ABSTRACT Primary nasopharyngeal diffuse large B-cell lymphoma (DLBCL) is an uncommon extra nodal lymphoma that may closely mimic nasopharyngeal carcinoma on clinical presentation, imaging, and histomorphology. Aberrant expression of epithelial markers, particularly p63, poses significant diagnostic challenges. 43-year-old man presented with recurrent cold-like symptoms, progressive nasal obstruction, aural fullness, and dysphagia for 8 to 9 months. Clinical examination revealed a nasopharyngeal mass without peripheral lymphadenopathy, and PET-CT showed a metabolically active posterior nasopharyngeal mass measuring approximately 4.5 x 3.8 x 4.9 cm, initially favouring carcinoma. Histopathology of biopsy from the mass demonstrated sheets, clusters, and cords of large atypical cells with high nuclear-to-cytoplasmic ratio, vesicular chromatin, prominent nucleoli, frequent mitoses, and focal necrosis, creating a strong impression of poorly differentiated carcinoma. Immunohistochemistry established the correct diagnosis: the tumour cells were positive for CD45, CD20, BCL2, BCL6, MUM1, with high Ki- 67 and aberrantly p63, while negative for CD10, pan-cytokeratin, CK5/6, S100, synaptophysin, and chromogranin. The CD10-negative, BCL6-positive, MUM1-positive profile supported activated B-cell-like DLBCL by the Hans algorithm. This case highlights the importance of a broad immunohistochemical panel in small nasopharyngeal biopsies and demonstrates how aberrant p63 expression can complicate distinction from epithelial malignancy.
ABSTRACT Early diagnosis of vulvar squamous cell carcinoma (VSCC) and its precursors is still a challenge to overcome. So far, research on the genomic characterization of VSCC tumors has been limited. We retrospectively analyzed mutational data, histology, and clinical features of eight samples from six patients (including four HPV‐negative VSCC patients with adjacent differentiated vulvar intraepithelial neoplasia (dVIN) tissues, one vulvar lichen sclerosus patient, and one vulvar acanthosis with altered differentiation-like patient). Targeted deep sequencing was performed on these samples with adjacent normal tissues as controls. Only one VSCC patient had moderately/poorly differentiated carcinoma, and neither TP53 nor PIK3CA mutations were identified in this case. Among the remaining seven samples, TERT (7/7) was the most frequently mutated gene, followed by TP53 ( 4/7), CASP8 ( 4/7), and NOTCH1 ( 4/7). Promoter mutation (C228T) was the only alteration seen in the TERT gene. In two patients with paired samples (dVIN + VSCC), one patient showed new single nucleotide variant (SNV) mutation clones, while the other maintained most of the previous SNV mutation clones with acquisition of de novo copy number variations. Further analysis of the entire sample suggested that TP53 (MAP kinase signaling pathway) and CASP8 (apoptosis signaling pathway) are driver genes. Our results indicate that TERT alterations may be the initiating molecular event of VSCC and its precursors as one of several different evolution patterns in the progression of dVIN to VSCC. Moreover, detecting gene mutations such as TERT and CASP8 can be used for the differential diagnosis of VSCC and its precursor lesions.
ABSTRACT The relationship between podoplanin expression and extra nodal extension of HPV-associated oro pharyngeal squamous cell carcinoma can be used as a significant diagnostic biomarker and a determinant of postoperative adjuvant chemoradiation.
ABSTRACT Background: Tumor-infiltrating lymphocytes (TILs) reflect the immune system’s response to cancer and their significance in Oral cavity Squamous Cell Carcinoma (OCSCC) is being increasingly recognized. Aim: This study is aimed to evaluate the histopathological presence and distribution of TILs in OCSCC and correlate them with clinicopathological parameters such as tumor grade, stage, perineural invasion (PNI) and lymphovascular invasion (LVI). Material and Methods: A cross-sectional observational study was conducted on 41 patients with OCSCC using tissue samples stained with hematoxylin and eosin. TILs were quantified in stromal and intratumoral regions and statistically correlated with clinical parameters using SPSS version 26. Results: High stromal TILs were observed in 90.2% of patients, while only 17% showed high intratumoral TILs. A significant inverse association was observed between TIL scores and tumor stage. Also statistical significance was noted between PNI and low stromal TILs. Conclusion: Morphological assessment of TILs using the H and E-stained sections can aid in immune-based classification and prognostication of OCSCC. TIL scoring can be incorporated into clinicopathological prognostic models and can be further explored for targeted immune therapies in OCSCC.
ABSTRACT A 58-year-old male presented with frank hematuria for three months and underwent radical nephrectomy outside, as a renal mass was detected on ultrasound involving the lower pole of the left kidney. The case was diagnosed as eosinophilic solid cystic renal cell carcinoma (RCC), WHO grade 4, with ipsilateral adrenal metastasis, but the adrenal gland additionally showed the presence of coexisting histoplasmosis. Interestingly, histoplasma colonization was found within metastatic RCC cells, which is hitherto unreported in existing literature. Rhabdoid differentiation of this tumor, a novel entity recently introduced in recent WHO classification, is again very unusual; there is a chance that the fungal organisms may have played a role in this phenomenon. The patient is currently under close follow-up after completing a systemic antifungal regimen.
