BACKGROUND: Meningiomas are neoplasms primarily originating from arachnoid cells and are classified into 3 grades (1, 2, and 3) based on histological features according to the World Health Organization classification. However, this classification system is imperfect especially for grade 1 and 2 meningiomas as many grade 1 tumors recur. Meningiomas are hence a histologically diverse class of tumors exhibiting more unpredictable behavior. Therefore, more improved classification is required, possibly using novel and more dependable biomarkers. In this study, we aim to investigate the role of the H3K27me3 and Ki-67 labeling index (LI) in assessing the biological behavior of meningiomas. The study was conceived, with the primary objective of examining the expression of H3K27me3 and Ki-67 LI in grade 1/2 meningiomas with atypical features to ascertain if this potentially impacts patient prognosis. METHODS: Upon obtaining clearance from the Institutional Ethical Committee, the authors studied 81 cases of meningiomas including 11 recurrent cases. The study used immunohistochemistry to evaluate the Ki-67 index and H3K27me3 immunohistochemistry. The Ki-67 LI was determined by counting the positively stained MIB-1 cells and categorizing them into < 5%, 5%-10%, and > 10%. The H3K27me3 staining was evaluated by finding the product of the tumor cells showing positive staining and the intensity of staining. Based on the product of the two, the cases were subdivided into negative (0), low (1-4), and high expression (5-9) of H3K27me3. RESULTS: The results showed that the presence of atypical morphological features including necrosis and prominent nucleoli in grade 1 meningioma and low expression of H3K27me3 was significantly associated with higher grade, recurrence, and shorter progression-free survival (Kaplan-Meier curves showed higher negative slope). The study also found that a higher Ki-67 LI was associated with recurrence and poor prognosis. prognostic markers in meningiomas, particularly in challenging grade 1 and 2 cases and recurrent meningiomas. CONCLUSIONS: The study highlights the importance of the H3K27me3 and Ki-67 LI in assessing the biological behavior of meningiomas. The findings provide valuable insights into the prognosis and treatment of meningiomas, emphasizing the need for further research to validate these markers and develop targeted therapeutic strategies.

Objective: Three-dimensional surface rendering of 2-D ultrasound images of the uterus in mapping uterine fibroids is a fast-evolving imaging technique that holds great potential for gynecology. The purpose of this study was to assess the accuracy of 3-D surface rendering of 2-D ultrasound images of the uterus using a new Fibroid Mapping Reviewer Application (FMRA) software for mapping uterine fibroids as compared with the pathological evalua-tion of uterine fibroids in pre-menopausal women undergoing hysterectomy. Methods: We enrolled women aged 35-55 y scheduled for hysterectomy for symptomatic fibroids at a tertiary care hospital from 2019 to 2021. Per pre-set guidelines, we recorded 2-D images and videos of the uterus with fibroids during the transvaginal ultrasound. The recordings were transferred through USB, loaded in the FMRA software and post-processed to generate a 3-D rendered uterus model. An experienced pathologist assessed and docu-mented the gross examination details per a set protocol. We compared the prespecified dimensions related to the size (L1, L2) and location (X, Y) of fibroids between the 3-D model and the pathologist's assessment of the hyster-ectomy specimen. Results: A total of 25 fibroids in 25 women, the single largest per woman, were considered for analysis. The two methods had good correlation with respect to size (for L1, R2 = 0.9723, and for L2, R2 = 0.9784) and location (for X, R2 = 0.9618, and for Y, R2 = 0.9753). Inter-observer analysis revealed that measurements from two sonol-ogists were reproducible (Cronbach's alpha = 0.9 for the L1, L2 and L3 dimensions of fibroids from the 3-D model). Conclusion: The FMRA is a novel tool for mapping fibroids. With its proven accuracy, it will be helpful in planning surgeries and during guided procedures for managing uterine fibroids.

Objectives: Primary colo-rectal adenocarcinoma is one of the common malignancies the world-over. Metastasis to colo-rectum is uncommon. We aim to study the clinical and histological features of a few cases of metastatic carcinoma from stomach, with an emphasis on immunohistochemistry to help us distinguish these tumours from colonic primary. Methods: Data from the laboratory information system was retrieved and biopsies/ resection specimen, taken from colon or rectum, with a diagnosis of metastatic adenocarcinoma from stomach with immunohistochemical studies supporting the same were included. Results: Previous history of carcinoma stomach is an essential part in diagnosing metastases to colo-rectum. Clues to diagnosis on histopathology include expanded lamina by bland looking/ signet ring cells with a relatively preserved colonic glandular mucosa. Useful panel of immunohistochemical stains include cytokeratin (CK) 7 and 20, epithelial membrane antigen (EMA) and CDX2. Conclusion: In a colonic biopsy with a relatively normal mucosa and signet ring cells in the lamina, the possibility of metastatic signet ring cell carcinoma from stomach should also be considered. Clinical history and imaging can be useful to correlate the findings. A small immunohistochemistry (IHC) panel with a minimum of 4 markers (CK7/20, CDX2 and EMA) serves as a valuable adjunct to confirm the same.

Background: Esthesioneuroblastoma is a slow-growing rare malignant neuroectodermal tumor arising from the olfactory epithelium. It has a bimodal incidence with peaks in the second and third decades of life and the sixth and seventh decades of life with equal incidence among men and women. Prognostic factors include the Hyams grade and modified Kadish stage. This study analyzed the clinicopathological features of esthesioneuroblastoma. Materials and methods- Retrospective study of patients who were diagnosed with esthesioneuroblastoma at a tertiary care hospital between January 2012 and May 2019 was conducted. The research was performed according to the World Medical Association Declaration of Helsinki. Institutional research committee approval (IEC: 473/2019) was obtained. Results: Clinicopathological profiles of 8 patients who were diagnosed with esthesioneuroblastoma during the period were included. Among the eight patients, five were female and three were male. Common presenting complaints were nasal obstruction, difficulty in breathing, epistaxis, local pain, and anosmia. The average age of presentation was 52 years, ranging from 14 to 73 years. Anterior rhinoscopic examination in these cases showed a polypoid mass located in the nasal cavity. According to the Hyams grading system, three of the eight cases were grade-2 and the remaining five cases were grade-3 Hyams histological grade. Three cases exhibited foci of ganglioneuroblastic transformation. Three patients had metastases to cervical lymph nodes and three patients had recurrence. Conclusions: Esthesioneuroblastoma is a rare aggressive malignant tumor. It can exhibit divergent epithelial or ganglionic differentiation. A proper diagnosis should be made, graded and staged before proceeding to treatment.

Mucosal melanomas are rare head-and-neck tumors and have a distinct etiology and genetic profile different from cutaneous counterparts. They are most commonly seen in sixth–seventh decade of life and have aggressive behavior. The patients usually present with nodal metastasis, which is the most important poor prognostic indicator for mucosal melanomas. We present a case of mucosal melanomas in a young male (30 years), who presented with nonpigmented, polypoidal mass in the right nasal cavity simulating an inverted papilloma. Histological examination showed small to large pleomorphic cells and no melanin pigment. Based on the immunopositivity of the tumour cells were positive for HMB45 and S100 confirming a diagnosis of amelanotic mucosal melanoma. The partied had a localized disease to the right nasal cavity with no nodal involvement and no recurrences in the available follow-up of 24 months.

Syringocystadenoma papilliferum is also known as papillary syringadenoma. This is a warty tumour of the scalp, neck and face that occurs at any age. These lesions usually have an adjacent nevus sebaceous or adjacent basal cell carcinoma. Here, the authors present case series of eight cases, four male and four female patients, with varied presentations at different sites: scalp,upper eyelid, left arm and back, aged 11 years to 68 years, mean age being 45 years. Most of the cases had a clinical diagnosis of sebaceous horn and one was diagnosed as squamous cell carcinoma. All of them had a histopathological diagnosis of Syringocystadenoma Papilliferum.

Primary ovarian neoplasms constitute a heterogenous group of benign and malignant tumors of epithelial, sex cord–stromal, mesenchymal and germ cell origin. Secondary tumors constitute a minority. The management of benign and malignant ovarian neoplasms varies and it is here that imprint cytology plays a crucial role in diagnosis. It provides a rapid intraoperative diagnosis which will decide further treatment course for the patient. Imprint cytology of ovarian neoplasms is simple, inexpensive, challenging and provides a rapid diagnosis with excellent cellular details. The aim of the present study is to determine the role of imprint cytology in the diagnosis of ovarian neoplasms. A retrospective study was conducted in the department of pathology. A total of 53 cases were included in the study. In 48 cases, the imprint cytology findings correlated with the histopathological diagnosis. 5 cases did not correlate. Epithelial ovarian tumors accounted for the majority, (85%) followed by germ cell tumors (9.4%) and sex cord stromal tumors (5.6%). The sensitivity and specificity were 93.75% and 100% respectively. Thus imprint cytology is an effective cytological method in the diagnosis of ovarian neoplasms. Knowledge of specific cytological features for each tumor type helps in accurate diagnosis which in turn is valuable in immediate appropriate treatment and management of patients with benign or malignant neoplasms.

Introduction: Superficial palpable swellings with helmintic infection as an underlying etiology is usually an accidental finding in the surgically excised specimens. Somatic nematodes and cestodes are the commonly implicated organisms, and the zoonotic nematodes show an emerging trend. The present study aims to reappraise the histopathological findings of helminthic etiology in superficial swellings which were clinically suspected to be of neoplastic/non neoplastic nature. Materials and methods: Thirty six cases of palpable superficial nodules with infective etiology over a period of five years were reviewed. 19/36 were of helminthic etiology were included in the present study. Pertinent demographic and clinical data were retrieved from the medical archives. Results: Amongst the 19 cases, 8 were males and 11 females. Chest wall (4/19), and eyelids (3/19) were the most common sites involved. The size ranged from 0.8-15 cm in greatest dimension. Presence of histiocytes (13/19), granulomas (11/19), eosinophils (10/19), and giant cells (9/19) were the most consistent histological findings. 14 cases had discernible parasite morphology with diagnosis of filarial worms (7/19), Dirofilaria (3/19), cysticercosis (4/19), and hydatid cyst (1/19). Four cases had dead and calcified parasites with no discernible morphology. Conclusion: Granulomatous inflammation and tissue eosinophilia are strong indicators of a parasitic etiology. Subcutaneous and intramuscular filariasis, cysticercosis and hydatid cyst are well documented etoiologies whereas Dirofilariasis is an emerging zoonotic infection with worldwide case reports. Imaging techniques and fine needle aspiration can point towards the diagnosis; however in the absence of characteristic features, histopathology can be relied upon to diagnose a helminthicetiology.

Aim: The present series aims to highlight the sites, clinical presentation, histopathological features, anddiagnostic dilemmas of extra-nasal rhinosporidiosis. Materials and methods: A review of pertinent demographic and laboratory data for patients diagnosed with extra-nasal rhinosporidiosis, over a period of 7 years (2012- 2019) was done. Results: Amongst the 8 cases of extra-nasal rhinosporidiosis, the sites of involvement were medialcanthus (2/8), trachea (2/8), skin and bone (1/8), hard palate (1/8), and concurrent multiple sites (2/8). Clinical differential diagnoses included fungal osteomyelitis, laryngeal papilloma, conjunctival tumor, disseminated rhinosporidiosis, and carcinoma palate. The presence of sporangia, endospores, chronic inflammation, histiocytes was the most consistent histopathological features. Sevencases were managed with a laser-guided excision, and one underwent wide local excision with cauterization. Recurrence was seen in 5/8 cases (62.5%). Conclusion: The diagnosis of extra-nasal rhinosporidiosisis often missed due to an unusual site of presentation, or mistaken for a tumor. A proper history and histopathological examination must be carried out in patients with bleeding polyps, especially in an endemic region. The rate of local recurrence is high, which may be reduced by the use of lasers during surgery.

Mucinous (colloid) carcinoma (MC) of the breast is relatively rare and accounts for 1-6% of all breast cancers. Traditionally, pure mucinous tumors and mixed infiltrating ductal carcinomas with a mucinous component have been described. Pure mucinous carcinoma of the breast has a favorable prognosis than the mixed variety noted in several studies. The common age of presentation is the postmenopausal group. Cytological diagnosis of these tumors is challenging. A retrospective study was conducted at our institute. 22 cases consisting of both mixed and pure mucinous carcinomas diagnosed by cytology and verified on histopathology between January 2007 and November 2015 were included in the study. All cytology and histopathology slides were reviewed. A total of 22 cases were evaluated. The age ranged from 34-78years. The left breast was involved in 12 cases and the right breast in 10cases. 19 cases were diagnosed as mucinous carcinoma on cytology. However 12 of these cases were reported as pure mucinous carcinoma on biopsy. All these cases displayed abundant mucin, small nuclei and/or regular nuclear outlines on cytology. 7 cases turned out to be mixed tumors on histopathology. Sparse mucin, large nuclei, irregular nuclear outlines or the presence of nucleoli were found in mixed mucinous carcinomas but not in pure tumors. Three cases were diagnosed as infiltrating ductal carcinoma (IDC) on cytology. One of these patients had 2 nodules, diagnosed on histopathological examination as IDC and mucinous carcinoma. Out of the other two cases, 1 case was diagnosed as cellular variant of mucinous carcinoma and another case as mixed carcinoma on biopsy. Cellular variant of mucinous carcinoma can mimic low grade ductal carcinoma on cytology. A thorough examination of the slides for mucinous material and few thin capillary fragments provide a valuable diagnostic clue. The distinction between pure and mixed mucinous carcinoma is important, because patients with the former type have a much favorable prognosis, with a low propensity for lymph node and distant metastasis. Cytopathological identification of patients with pure mucinous carcinomas may be performed only in a limited number of cases. The various differential diagnosis should always be kept in mind while dealing with lesions associated with mucin. However the age of presentation, clinical features and radiological findings can help to further categorize the various mucinous lesions.

Figure S1. (A) Spongiotic epidermis overlying dermis with dense perivascular lymphohistiocytic infiltrate, Hematoxylin & Eosin (H&E), x100. (B) Epidermis with focal spongiosis and vesicle formation, H&E, ×400. (C) Direct immunofluorescence showing vessel-wall staining with C3 deposits Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Introduction: Intussusception in adults is a rare entity. Being one of the most common causes of intestinal obstruction in children, it accounts for only 5% of all cases of intussusceptions and about 1%-5% of bowel obstruction in adults. A minority of cases are idiopathic, without a lead point lesion. Postoperative adhesions, meckel’s diverticulum, inflammatory bowel disease, benign and malignant tumors, metastatic neoplasms or even iatrogenic presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery account for the various causes of secondary intussusception in 70%-90% of cases. Computerized tomography (CT) is often considered as one of the most useful, sensitive imaging modality in the diagnosis of intussusception. AIM: To study and describe the different pathological causes, clinical features and management of intussusception in adults. Materials & methods: A retrospective study was conducted to evaluate the various causes of intussusception. All patients above the age of 18yrs presenting with a clinical diagnosis of intussusception, between Jan 2008 and June 2015 were included in the study. Results: There were 15 cases of adult intussusception. A male predominance was noted and the mean age was 41.7 years. Majority of the patients presented with abdominal pain, abdominal distension, nausea and vomiting. The commonest site of intussception was the ileo-colic junction (46.7%, 7cases). There were four jejuno-jejunal cases (26.7%) and two ileo-ileal cases (13.3%). There were also two other cases of colonic intussusception, not involving the ileo-colic junction (13.3%). Among the pathological causes of intussusception, four cases were secondary to diffuse large B cell lymphoma (DLBCL), four due to submucosal lipomas, two cases secondary to peutz jegher polyps, one case of carcinoid involving the appendix, three cases due to inflammatory causes and one being idiopathic. All cases were treated surgically. Conclusion: Malignant lesions account for majority of causes of adult intussusception involving the colon. Adult intussusception is a challenging condition for the surgeon and is very often a preoperative diagnostic problem when compared to that in children. Because of the high incidence of malignancy in colonic intussusceptions, a segmental bowel resection is generally undertaken.

Breast cancer patients need to be on regular follow-up after definitive treatment, for early detection and treatment of recurrence or distant metastasis. Gastrointestinal and peritoneal metastases from breast cancer are rare. Invasive lobular carcinoma has a tendency to spread to the gastrointestinal organs, and usually, is present a few years after the primary breast cancer has been treated. Histopathological examination with immunohistochemistry (IHC) analysis is paramount for diagnosis. We report a 49-year-old lady, treated for carcinoma breast 7 years back, on regular follow-up, who presented with features of gastric outlet obstruction. Endoscopic biopsy and detailed IHC from stomach was suggestive of metastases from breast carcinoma. Initial diagnostic and staging workup failed to detect peritoneal metastasis, however, which was confirmed by final histopathology from peritoneal biopsy. A high index of suspicion and accurate tissue diagnosis is imperative to plan the treatment in patients with a history of breast cancer with coexisting gastric symptoms. If a patient with solitary gastric metastasis is planned for curative surgical resection, it is very important to perform a staging laparoscopy and peritoneal biopsy to rule out metastasis to avoid unnecessary morbidity.

Purpose Orbital haemangiomas are common orbital tumors known for their slow growth. Acute presentation with haemorrhage into the tumor is a rare occurrence with only nine cases reported in literature. Methods: The authors present a case of an elderly female with sudden onset of proptosis and swelling of the eye. There was a transient relief of symptoms with steroids with residual proptosis and ptosis at two weeks. Magnetic resonance imaging revealed an intraconal soft tissue mass in the inferolateral quadrant of the left orbit with a differential diagnosis of haemangioma with bleed or metastasis. Results: Patient underwent a lateral orbitotomy and tumour excision and histopathological examination revealed a cavernous haemangioma with a thrombus. The patient had complete symptomatic recovery following surgery. Conclusion: Orbital haemangiomas presenting with haemorrhage is rare and should be differentiated from orbital venous anomalies prior to surgery.

Cutaneous epithelioid hemangioma is a vascular lesion of uncertain pathogenesis.Recurrences are common in cases with incomplete surgical excision.Histologically, it can be differentiated from other conditions by the presence of prominent endothelial lining and mixed inflammatory infiltrate in the background with predominance of lymphocytes and eosinophils.A 19 year old lady presented with a painful left breast swelling, which was clinically diagnosed as infected Montgomery's tubercle and excised.Histopathology showed features of cutaneous epithelioid hemangioma.Cutaneous epithelioid hemangioma can occur rarely in the breast, where it can mimic an inflammatory pathology.

Introduction: Bladder paragangliomas (BP) are rare tumors, with clinical manifestations ranging from hypertension to hematuria to being asymptomatic. Histologically, they can mimic urothelial carcinomas. Around 200 cases of paragangliomas arising in the urinary bladder have been described in the world literature. Observation: We report 2 new cases of BPs presenting with subtle clinical symptoms like increased urinary frequency. On routine cystoscopic examination of the bladder, bladder tumors were detected. Conclusion: We would like to stress on the histomorphology and immunohistochemistry findings of this rare condition and its diagnosis on transurethral resection specimens. (C) 2018 Pan African Urological Surgeons Association. Production and hosting by Elsevier B.V.

Granular Cell Tumour (GCT) is a rare tumour involving the breast, pre- and intraoperative diagnosis of which plays an important role in deciding the treatment. Recognition of this usually benign tumour is important, since clinical (irregular and firm), radiological (ill defined or spiculated lesion without microcalcifications) and gross findings often mimic carcinoma. We report a case of a GCT of the breast mimicking carcinoma clinically and on mammography. The diagnosis was made by frozen section, confirmed by histological examination and immunohistochemistry (IHC), We emphasise the role of frozen section and intraoperative diagnosis in guiding treatment and preventing radical surgery. The clinico-radiological, histopathological and therapeutic aspects of this rare tumour, are also discussed.

Amyloidosis is characterized by the deposition of fibrillar proteins by either plasma cells or derived from circulating proteins, the former especially involved in pathogenesis of localised amyloidosis. We describe a case of primary localised amyloidosis involving the urethra, in a 54-year-old diabetic patient, presenting with symptoms of stricture. Though a rare cause, in a patient with clinical diagnosis of urethral stricture, one of the differential diagnosis to be ruled out is primary urethral amyloidosis.

Borderline mucinous tumor (BMT) is often associated with other entities such as dermoid cyst, Brenner tumor, and endometriosis. Squamous areas are often associated which may be a part of BMT or its associated conditions. Here, we describe squamous overgrowth in a case of intestinal type of mucinous borderline tumor in a 29-year-old uniparous female and discuss the diagnostic difficulties.

Introduction: Parathyroid surgeries are becoming less extensive procedures, with reduced hospital stay. The use of intraoperative frozen section help the surgeon in identifying the pathology, thereby determining the nature of surgery. Aim: To study the utility of frozen section in comparison to chemical frozen section in our set up Materials and Methods: Data was collected from records of department of Pathology during a period of 3 years. Only those cases were included in which the patient had undergone parathyroidectomy, with specimen being sent for frozen section and intra-operative parathyroid hormone (IOPTH) simultaneously. Results: Frozen section diagnosis was concordant in 11/15 (73%) cases. Significant percentage drop in IOPTH was seen in 13/15 (86%) cases. We found frozen section useful in identifying parathyroid when there were multiple neck swellings. Conclusion: The utility of frozen section in parathyroid surgery is diminishing and it is being replaced by better and more accurate biochemical assays.