Neha Kawatra Madan

Completely isolated enteric duplication cyst associated with a classic enterogenous duplication cyst

This report describes an 18-month-old boy with a completely isolated duplication cyst (CIDC) of the ileum associated with another classic enteric duplication cyst in the adjacent bowel and presenting as an acute abdomen due to torsion of the pedicle of the CIDC. Cysts excision was curative.

Congenital ovarian cyst: A report of two cases

Journal of Laboratory Physicians / Jan-Jun 2012 / Vol-4 / Issue-1 63 symptoms are perimenopausal and postmenopausal bleeding per vagina followed by amber-coloured vaginal discharge and abdominal pain. [2] But all these features are present in 6% of cases.[3] Tubal carcinoma usually originates in the ampulla and its pattern of growth can be nodular, papillary, and infiltrative.[1] These tumors are relatively confined to the tube and may not have any alteration in size and shape of the fallopian tube, or it may feature diffuse swelling, a sausage-shape resembling hydro, hemato, and pyosalpinx. Histo-pathological examination reveals a papillary adenocarcinoma extending into submucosa and muscularis layer, as was seen in our case.[2] Preoperative diagnosis of the fallopian tube carcinoma is seldom made prior to surgery. It is suspected in fewer than 5% of cases preoperatively. Primary ovarian neoplasm is the most common preoperative diagnosis made in these patients. Since it is difficult to differentiate the primary fallopian tube carcinoma from epithelial ovarian cancer, Hu et al established diagnostic criteria for their differentiation in 1950, which were modified in 1978. Patients with at least one of the following criteria should have the diagnosis of primary fallopian tube carcinoma.[4-6] • The tumour arises from the endosalpinx. • The histological pattern reproduces the epithelium of tubal mucosa. • Transition from benign to malignant epithelium is found. • The ovaries and endometrium are either normal or contain less tumor than the tube.

Pigmented basal cell carcinoma: Cytological diagnosis and differential diagnoses

Pigmented basal cell carcinoma is a rare cutaneous neoplasm with only a few cases reported so far. Review of the literature yielded only an occasional fine-needle aspiration report of the cytologic features of the tumor.We report a rare case of pigmented basal cell carcinoma occurring on the thigh of a 55-year-old woman. The cytological features are described with discussion over the possible differential diagnoses.

Intramuscular, extraskeletal mesenchymal chondrosarcoma

Extraskeletal mesenchymal chondrosarcoma (EMC) is a rare and a malignant chondrogenic neoplasm. As a particularity of this neoplasm, about one-third of the cases develop outside the bone, with intramuscular site being a very rare location for development of EMC. The diagnosis of mesenchymal chondrosarcoma can be very challenging, especially in cases without conspicuous cartilaginous differentiation. In such cases its distinction from other small cell mesenchymal neoplasms cannot be safely established. This, however, is of major clinical interest as it implicates different treatment protocols as well as a different prognosis. We hereby present a case of EMC at a unusual location in a 23-year-old female with the purpose to highlight its morphologic features and to discuss its differential diagnosis.

Aberrant adrenal tissue in omentum: an incidental finding on ovarian cystectomy.

Sir, Aaberrant adrenal tissue is a rare occurrence in adults. It is divided into ectopic or heterotopic and accessory adrenal tissue: the former is derived from the adrenal primordium that has migrated to other organs like the kidney and the liver at an embryonic stage, whereas when the medullary tissue migrates to the region of the adrenal cortex and the fragments of the cortical tissue may be split off, forming the accessory adrenal tissue [1]. An accessory adrenal tissue may be found in at least 50% of the neonates and infants if it is meticulously searched for; however, with advancing age, the accessory tissue atrophies and it is present in less than 1% of all the adults [2]. We are reporting a case of a 21 years old unmarried woman who came with the complaint of lower abdominal pain. On ultrasonography, a 6x7 cm anechoic cyst was seen in the left ovary. A laparoscopic cystectomy was performed. A small, yellowish brown nodule which was 0.5 cm in diameter and which was embedded in the omentum was also found, which was clinically suspected to be a caseous lymph node. It was also excised and sent for a histopathological examination. A microscopic examination of the ovarian cyst revealed a serous cystadenoma. The excised nodule was composed of encapsulated adrenal cortical tissue which comprised of the zona glomerulosa and the zona fasciculata which were surrounded by omental adipose tissue [Table/Fig-1 and ​and2].2]. A medullary component was not present. [Table/Fig-1]: Tissue section showing adrenal cortical tissue: Zona glomerulosa and Zona fasciculata (H&E, 100X) [Table/Fig-2]: Tissue section showing adrenal cortical nodule with omental fat (H&E, 40X) Since the discovery of the yellowish nodules of the adrenal tissue by Morgagini in 1740, several researchers have noticed the presence of the ectopic adrenal tissue in the lung, brain, pancreas, transverse colon and the large intestine [1,3,4]. The unusual location of the ectopic tissue could be related to the misplaced mesothelial cells or the autonomous differentiation of the mesodermal elements [5]. Occasional cases which have described the occurrence of the ectopic adrenal tissue in the omentum, have been reported in the literature [1,6]. Most of the ectopic adrenal nodules are clinically silent. However, the importance of recognition of the ectopic adrenal tissue lies in the fact that it could be the only adrenal tissue in the body, which if accidentally removed surgically, may prove to be fatal. It may become hormonally functional or it may rarely undergo a malignant transformation- Phaeochromocytoma, Leydig’s cell tumour and adrenal adenoma have been documented in the literature [4]. The patients who have undergone bilateral adrenalectomy due to a pathologic ACTH production and compensatory hyperplasia of the aberrant adrenal tissue, could lead to relapse of the symptomatology. It is important to recognize the existence of such an aberrant tissue at unusual sites like the omentum and to treat them accordingly, in order to avoid any potential complications.

Onchocercoma-cytological diagnosis.

Sir, Onchocerciasis also known as river blindness and Robles’ disease is an infection caused by the nematode Onchocerca volvulus. It is transmitted through the bite of Simulium blackflies that breed near fast-flowing rivers and streams. The disease is endemic in Africa, Yemen, and in small foci in Central and South America. In humans, three principal pathological lesions are seen: blindness (River Blindness), dermatitis (Onchodermatitis), and subcutaneous nodules (Onchocercoma). Only three cases of onchocerciasis have been reported previously from India, one presenting as blindness and other two as dermatitis. To the best of our knowledge, this is the first reported case of subcutaneous onchocercal nodule from India. A 28-year-old male patient presented with history of swelling over the right arm of two months duration. On examination, a firm, mobile, and non-tender subcutaneous nodule was palpated on the medial aspect of right arm measuring 1.5 cm 3 1 cm. Overlying skin was normal (Fig. 1, panel a). There were no other complaints. There was no history of international travel. A clinical possibility of lipoma or neurofibroma was kept and fine-needle aspiration cytology was performed. Aspiration yielded 1 ml of straw colored fluid. On cytological examination, numerous unsheathed, coiled-up microfilariae, and pre-larvae were seen in a background of eosinophils, neutrophils, and macrophages (Fig. 1, panel c). Under oil immersion, prominent cross-striations were seen in the body wall of these microfilariae (Fig. 1, panel d). A diagnosis of “Subcutaneous filariasis-likely Onchocerciasis” was rendered. Excision biopsy (nodulectomy) was performed under local anesthesia (Fig. 1, panel b). On histopathological examination, adult female onchocerca worm was seen in the subcutaneous tissue surrounded by dense inflammatory reaction and fibrosis (Fig. 1, panel e). The worm had a cuticle of variable thickness bearing some annular ridges on the outer surface and prominent cross-striations on the internal surface (Fig. 1, panel f). Two uterine cavities were seen showing numerous microfilariae (pre-larvae) inside them. Complete blood counts and peripheral smear examination revealed mild leukocytosis with eosinophilia; however no microfilariae were seen on buffy coat preparation. A final diagnosis of “Subcutaneous onchocercal nodule/ Onchocercoma” was made. Cutaneous manifestations of onchocercariasis include onchocercomas, diffuse onchodermatitis, lymphedema or atrophic changes. Adult worms cluster in subcutaneous nodules which are typically painless and usually asymptomatic. Nodules are usually firm, often flattened, or bean-shaped and mobile. They are most common over bony prominences and in deeper sites near joints and bones or between muscles. In Africa, nodules occur mainly around the pelvis, whereas in Mexico and Guatemala, most nodules arise in the upper part of the body, especially the head. The clinical differential diagnoses include lipomata, sebaceous cysts, ganglia, lymph nodes, and cystic reaction around foreign bodies. Traditionally, diagnosis requires demonstration of emerging microfilariae in a skin-snip biopsy sample where a tiny slice (3–5 mg) of the skin is removed with a small razorblade and is placed in saline or incubated for 4 hours in a culture medium. Immunodiagnosis is possible by antibody or antigen detection. Antibody detection does not distinguish between active and past infections. Ov16 card test, Recombinant hybrid proteins—OvH2/ OvH3 test, and an ELISA-based test using a cocktail of three antigens (Ov7, Ov11, Ov16) are some of the tests that have been used but these tests are either experimental and are not easily available. Detection of parasite DNA sequences can also be performed on the skin-snip sample by polymerase chain reaction but the technique is *Correspondence to: Neha Kawatra Madan, Senior Resident, Department of Pathology, Lady Hardinge Medical College, New Delhi, India – 110002. E-mail: nehakawatramadan@gmail.com Received 5 July 2012; revised 9 May 2013; Accepted 21 August 2013 DOI: 10.1002/dc.23036 Published online 25 October 2013 in Wiley Online Library (wileyonlinelibrary.com).

The unusual nested carcinoma of the renal pelvis

Invasive urothelial carcinoma has a potential to show divergent differentiation. Several uncommon morphological variants have been described in the recent past. One such rare type is the nested variant of urothelial carcinoma. Most of the published reports depict occurrence of this variant in the urinary bladder. We report an unusual presentation of this uncommon entity in the renal pelvis of a 54-year-old lady who presented with widespread skeletal metastases without any urinary symptoms.

Congenital pseudoarthrosis tibia with fibrous hamartoma in a child with neurofibromatosis

Sir, Congenital pseudoarthrosis tibia (CPT) refers to the non‐union of a tibial fracture that develops spontaneously after trivial trauma in a tibial diaphyseal segment. It usually develops during the first two years or sometimes later in life. The etiological nature of this lesion is unclear, however there is a strong association between CPT and neurofibromatosis type I (NF‐I). Overall, 55% of the patients of CPT have evidence of NF‐I, however only 6% patients with NF‐I develop tibial dysplasia.[1] It is a rare condition with a reported incidence by Andersen of 1/190,000 live births.[2]

Tubulopapillary hidradenoma: A rare case with cytohistopathological correlation.

Tubulopapillary hidradenoma is a rare adnexal neoplasm with only a few cases reported in literature. The tumor shows a female predominance with a wide age range and presents as a well-defined, non-tender nodule most often located on the scalp. Review of the literature yielded no fine-needle aspiration reports of the cytological features of the tumor. We report a rare case of tubulopapillary hidradenoma in a 30-year-old male, presenting with a scalp swelling. The cytomorphological features are described in detail with histopathological correlation.