Background: Neuroendocrine tumors (NENs) are a group heterogenous group of tumors that can arise in any organ in the body and have a wide range of aggressiveness. Aims and Objective: To compare the frequency of NENs in our setup to those reported in the literature to age, site, and degree of differentiation by doing a retrospective study. Materials and Methods: Cases of NENs that were diagnosed in the Department of Pathology, in our hospital over the past 5 years were studied considering the age, location, and degree of differentiation. A fresh panel of immunohistochemistry (IHC) was conducted for those cases where IHC was not done. Results: A total of 46 cases of NENs were reviewed. About 56.5% (26 cases) were males and 43.5% (20 cases) were females, with a median age of 46 years. In our study, most of the tumors are found in the gastro-entero-pancreatico-hepatobilliary group followed by the NENs of the endocrine gland (21.7%) and broncho-pulmonary group (15.2%). NENs were graded based on mitotic count and/or Ki-67 labeling index, and/or the presence of necrosis. In total 21 cases (45.7%) had G1 grading, 7 cases (15.2%) had G2 grading, 2 cases (4.3%) had a G3 grading, and 16 cases (34.7%) were graded as neuroendocrine carcinoma. Conclusion: As the majority of the studies do not include benign NENs and those arising from the endocrine glands, therefore comparison of our results can be difficult. This is the first attempt to study the NENs from North East India and to analyze their clinicopathological features.

Hindleg muscles of normal and dystrophic mice were immobilized unilaterally early during the postnatal period. After 1 week the casts were removed. Of one group of mice hindleg muscles were processed for histopathological and morphometrical evaluation at the end of the immobilization period. Hindlegs of other groups of mice were remobilized for various periods of time before the muscles were examined. In normal mice immobilization of calf muscles that were fixed in a shortened position resulted in atrophy of about 35% compared with untreated muscles. This was accompanied by a reduction in fibre number of about 15%. The antagonists that had been fixed extended, did not show those effects. Immobilization of dystrophic muscles minimized pathology in both agonists and antagonists, although atrophy developed. Upon remobilization the normal muscles resumed postnatal development. They did not deviate from normal, untreated muscles at the age of 3.5 months. Upon remobilization of dystrophic muscles pathology developed, but less severely than during the second and third postnatal week in untreated dystrophic muscles. Significant differences in morphometrical parameters compared with untreated dystrophic muscles were observed during the 3 months remobilization period studied.

Hematological parameters like total leukocyte count (TLC), neutrophil, lymphocyte, and absolute eosinophil counts (AEC), and neutrophil-to-lymphocyte ratio (NLR) are known to predict the severity of novel coronavirus disease 2019 (COVID-19) patients. In the present study, we aimed to study the role of complete blood count parameters in triaging these patients requiring intensive care unit (ICU) admission. A retrospective study was done over a period of 2 months. Patients, who were ≥ 18 years of age with COVID-19 confirmed on SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) and whose routine hematology counts were sent within 24 h of admission, were included in the study. Cut-off values of 47.5 years for age, 11.3 × 109/L for TLC, and 9.1 for NLR were predictive of disease severity among COVID-19 patients. Relative neutrophilia ≥ 70% (p < 0.007), relative lymphopenia ≤ 20% (p < 0.002), AEC ≤ 40/cumm (p < 0.001), and NLR ≥ 9.1 (p < 0.001) were significantly associated with ICU admission. Routine hematological parameters are cost-effective and fast predictive markers for severe COVID-19 patients, especially in resource-constrained health care settings to utilize limited ICU resources more effectively.

Background:Myasthenia gravis (MG) is a neuromuscular junction disorder usually associated with a thymic lesion. Aims and Objective:To study the clinical, serological, and thymic pathology in patient of MG from this corner of the country. Material and Method:A retrospective study involving all myasthenia patients presenting to neurology and cardio-thoracic department from the year 2013 to 2020. The clinical findings, Osserman grade of severity, antibodies profile, computed scanning thorax findings and histopathology of the thymic lesion were noted and collected as data. Results:Thirty patients of MG were included with mean age of onset being 39.10 ± 15.77 years which included 22 females and eight males. Four patients had only ocular findings while 26 patients had generalized myasthenia with three patients of respiratory failure. Ach receptor antibodies were positive in 27 patients and negative in two patients. Anti-MUSK was positive in one out of five patients. Abnormal findings in CT thorax seen in 20 patients which included enlarged thymic gland in 11 patients, thymic hyperplasia in two patients, thymoma in four patients, and anterior mediastinal mass in three patients. Thymectomy was done in eighteen patients with thymoma as the most common histopathological findings seen in eight patients, follicular hyperplasia in five patients; other was thymic hyperplasia, thymic cyst, normal thymus gland, and features of sarcoidosis in one patient. Conclusion:MG is a treatable autoimmune disorder with a variety of clinical, radiological, and histopathological findings.

BACKGROUND:High-grade transformation Adenoid cystic carcinoma (HGT-AdCC) of the parotid gland is a rare transformation noted in slow growing low grade AdCC. Perineural invasion and spread is an important feature of this tumor. Temporal bone involvement is rare. A total of only 10 cases of HGT-AdCC in parotid gland has been reported in literature so far predominantly in the elderly with peak incidence in 5th-6th decade. CASE PRESENTATION:We present a young lady of HGT-AdCC of right parotid gland with temporal bone involvement in the form of isolated perineural invasion (PNI) of facial nerve till the tympanic segment. She underwent right radical parotidectomy with modified radical neck dissection with modified lateral temporal bone resection and pectoralis major myocutaneous flap reconstruction. Histopathological examination revealed both low- and high-grade areas. Sections from facial nerve showed tumor invasion. CONCLUSION:The radiological features of isolated perineural spread in intratympanic part of facial nerve can be easily missed if not specifically looked for. Every attempt should be made preoperatively and intraoperatively to determine the complete extent of the tumor for adequate disease clearance. A combined clinico-radiological approach aided by histopathology examination helps in early detection of this carcinoma and in better patient management.

Budd–Chiari syndrome caused by right atrial myxomas are extremely rare. We report the case of a patient who presented with chronic liver disease who upon consequent investigation was found to have a mass occupying the right atrium and ventricle consistent with cardiac tumour. Intraoperatively, a giant mass was removed from the right atrium with the tumour stalk originating from the Eustachian valve. Histologic findings were consistent with myxoma.

Diabetes mellitus is one of the foremost diseases in the modern era and diabetic nephropathy contributes to a major percentage of end-stage kidney disease. Although diabetic nephropathy is difficult to revert back, detection of nondiabetic renal disease (NDRD) is important to detect as most of them are treatable. We describe a case of a 62-year-old female with long-standing diabetes mellitus presenting with massive proteinuria and clinical features of nephrotic syndrome. The kidney biopsy showed class III diabetic nephropathy along with focal proliferative glomerulonephritis with crescent formations. The immunofluorescence study showed strong mesangial IgA deposition with the predominance of lambda stain. This confirmed the diagnosis of diabetic nephropathy with superimposed IgA nephropathy. We reviewed eight Indian studies herewith to demonstrate NDRD spectrum in the Indian diabetic scenario.

BACKGROUND:Intraoperative crush smear is an adjuvant in diagnosing central nervous system (CNS) lesions on tissue sent for frozen section. Besides rapid decision-making, it also ensures that minimum injury is caused to the normal brain structures surrounding the intracranial neoplasm. A rapid intraoperative diagnosis helps the surgeon in planning the appropriate surgery.OBJECTIVE:Our objective is to review all the discordant cases between intraoperative and histopathological diagnosis and also to study the crush smear slides for morphological clues that could have been helpful in minimizing such errors, especially for an inexperienced neuropathologist/general pathologist. The surgeon's perspective on the impact of these errors on management is also discussed.METHOD:A prospective study of six years from 2013 to 2019 was conducted. Crush smears were made and stained with rapid hematoxylin and eosin (H&E). The rest of the tissue was processed for permanent tissue sections. Slides in which there was discordance between the intraoperative and permanent paraffin sections were reviewed to ascertain the reasons thereof.RESULTS:A total of 81 specimens of CNS tumors were sent for intraoperative consultation. Out of these, discordance was seen in 13 (16%) cases.CONCLUSION:To minimize diagnostic errors, it is important to do regular analyses of the misinterpreted cases. Knowledge of the pre-operative radiological differential diagnosis is mandatory. Discussion with the surgeon regarding the clinical impact of the errors made will give a clearer picture to the pathologists regarding clinically relevant reporting during intraoperative consultation.

Bone metastasis as an initial presentation of esophageal carcinoma is uncommon. In the absence of typical presentations like dysphagia, these cases may lead to diagnostic dilemmas both for the clinicians and pathologists. Here, we report a case of disseminated metastasis of esophageal squamous cell carcinoma to the bone in a 47-year-old female, who presented with multiple osteolytic lesions and clinically mimicking multiple myeloma. A detailed diagnostic work-up established the diagnosis of esophageal squamous cell carcinoma.

Angiomyolipoma is a benign mesenchymal neoplasm of the renal parenchyma, accounting for 1% of all renal parenchymal tumors. However, this entity may rarely occur in extrarenal sites. Extrarenal angiomyolipoma has been documented in various sites of the body, but angiomyolipoma of the broad ligament was reported in only two cases. We report the reputed third case of angiomyolipoma of the broad ligament in a 33-year-old female, who presented clinically with abdominal distension. With a working diagnosis of low-grade neoplasm, an en-bloc excision of the left broad ligament mass was performed. Based on histopathology and immunohistochemistry, a diagnosis of the classical variant of angiomyolipoma of the left broad ligament was made. The post-operative period was uneventful with no recurrence after 6 months of follow-up.

First described in 1896 by Friedrich Ernst Krukenberg (1871-1946), Krukenberg tumor is a metastatic signet ring cell adenocarcinoma of the ovary.1 The incidence of Krukenberg tumors varies from 1% to 21%.2,3 The most common primary tumor sites metastasizing to ovaries include stomach usually arising in the pylorus followed by colorectal, breast, and appendix.1 The stomach has been attributed as the primary site in about 70% of cases.4 Krukenberg tumor is more prevalent in Asian countries, which have a higher prevalence of gastric carcinoma.1 There are no apparent differences between the symptoms arising from primary and secondary ovarian malignancies. Krukenberg tumors remain asymptomatic until very advanced. In some cases, the features are non-specific, like abdominal pain, weight loss, and increasing abdominal girth.1 The age profile of these patients is relatively younger than patients with other metastatic carcinomas.1 This may be attributed to the higher frequency of gastric signet ring cell carcinoma in younger females.1 Mechanisms of the spread of Krukenberg tumor proposed are retrograde lymphatic dissemination involved in gastric cancer metastases, hematogenous spread most frequent in colorectal cancer, and transperitoneal direct spread.5 Radiologically, Krukenberg tumors appear as complex semisolid masses with varying proportions of solid and cystic components.6 Secondary lymphomatous involvement of ovary usually from the upper gastrointestinal tract is solid, whereas colonic primaries are predominantly cystic in nature.6 Metastases from breast primaries to the ovaries tend to be of small size.6 Among all the other imaging characteristics of Krukenberg tumors, bilateral involvement of the ovaries appears to be the most helpful finding in differentiating from primary ones with over 80% of them being bilateral in nature.4,6 Grossly, Krukenberg tumors are asymmetrically enlarged with bosselated contour.1,4 Microscopically, they are signet ring cells adenocarcinomas accounting for at least 10% of the tumor.2 IHC plays an important ancillary method in confirming the diagnosis. The most commonly used IHC markers are CK7, and CK20.1 Metastatic gastric carcinomas are CK7 and CK20 positive in 55%, and 70% of cases, respectively.7 Colorectal carcinomas are usually negative for CK7 but positive for CK20 in most cases.7 In contrast, primary ovarian carcinomas are almost always positive for CK7 and usually negative for CK20.1,7 Thus, a combination of CK7+/CK20− favors a primary ovarian carcinoma, whereas an immunophenotype of CK7−/CK20+ or CK7+/CK20+ favors a Krukenberg tumor metastasis from the gastrointestinal tract.1,7 Positive IHC for MUC5AC suggests gastric primary.8 Krukenberg tumor must be differentiated from ovarian tumors showing signet-ring cells morphology and filled with either mucinous or non-mucinous material.8 Primary mucinous ovarian carcinomas and mucinous carcinoid tumors are the important differential diagnoses for tumors with signet-ring cells filled with mucin.8 Primary mucinous ovarian tumors have a complex papillary pattern and are usually unilateral.9 IHC for chromogranin and synaptophysin help in ruling out mucinous carcinoid.9 Ovarian signet-ring stromal tumor, sclerosing stromal cell tumor and clear cell adenocarcinoma are the differential diagnoses for tumors that can contain signet-ring cells filled with non-mucinous material.9 Usually, these tumors are non-reactive for AB-PAS stain.9 The various unfavorable prognostic factors in Krukenberg tumors include peritoneal involvement, synchronous presentation, ascites, and increased serum carcinoembryonic antigen (CEA) levels.10 Krukenberg tumors are stage IV disease and have a poor prognosis with a median survival of 14 months.4 Figure 1 represents the surgical specimen of a total abdominal hysterectomy with bilateral salpingo-oophorectomy from a 35-year-old female that was hospitalized with the working diagnosis of bilateral malignant adnexal masses. On gross examination, the uterus, along with the cervix, measured 9.5 cm at its longest axis with asymmetrically enlarged ovaries. The right ovarian mass measured 5 cm in the largest dimension, and the left ovary measured 23 cm in the largest dimension. The external surface of both ovaries was bosselated (Figure 1A and 1B). The capsules were intact and smooth without any adhesions or deposits. The attached fallopian tubes were uninvolved. On cut surface, both ovaries were solid, whitish, and with foci of congestion (Figure 1C). Figure 1The external surface of both A – the right ovary and B – the left ovary was bosselated; C – The cut surface of the left ovary was solid, whitish with foci of congestion; D – Photomicrograph of the ovary showing signet ring cell adenocarcinoma (H&E, 400X).: Microscopic examination revealed infiltrating signet ring cell adenocarcinoma (Figure 1D). Alcian blue in the combination with Periodic acid-Schiff (AB-PAS) at pH 2.5 highlighted the cytoplasmic mucin in the signet ring cells. Immunohistochemistry (IHC) performed showed tumor cells positive for cytokeratin 20 (CK20) and MUC5AC. The tumor cells were negative for cytokeratin 7 (CK7), chromogranin, and synaptophysin. Upper gastrointestinal endoscopy revealed an ulcer measuring 2 cm in diameter in the greater curvature, a biopsy from which confirmed a diagnosis of signet ring cell carcinoma. Thus, a final diagnosis of the Krukenberg tumor was made.

Hepatic Space Occupying Lesions (SOLs) are increasingly being detected due to the widespread use of imaging modalities.It is important to label the lesion as benign or malignant.It is also essential to categorise the malignant lesion as primary or secondary.Knowledge of the underlying key pathologic features with biochemical indices and imaging findings of liver masses on MDCT(MultidetectorComputed Tomography) allows characterization in most cases. Some masses, however, may exhibit overlapping and nonspecific radiologic features, and in such cases percutaneous image-guided biopsy may become necessary. This study was performed to review the CT characteristics of malignant hepatic lesions with biochemical and pathological correlation.61patients who underwent contrast CT with a 128-slice CT scanner were included. The precontrast,late arterial,portal venous phase and equilibrium phase were evaluated with biochemical and histopathological correlation.22 patients belonged to non-tribal population while 39 were tribals from Northeast India.The age ranged from 16-80 years and 22 patients were females.31 patients had hepatic metastases from various primaries,27 patients had Hepatocellular carcinoma,2 patients had primary hepatic neuroendocrine cancer(PHNEC) and one had desmoplastic round cell tumour. The imaging characteristics on multiphase contrast-enhanced CT in combination with clinical and biochemical correlation allows noninvasive characterization of most liver lesions comparable to MRI. It also has an added advantage of detecting primary extrahepatic tumor and allows proper staging.

Orbital location of extraskeletal osteosarcoma is extremely rare with only 4 cases reported so far in the English literature. We present the case of a 32-year-old female who presented with proptosis and complete loss of vision of the left eye. Contrast-enhanced computed tomography scan showed a densely calcified lobulated lesion in the left optic nerve showing strong enhancement. A left fronto-occipito-zygomatic osteotomy was conducted and a greyish brown tumor was identified. Histopathological and immunohistochemical examination of the curetted material revealed it to be extraskeletal osteosarcoma. A left partial maxillectomy with ethmoidectomy and left orbital exenteration was done and the patient was advised chemotherapy with radiotherapy.

Background: Thyroid cancer is the most common endocrine malignancy, and 85% of thyroid cancers are papillary thyroid carcinoma (PTC) making it the most common malignant tumor among all thyroid cancers. Objectives: To analyze the efficacy of fine needle aspiration cytology (FNAC) as the first-line diagnosis of PTC. Materials and Methods: A retrospective study was conducted over a period of 10 years 6 months from January 2007 to June 2017. All the cases of thyroid nodules, which are suspected to have thyroid malignancy from history and clinical examination, and morphologically proven cases of PTC either on FNAC or histopathology were included in the study. FNAC results were compared with the definitive histological diagnosis, which was considered the gold standard. The cytological evaluation and reporting of thyroid lesions were done in accordance with the Bethesda system of reporting thyroid cytopathology. Results: A total of 106 cases were included in the study. Out of the 106 cases, FNAC was inadequate in 8 cases (7.54%), benign in 18 cases (16.98%), atypia of undetermined significance/follicular lesion of undetermined significance in 2 cases (1.88%), follicular neoplasm (FN)/ suspicious for FN in 8 cases (7.54%), suspicious for malignancy in 27 cases (25.47%), and malignant in 43 cases (40.56%). Out of the 106 cases, 75 cases (70.75%) were PTC, which had histopathological correlation. The sensitivity and specificity of FNAC were 87.14% and 77.27%, respectively. Conclusion: FNAC is helpful in triaging the suspicious thyroid lesions for further management. FNAC is quite useful in diagnosis of PTC.

Angiolymphoid hyperplasia with eosinophilia (ALHE) rarely involves the parotid glands or other major glands. ALHE and Kimurau0027s disease (KD) share many clinical and histopathological features. Ill-defined, deeply seated lesions involving the parotid glands are frequently observed in KD, and only three cases of intraparotid ALHE have been reported in the literature. Often these benign angioproliferative lesions of unknown etiology will be misdiagnosed as parotid tumors clinically. We report a case of ALHE in a 29-year-old Indian male who presented with unilateral parotid enlargement. The previous fine-needle aspiration cytology (FNAC) report indicated parotid sialadenitis but histopathological examination following superficial parotidectomy of the lesion allowed us to make a definitive diagnosis.