Somak Roy

Malignant peripheral nerve sheath tumor of the breast: case report

BackgroundMalignant peripheral nerve sheath tumor is a rare soft tissue sarcoma of ectomesenchymal origin. It is the malignant counterpart of benign soft tissue tumors like neurofibromas and schwannomas and may often follow them. Common sites include deeper soft tissues, usually in the proximity of a nerve trunk. Breast is an extremely rare location of this lesion and presentation as a breast lump in the absence of pain or previous benign neural tumor is even rarer.Case presentationA 38-year-old female presented with complaints of painless, hard breast lump for three months which was clinically suspected to be a ductal carcinoma with inconclusive fine needle aspiration cytology. Histopathology revealed a malignant spindle cell tumor which was confirmed to be malignant peripheral nerve sheath tumor on the basis of immunopositivity for vimentin, neurone specific enolase and S-100.ConclusionTo the best of our knowledge only six such case reports have been published in literature. The differential diagnosis of malignant peripheral nerve sheath tumor should be considered by the clinician as well as the pathologists in the work-up of a breast neoplasm as treatment and prognosis of this rare malignancy is different.

Aggressive angiomyxoma of the vulva presenting as a pedunculated swelling.

Aggressive angiomyxoma is a rare, locally aggressive soft tissue tumor that has high propensity for local recurrence. It involves mainly the pelvis, vulva, perineum, vagina and urinary bladder in adult women in the reproductive age. Considering its locally aggressive nature, appropriate management and long-term follow-up is necessary. We describe a case of a 22-year-old young pregnant patient presenting with a large pedunculated swelling on the left labia majora.

An acute myeloid leukemia M6b blast crisis with giant proerythroblasts in chronic myeloid leukemia.

The case of a 12 yr old female with bcr-abl positive chronic myeloid leukemia who subsequently developed a fatal AML-M6b (pure erythroleukemia) blast crisis is presented. The case is unique for its rarity of occurrence and for the striking resemblance that the circulating proerythroblasts showed to the giant cells characteristically seen in Parvovirus B19-induced acute pure red cell aplasia. This is, to the best of our knowledge, the first description of such cells in a blast crisis of chronic myeloid leukemia.

Clear Cell Malignant Myoepithelioma—Breast Presenting as a Fungating Mass

logically distinct type of invasive breast carcinoma. This report is of apocrine carcinoma of the breast arising in a 78-year-old female presenting with right areolar retraction and palpable axillary lymphadenopathy. Mammography was obtained, and it showed a retroareolar high-density mass, 1 cm in diameter, with speculated margin (Fig. 1a, b). There were also several heterogenous macrocalcifications in the mass. Corresponding sonography revealed hypoechoic mass with posterior shadows. A fine needle aspirate of the subareolar mass showed clusters of atypical cells that were enlarged and showed nuclear atypia, prominent nucleoli, and cytoplasmic granules (Fig. 2). Papillary cohesive clusters of ductal cells with apocrine change were also identified. The fine needle aspiration diagnosis was apocrine carcinoma. The patient underwent modified radical mastectomy. Histologic examination of the excised specimens showed extensive, solid apocrine carcinoma with focal stromal invasion (Fig. 3). Apocrine carcinoma of the breast is typically, although not always, positive for gross cystic disease fluid protein-15 (GCDFP-15). Compared with nonapocrine carcinoma, apocrine carcinoma is characterized by less positive rates of estrogen receptor (ER) and progesterone receptor (PR), and by frequent rates of unilateral multicentric breast carcinoma with significant difference. These features were also well-correlated with our findings in the present case (GCDFP15+, ER), and PR)).

Highly Cellular Leiomyoma Mimics A Malignant Small Round-Cell Tumor: A Diagnostic Dilemma On Frozen Sections

OBJECTIVE Cellular leiomyoma is characterized by significantly increased cellularity and may mimic malignant tumors. Our aim was to differentiate these from other malignant small round-cell tumors. CASE REPORT We report a case of cellular leiomyoma that mimicked a malignant small round-cell tumor upon frozen section examination. CONCLUSION Pathologists should be aware that highly cellular leiomyomas can mimic malignant tumors especially on frozen section analysis.

Tubercular Epididymo-orchitis Masquerading as Testicular Malignancy: An Interesting Case

Basal cell carcinoma (BCC) is said to be the most common malignant tumor of the eyelid encountered in the ophthalmic practice,1 accounting for 80–95% of all malignancies involving the eyelid and canthi. It does not metastasize, but often extends beyond its apparent clinical margins and has a tendency to recur if not adequately excised.2 Pigmented BCC has to be differentiated from melanoma and other pigmented tumors due to their varied biologic behavior.3,4 A preoperative diagnosis of pigmented BCC is not always easy. In a study of 9 cases of pigmented BCC by Hornblass and Stefano,5 only 1 case was correctly diagnosed clinically. Even pathologically, pigmented BCC often may be misdiagnosed as melanoma, and the diagnosis may have to be supported by immunostaining.3 We report a case of pigmented BCC highlighting the cytologic features and emphasizing the role of the fine needle aspiration biopsy (FNAB) in its pretreatment diagnosis. A 60-year-old woman presented in our outpatient ophthalmology department with a history of a painful, pigmented and ulceronodular lesion of the left eyelid for 3 months. On examination, the swelling was blackish, firm and nodular, with an irregular ulceration and serous discharge. The swelling measured 7 × 5 cm (Figure 1), with involvement of the periorbital region, and extended up to the left ala of the nose medially and the temple region laterally. Except for a single left submandibular lymph node measuring 1 × 1 cm, no other positive findings were noted. Clinical diagnosis was BCC. A routine FNAB of the lesion and the lymph node was performed. Papanicolaou and MayGrünwald-Giemsa stained smears showed high cellular yield with many tightly cohesive 3-D clusters and monolayered sheets of round-ovoid-spindle cells with LETTERS TO THE EDITORS

Fibroma with minor sex cord elements – an incidental finding in a normal sized ovary A case report with literature review

Ovarian fibroma with minor sex cord element is a rare neoplasm. Microscopically it is composed of predominantly fibromatous or a thecomatous tumor containing scattered minor sex cord elements in less than 10% of the tumor area.A case of fibroma with minor sex cord elements discovered incidentally in a normal sized ovary in a patient who presented with dysfunctional uterine bleeding is being presented. This is the first case report describing this entity in a normal sized ovary as an incidental finding.

Xanthogranulomatous endometritis coexisting with carcinoma cervix

A 57-year-old female presented with history of post-menopausal bleeding. Per speculum examination showed an irregular growth involving the cervix. Colposcopic biopsy revealed moderately differentiated squamous cell carcinoma. Hysterectomy, bilateral salphingoophorectomy and node dissection was performed. Grossly cervix was destroyed by an irregular grey white growth. Endometrial cavity was 3 mm, shaggy yellow with a small polyp (Fig. 1a). Sections from the cervix revealed moderately differentiated squamous cell carcinoma with parametrial extension. The polyp was lined by squamous carcinoma in situ overlying endometrial glands (Fig. 1b). Endometrium was replaced by infiltrate composed of foamy histiocytes neutrophils, plasma cells and lymphocytes (Fig. 1c). There was no endometrial hyperplasia or carcinoma. Periodic acid schiff PAS, Grocotts methenamine silver and Gram stain revealed no bacteria or fungi. Prussian blue stain showed iron deposit in some histiocytes. Xanthogranulomatous endometritis (XGE) macroscopically mimics endometrial carcinoma, as it converts endometrium into friable yellowish tissue. XGE is described in association with endometrial carcinoma. Barua described the first case of XGE without evidence of endometrial carcinoma. Buckley and Fox labelled them as histiocytic endometritis. Ashkenazy reported endometrium with foamy cells. Russack reported XGE in endometrial carcinoma as a result of radiation therapy. Blanco mentioned macrophage as a non-specific inflammatory reaction phagocytosing breakdown product of endometrial hemorrhage. In our case no focus of endometrial hyperplasia or carcinoma was present. However, cervical carcinoma extended up to the endometrium. Cervical stenosis by carcinoma causes accumulation of secretions leading to inflammation, tissue destruction and necrosis accounting for XGE. Noack et al. reported XGE with lethal outcome isolating enterococci and P. magnus from aspirates. Barua et al. postulated E. coli or P. vulgaris to cause XGE. The present case showed no micro-organism with special stains and culture. To conclude, XGE is influenced by tumour bulk, radiation, necrosis, intrauterine hemorrhage and cervical stenosis. The irregular, necrotic appearance of XGE mimics carcinoma grossly. Histologically, foamy histiocytes may mimic clear cell carcinoma or sarcoma and immunohistochemistry helps to reach the diagnosis. However, the presence of XGE does not exclude likelihood of accompanying carcinoma, for which reason extensive cervical sectioning is recommended. This is the first case reporting XGE with carcinoma cervix, highlighting importance of cervical stenosis in the pathogenesis of XGE. The present case highlights importance of extensive cervical sampling whenever XGE is diagnosed.

Extensive bone with marrow formation in pleomorphic adenoma. Report of a case

Extensive ossification in benign mixed tumours at any anatomical site is exceedingly rare.1–5 Only four cases of pleomorphic adenoma with extensive areas of bone have been reported in published studies till date; we are reporting the fifth case.2–4 A 27-year-old man presented with a progressively increasing lump on the right side of cheek for the past 3months. On examination, the lump measured 2 cm in size and was non-tender, firm and involved the buccal mucosa. Fine-needle aspiration cytology showed moderately cellular smears, cohesive clusters of uniform epithelial like cells intimately admixed in a fibrillary fibromyxoid stroma. The nucleus was round to oval with a fine granular chromatin and inconspicuous nucleoli. A diagnosis of pleomorphic adenoma was suggested. A total excision of the lesion was carried out. Grossly, the tumour measured 1.8· 1· 0.5 cm, it was well encapsulated, and no area of capsular breech was identified. Cut section was grey white, firm and glistening. Histological examination of the excision specimen showed a well-circumscribed tumour composed of large areas of chondroid tissue along with focal areas showing bone formation. The bone included marrow fat with erythroid elements and occasional megakaryocytes (Fig. 1a,b). The chondroid tissues merged continuously into bone tissues and seemed to be formed within areas of chondral tissue by a process of enchondral ossification (Fig. 1c). Other areas showed histological features of typical pleomorphic adenoma. A diagnosis of pleomorphic adenoma was made with extensive ossification and marrow formation. The exact mechanism of osseous tissue formation in pleomorphic adenoma is not known. It is thought to result from enchondral ossification, by direct laying down of bone by metaplastic myoepithelial cells or by modified myoepithelial cells and as well as by partial enchondral ossification.3–5 Angiogenesis is generally increased in both chondroid and osseous tissue in cases of pleomorphic adenoma, suggesting that it might have a role in ossification of chondroid areas and the absence of angiogenesis in chondroid tissue in majority of pleomorphic adenoma may be responsible for the low incidence of ossification in these cases.3 Pleomorphic adenoma with extensive bone and marrow formation is exceedingly rare, and thus, the knowledge of this unusual finding could avoid future diagnostic pitfalls.