Kafil Akhtar

Chondrosarcoma is cartilage forming neoplasm which mostly occurs in pelvis, femur and humerous. Chondrosarcoma is rare in the foot and the involvement of phalanges is extremely rare. It is a malignant neoplasm which mimics various epiphysial tumors clinically and radiologically, so histopathology is the gold standard for confirming the diagnosis. We report an unusual case of Grade II Chondrosarcoma in a 60 years old male, who complained of swelling and pain in left great toe for the past two years, which clinically mimicked Osteoclastoma. Imprint smear from swelling in the left great toe showed scattered mononucleated to binucleated oval to plump to polygonal cells with coarse chromatin and moderate eosinophilic cytoplasm in a chondromyxoid background suggestive of malignancy with differentials of Osteosarcoma and Chondrosarcoma. Histomorphology with immunohistochemistry led to the confirmation of diagnosis of this tumor at a rare site. Keywords: Chondrosarcoma, Osteoclastoma, Osteosarcoma, Immunohistochemistry, Great Toe

Tuberculosis is one of the most prevalent disease of the developing countries resulting in significant morbidity. Extra pulmonary tuberculosis results in pleurisy among predilection to other organ and organ systems like lymph nodes. Pleurisy results in tubercular pleural effusion. Pleural effusions are mostly seen in immunocompetent patients. Here we present a case of tubercular pleural effusion which was diagnosed by cytology examination of pleural fluid in a 22-year-old female, who presented with shortness of breath, generalized weakness with decreased appetite. Radiological investigations revealed a unilateral pleural effusion. Pleural tapping was done and sent for cytological examination. Cytospin aspirate smear showed degenerated mesothelial cells, histiocytes, few epithelioid cells, mature lymphocytes and lymphocytes with splintered chromatin. A diagnosis of tubercular pleural effusion was made with further tests like CBNAAT for confirmation of diagnosis. CBNAAT was positive with a strain of Rifampicin sensitive mycobacterial tuberculosis identified. Patient was started on anti tubercular drugs according to the National Tuberculosis Elimination Program. To conclude, cytology is a fast inexpensive method for diagnosing the etiology of pleural effusions by pointing us in the right direction.   Keywords: Cytology, Epithelioid cells, Pleural Effusion, Tuberculosis

Subleukemic leukemia is characterized by the presence of atypical or abnormal white blood cells in peripheral blood with total leukocyte count in within normal range. The clinical features are nonspecific and include fever, fatigue, and weight loss, vague bone pain, bruising or bleeding. We present a rare case of subleukemic leukemia presenting as pancytopenia in a 55 years female, who presented with mild constitutional symptoms of generalized weakness, easy fatiguability and loss of appetite for the past 3 months. We should be aware of this rare finding of subleukemic leukemia in patients with mild constitutional symptoms and keep it in the differentials of a case of pancytopenia, for prompt diagnosis and early initiation of treatment, with better outcome.   Keywords: Constitutional Symptoms, Cytochemical Stains, Pancytopenia, Subleukemic Leukemia

Introduction: Meningiomas are most common primary intracranial neoplasm. They arise from the arachnoid cap cells. They were previously divided into WHO grade I, grade II and grade III depending on their histological features and clinical features. However, in the new WHO 2021 updates it has been assigned a single group. Meningiomas may arise in the brain and spinal cord. An integrated approach based on clinical examination, history, radiology and histopathology aids in diagnosis. Herein we present a case series of a spectrum of clinico-pathological presentations of meningiomas. Case 1: A 35-year-old female presented with headache. After clinical examination and on CT scan an intracranial lesion was noted. Craniotomy was performed and tissues examination was consistent with meningothelial meningioma. Case 2: A 55-year-old female presented with pain in the limbs associated with weakness to the orthopaedics clinic. On neurological examination there was loss of power in the limbs. MRI spine revealed a round extramedullary intradural mass at T7 level. Laminectomy was done and histopathological examination showed features of Psammomatous meningioma, based on histomorphology and immunohistochemistry. A 32-year-old female presented to the Surgery clinics with dizziness and headache which was progressive and not responding to medications. MRI revealed an ovoid enhancing mass involving left parieto-occipital region, with a provisional diagnosis of meningioma. A report of Transitional meningioma was given based on histomorphology and immunohistochemistry. Case 4: A 40-year-old female presented to the ophthalmic clinic with complaints of diplopia and disturbances in gait. Fundus examination revealed disc oedema and retinal vessel narrowing. MRI revealed large ovoid extra axial mass, with a provisional diagnosis of meningioma. A report of Secretory meningioma was signed out on histomorphology and immunohistochemistry.   Keywords: Meningioma, Psammomatous, Transitional, Secretory, Histomorphology, Immunohistochemistry

Filariasis is a major public health problem in developing countries, and the diagnosis is conventionally made by demonstrating microfilariae in the peripheral blood smear. However, microfilariae have been incidentally detected in fine needle aspirates of various lesions in clinically unsuspected cases of filariasis with absence of microfilariae in the peripheral blood. Microfilariae in cytological smears of malignant neoplasms is a chance finding. Cytology can be an effective tool for detection of asymptomatic filariasis and malignancy, thus helping in disease eradication and mortality. There are reports of coexistence of microfilaria with Ewing’s sarcoma, squamous cell carcinoma of maxillary antrum and dentigerous cyst by different cytopathologists. Here we present a rare case of microfilariae in a cytological aspirate smear from left knee swelling with a malignant osteogenic tumor, osteosarcoma.   Keywords: Cytology, Microfilaria, Osteosarcoma, Femur

Extrapulmonary tuberculosis is one of the major concern in developing countries. It presents with various clinical features, hence most of the times it is difficult to make diagnosis on the basis of single investigation. Multiple investigations should be done simultaneously for making appropriate diagnosis. We report a rare case of a 50 years old female, diagnosed as ovarian tuberculosis, who presented with complaints of dysmenorrhea, abnormal uterine bleeding and low grade fever for 4-6 months. Tuberculosis should always be kept in mind as the most common cause of granulomatous lesion in endemic regions.   Keywords: Extrapulmonary, Histopathology, Ovary, Tuberculosis

Aims and Objectives: To study the cytomorphological presentation of post covid mucormycosis. Materials and Methods: A retrospective observational study was conducted at a tertiary care center in Northern India for a period of six months, in patients with post covid mucormycosis. Results: The study included 50 cases with post covid mucormycosis. Males with 28 cases (56.0%) were more commonly affected than females. Nose comprising of 36 cases (72.0%) was the most commonly affected area, with nasal cavity showing 24 cases (48.0%) being most common site within the nose. 36 cases (72.0%) were positive exclusively for Mucormycosis. 10.0% cases of mucor showed superadded bacterial infection. Candida was seen in 03 cases (6.0%) and aspergillosis in 02 cases (4.0%). There were 6.0% cases of mucormycosis with associated chronic osteomyelitis. All the patients had a history of steroid use throughout their coronavirus treatment. Conclusions: A rare but fatal fungal infection (mucormycosis) has a strong association with covid-19 infection, in active as well as recovered patients, particularly in those with co-morbid medical conditions and treated with high doses of corticosteroids.   Keywords: Covid­19, Mucormycosis, Post covid treatment, SARS­CoV­2 Infection

Filariasis is a major health problem in many tropical countries including India. Most commonly affected organs are lymphatics of lower limbs, retroperitoneal tissue, spermatic cord, epididymis and breast. Despite high incidence, it is infrequent to find microfilariae in fine needle aspiration cytology smears and body fluids. Microfilaremia is usually detected in blood or skin specimens. Cytological examination with FNAC is an investigation of choice especially in patients with evident swelling with difficult clinical diagnosis. We present a case of spermatic cord microfilariasis in a 32 years male presented with right scrotal swelling with dancing filarial sign on ultrasonograpghy, while the peripheral blood smear was negative for the organism.   Keywords: Cytology, Filariasis, Spermatic Cord

Aims and Objectives: To study the expression of Ki-67 and p16 in neoplastic lesions of uterine cervix and to evaluate the prognostic significance of tumour differentiation, histological type, stage and grade, depth of tumour invasion and lymphovascular invasion in women with neoplasia of uterine cervix. Materials and Methods: This study was performed on 50 biopsies and surgically resected specimens of uterine cervix, which were fixed in 10% formalin, processed, paraffin embedded and cut into 3-5 microns thickness, stained with hematoxylin and eosin stains and immunohistochemical staining by p16 and Ki-67 antibodies was performed and studied. Observations: Majority of cases of invasive carcinoma cervix were large cell non-keratinizing squamous cell carcinoma, 58 cases (48.2%). Majority of cases of invasive carcinoma cervix were seen in stage 2B, 40 (40.8%) cases followed by stage 3B, 24 (24.4%) cases. Out of 18 cases of large cell non-keratinizing squamous cell carcinoma, 12 (66.7%) showed 3+ positivity for Ki-67. 7 (53.8%) cases of stage 2A showed 3+ positivity, 3 (23.1%) cases each showed 2+ positivity for p16. 7 (36.8%) cases of moderately differentiated SCC showed 3+ positivity, 4 (21.1%) showed 2+ positivity and 5 (26.3%) showed 1+positivity of Ki-67. Out of 10 stable patients, 4 (40.0%) showed negative p16 immunoexpression and all the 3 cases (100%) with recurrence showed 2+ positivity and 2 (100%) patients with metastasis showed 3+ positivity. Out of 10 stable patients, 6 (60%) showed negative Ki-67 immunoexpression and all the 3 (100%) cases with recurrence showed 3+ positivity and one each (50.0%) patient with metastasis showed 2+ positivity and 3+ positivity. Conclusions: p16 and Ki-67 immunomarkers are useful as a diagnostic and prognostic tool in cases with recurrence and metastasis, helping in early detection of disease progression. Keywords: Neoplasia, Uterine Cervix, Immunohistochemistry, p16, Ki­67

Introduction: Quality control describes steps taken by blood and component bank to ensure that tests are performed correctly. Primary goal of quality control is transfusion of safe quality of blood. It is to ensure availability of efficient supply of blood and blood components. Internal quality control is the backbone of quality assurance program. Aims and Objectives: To analyze the internal quality control of blood components in modern blood banking as an indicator of our blood bank performance. Materials and Methods: An observational cross sectional study conducted at the Blood and Component Bank, JN Medical College and Hospital from 2018 to 2020. Each blood component was arbitrarily chosen during the study on monthly basis. Selection criteria was 1.0% of total collection or minimum 4 bags per month. Packed red cells were evaluated for hemoglobin, hematocrit, RBC count; platelet concentrates for pH, yield and culture; fresh frozen plasma and cryoprecipitate were evaluated for unit volume, factor VIII and fibrinogen concentration. Results: The mean HCT of packed red cells was 65.75+7.42%, volume was 238+26.25ml, Hb was 20.5+0.15g/dL and RBC count of 5.89x1012+0.30x1012. The mean platelet yield was 5.7x1010, pH was ?6.8+0.175 and volume was 82.5+13.75ml; cultures were negative and swirling was present in all the platelet units tested. Mean factor VIII and fibrinogen levels were found to be 95.25 +7.37and 307.5+41.37gm/l for FFP respectively. Mean volume, PT and APTT were 215+32.5ml, 14.15+0.325 sec and 29.50+1.5 sec respectively. Conclusions: The quality control of blood components ensures the timely availability of a blood component of high quality with maximum efficacy and minimal risk to potential recipients. Keywords: Internal Quality Control, Modern Blood Banking, Health Care, .Components

Aims and Objectives: To study the expression of immunomarker CD 44 and evaluate its diagnostic and prognostic significance and its correlation with clinicopathological variables in Breast Carcinoma.  Materials and Methods: 50 diagnosed cases of breast carcinoma, presenting clinically with breast lumps were processed routinely for histopathological diagnosis of breast cancer and immunoexpression of CD 44 was performed. The immunoexpression of CD44 was detected mainly at the membrane of tumour cells and the scoring was performed. Results: 217 (98.2%) were females and 4(1.8%) males. Most common subtype involved was invasive carcinoma (NST) in 205(92.8%) cases. Out of 29 cases of grade 2 tumor, 07 (14.0%) showed 1+ score, 10(20.0 %) showed 2+ score and 12 (24.0%) cases showed 3+ immunoexpression. Out of 25 cases of T2 (2-5cm) size, 07(14.0%) showed 1+ score, 09(18.0%) case each showed 2+ score and 3+ immunoexpression. Out of 26 cases of stage III, 04(8.0%) showed 1+ score, 09(18.0%) showed 2+ score and 13(26.0%) cases showed 3+ immunoexpression. Out of 05 cases of N3, 02(4.0%) showed 2+ score and 03(6.0%) showed 3+ immunoexpression. Out of 21 cases of basal cell type, 03(6.0%) showed 1+ score, 07(14.0 %) showed 2+ score and 11(22.0%) cases showed 3+ immunoexpression. Out of 11 (50.0%) cases with weak to moderate expression of CD44, 7(31.8%) cases were stable and alive while 4(18.2%) died due to distant metastasis to various sites. Conclusions: CD 44 is associated with disease progression, recurrence, advanced metastasis and reduced disease free survival and can be used in future to predict early diagnosis of advanced disease. Keywords: Breast carcinoma, CD 44, Immunohistochemistry, Prognosis.

Epithelial ovarian cancer normally spreads transcoelomically via the peritoneal cavity and then, in more advanced stages, to the intra-abdominal lymph nodes and the liver and lung parenchyma. Bone metastasis is an extremely rare initial presentation in patients with primary carcinoma of the ovary and is associated with poor prognosis. Herein we report a rare case of femoral metastasis of papillary carcinoma of the ovary in a 49-year-old female, who presented to the orthopaedics clinic with complaints of pain and swelling around the left knee joint since 2 months. X ray and MRI of left leg showed a diffuse soft tissue swelling and osteolytic lesions in the lower femur around the condyles with focal cortical destruction. Fine needle aspiration biopsy of the lesion was suggestive of metastatic adenocarcinoma. Subsequent ultrasonography of the lower abdomen showed a hypoechoic shadow in the left ovary. Local surgical excision with left oopherectomy was performed. After histopathologic and immunohistochemical examination from both the sites, a final diagnosis of primary papillary adenocarcinoma of the ovary with femoral metastasis was given. She was treated with 6 cycles of adjuvant combination chemotherapy of Paclitaxel 150 mg/m2and Cisplatin 50 mg/m2 and a good response was seen. This case is unique in presentation of bony femoral metastasis with silent epithelial ovarian carcinoma. Keywords: Bone, Femur, Metastasis, Ovarian cancer, Immunohistochemistry.

Adrenocortical neoplasms are rare tumours that can be diagnostically challenging in some cases. Numerous diagnostic algorithms and scoring systems are in practice to differentiate adenoma from carcinoma. Besides, the different histological variants of adrenocortical carcinoma need to be identified. We present a case of 44 year old female with vaginal bleeding with a large, heterogenous suprarenal mass on imaging. Provisional clinical diagnosis of pheochromocytoma was made and patient underwent adrenalectomy. The histological examination of tumour sections showed sheets and trabeculae of moderately pleomorphic cells with extracellular mucin deposition. Immunohistochemical evaluation showed tumour cells to be negative for chromogranin with focal pan cytokeratin positivity. Finally a diagnosis of adrenal cortical carcinoma – myxoid variant was made. Post operative period was uneventful and following en bloc resection of the tumour patient did not receive any adjuvant adrenolytic treatment. The patient is doing well at 6 months of follow up period, without any evidence of recurrence. Keywords: Adrenal cortical malignancy, Cytokeratin, Histopathology, Immunohistochemistry, Myxoid.

Spindle cell carcinoma of the salivary gland is very rare. Spindle cell carcinoma is a variant of squamous cell carcinoma with an aggressive course. We present a rare case of spindle cell carcinoma of the parotid in a 54-year-old male, who presented with a rapidly enlarging mass in the right parotid gland. Histopathologically, the tumour was composed of foci of squamous cell carcinoma with sheets of malignant squamoid cells and spindle cell sarcoma with scattered pleomorphic, plump to spindle- shaped cells with foci of bone formation. Immunohistochemical studies revealed cytokeratin positivity and vimentin negativity in the squamous cell carcinoma component with focal positivity for epithelial membrane antigen and negative expression of cytokeratin and vimentin positivity in the sarcomatoid component. A final diagnosis of primary spindle cell carcinoma of the parotid gland was given. Our patient is alive and well with no clinical or radiological evidence of recurrence or metastatic disease after 12 months of follow up period. Keywords: Salivary gland, Spindle cell carcinoma, Histopathology, Immunohistochemistry.

Melanoma is an aggressive malignancy, and early diagnosis and treatment can reduce mortality in patients. A new or changing lesion is the most common warning sign of melanoma. In amelanotic tumors, diagnosis may be delayed. Amelanotic melanoma is a form of melanoma in which malignant cells have little or no pigment. Amelanotic melanoma is classically described as skin coloured but a subset of these tumors are red, pink or erythematous. Typical early lesions present as asymmetrical macular lesions. FNAC may show varied cytomorphology ranging from epithelioid to spindled to plasmacytoid pleomorphic cells with marked anisonucleosis and eosinophilic to basophilic cytoplasm with intranuclear pseudoinclusions and cytoplasmic vacoulations admixed with bi- and multinucleate giant cells.We present a case series of varied presentation of amelanotic melanoma with its cytomorphological features. Keywords: Amelanotic, Clinical Presentation, Cytomorphology, FNAC, Melanoma.

Lymphangioma is a relatively uncommon benign tumour occurring due to malformation of the lymphatic vessels. Lymphangioma in adults is a rare occurrence. Intraoral lymphangiomas occur most frequently on the dorsal tongue and rarely on the palate, buccal mucosa, gingiva and lips. Clinically, lymphangiomas of the oral cavity usually have a plaque formed of small thin-walled vesicles and similar in surface to frog eggs. We present a case of lymphangioma of the tongue in a 34-year-old male who presented with complaints of painless swelling in his tongue with difficulty in speaking for the last 25 days. CT scan revealed a lobulated sharp-contoured soft tissue communicating with the superficial planes with minimum vascularity in colour doppler studies. En masse excision of the firm, solid erythematous mass was performed which microscopically showed multiple dilated endothelial lined vessels filled with a proteinaceous fluid and lymphocytes. A diagnosis of lymphangioma of the tongue was given. Keywords: Lymphangioma, Tongue, Histopathology.

Squamous cell carcinoma (SCC) of upper gastrointestinal (GI) tract is an aggressive malignancy more common in older age group. Post 1970’s with advent of endoscopy and the discovery of H. pylori bacteria and with it’s role in malignancy of esophagus and stomach, detection rate of squamous cell carcinoma esophagus has increased subsequently. In this case report we present a case of squamous cell carcinoma gastroesophageal (GE) junction in a 15 years old female owing to its rarity in younger age. The patient presented in the surgery OPD with history of weight loss and dysphagia since the last 5 months. She also complained of epigastric pain and heartburn since the last 2 months. There was no past history of carcinoma of GIT in any family members. Upper GI endoscopy showed an exophytic growth at the GE junction. Histopathological examination of subsequent GE biopsy confirmed the diagnosis of microinvasive squamous cell carcinoma while the stomach showed features of chronic atrophic gastritis. The patient underwent resection of GE junction through thoraco-abdominal approach followed by radiotherapy for any residual tumour. Our patient is doing well after 3 months post op follow up. This case report emphasises the rare occurrence of SCC in a teenage female with no family history and to consider it in the differential diagnosis in younger patients with similar complaints. Keywords: Endoscopy, Gastroesophageal junction, Squamous cell carcinoma, Teenage female.

Primary ovarian carcinoma may metastasize to the peritoneum leading to malignant ascites. Four percent cases of primary ovarian carcinoma can involve the colorectum. We present a case report of a 50-year-old women who had complaints of bilateral adnexal mass and disturbed menstruation with altered bowel habits. Computed tomography scan of the abdomen and pelvis showed a bilaterally enlarged ovaries and a lobular rectal mass. Proctoscopy substantiated the rectal mass as an ulcerated lesion. Histopathology confirmed the diagnosis as bilateral serous papillary cystadenocarcinoma. Left hemicolectomy specimen illustrated foci of atypical glands. Immunohistochemical staining of both the tumor masses showed strong cytokeratin 7 positivity with negative cytokeratin 20 expression. Bilateral involvement of the ovaries with colorectal metastasis is very uncommon, which is highlighted in this paper. Keywords: Bilateral, Cancer, Colorectum, Immunohistochemistry, Ovary, Metastasis.

Papillary lesions of the breast include a broad spectrum of entities, many of which pose a diagnostic challenge for the pathologist. Papillary Carcinoma is a rare malignancy of the breast accounting for 0.5- 2% of all breast carcinomas. It occurs more frequently in post-menopausal women over the age of 60. The most common presentation is a painless, mobile mass with bloody nipple discharge. Mammography typically shows a large circumscribed mass with an irregular or nodular contour.We present a case of a 42-year-old-woman with a painless lump in the right breast for 11 months, diagnosed as encapsulated papillary carcinoma of breast with in-situ component. Keywords: Breast, Encapsulated papillary carcinoma, Histopathology.

Sinonasal hemangiopericytoma, also known as glomangiopericytoma (GPC) is a benign perivascular tumor of low malignant potential, with an incidence rate of 0.5-1% of all sinonasal tumors. It often shows local recurrences with invasion to the surrounding bony tissues. It usually arises from the perivascular cells surrounding the capillaries. Etiology of the tumour is uncertain, with few postulated hypothesis like pregnancy, trauma, hypertension and corticosteroid drugs. They have an indolent course and tend to occur most commonly in the adults of seventh decade of life. We present a case report of 55 years old male presenting to the ENT OPD, with complaints of right sided nasal obstruction and repeated episodes of epistaxis since the last 9 months. History and general examination was unremarkable except for antihypertensive intake since the last few years. Laboratory investigations showed microcytic hypochromic anaemia, raised absolute eosinophil count of 1500 cells per microliter and positive Hepatitis B surface antigen (HBsAg) in the blood. Rhinoscopic examination showed a reddish brown nodular swelling in the right nasal cavity beneath the middle turbinate and hypertrophy of left nasal mucosa. CT imaging suggested an 18x15 mms, well defined soft tissue mass in the right nasal cavity. Complete resection of the mass with endoscopic surgery was performed. Histopathological examination coupled with immunohistochemistry confirmed the diagnosis of Sinonasal Hemangiopericytoma. This case report stresses upon various differential diagnosis of sinonasal swellings and the importance of considering long term follow up of Sinonasal Hemagiopericytoma. Keywords: Hemangiopericytoma, Histopathology, Immunohistochemistry, Sinonasal, Soft tissue swelling.

Introduction: Although vitamin D insufficiency is very prevalent in Type-2 diabetes mellitus, there are no studies to prove its role or association in diabetic peripheral neuropathy. Aims and Objectives: We intend to highlight the relationship of Serum Vitamin D levels with Nerve Conduction Velocity in patients of Diabetic Peripheral Neuropathy. Material and Methods: 52 patients of diabetic neuropathy were assessed for sensory and motor nerve conduction velocity along with serum Vitamin D levels estimation and the results were statistically analyzed. Results: Tingling was the most common symptom, seen in 31.1% cases. The numbers of nerve involvement increased with the duration of diabetes mellitus. Majority of the patients showed decrease in SNCV and MNCV in more than three nerves,17(32.69%) and 15(28.84%) cases. 14(87.5%) vitamin D deficient patients had HbA1c levels >11.5. Vitamin D deficiency was more pronounced than insufficiency as the HbA1c levels got increased. The vitamin D deficiency increased in proportion to the duration of disease, with maximum number of vitamin D deficient patients in the disease duration of 11-15 years followed by vitamin D deficient patients with duration of disease>15 years. 36(69.2%) of the diabetic patients were deficient in vitamin D, followed by vitamin D insufficiency in 14(26.9%) (p value Conclusions: Nerve conduction velocities and vitamin D deficiency might be independently associated with diabetic peripheral neuropathy, so these investigative parameters could be used as an independent marker to assess the severity of the neuropathy. Keywords: Diabetes, Peripheral Neuropathy, Nerve Conduction Velocity, Vitamin D.

Eyelid tumors are the most common neoplasm in routine ophthalmology practice and encompass a wide variety of benign and malignant tumors, predominant being benign tumors. Hidrocystomas are rare, benign, cystic lesions of the skin often found on the head and neck region and typically occurs on the face in adults between 30 and 70 years of age. They are further divided into two groups - apocrine and eccrine hidrocystoma; both closely mimic clinically and morphologically related cystic sweat gland tumors. We present a “classic” case of eccrine hidrocystoma in a 60 year old female. The cysts are small, clear to blue and size ranging 1 to 6 mm in diameter. Histologically, the cysts are simple and lined by a 2 - 3 wall layers of cuboidal epithelium (non keratinizing), devoid of a myoepithelial layer. Eccrine lobules are often closely apposed, and occasionally the ducts enter the cysts. Immunohistochemically, they stain positive for S100 protein. Management of hidrocystomas mainly involves simple needle puncture with excision en mass. However, other treatment modalities are also available. Keywords: Eccrine, Eyelid, Histopatholoy, Hidrocystoma.

Objectives: To evaluate the role of angiogenesis by the assessment of mean vessel density and to quantify angiogenesis as an important variable in different benign and premalignant endometrial lesions. Materials and Methods: Endometrial biopsies and hysterectomy specimens were examined to evaluate and define any correlation between angiogenesis and different phases and premalignant diseased states of the endometrium. Microvessel counts were performed by examining the microvessels thoroughly in terms of count, morphology and density after staining the tissues by hematoxylin & eosin stain, reticulin stain and immunostain CD 34. Results: A total of 381cases of benign and premalignant endometrial lesions were included in the study. In 135 cases of simple hyperplasias, Microvessel Density (MVD) ranged from 2.4 - 6.7 and Mean MVD was 4.71 on H&E stain and MVD ranged from 2.8 - 8.3 with Mean MVD of 5.39 on reticulin stain. In 105 cases of complex hyperplasias, MVD ranged from 2.3 - 7.0 and Mean MVD was 4.93 on H &E satin and MVD ranged from 3.1-7.7 with Mean MVD of 5.68 on reticulin stain. In 67 cases of atypical hyperplasias, inbudding and outpouching of the glandular epithelium together with multilayering was appreciated with MVD from 4.5 - 8.8 and Mean MVD of 6.31 on H &E stain and MVD of 5.5 - 9.4 with Mean MVD of 7.19 on reticulin stain. A statistically significant difference was noted in all categories except in between simple and complex hyperplasia where the difference was not statistically significant. The role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although angiogenesis can be detected on immunostain more easily, it can be illustrated well by H and E or Reticulin stain. Conclusions: Role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although angiogenesis can be illustrated well by routine H and E and Reticulin stains, it can be detected on immunostains with greater degree of ease and accuracy. Keywords: Angiogenesis, Endometrium, Histopathology, MVD, Premalignant.

An association between chronic granulomatous infection, like tuberculosis and cancer exists, but few studies elucidate the possible mechanism of development. Break in the mucosal barriers with bacterial infection and impaired cell mediated immunity are known to be associated with cancer. Gastrointestinal tuberculosis is common in the ileocecal region, but isolated appendiceal tuberculosis is rare. Cancers of the appendix are rare and most of them are found accidentally on surgical appendicectomy specimens performed for appendicitis. The common appendiceal tumors are carcinoid, adenoma and lymphoma. Adenocarcinoma of the appendix accounts for only 0.08% of all cancers. It usually presents as appendicitis with evident lump or abscess. We present a case of a 42-year-old lady, who presented with symptoms of vague abdominal pain with low grade fever for 4 months and was diagnosed as appendiceal tuberculosis with coexistent mucinous adenocarcinoma of the appendix. Appendicectomy with right hemicolectomy was performed followed by adjuvant chemo-irradiation. She is doing well after 6 months of follow up period. Keywords: Appendix, Adenocarcinoma, Histopathology, Tuberculosis.

Skin adnexal tumours are a heterogeneous group of uncommon and rare tumours usually misdiagnosed clinically due to different types and similar presentation. They include a diverse group of benign and malignant neoplasms. They may present as single or multiple lesions and can be sporadic or familial in inheritance. They might be a superficial manifestation of an internal malignancy. Benign lesions are more common but malignant tumours are rare and locally aggressive, with potential nodal and distant metastasis with a poor clinical outcome. Histopathology is the basis of critical diagnosis, which has therapeutic and prognostic implications. Here we report a case series of skin adnexal tumours with aggressive behaviour on histopathology which appeared benign clinically. This case series emphasises the need for early detection and proper follow up of skin adnexal tumours to reduce the morbidity and mortality. Keywords: Adnexal Tumours, Benign, Histopathology, Malignant, Skin.

Scrotal calcinosis is a rare benign disease, which presents as multiple, painless, hard nodular growth in the scrotum without any systemic metabolic disorder. Histologic features of the lesion are extensive dermal deposits of calcium, with associated lympho-histiocytic aggregates and focal foreign body giant cell reaction. The pathogenetic mechanisms could be either purely idiopathic or any form of dystrophic calcification of the lining epithelial cysts or any inflammatory process with subsequent rupture, calcification and obliteration of the cyst wall. We present a rare case report of a 23-year-old male, who presented to the general surgery clinic with complaints of multiple, firm to hard scrotal swellings for the last 6 months. Microscopic examination of the excised growth showed multiple cysts with foci of normal and inflamed lining, with luminal calcific material with foci of ‘naked’ calcium deposits in the dermis. Biochemical tests showed normal values of serum calcium and phosphorus levels in our patient. Keywords: Scrotum, Biochemical, Calcinosis, Histopathology.

Introduction: Immunohistochemistry plays an important but limited role in the diagnosis of primary bone tumors. Sometimes it is very difficult to differentiate osteosarcomas histologically from other tumors with similar morphology but with different malignant potential and treatment protocol. The correct diagnosis of OSA relies on identification of osteoid production by malignant cells which can be detected by the use of osteonectin. Materials and Methods: The present study was carried out on 200 patients of benign and malignant lesions of bone. After a detailed clinical history and local examination, paraffin section of resected specimens were studied by hematoxylin and eosin and immunohistochemical stain, osteonectin and matrix was graded on a four-tiered grading system with statistical analysis of osteonectin positivity in osteogenic bone tumours and tumour-like lesions. Results: Benign and malignant tumours accounted for 74.6% and 25.0% of the total cases. Osteoid production were seen in 36 cases (100.0%) of osteosarcomas, followed by fibrous dysplasia in 18 cases (100.0%) and osteoid osteoma in 10 cases (100.0%). Both polygonal and spindle shaped tumour cells in osteosarcoma showed Grade 4 positivity with osteonectin. Fibroblastic variant of osteosarcoma showed diffuse (Grade 4) and focal strong staining (Grade 2) alternating with negative areas. Chondroblastic variant of osteosarcoma showed Grade 4+ immunoreactivity in conventional osteosarcoma like areas, whereas chondrocyte- like tumour cells surrounded by chondro-osteoid –like matrix showed well- defined osteonectin staining. Conclusions: Osteonectin is a helpful osteogenic marker for establishing the diagnosis of osteoblastic origin of a tumour that produce no or scarcely any matrix. Keywords: Bone Tumors, Immunohistochemistry, Osteonectin.

Acute appendicitis is a surgical emergency and accounts for 27.5% of the surgical cases. It is a very common cause of non-gynecologic lower abdominal pain and may occur simultaneously with a variety of gynecologic diseases. We report a case of a 24 years old female, who presented to the surgical emergency department with complaints of acute pain in abdomen for the last 1 day with tenderness in right iliac fossa. Laboratory reports showed leucocytosis with neutrophilia, with presence of toxic granules. A provisional diagnosis of appendicitis was made and the patient was operated. The appendectomy specimen on histopathological examination showed ectopic endometrial glands and stroma in the serosa, based on which a diagnosis of appendiceal endometriosis was given. This case emphasizes the importance of considering the diagnosis of appendiceal endometriosis in a young female of child bearing age with a clinical diagnosis of appendicitis. Keywords: Appendicitis, Endometriosis, Endometrial glands, Stroma.

Background: TGF-β is a pleiotropic cytokine that deploys several functions on different types of cells. In the lepromatous (LL) form of Leprosy, there is predominance of M2 macrophages, which induce the production of growth factors, such as TGF-β which is important for the mechanisms that cause apoptosis and healing. Aims: To study the immunoexpression of TGF-β in Hansen’s disease and to assess the severity of infection with potential response to treatment. Materials and Methods: The present study was carried out in 45 patients of Hansen’s disease after a detailed history and thorough physical examination performed in every subject and punch biopsies were performed. The specimens were fixed, paraffin embedded and sections of 3-5 microns thickness were cut and stained with hematoxylin and eosin stains. Additional sections of 3-4 microns thickness were cut and immunohistochemical staining by TGF-β antibody was performed. Results: Of the 45 cases of Hansen’s disease, most of the cases were of Borderline Tuberculoid and Borderline Lepromatous, constituting 14 (31.1%) cases each, followed by 9 (20.0%) cases of Lepromatous Leprosy. Maximum cases, 12 (26.7%) each with intense reaction were of Borderline Tuberculoid and Borderline Lepromatous, followed by 6 (13.3%) cases of Lepromatous Leprosy. Most of the cases, 9 (20.0%) were of Borderline Lepromatous category with highest proportion score, followed by 7 cases (15.6%) of Borderline Tuberculoid. Highest number of cases, 9 (20.0%) with high immunoreactivity score were in Borderline Lepromatous, whereas most of the cases, 7(15.6%) with low immunoreactivity score were in Borderline Tuberculoid. Conclusion: The immunoexpression of TGF-β was more intense in lepromatous side of the spectrum as compared to the tuberculoid, which indicates the severity of the disease with less cure potential.   Keywords: Hansen's disease, Immunoexpression, Prognosis, TGF­, Biomarker β

Endometrial stromal tumors are extremely rare uterine malignancy, mainly among young females. Herein, we report a case of low-grade endometrial stromal tumor in a 19-year-old women who presented with the non-specific symptoms of lower abdominal pain, swelling and vaginal bleeding similar to the uterine leiomyoma. Ultrasound finding showed bulky uterus with multiple fibroid and degenerative changes. Contrast enhanced computed tomography (CECT) displayed diffusely enlarged uterus with heterogenous enhancement of the solid cystic mass with normal bilateral tubes and ovary. Considering the patient in the reproductive age group and her fertility status, she was operated with surgical subtotal hysterectomy. Histopathological examination and immunohistochemistry confirmed the diagnosis of Low-Grade Endometrial Stromal Sarcoma (LG-ESS). Patient was closely followed up for recurrence. Endometrial Stromal Sarcoma (ESS) should be included in the differential diagnosis of uterine leiomyoma to avoid recurrence of the lesion.   Keywords: Endometrial stromal tumor, Sarcoma, Uterine leiomyoma, Immunohistochemistry.