Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare and aggressive extranodal T-cell lymphoma of the gastrointestinal tract with exceedingly poor prognosis. Its diagnosis and clinical management are complicated by a broad differential, frequently manifesting with non-specific clinical presentation. While recent studies have provided useful insights in regard to its molecular and genetic characteristics, its pathogenesis remains poorly understood. We present a case of an 81year-old female with T-cell lymphoma, showing MEITL morphologic features, involving the ileum. The patient presented with repeated episodes of nausea, decreased oral tolerance and abdominal pain. Amongst the many lymphoid markers studied, CD3, TIA-1, and bcl-2 were the only ones that were positive by immunohistochemistry (IHC) and T-cell receptors beta and gamma by molecular studies. Although positive in most reported cases, CD8 and CD56 were negative in our case. Recognition of various IHC and molecular markers of this rare neoplasm may elucidate a better understanding of its pathogenesis and eventual approach to therapeutic modalities.
Extranodal NK/T cell lymphoma, nasal type (ENKTLNT), is an angiodestructive T-cell non-Hodgkin’s lymphoma associated with latent Epstein Barr virus (EBV) infection.[7] On biopsy, it can present as a poorly differentiated necrotic lesion, requiring a methodical histopathological assessment. The final diagnosis is confirmed by the demonstration of a cytotoxic T-cell phenotype and the presence of EBV in the malignant cells.[7,3] We present the case of a 66-year-old male with an ulcerated maxillary lesion in which we review the histological features of these lymphomas and discuss the general histopathological approach to the diagnosis.
All the patients with a non-operative diagnosis of invasive breast cancer should have ipsilateral axillary ultrasound performed, preferably at the time of initial assessment. If this was not performed initially, it should be done as soon as possible following core biopsy diagnosis of the breast cancer. The number and morphology of any abnormal nodes should be documented1. No national guidelines are available to give the utility of FNA versus biopsy of axillary nodes. They are regarded as equal, however, we had a couple of difficult experiences in reporting of FNA results, and therefore we decided to do an audit while comparing the two techniques by keeping the histology as gold standard.
Background: Sigma is a quality management tool that helps in continuous monitoring and improvement of the performance of the analytes in the clinical laboratory. The present study evaluated the performance of our Quality Management System under optimal condition as well as during the adverse condition due to unexpected flooding in Chennai, India in the month of December 2015. Methods: The performance of the assays in the clinical laboratory was evaluated in sigma scale for 27 routine analytes under optimal condition, adverse condition during the disaster, and after restoring the optimal condition. Results: The performance of each analyte was analyzed to evaluate the quality of results released under all the three situations viz., optimal condition (Pre-disaster phase); adverse condition (Disaster phase) and after re-establishing the optimal condition (Post-disaster phase). Six analytes showed poor performance with a sigma 3 sigma. Alanine aminotransferase showed a <3 sigma performance at level 1 control and bicarbonate at both levels of quality control even after the optimal condition was restored. Conclusion: Even in adverse condition, the quality of the results released from VITROS 5600 integrated system was not much impacted except for a few analytes. Analysis using quality goal index (QGI) showed that imprecision was the reason behind the unacceptable sigma. Good clinical laboratory practices aided us in improving the quality of performance of these analytes.
We describe an 80-year-old male with a history of idiopathic lung fibrosis who was feeling generally unwell over a few weeks. Tissue biopsy from a rapidly growing ulcerated skin lesion on the abdomen showed a malignant epithelioid tumour positive for epithelial, mesothelial and embryonal tumour markers. The patient deteriorated rapidly and passed away. A post mortem examination was carried out and revealed thickened right pleura with multiple intra and extra-thoracic metastatic deposits. Histology of the pleural thickening and the multiple deposits were identical to that seen in the skin. The diagnosis of malignant epithelioid mesothelioma with rhabdoid features was made on histology. This is a rare case of malignant metastatic mesothelioma with ectopic hCG production and rhabdoid morphology in a patient without previous asbestos exposure.
Diabetes and hemoglobinopathy can co-exist, but the extent of diagnosis of such co-existence may depend on choosing the appropriate diagnostic methodology. This case report emphasizes the importance of such methods like HPLC and capillary electrophoresis in diagnosing these disorders.
A large number of foreign substances invade the skin voluntarily and involuntarily. The voluntary substances include particulate materials used in tattoos and cosmetic filters, whereas, the latter involves accidental inclusion of external substances secondary to trauma. Clinical presentation of these foreign substances as pigmented lesion, mimicking a nevus/melanoma, poses a major concern to both clinician and the patient. The present case study focuses on the unusual presentation of vegetable matter, clinically mimicking as junctional nevus/melanoma.
Oral cavity and the oropharynx are the two most common sites of cancer in the head and neck region. The exposure of mucosal surface of the oral cavity and entire oropharynx to alcohol and tobacco-related carcinogens increases the risk for developing premalignant or malignant lesions. The purpose of this study is to assess the serum levels of total antioxidant capacity, vitamin C and malondialdehyde in confirmed cases of oral and oropharyngeal squamous cell carcinoma and their correlation in healthy subjects.
Oral and oropharyngeal cancers are the commonest of head and neck malignancies. They share common etiological factors, which are often the personal habits of the patients. Human papillomavirus is increasingly being reported in patients with oral and oropharyngeal malignancies, especially in Western population. However in India, smoking, alcohol consumption and tobacco chewing are the common etiological factors. We conducted a retrospective study of 202 histopathologically confirmed cases of oral and oropharyngeal malignancies in Justice K.S. Hegde Charitable Hospital, Mangalore, during the three years period between January 2011 and December 2013. Majority of the patients were males. Buccal mucosa was the commonest site of lesions. Half of them had history of smoking, whereas the remaining had history of smokeless tobacco consumption. One-third of the patients had history of alcohol consumption. However, 10.8% of the patients had no addictions and this group was dominated by females.
Background: To evaluate whether a proven association between clinicopathological features and expression of molecular markers could provide a clue towards the relevance of these markers in gastric adenocarcinoma (GAC). Aims: The present study aimed to find any relation between immunohistochemical expression of E-cadherin and HER-2/neu proteins, and Lauren’s histological type and stages of GAC. Materials and Methods: 100 cases of primary GAC diagnosed on biopsy or gastrectomy were included in the study. Immunohistochemical expression of E-cadherin and HER-2/neu was studied with respect to site, Lauren’s histological type, and stages of GAC. Results: A total of 11 cases showed a loss of E-cadherin expression and 17 cases overexpressed HER-2/neu. Loss of E-cadherin was seen in 26% of Lauren’s diffuse type, but only in 5.7% of intestinal GAC (P=0.014). While 35% of the GAC present at greater curvature showed HER-2/neu overexpression, whereas 16% at antro-pyloric region and none at lesser curvature showed HER-2/neu overexpression (P=0.04). All of the 17 HER-2/neu overexpressing GAC were Lauren’s intestinal type (P=0.012). Conclusion: Loss of E-cadherin and HER-2/neu overexpression are associated with Lauren’s diffuse and intestinal type respectively. Anti-HER-2/neu monoclonal antibody therapy would be helpful in approximately one-fifth of gastric adenocarcinoma patients.
Carcinoma of the gallbladder is the most common malignancy of the biliary tract. Although adenocarcinomas account for more than 90% of gallbladder cancers, the incidence of adenosquamous carcinomas (ASCs) is only approximately 5%. ASCs have aggressive biological behavior due to their potential for direct extension into the liver and neighboring structures like stomach, duodenum, and transverse colon. In most cases, the disease would have advanced at the time of diagnosis and the prognosis might be dismal when compared to ordinary adenocarcinoma of the gallbladder. We present here a rare case of ASC of gallbladder in a 59-yr-old female who presented with right upper abdominal pain.
Hyperlipidemia can give rise to acute polyarthritis and the disease is more often confused with reactive arthritis or other causes of polyarthritis. We report here a case of secondary hypercholesterolemia with clinical presentations of acute polyarthritis.
Colonic lipomas with overlying adenomatous change are exceedingly rare with few reported cases.1, 2, 3 This is a case report of a 74 year old female who was found to have a polyp on the ileocaecal valve that was not amenable to endoscopic mucosal resection. The patient subsequently underwent a successful laparoscopic right hemicolectomy. The diagnosis of a submucosal lipoma with an overlying low grade tubulovillous adenoma was made on histology.
Diffuse Alveolar Damage (DAD) is a clinicopathologic syndrome depicting a deposition of intraalveolar red blood cells, fibrin, and hemosiderin-laden macrophages coming from the alveolar capillaries. The causes of DAD originate from injury to the alveolar circulation. The typical computed tomography scan pattern of DAD comprises of diffuse ground glass opacities with or without consolidation. There is no evidence of DAD presenting as a mass in the literature. Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) is not a popular method for diagnosis of DAD. This case report is an example of an immunocompromised patient undergoing induction chemotherapy for myelofibrosis transforming into acute myelogenous leukemia presenting with a left upper lobe mass on imaging. The clinical diagnosis was concerning for fungal pneumonia versus less likely malignancy. EBUS-FNA was performed on the left upper lobe mass to reveal groups of reactive looking pneumocytes wrapping around fibrin deposits forming a pseudopapillary architecture with a background of mixed inflammatory cells, necrotic material, histiocytes, giant cells, and occasional clusters of crowded epithelioid cells. The cell block revealed fibrin deposits and collection of histiocytes consistent with DAD and organizing pneumonia. Special stains and immunohistochemistry did not reveal microorganisms. This case report demonstrates EBUS-FNA of a mass-like lesion showed features of DAD and organizing pneumonia in an immunocompromised patient. EBUS-FNA can be used as a non-invasive procedure for diagnosis of DAD and organizing pneumonia. The cytopathologist should be familiar with these features to help improving the diagnostic accuracy. [The material was presented as an abstract at the American Society of Clinical Pathology (ASCP), 2014 Annual Meeting, October 8-10, 2014, Tampa, Florida, United States.]
A 23 year old Qatari female was followed for infertility for two years in the IVF unit in woman hospital in Doha, Hamad Medical Corporation, Qatar. After two years of medical follow up and treatment, IVF was tried and the patient got pregnant. Follow-up during pregnancy continued and the pregnancy ended by full term live born boy. Histological examination of a placentomegally showed placental mesenchymal dysplasia. Herein, we represent this interesting case of infertility managed by IVF, which was associated with placental mesenchymal dysplasia, with review of literatures.
Dieulafoy’s lesion was first described in the stomach but there has been an increasing frequency of similar lesions been described in the oesophagus, small intestine, rectum and anal canal. In this paper, we report a case of moderately differentiated adenocarcinoma with Dieulafoy’s lesion of the colon in a 64 year old lady.
