Sonia Hasija

Lipoleiomyoma of Uterus: Uncommon Incidental Finding

Fatty tumours of the uterus are exceedingly rare. Lipoleiomyoma of the uterus is a rare benign uterine tumour thought to be a variation of leiomyoma. The presence of fatty tissue in the myometrium is anomalous, interpreted as lipomatous degeneration, smooth muscle metaplasia or as a benign tumour called as lipoleiomyoma. Imaging can play an important role in determining the intrauterine location and fatty nature of lipoleiomyomas but most of these are detected by chance pathological findings postoperatively. We report a case of lipoleiomyoma in anterior uterine wall in 66 years old postmenopausal female, who presented with postmenopausal bleeding.

Frontal bone metastasis from an occult follicular thyroid carcinoma: Diagnosed by FNAC

Metastatic deposits in skull bones from follicular thyroid carcinoma is rare, and metastatic disease in skull being the presenting symptom without obvious thyroid lesion (occult primary) is even rarer. A 60-year-old female patient presented with a mass in the frontal region of the skull. Fine needle aspiration cytology was done which revealed an adenocarcinoma with repeated follicular pattern, reminiscent of follicular neoplasm of thyroid, which on immunocytochemistry revealed positivity for thyroglobulin. Patient was investigated further for primary thyroid malignancy, and imaging revealed a nodule in the left lobe of thyroid. Neuroimaging showed osteolytic lesion involving the cranium.

Pleomorphic adenoma of lacrimal gland in a 5-year-old child: Diagnosed on aspiration cytology

Dear Dr. Bedrossian: The term mixed cell tumor of lacrimal gland was first used as early as in 1874. Initially, it encompassed both benign and malignant lesions but gradually was specifically reserved for pleomorphic adenoma. It is one of the most common tumors of the lacrimal gland. It commonly occurs in middle age group and is extremely rare in children. The malignant counterpart of pleomorphic adenoma, the malignant mixed tumor, is much less common but pleomorphic adenoma is known to recur and also to undergo malignant transformation when incompletely excised. So it requires a well established clinical and therapeutic protocol to avoid the risk of malignant transformation or disease recurrence. We report a case of pleomorphic adenoma of lacrimal gland in a 5-year-old child diagnosed on fine-needle aspiration cytology. A 5-year-old child presented with a painless progressively increasing swelling in the right supraorbital fissure since 1 year (Fig. 1). On examination, the swelling was 1.5 3 1 cm in size, firm, well-defined, non-tender, and free from overlying skin. Ptosis of right eyelid was present; however, visual acuity in both the eyes was normal. There was no diplopia or squint. Ultrasonography revealed an ill-defined hypoechoic lesion of size 28.5 3 12.6 3 12.7 mm in superomedial aspect of right orbit which showed flow on color Doppler. On computed tomography (CT scan), there was a hyperdense lesion showing slight contrast enhancement and causing scalloping of the underlying bone. On magnetic resonance imaging (MRI) a heterogeneously enhancing soft tissue mass was seen in superomedial portion of right eye. Radiological possibilities include lacrimal sac tumor, lymphoproliferative disorder, or a dermoid cyst and a fine needle aspiration cytology (FNAC)/biopsy was advised. FNAC was done using 22-gauge needle, smears were stained with romanowsky stains, smears were cellular and revealed epithelial cells dispersed singly and in sheets intermingled in chondromyxoid matrix (Fig. 2). The diagnosis of benign mixed tumor of lacrimal gland was made and an excision biopsy was advised. En bloc excision of the mass through lateral orbitotomy was done and sent for histopathology. The microsections examined revealed a heterogenous encapsulated tumor with epithelial as well as mesenchymal components. The epithelial cells were arranged in sheets, tubules, and strands in an abundant chondromyxoid stroma (Fig. 3). No feature of malignant transformation was seen in the sections examined. Thus, biopsy confirmed the cytological diagnosis of benign mixed tumor of lacrimal gland. Tumors of lacrimal gland constitute only 3–15% of all orbital lesions. Pleomorphic adenoma is the most common and constitute 50% of all epithelial tumors of orbit,

Conjunctival Squamous Cell Carcinoma, A Rare Entity: Case Report of 2 Cases

Squamous cell carcinoma (SCC) conjunctiva is a rare cancer of the ocular surface with an incidence rate of 0.02 per 100,000 in high latitude areas to 3.5 per 100,000 at low latitudes near the Equator. This positive correlation between this SCC incidence and latitude indicates that exposure to ultraviolet radiation may play a role its etiology. The disease is more common in elderly and male patients, but may develop at a younger age, especially in association with xeroderma pigmentosum or immunodeficiency. Isolated squamous cell carcinoma of cornea is rare with few case reports. Here, we report two cases of conjunctival SCC, both in elderly males who presented with whitish painless mass encroaching the cornea. This mass was excised in both the patients. Histopathological examination confirmed the diagnosis of SCC conjunctiva.IOFF

Granular cell tumor: A rare tumor at rare location

Granular cell tumor (GCT) is a rare tumor affecting the middle-aged people with an incidence of 0.017–0.029%. In 1926, Abrikossoff was the first to describe this tumor as myoblastoma as it was arising from muscle in the tongue. Common sites are the tongue, skin, and subcutaneous tissue. Here in, a 29-year-old female presented with a swelling on the ring finger of the right hand. Excision biopsy was performed. Histological features were suggestive of GCT. This case is of particular interest due to the atypical location and clinical presentation.

Morphometric Analysis and Immunocytochemical Staining on Cytospin Preparation in Effusion Cytology: A Study

Introduction: Morphological differentiation between reactive mesothelial proliferation and metastatic carcinoma cells may be extremely difficult in conventional centrifuge deposit smears stained with papanicolaou and romanowsky dyes. In the present study immunocytochemistry and morphometric analysis were performed on cytospin preparation of effusion categorized as atypical/suspicious on toluidine blue stained wet films. Materials and methods: A total of 100 cases comprising 26 benign (control group) and 74 malignant (study group) effusions were included in the study. Samples showing atypical /suspicious cells on preliminary conventional centrifuged wet film stained with toluidine blue; 63 were aspirated from pleural, 36 from peritoneal and 1 from pericardial effusions. These samples were processed for 6 cytospin preparations, 1 air dried stained with giemsa and others fixed in ethanol stained with papnicolaou stain, Cytokeratin 8/18, Epithelial Membrane Antigen (EMA) and Calretinin. Morphometric analysis was performed using software Image Pro Plus Version 6.3 on a minimum of 20 positive and negative stained cells on IHC stained smears. Results: The sensitivity and specificity of CK 8/18 in diagnosing benign, atypical and malignant cases were 91.89% and 89.5% respectively. The sensitivity and specificity of EMA was 90.5% and 86.6% respectively. Calretinin had 97% sensitivity for mesothelial cells. The 3 negative cases did not express CK 8/18 and EMA also. Thus, Calretinin can be accepted as a technique control to decide that immunocytochemical staining is working in a given case because mesothelial cells are generally present in benign as well as malignant effusions as native exfoliated cells. Nuclear area, cytoplasmic area and N:C ratio of mesothelial cells in benign effusions were 56.2 ± 2.03 um2, 182.41 ± 4.61 um2 and 0.31 ± 0.01 um2 and in malignant effusions were 63.15 ± 2.44 um2, 185.67 ± 2.15 um2 and 0.34 ± 0.01 um2 respectively. Using ROC (Receiver Operating Characteristic) curve nuclear area 88.30 μm2 area [sensitivity (98.6%) and specificity (94%)] cytoplasmic area 200.55 μm2 area [sensitivity (100%) and specificity (90%)] and N:C ratio 0.345 [sensitivity (93%) and specificity (94%)] considered as cut off values. So, we can use this value to discriminate between reactive mesothelial proliferations from malignant cells. Conclusion: IHC can be easily performed on cytospin preparation without requiring antigen retrieval and is extremely useful in differentiating metastasis from reactive mesothelial proliferation. The results of morphometric analysis were useful adjunct.

Typing and Grading of Soft Tissue Tumors and their Correlation with Proliferative Marker Ki-67

Aim and Objective: The main aim of this study is to categorize, type, grade of soft tissue tumors & correlate it with Ki-67 proliferative index. Material and Methods: The present study was conducted in the Department of Pathology, PGIMS, Rohtak. The study group comprised of excised 44 cases of STT (soft tissue tumors) specimens. Tumor grade was assigned based on the FNCLCC (Federation Nationale des Centers de Lutte Contre le Cancer) grading system. According to the Ki-67 index the patients were divided into two groups: high index group (>50/10HPF) and low index group (<50/10HPF). These grades were correlated with proliferative activity using Ki-67 index. Results: Out of 44 soft tissue tumors in our study 12 (27.27%) were diagnosed as benign and 32 (72.72%) were diagnosed as malignant soft tissue tumors. Average size of benign tumors was 4.50 cm and that of malignant tumors was 10.33 cm. Maximum number of soft tissue tumor were located in the extremities i.e.10 (22.72%) in upper extremity and 24 (54.54%) in the lower extremity. The commonest site affected was thigh (18.2%). Out of the 32 cases of (STS) soft tissue sarcomas, 15 (46.87%) were Grade 2, 13 (40.63%) were Grade 3 and 4 (12.5%) were Grade 1. MPNST (malignant peripheral nerve sheath tumor) had the largest number of cases with Grade 3 (31.3%). All the benign STT had low Ki-67 index, while the Ki-67 index was low in 12 STS and high in 20 STS. The size as well as grade of the tumors showed a significant correlation with Ki-67 index. Conclusion: Grading based on assessment of morphologic variables is one of the most important factors for predicting the prognosis of the patients with STS. Therefore, it should be a part of the pathology report and should be adapted to the modern management of patients.