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Byline: Gnanapriya. Vellaisamy, Anuradha. Ananthamurthy, Kiran. Mahadevappa, Suravi. Mohanty, Kanishka. Das Perivascular epithelioid cell tumors (PEComas) are a family of tumors that includes angiomyolipoma (AML), clear-cell 'sugar' tumor of the [...]

Introduction: Regional lymph node involvement is an important predictor of outcome in colorectal cancer (CRC). The lymph node yield in resected specimens varies from case to case. Aim: 1. To assess whether clinicopathologic factors have an impact on the number of lymph nodes harvested from surgical resection specimens of CRCs 2. To assess whether the total number of lymph nodes retrieved has a bearing on the positivity of lymph nodes and hence the N category. Materials and Methods: All resection specimens of treatment naïve CRC received in the department of pathology during a 2 year period (2017--2019) were reviewed. The lymph node yield was correlated with age, sex, type of surgical procedure, length of resected segment, tumor location, histological type and grade, T and N categories. The statistical tests used were Spearman rank, Mann--Whitney U, Kruskal--Wallis, and Chi-square tests. Results: A total of 51 resections were studied. The mean age was 59.64 years with 72.55% being male. About 76.47% were hemicolectomies and 23.52% were rectosigmoid surgeries. The lymph node yield ranged from 0 to 38, the mean being 12.67. None of the parameters studied had a significant correlation with the lymph node yield except histological grade, specimens with higher-grade tumors yielding more number of nodes (P = 0.0242). There was no significant correlation between node positivity and the average number of lymph nodes (P = 0.0883). There was no significant correlation between total yield in cases with ≥12 lymph nodes and N category (P = 0.180). Furthermore, there was no significant correlation between total yield in node-positive cases with ≥12 lymph nodes and N category (P = 0.216). There was no significant difference in the sizes of the lymph nodes in node-positive and negative cases (P = 0.3930 and 0.2355, respectively). Conclusion: Among the parameters affecting lymph node yield, the current study found a significant correlation between histological grade and lymph node yield. There was no significant difference in the size of lymph nodes between node-positive and negative cases. The total lymph node yield did not have a bearing on node positivity and this shows that a lower lymph node yield may be accepted as adequate after thorough examination of the specimen. [ABSTRACT FROM AUTHOR]

Background: Amebic colitis although common, rarely presents as fulminant colitis which has a high morbidity and mortality unless treated promptly and appropriately. Aim: To study the clinical, morphological features and outcome of fulminant amebic colitis (FAC). Materials and m0 ethods: A retrospective study of six patients who underwent surgical resections from 2002-06 and were diagnosed with FAC, was carried out. The morphological features assessed included the average number of trophozoites per high-power field and the depth of invasion of trophozoites into the muscularis propria. Results: The study included five adults and one child who underwent surgery for fulminant colitis. Interestingly, a definite preoperative diagnosis of amebic colitis was made only in one patient and suspected in another. Intraoperatively, multiple perforations of the intestine with peritonitis were the most common findings. Gross examination typically revealed multiple ulcers with exudate and intervening normal mucosa. Microscopically, ulceration and myonecrosis with trophozoites within the exudate were seen in all cases. Trophozoites invading the muscularis propria were seen in five cases. Of the cases that showed myoinvasion by trophozoites, two patients expired within two weeks of surgery. One of the patients who expired also showed co-infection with Actinomyces. Conclusion: FAC is an uncommon outcome in amebic colitis with a high mortality requiring prompt surgical intervention.

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma with limited literature available on its cytological features. We report here one such case where a diagnosis of EMC was made based on fine needle aspiration cytology (FNAC). A 51 year-old male presented to our FNAC clinic with a slowly growing mass in the left thigh, which was subjected to fine needle aspiration biopsy. Radiological images showed no involvement of the underlying bone. Magnetic resonance imaging was suggestive of a malignant neoplasm. The FNA smears showed cell fragments and cords of monotonous cells embedded in abundant myxoid stroma. A diagnosis of a myxoid sarcoma favoring an EMC was made in this patient. Subsequent excision of the mass for histopathological examination confirmed this diagnosis. EMC has distinctive cytological features that are helpful in confidently making a diagnosis in the appropriate clinical setting.

OBJECTIVE: To report the results of treating patients with orbital pseudolymphomas with the anti-CD20 monoclonal antibody rituximab. PATIENTS AND METHODS: Patients were included in the study if they had an [...]

Introduction: The term 'Disorders of Sexual Differentiation' (DSD) is defined as a congenital discrepancy between external genitalia, gonadal and chromosomal sex. The Chicago consensus based on the primary genetic defect is used for current nomenclature and classification. A child with DSD, if identified and treated early, may grow to become a well-adjusted, functional member of the society. Patients with DSD carry a low but definite risk of developing germ cell tumours which necessitates a histological analysis in all cases. Aim: To describe the clinicopathological features of individuals with DSD and to classify the available cases according to the Chicago consensus which is based on karyotype and histopathology. Materials and Methods: The study was a retrospective descriptive study done at a tertiary referral centre in South India, for a period of four months from May to August 2016. Case charts and histopathology slides of cases received in the department of Pathology from January 2011 to May 2016 were included and reviewed. Cases where the histopathology slides/blocks were not retrievable/difficult to assess due to technical issues were excluded. Case charts and slides were reviewed retrospectively with a view to classify as per karyotypic or histological classification. The slides were reviewed by two pathologists to help in the classification wherever possible. Statistical measures like mean and percentages were used to describe the results. Results: A total of 22 cases of DSD were studied for which karyotype was available in 13 cases. Common clinical presentations were primary amenorrhoea, cryptorchidism and ambiguous genitalia. Age at presentation varied from nine months to 30 years. The initial diagnosis based on karyotype, clinical findings, hormonal assays and imaging were concordant with the final diagnosis in 11 cases. In two cases, histopathology was essential in arriving at a definitive diagnosis. Of the 13 cases with karyotype reports available, five were sex chromosome DSD, five were 46XY DSD and three were 46XX DSD. Gonadoblastoma was seen in three cases. Conclusion: Histopathological examination together with karyotype plays a crucial role in proper categorisation of disorders of sexual differentiation. A multidisciplinary team approach for early diagnosis and management of DSD is essential for the psychosexual development of these individuals. [ABSTRACT FROM AUTHOR]

Background and Aims: T-lymphoblastic lymphoma (T-LBL) is a type of non-Hodgkin lymphoma (NHL), the cell of origin being the precursor T cell. This study was undertaken to describe the distribution, clinical presentation, morphological spectrum, immunohistochemical profile, and outcomes in patients with LBL presenting to our institution which is a tertiary care center. Methods: A total of 41 cases of T-LBL diagnosed during a 7-year period were included in this study. These patients were stratified into T-LBL cases and T-LBL/acute lymphoblastic leukemia cases, the latter defined as those with a lymphomatous mass and more than 25% blasts in the bone marrow. Medical records were reviewed for clinical, laboratory data, imaging findings, treatment, and follow-up. The histopathology and immunohistochemistry slides were reviewed. Results: T-LBL constituted 8.4% of all NHL seen in the period. This lymphoma is most common in childhood and adolescence. Mediastinal compression and pleural effusion are very common in patients with T-LBL (65% and 40%, respectively). The morphology consists of small-to-medium sized blasts that typically are positive for CD3, CD99, and TdT. T-LBL is an aggressive disease; relapse and progression being markers of poor outcome. Conclusion: This study is a comprehensive account of T-LBL from a tertiary care center in South India which describes the distribution, clinicopathological attributes and outcome in patients with this aggressive form of NHL. [ABSTRACT FROM AUTHOR]

TITLE : BLEEDING JEJUNAL METASTASES FROM AN ALVEOLAR SOFT PART SARCOMA Authors: Elvis Peter Joseph, Suraj Manjunath, Harisk K, Anuradha A* Affiliations: Departments of Surgical Oncology &Pathology*, St. John's Medical College & Hospital, Bangalore - 560 034. India INTRODUCTION Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor that most often originates in the thigh or buttocks in young adults with a proclivity for metastases to the lung, bone and brain. Hematogenous metastases to the gastrointestinal tract from ASPS is an extremely rare occurrence with only a few case reports. CASE REPORT A 48 year old house wife, a known case of Alveolar soft part sarcoma (ASPS) left thigh ( since 1990) with pulmonary secondaries presented with h/o two episodes of malena to emergency department in shock. She was resuscitated and EGD done showed an actively bleeding jejunal tumor not amendable to endoscopic measures. She was taken up for emergency laparotomy and a palliative resection of jejunal tumor was done. Histopathological analysis showed features of an alveolar soft part sarcoma. DISCUSSION Alveolar soft part sarcoma (ASPS ) is a rare tumor of unknown etiology with predilection for young females and is characterized by slow growth and an early high frequency of distant metastases. The presence of metastasis though a carries a poorer prognosis does not preclude a long survival . Hematogenous metastases to the gastrointestinal tract from ASPS is exceedingly rare. CONCLUSION We report a 48 year-old female patient with a long history of metastatic Alveolar Soft Part Sarcoma, who presented with chief complaints of a bleeding tumor in jejunum on an esophagogastroduodenoscopy (EGD) in hemorrhagic shock. [ABSTRACT FROM AUTHOR]

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common type of B-cell lymphoma accounting for about 40% of all lymphomas. The international prognostic index (IPI), which relies on clinical and laboratory parameters, is used as a prognostic tool in DLBCL. In this study, we have included cases of DLBCL not otherwise specified (NOS) type to test the usefulness of the biological subclassification of DLBCL by immunohistochemistry (IHC) using the Hans algorithm into the germinal center B-like (GCB) type and nongerminal center (non-GCB) type. We correlated the subtypes with the demographics, site of involvement, IPI scores, and stage., Objectives: 1. To study the immunohistochemical profile of DLBCL. 2. To classify patients with DLBCL into germinal center and nongerminal center subtypes. 3. To review the clinical presentations, clinical staging, and follow-up data in cases of DLBCL., Materials and Methods: A total of 152 cases of DLBCL reported from January 2010 to March 2018 were included in this study. Clinical data, treatment details, and follow-up were reviewed. Apart from the routine IHC markers for DLBCL, additional markers CD10, BCL6, and MUM 1 were performed to classify DLBCL into GCB type and non-GCB type using the Hans algorithm., Results: The median age of presentation was 53 years with male-to-female ratio of 2:1. Most of the patients presented with nodal involvement (56.6%); cervical lymph node is the most common site (46.5%). The majority of the patients presented in Ann Arbor stage 1 (44.8%). According to the international prognostic index, 34.8% had a score of 3 (high intermediate). After IHC studies, GCB subtype (51.5%) of DLBCL emerged as more common than non-GCB type (48.5%). The two subtypes differed significantly with regard to sex (i.e. GCB type was more common in males and non-GCB type in females) and showed no significance with regard to any of the other clinical features and prognostic parameters evaluated., Conclusion: Our study showed that IHC was a useful tool to subclassify DLBCL into GCB and non-GCB subtypes and may be easily incorporated in routine clinical practice., (Copyright © 2023 Copyright: © 2023 Indian Journal of Pathology and Microbiology.)

A 42-year-old man diagnosed to be HIV positive and on highly active antiretroviral treatment (HAART), presented with double vision and gradual drooping of the left eyelid. He had left 3rd cranial nerve palsy and partial right lower-motor-neuron facial palsy. CT of the PNS revealed soft tissue filling the right maxillary sinus antruin. Further workup showed the mass to be an NK/T cell lymphoma.