Spectrum of malignant skin adnexal tumors – a single institution study of 17 cases with clinicopathological correlation

Background: Skin adnexal tumors are a rare, assorted group of tumors with differentiation towards hair follicle, sebaceous glands or sweat glands. A vast majority of them are benign. But for every benign adnexal tumor, a malignant counterpart exists. Many histological subtypes of these malignant tumors been described, but only in short series or individual case reports. So, not much is known about their incidence or prognosis simply because of the limited number of cases available for analysis. This study was undertaken to contribute towards this less traversed area of dermatopathology. Methods: In the present study, a total of 60 cases with a histopathological diagnosis of skin adnexal tumors were studied. The slides and blocks were retrieved from the archives and were reviewed and were reclassified and subtyped as per WHO classification of skin tumors, 2006. Results: Among the 60 cases of adnexal tumors documented and reviewed over the four year study period, 17 cases of malignant adnexal tumors were encountered. Of these, 10 (58%) were tumors with eccrine or apocrine differentiation, 5 (29%) were of follicular differentiation and two (12%) were of sebaceous differentiation. Mammary paget disease (MPD) was the most frequent malignant tumor encountered both overall and among the tumors with eccrine and apocrine differentiation. Other tumors encountered in their order of frequency were Malignant proliferating trichelemmal tumor, apocrine carcinoma, sebaceous carcinoma and extramammary paget disease, trichelemmal carcinoma and eccrine carcinoma. These tumors were evaluated with regard to their age, site, gender distribution, clinical characters and histopathological features. Conclusion: Malignant adnexal tumors are extremely rare with indistinct clinical characteristics. They are locally aggressive, and have the potential for nodal involvement and distant metastasis, with a poor clinical outcome. A high index of suspicion is necessary to establish a diagnosis in most cases.

A simple and cost effective technique for construction of tissue microarrays

Background: Tissue microarray is widely used in histopathology and biomedical research. Construction of tissue microarray can help institutes to considerably reduce, cost of consumables, skilled man power needed and time needed in performing high output research. However resource poor centers in developing countries have hardly any access to such techniques.  The aim of this research is to develop simple, cost effective technique for making tissue microarray.Materials and methods: Materials available in a standard pathology laboratory such as skin punch biopsy needle, bone marrow aspiration needle, trephine biopsy needle, stylet, paraffin wax, hot air oven, slide warming table, drawing pin and measuring scale were used in developing this tissue microarray. The tissue array thus developed was sectioned using a standard microtome. Immunohistochemical studies were also performed on these tissue array sections which yielded satisfactory results.Results: This technique for construction of TMAs is simple and cost effective. When 3.5 to 3mm cores were used we were able to construct arrays up to 32 cores in one block. When 1mm cores were used we were able to construct arrays with 100 representative cores in one block. Morphological identification, histological typing and grading could be done in TMA sectionsConclusion: Tissue microarray is a relatively recent innovation in the field of pathology. We hope that our technique will encourage the younger researchers to take up research projects of large sample size requiring molecular studies with significantly lesser economic burden and thus leading to a significant acceleration in the transition of basic research findings into clinical applications.</p

Lesion with blue bone-a case report

Bizzare parosteal osteochondromatous proliferation, or Nora‘s lesion is a unique bone lesion that most often arises in the small bones of hands and feet.  It is characterised by proliferation of chondroid, bony and fibrous tissue, and is occasionally misdiagnosed as a malignant process.  Our case was a 31 yr old lady, who presented with a painless swelling near the 5th metacarpal bone of right hand.  X-ray showed well marginated mineralised mass arising from the cortical surface of the metacarpal bone.  Histopathological examination revealed bizarre parosteal osteochondromatous proliferation composed of varying amounts of cartilage, bone and spindle cells. Cartilage was hypercellular and chondrocytes were enlarged. Ossification was irregular and had a peculiar blue tinctorial quality. </p