Kafil Akhtar

ABSTRACT Primary signet-ring cell carcinoma (SRCC) of vermiform appendix is extremely rare. A 62-year-old man presented to the Surgical Clinics with right lower abdominal pain, where he was diagnosed with acute appendicitis based on the history and examination with hematologic investigations and computed tomography. Appendectomy specimen grossly showed acute inflammation with appendiceal adhesions and body of the appendix showed wall thickening and luminal occlusion. Microscopically nests of carcinoma cells were seen with compressed nuclei and intracytoplasmic mucin invading into the muscular layer. No lymphovascular permeation was seen. The cut margins were negative for carcinoma cells. Immunohistochemically, SRCC cells were positive for cytokeratin (CK) AE1/3, EMA, CEA, MUC2, and high Ki-67 labeling index. They were negative for CK5/6, CK7, Vimentin, MUC1 and chromogranin. Our patient is fine after 6 months of follow up, with no evidence of recurrence or metastasis.

ABSTRACT The spectrum of the bladder cancer is quite diverse, with urothelial cancer making up the majority of the cases. Urothelial carcinoma represents more than 90.0% of bladder cancers. Most cases of urothelial carcinoma of the bladder present in patients over the age of 50 years. We present a case report of a 47 year old male, who presented with complaints of blood in urine for one and a half months. CT-Scan showed an endophytic mass lesion involving left posterolateral wall of urinary bladder and left vesicoureteric junction. He was operated upon and was diagnosed as high grade urothelial carcinoma with sarcomatoid differentiation on histopathogical examination. Our patient was administered adjuvant chemotherapy, cisplastin 50mg/m2 x 6 cycles. He is doing well after 6 months of follow up period. Keywords: Urinary Bladder, Urothelial, Hematuria, Histopathology, Immunohistochemistry

Anaplastic carcinomas are the lethal thyroid neoplasms and have poor survival rate and prognosis. Pre existing well differentiated thyroid neoplasms can give rise to anaplastic carcinoma. Here, we report a case of anaplastic carcinoma in a young female in a colloid goitre as an incidental finding diagnosed by histopathological examination. Thyroid function tests showed suppressed TSH and elevated FT4 and FT3. Anti-thyroid hormone drugs were started. Thyrotropin receptor antibody was negative. USG neck showed single hypoechoic lesion in the periphery of the right lobe. A thyroid scan revealed focal hot and cold nodules and fine needle aspiration biopsy (FNAB) of the thyroid gland showed colloid nodule. Patient underwent right side lobectomy and final histopathology showed anaplastic thyroid carcinoma. Our case is interesting from a pathophysiologic perspective, since it suggests that nodular goiter can be associated with an aggressive form of thyroid carcinoma. We would like to emphasize that there should be a high index of suspicion in patients with nodular goiter for careful evaluation to detect any associated cancer.

To study the clinical and radiological presentation of lung cancer and diagnose the type of lung cancers using cytohistopathology and immunohistochemistry where-ever required. The study was carried out on 200 patients of lung cancer. Cytological investigations included sputum cytology, pleural fluid examination, percutaneous needle aspiration, trans-bronchial needle aspiration and FNAC lymph-node. Histopathology of paraffin embedded sections of lung biopsies was done. Immunohistochemical staining was done where ever required. Out of 200 cases, cytology was helpful in typing malignancy in 165 cases (82.5%).In the remaining 35 cases, 21 cases (10.5%) were suggestive of malignancy and 14 cases (7.0%) were inconclusive. On histological evaluation of 64 cases, typing was possible in 48 cases (71.8%) and 18 cases (28%) were reported as poorly differentiated carcinoma. After applying immunohistochemistry in 18 cases of poorly differentiated malignancies, 13 cases(72.2%) were positive only for CK5/6 as squamous cell carcinoma, 4 cases were positive for TTF1, out of which 3 were positive for CK7 making it as 4 cases(22.2%) of adenocarcinoma. One case (5.5% was positive for CK5/6, CK7 and TTF1 and was diagnosed as adeno-squamous carcinoma. Combination of various cytological techniques following additional use of histological evaluation of lung biopsies where ever required has raised the sensitivity of diagnosing lung cancer from 82.5% to 91.0% and immunohistochemistry clinched the diagnosis in poorly differentiated lung cancers.

Granulomatous dermal lesions pose a diagnostic challenge, since several causes can produce an identical histologic picture and, conversely, a single cause may produce varied histologic pattern. The aim of this study is to analyze the spectrum of various etiologies involved in granulomatous skin diseases and their clinicopathological correlation. Cases of granulomatous lesions reported over last one year on histopathological and cytological examination were reviewed along with special stains. A total of 20 cases of different etiologies were taken for study including infectious and non-infectious underlying causes. Out of the 20 dermal granulomatous lesions studied, 12 cases (60.0%) were bacterial, 1 case (5%) each of fungal and associated with malignancy and 6 cases (30%) due to non-infectious etiology like granuloma annulare and foreign body associated were recorded. Amongst the bacterial granulomatous lesions, predominance of Mycobacterium leprae was seen, 6 cases (40%). The varied presentation of Hansen’s disease in our study included 4 cases (20%) of tuberculoid leprosy and 2 cases (10%) each of lepromatous leprosy and borderline tuberculoid leprosy. Three cases (15%) of cutaneous tuberculosis seen in our study and were typified as lupus vulgaris, 2 cases (10%) and a single case (5%) of tuberculosa verrucosa cutis. One case, (5%) of Klebsiella rhinoscleromatis was also seen. Skin biopsies help in arriving at a conclusive diagnosis, if aided by a proper clinical history and examination and assisted by special stains, culture of organisms, PCR and immunoflourescence.

Sacrococcygeal teratoma (SCT) is a congenital neoplasm that develop embryologically from totipotent cells and enlarge as a mass in sacrococcygeal region. SCT is usually benign but in a significant number of patients it presents with metastatic disease. A 1-year-old female child presented to our hospital with a history of a sacrococcygeal swelling since birth. Investigations revealed the lump to be a sacrococcygeal teratoma. The size of swelling increased gradually over time to a size of 12 cm × 9 cm at presentation. On further work up the patient was found to have metastasis in cerebrospinal fluid (CSF). We present a very rare case of CNS metastasis in a girl with sacrococcygeal teratoma reported on cytology.

Progress in the diagnosis and treatment of neoplasm in children in past few decades is one of the most gratifying achievement in the field of oncology. Childhood lymphomas are rare paediatric malignancy characterized by abnormal growth of lymphocytes. Aims and Objectives of this study was to describe the epidemiology of childhood cancer in western Uttar Pradesh, a state in Northern India, that would serve as a National reference source and will act as a seminal to spawn new research in the field of childhood lymphomas. The study evaluated a total of 252 cases of pediatric tumors over a period of seven years, including patient of 0-12 years of age group; attending the out-patients and in-patients of Jawaharlal Nehru Medical College (tertiary care centre), Aligarh, with the complaints of tumor associated sign and symptomsLymphoma being 3rd most common childhood malignancy in our study comprised a total of 15 cases, that included 9 cases of Hodgkin’s Lymphoma (HL) and 6 cases of Non Hodgkin’s Lymphoma (NHL). It accounted for 6% of total neoplasm and 12.5% of all pediatric malignancies. The mean age of occurrence was 8.1 years with a slight male predilection.

Breast carcinoma is one of the most common cancers in women. The important preoperative diagnostic modalities include ultrasonography and cytology. Prior to operation cytological grading of breast carcinomas would be desirable for the selection of patients for neoadjuvant therapy. This study has been carried with the aim to evaluate and correlate Robinson’s cytological grading with modified Bloom Richardson histological grading system for infiltrating ductal carcinoma. The period of study was one year (January 2015- December 2015), comprising of 56 female patients attending both outpatient departments (OPD) as well as admitted in ward. Fine needle aspiration cytology (FNAC) smears of invasive breast carcinoma, were graded according to the Robinson’s grading system. The corresponding histological sections were graded according to Elston and Ellis’ Nottingham modification of Bloom Richardson method. Out of 56 cases, 15 (27%) cases were graded as grade I, 31 (55%) grade II, and 10 (18%) grade III on cytology, whereas 16 (29%), 32 (57%) and 8 (14%) cases were graded as grade I, II and III on histology. The concordance rate between cytology and histology grades were 73.3%, 81% and 70% for grade I, II and III tumor respectively. Absolute concordance rate was 76.78%. Apart from being simple and non-invasive investigation, cytologic grading method could be comparable with histologic grading system and a useful parameter for selecting neoadjuvant chemotherapy in patients of breast carcinoma.