Nadeem Tanveer

Granular cell tumor in a child: An uncommon cutaneous presentation

Granular cell tumors (GCTs) are uncommon soft tissue tumors which present as papulonodular lesions and are often diagnosed histopathologically. These usually develop in adulthood and are considered to be of Schwann cell origin. Most of the lesions are benign, but malignant lesions with poor prognosis are known to occur. We report a case of GCT in a 9-year-old girl presenting as an isolated lesion simulating an acrochordon. The histopathological and immunohistochemical evaluation showing polygonal granular cells positive for S-100 and neuron-specific enolase, and negative for cytokeratin and desmin helped clinch the diagnosis. Complete excision under local anesthesia was done. The atypical clinical morphology and diagnostic histopathology of this uncommon entity are presented to aid the clinician in recognizing it. These tumors are mostly benign, rarely malignant, with the latter category having a poor prognosis. A near-complete excision is recommended in view of the minimal risk of malignant transformation.

WhatsApp for teaching pathology postgraduates: a pilot study

Introduction: Postgraduate students spend a sizeable proportion of their time on social media platforms such as WhatsApp and Facebook. This change in our social interaction needs to be accommodated in our teaching methods. To engage them and arouse their curiosity, WhatsApp is an ideal platform. Digital photography by cell phone cameras has made it possible to share cases and discuss them with students round the clock. Objective: The primary aim of the study was to develop sharing and discussion of images using WhatsApp. It also aimed at gathering feedback by means of a questionnaire from pathology residents about their views about the use of WhatsApp for teaching purpose. Materials and Methods: A WhatsApp group by the name “Pathology on the Go” was created with the authors of this study as group administrators and all junior and senior resident doctors (69) as members. The group was used to discuss interesting cases, quiz questions, and other pathology-related academic issues. At the end of 4 weeks, a questionnaire was distributed among the members, and feedback was sought regarding their experience in the group. Results: Over a 4-week period, 16 cases were discussed with 647 posts. A total of 45 participants out of 69 were active participants, and they had an average of 14 posts over the 4-week period. Majority of the participants found the discussions very useful with minimal disruption of the daily routine. Conclusion: There is a need to incorporate Web 2.0 tools such as WhatsApp in our teaching methods to capture as much screen time of the students as possible.

Cytological features of Kimura's disease: A case report with histological correlation

Kimuras disease and angiolymphoid hyperplasia with eosinophilia (ALHE) together form a spectrum of chronic inflammatory disorders of unknown etiology with similar and overlapping histological features. We report a case of Kimuras disease in a young Indian girl with its cytohistological correlation. The cytological features of these inflammatory disorders are fairly specific and in an appropriate clinical setting, a cytological diagnosis of Kimuras/ALHE is possible. However, it may not be possible to differentiate between the two based on cytology alone.

A search for entrustable professional activities for the 1st year pathology postgraduate trainees

INTRODUCTION: During the past decade, there has been a paradigm shift in medical education from the problem-based learning to competency-based training. This has forced a rethink on the way we evaluate the residents and finally give them the right to handle patients independently. This study makes the first attempt towards designing competency-based training program for pathology residents by formulating the entrustable professional activities (EPAs) for the 1st year pathology residents. MATERIALS AND METHODS: A questionnaire comprising 18 potential EPAs in histopathology and 12 potential EPAs in cytology were circulated among the residents of Pathology Department. The respondents were asked to grade the EPAs on a scale of 0–4 based on how important they considered that activity as EPA. The cumulative score of each EPA was divided by the number of respondents to arrive at the average score. The EPAs with an average score of 3 or more qualified to be shortlisted as consensus EPAs. RESULTS: Five activities each of histopathology and cytopathology had an average score of 3 or above and were shortlisted as EPAs for the 1st year pathology postgraduates. Each of these was also mapped to their respective competencies. CONCLUSION: There is an urgent need to restructure the postgraduate pathology curriculum in line with competency-based training. This study is the first step in this direction.

Controlling Human Papilloma Virus: A Public Health Perspective of Treatment of Anogenital Warts

The success of human papilloma virus (HPV) screening is attributable to clear‐cut guidelines on the detection and management of premalignant HPV lesions. A similar approach is necessary for both low‐risk and high‐risk lesions, including anogenital warts.

Glomus vagale tumour, can it be diagnosed only on sonography?

Vagal paragangliomas are rare benign tumors accounting for only 3% of head and neck paragangliomas and arise from vagal ganglions, predominately the nodose ganglion in the carotid sheath. Imaging plays an important role in their diagnosis, differentiation from more common lesions presenting in the carotid space, and management. MRI is the method of choice for investigation when paragangliomas are clinically suspected. The typical salt-and-pepper appearance in T1-weighted images is well known but not specific to paragangliomas. Demonstration of the continuity of the lesion with the vagus nerve on magnetic resonance imaging (MRI) further asserts the diagnosis of glomus vagale. Although this tumor can be diagnosed on a contrast-enhanced computed tomography (CECT) examination, it is limited by the non-demonstration of its neural origin. Sonography is considered only a preliminary investigation in patients, and a CECT and/or MRI study of the neck is conducted before treatment planning. This case is unique as a confident diagnosis of glomus vagale was made on high-resolution sonography of the neck. A middle-aged male patient presenting with a neck swelling was diagnosed with a glomus vagale tumor on USG by the direct demonstration of its continuity with the vagus nerve, and Doppler examination confirmed its vascularity. The diagnosis was confirmed on histopathology after surgical excision. The sonographic appearance, Doppler characteristics, and imaging differential diagnosis of glomus vagale are discussed in detail.SommarioI paragangliomi vagali sono rari tumori benigni e rappresentano solo il 3% dei paragangliomi del distretto testa-collo; originano dai gangli vagali e più frequentemente dal ganglio nodoso localizzato all’interno della guaina carotidea. L’imaging svolge un ruolo importante nella sua diagnosi, nella differenziazione dalle lesioni più comuni che possono trovarsi nello spazio carotideo e, nella sua gestione, una volta identificato. La RM è tuttavia l’indagine di scelta; tuttavia il tipico aspetto “sale e pepe” in T1 pesate pur essendo ben noto non è specifico per i paragangliomi. Pertanto la dimostrazione della continuità della lesione con il nervo vago con la RM è fondamentale per la diagnosi di glomo carotideo. La TC con mdc, può suggerirne la diagnosi, ma è limitata nel dimostrarne la sua origine neurale. Pertanto l’ecografia è considerata solo come un’indagine preliminare in questi pazienti e TC con mdc e/o RM del collo vengono effettuate prima di pianificare il trattamento. In questo caso viene mostrato come la diagnosi di Tumore del glomo carotideo sia stata effettuata con esame ecografico. Un pz maschio di mezza età presentatosi con tumefazione del collo, grazie all’esame ecografico che dimostrava la presenza di una massa riccamente vascolarizzata al color-Doppler e in continuità con il nervo vago veniva inviato col sospetto di tumore glomivo, a esame di II livello e quindi a intervento chirurgico che ne confermavano, grazie all’esame istologico, la diagnosi. L’aspetto ecografico, le caratteristiche Doppler e di imaging del tumore del glomo vagale è di seguito discusso nei dettagli.

An atypical presentation of alveolar soft part sarcoma of tongue

An incisional biopsy was performed [Figure 1] which revealed tumor in subepithelium composed of epithelioid cells arranged in alveolar and solid pattern with intervening thin‐walled blood vessels. The cells had a moderate amount of cytoplasm, round nuclei, and prominent eosinophilic nucleoli and showed increased mitotic activity. Immunohistochemical studies and special stains were performed to confirm the diagnosis. The tumor was positive for neuron‐specific enolase (NSE) and vimentin and negative for desmin, HMB‐45, and cytokeratin (CK). Periodic acid– Schiff‐reaction with diastase digestion highlighted intracytoplasmic needle‐shaped crystals consistent with the diagnosis of ASPS [Figure 2]. Computerized tomographic examination of the chest and abdomen was performed, and metastasis to lung and liver ruled out. The patient was referred to an oncology center for oncosurgery and further management.

Social media: The new frontier for pathologists

I n d I a n J o u r n a l o f P a t h o l o g y a n d M I c r o b I o l o g y ¦ V o l u M e 6 0 ¦ I s s u e 1 ¦ J a n u a r y M a r c h 2 0 1 7 143 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Polypoid adenosarcoma of uterus with chondroid differentiation: A rare diagnosis

A 40‐year‐old previously healthy woman P2L2 presented to the gynecology outpatient department with a 6‐month history of bleeding per vaginum and dull aching pain abdomen. She was a known case of type II diabetes mellitus and hypothyroidism and was on regular medications for these conditions. Her general physical examination was unremarkable except for mild pallor. Her routine laboratory investigations were within normal limits except for hemoglobin of 11.2 g%. A hysteroscopic examination revealed an endometrial polyp measuring about 6 cm in maximum dimension, and polypectomy was performed.

Nevoid hypertrichosis in a pre-adolescent girl

5. Lee JI, Lee YB, Cho BK, Park HJ. Acanthoma fissuratum on the penis. Int J Dermatol 2013;52:382‐4. 6. Gonzalez SA, Moore AGN. Acanthoma fissuratum of the outer auditory canal from a hearing aid. J Cutan Pathol 1989;16:304. 7. Sand M, Sand D, Brors D, Altmeyer P, Mann B, Bechara FG. Cutaneous lesions of the external ear. Head Face Med 2008;4:2. 8. Jacqueline M. Disorders associated with physical agents: Heat, cold, radiation, and trauma. In: David EE. editor. Lever’s Histopathology of the Skin. 10th ed. USA: Lippincott Williams and Wilkins; 2009. pp. 343.