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Aggressive osteoblastoma (AO) is a rare variant of osteoblastoma characterized histologically by epithelioid osteoblasts and clinically by local recurrences if not excised completely. Aggressive osteoblastoma has been described in various unusual sites; however, based on our search of the literature, involvement of the tarsal navicular has not been previously described. Herein, we report what we believe to be the first case of aggressive osteoblastoma involving the tarsal navicular in a 35-year-old woman. The tumor showed osteoid surrounded by epithelioid cells along with numerous osteoclastic giant cells. Absence of necrosis, mitosis, and infiltration into the surrounding native bone helped rule out the possibility of low-grade osteosarcoma.

Testicular regression syndrome (TRS) represents a congenital condition in which no normal testicular tissue can be identified following exploration for a clinically impalpable testis. It is seen in less than 5% of cryptorchidism cases, however accounts for 35-60% of clinically impalpable testis. To study the Clinicopathological spectrum of Testicular regression syndrome (TRS) and review the literature. Study design: The study included 22 patients with nonpalpable testis, who had undergone resection of testicular nubbins. Original diagnosis was studied in context of pathological recognition of TRS and additional sections and stains were examined. Pathological assessment included identification of epididymis and vas deferens, vascularised fibrous nodule (VFN), dystrophic calcification, hemosiderin and pampiniform plexus like veins. Stain for iron and calcium were performed. On secondary review, 21 out of 26 cases of undescended testis (UDT) showed features consistent with the diagnosis of TRS. On microscopy, VFN was observed in 17 (77.3%), calcification in 4 (18.2%), hemosiderin in 15 (68.2%), vas deferens in 13 (59%), epididymis in 11 (50%), prominent vessels in 21 (95.4%) and seminiferous tubules in 6 (27.3%) cases. The presence of dystrophic calcification and hemosiderin deposition with absent viable tissue points to the hypoxic injury to the testis. TRS theoretically carries a long-term risk for malignant degeneration therefore In the typical situation in which a blind-ending spermatic cord without viable testis is submitted for tissue analysis, it is imperative to characterize such cases as consistent with regressed testis thus eliminating the need for further surgical intervention.

Objective: To evaluate the utility of intraoral fine-needle aspiration cytology (FNAC) in diagnosis of minor salivary gland neoplasms (MSGN) with application of Milan system of reporting salivary gland cytopathology; keeping histopathology as gold standard and to detail the cytological findings of MSGNs. Method: Retrospective study between Jan 2008 and June 2017 (appro × 10 years) on the cytology of the minor salivary gland tumor along with the histopathological correlation. The relevant clinical data was collected from the medical record. Result: Sixty-four cases of MSGNs were included in the study. The histodiagnosis of the 41 were available. Twenty-one cases were diagnosed as malignant, while rest 20 cases were reported as benign. The most common tumor diagnosed was pleomorphic adenoma (PA) (50% cases), followed by mucoepidermoid carcinoma (14%) and adenoid cystic carcinoma (12.5%). The most common site of MSGT was found to be hard palate (44%), followed by soft palate (23%), floor of the mouth (12%), lip (11%), buccal mucosa (5%), and tongue (5%) with no gender predilection. Sensitivity of FNAC for detection of malignancy was 81% while specificity 95%. For malignancies, positive predictive value for malignancies was 17/18 (94.4%) and negative predictive value was 19/23 (82.3%). According to Milan system out of 21 cases in category IV B, 4 cases were found malignant (Category VI), while 1/18 case in category VI turned out to be nonneoplastic lesion (Category II). Conclusion: FNAC is imperative in early diagnosis and subsequent management of MSGNs

Background Hepatoblastoma (HB), rare malignancy in itself, is the most common primary liver tumor in children. Most common presenting features are abdominal distension or abdominal mass. Several patterns are associated with HB with different prognosis. Furthermore, some patterns have overlapping features with other childhood tumors. Aims and objectives The aim of this study is to discuss various patterns of HB which we came across in a tertiary care hospital during our study. H and E slides were reviewed with respect to different patterns, postchemotherapy changes including extramedullary hematopoiesis, necrosis, osteoid metaplasia, necrosis, and fibrosis. Conclusion Different patterns of HB should be kept in mind by the pathologists to avoid any misdiagnosis.

Ritu Arora,1 Ruchi Goel,1 Samreen Khanam,1 Sumit Kumar,1 Shalin Shah,1 Sonam Singh,1 Mohit Chhabra,1 Ravi Meher,2 Nita Khurana,3 Tanu Sagar,4 Suresh Kumar,5 Sandeep Garg,5 Jyoti Kumar,6 Sonal Saxena,4 Rashmi Pant7 1Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India; 2Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India; 3Department of Pathology, Maulana Azad Medical College, New Delhi, India; 4Department of Microbiology, Maulana Azad Medical College, New Delhi, India; 5Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 6Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 7Society for Health Education and Allied Research, New Delhi, IndiaCorrespondence: Ruchi GoelDepartment of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, IndiaTel +91 9811305645; +91-11-41440108Email gruchi1@rediffmail.comPurpose: To list the clinico-epidemiological profile and possible risk factors of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) patients presenting to a COVID dedicated hospital during the second wave of COVID-19 in India.Patients and Methods: A cross-sectional, single-center study was done on 60 cases of probable CA-ROCM based on clinical features and supportive diagnostic nasal endoscopic findings and/or radiologic findings. Patients with recent or active COVID-19 were included. The demographic profile, clinical features, possible risk factors and diagnostic workup (microbiological, pathological and radiological) were analysed to identify the triggering factors for CA-ROCM.Results: The age of patients ranged from 29 to 75 years and male–female ratio was 3:1. The duration between the first positive COVID report and onset of CA-ROCM was 0 to 47 days. Forty-nine (81.66%) patients had a recent COVID infection and 11 (18.33%) had active COVID infection at presentation. Thirty-five patients (58%) had ocular/orbital involvement at presentation. In the affected eye, 10 had no perception of light and in the rest visual acuity ranged from log MAR 0 to +1.5. Ocular manifestations were ptosis (29), ophthalmoplegia (23), periocular tenderness and edema (33), proptosis (14), black discoloration of eyelids (3), facial palsy (3), endophthalmitis (4), retinal artery occlusion (8), disc edema (4) and disc pallor (5). Twenty-two (25%) patients had neither received steroids nor oxygen. Thirty patients (50%) were managed with oxygen while 38 patients (63.3%) with systemic steroids. The most common risk factor was diabetes in 59 patients. The average glycosylated hemoglobin (HbA1c) was 10.31 ± 2.59%. Systemic Amphotericin B was started in all the patients. Radical surgical debridement was performed in 12 patients and the remaining were planned.Conclusion: SARS-CoV-2 variant with accompanying glycaemic dysregulation was found to be the triggering factor for the epidemic of CA-ROCM.Keywords: COVID-19 treatment, CA-ROCM, orbital apex syndrome, ophthalmoplegia, retinal arterial occlusion, COVID-19 associated rhino-orbital-cerebral mucormycosis

Objective: To study the histopathological pattern of endometrium and associated pathological conditions in patients presenting with abnormal uterine bleeding due to adenomyosis. Material and Methods: The study was conducted at Maulana Azad Medical College, New Delhi and included 87 patients who underwent hysterectomy and were diagnosed with adenomyosis from Jan 2017 to Dec 2019. These cases were subsequently reviewed for presenting symptoms of adenomyosis and correlated with histomorphological features and associated comorbidities. The quantitative variables were expressed as mean and qualitative variables as percentages. Results and Conclusion : The age of the patients who had adenomyosis ranged from 25 to 65 years, majority were in the age group of 40- 50 years. Abnormal uterine bleeding was the most common symptom. The associated histopathological examination reveals pattern of endometrium from proliferative endometrium to endometrial hyperplasia. Estrogen may be a risk factor as it is associated with fibroid and endometrial hyperplasia.

Objective The aim of the study was to evaluate the gingival manifestations of tuberculosis (TB) in the oral cavity in pediatric patients. Study Design Four pediatric patients were enrolled in the study. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed. Four pediatric patients who presented with atypical gingival lesions were thoroughly examined for local and systemic signs and symptoms, and a detailed history was obtained. All relevant investigations led to a definitive diagnosis of oral tuberculous lesions. On the basis of the final diagnosis, antitubercular therapy (ATT) was started for all the pediatric patients, and outcomes were measured. Results All 4 patients responded very well to the treatment, with complete resolution of the lesions within 6 months after the initiation of ATT. Conclusions Health care professionals should rule out TB as one of the differential diagnoses in pediatric patients with atypical gingival lesions. ATT is strongly recommended for the treatment of oral TB to achieve good clinical outcomes. Rapid molecular tests based on nucleic amplification should be utilized for the diagnosis of TB in children and also for extrapulmonary TB because they are much faster and reliable compared with conventional methods.

Introduction: Invasive breast cancer (IBC) is a heterogeneous entity, showing distinct molecular features and biologic behaviour. Immunohistochemistry (IHC) based molecular classification has been recommended for clinical decision making. Variable expression of cytokeratins (CK) is now a major therapeutic determinant in addition to the hormone receptor status, clinical stage and grade of the tumour. Aims and Objectives: This study was conducted to assess the expression of CK 8/18, CK 19, CK5/6 and CK 20 in patients of invasive breast carcinoma and its correlation with hormone receptor status and clinicopathological profile. Materials and Methods: IHC staining for CK 8/18, CK 19, CK5/6 and CK 20 and ER, PR, Her2neu was applied on sections of 43 cases of carcinoma breast using avid in biotin peroxidase technique. The distribution and intensity of staining was recorded and statistical analysis was done using chi square and fischers test. P value of Observations: CK 8/18, CK 19, CK 20 and CK 5/6 was observed in 72%, 83.7%, 13.9% and 18.6% of cases respectively. There was no significant difference of various Cytokeratin expression with ER, PR and Her2neu expression. One fourth of CK5/6 positive cases also expressed ER and PR. CK8/18 correlated positively with CK 19 expression as both are luminal markers. Conclusion: Breast cancer cases could be subdivided into different cellular phenotypes based on the expression of luminal and basal CK. There was no correlation of CK expression with hormone receptor expression. This study has further characterized the heterogeneous nature of breast carcinoma using IHC which may facilitate the physician in making patient diagnosis, prognostication and outcome. Keywords: Breast cancer, Cytokeratin, Hormone receptor.

Background: Intraoperative evaluation of an ovarian mass is of crucial importance in its further management, accomplished by frozen section (FS) and scrape smear (SS) examination. Aim: To evaluate utility of SS over FS and to study scrape cytological features of a variety of ovarian neoplasms. Materials and Methods: The study comprised ovarian tumors studied over a period of 1 year (2014–2015) that were submitted for intraoperative assessment. SS and FS were examined and evaluated independently. The results were compared with final pathological diagnosis in each case, and cases with discordant diagnoses were reviewed. All the SSs of ovarian tumors were re-evaluated with Giemsa-stained smears, and cytological features were described. Results: The results of SS and FS were 100% concordant. On histopathology, of 81 cases, 43 were epithelial [(categorized further as serous, mucinous, or malignant mixed Mullerian tumor (MMMT)] along with subcategorization of benign, borderline, and malignant), 16 were germ cell (categorized as teratoma: mature/immature and yolk sac tumor), 11 were sex cord stromal tumors (fibroma, granulosa cell tumor, Sertoli–Leydig cell tumor), 8 cases were hemorrhagic cysts (torsion, endometroid, corpus luteal cyst, etc.), and 3 were metastasis. There were 61 benign, 2 borderline, and 18 malignant cases on FS and scrape. Combining all the values, sensitivity and specificity were 76% and 98.21%, respectively. The diagnostic accuracy in diagnosing malignant lesions was 91%. Conclusion: Adequate knowledge on cytohistological correlation of ovarian scrape cytology may phase out the use of cryostat in intraoperative diagnosis of ovarian neoplasms, and thus be a boon for resource-deprived settings.

Background: Cytological examination of pericardial effusion fluids is important in diagnosing the etiology of underlying disease, staging, and prognosis of cancer. Aims and Objectives: (1) To study cytological evaluation of pericardial effusions in various pathological conditions in a tertiary care center. (2) To analyze their frequency and clincopathological correlation of the diagnosis. Materials and Methods: Our study was a retrospective study performed in the Department of Pathology from 1st January 2012 to 31st December 2016. The study sample included all the pericardial effusions submitted in the pathology department for cytological evaluation. Clinical details and relevant parameters correlated with clinical findings. Each fluid underwent cytospin and cytocentrifuge along with preparation of conventional smears. Results: Of 120 cases, 80% were of benign effusion and 20% were of malignant effusion. Male-to-female ratio was 1.44:1 with patient age ranging from 3 to 90 years. Conclusion: Benign effusions can been seen in younger age group and malignant ones in the older age group. The preliminary pericardial fluid analysis in resource-limited settings is the most convenient and cost-effective method for accurate diagnosis. It reduces the demand of invasive investigations and its complications. At times, it is the first test to point toward underlying malignant process thereby affecting the prognosis, survival, and treatment outcome of the patient.

Objectives: To study the direct immunofluorescence (DIF) in cicatricial alopecia (CA) patients. Materials and Methods: Approximately, 155 skin biopsies from CA patients examined over 7 years (2009–2015). Special stains and Hematoxylin and Eosin were performed, and final histopathological diagnosis was made. DIF (against anti-IgG, IgM, C3, IgA, and fibrinogen) on all these cases and patterns were noted. The descriptive statistics were applied along with ANOVA test. Results: Approximately, 155 patients with Male: Female = 1.24:1, age 7–65 years. In total, 57 cases were of Lichen planopilaris (LPP; 36.7%), 22 Lichen planus (LP; 14.2%), 22 Psuedopalade of Brocq (PPB; 14.2%),16 discoid lupus erythematosus (DLE; 10.3%), 8 end-stage scarring alopecia (ESSA; 5.2%), 2 cases each of Fungal folliculitis (FF), and Folliculitis decalvans (FD; 1.3% each), and in 26 cases, no specific diagnosis could be reached were collectively kept in the category of non-specific findings (NSP; 16.7%). On DIF: LPP positive for IgG = 4 cases (7%), IgM = 26 (45%), IgA = 11 (19.3%), C3 = 16 (28.1%), and fibrinogen = 11 (19.3%). LP positive for IgG = 2 (9%), IgM = 18 (81%), IgA = 2 (9.1%), C3 = 10 (45%), and fibrinogen = 1 (4.5%). DLE positive for IgG = 6 (37%), IgM = 8 (50%), IgA = 1 (6.3%), C3 = 9 (56%), and fibrinogen = 1 (4.5%). Limitations: Because this was a retrospective study, clinical follow-up and treatment history of the patient could not be retrieved. Conclusions: IgG positivity helps significantly in differentiating LPP from DLE (P 0.004) and NSP from DLE (P 0.005). IgM positivity helps significantly in differentiating LPP from LP (P 0.04), LP from PPB (P 0.00) and NSP (P 0.00). C3 positivity helps significantly in differentiating PPB from DLE (P 0.02).

We present a case of a 38-year-old male with osseous Diffuse large B-cell lymphoma (DLBCL) involving bilateral femur, with secondary cardiac dissemination involving right atrium and pericardium extending into SVC. The article discusses the osseous involvement of lymphoma and emphasizes the presence of cardiac involvement in the extra nodal lymphoma which may cause secondary symptoms like SVC obstruction. Such cases carry poor prognosis and require treatment modification and careful monitoring to avoid cardiac complications after initiation of chemotherapy. Only few such cases have been described in literature so far.

Radiation-induced sarcoma is a rare entity, with leiomyosarcoma (LMS) in the oral cavity post radiation being extremely rare. We report two such cases who presented with swelling in the oral cavity with a history of moderately differentiated squamous cell carcinoma. Both cases prior to the diagnosis of LMS had been managed with surgery and radiation therapy and later developed swelling in the oral cavity. The management of LMS is uncertain; hence, this article aims to spread awareness about this rare diagnosis and to know the importance of differentiation from other more common lesions including recurrence.

Objective Fine needle aspiration (FNA) cytology has been successfully utilized in the preoperative diagnosis of oral masses. Lymphoma involving other sites has also been diagnosed frequently on FNA. Oral cavity lymphoma (OL) is rare and is clinically indistinguishable from other lesions of the mouth. A complete excision of these may be difficult. Our experience with FNA diagnosis of 11 OLs along with histopathological correlation is reported herein in a tertiary health care setting. Methods In this retrospective study, clinico pathological characteristics of patients with final diagnosis of non-Hodgkin's lymphoma (NHL) were reviewed over a 7 year period. Routine cytological giemsa staining was performed in all cases along with immunocytochemistry (ICC) wherever possible. The gold standard for diagnosis of NHL was based on: (1) Histopathology and immunohistochemistry and/or (2) Flow cytometry (FC). Results A total of 11 cases were diagnosed as NHL. All showed B cell immunophenotype. Two of them were diagnosed as follicular lymphoma on histopathology. Male to female ratio was 7:4 and ranged in age from 37 to 70 years. The most common site was tonsillar fossa (N = 5), followed by hard palate (N = 3), soft palate (N = 2), and buccal mucosa (N = 1). Size ranged from 1 to 6 cm. Conclusions Diagnosis of OLs may be hampered by its rarity and difficulties in obtaining sufficient cellularity in oral FNA but there is need for immediate and accurate diagnostic procedures, including immunohistochemical analysis to avoid delay in treatment. FNA along with ICC helps in early diagnosis of this rare entity and can also provide sample for FC.

Background It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady. Objective To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions. Methodology. Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month. Results Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity. Conclusion It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.

Placental site trophoblastic tumor is a very rare neoplasm and is a subtype of gestational trophoblastic neoplasm. Owing to its rarity and varied clinical manifestations, it can lead to a diagnostic dilemma. We report a very rare case of PSTT presenting as massive hemoperitoneum caused by rupture of secondary arteriovenous malformation. MR angiogram revealed the presence of arteriovenous malformation and the diagnosis of the neoplasm was confirmed on histopathology and immunohistochemistry. Hysterectomy was done and the patient was managed successfully. Keywords: Placental site trophoblastic tumor, Arteriovenous malformation, Hemoperitoneum, Embolisation, Immunohistochemistry

To analyse the distribution of Neck metastases (NM) and to study frequency of skip metastases in oral squamous cell carcinoma (SCC) of oral cavity. From September 2012 to April 2013, 30 previously untreated patients with SCC of oral cavity underwent primary surgical treatment in our institution. From pathological report of Neck dissection specimen prevalence and distribution of NM were ascertained. All patients were classified according to American Joint Committee on Cancer 2005 TNM classification. Overall frequency of NM was 36.7%. Frequency of occult metastases was 33.3%. N+ metastases found in 37% cases. The overall frequency of NM in level IV and V was 9.5%. Isolated level III involvement was found in 3.3%. No isolated level IV and V involvement was found. Skip metastases to level III LN was 6.7%. We did not find any skip metastases to level IV in our study. Neck nodes at greater risk for metastases were level I and II (50 and 28.6%). Level III (11.9%), IV (7.14%), V (2.38%). The risk of skip metastases to level IV was nil in our study.

Introduction Pleomorphic sarcoma is the commonest soft tissue sarcoma of adult life. Less than 10% cases of this disease occur as primary in head and neck region. Although a case of pleomorphic sarcoma of lower extremity with metastasis to base of tongue had been reported earlier, a pleomorphic sarcoma arising from oropharynx is being reported for the first time. Case Report A 75-year-old male chronic smoker was evaluated for complaints of dysphagia, change in voice, and multiple episodes of oral bleeding. He was found to have a locally advanced pleomorphic sarcoma of oropharynx. He was treated nonsurgically. He showed complete clinical and radiologic response. The disease-free survival is 12 months and overall survival is 74 months. Conclusion This report highlights the importance of nonsurgical management of a case that would have otherwise needed surgery.

Lichen nitidus is a common dermatosis described classically as shiny, skin-colored, nonfollicular, flat-topped papules. A number of variants have been described in literature including localized, generalized, actinic, vesicular, perforating, hemorrhagic, palmar/plantar, purpuric, and linear forms. Here, we report an unusual case of linear lichen nitidus in an 11-year-old boy mimicking lichen striatus along the left thumb with isolated nail involvement of the affected digit. Nail involvement in lichen nitidus is very rare; there are only seven cases of lichen nitidus associated nail changes reported in the literature. To the best of our knowledge, this is the first such case reported from India.

Phaeohyphomycosis is an unusual granulomatous fungal infection, observed in immunocompromised or diabetic patients; however, it is even rarer in immunocompetent patients. Cytological findings of the same have been infrequently reported. The histopathological diagnosis or fungal culture helps in definitive diagnosis to identify the exact fungal species. Hereby, we report a rare case of invasive fungal infection in a breast lump in a young female, presenting as fibroadenoma breast. Fine needle aspiration cytology from the breast lesion showed the presence of septate acute-angled branching fungal hyphae with focal pigmentation, morphologically suggestive of phaeohyphomycosis which was positive with fungal stains. This was later confirmed on biopsy as histopathology slides showed the presence of prominent pigmented fungal hyphae. The pus culture from needle aspirate also showed phaeohyphomycotic fungal organism delineating the species Exophiala dermatitidis. Aspiration cytology is crucial for the diagnosis of fungal infection in such cases. An appropriate diagnosis will help in early detection and treatment of such infections as these are usually associated with high morbidity and mortality.

The monodermal teratoma struma ovarii is a rare ovarian tumour; however, struma ovarii presenting with pseudo-Meigs' syndrome and raised cancer antigen (CA)-125 levels is even rarer. In elderly patients, this presentation can potentially lead to a misdiagnosis of a malignant ovarian carcinoma, resulting in unnecessary extensive surgery. We report a 55-year-old female who presented to the Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India, in 2016 with progressive abdominal discomfort, fatigue and abdominal distention. Clinical and radiological features were indicative of a malignant ovarian tumour and ascites. Serum CA-125 levels were elevated at 258 U/mL. A left-sided salpingo-oophorectomy was performed, after which the serum CA-125 levels normalised. There was no evidence of recurrence at a six-month follow-up. A frozen section procedure confirmed the diagnosis of a struma ovarii. This rare condition should be considered as a differential diagnosis in patients presenting with ovarian masses, ascites and raised CA-125 levels.

Background: Myeloid sarcomas (MS) are rare extramedullary tumors composed of blasts of myeloid lineage that either precede, follow or present concomitantly with acute myeloid leukaemia (AML) or myeloproliferative neoplasms. The diagnosis of MS is especially challenging in patients without an antecedent history of leukemia. Methods: We present 2 cases of intraoral MS that presented as de novo lesions. A detailed review of cases of intraoral MS that either preceded or presented along with leukemia has been done with emphasis on diagnostic criteria used. Results: Two male patients aged 28 and 5 years presented with MS with one patient presenting with concomitant AML. A combination of morphological and immunohistochemical methods was used for diagnosis. A thorough review of world literature revealed 44 cases of intraoral MS that presented as de novo lesions. Conclusion: Intraoral MS is a rare tumor with poor prognosis. It may be diagnostically challenging due to its protean clinical manifestations and histological overlap with other tumors.

Ovarian mucinous tumors in

Sarcomatoid carcinoma (SC) is a rare variant of squamous cell carcinoma which is characterized by a dysplastic epithelial component and a stromal element with invasive fusiform or spindle-shaped cells. The clinical and histopathologic characteristics make it very difficult to distinguish SC from epithelioid sarcoma (ES). We present a case of a 51-year-old man with a soft tissue mass in the oral cavity diagnosed as proximal variant of epithelioid sarcoma on incisional biopsy. A thorough radiologic examination was conducted to rule out the possibility of a primary elsewhere in the body. Supraomohyoid neck dissection, mandibular resection, and reconstruction with recon plates were carried out. Histopathologic examination was suggestive of epithelioid variant of SC which was contrary to the incisional biopsy report. The dilemma in diagnosis was resolved by observing the presence of invading atypical epithelial cells into the stroma confirming the epithelial origin of the tumor.

Dermatofibrosarcomas protuberans (DFSP) are rare low-grade tumours with various subtypes and usually occur among middle-aged adults. However, myoid differentiation is very rare. We report a 44-year-old woman who presented to the Lok Nayak Jai Prakash Hospital, New Delhi, India, in 2017 with a recurrent pigmented DFSP presenting as an arm swelling. Upon histological and immunohistochemical analysis, myoid differentiation was confirmed. A literature review of the clinical and histopathological features of this rare entity is presented.Keywords: Dermatofibrosarcoma Protuberans; Melanocytes; Pigmentation; Cell Differentiation; Case Report; India.

Breast phyllodes are rare fibroepithelial neoplasms. Various classifications adopted to grade them into benign, borderline and malignant but the presently used one is the WHO classification of 2012. Trucut biopsy is a sensitive prediagnostic tool to grade phyllodes. But features can sometimes be overlapping making it difficult to grade it. In this study, an effort has been made to compare the morphology of trucut and histolopathology specimens. Sensitivity of the trucut bopsy in diagnosing benign and malignant phyllodes is calculated and is being compared with other studies. Hence due to varied morphological features sole diagnosis should not be based on trucut biopsy.

Introduction: Tumor budding (TB) is proposed as an essential step in the invasion and metastasis of various tumors. However, there is limited information about its role in breast cancer. This study was designed to assess the prognostic significance of TB in clinical practice. Objectives: To study and grade TB in patients with invasive breast cancer and to correlate it with known prognostic parameters. Materials and Methods: In this prospective study, 40 cases of invasive breast cancer were studied over a period of 1.5 years. Tumor buds were defined as comprising five tumor cells or less at the invasive front of the tumor. Cases were separated into two groups according to TB density as low grade and high grade. Significance and correlation between TB with established clinicopathological parameters and hormone receptor status were studied by Chi-square test. P value

Acinic cell carcinoma (ACC) is a malignant salivary gland tumor characterized by tumor cells displaying acinar features. Usually presenting as a slow-growing tumor, ACC, however, may show dedifferentiation to a higher grade including neuroendocrine carcinoma. In addition, ACC may rarely show focal neuroendocrine differentiation without any frank evidence of neuroendocrine carcinoma. We describe such a case of ACC of the parotid gland in a 65-year-old female, which showed neuroendocrine differentiation. The diagnostic clues, immunohistochemistry panel, and prognostic and treatment aspects are also presented.

Objective: Congenital pulmonary airway malformation (CPAM) is a rare developmental lung disease. The aim of this study is to analyze the histomorphological spectrum of CPAM in a series of 15 cases. Materials and Methods: A retrospective descriptive study of 15 cases of CPAM was carried out from 2013 to 2018 in our hospital, and cases were classified based on the Stocker's classification. Results: The age ranged from 4 days to 9 years (66.6% were infants). The left lung was most commonly involved (66.6%). The most common lobe was the left upper lobe (60%), followed by right lower lobe (20%). Grossly, cysts measured 0.2–5 cm, filled with mainly serous fluid with few having hemorrhagic and brownish mucoid secretions. On microscopy, single to multiple noncommunicating cysts of size 0.2–5 cm were seen, lined by ciliated columnar epithelium (60%), pseudostratified ciliated columnar epithelium (26.7%), mucin-secreting columnar epithelium (6.7%), and flattened epithelium (6.7%). Few cases showed smooth muscle (20%) and cartilage (13.3%) in the cyst wall. Chronic inflammation (73.3%) with dense histiocytic infiltrate (13.3%) was also seen. Emphysematous changes were also observed (13.3%). Cytomegalovirus inclusions (6.7%), zygomycete fungus (6.7%), and red hepatization (6.7%) were observed. The most common type was type II (60%), followed by type I (33.3%) and type IV (6.7%). Conclusion: Type II was the most common variant in this study. A careful observation should be done to look for fungal hyphae or viral inclusions.

Prostate cancer is a very common cause of morbidity and mortality in India. The commonest type of prostate carcinoma is adenocarcinoma, most of them are confined to prostate at the time of presentation. Bone is the preferred site for metastasis. The following is a case of neuroendocrine carcinoma of prostate arising in a 36 years old male who presented with ascitis and jaundice to the emergency department. The ascitic tap was positive for malignant cells. CECT done to detect primary showed osteoblastic secondaries in the spine along with lesions in the liver. DRE revealed grade 2 prostatomegaly. A TRUS guided biopsy showed neuroendocrine carcinoma of the prostate. Neuroendocrine carcinoma is a very rare type of prostatic carcinoma, with presentation of the same as ascitis is very uncommon. The following case is presented due to its rarity.

MiRNA-21 is recognized as the main active candidate and high expression in many solid tumors consequential cell proliferation, differentiation, apoptosis, and closely related to metastasis of disease. The study aimed to evaluate the serum miRNA-21 expression and therapy outcome in breast cancer patients and cell lines. Seventy-five histopathologically confirmed newly diagnosed breast cancer patients were included in the study; before and after therapy, patient’s blood sample were collected and analyzed for serum microRNA-21 expression by quantitative real-time PCR. In patients, 8.9 mean fold increased microRNA-21 expression was observed compared to controls. Increased expression was found to be associated with advanced stage (11.72-fold), lymph node involvement (11.12-fold), and distant metastases (20.17-fold). After treatment significant decrease in miRNA-21 expression was observed and found to be significant (p

Spindle-cell rhabdomyosarcoma (RMS) is a relatively recently recognized favorable variant of embryonal RMS occurring mainly in the paratesticular and head and neck regions. Cytological reports of spindle-cell RMS have been sparse in the literature and the awareness of its cytological features is not very wide among cytopathologists. A 2-year-old girl was brought to clinical attention for a progressively enlarging swelling of right thumb. Imaging studies showed it to be a soft-tissue tumor in the subcutaneous region. Fine-needle aspiration yielded moderately cellular smears composed of small, round cells and few spindle cells with tapered cytoplasm. A cytological impression of RMS was rendered, which was later confirmed as spindle-cell RMS on excision biopsy. Spindle-cell RMS, a favorable prognostic variant of embryonal RMS, should be considered in the cytologic diagnosis of soft-tissue tumors with round cell and spindle cell morphology. This is especially true for tumors occurring in hitherto unreported sites. Diagn. Cytopathol. 2016;44:1094-1097. © 2016 Wiley Periodicals, Inc.

Plasmablastic lymphoma (PBL) is a rare variant of a diffuse B-cell lymphoma that is so named for its blastoid morphology and immunophenotype. It affects approximately 3% of all HIV patients. This report details a case of the plasmablastic lymphoma of the gingiva in a HIV positive patient. The tumor manifested as a large mass of the right lower alveolus, causing bony destruction and tooth mobility, clinically indicative of carcinoma. Histologic examination of the lesion revealed a lymphoid tumor with a high proliferation rate containing lymphoplasmacytoid cells that were reactive to the plasma cell marker CD138 with lambda chain restriction but not to CD20 or CD79a, consistent with plasmablastic lymphoma. Recognition of this entity is important, as it represents an HIV-associated malignancy that predominately involves the oral cavity, and may mimic Kaposi's sarcoma and has a poor prognosis.

Background: Worldwide, breast cancer is the most common cancer among women and is a leading cause of cancer death. In the present study, we investigated the NQO1 C609T genotypic and allelic distribution in north Indian breast cancer patients. Materials and Methods: The genotypic distribution of the NQ01 C609T polymorphism was assessed in 100 invasive ductal carcinoma (IDC) breast cancer patients and 100 healthy controls using allele specific PCR (AS-PCR). Results: A lower frequency of the CC genotype was found in breast cancer patients (24%) than in the controls. On the other hand, TT genotype frequency was also found to be higher in female healthy controls (32%) than the female breast cancer patients (20%). The frequencies of all three genotypes CC, CT, TT in patients were 24%, 56% and 20% and in healthy controls 50%, 22% and 32% respectively. We did not find any significant correlation between the NQO1 C609T polymorphism and age group, grading, menopausal status and distant metastasis. A less significant association was found between the NQ01 C609T polymorphism and the stage of breast cancer (X2=5.931, P=0.05). Conclusions: The present study shows a strong association between NQO1 C609T polymorphism with the breast cancer risk in the north Indian breast cancer patients so that possible use as a risk factor should be further explored.

Brenner tumor is a rare ovarian neoplasm that is seen in women of the fifth to sixth decade. Classified as benign, borderline, and malignant, these tumors may be associated with estrogen production, thus altering the estrogen-progesterone ratio. High estrogen stimulates the endometrium and this is responsible for producing various pathologies, namely, hyperplasia, atypia, and carcinoma. Very few case reports have been published highlighting the same. A case report is being presented here of a coexisting Brenner tumor and well-differentiated endometrial carcinoma in a 55-year-old nulliparous postmenopausal woman.

Leiomyoma is the most common tumor seen affecting women mostly of reproductive age groups. It is composed of smooth muscle cells that are positive for smooth muscle actin on immunohistochemistry. Leiomyomata peritonealis dissi»?eminata (LPD) is characterized by nodules that stud the peritoneum. It is seen in association with hormone-producing ovarian tumors and coexisting leiomyomas of the uterus. Association with mesenteric leiomyomas has been reported. Ovarian leiomyomas are very rare tumors of the ovary and coexisting LPD with ovarian leiomyomas has not been reported before. We present this rare case of LPD and ovarian leiomyoma.

Periductal stromal sarcoma is a rare low-grade biphasic malignancy arising from periductal breast stroma. This tumor is distinct from phyllodes as it lacks the characteristic leaf-like architecture. Tuberculous mastitis is an uncommon infection seen rarely in the breast parenchyma. We present a rare association between the two diseases, which to the best of our knowledge is the first case reported so far.

Mesenchymal neoplasm is rare in renal pelvic region. Aggressive angiomyxomas are the neoplasms seen predominantly in female genital region. These tumors are locally aggressive with rare cases presenting with metastasis. Its occurrence in renal pelvis is extremely rare with only five cases reported in the literature. The present case is the sixth case reported in a 15-year-old girl who presented to the surgery department as a case of horseshoe kidney. The mass was excised and a diagnosis of aggressive angiomyxoma was rendered.

Aims and Objectives: We examined the prognostic value of Tumor stroma ratio (TSR) in breast tumor core biopsy (TCB) specimen to determine response to neoadjuvant therapy (NAT) prior to modified radical mastectomy (MRM). Methods: This was a retrospective analysis of patients with breast cancer who underwent TCB before NAT between August 2016 and July 2018. TSR in TCB was studied independently by 2 pathologists ( VM, VS) defined as stroma rich (TSR≤50%) or stroma poor (TSR>50%). MRM specimen of these patients were subsequently studied .Residual cancer burden (RCB) was calculated using the MD Anderson RCB calculator, categorized as complete (0), good (1) Partial (2) and no response (3). Statistical analysis was done to assess correlation of TSR to RCB. Results: A total of 62 patients were analyzed. Mean(SD) age was 48(11) years.Twenty eight (45%) and 34 (55%) patients were stroma rich and stroma poor respectively. Twenty six (42%) patients were responders and 36 (58%) non-responders to NAT. Among stroma rich patients, only 3 (10%) were responders (Class 0 &1)and 25 (90%) non-responders(Class2&3)to NAT, among stroma poor patients 23 (68%) responded well and 11 (32%) did not.TSR had a moderate negative correlation with RCB (-0.6). On univariate analysis, only TSR had a significant effect on RCB class (

Acute hemorrhagic edema of infancy is a disease marked by its dramatic presentation of purpuric plaques in a cockade or targetoid pattern. A 1-year-old boy was brought by his mother to our outpatient department with large purpuric plaques in annular and cockade pattern over the cheeks and bilateral lower limbs. Both the pinna showed purpura in a peculiar reticulate pattern, with vesiculation seen at the margin of the lesions along with mild edema. The skin biopsy showed cutaneous small-vessel vasculitis; direct immunofluorescence showed fibrinogen deposits around the small cutaneous vessels. The unusual features of our case were the reticulate pattern of purpura seen over the ears.

Introduction: Phyllodes tumor is a group of biphasic fibroepithelial tumors of the breast, graded as benign, borderline, and malignant. The grading of breast phyllodes remains a challenging task for the pathologists as the prognosis, and further treatment depends on it. In this study, an effort has been made to grade phyllodes tumor on the basis of immunohistochemistry. Aims and Objectives: Vascular endothelial growth factor, CD10, and factor 8 have been used as immunohistochemical markers for grading. Results and Conclusion: We have found a significant correlation between the expression of these markers and grading of phyllodes tumor. Positive correlation was also found amongst expression of all three markers. To conclude, increased expression of these markers with increasing grade can aid in diagnosis and guide treatment.

Epithelial-myoepithelial carcinomas (EMCs) account for

Sporadic adrenal medullary hyperplasia (AMH) is a rare entity and mimics pheochromocytoma clinically as well as pharmacologically. It is characterized by increase in adrenal medullary cells with the expansion of cells into areas normally not seen. A 59-year-old male presented with chronic hypertension and raised 24-h urinary normetanephrine levels. Radiological and clinical possibility of pheochromocytoma led to left transperitoneal laparoscopic adrenalectomy. Histopathology, however, showed increase in adrenal medullary to cortical ratio, further confirmed by immunohistochemistry. The absence of any well-defined lesion led to the diagnosis of AMH. Furthermore, on routine imaging, two asymptomatic cavernous hemangiomas were seen. We present this case to reiterate that AMH is an entity which should be considered as a differential for pheochromocytoma. Furthermore, the presence of asymptomatic cavernous hemangiomas in the cerebrum, in this case, makes it rarer since this sporadic association is seldom seen.

Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy. Abbreviations: PCR: polymerase chain reaction; NAAT: nucleic acid amplification test.

Introduction The accurate histopathological diagnosis of the phimotic prepuce is indispensable because early diagnosis, treatment, and close follow-up are crucial in genital dermatosis such as lichen sclerosus (LS). This study analyzes the histopathological spectrum of childhood phimosis with special emphasis on LS. We also highlight a peculiar pattern of histopathological evolution in LS, prepuce. Material and methods The histopathology slides of all the pediatric preputial circumcision specimens performed for the indication of pathological phimosis (n = 43) during the study period (2012-2017) were analyzed. Eight histopathological features viz. hyperkeratosis, hypergranulosis, epidermal atrophy, acanthosis, dermoepidermal cleft, upper dermal edema and homogenization, mid dermal lymphocytic band, and interface dermatitis were studied in each case, separately in inner preputial surface, tip, and outer preputial surface. On the basis of evolution of the disease and histopathological features, the lesions of LS were classified into early, established, and advanced. Result LS was found in 32 cases, whereas 11 cases showed nonspecific inflammation and fibrosis. The upper dermal homogenization (n = 29), dermoepidermal cleft (n = 28), and mid dermal band (n = 27) were the commonest histopathological changes. The established and advanced changes were confined to the inner preputial surface (n = 31), and the outer preputial skin surface was unaffected in all the cases. A peculiar histopathological evolution pattern was seen with established or advanced lesions, early lesion, and normal histology on the inner preputial surface, mucocutaneous junction, and outer preputial skin, respectively. Conclusions LS is a common cause of childhood phimosis. It shows a peculiar histopathological evolution that mandates the thorough analysis of inner mucosal surface.

Juvenile xanthogranuloma (JXG) is a benign histiocytic disorder of unknown etiology. We report a case of JXG in 18-day-old girl, probably the youngest reported hitherto, who presented as nodular lesion on scalp (right temporo-perietal region). The lesion was excised and sent for histopathological examination. Histopathology revealed JXG with scattered mitotic figures. The girl is doing well on follow up for more than 5 years now.

Tuberculosis usually involves the lungs, but can also involve various other organs. Extra pulmonary tuberculosis is very rarely confined to the larynx in the absence of an associated pulmonary lesion. In this retrospective study, clinicopathological characteristics of patients with final diagnosis of laryngeal tuberculosis (LTB) were reviewed. The diagnosis of LTB was based on: (1) the existence of chronic granulomatous inflammation with caseous necrosis in the histopathology of laryngeal lesions or (2) the presence of laryngeal lesions with atypical histopathology (chronic granulomatous inflammation) which had a complete response to anti-tuberculosis therapy. Fifteen cases with a diagnosis of LTB were collected. The patients’ age ranged between 24 and 75 years with a mean of 49 years. On laryngoscopy, 66.6% of cases (10/15) had an ulceroproliferative lesion while the remaining 33.3% of cases (5/15) had an exophytic growth. The pathology of laryngeal lesions revealed chronic granulomatous inflammation with caseous necrosis in nine cases and chronic granulomatous inflammation without necrosis in six cases. Nine out of 15 cases (60%) showed presence of acid-fast bacilli on Ziehl–Neelsen stain. Any evidence of pulmonary tuberculosis was ruled out by chest X-ray findings. The response to anti-tuberculosis therapy was desirable in all patients. Since the introduction of anti-tuberculous therapy, the incidence of LTB has declined. However, with the incidence of TB increasing, the overall incidence of laryngeal involvement may be on the rise. This study highlights the importance to consider the rare possibility of LTB in the presence of non-specific clinical and laryngoscopic signs and to confirm this by histological examination.