Search

Introduction– Osteoid Osteomas are rare and extremely painful benign bone tumours. They are usually seen in children in the growing age group and young adults. The patients typically complain of bony pain during the night time and usually relieved with rest and salicylates. Osteoid Osteomas are commonly encountered in the limbs with Proximal femur/ Hip region and Tibial diaphysis being the usual locations. Pelvic locations are rare for osteoid osteoma and few cases have been published/ reported in literature. Case Presentation – A young female with long standing hip pain was diagnosed to have osteoid osteoma in an extremely rare location in her pelvic bone. After careful evaluation of the imaging the lesion was found to be in the Quadrilateral plate/Medial wall of acetabulum. After through pre-surgical planning she underwent the Gold-standard treatment for osteoid osteoma i.e., Computed Tomography (CT)- guided Radiofrequency Ablation (RFA). Immediate post-procedure the patient reported complete relief of her symptoms and has been symptoms-free for the past 2years of follow-up. Conclusion - A high level of clinical suspicion is warranted to keep osteoid osteoma as a differential diagnosis in a patient presenting with the relevant symptoms. They can be easily missed on Radiographs and CT is a clincher for diagnosis and unusual anatomic sites can harbour the same. A carefully planned Radiofrequency ablation under CT-guidance gives favourable and reliable results for treatment of osteoid osteomas.

In the current COVID-19 pandemic, tremendous pressure is been exerted on the existing health infrastructure of many developing nations. Limb salvage surgeries in bone and soft tissue sarcomas cannot be delayed beyond a certain time-period and constitute an orthopaedic emergency in certain situations. Evaluation of intra-operative surgical margins forms an important step especially in cases with planned close margins or intercalary resections. Techniques such as imprint cytology can be preferred over frozen sections for evaluation of the surgical margins especially in COVID-19 positive patients. The advantages it offers such as completion of the procedure within the operation room complex, no generation of aerosols, and almost equal sensitivity and specificity when compared with frozen section method do warrant a modification of current surgical practice in the current health crisis especially in resource-constrained nations. Awareness and better communication regarding the same from the pathologist to the surgical team will go a long way in conserving resources and avoid unnecessary exposure to potentially infected aerosols.

Castleman disease (CD) is a rare lymphoproliferative disorder, the etiology and pathogenesis of which is not clearly established. It presents more commonly as a localised disease or unicentric CD (UCD), and less often as generalised disease or multricentric CD (MCD). The most common site of UCD is in the thorax; however, UCD is rarely included in the differential diagnosis of an intrathoracic mass due to its rarity. The lesion is highly vascular and often has dense adhesions with adjacent organs, making the surgery a difficult task. We report a case of posterior mediastinal mass located in left paraspinal region which was detected incidentally in a 53-year old female and was subsequently resected successfully via left postero-lateral thoracotomy, and was diagnosed post-operatively on histopathological examination (HPE) as CD, hyaline vascular variant (HVV). This case report highlights the relevant clinical, pathological and radiological findings of CD, which may act as clinical pointers for establishing a preoperative diagnosis of CD. Suspecting CD preoperatively would guide the surgeon for appropriate surgical planning and may avoid facing such surprise on the operating table.

Introduction: Xanthomas are defined as benign lesions characterized by an accumulation of lipid-laden macrophages that develop in the cutis and subcutaneous tissue. Xanthomas are classified as eruptive, tuberous, tendinous, or planar depending on their location and clinical appearance. Co-existence of both tuberous and tendinous forms in an atypical large-sized pattern is a rarity and presented herewith. Case Presentation: A 48-year-old male patient presented with multiple large masses in his elbows, knees, Achilles tendons, feet, and hands. The largest swellings measured 12 cm × 10 cm in dimensions. The blood workup of the patient showed an elevated level of low-density lipoprotein cholesterol and was subsequently diagnosed with Type IIa familial hypercholesterolemia and multiple large co-existing tuberous and tendinous xanthomas which is a rare clinical presentation. Local surgical excision was performed to remove the symptomatic massive xanthomas from the elbows, knees, and feet. Histological analysis of the surgical specimens confirmed the clinical diagnosis of xanthomas. Conclusion: Tuberous and tendinous xanthomas can co-exist in the same patient, including atypical large-sized forms. Usually, patients with xanthomas have some underlying metabolic lipid derangement and a cardiology workup to detect future cardiac risk is warranted. Intervention at an early stage can prevent the formation of disfiguring xanthomas in patients with underlying lipid disorder. The case also highlights a multi-disciplinary approach to such rare clinical presentations. Keywords: Xanthomas, Familial Hypercholesterolemia, Giant, Tuberous.

A 36-year-old man presented in the orthopaedic oncology outpatient with a history of gradually increasing pain in his right lower thigh and knee region for the past 3 months. There was no history of fever, night sweats or decreased appetite. On physical examination, some swelling and mild tenderness

BACKGROUND Precursor T-lymphoblastic lymphoma (T-LBL) is a rare lymphoma presenting clinically in children and adolescents with a rapidly enlarging mediastinal mass, dyspnea, and cervical lymphadenopathy requiring quick diagnosis. The objective of the current study was to report on the spectrum of cytomorphology and flow cytometric immunophenotyping (FCI). METHODS The clinical profile, cytomorphological features, FCI, and cell block immunocytochemistry (CB-ICC) of all cases of T-LBL diagnosed from 2011 through 2013 were reviewed. RESULTS Fifteen cases of precursor T-LBL (10 fine-needle aspiration samples and 5 pleural/pericardial fluid samples) were evaluated. Smears demonstrated dispersed lymphoblasts, with a high nuclear:cytoplasmic ratio and scanty basophilic cytoplasm. Nuclei demonstrated notches, clefts, and indentations. The chromatin was condensed in small and intermediate-sized blasts and dispersed in larger blasts. Nucleoli were present only in the larger blasts. Hand mirror-shaped cells and mitoses were variable. With regard to immunophenotyping, flow cytometry demonstrated positivity for CD2 (15 of 15 cases), surface CD3 (14 of 15 cases), cytoplasmic CD3 (15 of 15 cases), terminal deoxynucleotidyl transferase (TdT) (8 of 15 cases), CD5 (13 of 15 cases), CD10 (7 of 15 cases), and human leukocyte antigen-D related (HLA-DR) (1 of 15 cases). Dual CD4/CD8 positivity was observed in all cases forming a tight cluster, which is consistent with the cortical T-LBL subtype. CB-ICC demonstrated a uniform CD3-positive/TdT-positive/CD20-negative phenotype. In 7 cases in which TdT was negative by flow cytometry, CB-ICC was positive. CONCLUSIONS Combining cytomorphology and FCI enables the accurate and rapid diagnosis of T-LBL on fine-needle aspiration and effusion cytology specimens, thereby obviating the need for a biopsy. Cancer (Cancer Cytopathol) 2015;123:557–565. © 2015 American Cancer Society.

In this brief report, we have described a rare case of schwannoma of the parotid gland in a young female who presented to us with a 3 cm diameter parotid swelling. The fine-needle aspiration cytology showed small fascicles, clusters and discrete spindle-shaped cells with long wavy nuclei. The cytological diagnosis of schwannoma of the parotid gland was offered and later confirmed by excision and histopathology.

Precursor T-lymphoblastic lymphoma (T-LBL) is a rare lymphoma presenting clinically in children and adolescents with a rapidly enlarging mediastinal mass, dyspnea, and cervical lymphadenopathy requiring quick diagnosis. The objective of the current study was to report on the spectrum of cytomorphology and flow cytometric immunophenotyping (FCI).The clinical profile, cytomorphological features, FCI, and cell block immunocytochemistry (CB-ICC) of all cases of T-LBL diagnosed from 2011 through 2013 were reviewed.Fifteen cases of precursor T-LBL (10 fine-needle aspiration samples and 5 pleural/pericardial fluid samples) were evaluated. Smears demonstrated dispersed lymphoblasts, with a high nuclear:cytoplasmic ratio and scanty basophilic cytoplasm. Nuclei demonstrated notches, clefts, and indentations. The chromatin was condensed in small and intermediate-sized blasts and dispersed in larger blasts. Nucleoli were present only in the larger blasts. Hand mirror-shaped cells and mitoses were variable. With regard to immunophenotyping, flow cytometry demonstrated positivity for CD2 (15 of 15 cases), surface CD3 (14 of 15 cases), cytoplasmic CD3 (15 of 15 cases), terminal deoxynucleotidyl transferase (TdT) (8 of 15 cases), CD5 (13 of 15 cases), CD10 (7 of 15 cases), and human leukocyte antigen-D related (HLA-DR) (1 of 15 cases). Dual CD4/CD8 positivity was observed in all cases forming a tight cluster, which is consistent with the cortical T-LBL subtype. CB-ICC demonstrated a uniform CD3-positive/TdT-positive/CD20-negative phenotype. In 7 cases in which TdT was negative by flow cytometry, CB-ICC was positive.Combining cytomorphology and FCI enables the accurate and rapid diagnosis of T-LBL on fine-needle aspiration and effusion cytology specimens, thereby obviating the need for a biopsy.

Background: Arachnoid proliferation, although rare, is known to occur in association with optic gliomas. However, chondroid and chordoid metaplasia has not been reported previously. Case Description: A 27‑year‑old male presented with progressive, painless loss of vision in right eye, associated with vomiting and headache for one and a half months. Computed tomography (CT) scan revealed a contrast enhancing mass arising from planum sphenoidale. Perioperative findings showed the tumor adherent to the right optic nerve and attached to basal dura and falx. A clinical impression of an intradural, optic nerve sheath meningioma was made. Histopathological examination revealed a glial tumor with adjacent areas displaying marked fibroblastic and arachnoid cell proliferation with chondroid as well as chordoid differentiation along with myxoid change and dense collagenisation. Reticulin stain, immunochemistry with glial fibrillary acid protein (GFAP), epithelial membrane antigen (EMA), and S‑100 helped to arrive at the final diagnosis of optic glioma displaying exuberant arachnoid proliferation with cartilaginous metaplasia. Conclusion: We report a case of optic nerve glioma displaying extensive arachnoid proliferation, chordoid, and cartilaginous metaplasia, which mimicked chondrosarcoma or chordoid meningioma, posing a diagnostic dilemma. A clinical feedback, simple reticulin stain, and GFAP staining is of immense value in such cases to arrive at the correct diagnosis.