Vishnu Subramanian

Renal Anastomosing Hemangiomas With a Diverse Morphologic Spectrum: Report of Two Cases and Review of Literature.

Benign vascular lesions have a diverse appearance and can be extremely difficult to classify. We present renal anastomosing hemangiomas from 2 patients that exemplify the potential diverse range of appearances that can occur in this recently described, rare variant of capillary hemangioma. The lesion from one patient was an intravenous hemangioma with closely packed, fenestrated vascular channels that were reminiscent of the splenic red pulp. Also, the endothelial cells contained hyaline globules. On the other hand, the second patient had multifocal tumor. The lesions showed more extensive hyalinization and vascular ectasia reminiscent of cavernous hemangioma. Extramedullary hematopoiesis was a feature in all the tumors, particularly in the second patient where numerous immature blasts were present within vascular spaces.

Comparison of the histopathological effects of two electrosurgical currents in an in vivo porcine model of esophageal endoscopic mucosal resection

BACKGROUND AND STUDY AIMS Stricture formation is the main limitation of endoscopic resection in the esophagus. The optimal electrosurgical current (ESC) for endoscopic resection in the esophagus and other gastrointestinal sites is unknown. There may be a relationship between the type of ESC used and the development of post-procedure esophageal stricture. Unlike the low power coagulating current (LPCC), the microprocessor-controlled current (MCC), which alternates between short pulse cutting and coagulation, avoids high peak voltages that are thought to result in deep thermal injury. The aim of this study was to determine the histopathological variables associated with these two commonly employed ESCs used for esophageal endoscopic resection. METHODS Standardized endoscopic resection of normal mucosa by band mucosectomy was performed by a single endoscopist in 12 adult pigs. The procedures were randomized 1 : 1 to either LPCC (ERBE 100 C at 25 W) or MCC (ERBE Endocut Q, Effect 3). Necropsy and esophagectomy were performed at 72 hours after the procedure. Two histopathologists, who were blinded to the ESC allocation, independently assessed the presence and depth of ulceration, necrosis and inflammation. RESULTS A total of 45 resections were analyzed. In the LPCC and MCC groups, ulceration extending into the muscularis propria was present in 9/24 (37.5 %) and 1/21 (4.8 %) resected specimens, respectively (P = 0.04). Necrosis extending into the muscularis propria was present in 13/24 (54.1 %) and 1/21 (4.8 %) resected specimens, respectively (P = 0.002). One case of microperforation with muscularis propria injury was noted in the LPCC group compared with none in the MCC group. The quantified mean depth of ulceration, necrosis, and acute inflammation was significantly greater in the LPCC group.  CONCLUSIONS In an in vivo porcine survival model of esophageal endoscopic mucosal resection, the use of MCC resulted in significantly less deep thermal ulceration, necrosis, and acute inflammation compared with LPCC. MCC should be used in preference over LPCC for esophageal endoscopic resection.

Renal Anastomosing Hemangiomas With Diverse Spectrum of Morphologic Appearance: Report of Two Cases and Review of Literature

Benign vascular lesions have a diverse appearance and can be extremely difficult to classify. We present renal anastomosing hemangiomas from 2 patients that exemplify the potential diverse range of appearances that can occur in this recently described, rare variant of capillary hemangioma. The lesion from one patient was an intravenous hemangioma with closely packed, fenestrated vascular channels that were reminiscent of the splenic red pulp. Also, the endothelial cells contained hyaline globules. On the other hand, the second patient had multifocal tumor. The lesions showed more extensive hyalinization and vascular ectasia reminiscent of cavernous hemangioma. Extramedullary hematopoiesis was a feature in all the tumors, particularly in the second patient where numerous immature blasts were present within vascular spaces.

56. Pituicytoma: A case report and literature review

Background: The pituicytoma, or infundibuloma, is an exceptionally rare sellar-suprasellar glial neoplasm of adults with low proliferative activity (WHO grade I).1,2 They are thought to arise from the pituicytes, which are specialised glial cells of the neurohypophysis.3 Less than 60 cases are reported so far. Case report: A 37-year-old female presented with amenorrhoea. No other clinical or neuro-endocrine symptoms were present. MRI brain showed a 22 mm intrasellar/suprasellar mass. Frozen section showed a spindle cell tumour. Histology showed cellular tumour with spindle cells arranged in short fascicles and sheets with focal storiform and packeted pattern. The tumour cells had an oval to elongated nuclei with pinpoint nucleoli. Scattered dilated stag-horn-like blood vessels and patchy lymphocytic infiltrates were present. No whorls, psammoma bodies, cytoplasmic granularity, eosinophilic granular bodies or Rosenthal fibres were noted. No mitotic figures or necrosis were noted. The spindle cells were strongly immunoreactive to S-100 protein, BCL-2, and CD99; patchy strong reactivity to GFAP and EMA; patchy weak reactivity to synaptophysin, and CD31; negative to broad-spectrum cytokeratins (AE1/AE3), chromogranin and CD34. The Ki-67 (MIB1) proliferation index was 2% to 8%. Conclusion: We present a case report of this rare entity, review available literature, and discuss the clues to differentiate it from other spindle cell tumours such as granular cell tumour, meningioma, pilocytic astrocytoma, schwannoma and other lesions, which are common to the sellar-suprasellar site, as accurate diagnosis is essential to guide the appropriate management.

Renal Anastomosing Hemangiomas With a Diverse Morphologic Spectrum

Benign vascular lesions have a diverse appearance and can be extremely difficult to classify. We present renal anastomosing hemangiomas from 2 patients that exemplify the potential diverse range of appearances that can occur in this recently described, rare variant of capillary hemangioma. The lesion from one patient was an intravenous hemangioma with closely packed, fenestrated vascular channels that were reminiscent of the splenic red pulp. Also, the endothelial cells contained hyaline globules. On the other hand, the second patient had multifocal tumor. The lesions showed more extensive hyalinization and vascular ectasia reminiscent of cavernous hemangioma. Extramedullary hematopoiesis was a feature in all the tumors, particularly in the second patient where numerous immature blasts were present within vascular spaces.

Urothelial carcinoma of the ovary: privary versus metastatic. a case report and literature review

The ovaries are common sites for intra-abdominal metastasis. About 6% of ovarian cancers found at laparotomy are secondary tumours from other sites. 1 However, metastatic transitional cell carcinoma (TCC) involving the ovary from the urinary bladder or elsewhere within the urinary tract is extremely rare. Primary TCC accounts for 1–2% of all ovarian tumours. 2 TCC of the ovary is a recently recognised subtype of ovarian surface epithelial-stromal cancer. Microscopically, metastatic urothelial carcinoma of ovary is very similar to a primary ovarian TCC. The presence of a component of benign or borderline Brenner tumour confirms an ovarian primary. 3 The distinction between metastatic TCC of urothelial origin and a borderline or malignant Brenner tumour and a primary ovarian TCC can be difficult or sometimes impossible. We present a case of ovarian metastasis from urothelial carcinoma of the bladder. The patient developed bilateral bulky ovarian metastases 7 years after the diagnosis of the primary bladder tumour. The history of primary tumour was not available initially. We favoured metastatic ovarian tumours for the following reasons: (a) definite histological evidence of a primary bladder tumour, (b) bilateral ovarian involvement, and (c) lack of residual Brenner tumour. Although rare, possibility of metastasis from urothelial carcinoma should be considered as a differential diagnosis in cases of transitional cell carcinoma of ovary. Relevant clinical information is vital for accurate diagnosis. Careful histological and histochemical analysis may help to differentiate between the two.