Richa Katiyar

Non-Functional Paraganglioma of the Urinary Bladder Treated by Transurethral Resection: Report of Two Cases.

Paraganglioma of the urinary bladder is a rare tumour derived from chromaffin tissue of the sympathetic nervous system. Paraganglioma of the urinary bladder especially the non-functional type is often misdiagnosed as urothelial cancer. Two female patients aged 32 years and 45 years presented with painless haematuria without any symptoms of catecholamine excess. Radiological investigations revealed urinary bladder tumour. The tumour was removed by transurethral resection in both the patients. Histopathological diagnosis was paraganglioma, which was confirmed by immunohistochemistry. Complete resection of tumour by transurethral approach is curative in paraganglioma of the urinary bladder. We hereby, also discuss the salient features of nonfunctional paraganglioma of the urinary bladder.

Dysuria and fever in a young woman diagnosed as having inflammatory myofibroblastic tumour of the urinary bladder

A 38-year-old woman presented with dysuria and fever. Her medical and family histories were unremarkable. CT scan of the abdomen revealed a polypoid mass of 4×2.6×2.2 cm. Her cystoscopy showed a 4×2 cm solid broad-based growth at trigone of the urinary bladder. She underwent transurethral resection of the urinary bladder tumour (TURBT). Histopathology revealed a poorly circumscribed proliferation of spindle cells arranged in a haphazard and fascicular manner along with many traversing blood vessels in a myxoid and hyalinised stroma. Immunohistochemistry was positive for anaplastic lymphoma kinase-1, smooth muscle actin, CD10, cytokeratin and desmin; and negative for CD34 and S-100 protein. Ki-67 proliferative index in the tumour was <1%. The patient was diagnosed as having inflammatory myofibroblastic tumour of the urinary bladder. After TURBT, her fever and urinary symptoms resolved. Her 1-month postoperative period was uneventful. She has been advised regular follow-up.

Cytological diagnosis of microfilaria at unusual sites in clinically unsuspected cases: some rare presentations of filariasis

Filariasis is a major concern, particularly in endemic regions. The majority of patients harbouring the parasite may remain asymptomatic for years. Here, we present six patients who were sent for routine cytological examination to rule out neoplastic pathology, in whom cytology identified filarial infestation. The main purposes of our paper are to highlight the importance of fine needle aspiration cytology (FNAC), a cheap and quick investigation to detect the microfilaria from tissue swelling and body fluids, and to point out that clinicians practising in endemic regions should always consider filarial infestation in patients presenting with longstanding swelling.

Intramuscular myxoinflammatory fibroblastic sarcoma of the thigh

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Capillary Hemangioma of the Fallopian Tube

Neoplastic lesions of the fallopian tube are rarely seen by surgical pathologists. Haemangioma of the fallopian tube is an extremely rare benign neoplasm. A 30-year-old lady with polymenorrhea and dysmenorrhea underwent hysterectomy and bilateral salpingo-oophorectomy. Her left fallopian tube showed a 2mm sized solid nodule in the wall. Histopathological examination revealed a well-defined vascular lesion in the left fallopian tube, consistent with capillary haemangioma. The vascular endothelium was highlighted by CD34 immunostaining. Our literature review has identified 10 cases of cavernous haemangioma of the fallopian tube. To the best of our knowledge, we report the first ever case of capillary haemangioma of the fallopian tube. This is also the smallest detected haemangioma in the fallopian tube.

Filarial Orchitis due to Wuchereria bancrofti Masquerading as Testicular Neoplasm

A 37-year-old man from eastern Uttar Pradesh, India, presented with 20 days of a painless swelling of the left testis. There was no history of trauma, fever, infertility, lymphadenitis, lymphangitis, or previous history of testicular tumor. On examination, the left testis measured 5×4 cm, and was found to be slightly enlarged, firm, and nontender on palpation (Figure 1 ). Palpation of the right testis and bilateral spermatic cords were unremarkable. There was no inguinal lymphadenopathy. His complete blood counts were within the normal limits; differential count showed 9% eosinophils (absolute eosinophil count = 870/μL). The patient was amicrofilaremic on peripheral blood smears examined at 10 am. Results for serum alpha-fetoprotein, β-human chorionic gonadotropin, and carcinoembryonic antigen were within normal limits. Ultrasonography of the left testis showed increased vascularity and presence of hypoechoic areas containing mottled hyperechogenicity (Figure 2 ). The right testis, bilateral epididymis, and bilateral spermatic cords were of normal size, shape, and echotexture. Considering clinical presentation, age, and radiological findings of the patient, a provisional diagnosis of the left testicular neoplasm (teratoma) was made, and he was advised to undergo orchiectomy. However, owing to the patients refusal of the orchiectomy, trans-scrotal fine-needle aspiration cytology (FNAC) was done as a second line of investigation. Papanicolaou- and Giemsa-stained smears revealed a dense inflammatory infiltrate comprised of neutrophils, histiocytes, and occasional multinucleate giant cells along with many sheathed microfilarial larvae without nuclei at the tail tip (Figure 3 ). FNAC findings confirmed the diagnosis of filariasis due to Wuchereria bancrofti. There was no evidence of malignant cells or fungal elements in the smears examined. The final diagnosis was bancroftian filarial orchitis. The patient was prescribed a 14-day course of diethylcarbamazine.

Post electric shock reactive thrombocytosis.

Thrombocytosis is defined as a platelet count greater than 400×10(9)/L. Electric shock may lead to tissue injury and marked thrombocytosis. We herein report a case of 45-year-old woman, who was hospitalized with progressively increasing weakness, tingling sensation, and numbness of the bilateral lower limbs. She had a history of receiving electric shock during household work, 15 days prior to her admission. Her laboratory investigations revealed a markedly increased platelet count (1,570×10(9)/L) along with increased level of serum uric acid (12 mg/dL), and mild increase in serum potassium (6.7 mmol/L), and serum alanine transaminase (50 U/L). She was treated with intravenous fluids, calcium, and multivitamins. Following hospitalization and treatment, condition of the patient improved, her symptoms resolved, and her platelet counts declined. We report this case because of rare presentation of marked thrombocytosis secondary to electric shock with a brief discussion on pathophysiology of this condition.

Primary B-cell Non-Hodgkin Lymphoma of Gallbladder Presenting as Cholecystitis.

A 48‐year‐old woman presented with malaise and sudden onset of abdominal pain. Her blood pressure was 118/80 mm Hg. Tenderness was present in the right upper quadrant of the abdomen. Laboratory tests revealed reactive HBsAg and serum creatinine 2.5 mg/dl, while other investigations were normal. Abdominal ultrasound showed irregular edematous gallbladder wall, multiple calculi and sludge particles suggestive of cholelithiasis, acute cholecystitis and empyema gallbladder. Sizeable retroperitoneal lymphadenopathy was absent. Patient underwent cholecystectomy elsewhere. Specimen was submitted to author AA. Grossly, gallbladder was 10 cm × 4 cm with multiple small yellow‐brown multifaceted stones and normal velvety mucosa. Gallbladder wall was thickened (1.5–2 cm) with rubbery and gray white cut surface [Figure 1a]. Microscopically, intact gallbladder mucosa was infiltrated by lymphocytes and plasma cells. However, muscular and adventitial layers showed diffuse infiltrates of medium‐sized atypical lymphoid cells with centrocyte and centroblast‐like morphology [Figure 1b and c]. On immunohistochemistry, CD45 and CD20 positive B‐cells expressing scattered positivity for bcl‐2 [Figure 1d‐f] and negative expression for CD3, CD5, CD15, CD23, CD30 and cyclin D1 were seen. A diagnosis of non‐Hodgkin lymphoma (NHL) B‐cell diffuse type, not further specified was made. Patient died on postoperative 2nd day.

Langerhans cell histiocytosis diagnosed by FNAC of lymph nodes.

Langerhans cell histiocytosis (LCH) is a rare clonal disorder of unknown etiology and characterized by the proliferation of dendritic cells. LCH most commonly involves the bone followed by the skin and the lymph nodes. Recently, only a few cases of LCH with predominant lymph node involvement have been diagnosed by fine-needle aspiration cytology (FNAC). A 2-year-old boy presented with generalized lymphadenopathy, fever, and cough. The patient had hepatosplenomegaly, anemia, and lytic lesions in the skull. FNAC from the largest submandibular lymph node showed features of LCH. The large cells of LCH showed positive immunostaining for S-100 protein on FNAC smears. Later, lymph node biopsy and immunohistochemistry against S-100 protein and CD1a confirmed the diagnosis of LCH. The patient was treated with chemotherapy and he is under regular follow-up. This case report highlights the importance of FNAC as a rapid and accurate investigation in the diagnosis of lymph node predominant LCH.