Nausheen Yaqoob

Gastrointestinal basidiobolomycosis: an unusual fungal infection mimicking colon cancer.

CONTEXT -Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum, an environmental saprophyte found worldwide. Patients with B ranarum infection may present with subcutaneous, gastrointestinal, or systemic lesions. Gastrointestinal basidiobolomycosis poses diagnostic difficulties, as its clinical presentation is nonspecific, with no identifiable risk factors. OBJECTIVE -To discuss and compare the clinical features and histopathologic findings and other ancillary techniques that could be helpful in identifying gastrointestinal basidiobolomycosis. DESIGN -We report 3 cases of gastrointestinal basidiobolomycosis and describe the clinical and morphologic findings while emphasizing the importance of identifying this unusual entity on endoscopic biopsies, thus avoiding unnecessary major surgeries. Fungal cultures were also performed, which are of diagnostic significance. Our first patient was lost to follow-up; however, patients 2 and 3 were followed up for 4 and 2 years, respectively. RESULTS -In all 3 cases, patients presented with a clinical profile suggestive of malignancy. None of the patients gave any specific history. There was widespread abdominal disease with peritoneal involvement and colonic masses. Colonoscopic biopsy specimens showed nonspecific inflammation in 1 case; however, they showed only granulomatous inflammation in a second case and granulomas associated with fungal hyphae in a third. Typical morphology included hyphae, irregularly branched, thin-walled, occasionally septated and surrounded by a thick eosinophilic cuff (Splendore-Hoeppli phenomenon). CONCLUSION -Gastrointestinal basidiobolomycosis can be detected on small endoscopic biopsy. The unequivocal diagnosis requires microbiologic cultivation of the fungus obtained from tissues. The prognosis for this disease is usually favorable as seen in 3 of our cases; however, cases with fatal outcome are on record.

Xanthogranulomatous prostatitis: a mimic of carcinoma of prostate

BackgroundXanthogranulomatous prostatitis is an unusual benign inflammatory process of prostate. Clinically it mimics prostatic carcinoma, requiring pathological examination for diagnosis.Case presentationA 60-year-old patient presented with 6 months history of increasing difficulty in micturition. On digital rectal examination prostate was hard and nodular and estimated weight was 50-gram. His serum prostate specific antigen (PSA) was 150 ng/ml. Clinically a locally advanced carcinoma of prostate was suspected. In view of severe obstructive urinary symptoms and significant post-micturition residual urine, transurethral resection of prostate was carried out. Histopathological examination of resected prostatic tissue revealed xanthogranulomatous prostatitis with no evidence of malignancy. Patient remains symptom free at 16 months follow-up and serum PSA has decreased to 6 ng/ml.ConclusionXanthogranulomatous prostatitis is a benign inflammatory disorder of prostate that can clinically and even biochemically mimic prostatic carcinoma. A high degree of suspecion and close co-operation with pathologist is necessary for the diagnosis of xanthogranulomatous prostatitis.

Prevalence of mycosis fungoides and its association with EBV and HTLV-1 in Pakistanian patients

Mycosis fungoides (MF) is an indolent T cell lymphoma that is distinguished from other lymphomas by its initial appearance on the skin. The histologic diagnosis of MF may be difficult because there is significant overlap in the histologic features of neoplastic T-cell infiltrates and inflammatory dermatoses. This T-cell neoplasm commonly occurs in a mixed, reactive background and can show only a subtle degree of cytologic atypia, rendering histologic diagnosis difficult. In this study MF constituted 0.86% of all non-Hodgkin’s lymphoma (NHL) both T and B, as compared to the Western studies which have reported 0.5% prevalence for MF of all NHL. Polymerase chain reaction (PCR) technique was used to assess T-cell clonality in paraffinembedded skin biopsies clinically and pathologically suspicious for early MF. Out of the 14 cases diagnosed as MF, amplifiable DNA was isolated from 6 cases, which were further studied for T-cell receptor (TcR)-β, γ, and δ chain gene rearrangements. Clonal product was seen in 4 out of 6 cases for β, γ, and δ TcR chain genes. Association for Epstein Barr virus (EBV) was observed in 3 out of 6 cases (50%) of MF. Although these 3 cases were positive for EBV by PCR, but were negative by in-situ hybridization (ISH). No heterogeneity was noted in these 3 cases of MF for BainHI E, K, N, and Z regions of EBV. All six cases were negative for HTLV-1 (tax region) by PCR. It was concluded that the prevalence of MF in Pakistani population is comparable to the Western data, and that EBV association to MF cases was higher than in Western studies.

Ovarian angiosarcoma: a case report and review of the literature

IntroductionSarcomas of the ovary can either be histologically pure or can represent components of a more complex tumor. Ovarian angiosarcomas are rare, and probably arise from carcinosarcomas, teratomas or the rich ovarian vasculature. To date, only two small case series have been published, one with four cases and the other with seven.Case presentationA 41-year-old Saudi woman presented to our gynecological clinic with abnormal vaginal bleeding. The initial clinical diagnosis was left ovarian cyst. The results of the remainder of her abdominopelvic examination were normal. Peri-operatively, the left ovarian mass resembled a hemorrhagic solid tumor. It was sent for frozen sectioning, which revealed it was an undifferentiated neoplasm. The final histopathological examination showed a vascular neoplasm showing vasoformative arborizing channels of variable sizes and shapes lined by atypical endothelial cells with intact capsule. Areas of necrosis were seen, along with fused anastomosing solid vascular area. She was diagnosed as having an angiosarcoma of intermediate grade, International Federation of Gynecology and Obstetrics stage IA.ConclusionsPatients with ovarian angiosarcomas most commonly present with abdominal pain, however some patients present with distant metastases, often in the lungs. Spread beyond the ovary is present at the time of diagnosis in most reported cases, with disease progression within less than a year after diagnosis. Cases of advanced stage disease behave aggressively and demonstrate poor response to surgery and chemotherapy, with an overall poor prognosis. They have a tendency for local recurrence and metastases, and prognosis is hence poor; the reported five-year survival rate is 10 percent to 35 percent, however, cases confined to the ovary have survived up to nine years.

'Nuclear grooves' in nodular hidradenoma: frequency and significance of an unrecognized histopatological feature.

Background:  Nodular hidradenoma is a distinctive sweat gland neoplasm. In addition to the well‐known histological and cytological features, we hereby describe for the first time nuclear grooving as a useful morphological feature to aid in its diagnosis.

Painless Breast Lump in an Elderly Woman

Secretory breast carcinoma is a rare breast cancer. It occurs in all age groups, with the majority of patients being adults. It is a rare occurrence in elderly (>50 years) patients; only 5 cases have been reported in this patient group in the English literature. It is even rarer in males, with only 15 cases reported in the world literature. Ultrasonographic findings may resemble other well-circumscribed breast carcinomas as well as some benign masses, including fibroadenomas. We present a case of a 60-year-old woman who had a painless lump in her right breast. The tumor was ulcerating through the skin. Axillary lymph nodes were also palpable. Simple mastectomy was performed and the histopathologic findings revealed secretory carcinoma of the breast.

A 27-year-old man with hyperpigmented patches at upper back and limbs. Primary localized cutaneous amyloidosis.

27-year-old Asian man presented with a flat patch of darkened skin on his upper back between his shoulder blades. He had a history of intense pruritus for the last 8 years, and the patch developed within the preceding 5 years. The patient also had a history of scratching all over his body, especially over his back using his fingernails. His past medical history was insignificant, except for history of psoriasis involving his thumbs for the past 2 years. On examination, a 20-cm, wing-shaped, flat, dusky brown patch was evident on his upper back between his shoulder blades (Figure 1). The rash first appeared at the nape of his neck and subsequently spread to his shoulders. Clusters of densely packed, 0.5- to 1-mm, flattened, hyperpigmented macules imparted a rippled appearance. These skin changes were present bilaterally on the patient’s shoulders, upper chest, dorsal aspect of arm and forearm, and ventral aspects of thighs and shins. The patient’s palms, soles, and oral mucosa were spared. The rest of the systemic examination was unremarkable. Complete blood count was essentially unremarkable. Blood chemistry profile and coagulation panels were normal. Serum protein electrophoresis did not show a monoclonal spike. A skin biopsy of the hyperpigmented patch at the shoulder was taken. Histologically, patchy basal melanosis and clumps of acellular hyaline amorphous material were evident within the papillary dermis. Special stains were performed, which showed positivity for Sirius red (Figure 2). A panel of monoclonal antibodies was applied using envision technique; the panel showed positivity for cytokeratin MNF (Figure 3). What is your diagnosis?