Vijay Saroha

Demodex-associated dermatologic conditions--A coincidence or an etiological correlate. Review with a report of a rare case of sebaceous adenoma.

Demodex folliculorum is a saprophytic mite of the human pilosebaceous unit with a prelidiction for facial skin and eyelashes. Infestation occurs frequently without symptoms; however, suppurative or granulomatous inflammation may be seen with high mite density. Skin lesions, such as rosacea, pityriasis, and blepharitis, have been attributed to Demodex; however, its role in sebaceous adenoma (SA) has not been reported in extensively searched medical literature. We report this rare case and review the skin lesions associated with Demodex folliculorum.

Morphological findings in bone marrow biopsy and aspirate smears of visceral Kala Azar: a review.

CONTEXT Visceral leishmaniasis (VL) is endemic in India and may simulate and cause many hematological disorders like pancytopenia, myelofibrosis, myelodysplasia and hemophagocytosis. AIMS The study aims to investigate the hematological manifestation of Visceral Leishmaniasis and associated changes that may be observed in bone marrow aspirate smears and biopsy which may warn a pathologist of possible infections. SETTINGS AND DESIGN This is a retrospective study of 18 VL cases on B (b) one marrow aspirate and biopsy in the department of Pathology in a tertiary care teaching hospital in New Delhi. METHODS AND MATERIAL Giemsa stained slides of bone marrow aspirates and hematoxylin and Eosin stained biopsy slides were reviewed in detail by two competent pathologists. All the findings were tabulated and discussed and comparisons made with the previous similar studies. RESULTS Hyper cellular marrow, increased lymphocytes and plasma cells, marrow granulomas, hemophagocytosis, myelofibrosis, myelodysplasia and gelatinous transformation of the marrow were notable features the presence of which together or individually should caution a pathologist to search for Leishman Donovan (LD) bodies in patients especially in a non-endemic zone in a tropical country.

Pseudogaucher cells obscuring multiple myeloma: a case report

Gaucher-like or pseudo-Gaucher cells have been noted in a variety of conditions including acute lymphoblastic leukemia, Hodgkins disease, thalassemia, and multiple myeloma. They have an eccentric, lobulated nucleus, foamy cytoplasm but lack the tubular inclusions seen in Gaucher cells. The pseudo-Gaucher cells have distinct appearances on electron microscopy which distinguish them from true Gaucher cells.Increased pseudo-Gaucher cells probably reflects the increased load of leukocyte membrane derived glucosylceramide presented to macrophages under conditions of high cell turnover when the normal pathways for its removal may be saturated.We present a case of a 72-year-old Indian Aryan female, in which the bone marrow contained sheets of histiocytes with features mimicking gaucher cells. These pseudo-Gaucher cells obscured neoplastic plasma cells causing diagnostic difficulty.

Lymphangioma of the ovary.

Aleem F, Pennisi J, Zeitoun K, et al. 1995. The role of color Doppler in diagnosis of endometriomas. Ultrasound in Obstetrics and Gynaecology 5:51–55. Asch E, Levine D. 2007. Variations in appearance of endometriomas. Journal of Ultrasound in Medicine 26:993–1002. Del Frate C, Girometti R, Pittino M, et al. 2006. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation Radiographics 26:1705–1718. Dwivedi AJ, Agrawal SN, Silva YJ. 2002. Abdominal wall endometriosis. Digestive Diseases and Sciences 47:456–461. Fauconnier A. 2005. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Human Reproduction Update 11:595–606. Kinkel K, Frei KA, Balleyguier C, et al. 2006. Diagnosis of endometriosis with imaging: a review. European Radiology 16:285–298. Moen MH, Stokstad T. 2002. A long-term follow-up study of women with asymptomatic endometriosis diagnosed incidentally at sterilization. Fertility and Sterility 78:773–776. Patel MD, Feldestein VA, Chen DC, et al. 1999. Endometriomas: Diagnostic performance of US. Radiology 210:739–745. Picod G, Boulanger L, Bounoua F, et al. 2006. Abdominal wall endometriosis after caesarean section: report of fifteen cases. Gynecologie, Obstetrique et Fertilite 34:8–13. Purvis RS, Tyring SK. 1994. Cutaneous and subcutaneous endometriosis. Surgical and hormonal therapy. Journal of Dermatologic Surgery and Oncology 20:693–695. Wang PH, Juang CM, Chao HT, et al. 2003. Wound endometriosis: risk factor evaluation and treatment. Journal of the Chinese Medical Association 66:113–119. Woodward PJ, Roya S, Mezzetti JP. 2001. Endometriosis: Radiologic-Pathologic correlation. Radiographics 21:193–216. Zhao X, Lang J, Leng J, et al. 2005. Abdominal wall endometriomas. International Journal of Gynaecology and Obstetrics 90:218–222.

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)).

Hyaline vascular Castleman disease relapsing as T cell rich B cell lymphoma with paraneoplastic pemphigus

A 32-year-old woman presented with mild fever and solitary discrete cervical lymph node (5 cm) for 2 years. The excision biopsy showed preserved lymph-node architecture with prominent onion skinning (figure 1) and hyalinised blood vessels in the germinal centres (figure 1, inset). The patient was investigated thoroughly for lymph nodes else where, but no lymph nodes could be detected. The overall picture was suggestive of localised Castleman disease (LCD), hyaline vascular type. The HIV, HHV-8 and Epstein Barr Virus serology was negative. Figure 1 Hyaline vascular Castleman disease with prominent onion skinning and hyalinised blood vessels (H& E staining, 100×; inset: 400×). The patient returned 5 years later with abdominal distension, weight loss, cervical and inguinal lymphadenopathy, hepatoslenomegaly and vescicobullous skin rashes for 3 months. CT and MRI revealed multiple cervical, retroperitoneal and mediastinal lymph nodes (figure 2). …

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.

Solitary Lymphangioleiomyoma of Pancreas Mimicking Pancreatic Pseudocyst—A Case Report

IntroductionLymphangioleiomyomatosis (LAM) is a rare disease characterized by proliferation of morphologically distinguishable smooth muscle cells in the lymphatics and lymph nodes of the pulmonary parenchyma in most cases. Extrapulmonary LAM is a rare condition and is found to occur concurrently, before or after pulmonary LAM, and show strong association with tuberous sclerosis.DiscussionThe literature regarding extrapulmonary LAM without associated pulmonary LAM is limited due to the extreme rarity of the cases. We hereby describe clinical, pathological and radiological features of primary pancreatic LAM presenting clinicoradiologically as pseudocyst of pancreas in a 43-year-old lady.ConclusionThe present case is unique as LAM in pancreas without associated pulmonary LAM has never been reported in the literature before.

Inflammatory myofibroblastic tumour of the kidney with a papillary adenoma

Sir,Inflammatory myofibroblastic tumour (IMT) is a rare condition known by a variety of terms including plasma cell granuloma, post-inflammatory tumour, xanthomatous pseudotumour, inflammatory pseu...

Lymphoepithelioma-like carcinoma of the cervix

Lymphoepithelioma are common tumours of the nasopharynx. Similar tumours have been identified in other areas of body, including the stomach, salivary gland, lung, thymus, skin, breast and urinary bladder, where they are designated as lymphoepithelioma-like carcinomas (Skinner et al. 2000). Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is an uncommon entity and constitutes approximately 0.7% of primary cervical malignancies (Kohrenhagen et al. 2008). The WHO classification of epithelial tumours of uterine cervix categorises LELC as a histological subtype of squamous cell carcinoma. However, it should be considered as a distinct entity, as it differs from squamous cell carcinoma in having a more favourable prognosis, typically affecting a younger population of women, more prevalent in non-Caucasian populations (especially those of Asian descent), and lacking a clearly defined association with human papilloma virus (HPV) infection (Skinner et al. 2000).