Dandy Walker Syndrome with Unusual Associated Findings in a Fetal Autopsy Study

Dandy Walker Syndrome (DWS) is a congenital brain malformation characterized by hypoplasia or absence of cerebellar vermis, cystic dilatation of fourth ventricle and hydrocephalus. It is frequently associated with other congenital anomalies. Associated central nervous system anomalies such as agenesis of corpus callosum and vermis are associated with poor prognosis. Association of DWS with congenital absence of spleen is life threatening condition and has been reported very rarely. Autopsy findings of DWS with association of congenital absence of corpus callosum, vermis and spleen are reported in a stillborn fetus of 28 weeks gestation and review of relevant literature was don

Metastatic Renal Cell Carcinoma Masquerading As Benign Cystic Lesion on Cytology

Clear Cell-Renal Cell Carcinoma (CC-RCC), the most common subtype, accounting for 75% of all RCCs, can metastasize to any part of the body. Nodal metastasis is commonly noted in the pulmonary, tracheal and retroperitoneal lymph nodes. However, metastasis to cervical/supraclavicular lymph nodes is extremely rare. Moreover, these metastatic nodal deposits are usually solid, but may become cystic, which warrants a differential diagnosis of metastatic lesion in an elderly patient. So, here we report a case of metastatic RCC presenting as left supraclavicular lymphadenopathy without any clinical manifestations of the primary which was misdiagnosed as a benign cystic lesion on cytology

Phaeohyphomycosis Masquerading As Epidermal Cyst – A Diagnostic Dilemma in Immunocompetent Hosts and Review of Literature

Phaeohyphomycosis is caused by a rare dematiaceous, pigmented, mycelia forming fungi. It is an opportunistic fungal infection in immunocompromised hosts. It can present with varied clinical manifestations, as subcutaneous infection to widespread fulminant disseminated disease. Here we present three cases of subcutaneous phaeohyphomycosis in immunocompetent hosts at unusual site – popliteal fossa, great toe and sole of the foot. Awareness of unusual clinical presentation of Phaeohyphomycosis can lead to early diagnosis which may help in prevention of wide spread dissemination of disease and fatal outcome

Xanthogranulomatous Appendicitis: A Rare Case Report

Xanthogranulomatous inflammation is a form of chronic inflammation where the exact eitiology is not known. It is commonly reported in organs like kidney and gall bladder Very few cases of xanthogranulomatous inflammation of appendix have been reported in the literature. We report a case of 30 year female presenting with pain abdomen and fever for which provisional diagnosis of appendicitis was made. Open appendicectomy was performed which on intraoperative examination showed that appendix was adherent to surrounding structures forming a mass. Resection of the mass was done and sent for histopathological examination. Gross examination of the received specimen revealed multiple irregular tissue bits and one tubular tissue bit. Multiple sections studied from resected tissue showed features of xanthogranulomatous inflammation in appendix and periappendicular tissue

Effectiveness of the International Consensus Group criteria for manual peripheral smear review

Context: The International Consensus Group for Hematology Review (ICGHR) are essentially review criteria designed to reduce the number of manual smear reviews following analysis in automated hematology analyzers (AHAs). Although AHAs are an indispensable part of the present-day clinical laboratory, manual smear reviews still play an integral role in identifying morphological abnormalities and to confirm the results of the analyzers. Aims: The aim of this study is to evaluate the efficacy of the ICGHR criteria and our laboratory criteria using the Sysmex XN-1000 for manual peripheral smear review (MSR). Study Design: A prospective cross-sectional comparative study between the two sets of criteria for MSR was performed. Material and Methods: A total of 860 whole blood samples sent over a period of 19 months for complete blood count testing to our laboratory were collected using systematic random sampling. Truth tables were prepared for each set of criteria. Tests of proportion were used to compare performance specifications between both sets of criteria. Results: Using ICGHR criteria, sensitivity was 81.58%, specificity was 84.61%, 83.38% positive predictive value, and 82.92% negative predictive value. The microscopic smear review rate was 47.56% and efficiency was 83.14%. Using our laboratory criteria, sensitivity was 98.80%, specificity was 41.40%, positive predictive value of 61.46%, and negative predictive value of 97.34%. The microscopic smear review rate was 78.14% and efficiency 69.30%. Conclusions: There was a significant reduction in the microscopic smear review rates using the ICGHR criteria compared to our laboratory criteria. The ICGHR criteria can thus be adapted to daily laboratory practice provided they are first optimized and locally validated before use

A Rare Cutaneous Adnexal Tumour with a Rare Presentation

Proliferating Trichilemmal Tumour (PTT) is a rapidly growing large cutaneous adnexal neoplasm. Although biologically considered as benign, it may be locally aggressive. Malignant transformation of these lesions, known as Malignant Proliferating Trichilemmal Tumour (MPTT) has rarely been reported. So far in the literature, only 39 well-documented cases of MPTT have been reported. MPTT has been stated to be a neoplasm of the older age group according to review of the literature. We present a case of MPTT in a young male. A 25 year old male presented with a scalp swelling of 2 years duration with a recent rapid enlargement. The swelling was excised and histopathological examination of the excised specimen revealed features of MPTT. The differential diagnosis of MPTTis squamous cell carcinoma as both share common features. Accurate diagnosis of MPTT is essential since it has a tendency to metastasize and recur more frequently than squamous cell carcinoma

Expression of proliferative marker Ki-67 in epithelial dysplasia and squamous cell carcinoma of oral cavity

Background: The proliferative index helps to evaluate the growth rate and aggressiveness of the malignant tumor. Ki-67 is one of the proliferating markers that help to predict the patient's survival in Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC). Hence, the present study evaluated the expression of Ki-67 in OSCC and OED. Aim and Objectives: To evaluate the expression of Ki-67 in OED and OSCC and to correlate the Ki-67 expression with various grades of OED and OSCC. Material and Methods: A prospective observational study was done on clinically suspected oral epithelial dysplasia and malignancy cases received in the histopathology section. For each case, two sections of 4 μm were prepared. One was stained by hematoxylin and eosin stain, and another section was used for immunohistochemical staining of Ki-67. Results: Out of 64 cases evaluated for Ki-67 expression, 19 cases were OED, and 45 were OSCC. In OED, 15 cases were mild, and three were severe. In severe OED, Ki-67 expression was seen in all three lining epithelium layers: basal, parabasal, and spinous. In mild OED, Ki-67 expression was noted only in the basal layer. Out of 45 cases of OSCC, 31 cases were moderately differentiated, and one was poorly differentiated OSCC. Ki-67 expression was highest in poorly differentiated OSCC and lowest in well-differentiated OSCC. Conclusion: Ki-67 expression was high in poorly differentiated carcinoma compared to well-differentiated squamous cell carcinoma, and in severe OED Ki-67 was noted in all layers of lining epithelium. These findings suggest that Ki-67 expression correlates with the grading of OED and OSCC. Thus, it can be considered a proliferating marker that predicts the malignant transformation in OED and the aggressiveness of tumor

Retroperitoneal Desmoid Tumour Masquerading as Malignancy: A Case Report

Desmoid tumour is a rare, benign soft tissue tumour. It is noted to be clinically aggressive but pathologically benign, showing a high local recurrence rate; however, it cannot metastasize. Although it is benign, it can impact functionality. The majority of these cases remain sporadic, and the aetiology is unknown. The retroperitoneum is a rare site, and there are few reports of desmoidtype fibromatosis occurring in this region. It is difficult to distinguish from other tumours and to identify the tumour’s origin. Here, the authors present a case of a 36-year-old female who presented with abdominal pain and a mass in her abdomen. Imaging studies revealed a large retroperitoneal mass extending from the L5 vertebral body up to the inferior endplate of the L1 vertebral body. Exploratory laparotomy was performed, and the retroperitoneal mass was resected. Grossly, it was a capsulated dark brown to grey-coloured mass measuring 15×12×10 cm. The mass was sent for histopathology {Haematoxylin and Eosin (H&E)} study and reported as a retroperitoneal desmoid tumour, which was further confirmed on Immunohistochemistry (IHC) by showing immunopositivity for Desmin, Muscle-Specific Actin (MSA), and Beta-catenin. The patient is doing well with no further complaints to date. No disease relapse has occurred. Follow-up has been done every three months till the writing of the present report

Rehydration of air-dried smears with normal saline: An alternative for conventional wet fixation method in cervical cytological study

Context: Papanicolaou (Pap) smear is an effective exfoliative cytological investigation done for early recognition of cervical cancer. It also plays role in diagnosis of inflammatory lesions of cervix. Aims: The aim of this study is (1) to compare the cytomorphological features in conventional Pap smear (C-PAPS) and rehydrated air-dried Pap smear (RADPS) and (2) to evaluate the efficacy of RADPS in cytodiagnosis of cervical lesion by comparing with cytomorphological features of conventional wet-fixed Pap smear. Subjects and Methods: Paired cervical smears were prepared for 247 patients. One was labeled as C-PAPS and another was labeled as RADPS. Comparison of both smears was done for various cytomorphological parameters. Results: Out of 247 smears, 2.4% RADPS and 7.3% C-PAPS were reported as unsatisfactory. Red blood cell (RBC) background was present in 2% of RADPS and 42% of C-PAPS. Cytolysis and air-drying artifact were observed more in C-PAPS amounting to 2% and 4% in RADPS and 11% and 15% in C-PAPS. Cytoplasmic staining (97% RADPS vs. 94% C-PAPS) was superior in RADPS. Cell border, nuclear border, and chromatin of squamous and endocervical cells were better appreciated on RADPS compared to C-PAPS, and also statistically significant difference was observed. Conclusion: Rehydrated air-dried technique can be satisfactory alternative for conventional wet fixation method which can be followed routinely or in conjugation with C-PAPS, especially in cervical screening programs

Diagnostic utility of the cell block method versus the conventional smear study in pleural fluid cytology

Background: The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered as a definitive diagnosis. It helps in staging, prognosis and management of the patients in malignancies and also gives information about various inflammatory and non-inflammatory lesions. Diagnostic problems arise in everyday practice to differentiate reactive atypical mesothelial cells and malignant cells by the routine conventional smear (CS) method. Aims: To compare the morphological features of the CS method with those of the cell block (CB) method and also to assess the utility and sensitivity of the CB method in the cytodiagnosis of pleural effusions. Materials and Methods: The study was conducted in the cytology section of the Department of Pathology. Sixty pleural fluid samples were subjected to diagnostic evaluation for over a period of 20 months. Along with the conventional smears, cell blocks were prepared by using 10% alcohol-formalin as a fixative agent. Statistical analysis with the ′z test′ was performed to identify the cellularity, using the CS and CB methods. Mc. Naemer′s χ2 test was used to identify the additional yield for malignancy by the CB method. Results: Cellularity and additional yield for malignancy was 15% more by the CB method. Conclusions: The CB method provides high cellularity, better architectural patterns, morphological features and an additional yield of malignant cells, and thereby, increases the sensitivity of the cytodiagnosis when compared with the CS method