Prasenjit Sen Ray

Paraganglioma of the thyroid gland: cytologists' enigma.

Paraganglioma is a neuroendocrine tumour derived from extra-adrenal cells of the neural crest paraganglia of the autonomic nervous system. These rare neoplasms comprise of around 0.012% of head and neck tumours. Paraganglioma arising in the thyroid gland is exceptionally uncommon and can present as a diagnostic challenge on fine-needle aspiration cytology (FNAC). We report a case of primary thyroid paraganglioma in a 19-year-old woman who presented with a solitary thyroid nodule without palpable cervical lymphadenopathy. FNAC from the lesion caused diagnostic dilemma by mimicking follicular neoplasm and C-cell-derived thyroid tumours; final diagnosis was established by histopathology and immunohistochemistry. The main purpose of this case report is to discuss the differential diagnosis and emphasise on the need of immune markers in the diagnosis of thyroid paraganglioma. In view of the uncertain malignant potential of these tumours, a long-term follow-up is recommended.

Primary squamous cell carcinoma of the parotid gland: a rare entity

Primary squamous cell carcinoma of the parotid gland is a rare aggressive malignancy. It is a rapidly advancing lesion which, if not recognised and treated early, results in high morbidity and mortality. Despite radical surgery and adjuvant radiotherapy, prognosis of this cancer continues to be poor. Careful clinical and histological examination is mandatory to differentiate this tumour from metastatic squamous cell carcinoma and other primary malignancies of the parotid. The authors hereby report the case of a 50-year-old male patient who presented with a progressively increasing, painless mass in parotid region of 6 months duration. An initial fine-needle aspiration cytology and subsequent histopathological examination confirmed that the tumour was squamous cell carcinoma. As no other primary source could be demonstrated in the patient, a final diagnosis of primary squamous cell carcinoma of parotid was offered. Currently the patient is on regular follow-up without any signs of recurrence.

Retinal tissue in mature cystic teratoma of ovary presenting with full-term pregnancy

Mature cystic teratomas are benign ovarian neoplasms which account for around 95% of all ovarian germ cell tumours and contain tissues derived from two or three embryonic germ layers. These tumours are frequently diagnosed in women of reproductive age group and can result in fetomaternal distress if concurrent pregnancy occurs. The authors describe a case of successful natural pregnancy in a 30-year-old woman with coexisting mature cystic teratoma of ovary that culminated in viable childbirth at term. Subsequent histopathological examination of the tumour revealed a mature teratoma composed predominantly of ectodermal elements along with retinal tissues—a rare finding that prompted this case report.

Dermatofibrosarcoma Protuberans of Male Breast: An Unusual Presentation

Dermatofibrosarcoma protuberans (DFSP) is a rare tumor, which usually presents during early or middle adult life, as erythematous indurated firm subcutaneous nodules. DFSP involving the breast is a rare phenomenon and even rarer in males. We describe a case of a male patient who presented with this tumor in his left breast.

Survival in Haemolytic Disease of Newborn Due to Rh-Isoimmunisation: An Unusual Presentation

Haemolytic disease of newborn (HDN) is a condition of premature destruction of red blood cells (RBC) of foetus in uteri and newborns during early neonatal period. This can be immune or non-immune mediated. The commonest underlying reason of the former is transplacental passage of IgG Antibodies produced by sensitized mother and directed against Rhesus, ABO or other antigens on foetal RBCs. Of these, Isoimmunisation with Rh-D antigen causes the most severe form of HDN. A history of previously affected foetus or infant in Rh-negative mother predicts a high chance of similar or greater morbidity in future pregnancies with Rh-positive foetus.1

Spindle-cell ameloblastic carcinoma of the maxilla with adenoid cystic carcinoma-like areas: A new variant?

Ameloblastic carcinoma is a rare aggressive malignancy of odontogenic epithelial origin. The disease has been reported to afflict people over a wide range of age group without any sex predilection. It is characterized by rapid growth and destruction of overlying bones along with involvement of adjacent soft tissues. The overall prognosis of this cancer is poor despite radical surgery and radiotherapy. Owing to the rarity of this lesion, complete data on the biological behavior and response to different treatment modalities are still lacking. The authors hereby report a case of this uncommon tumor arising from left maxilla in a 60-year-old Indian male. Histopathological examination of the tumor showed foci of spindling intermixed with large areas of tumor cells arranged in cribriform pattern and having luminal eosinophilic material which was reminiscent of adenoid cystic carcinoma. A final diagnosis was achieved after immunohistochemical study. These unusual findings prompted this case report.

Eosinophilic granuloma of the mandible: a diagnostic dilemma

Eosinophilic granuloma (EG) is a rare histiocytic disorder resulting from clonal proliferation of Langerhans cells. It accounts for less than 1% of all osseous neoplasms and has a predilection for involving the axial skeleton. Although suspicion of the disease may arise from clinical features and radiographic demonstration of destructive bone lesions, it is still difficult to make a correct diagnosis without proper pathological evaluation. This is more evident when common differentials mimicking EG, both clinically and radiologically, need to be ruled out. This report describes a case of unifocal EG of the mandible occurring in a 4-year-old boy whose initial presentation led to confusion between osteomyelitis, primary bone tumour and lymphoma. A final diagnosis of EG was established after histopathological examination of the biopsy specimen.

Cytological diagnosis of chondroblastoma: diagnostic challenge for the cytopathologist

Chondroblastoma is an uncommon osseous neoplasm that accounts for less than 1% of all bone tumours. It characteristically arises in the epiphysis or epimetaphyseal region of long bones and has been reported to affect people of all ages with slight male predilection. WHO has defined chondroblastoma as ‘a benign, cartilage-producing neoplasm usually arising in the epiphyses of skeletally immature patients’. The authors document the cytological features on fine-needle aspiration cytology of a chondroblastoma which appeared as a lytic lesion in the upper end of the right fibula, an uncommon site, in an 18-year-old male patient. X-ray feature combined with fine-needle aspiration cytology favoured the diagnosis of chondroblastoma, which was further confirmed by histopathological examination.

The significance of microbiopsies in cytological smears

BACKGROUND The role of fine needle aspiration cytology (FNAC) in the diagnosis of malignant lesions is well documented. Conventionally obtained fine needle aspiration (FNA) smears frequently contain well preserved viable intact tissue fragments (microbiopsies). AIMS The present study was aimed at evaluating the microbiopsies and carrying out further cyto-histopathologic correlation in order to assess what additional information they could provide. MATERIALS AND METHODS A total of 116 FNA smears from clinically suspected malignant lesions were examined, of which 81 smears (70.0%) contained representative tissue fragments of the tumors. Histopathological details were available in 75 cases. Immunocytochemistry (ICC) was applied in selected smears as and when required. RESULTS Tumors in which microbiopsies aided in diagnosis chiefly included soft tissue malignancies (12 cases), typed into malignant peripheral nerve sheath tumor, fibrosarcoma, spindle cell sarcoma and malignant melanoma; lung tumors (14 cases) classified as small cell carcinoma, large cell carcinoma, squamous carcinoma and adenocarcinoma; breast tumors (08 cases), typed into ductal, medullary and lobular carcinoma; and lymph node metastasis (19 cases) from primaries in lung, larynx and thyroid. The cyto-histopathologic concordance was raised from 81.2% in the absence of microbiopsies to 93.2% in their presence. CONCLUSIONS FNA smears containing microbiopsies are of ample help in establishing firm diagnosis, tumor typing, and predicting possible primary sites in metastatic tumors which were not possible by cytology alone. Hence, this technique can be utilized to enhance the diagnostic accuracy of FNAC, if put into practice in evaluation of routine cytology smears, without increasing any financial burden on patients.