Malignant peripheral nerve sheath tumor presenting as pathological fracture of femur in neurofibromatosis patient

Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue sarcomas that arise from a peripheral nerve or cells associated with the nerve sheath, such as Schwann cells, perineural cells, or fibroblasts. MPNSTs account for 5%–10% of all soft tissue sarcomas. Neurofibromas in Neurofibromatosis-1 (NF-1) may undergo malignant transformation in 2%–5% of patients. We are reporting a very rare case in NF-1 patient who, presented with pathological intertrochanteric fracture of femur and liver metastasis. X-ray from left hip joint shows lytic lesion which on histopathology turned out to be MPNST. S-100 was positive confirming its neural origin. Elbow lesion which was excised later, also showed similar features with S-100 positivity. Ultrasonography abdomen showed target lesions in liver. Fine-needle aspiration cytology from liver showed scattered malignant spindle cells. A final diagnosis of metastatic MPNST was made. Although malignant transformation in neurofibromas is extremely rare when it occurs, it is associated with NF-1 in 75% of patients. This case highlights the possibility of fracture femur as the presenting complains, in patients of NF with malignant transformation. The case is unique with regard to its presentation and rarity of metastatic sites

Conjunctival cytology in glaucomatous patients using long-term topical therapy

<b>Background:</b> Long-term use of antiglaucoma drugs induces adverse changes on the conjunctival surface. <b> Aim:</b> To evaluate the cytological changes in the conjunctival scrape smears of patients receiving long-term antiglaucoma medication and their histopathological correlation. <b> Materials and Methods:</b> Conjunctival scrape smears were taken from the eyes of patients on long-term antiglaucoma therapy for over three months (<i>n</i> = 75), patients taking antiglaucoma medication for less than three months (<i>n</i> = 100) and from glaucomatous patients in whom trabeculectomy was done as a primary procedure. Inflammatory cell counts, fibroblasts, and the degree of metaplasia were then evaluated both cytologically and histologically. The <i>t</i>-test was used to determine the predictive values of these parameters for the surgical outcome of trabeculectomies. <b> Results:</b> Long-term use of antiglaucoma therapy leads to a higher stage of metaplasia with an increase in the number of fibroblasts, subepithelial collagen deposition, and inflammatory infiltrate within the substantia propria of the conjunctiva. <b> Conclusions:</b> Long-term antiglaucoma medications induce a significant degree of metaplasia in the conjunctival surface that adversely affects the outcome of filtration surgery

Clinico-radiological and pathological evaluation of extra testicular scrotal lesions

Background: Scrotal ultrasound, though reliable in distinguishing between intratesticular and extratesticular lesions and characterizing them as cystic and solid, cannot distinguish benign from malignant pathology. Although fine needle aspiration cytology (FNAC) has proved to be of great diagnostic importance in testicular lesions, its scope in extratesticular lesions is largely unexplored. Aim: To evaluate extratesticular scrotal lesions cytologically and compare it with their clinical, radiological, and histological findings. Materials and Methods: Sixty five patients with extratesticular scrotal lesions were assessed clinically, radiologically, and cytologically. Histopathology was done in 45 cases where surgical exploration was undertaken. All the data were then analyzed and correlated. Results : Extratesticular lesions accounted for 72.2% of the scrotal swellings. Of these, the epididymis is most commonly involved (61.5% cases) with the commonest type of lesion being cystic (49.3% cases). Ultrasonography preferably with color doppler is highly useful for the evaluation of the scrotum. Apart from distinguishing extratesticular from testicular and cystic from solid lesions, it has an important role in identifying individual lesions, thus reducing the list of differential diagnosis. Fine needle aspiration cytology contributed to a definitive diagnosis in 47.7% cases. It helps classify cystic masses on the basis of their contents and defines the etiology of chronic inflammatory lesions, apart from corroborating with the clinico-radiological diagnosis. Histological evaluation was possible only in cases where surgery was performed and helps further define the diagnosis. Conclusion : Fine needle aspiration cytology is essentially non-traumatic and easy to carry out and should be a technique of choice for the study of scrotal pathology, main advantage being avoidance of delays in diagnosis

Teratoma of the lumbosacral region: a case report

<p>Abstract</p> <p>Introduction</p> <p>Teratoma is a tumor that usually arises from one or more germ layers. They are most commonly found in the sacrococcygeal region and have a female preponderance. We present a very rare case of a boy with a benign cystic teratoma in the lumbosacral region.</p> <p>Case presentation</p> <p>A 16-year-old Indian boy presented to our hospital with a history of a lump in the lower back region since birth. Initially, it was small, but its size increased gradually over time to a size of 15 cm × 15 cm at presentation. There were no other associated abnormalities. Investigations revealed the lump to be a benign cystic teratoma. The patient underwent surgery, and the whole tumor, from its base to the vertebrae, was excised. Bisection of the tumor revealed that it contained hair and pultaceous material consistent with a teratoma, which was later confirmed by histopathologic examination.</p> <p>Conclusion</p> <p>Benign cystic teratomas should be diagnosed and managed aggressively because they generally have a greater tendency to progress toward malignancy. After extensively searching the case report database, we arrived at the conclusion that this was a rare case of a benign cystic teratoma in the lumbosacral region in a boy.</p