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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.

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.

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.

Chorangiocarcinoma is an extremely rare tumor seen in the placenta, with only six cases reported in the literature so far. Its morphological characteristics, criteria for diagnosis, and the pathophysiology remain controversial to date. Although it was predominantly considered a benign entity, a solitary case of distant metastasis has been reported in the literature. We present a case of this unusual tumor in the preterm placenta of a 29-year-old female. Grossly seen as a grey white nodule, microscopic examination revealed nests of atypical trophoblastic proliferation surrounded by vascularized stroma. No evidence of basement membrane invasion was noted. On immunohistochemistry, the trophoblastic component expressed pancytokeratin, Beta HCG, and Placental Alkaline Phosphatase with high Ki-67 labelling index. The present case highlights this exceedingly rare entity with emphasis on its morpho-immunohistochemical features along with a review of literature.

Ovarian tumours have been divided on the basis of origin into surface tumours, sex cord-stromal tumours, sertoli-stromal tumours and various other types. A sertoli-stromal tumour is a subtype of th...

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.

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.

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.

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.

Background & objectives: Lingual squamous cell carcinomas (SCC) pose a major public health burden in India. Epithelial-mesenchymal transition (EMT) is the conversion of an epithelial cell to a mesenchymal phenotype at the invasive front (IF) enhancing invasiveness of these cells which may be studied using immunohistochemistry. The objective of this study was to assess the expression of E-cadherin and vimentin at the IF, and their correlation with the histological risk assessment score, clinicopathological parameters and lymph node metastasis. Methods: Thirty consecutive untreated patients diagnosed as lingual SCC who underwent hemiglossectomy over one year formed the study group. The immunohistochemical expression of E-cadherin and vimentin in the periphery as well as the centre of tumour islands was correlated with clinicopathological parameters, Brandwein-Gensler risk assessment score and lymph node metastasis, along with a correlation between the coexpression of two markers at the IF. Results: Loss of E-cadherin expression was seen at IF in 83.3 per cent (25/30) cases. Out of these, 20 per cent (5/25) showed a corresponding gain in vimentin expression (complete epithelial-mesenchymal transition) and 80 per cent (20/25) did not. Overall, 16.6 per cent (5/30) cases showed complete EMT. However, no correlation between E- cadherin and vimentin expression at the IF was found. No statistical significance was found between E-cadherin loss and vimentin gain at the IF, with the various parameters or the risk score. Interpretation & conclusions: The present study suggests that the cells at IF may metastasize even without a gain in vimentin expression (without classical EMT), as cohesive clusters showing incomplete EMT (E-cadh-/Vim-).

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.

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.

Neuroendocrine tumors of the larynx are the most common nonepidermoid tumors of the larynx and comprise less than 1% of the laryngeal tumors. Most of the symptoms and presentation mimic a usual laryngeal malignancy making the diagnosis difficult.How to cite this articleRai V, Malhotra V, Kumar N, Khurana N. Laryngeal Neuroendocrine Tumor: Atypical Presentation. Int Int J Otorhinolaryngol Clin 2017;9(1):32-34.