Suhail Muzaffar

Inflammatory pseudotumour of the trachea: report of a case in an eight-year-old child

A polypoid inflammatory pseudotumour was diagnosed in the trachea of an eight-year-old child who presented with asthmatic symptoms. The tumour showed 80 per cent blockage of the lower trachea and consisted of proliferating spindly fibroblastic cells admixed with a variable number of inflammatory cells. The literature on childhood inflammatory pseudotumours is reviewed together with the differential diagnosis of other polypoid mesenchymal tumours of the trachea.

Assessment of Nucleolar Organizer Regions (NORs) in Proliferative Conditions of the Liver

To overcome the diagnostic dilemma in proliferative conditions of the liver which sometimes pose a problem to the working pathologist especially when the material is inadequate, a special staining technique (AgNOR) has been applied. By using this technique, nucleolar organizer regions were counted which determine the proliferative status of the cells. This prospective study included 65 cases of randomly selected liver core and fine needle aspiration biopsies. AgNOR staining was performed on formalin-fixed, paraffin-embedded tissue sections NOR dots were counted in 100 randomly selected hepatocytes at x100 oil immersion objective, and the mean count per cell was calculated for each case. Statistical analysis was done by using the Mann Whitney U test. AgNOR count results were later compared with the histologic diagnosis. The study revealed a gradual increase in mean AgNOR counts from normal liver through cirrhosis to hepatocellular carcinoma. The difference in NOR counts was significant in these three groups. The hepatocellular carcinomas were graded according to the Edmondson-Steiner histological grading system. The Grade I hepatocellular carcinomas show AgNOR counts ranging between 5-6/cell, a score which is much higher than in the normal liver, where it ranges between 1.2-2.0/cell. This technique can be used to assess the lesions where the distinction between normal liver and Grade I hepatocellular carcinoma is difficult with the use of routine methods. AgNOR counts in normal liver and chronic hepatitis cases were insignificant, but there was an appreciable difference between cases of chronic hepatitis, cirrhosis and hepatocellular carcinoma. In view of the results of this study, the AgNOR staining method is found to be a useful diagnostic tool to differentiate between normal liver, cirrhosis and hepatocellular carcinoma and also to precisely discriminate between cases of normal liver and Grade I hepatocellular carcinoma.

Capillary haemangioma of the uterus: A rare cause of menorrhagia

Haemangiomas are benign neoplasms of vascular origin. Capillary haemangioma is made up of small, narrow vascular channels lined by a single flat layer of endothelium and is surrounded by variable amounts of fibrous connective tissue. Capillary haemangioma of the uterus is extremely rare, although it has been commonly reported from other body sites. We report a patient with a case of capillary haemangioma of the uterus who primarily presented with menorrhagia.

Clinicopathological profile of Wilms’ tumor

The profile of renal tumors in children less than 15 years of age during the period 1991–1997 is presented. Among the 37 children with kidney tumors, 29 (78.4%) had Wilms′ tumor. There was also a 20-year-old female with Wilms′ tumor. The median age at presentation was 2.6 years (range 2.5 months to 20 years). 66.7% of the cases diagnosed were ≤3 years and 90% were ≤6 years. Five cases were under one year of age. The male to female ratio was 2 : 1. Twenty-two cases (73.3%) were triphasic and 7 (23.3%) were biphasic. Only one case was monophasic with blastemal component. Five cases (16.7%) showed nephrogenic rests in the uninvolved renal parenchyma and one case had nephroblastomatosis. The tumor was favorable in 26 cases (86.7%) and unfavorable in 4. Fourteen cases were in-patients while 16 were outside referrals. The pathological (10 cases whose specimens were sent from other centers) and clinicopathological (13 hospitalized patients) staging showed 10 cases (43.5%) with stage 1,4 cases (17.4%) with stage 2, and 7 cases (30.4%) with stage 3. In two cases (8.7%), there was stage 4 disease. The length of the follow-up period in the 13 hospitalized patients ranged from 7 days to 5 years 5 months (median 14 months). There was one recurrence and one death after 2 years of diagnosis.

Fallopian tube carcinoma presenting as cervical growth: The dilemma of skip metastasis

A 55-year-old woman, para 8 + 0, presented with a 6-week history of postmenopausal bleeding and the recent onset of foul smelling, white vaginal discharge. Her menarche was at age 11 and menopause at age 43, with no history of irregular menses or use of hormone replacement therapy. For the past year she had had reducible haemorrhoids with no associated rectal bleeding. There were no other active medical problems. Family history for gynaecological and colonic malignancies was absent. On examination, the patient was vitally stable. She was pale and had moderate pedal oedema; there was no lymphadenopathy. Chest examination was clear and the abdomen was soft and non-tender, with no gross visceromegly. On abdominal examination, the uterus was not palpable. Speculum and pelvic examination revealed a bulky uterus of 3.5-weeks in size, with a large polyploidal mass projecting from the external cervical opening. A provisional diagnosis of carcinoma of the cervix was made. Routine laboratory investigations revealed a haemoglobin concentration of 12.1 g/dL and the total leucocyte count was 6.6 × 10/L with neutrophils 66%, lymphocytes 31%, eosinophils 2% and monocytes 1%. Platelets were 278 × 10/L. The urine detail report was normal; however, urine culture and sensitivity showed β-lactamase producing Staphylococcus aureus. A Papanicolaou smear showed mostly intermediate type cells with numerous red blood cells and neutrophils. There were very few atypical cells seen, that were irregular with large and hyperchromatic nuclei. Dilatation and curettage under general anaesthesia was undertaken and polypectomy was carried out. Biopsy examination revealed an infiltrating carcinoma with features suggesting adenocarcinoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was carried out and the vaginal vault was closed. On laparotomy, the uterus was found to be smaller than normal size and was mobile. The ovaries and left fallopian tube were of normal appearance. The right fallopian tube was grossly enlarged with an intact and smooth outer surface. All fimbrial ends were enclosed and stuck in the pouch of Douglas giving a picture of hydrosalpinx. There were minimal adhesions with the bowel. The uterus was opened and no gross pathology was found in the uterus and cervix, so lymph node biopsy was not carried out. Peritoneal fluid for cytology was obtained which showed numerous red blood cells, occasional neutrophils, lymphocytes and histiocytes. No malignant cells were seen. Gross examination of the resected specimen revealed a relatively small uterus measuring 7.5 × 4.8 × 2.6 cm. The left ovary was 1.5 × 1.0 × 0.5 cm and right ovary was 2.5 × 0.8 × 0.5 cm. On sectioning, apart from an irregular and roughened area in the cervix, the uterine and cervical canals were unremarkable. The ovaries and left fallopian tube were also unremarkable. The right fallopian tube revealed two grey white growths separated by 1 cm; a 2.5 × 1.5 cm multiloculated growth was present near isthmic end, and a 1.0 × 1.0 cm growth was found more laterally. The histopathology revealed a papillary serous cystadenocarcinoma of the fallopian tube (Fig. 1) with metastatic superficial invading adenocarcinoma in the cervix (Fig. 2). There was no other evidence of metastasis elsewhere. The question of two separate primary carcinomas in the cervix and right fallopian tube was considered. Histological stains were carried out on the cervical biopsy, which did not reveal intracytoplasmic mucin on Alcian Blue stain. Instead focal luminal mucin was found. Immunohistochemical analysis was also carried out on the cervical biopsy, showing the tumour cells of cervical adenocarcinoma to be negative for carcinoembryonic antigen. These features substantiated the impression that the cervical adenocarcinoma was most probably metastasised from the primary carcinoma in the fallopian tube. Moreover, no evidence of cervical intraglandular neoplasm was seen in the adjacent glands. As primary fallopian tube carcinoma is treated like ovarian carcinoma, the patient was referred for chemotherapy.