diagnosis of SC and can help in early diagnosis.

Profile of molecular subtypes of breast cancer with special reference to triple negative: A study from Northeast India

Background: Different molecular classes of breast cancer (BRCA) correlate with prognosis and response to therapy. Triple-negative breast cancer (TNBC) is a newer concept and very limited studies were carried out in India. The aim of this study was to profile the molecular types with a particular emphasis on TNBCs. Materials and Methods: Prospectively evaluated descriptive study for 2 years from June 2014 to March 2016, was carried out in the Department of Pathology and Surgery in a tertiary care institute. Cases included were of invasive breast carcinoma in females, confirmed by histopathology. Ethical clearance was received. Data were analyzed using Statistical SAS software. Results: A total of 123 cases of invasive BRCA were studied and mean age was 44.64 years. The peak age group was 36–45 years (43.9%). Tumor sizes ≥2 cm was 30%, between 2 and 5 cm was 50.40%, over 5 cm was 19.51%. Invasive duct carcinoma was 82.11% and invasive lobular carcinoma 8.13%. Only 21% of subjects presented as early breast carcinoma. Cases of 1–3 nodes were 22.8%, 4–5 nodes 21.1%, more than five nodes were 34%. Histologic Grade 3 was 50.4%, Grade 2 was 41%, and Grade 1 was only 8.1. The American Joint Committee on Cancer, Stage 1 (17.9%) in Stage 2 (29.3%) Stage 3 was 46.3%, Stage 4 was 6.5%. Estrogen receptor was in 40.62%, progesterone receptor 35.77%, Her2/Neu 18.69% luminal A (19.51%), luminal B (21.13%), Her2/Neu type (17.88%), and triple negatives (38.21). Conclusion: The present study showed significantly higher TNBC with poor prognostic factors in younger women in a background of peculiar ethic spectrum in this geographical region.

Adrenocortical carcinoma: An extremely uncommon entity and the role of Immunohistochemistry in its diagnosis

Adrenocortcal carcinoma is an extremely uncommon entity with an incidence of two in one millionth population. Here we present a 60 year gentleman with pain in abdomen, nausea, and backache, and weight loss. Contrast enhanced computed tomography (CECT) abdomen revealed a heterogenous well defined mass measuring (15 × 10.3 × 13) cm3 on the left suprarenal region with central necrosis which extended medially up to the midline. Locally, the growth infiltrated the upper pole of left kidney. Initially, the differential diagnosis included that of renal cell carcinoma arising from upper pole of left kidney involving adrenal gland. The patient underwent left radical nephrectomy and left adrenalectomy. Histological evaluation could not differentiate it from of malignant pheochromocytoma, but immunohistochemistry confirmed it as adrenocortical carcinoma. This case highlights the crucial role of immunohistochemistry in establishing the diagnosis like tumors.