Ranjini Kudva

Primary epithelioid angiosarcoma of bone: a case report with immunohistochemical study.

Primary malignant vascular tumors of the bone are exceedingly rare and represent <1% of primary malignant bone tumors. Angiosarcoma is a malignant mesenchymal neoplasm in which the neoplastic cells demonstrate endothelial differentiation. Epithelioid angiosarcoma (EA) is a rare variant of angiosarcoma that is characterized by large cells with an epithelioid morphology. EA is an aggressive tumor with poor prognosis. Here, we present a case of a 62-year-old man who had primary EA of the left tibia. He was treated with amputation and chemotherapy. After 1 month of chemotherapy, he developed pleural effusion and died.

Quantitative Fraction Evaluation of Dermal Collagen and Elastic Fibres in the Skin Samples Obtained in Two Orientations from the Trunk Region

Background. Histomorphic evaluation of dermal collagen and elastic fibres was analysed by image analysis technique. The quantification of dermal elements was performed in skin tissues, collected in horizontal and vertical directions from trunk region and discussed under the perspective of consequences of scar related complications. Materials and Method. Total number of 200 skin samples collected from 5 areas of trunk region were processed histologically and subjected to tissue-quant image analysis. Statistical analysis involving mean with SEM and paired t test by SPSS were employed to the percentage values obtained from image analysis. Result. Among the chosen 5 areas of trunk region, abdomen showed the statistically significant difference for both collagen and elastic content between horizontal and vertical orientations (P< 0.05), whereas upper back, presternal, and lateral chest areas showed significant difference (P< 0.05) only for collagen and groin only for elastic content. Conclusion. The differences in the distribution of dermal collagen and elastic fibres in 2 directions of the samples from the same areas might be attributed to final outcome of wound healing process by influencing the appearance and behaviour of scar related complications in the region of trunk.

A Comparative Study of Fine Needle Aspiration Cytology (FNAC) and Fine Needle Non-aspiration Cytology (FNNAC) Technique in Lesions of Thyroid Gland.

The present study was done to compare diagnostic yield by fine needle non aspiration technique (FNNAC) with Fine Needle Aspiration cytology (FNAC) of lesions in thyroid gland. FNNAC and FNAC both were performed on 69 patients presenting with thyroid lesions, except those suffering from thyrotoxicosis. Smears were then cytologically interpreted by a single pathologist as unsuitable, diagnostically adequate or diagnostically superior for opinion, without the knowledge of sampling method employed. Slides were evaluated for following aspects namely cellularity, presence of colloid, inflammatory cell, hemosiderin laden macrophages, papillary clusters nuclear overlapping, nuclear grooving, hurthle cells. FNNAC gave better results in form of better quality of cellularity and less field obscurity by blood in lesions of thyroid. Diagnostically superior specimens were obtained more frequently by FNNAC, so this technique should be used alone or in tandem with FNAC for better diagnostic yield.

Primary Small Cell Carcinoma of The Esophagus - An Eight Year Retrospective Study

INTRODUCTION Primary small cell carcinoma of the esophagus is a rare and aggressive tumor. Patients present with metastatic disease and have a poor clinical outcome. The objective of the study was to correlate clinical and histopathological features of primary small cell carcinoma of the esophagus diagnosed and treated at our hospital. MATERIALS AND METHODS A retrospective study of 11 patients diagnosed with primary small cell carcinoma of the esophagus in Kasturba Hospital, Manipal between 2006 and 2014 was done. The histopathological and immunohistochemical features were correlated with clinical and endoscopic findings. RESULTS Eleven patients were diagnosed to have small cell carcinoma of esophagus with a male preponderance. Common presenting symptoms were dysphagia and weight loss. Majority of the patients showed mid esophageal ulceroproliferative growth. Biopsy findings were consistent with the characteristic morphology of small cell carcinoma and demonstrated immunoreactivity to neuroendocrine markers. In addition, few cases also showed adjacent squamous dysplasia/carcinoma. Most of the patients presented with metastatic disease, liver being the most common site. These patients were treated by chemotherapy and radiotherapy. CONCLUSION Esophageal small cell carcinomas are aggressive tumors with high rates of distant metastasis. Presence of squamous dysplasia /squamous cell carcinoma in the adjacent mucosa supports the hypothesis that this neoplasm arise from pleuripotent stem cells. Presence of the latter is also useful to rule out spread from lung primary.

Surgical Implications of Asymmetric Distribution of Dermal Collagen and Elastic Fibres in Two Orientations of Skin Samples from Extremities

Background. Clinically, scar related complications are observed to be dissimilar in different regions of the body. Unequal distribution of dermal collagen and elastic fibres in different orientations could be one of the multifocal causes of scar related complications, for which this evaluating study has been taken up. Materials and Method. 300 skin samples collected in horizontal and vertical orientations were studied histomorphometrically. This study involved image analysis of specially stained histological section using tissue-quant software. The outcome result was termed as quantitative fraction. From the result, various ratio values were also calculated for the ratio analysis. Results. The differences in the quantitative fraction of dermal elastic content between 2 directions were statistically significant at joint areas (shoulder joint, wrist, and ankle) (P < 0.001) but for collagen, significant difference was observed at shoulder joint and wrist only. Dermis of the forearm and thigh did not show any differences in their collagen content, but for elastic, thigh did show a significant difference while forearm had no change between 2 directions. Conclusion. Analysis of unequal content of dermal element in two directions under the perspective of wound healing consequences is subjective depending upon the anatomical position and functional status of the areas.

Mullerianosis of the Urinary Bladder

Mullerianosis of the urinary bladder is a rare and morphologically complex tumor-like lesion, composed of several types of mullerian lesions like endometriosis, endocervicosis, and endosalpingiosis. This disease occurs in women of reproductive age group. Implantative and metaplastic origins have been suggested in the pathogenesis.

Autosomal recessive polycystic kidney disease diagnosed in fetus

The presence of isolated large and hyperechoic fetal kidneys suggest polycystic kidney disease. The antenatal diagnosis has to be made without doubt as it has serious implications in the continuation of pregnancy, evaluation of family members and genetic counseling for the family. We present the features of autosomal recessive polycystic kidney disease (ARPKD) diagnosed antenatally by ultrasound and confirmed by fetal autopsy.

Malignant Melanoma Arising in an Ovarian Mature Cystic Teratoma - A Rare Entity

Mature cystic teratomas, also known as dermoid cysts, are composed of a mixture of tissues derived from all three germ layers and constitute about 20% of all ovarian neoplasms. However, malignant transformation in a mature cystic teratoma is an uncommon event occurring only in about 1.8% cases. A variety of tumours can arise within a mature cystic teratoma (most common being squamous cell carcinoma), with malignant melanoma being extremely rare among such tumors. While most authors believe that primary ovarian melanoma almost always arises within a mature cystic teratoma, the primary nature of an ovarian malignant melanoma can be ascertained only once metastasis from a cutaneous melanoma is ruled out. The first case of malignant melanoma arising in an ovarian mature cystic teratoma was reported in 1901 and only about 45 additional cases have been reported till date. We present another case of a primary malignant melanoma arising within a mature cystic teratoma.

Histology as a diagnostic tool for intestinal isosporiasis in immunocompromised patients

Abstract Isospora belli is an opportunistic protozoan causing wasting diarrhea especially in patients with an immunocompromised status. Diagnosis is usually established by demonstrating the oocyst of the organism on stool examination, which however can often be inconclusive. Serological tests for isosporiasis are currently not available. In such a scenario, biopsy often provides evidence for a confirmatory diagnosis. We describe two such cases, in which intestinal biopsy was the only diagnostic evidence of isosporiasis as the cause for chronic diarrhea.

Multiple painful nodules

A 49-year-old lady presented with multiple painful reddish brown nodules over the body since the age of 15 years. At onset there was only one nodule on the left scapula that gradually increased in size associated with pain on tactile stimulus. Later, over the course of years, she developed multiple small reddish-brown papulonodules on the left forearm, left gluteal region [Figure - 1], and face, and on the right breast around the areola. On further questioning, she gave a history of having undergone hysterectomy a few years back due to nodules in the uterus. There was no history of similar lesions in her mother or sister. All routine investigations such as hemogram, urine analysis, liver and renal function tests, chest X-ray, and ultrasonography of abdomen were normal.