Vijay Kaushal

Basal cell adenocarcinoma of submandibular salivary gland-problems in cytologic diagnosis.

Basal-cell adenoma and basal-cell adenocarcinoma of the salivary gland are rare tumors. Fine-needle aspiration cytology of these tumors, particularly those of basal-cell adenocarcinoma, has rarely been described in the literature. In this report, we describe the clinical, cytomorphologic and histopathologic features of basal cell adenocarcinoma in a 48-year-old male patient. Fine-needle aspiration specimen showed abundant cohesive groups of basaloid cells revealing focal anisonucleosis and nuclear atypia. The tumor cells also showed rosette-like arrangement around central eosinophilic globule. Pertinent literature is reviewed and differential diagnosis are discussed.

Rare coexistence of keratinizing squamous cell carcinoma with xanthogranulomatous pyelonephritis in the same kidney: Report of two cases

Squamous cell carcinoma of urinary tract is a rarely encountered tumor. It is more frequently reported in urinary bladder and male urethra than renal pelvis. Squamous cell carcinoma of renal pelvis is usually associated with nephrolithiasis. However, coexistence of keratinizing squamous cell carcinoma with xanthogranulomatous pyelonephritis is exceedingly rare with only one case on record so far. We report two such cases detected incidentally in patients who have undergone nephrectomy for hydronephrosis. The post operative histological evaluation revealed unsuspected squamous cell carcinoma of renal pelvis with concomitant xanthogranulomatous pyelonephritis.

Cytodiagnosis of intracranial metastatic adenoid cystic carcinoma: Spread from a primary tumor in the lacrimal gland

Adenoid cystic carcinoma (ACC) of the lacrimal gland is a rarely encountered orbital tumor. It invades intracranially more frequently than carcinomas of other glands in the head and neck. A 61-year-old man underwent right orbital exenteration for a tumor in the supraorbital region. He had lost all records and presented to us with a diffuse swelling in the right forehead, six years later. Fine-needle aspiration cytology of the right frontal swelling revealed monomorphic population of small, slightly atypical cells, arranged in multilayered groups with abundant fine intercellular metachromatic substance between cell groups. There were hyaline globules of varying size with attached tumor cells. Cytological diagnosis of metastatic intracranial ACC with a lacrimal gland primary was suggested. Biopsy of the swelling confirmed our cytological diagnosis of ACC with perineural, vascular and lymphatic invasion. Thus, the authors report this case of intracranial metastasis of ACC of the lacrimal gland to remind neurosurgeons planning intervention that this disease shows a tendency to invade intracranially.

Clear cell adenocarcinoma of the colon is a unique morphologic variant of intestinal carcinoma: A rare case report

Primary Clear cell adenocarcinoma of the colon is extremely rare, with only a handful of cases reported in literature. We herein report a case of such a tumor in a 42-year-old male who presented with rectal bleeding and pain abdomen. A circumferential growth occluding the lumen at the hepatic flexure was visualized on colonoscopy. The right hemicolectomy specimen revealed an ulceroinfiltrative growth which showed histologic features of clear cell adenocarcinoma.

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.

Cytohistological correlation in diagnosis of lung tumors by using fiberoptic bronchoscopy: study of 200 cases.

BACKGROUND Examination of specimens obtained through flexible fiberoptic bronchoscope is an important and often the initial diagnostic technique performed in patients with suspected malignant lung lesion. AIMS To evaluate the correlation of cytological findings of bronchial washings, bronchial brushing and imprint smear of bronchial biopsy in the diagnosis of lung tumors, with histopathology of bronchial biopsy taking the latter as the confirmatory diagnostic test. MATERIALS AND METHODS A total of 200 patients with lung mass were included in the study. Bronchial brushings were obtained from all 200 cases. In the first 100 cases, pre-biopsy bronchial washing (washing collected before the brushing and biopsy procedure) while post-biopsy washing (washing at the end of the procedure) was procured in all 200 cases. Imprint smears of bronchial biopsy were prepared in 150 cases. RESULTS Sensitivity and specificity of brushing was 76.58% and 77.78% respectively and that of imprint smear was 81.35% and 78.12% respectively. Pre-biopsy and post-biopsy washing showed high specificity of 88.89%, but low sensitivity of 30.14 and 36.77% respectively. No significant difference was found in sensitivity between brushing and imprint smear (Chi-square; P = 0.4187); and between pre-biopsy and post-biopsy washing (Chi-square; P = 0.7982). However, there was a significant difference between sensitivity of brushing and washing (Chi-square; P = 0.0001). The sensitivity of combination of three cytological diagnostic techniques was 87.29%. CONCLUSION Bronchial brushing and washing cytology in combination with imprint cytology aids in the diagnosis of lung tumors. Therefore, all these techniques may be used concurrently along with bronchial biopsy to diagnose lung tumors.

Diagnostic accuracy of endoscopic brush cytology in malignancies of upper gastrointestinal tract: A prospective study of 251 patients in North India

AIM To find the spectrum and frequency of upper gastrointestinal malignancies and diagnostic accuracy of endoscopic brush cytology in their diagnosis. MATERIALS AND METHODS This study was a prospective study carried out on 251 patients over 1-year in the Department of Pathology. Brushing material was smeared directly on to at least two clean glass slides and was stained with May-Grunwald-Giemsa stain. The endoscopic biopsies were examined grossly and were fixed in 10% formalin, processed, and stained with hematoxylin and eosin stain. OBSERVATION AND RESULTS The age range of the patients varied from 8 to 90 years, with the mean being 56 years. Male to female ratio was 2.5:1. On brush cytology, out of 251 cases, 110 had benign lesions and 97 had malignant lesions. Forty-four samples were considered suspicious of malignancy. On histopathology, benign lesions were present in 105 patients while malignant lesions were seen in 139 patients. In seven cases, results were inconclusive due to inadequate/superficial biopsy. STATISTICAL ANALYSIS Statistical analysis revealed the overall sensitivity of upper gastrointestinal brush cytology as 83.45% and specificity 80.95%. The accuracy of brush cytology came out to be 82.37% in upper gastrointestinal tract. CONCLUSION Brush cytology is a reliable, safe, inexpensive, and rapid method of diagnosing upper gastrointestinal lesions. Although endoscopic biopsies are established gold standard for diagnosing gastrointestinal malignancy, use of both biopsy and brushing together increases the diagnostic accuracy.

Sarcomatoid chromophobe renal cell carcinoma: A rare entity with prognostic significance.

Renal cell carcinoma (RCC) is the most common malignancy of the kidney and has multiple subtypes. The sarcomatoid variety is considered a form of dedifferentiated carcinoma. It is more commonly associated with clear cell variant but very few are associated with chromophobe RCC. When present, it is associated with a significant decrease in patient survival due to its rapid growth and intrusive behavior. Here, we report a unique case of sarcomatoid chromophobe RCC in a 35-year- old woman.

Primary Endometrioid Carcinoma of the Broad Ligament: A Rare Case Report

Although secondary involvement of the broad ligament by malignant tumours arising elsewhere in the abdomen is common, primary tumours in this location are rare. Most neoplasms in this region whether benign or malignant usually present clinically with vague symptoms and are often discovered either during a routine gynaecological examination or on abdominal exploration because of the presence of a pelvic mass and vague lower abdominal discomfort or pain [1]. The present case which was diagnosed clinically as left ovarian tumour and histopathologically as endometrioid carcinoma of the broad ligament is reported for its rarity and for the unique histological finding of transitional cell differentiation associated with the primary tumour.

Metaplastic carcinoma of the breast: A report of two cases along with review of literature

Metaplastic carcinomas of breast are uncommon, representing 0.3% of invasive carcinomas of breast. We are reporting two cases of metaplastic carcinoma breast, one revealing rhabdomyoblastic and spindle cell differentiation and other revealing osteoclast like giant cells. Both were estrogen receptor, progesterone receptor and Her2u negative on immunohistochemistry. Early diagnosis of metaplastic carcinomas is essential as these tumors are usually triple negative and hence, do not respond to transtuzumab. Metaplastic carcinomas typically express HER1/epidermal growth factor receptor (EGFR), thus majority of metaplastic carcinomas are treated with EGFR inhibitors such as geftinib and cetuximab. Also, metaplastic carcinomas are associated with a worse prognosis with a disease free survival rate being 78.1% in metaplastic breast carcinomas compared with 91% in infiltrating duct carcinomas.