Metastatic poorlydifferentiatedadenocarcinoma of the sternum unsolved diagnosticallyby immunohistochemicalstaining:a case repo

ABSTRACT A 42 year-old male admitted to Dr. Sardjito Hospital, Yogyakarta because of a painful sternal mass that was becoming larger since 6 months before hospitalized. He was diagnosed as malignant thymoma based on microscopic examination of specimen obtained from FNAB. Histological examination from biopsy specimen showed a tumor, composed of epithelial cells and arranged in nests, solid, partly tubular and glandular structures considered thymic carcinoma with differential diagnosis a poorly differentiated adenocarcinoma. PAS staining was positive and PASdiastase was negative, considered that the cytoplasm contained glycogen. The tumor cells showed expression of polykeratin (CAM5.2, TTF1, and CD10). Neurogenic and neuroendocrine markers (5100, CD56, CD57). mesothelial markers (calretinin,EMA),and mesenchymal markers (vimentin, CD6,S,desmin, SMA) are negative. The impression was metastatic adenocarcinoma. In case of metastatic one could consider a metastasis of a lung adenocarcinoma or thyroid carcinoma (TTF1+, but CD10 expression did not fit) and renal cell carcinoma (CD10 +, but TTF1 did not fit). The final considered diagnosis was poorly differentiated adenocarcinoma, metastasis from the lung, thyroid, or kidney. The aim of this presented article is to report a difficultcase of metastatic poorly differentiated adenocarcinoma of the sternum in which immunohistochemical staining could not solve the morphological diagnostic problems, to emphasize the importance of clinicalinformation and good morphologicevaluation to determine the diagnosis

Cranial unifocal langerhans cell histiocytosis in a female child: a difficult case with S-100 and CD1a immunonegativity

A 13-years old female child was carried to Dr. Sardjito General Hospital, Yogyakarta by her mother with chiefcomplaint of a mass on her forehead. Since eight months prior to her visiting, she had a mass on her forehead whichbecame larger slowly without tenderness and had no fever. Clinical examination revealed a well circumscribedmass, 3 cm in diameter, fixed, with rubbery consistency. The skull X-ray revealed a punch out lesion in frontal bone.The head CT scanning revealed a destruction of frontal bone. Clinical diagnosis of dermoid cyst was determined,excision and curettage was performed. Gross examination showed 2.5 cc fragmented tissue, brownish yellow, withrubbery consistency. A diagnosis of benign histiocytosis (Langerhans cell histiocytosis or non-Langerhans cellhistiocytosis) of frontal bone was determined based on morphological and immunohistochemical examination. Theaim of this presented article was to report a rare case of cranial unifocal Langerhans cell histiocytosis in a femalechild with S-100 and CD1a immunonegativity, and to discuss how to determine its diagnosis based on literaturereview.Key words: Langerhans cell histiocytosis - juvenile xanthogranuloma – reticulohistiocytoma - eosinophilic granuloma– S100 – CD1

Hubungan Kadar Interferon Gamma (IFN-γ) Pada Cairan Asites Dan Darah Dengan Grade Karsinoma Ovarium

Latar Belakang: Kanker ovarium dapat digolongkan berdasarkan grade, yang dibagi menjadi low grade dan high grade. IFN-γ memiliki efek anti-tumor dan juga pro-tumor. Penelitian tentang kadar IFN-γ pada asites dan darah serta hubungannya dengan grade belum banyak dilakukan.Tujuan: Mengetahui hubungan kadar interferon gamma (IFN-γ) dengan grade karsinoma ovarium pada cairan asites dan darah.Metode: Penelitian cross sectional dengan sampel asites dan darah dari pasien karsinoma ovarium yang dilakukan operasi di RSUP Dr. Sardjito.Hasil dan Pembahasan: Pada sampel asites rata-rata pada low grade sebesar 0,57 pg/ml, pada high grade sebesar 0,68 pg/ml, pada sampel darah rata-rata pada low grade sebesar 0,74 pg/ml, pada high grade sebesar 0,84 pg/ml. Namun perbedaan rata-rata tersebut tidak signifikan (asites, p=0,780; darah, p=0,861). Pada cairan asites dan darah, rata-rata pada asites sebesar 0,66 pg/ml, pada darah 0,81 pg/ml, namun perbedaan rata-rata tersebut tidak signifikan (p=0,568).Kesimpulan: Tidak terdapat perbedaan rata-rata yang signifikan antara kadar interferon-gamma (IFN- γ) cairan asites dan darah pada karsinoma ovarium low grade dan high grade. Tidak terdapat perbedaan rata-rata yang signifikan antara kadar interferon-gamma (IFN- γ) pada cairan asites dan darah karsinoma ovarium. Kata Kunci: asites, darah, grade, interferon gamma (IFN-γ), karsinoma ovariu

The accuracy of fine needle aspiration biopsy to diagnose breast neoplasm

Breast lump is a very common complaint among women, especially during the reproductive year. Fine needle aspiration biopsy (FNAB) is a less invasive procedure. It is usually performed as an initial diagnosis prior to the operative procedure. The accuracy of the FNAB in Indonesia needs to be elaborated. The study aimed to evaluate the sensitivity and specificity of FNAB in diagnosing breast neoplasm. This is a retrospective study with cross sectional design, involving 145 patients with breast lump who underwent FNAB and histopathology examination in Dr. Sardjito General Hospital, Yogyakarta, from 2012 to 2014. Data analysis showed that female to male ratio was 23. 2:1 commonly occurred at 41-50 years old. Forty-one cases (28.28%) diagnosed as a benign lesion with fibrocystic changes as the most frequentcase (11.19%). The malignant case was 104 cases (71.72%) with ductal carcinoma as the highest case (51.49%). FNAB achieved a sensitivity of 85.58%, a specificity of 100% and a total accuracy of 89.66% in determining the benign or malignant breast lump. The accuracy, sensitivity and specificity of FNAB in diagnosing ductal carcinoma were 83.58%, 85.51% and 81.54%, respectively. The accuracy, sensitivity and specificity of FNAB to diagnose fibrocystic changes lesion were 85.82%, 26.67% and 93.28%, respectively. FNAB can be used as an alternative diagnostic tool to diagnose breast neoplasm. It provides rapid, cheaper, effective, valuable, and less invasive procedure in diagnosis of breast lump.

Mutational heterogeneity between different regional tumour grades of clear cell renal cell carcinoma

Only a limited number of studies have explored the possible associations between tumour grade and mutated genes in clear cell renal cell carcinoma (ccRCC), and we set out to investigate this further using a multiple sampling and next generation sequencing (NGS) approach in a series of ccRCCs. Multiple regions were sampled from formalin-fixated paraffin-embedded ccRCC tumour blocks from seven patients. In 27 samples from six patients, we performed targeted NGS using a custom 42-gene panel based on the most frequently mutated genes in ccRCC reported in public databases. In four samples from the seventh patient, we performed whole exome sequencing (WES) and array comparative genomic hybridisation for detection of copy number variants (CNVs). Mutated genes and the tumour grades of the samples in which they had been identified were compared both within and between all individual tumours. CNVs were compared across all samples from patient 7. We identified clear genetic heterogeneity within and across tumours, but VHL mutations were seen in all patients. Looking across all samples, we identified eleven genes that were only mutated in samples with one particular tumour grade. However, these genes were never mutated in all samples with that tumour grade. Increasing chromosomal instability corresponded with increasing tumour grade, but we observed minimal association between tumour grade and total mutational load in the WES data. Our study confirms the genetic heterogeneity and tumour grade heterogeneity of ccRCC. Although a relatively small number of samples was analysed, genes were identified that could potentially be specific, though insensitive, markers of higher ccRCC tumour grades

Psoriasis in HIV patients: A paradox

Human immunodeficiency virus (HIV) infection is associated with increased susceptibility to skin disorders, including psoriasis. The exacerbation of psoriasis in severe advanced HIV is paradoxical. A 26-year-old man with HIV who had been diagnosed with psoriasis ten months before the diagnosis of HIV. The skin biopsy results indicated psoriasis vulgaris with a tissue CD4/CD8 ratio of 0/34. The initial CD4 count was 130 cells/L. The patient received ARV and topical steroids. There was a clinically significant rise in blood CD4 and tissue CD4/CD8 ratio in three-month follow-up. There are several hypotheses was proposed to explain the pathophysiology of psoriasis in HIV. The main therapy of psoriasis with HIV is ARV. HIV can induce or as a risk factor of psoriasis. It's important to do a search further for risk factors in sexually transmitted diseases in patients with severe and recalcitrant psoriasis. The main therapy of psoriasis with HIV is ARV © 2022 Pakistan Association of Dermatologists. All rights reserved

An Psoriasis in HIV patients: A paradox

Introduction: Human immunodeficiency virus (HIV) infection is associated with increased susceptibility to skin disorders, including psoriasis. The exacerbation of psoriasis in severe advanced HIV is paradoxical. Case: a 26-year-old man with HIV who had been diagnosed with psoriasis ten months before the diagnosis of HIV. The skin biopsy results indicated psoriasis vulgaris with a tissue CD4/CD8 ratio of 0/34. The initial CD4 count was 130 cells/L. The patient received ARV and topical steroids. There was a clinically significant rise in blood CD4 and tissue CD4/CD8 ratio in three-month follow-up. Discussion: There are several hypotheses was proposed to explain the pathophysiology of psoriasis in HIV. The main therapy of psoriasis with HIV is ARV. Conclusion: HIV can induce or as a risk factor of psoriasis. It's important to do a search further for risk factors in sexually transmitted diseases in patients with severe and recalcitrant psoriasis. The main therapy of psoriasis with HIV is ARV

Atypical carcinoid of the lung: A case report

A 3D-year old woman came to Dr Sardjito Hospital with chief complain of dyspneu that she had since 1 month before her visit. Clinicalexamination revealed a dull percussion below. The second intercostal of the left chest. The chest X ray revealed massive pleural effusion in the left chest, could not exclude a mass in left lung. Thoracoscopic biopsy of the left lung mass was done. Macroscopic examination of lung tissue sample revealed fragmented tissue, with volumeof 0.25 cc, blackcolour, and rubberyconsistency. The diagnosis of atypicalcarcinoid with small cell carcinoma as a differential diagnosis was determined based on morphological pattern. Immunohistochemical staining examination showed expression of cytokeratin, CAM5.2, and synaptophysin, but showed negative expression of chromogranin, CD56, and TTF-1 .A diagnosis of an atypical carcinoid was confirmed based on the immunohistochemicalexamination. A very rare case of atypical carcinoid of the lung in a non-smoker 3D-yearoldwoman with morphologicaldiagnostic problem solved by immunohistochemical staining was reported

Keloid-like Pilomatricoma of the Auricle: A Case Report and Review of Literature

Pilomatricoma is a rare benign skin adnexal tumor arising from hair matrix cells. It usually manifests as a firm-to-hard, well-circumscribed, nontender nodule often mistaken as a dermoid cyst. However, its clinical presentation has been reported to mimic keloid. In addition, although it occurs most frequently in the head and neck area, pilomatricoma is rarely reported on the auricle. Herein, we reported a case of pilomatricoma occurring on the posterior part of a 9-year-old girl's auricle. Unlike classic pilomatricoma, the tumor closely resembled a keloid. Nevertheless, histological examination following excision of the tumor revealed a dermal tumor arranged in solid nests consisting of basaloid and ghost cells along with foreign body reaction, calcification, and ossification, confirming the diagnosis of pilomatricoma. The rarity, atypical clinical presentation, and unique location of this tumor contributed to the misdiagnosis of this case. Therefore, we reviewed previous cases of pilomatricoma of the auricle reported in the literature to provide a comprehensive understanding of this rare entity. © 2022 The Author(s). Published by S. Karger AG, Basel