Primary ovarian carcinoid tumor arising within a mature cystic teratoma

Primary carcinoid tumor of the ovary in association with a mature cystic teratoma is very rare. Preoperative diagnosis of this tumor is difficult, particularly in the absence of symptoms of carcinoid syndrome. Here, we report a case of a premenopausal woman who underwent operative treatment due to an ovarian mass. The ovary was cystic with a solid mural nodule. Microscopically, the cyst wall revealed features of mature teratoma while the nodule showed features of a low-grade insular carcinoid. Synaptophysin and CD56 were positive. Ki67 index was low. No evidence of primary gastrointestinal or respiratory malignancy was found. The histologic and immunohistochemical characteristics of this tumor, its intimate association with a mature cystic teratoma and the absence of primary malignancy elsewhere were compatible with the diagnosis of a primary ovarian insular carcinoid tumor. This case is reported to raise the awareness of a rare tumor entity among the pathology and gynecologic communities

EVALUATION OF DIAGNOSTIC PERFORMANCE OF USG GUIDED FNAC OF THYROID SWELLINGS: A PROSPECTIVE STUDY

  Background: USG-guided FNAC is a good preoperative screening technique when compared to FNAC and USG done separately for the diagnosis of a thyroid lesion. However, there is little evidence in the literature that emphasizes the importance of USG-guided FNAC as the first step in the investigation of thyroid lesions. Aim: Our study aims to see the sensitivity and specificity, adequacy, and diagnostic accuracy of USG-guided FNAC taking histopathology as a gold standard. Methods: This Hospital-based prospective observational study was carried out on patients who attended the OPD and/or IPD and underwent surgery in the Department of Otorhinolaryngology. Results: The sensitivity, specificity, and diagnostic accuracy of ultrasound-guided FNAC for thyroid lesions were 58.82%, 98.18%, and 88.89% respectively taking Bethesda categories 1 to 3 as benign and categories 4 to 6 as malignant. The positive likelihood ratio and negative likelihood ratio are 32.32 and 0.42 respectively. Positive predictive value and negative predictive value were 90.91% and 88.52%. The diagnostic accuracy of USG-guided FNAC for thyroid lesions in the present study is 88.89% and adequacy is 93.05%. Conclusion: Further study of a larger number of cases is desirable. US-FNAC is an expensive procedure as compared to palpable FNAC. Recommendation: We recommend the application of USG guide FNAC as the first step in the investigation of thyroid lesions along with a detailed interdepartmental correlation to make the diagnosis before surgery

HER-2/neu overexpression correlates with increased expression of VEGF in primary breast carcinoma

Background: Overexpression of HER-2/neu is associated with up-regulation of vascular endothelial growth factor (VEGF) in human breast cancer cells in vitro. Preclinical experiments indicate that increased expression of VEGF may in part mediate the biologically aggressive phenotype of HER-2/neu overexpressing human breast cancer. It was the purpose of this study to: (a) evaluate the association between HER-2/neu and VEGF expression in a cohort of primary breast cancer patients; (b) find out any association of HER-2/neu or VEGF with traditional histologic prognostic parameters. Materials and Methods: HER-2/neu and VEGF were measured by immunohistochemistry in 70 cases of newly diagnosed primary breast cancers and the relation between these two markers and their relations with traditional prognostic factors were analyzed by statistical methods. Results: Our findings indicate a significant positive association between HER-2/neu and VEGF expression. VEGF did not show significant association with tumor size, histologic grade or lymph node status. HER-2/neu overexpression was maximum in grade II, followed by grade I and III with a significant p value (<0.001). But HER-2/neu didn’t have any association with tumor size or lymph node status. Conclusion: The positive association between HER-2/neu and VEGF expression implicates VEGF in the aggressive phenotype exhibited by HER-2/neu overexpression, and supports the use of combination therapies directed against both HER-2/neu and VEGF for treatment of breast cancers that overexpress HER-2/neu. The unusual association found between HER-2/neu and grade of tumor may be due to uneven distribution of cases among different grades of tumor

Pierwotny rakowiak jajnika w obrębie dojrzałego potworniaka torbielowatego

Primary carcinoid tumor of the ovary in association with a mature cystic teratoma is very rare. Preoperative diagnosis of this tumor is difficult, particularly in the absence of symptoms of carcinoid syndrome. Here, we report a case of a premenopausal woman who underwent operative treatment due to an ovarian mass. The ovary was cystic with a solid mural nodule. Microscopically, the cyst wall revealed features of mature teratoma while the nodule showed features of a low-grade insular carcinoid. Synaptophysin and CD56 were positive. Ki67 index was low. No evidence of primary gastrointestinal or respiratory malignancy was found. The histologic and immunohistochemical characteristics of this tumor, its intimate association with a mature cystic teratoma and the absence of primary malignancy elsewhere were compatible with the diagnosis of a primary ovarian insular carcinoid tumor. This case is reported to raise the awareness of a rare tumor entity among the pathology and gynecologic communities.Pierwotny rakowiak jajnika w obrębie dojrzałego potworniaka torbielowatego to bardzo rzadki nowotwór. Rozpoznanie takiej zmiany w ramach diagnostyki przedoperacyjnej jest trudne, szczególnie wobec braku objawów zespołu rakowiaka. W pracy przedstawiono przypadek pacjentki w wieku przedmenopauzalnym leczonej operacyjnie z powodu zmiany w obrębie jajnika. Zaobserwowano torbielowato zmieniony jajnik z litym przyściennym guzkiem. Obraz mikroskopowy wykazał cechy dojrzałego potworniaka z guzkiem odpowiadającym rakowiakowi wyspowemu o niskim stopniu złośliwości. Uzyskano dodatni wynik dla synaptofizyny i CD56; wskaźnik Ki67 był niski. Nie potwierdzono obecności pierwotnego nowotworu w przewodzie pokarmowym ani układzie oddechowym. Charakterystyka histopatologiczna i immunohistochemiczna zmiany, jej ścisły związek z dojrzałym potworniakiem torbielowatym oraz brak pierwotnej zmiany złośliwej w innej lokalizacji sugerowały rozpoznanie pierwotnego rakowiaka wyspowego jajnika. Celem prezentacji przypadku jest podniesienie świadomości patologów i ginekologów w zakresie rzadkich nowotworów

Extramedullary hematopoiesis in case of hemoglobin E Beta-thalassemia: An unusual cause of paraplegia

Hemoglobin E (HbE) beta-thalassemia is common in Asian countries. Extramedullary hematopoiesis (EMH) is a chronic complication of this condition, which is a rare cause of paraplegia. Here, we discuss an uncommon presentation of HbE beta-thalassemia with EMH. A 32-year-old male patient presented with spastic paraplegia at C7 level. Contrast magnetic resonance imaging showed epidural extramedullary soft-tissue clumps at D2–D7 vertebra. Histology section showed numerous pleomorphic large cells admixed with colonies of small cells having rounded contour. A relook at the history revealed a history of hemolytic anemia diagnosed at the age of 12 years, for which he was on 1–2 transfusions/year. HbE beta-thalassemia had been diagnosed 20 years before. Hence, a final diagnosis of EMH was made. Although such case reports have been documented, the amount of available data is limited. A high index of suspicion for EMH should be held in patients with hematological disease who present with neurological disorders