Sunitha Jacob

Transfusion associated GVHD.

Transfusion-associated graft-versus-host disease (TA-GVHD) is an under-diagnosed condition in clinical practice. It can occur in immunocompromised as well as immunocompetent hosts and may follow allogeneic bone marrow transplant or transfusion from a related donor. The clinical course is stormy with a high mortality rate. Avoiding the use of blood transfusions from related donors and irradiation of blood products can prevent graft versus host disease. A case of graft versus host disease following related donor transfusion is presented here

Placental site nodule: a tumor-like trophoblastic lesion.

Placental site nodule is an uncommon, benign, generally asymptomatic lesion of trophoblastic origin, which may often be detected several months to years after the pregnancy from which it resulted. This entity may have bizarre histologic findings and should be distinguished from other aggressive lesions like placental site trophoblastic tumor, epithelioid trophoblastic tumor and squamous cell carcinoma.

Serous microcystic adenoma (glycogen rich cystadenoma) of the pancreas

Serous microcystic adenoma (SMCA) is a rare pancreatic tumor with a striking predilection for elderly females and a rather unique morphology. Classically, the tumor is riddled with innumerable small cysts around a stellate scar. The quintessential histological features are closely placed small cysts lined by glycogen rich cuboidal epithelium. In view of its excellent prognostic outcome, this tumor needs to be accurately diagnosed. This report documents a case of SMCA occurring in a 60-year-old female.

Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma.

Chondroid hamartomas of the lung are uncommon lesions which are generally small sized and asymptomatic. Herein we describe a case of a large-sized pulmonary chondroid hamartoma which clinically mimicked bronchogenic carcinoma. A large hilar growth was detected in the left lung on radiological studies. Left upper lobectomy was done. The growth was well defined with a lobulated bluish cut surface. Histopathology disclosed lobules of mature cartilage rimmed by long slit-like epithelial channels admixed with mature adipose tissue.

Cytomegalovirus colitis masquerading as rectal malignancy in an immunocompetent patient.

Gastrointestinal tract (GIT) involvement by cytomegalovirus (CMV) infection is well-recognized in immunosuppressed patients but is uncommon in immunocompetent hosts. The colon and esophagus are the most frequently affected sites with punched out ulcers being the characteristic mucosal lesion. CMV-induced pseudotumor is an exceptionally rare presentation, especially in immunocompetent hosts. A 76-year-old immunocompetent female presented with abdominal pain and constipation. Colonoscopy revealed an ulcerated polypoidal tumor-like mass in the anorectal region. Biopsy of the lesion showed large basophilic intranuclear inclusions which were positive for CMV on immunohistochemical staining. The patient responded to 2 weeks of antiviral therapy with complete resolution of the mass. Although rare, pseudotumors associated with CMV infection should be considered in the differential diagnosis of tumorous lesions of the GIT.

Primary osteogenic sarcoma of the breast

Primary osteogenic sarcomas of the breast are extremely rare with less than 100 cases reported in literature. They generally present in middle aged and older women and are highly aggressive. These tumors need to be differentiated from osteoid/bone- producing metaplastic carcinomas as the two differ in their biologic behavior and treatment protocols. A 60-year-old lady presented with a short history of a rapidly enlarging breast lump. Histopathological examination revealed a richly cellular, pleomorphic tumor with abundant osteoid. The tumor cells were immunoreactive for vimentin and negative for cytokeratin and estrogen and progesterone receptors.

Primary intra-renal teratoma associated with renal dysplasia: an unusual entity.

Primary intrarenal teratomas are uncommon, and their association with renal dysplasia is rarer. We report a case of primary renal teratoma in a 1-year-old child who had undergone a retroperitoneoscopic nephrectomy. Pathologic examination showed evidence for a primary mature teratoma with renal dysplasia.

Benign signet ring cells in pseudomembranous colitis: A diagnostic trap

A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC) change. The SRCs possessed bland nuclei and were confined to the basement membranes of the crypts with no infiltration into the lamina propria. Benign SRCs in pseudomembranous colitis is an uncommon phenomenon. Awareness of this rare, but potential pitfall is of utmost importance to avoid a misdiagnosis of SRC carcinoma.

Long segment ileal duplication with extensive gastric heterotopia

Duplications of the alimentary tract are rare congenital anomalies which can be found at all levels of the alimentary tract. Majority of the duplications present as spherical cysts and usually range from a few millimeters to less than ten centimeters in size. Duplications produce complications such as intestinal obstruction or hemorrhage. A two-month-old infant presented with recurrent episodes of bleeding per rectum. Laparotomy revealed a giant ileal duplicated bowel segment which exhibited extensive gastric heterotopia with focal ulceration.

Autoimmune oophoritis: A rarely encountered ovarian lesion

Autoimmune oophoritis is a rare disorder causing ovarian failure clinically characterized by amenorrhea and infertility. It often occurs in a setting of autoimmune polyendocrine syndromes. A 38-year-old female presented with a 3 years history of secondary amenorrhea. She was on treatment for Hashimotos thyroiditis and Addisons disease. The ovaries were cystic and histologically featured by folliculotropic lymphoplasmacytic inflammatory infiltrate concentrated in the theca interna layer of developing follicles, but sparing the primordial follicles.