Shailja Puri Wahal

Multilocular cystic renal cell carcinoma: a rare entity with review of literature

Multilocular cystic renal cell carcinoma (MCRCC) represents a rare variant of clear cell renal cell carcinoma (RCC). MCRCC has been recognized as a separate subtype of RCC in the 2004 World Health Organization (WHO) classification of adult renal tumors. MCRCC is diagnosed on the basis of strict histological criteria according to 2004 WHO classification. The chief differentials diagnosis to be considered include cystic nephroma, cystic clear cell carcinoma, clear cell papillary renal cell carcinoma and tubulocystic carcinoma. Only few cases of MCRCC are reported in literature. This case is being highlighted for its rarity and so as to avoid a misdiagnosis as conventional RCC.

Lymphatic vessel assessment by podoplanin (D2-40) immunohistochemistry in breast cancer.

CONTEXT Lymph node metastasis has an important bearing on the staging of breast cancer. Lymph node metastasis occurs by hematogenous and lymphatic spread. The hematogenous and lymphatic spread can be quantified by the blood vessel and lymphatic vessel density in the intra-tumoral and peri-tumoral zone by specific markers for blood vessels and lymph vessels. AIMS In this study, we are trying to study the localization of podoplanin in lymph vessels of invasive breast carcinoma, to quantify lymphangiogenesis in tissue sections of invasive breast carcinomas by podoplanin immunohistochemistry (IHC) by D2-40 antibody, and compare it with blood microvessel count using CD-31 antibody and correlating clinicopathologic parameters with the results of IHC. MATERIALS AND METHODS IHC for biomarkers D2-40 and CD-31 were performed on sections from 30 mastectomy specimens to assess blood vessel and lymphatic vessel density in intra-tumoral and peri-tumoral zone. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 15.0 statistical analysis software. RESULTS The results showed that both lymph vessel density and blood vessel density increased with the increase in lymph node ratio. Lymph node ratio is the ratio of positive lymph nodes to the total number of lymph nodes removed. CONCLUSION Taking into account our small sample size, we conclude that a further large-sized study should be carried out to further prove the role of lymphatics in tumor dissemination. New therapeutic options can be developed targeting the lymphatic channels to arrest the lymphatic spread of the breast cancer.

Lipoleiomyoma of uterus and lipoma of broad ligament--a rare entity.

Lipoleiomyoma of uterus are a rare variant of uterine leiomyoma. Clinically the symptoms are indistinguishable from an ordinary leiomyoma. It is diagnosed pre-operatively as leiomyoma or mature ovarian teratoma. Majority of them are post operative chance finding. Solid tumors of broad ligament are also rare. Most of them are lateral extensions from the uterine tumors. Primary lipomas of broad ligament are rare. They are asymptomatic in majority of cases and are incidental post-operative finding. We report this case because of the rarity of individual lesions and rarity of the combination and also speculate their histogenesis as adipose tissue is rare absent at both locations.

Primary ovarian carcinoid in mature cystic teratoma: A rare entity

Primary ovarian carcinoids are rare, accounting for 0.3% of all carcinoid tumors; however, carcinoid tumors metastatic to the ovary are common. A majority of primary ovarian carcinoids occur in association with mature cystic teratoma. In this paper, we present a case of carcinoid tumor developing in a mature cystic teratoma in a 50-year-old female.

Idiopathic necrotizing sialometaplasia of parotid gland

Necrotizing sialometaplasia (NS) is an uncommon non-neoplastic, self-limiting inflammatory condition of the salivary glands. NS of major salivary glands is rare and simulates malignancy. If it is seen at this location, most of the cases are due to ischemia caused by vessel injury secondary to previous dental procedure or parotid gland surgery. We present a case of a parotid swelling that appeared as Warthin tumor on fine needle aspiration cytology (FNAC). On histology it turned out to be NS of parotid gland. The well known etiologies were absent in this case and hence it was labeled as idiopathic.

Mesenteric panniculitis: A rare entity, report of two cases with review of the literature

Mesenteric panniculitis is a rare, benign, and chronic fibrosing inflammatory disease that affects the adipose tissue of the mesentery of the small intestine and colon. Mesenteric panniculitis of the sigmoid colon is an extremely rare occurrence in surgical practice. The specific etiology of the disease is unknown. The diagnosis is suggested by computed tomography (CT) and is usually confirmed by surgical biopsies. Treatment is empirical and based on a few selected drugs. Surgical resection is sometimes attempted for definitive therapy although the surgical approach is often limited. We are reporting two cases of mesenteric panniculitis of the sigmoid colon, one of which was associated with carcinoma.

Black pancreatic neuro-endocrine tumor: A rare finding

Pigmented lesions most commonly encountered in any organ are due to deposition of melanin in primary or metastatic malignant melanoma. Other less common pigments are lipofuscin and neuromelanin. Lipofuscin and neuromelanin are usually associated with benign lesions. Differentiating melanin from lipofuscin and neuromelanin is important as the former is usually associated with malignancy. However, melanin can occur in benign lesion also. All there pigments are differentiated by histopathological examination, histochemical stain, and immunohistochemistry. Black pigment is associated with black adenoma of the adrenal gland, neuro-endocrine tumor of lung, and foregut; however, it is rarely seen in neuro-endocrine tumor of the pancreas. We report a case of 61-year-old male patient with neuro-endocrine tumor of the pancreas associated with extensive deposition of black-colored melanin pigment.

Vaginal Polypoidal Endometriosis Masquedering Malignancy in a Young Female

Endometriosis is ectopic presence of endometrial glands surrounded by endometrial stroma. Polypoidal endometriosis is a recently described entity which mimics neoplastic growth. Grossly and microscopically, polypoidal endometriosis can mimic benign and malignant tumors like adenofibroma, adenomyoma, low-grade stromal sarcoma, endometrial carcinoma and adenosarcoma. We report this case of polypoidal endometriosis of vagina which clinically mimicked an embryonal rhabdomyosarcoma. We present this case due to its rarity and to consider this entity as one of the possibilities of vaginal growths.

Idiopathic renal replacement lipomatosis: A rare renal pseudo tumor

Renal replacement lipomatosis (RRL) is a rare condition that occurs as an end result of renal atrophy or destruction of renal parenchyma by excessive lipomatous tissue in renal sinus and perinephric space. We report a case of RRL presenting as a right renal mass clinically. Intra-venous pyelography and renal scan revealed a left non-functioning kidney. A left nephrectomy was performed. After histopathological examination and extensive literature search, a diagnosis of RRL was given. In majority of cases, it is associated with renal calculi. Idiopathic variety is not common. It is a rare entity and the diagnosis may be missed due to lack of experience. It has to be differentiated from other fat-containing tumors such as renal lipoma, xanthogranulomatous pyelonephritis, angiomyolipoma and liposarcoma.

Colonic gastrointestinal stromal tumor: A diagnostic dilemma on cytology

Gastrointestinal stromal tumors (GIST) is mesenchymal tumors arising from the interstitial cells of Cajal (pace maker cells) of the gastrointestinal tract (GIT). Stomach is the most common site (60-65%) of these tumors. Large intestine and rectum constitute only 5-10% of GIT tumors. Pre-operative diagnosis helps in the management of this tumor as it responds well to c-kit inhibitors. The cytological diagnosis of GIST is characteristic, however, associated with many pitfalls leading to erroneous diagnosis. Morphological resemblance is seen with other spindle cell and epithelioid cell tumors. The differentiation between high grade and low grade GISTs is described but not reliable. Cytology combined with cell block and Immunocytochemistry helps in making a confident diagnosis. Here we present colonic GIST diagnosed as GIST on cytology and confirmed on histopathology. We report this case to describe the cytological features of GIST and pitfalls in the cytology.