Search

Nuclear Protein in Testis (NUT) carcinomas are rare, extremely aggressive, poorly differentiated squamous carcinoma, characterised by the presence of NUT gene (NUTM1) rearrangement. NUT carcinoma most commonly arises in head and neck region and thorax however, they can occur in other parts of the body also. Here, we are presenting a case series of three cases of NUT carcinoma.All patients were females with disease involving head and neck region. The first case was an eight-year-old girl. The second case was a 36-year-old woman. The third case was a 61-year-old woman. Histopathology of all cases showed poorly differentiated neoplasm, comprising of sheets of monotonous cells with minimal indistinct, clear cytoplasm, round to oval nuclei with prominent nucleoli. High mitotic rate with areas of tumour necrosis were also present. Areas of abrupt keratinisation classically described in this entity were seen in two of the cases. Speckled nuclear positivity for NUT1 monoclonal antibody by immunohistochemistry, which is sensitive and specific for diagnosis was observed in all three cases. There is no definite treatment for this disease, and most patients respond poorly to conventional chemotherapy and radiation. Targeted therapy targeting the BRD4 portion of BRD4-NUT, termed BET bromodomain inhibitors, are in clinical trials. Two of our patients succumbed to disease within one year of diagnosis. Third patient is on follow-up for eleven months after diagnosis.

Introduction: Papillary lesions of the breast include a spectrum of entities ranging from benign papilloma to malignant papillary carcinoma. The overlapping morphological features in benign and malignant lesions make their accurate sub categorisation difficult. Definitive surgical management decisions on papillary lesions of breast based on fine needle aspiration cytology report alone is a matter of concern. Aim: To evaluate the cytomorphological features of papillary lesions of breast and its concordance with histopathology. Materials and Methods: This retrospective study was conducted in Department of Pathology at Regional Cancer Centre, Thiruvananthapuram, Kerala, India (tertiary cancer centre) from January 2017 to June 2017. Total 28 cases diagnosed as papillary lesions/neoplasm on nipple discharge/fine needle aspiration cytology (FNAC) from January 2014 to December 2016 were reviewed and concordance with histopathology where ever available was analysed. Cytomorphological features that were analysed included cellularity, complex folded and branching epithelial sheets, stromal bare nuclei, cyst macrophages, single cells and atypia. Results: Total 28 cases of papillary lesions diagnosed by cytology were identified with mean age of 51 years. Out of 28, 22 cases had histopathology concordance. Most common diagnosis in cytology was papillary neoplasm, accurate categorisation into benign or malignant could not be done in cytology in most of the cases. Most common diagnosis in histopathology was carcinoma, in-situ and invasive. Of total 22 cases,16 cases showed true papillae. Majority of the cytomorphological features assessed were statistically insignificant in differentiating benign and malignant lesions. Fifteen cases out of the total 22 cases turned out to be malignant in final histopathology. Out of the total 22 cases wherein histopathology correlation was available, cytology could give a conclusive diagnosis of malignancy in two cases and could give a suggestion of malignancy in seven cases. Out of these nine cases where cytology favoured malignancy, one case turned out to be benign in histopathology while the rest eight cases were malignant. In five cases cytology gave benign diagnosis, one of these turned out to be malignant in histopathology, rest four cases histopathological diagnosis was in concordance with cytology. In eight cases cytology gave an equivocal diagnosis of papillary neoplasm, where further categorisation into benign and malignant category was not possible. Out of these equivocal cases, six turned out to be malignant in histopathology and two were benign. Conclusion: Cytomorphological features of papillary lesions of the breast are not unique and are inadequate for consistent categorisation into benign and malignant lesions. Excision biopsy with adequate sampling and immunostaining with myoepithelial markers and Oestrogen and Progesterone Receptors (ER and PR) are essential for accurate categorisation of papillary neoplasms of breast.

Follicular dendritic cells (FDC) are nonlymphoid, nonphagocytic accessory cells in the immune system. They have major roles in antigen presentation and regulation of germinal center reaction. FDC sarcoma is a rare and under-recognized malignancy. Most of the cases are reported in the lymph nodes. The typical morphology is syncytial aggregates of oval/spindly cells with vesicular bland nuclei and small nucleoli. Focal whorling and storiform pattern, multinucleate giant cells, and the presence of small lymphocytes in the background give additional clues for the diagnosis. As spindle cell tumors are rare in the lymph nodes, FDC sarcoma comes under the differential diagnosis of spindle cell neoplasms of the node and an accurate diagnosis is often rendered. However, when the neoplasm occurs in extranodal sites, the diagnosis is often missed because the FDC markers are not routinely used in the immunopanel for undifferentiated neoplasms. Because of its rarity, the extranodal FDC sarcomas pose a great diagnostic challenge and often misdiagnosed initially. Herein, we report a case of FDC sarcoma of the tonsil in a 36-year-old female patient. Biopsy of the lesion showed oval to spindly cells in syncytial sheets and focally in whorled pattern. The individual cells were having plump vesicular nuclei and small nucleoli. Occasional multinucleate cells and sprinkling of lymphocytes within the tumor were also noted. The tumor cells were positive for CD23 and CD35. A diagnosis of FDC sarcoma was given. Greater awareness of the morphologic spectrum of FDC sarcoma and appropriate immunostains for FDC differentiation will help in recognition of this rare neoplasm. [ABSTRACT FROM AUTHOR]

Malignant melanoma (MM) has a high potential of lymphatic and hematogeneous spread, and metastatic disease is always incurable with a high mortality. We present a rare phenomenon of MM metastasizing to the palatine tonsil. [ABSTRACT FROM AUTHOR]

Acute promyelocytic leukemia (APL) is an uncommon malignancy in the pediatric population, accounting for only 5-10% of pediatric acute myeloid leukemias, and for this disease to present with bone lesions at diagnosis is extremely unusual. We wish to convey that very rarely, in a pediatric cancer patient presenting with multiple extensive lytic bone lesions, the diagnosis can be APL. The treatment protocol and prognostic implications are vastly different. Histopathology is the gold standard in arriving at a correct diagnosis and delivering proper treatment in such cases. This patient had excellent response to chemotherapy. [ABSTRACT FROM AUTHOR]