Adenomatoid tumor of the uterus; report of a rare incidentaloma

Adenomatoid tumor of the uterus is extremely rare and usually an incidental finding in the uteri removed surgically for some other cause as in the present case. The histogenesis of this tumor has been controversial ever since its discovery, although the most favored and proposed is a mesothelial origin. Grossly it is usually mistaken for a leiomyoma. The tumor may have a variety of histomorphologic patterns with rare bizarre appearances, at times leading to an erroneous diagnosis of metastatic adenocarcinoma

Uterine leiomyosarcoma metastasizing to multiple sites: a rare presentation

Uterine leiomyosarcoma is a rare malignant neoplasm which has a dismal outcome especially when associated with widespread metastasis. It shows early metastasis primarily to the lungs, peritoneal cavity, bones, pelvic and para-aortic lymph nodes. We report simultaneous metastasis to the scalp, breast and soft tissue from leiomyosarcoma arising in the uterine broad ligament. Leiomyosarcoma poses a diagnostic difficulty at the metastatic site, especially when the primary site is unknown. Correct tumor typing and separating a primary from a metastatic one is important because of the different treatment modalities for both. Fine Needle Aspiration Cytology (FNAC) has emerged as an indispensable preliminary modality in investigating the metastatic disease and therefore cytomorphological recognition of the tumor presumes a great significance

Spectrum of vulvar lesions: a clinicopathologic study of 170 cases

Background: A wide range lesions may occur in the vulvar region. The clinician is often confronted with the challenge to draw a distinction between normal variants, benign entities and a potentially serious pathology. The aim of the present study is to have an insight into the diverse morphologic spectrum of vulvar lesions.Methods: The present retrospective study was carried out by compiling the data from archival records over a period of eight years from January 2005 to December 2012. The vulvar biopsies/vulvectomy specimens were studied for histomorphological features. The lesions were categorized as non neoplastic, neoplastic and inconclusive; neoplastic ones were further divided into benign, malignant and premalignant.Results: The age of the women ranged from 6 to 80 years (mean 38.2±6.4) with the maximum number of patients between 31 to 40 years of age. Most common clinical presentation was itching and white plaque on the vulva (85 cases; 50%). The commonest site of vulval lesions was labia majora (87 cases, 51.18%). Non neoplastic lesions were more common (n = 94; 55.29%) than the neoplastic lesions (n =50; 29.41%). There were 23 (46%) benign lesions while 27 cases (54%) were malignant or premalignant ones. In 26 cases, no definitive histologic diagnosis could be rendered.Conclusion: Early recognition of vulvar lesions and a prompt biopsy diagnosis for all lesions with suspicious changes is of great significance. The term leukoplakia is imprecise and should be replaced by a precise histological description

Cytomorphologic spectrum in aspirates of extra-adrenal paraganglioma

Background: Paraganglioma is a rare tumor arising from clusters of neuroendocrine cells in association with sympathetic and parasympathetic nervous system. It poses a diagnostic challenge because of its widespread anatomic distribution, subtle clinical manifestations, and a variety of morphologic patterns. Aim: The aim of this study is to have an insight into the diverse morphologic spectrum of extra-adrenal paraganglioma (EAP). Materials and Methods: A retrospective analysis of seven cytologically diagnosed cases of EAP over a period of 10 years was performed. There were five superficial swellings and two deep seated retroperitoneal masses. The superficial swellings were aspirated directly, and the retroperitoneal masses were aspirated under ultrasound guidance using 22-gauge lumbar puncture needle fitted to a 10 mL syringe. Smears were reviewed for cellularity, pattern, cell shape, cytoplasm, nuclear features, and background. Results: The age of patients ranged from 25 to 75 years; four patients were males and three were females. Sites involved were carotid body region (four cases), para-pharyngeal space (one case) and para-aortic region (two cases). All the cases yielded hemorrhagic material on fine-needle aspiration. Smears showed scattered and clusters of cells and loosely cohesive acini of tumor cells. Cells were round to polygonal with pleomorphic nuclei, granular chromatin, inconspicuous nucleoli, and moderate to abundant cytoplasm containing fine pink granules and vacuolations. The cases were confirmed on radiology and histopathology. Conclusion: The cytologic features in EAP along with pertinent clinicoradiologic findings help in making an accurate preoperative diagnosis of an otherwise rare tumor

Aggressive Angiomyxoma of the Cervix: A Unique Entity

Introduction: Aggressive angiomyxoma is a mesenchymal tumour which presents rarely; usually in women in reproductive age group, as a mass in the pelvic tissue. Only exceptionally, has it been seen to originate from the uterus and cervix.&nbsp;Methods: We present a case of a 23-year-old woman who complained about abdominal pain and excessive vaginal bleeding three days after a spontaneous abortion. Examination revealed a large polyp arising from the cervix. Histopathologic examination of the polypectomy specimen revealed an aggressive angiomyxoma of the cervix. Immunohistochemistry was performed and the tumour was immunopositive for vimentin, desmin and smooth muscle actin. Management options are discussed, in light of need of fertility conservation.&nbsp;Result: Aggressive angiomyxoma can originate from the mesenchymal tissue of the cervix.&nbsp;Conclusions: Treatment may be individualized with surgery and hormonal treatment. Long term follow up is recommended.</p

Sclerosing perivascular epithelioid cell tumor of the uterus: A rare entity posing diagnostic challenge

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal uterine tumor and the histological variant, sclerosing PEComa is exceedingly rare. Sclerosing PEComas preferentially occur in the retroperitoneum and occurrence in the uterine corpus is seldom seen. These tumors pose a diagnostic challenge and need distinction from morphological mimickers such as epithelioid smooth muscle tumors, endometrial stromal sarcoma, and metastatic carcinoma. Accurate diagnosis can be established coupling histomorphology with immunostaining. The distinction from other entities is of prime importance considering the therapeutic and prognostic implications. Herein, we describe a case of uterine sclerosing variant of PEComa with diagnostic difficulties and key to diagnose this entity

Langerhans cell histiocytosis in children diagnosed by fine-needle aspiration

Background: Langerhans cell histiocytosis (LCH) is a rare intricate pediatric neoplasm with varied clinical manifestations and multiple treatment modalities. Aim: To study the cytological features of LCH and the differential diagnoses on fine-needle aspiration (FNA). Materials and Methods: FNA was performed using a 23-gauge needle fitted to a 10 mL syringe mounted on syringe holder. LCH was diagnosed on FNA smears in seven cases confined to the head and neck region, which included three cases of lymphadenopathy, three cases of scalp swelling, and one case of orbital swelling. Results: The age of the patients ranged from 25 days to 11 years and male-to-female ratio was 1:1.3. Clinically, the diagnoses suggested were tuberculosis, inflammatory lesion, abscess, and malignancy. The cytologic findings included high cellularity, isolated Langerhans cells (LCs) with prominent nuclear indentation, grooves and abundant vacuolated cytoplasm, multinucleated giant cells, eosinophils, and lymphocytes. Areas of necrosis were noted in one case. Histopathology, along with positive S-100 immunohistochemistry, confirmed the diagnosis of LCH. Conclusions: LCH is a rare disease occurring predominantly in children and can be diagnosed with ease on FNA cytology by the presence of characteristic Langerhans cells. The S-100 positivity aids in suggesting a diagnosis of LCH

Giant Cell Tumor of Soft Tissues with Neurofibromatosis: A Case Report

Giant cell tumor of soft tissues (GCT-ST) is a rare entity with unpredictable clinical behavior. However, metastasis and tumor-related death are rarities if these are adequately treated. GCT-ST is required to be distinguished from giant cell-rich tumors of the bone and other soft tissue neoplasms. Coexistence of multiple neurofibromas with GCT-ST is cited in very few literature reports, hence this case report. [Arch Clin Exp Surg 2014; 3(3.000): 190-192

Evaluation of grading and hormone receptor immunostaining on fine needle aspirates in carcinoma breast

Background: Grading and hormone receptor determination in breast carcinoma are predictive factors for response to hormonal therapy. Aim: This study was undertaken to grade breast carcinoma and to determine estrogen receptor (ER) and progesterone receptor (PR) expression on fine-needle aspiration cytology (FNAC). Furthermore, the objective was to compare the results with histological grading and immunohistochemistry on surgical material. Materials and Methods: Fifty cases of breast carcinoma diagnosed on FNAC were included. The cytological grading was done according to the Robinson′s grading system. The corresponding histology sections were graded using the modified Bloom-Richardson system. Immunostaining for ER and PR was done on smears and tissue sections. Results: On both cytological and histological evaluation, 49 cases were infiltrating ductal carcinoma and one case was colloid carcinoma. On comparing cytological and histological grading, 78% were correctly graded on cytology. The sensitivity, specificity, positive predictive value and negative predictive value for ER detection on immunocytochemistry (ICC) were 55.6%, 95%, 93.8% and 61.3%, respectively. The sensitivity, specificity, positive and negative predictive value for PR detection on ICC were 57.7%, 95.2%, 93.8% and 64.5%, respectively. The correlation for ER and PR between cytology and histology was 72.3% and 74.5%. Conclusion: The grading along with ER and PR immunostaining of breast carcinoma on smears is advocated because of high concordance between cytology and histology. This allows the patient to be treated with hormonal therapy on the basis of FNAC alone