Shailja Puri

Nephrolithiasis Associated Rare Renal Tumors Masquerading Non-Functional Kidney

Two cases - primary squamous cell carcinoma of renal parenchyma and adenocarcinoma of renal pelvis are added to those so far reported. There is very scant literature on primary squamous cell carcinoma of renal parenchyma making it a very rare tumor. Association with long standing chronic infection and nephrolithiasis is emphasized. Presence of a renal stone and occult gross appearance of most of these tumors and may lead the pathologist to overlook their presence and be overwhelmed with nephrolithiasis only. Hence, any kidney with nephrolithiasis should be examined carefully to look for the presence of any tumorous growth.

Collagenous spherulosis: An interesting cytological finding in breast lesion

Collagenous spherulosis (CS) is a rare and interesting entity associated with benign breast lesions. CS is an incidental finding picked up only on 0.2% of cytology specimen. Typically cytologically of CS of breast consists of central spherical hyaline spherule surrounded by myoepithelial cells. The central hyaline spherule has been found to be basement membrane material histochemically and immunohistochemically. The importance of recognizing CS of breast lies in the fact that similar hyaline globules can occur in adenoid cystic carcinoma of the breast (ACCB). The two lesions need to be differentiated on cytology failing which inappropriate treatment can be given for either of the two lesions. We present here a case of CS associated with benign breast lesion and a case of ACCB to describe their cytological features and key points to differentiate them cytologically.

Intrapericardial immature teratoma in the new-born

Intrapericardial teratomas are rare causes of mediastinal masses in children. Pericardial teratoma is a potentially curable lesion that may become life threatening when it induces mediastinal compression and fetal hydrops. Majority of the reported cases have been diagnosed prenatally. We report a case of an infant with intrapericardial immature teratoma, which was detected in a newborn infant presenting with respiratory distress. The tumor was excised completely, and histopathological examination of the resected tumor was suggestive of immature teratoma. The patient was asymptomatic three months postoperatively.

Hemangioma of rib masquerading a malignancy

Hemangioma of bone is a rare bone tumor accounting for <1% of all osseous tumors. Hemangiomas are common in skull and vertebrae but uncommon in rib. Rib hemangiomas may increase in size over a period and may cause symptoms due to increasing size. Preoperative diagnosis is not always possible due to overlapping radiological features between benign and malignant lesions. Use of preoperative aspiration and biopsy has their own risks and benefit. Excision of rib in case of monostotic rib lesions is the treatment of choice due to low risk of recurrence and no reported postoperative complications. We report a case of rib hemangioma which mimicked a malignancy preoperatively.

Adrenal Incidentalomas with Review of Literature

Adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered by radiologic examination. The reported incidence of adrenal incidentalomas is between 4-6%. Majority of reported adrenal incidentalomas are adenomas (hormonally active/inactive), pheochromocytoma, adrenal carcinoma and metastatic carcinomas. We report three rare adrenal incidentalomas with brief review of literature. The three adrenal incidentalomas proved to be adrenal myelolipoma, adrenal pseudocyst and adrenal teratoma on histopathology. Preoperative hormonal assessment and postoperative histopathological examination is required in all cases of adrenal incidentalomas to rule out malignancy.

Limbal carcinoma: Common malignancy at uncommon site

Limbus is the region of the eye between the cornea on one side and the sclera on the other. Limbus houses the stem cells. Neoplastic growths in limbus are the most common among growths of cornea and conjunctiva owing to the transition nature of the limbus. Although squamous cell carcinoma (SCC) is the most common carcinoma of limbus, its incidence is only 0.2–3.5/100,000. We present a 65-year-old patient with a limbal growth over a long period initially diagnosed as limbal stem cell deficiency. The patient sequentially developed epithelial dysplasia and then SCC. The complete excision of eyeball had to be done due to the recurrent nature of the lesion. The need for early detection of limbal mass and its prompt treatment cannot be overemphasized. Limbal growths have a good prognosis when treated early since they do not invade cornea and conjunctiva readily. Treatment is both surgical and medical. We present this case because of its rarity with a review of literature.

Left atrial myxoma complicated by acute embolism to the left subclavian artery

A 65-year-old man presented with acute-onset pain and numbness in the left upper limb for the past 6 hours. On examination, the left upper limb was pale and cold with absent pulses. There was no neurological deficit. The patient was a non-smoker, and had no atherosclerotic risk factors. Cardiac auscultation was normal. Subclavian artery angiography showed multiple filling defects in the proximal segment and total occlusion just after the origin of the vertebral artery (figure 1 and video 1). Transthoracic echocardiogram was carried out to assess a possible cardiac source for the embolism. A 0.9×1.2 cm rounded, heterogeneous, mobile mass was detected in the left atrium …

Cyto-histological correlation of sarcomatoid carcinoma of kidney

Sarcomatoid renal cell carcinoma (RCC) is a rare malignancy constituting 0.7% to 13.2% of all renal parenchymal malignancies. It is also called anaplastic carcinoma, spindle cell carcinoma or carcinosarcoma. The sarcomatoid differentiation is not a distinct histological entity, but it confers high aggressiveness on any subtype of RCC. Cytology of sarcomatoid RCC has rarely been described in literature. We describe cytology of a renal tumor that was later proven to be sarcomatoid RCC on histopathology and immunohistochemistry.