Primary ovarian leiomyoma is extremely uncommon, with a low incidence rate of 0.5-1% of benign ovarian tumors. Due to its rarity, it poses a diagnostic dilemma and needs to be differentiated from other spindle cell neoplasms of the ovary. We report a case of a large symptomatic primary ovarian leiomyoma in a postmenopausal woman, which was misdiagnosed as fibroma of the ovary both clinically and radiologically. Microscopy revealed a spindle cell tumor arranged in short intersecting fascicles, which were positive for SMA and h-caldesmon on immunohistochemistry. is a useful adjunct for definitive diagnosis and confirming smooth muscle origin. While malignant solid ovarian tumors are much more common, the consideration of ovarian leiomyoma as a differential diagnosis of solid ovarian tumors is essential, as the treatment modality is surgical resection. Diagnosing ovarian leiomyoma before and during surgery is challenging. It is advisable to perform both histopathological examination and immunohistochemical analysis.

BACKGROUND:Programmed death ligand ( PD-L1 ) binds to its receptor PD-1 on T-cells and inhibits the immune response of T-lymphocytes. Cancer cells evade immune surveillance by upregulating PD-L1 expression, leading to tumor progression. Anti- PD-L1 immunotherapy has emerged as a new treatment modality in various solid carcinomas. Food and Drug Administration (FDA) has approved PD-1 / PD-L1 axis immunotherapy for immunohistochemically PD-L1 positive cervical cancer. In India, cervical cancer accounts for approximately 17% of all cancer deaths among women between 30 and 70 years. More than three-fourths of patients are diagnosed at an advanced stage. MATERIALS AND METHODS:A hospital-based, cross-sectional prospective study was conducted over five years. 119 histologically proven cases of cervical carcinoma meeting the inclusion criteria were included in the study. Sections were stained with PD-L1 antibody clone SP263 as recommended on Ventana Benchmark XT. RESULTS:Of 119 cases, PD-L1 expression was found in 42 cases (35%). Patients over 45 years (75.6%) had higher PD-L1 positivity compared to those under 45 years (24.4%). 31% of squamous cell carcinoma was PD-L1 positive compared to adenocarcinoma (29%). PD-L1 expression was more frequent in poorly differentiated carcinoma (37.5%). CONCLUSION:A significant proportion of cervical cancers expressed PD-L1 . Increased PD-L1 expression was seen with increasing age and poorly differentiated histological grade. Anti- PD-L1 immunotherapy can be an option in PD-L1 -positive cervical cancer. The findings of our study support the requirement for further investigation of anti- PD-L1 immunotherapy for the treatment of PD-L1 -positive cervical carcinomas.

Filariasis is an endemic health issue in India and Southeast Asian countries. The diagnosis is conventionally made by demonstrating microfilaria in a peripheral blood smear. Detection of microfilaria is rarely reported in cytological evaluation, and even more infrequent is the presence of microfilaria in a neoplastic lesion. Here we report a rare case of microfilaria in a routine cytological smear of a liver aspirate, which was diagnosed as hepatocellular carcinoma.

Breast leiomyoma is a rare neoplasm, accounting for less than 1

Introduction: SARS-CoV-2 infected a wide range of age groups and caused significant morbidity and mortality. Even after constant efforts to combat the virus, it could spread rapidly and infected large groups of people worldwide. Pregnant females were always at risk of acquiring the disease and the coagulopathy caused by the virus may compromise the placental circulation. Materials and Methods: In this study, we compared histopathological findings of 61 placentas delivered from SARS-CoV2 positive mothers with 34 placentas of SARS-CoV2 negative mothers. Results: No significant difference was found between SARS-CoV2 positive and SARS-CoV2 negative placentas in terms of period of gestation, placental weight, preterm delivery, or intrauterine fetal death. Microscopically, placentas of SARS-CoV2 positive mothers were significantly associated with features of maternal and fetal vascular malperfusion. The predominant feature of fetal malperfusion was chorangiosis and maternal malperfusion was villous agglutination & atherosis. Increased perivillous fibrin deposition was also found significantly associated with the disease. Conclusion: COVID 19 disease is related to excessive perivillous fibrin deposition, villous edema, maternal and fetal malperfusion. However, these changes are not specific for the disease, as these changes can be found in other conditions as well. No significant adverse fetal outcome was reported in our study. Keywords: COVID-19, Fetal vascular malperfusion, Maternal vascular malperfusion, Placenta, perivillous fibrin, SARS-CoV2.

Background & Objective:Fine-needle aspiration cytology (FNAC) is a minimally invasive, rapid, and relatively safe diagnostic method for the initial evaluation of lymphadenopathy of unknown origin. In May 2020, the Sydney System was proposed to provide recommendations for diagnostic categorization, FNAC of lymphadenopathy, pathology reporting, and related practices. This study aimed to analyze the applicability of the Sydney System in lymph node FNAC and to evaluate diagnostic accuracy and risk of malignancy (ROM) for each diagnostic category. Methods:A 2-year retrospective diagnostic study was conducted from January 2019 through December 2020. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy (DA), and ROM were calculated using histopathology as the gold standard. Results:A total of 632 lymph node FNAC cases were included, with histopathological follow-up available in 45 cases. The median age of patients was 26 years, with a male-to-female ratio of 1.2:1. Cervical lymph nodes were most frequently involved (367 cases, 58.1%). Overall sensitivity, specificity, and diagnostic accuracy were 66.7%, 85.0%, and 76.3%, respectively. ROM by diagnostic category was: nondiagnostic (25%), benign (5.2%), atypia of undetermined significance (AUS) (50%), suspicious (80%), and malignant (88.8%). Conclusion:FNAC demonstrated high diagnostic efficacy when applied using the proposed Sydney System, supporting the utility of this standardized reporting scheme for lymph node cytology.

Lymphoepithelial carcinoma (LEC) of salivary glands are rare tumours and present as gradually progressing painless masses. LECs have good prognosis and accurate differentiation from secondary tumours and nasopharyngeal carcinoma is essential to dictate management. We present a case of an elderly male presenting with a parotid swelling diagnosed as LEC on fine needle aspiration cytology and confirmed on histopathology and immunohistochemistry.

Chyliform (pseudochylous) pleural effusions build up over time as a result of the breakdown of cellular lipids in long-lasting pleural effusions such as those caused by tuberculosis and rheumatoid arthritis. Due to the high quantities of cholesterol in the pleural fluid and the presence of cholesterol crystals, these are also known as cholesterol effusions. We present the case report of a 62-year-old man who visited the outpatient pulmonary medicine clinic with a complaint of cough, hemoptysis, and shortness of breath. On radiological examination, a pleural effusion on the left side was found. A diagnosis of pseudochylous effusion was determined on the basis of the distinctive cytological features in the pleural fluid.

Any exophytic/raised growth on the skin's surface or on any organ that resembles a wart is described as verrucous lesion. Not all verrucous lesions are caused by the human papillomavirus (HPV), there are both infectious and non-infectious etiologies. These lesions are very similar to each other and histopathology is needed to categorize them. This chapter aims to highlight specific histological characteristics seen under light microscopy that can aid pathologists in categorising common exophytic/verrucous lesions

Abstract Introduction: Hypoplastic acute leukemia (HAL), also known as smoldering leukemia, is a form of atypical leukemia. It is a rare entity and currently defined as having cellularity of < 20 % in bone marrow with>20 % blasts at presentation. Hypocellular acute myeloid leukemia are more frequent than hypocellular variant of acute lymphoid leukemia. Although cases of hypoplastic acute myeloid in children and younger age group have been reported in literature, they are extremely rare. Case Presentation: A 16 year old boy presenting with fever, dyspnea, weakness and easy fatigueability. Bone marrow aspirate revealed hypocellular smears with presence of 38 % blasts. Immunohistochemistry was performed on biopsy. Blasts were positive for CD34 and MPO with strong membranous positivity for CD7. A final diagnosis of ‘Hypoplastic acute myeloid leukemia AML-M0’ was made. Conclusion: These cases pose a diagnostic challenge to the hematopathologist and treating physician, as hematological features of hypoplasticAML, hypocellularmyelodysplastic syndrome and aplastic anemia are similar. Therefore, it is crucial to distinguish between these diseases as treatment modalities are different for each entity.

Malignant melanoma is an aggressive neoplasm, its metastasis to bone marrow is rare phenomenon. Here, we are presenting a case of metastatic malignant melanoma to bone marrow with unknown primary in 40 years old patient along with review of literature. This case is diagnosed as metastatic malignant melanoma in bone marrow aspirate and biopsy specimen first. Diagnosis was done on the basis of classical histological features and with the help of immunohistochemistry. Radiological investigations were done to know primary site. Multiple metastasis in liver and vertebra were also identified. USG guided fine needle aspiration cytology of liver and biopsy of vertebral lesion were also performed, which confirms the diagnosis of malignant melanoma metastasis. In our case, patient died within one month after diagnosis. Early diagnosis of metastatic malignant melanoma will help clinicians to better understanding of course of disease, so they can provide best possible patient care and management. Clinicians must be aware of progression of disease, clinical manifestations of metastatic malignant melanoma.

Background: The epidemic of coronavirus disease 2019 (COVID-19) has been rapidly spreading on a global scale affecting many countries and territories. There is rapid onset of generalized inflammation resulting in acute respiratory distress syndrome. We, thus, aimed to explore the potential of immune-inflammatory parameters in predicting the severity of COVID-19. Materials and Methods: Age, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Lactate Dehydrogenase (LDH), C-reaction protein (CRP), and procalcitonin (PCT) of 611 patients with laboratory-confirmed COVID-19 were investigated and compared. Patients were divided on the basis of severity and survival into two groups. Data were expressed as mean or median values and percentages. The receiver operating characteristic curve was applied to determine the optimal cut-off values of these biomarkers. Results: The median age was 50 years and the male to female ratio was 3.7:1. The mean NLR, LMR, PLR, LDH, CRP, and Procalcitonin for the non-severe group were 4.16, 10.8, 133.7, 666.1, 49.9, and 0.15, respectively. In the severe group mean values of the above-mentioned immune-inflammatory markers were 17.8, 4.69, 268.2, 1277, 158.6, and 3.05, respectively. Elevated levels were significantly associated with disease severity. In ROC curve analysis, NLR had the largest area under the curve at 0.923 with the highest specificity (0.83) and sensitivity (0.88). Conclusion: This study shows that NLR, PLR, LDH, CRP, and Procalcitonin may be a rapid, widely available, useful predictive factor for determining the severity of COVID-19 patients.

Endometrial stromal sarcoma (ESS) involving the urinary bladder is very rare, with very few reported cases in literature. ESS have indolent clinical course with late recurrences thus warrants long-term monitoring. Here, we report case of 38-year-old woman presenting to department of radiotherapy after TURBT done outside. Block review of TURBT specimen and IHC was asked for final diagnosis. CT urogram revealed large malignant mass involving the vaginal vault with gross infiltration into urinary bladder. She also had history of total abdominal hysterectomy done on 2018. H and E–stained sections from submitted block for review revealed an ill-defined tumor mass composed of uniform, oval to spindle cells arranged in diffuse sheet. Immunohistochemical analysis showed diffuse positivity for vimentin, desmin, ER, PR, BCL-2, CD10, and CD99. Pan CK and SMA were focal and weak positive. WT-1 was nuclear positive. Based on immunohistochemical features, final diagnosis of metastatic low-grade endometrial stromal sarcoma was made. An unexpected extra-uterine location and unusual presentation of ESS may make the diagnosis challenging. Morphological and immunohistochemical features must be combined to render the correct diagnosis.

Primary ovarian lipoleiomyoma is a rare benign tumor of the ovary predominantly consisting of smooth muscles and adipocytes. Clinically, they are asymptomatic and are diagnosed accidentally during the histopathological examination after the surgery. Herein, we report a case of unilateral, primary ovarian lipoleiomyoma in a 20-year-old primigravida who presented with complaints of abdominal distension for 4 months. The abdominal contrast-enhanced computed tomography (CECT) revealed a large, well-defined, heterogeneously enhancing mass in the right adnexa measuring 35.9 × 26.1 × 12.9 cm. A primary clinical diagnosis of teratoma was raised. Unilateral salpingo-oophorectomy was performed, and histomorphology revealed a benign smooth muscle tumor admixed with mature adipocyte and cartilage arising primarily in the ovary. The diagnosis was confirmed by immunohistochemistry. The tumor may be asymptomatic or manifest with abdominal pain or distension, like in our index case. As there are no pathognomonic clinical symptoms, tumor markers, or characteristic imaging findings, definitive diagnosis is difficult prior to surgical removal. Histomorphology and immunohistochemistry confirm the smooth muscle nature of the tumor. This common and benign solid tumor at an unusual location should be kept in the differential diagnosis of solid ovarian masses.

Chromoblastomycosis (CBM) is a chronic, granulomatous, mycosis of the skin and subcutaneous tissue produced by the traumatic implantation of various dematiaceous fungi. The most prevalent species (90%) is Fonsecaea pedrosoi. We report a case of a 29 year male presented with complaints of non- healing ulcer since 6-7 months and underwent exploration and curettage. It was diagnosed as chromoblastomycosis in histopathological examination on identication of characteristic copper pennies/sclerotic bodies. Later on patient responded well to oral antifungal and antibiotic therapy. To conclude, CBM although infrequent, must be considered in the differential diagnosis of chronic skin lesions.

The non-specific clinical symptoms of anorectal brownish-black mass do not help to differentiate colorectal cancer, hemorrhoids, rectal ulcers which result in a delayed diagnosis or lead to inadequate management of lethal anorectal melanoma. Primary malignant melanoma of the anorectal region is an uncommon tumor, constituting approximately 1% of anal canal tumors which may be misdiagnosed clinically as hemorrhoids. Because of aggressive behavior and poor prognosis, efficient and prompt diagnosis is required in these cases. We report 2 cases of this rare tumor.

Mature cystic teratoma (MCT) is the most common benign germ cell tumor of the ovary and contains the different tissues that originate from the endoderm, mesoderm, and ectoderm. The monodermal teratoma has a component of only the germ layer. Ovarian carcinoid is rare and considered as a monodermal teratoma. We report a case of carcinoid tumor arising in MCT in a 60-year-old postmenopausal woman.