Mohammad Jaseem Hassan

Background: The present study was conducted with the aim to determine the pattern of distribution and to detect any association of transfusion transmitted infections (TTI) with ABO and Rh blood groups. Materials and Methods: A retrospective study was conducted at the blood bank of our hospital over a period of two years. A total of 36,614 healthy donors were included in the study. All the donor blood bags were screened for HbsAg, HIV, HCV, Syphilis and Malaria. The most common blood group was B positive (34.91%) while the least common was AB negative (0.61%). The total seroreactivity of TTI was 5.59%. Out of the total, 2.38% cases were reactive for HBsAg, 1.27% for anti HCV, 0.35% for HIV, 1.29% for syphilis and 0.29% for Malaria. Maximum seroreactivity was seen in blood group B positive (1.79%) followed by O positive (1.54%) and then A positive (1.28%). A significant association was seen between Rh positive blood group and HBsAg seropositivity (P value of 0.0459). In syphilis positive donors, there was significant association between syphilis infection and AB blood group with a P value of 0.0331. Conclusion: This study provides the prevalence of ABO and Rh blood group and also their association with the transfusion transmitted infections (TTI). This study shows a significant association between Rh positive blood group and HBsAg and also significant association was seen between AB positive blood group and syphilis infection. Keywords: ABO, Rh, Blood group, TTI.

Peripheral Ossifying fibroma is a slow growing tumor commonly found in the gingival region in females. We discuss an unusual occurrence of peripheral ossifying fibroma on the hard palate in a young male. Clinically the lesion should be differentiated from a pyogenic granuloma, peripheral giant cell granuloma and odontogenic tumors. Definitive diagnosis requires excision and histopathological examination. Keywords: Hard palate, Ossifying fibroma, Peripheral.

Angioleiomyoma is a slow-growing benign pericytic tumor originating from the tunica media layer of blood vessel wall and represents 4–5% of all benign soft tissue tumors. Vascular leiomyomas show a greater predilection for the lower extremities than other superficial leiomyomas. Excisional biopsy of the tumor is both diagnostic and curative, with a low recurrence rate reported in the literature and excellent prognosis. Malignant transformation is very rare. Whenever a patient presents with a painful mass in the lower extremity, the diagnosis of leiomyoma should be considered. We present a case of a 30-year-old male with angioleiomyoma of left lower leg who presented with painful slow growing nodular swelling since six years. The mass was excised and on microscopic examination a diagnosis of angioleiomyoma was rendered, which was confirmed by positivity for smooth muscle actin on immunohistochemistry. Keywords: Angioleiomyoma, Angiomyoma, Pericytic tumor, SMA, Vascular leiomyoma.

Tuberculosis is one of the major cause of morbidity and mortality worldwide. Primary tuberculosis of tonsils in absence of pulmonary involvement is a rare entity with an incidence of less than 5%. Palatine tonsils are located at a site which is frequently exposed with infected sputum or saliva. Chronic tonsillitis with enlarged tonsils and sore throat are the main clinical presentation. We report a case of primary tuberculosis of tonsils in a 21- year old male who presented with chief complaints of sore throat, difficulity in swallowing, odynophagia and swelling neck since 4 months. Final diagnosis of tonsillar tuberculosis was made on histopathology. Keywords: Sore throat, Tonsil, Tonsillitis, Tuberculosis.

Among all salivary gland tumors, Canalicular adenoma constitutes only 1% of all neoplasms. Oral cavity is the most common location for this rare benign neoplasm of minor salivary glands. Within oral cavity upper lip is the most common site for this tumor followed by buccal mucosa and sometimes it is rarely seen in parotid gland. Previously CA was considered as a type of monomorphic adenoma, however in latest World Health Organization (WHO) classification, CA is classified as a separate entity under benign neoplasms. Here we report a case of CA in a 65 year old female patient who presented with swelling upper lip since 10 months. The swelling was painless submucosal nodule, firm in consistency measuring approximately 2 cm in diameter. Diagnosis of mucous retention cyst was made clinically. Cyst was excised and on histopathological examination we made diagnosis of Canalicular adenoma. We report this case because of rarity of this lesion. Keywords: Benign cyst, Canalicular adenoma, Lips, Minor salivary gland, Monomorphic adenoma.

Idiopathic Scrotal Calcinosis (ISC) is a rare benign lesion involving the scrotal skin which is characterized by the presence of single or multiple calcified nodules. It usually presents during third decade of life. Many theories about the etiopathogenesis have been proposed, one of which is dystrophic calcification in the background of epidermal inclusion cyst over a period of time. Clinically, scrotal calcinosis may be confused with epidermal inclusion cysts, steatocystoma, cutaneous circumscription or benign tumors like lipoma, fibroma or others. Our patient, 25 year old male presented with multiple painless swellings over scrotal skin. Clinical diagnosis of multiple sebaceous cysts was made. Surgical excision of all the nodules was done and sent for histopathological examination. Microscopy revealed presence of amorphous basophilic calcified deposits in the dermis, predominantly without epithelial lining. The histopathological diagnosis of idiopathic scrotal calcinosis was made. Keywords: Idiopathic calcinosis scrotal calcinosis dystrophic calcification epidermal inclusion cyst.

A Schwannoma is a benign nerve sheath tumor composed of Schwann cells. Schwannoma arising from the vagus nerve is an uncommon (2–5%) benign nerve tumor. Less than 1% becomes malignant. Definitive pre-operative diagnosis may be difficult and investigations such as FNAC have low specificity. Surgical removal of tumor is the treatment of choice for vagal schwannomas with nerve preservation. Surgical removal can be done either by intra capsular enucleation or extra capsular excision of tumor. Definitive diagnosis is obtained by means of surgical pathology. Here we present a case of 40 year old male presented with swelling over anterio -lateral aspect of left lower neck region for last four years with mild change in his voice for few months. CECT of the neck was suggestive of left neck cystic necrotic lesion. On FNAC the swelling was misdiagnosed as colloid nodule. The mass was excised. Grossly a single encapsulated globular cystic tissue piece measuring 8.5x7x6 cm was received in histopathology lab, which on cut section show a unilocular cyst filled with blood mixed mucoid material. On Histopathology, a diagnosis of Schwannoma was rendered. Keywords: Benign tumor, Neck swelling, Schwannoma, Vagal nerve.

Abstract Simple renal cysts are the most common renal masses but the major concern is to differentiate a simple renal cyst from a complex cyst which may have foci of malignancy. However, this association is seen in 1% cases only. Most of the renal cysts are benign, asymptomatic and are usually treated conservatively. However, various cystic diseases are associated with renal cell carcinoma. Renal cysts with thickened, irregular septa and enhancement on contrast injection raise a suspicion of malignancy. We present a case of a 41 year old male who presented with renal cell carcinoma of left kidney with multiple simple renal cysts. Keywords: Multifocal RCC, Nephrectomy, Renal cyst, Renal cell carcinoma. Introduction Risk factors for Renal Cell Carcinoma (RCC) includes cystic diseases like Adult Polycystic Kidney Disease (APCKD), acquired cystic diseases, Von-Hippel Lindau (VHL) disease and tuberous sclerosis complex (TSC).[1],[2]Risk of RCC in ADPKD is not known exactly. On the other hand, risk of RCC in VHL patients is substantial and mortality rate is also high despite close follow-up. In tuberous sclerosis complex patient’s risk of development of RCC is far less as compared to the risk in VHL patients.[3]In cysts with a nodule, cystic tumour necrosis and intrinsically cystic neoplasms, the adjacent kidney tissue is mostly non-cystic. However, if multiple renal cysts are present, a cystic renal disease with a neoplastic diathesis should be considered and investigated. We present a case of 41 year old male patient who presented with RCC of left kidney in association with multiple simple renal cysts. Case Report A 41 year old male presented with lower back pain for 4 months. Ultrasound showed multiple solid and cystic lesions in left kidney and diagnosis was given as likely to be RCC. Left radical nephrectomy was done and renal specimen was received in histopathology measuring 8.5x7x6cm. External surface showed numerous cysts ranging in size from 1.8x1.5cm to 1x0.8cm. (Fig. 1) The cysts were thin-walled and filled with gelatinous material to clear fluid. On bisecting the kidney, two well-circumscribed growths measuring 4x3x3cm and 2.2x2x1.2cm were seen in the middle part and near the pelvis, respectively. The cut section of both the growth was variegated and showed areas of hemorrhage and necrosis. (Fig. 2) Microscopic examination from both the growth showed round to polygonal tumor cells with abundant clear cytoplasm, arranged in solid sheets and tubules. (Fig. 3A) These tumor cells were traversed by delicate branching vasculature. Focal area showed clear cells arranged in papillary fashion with fibrovascular core present in papillae. (Fig. 3B). At places tumor cells were forming tubular structure with presence of simple cyst adjacent to the tumor. (Fig. 4A) Multiple simple renal cysts lined by cuboidal epithelium and filled with proteinaceous material were identified in the adjacent renal tissue. (Fig. 4B) Thus, based on histopathological examination a diagnosis of Multifocal RCC, Clear cell type with focal papillary features with presence of multiple simple renal cyst was rendered. Furham’s nuclear grade of the neoplasm was 2. Pathological TNM staging was T1NX. Ureter, renal vein and perinephric fat were found to be free of tumour. Click here to view Fig. 1: Gross- Left radical nephrectomy specimen showing grey white nodular tumor mass (Green arrow) along with many variably sized simple renal cyst (Blue arrow). Click here to view Fig. 2: Gross- On bisecting the kidney, two well-circumscribed growth was seen in the middle part and near the pelvis. The cut section of both the growth was variegated and showed areas of hemorrhage and necrosis (Green arrow). A thin walled cyst is also seen adjacent to larger growth (Blue arrow). Click here to view Fig. 3: A- photomicrograph showing sheets of round to polygonal tumor cells with abundant clear cytoplasm along with traversing delicate branching vasculature (H&Ex400). B- Photomicrograph showing papillary arrangement of clear tumor cells (H&Ex400). Click here to view Fig-4: A- Photomicrograph showing tubular arrangement of tumor cells (Green arrow) along with adjacent simple cyst (Blue arrow). (H&Ex100). B- Photomicrograph showing simple cyst of kidney lined by cuboidal epithelium and filled with proteinaceous material. (H & Ex100) Discussion Simple renal cyst is the most common pathology associated with urinary tract system. However, Renal Cell Carcinoma is seen to be associated with multiple simple renal cysts in only 1% cases.[3]Case reports of this association are very rare. In the year 1875, association between Renal Cell Carcinoma (RCC) and simple renal cysts was first proposed by Sturm.[4] Mostly the simple renal cysts are unilocular and benign whereas the complex cysts have thickened irregular septa & may be multiloculated. Recent advances in radiology have improved the clinical approach towards diagnosing the asymptomatic renal masses. Bosniak classification system clinically classifies the renal cystic tumors into 3 categories based on the CT findings. In category I, the incidence of malignancy is very low whereas in categories II and III, a certain risk of malignant cystic disease is included and appropriate treatment may be required.[5],[6]However, it may be difficult to determine preoperatively whether or not a cyst is malignant due to the small size of the malignant tissue inside the cyst, which cannot be detected by imaging alone. Lin et al, reported a case which was initially diagnosed as a simple cyst and was treated by ultrasound?guided aspiration, but 3 weeks later ultrasound examination revealed a recur­rent sizeable cyst which was treated by performing nephrectomy. The pathological examination confirmed the diagnosis of papillary RCC.[7] Visapaa et al, evaluated 482 patients and demon­strated an association between simple renal cysts and papillary RCC.[8] Sakai et al, reported a case of a simple renal cyst that developed into a septated renal cyst and finally transformed into a cystic clear cell RCC over a duration of 6 years.[9]This case demonstrated the natural transformation of a simple renal cyst into malignancy and emphasized that careful follow?up of renal cysts, particularly of complicated type, is mandatory. Takao et al, also reported a similar case where cystic RCC was diagnosed as a simple cyst preoperatively.[10] Both acquired and syndromic renal cysts may be associated with Renal Cell Carcinomas such as Adult Polycystic Kidney Disease (APCKD), Von-Hippel Lindau (VHL) disease and tuberous sclerosis complex (TSC). A study conducted by Keith et al found that in association with Autosomal Dominant Polycystic Kidney Disease, Renal Cell Carcinoma develops at a younger age (47 years) as compared to sporadic Renal Cell Carcinoma (61 years). Also, it is more often bilateral (12 versus 2 to 6%) and multicentric (30 versus 5%).[11]Breysem L et al, observed that in Tuberosus Sclerosis Complex cases, renal involvement occurs in 50 to 80% cases in the form of rnalignant cysts and renal neoplasms.[12] Shehata BM et al, observed that in Von-Hippel Lindau patients, renal involvement occurs in the form of multiple, bilateral clear cell-lined cysts in 70 to 80% cases and multiple, bilateral clear cell type Renal Cell Carcinoma in 40-60% cases.[13],[14]Association between Renal Cell Carcinoma and End Stage Kidney Disease with Autosomal Dominant Polycystic Kidney Disease was first proposed by Dunhill et al.[15] In End Stage Kidney Disease and Autosomal Dominant Polycystic Kidney Disease patients the risk of developing Renal Cell Carcinoma increases with the duration of dialysis. The neoplasms developing in End Stage Kidney Disease and Autosomal Dominant Polycystic Kidney Disease are more often multifocal, bilateral and have a papillary appearance.[16],[17]Renal Cell Carcinoma associated with End Stage Kidney Disease has now been recognized as a distinct entity by World Health Organization (WHO). Also risk of RCC in acquired renal cystic disease is five times greater than in the general population. The morphology of the cysts and associated tumor types can help to predict the acquired or genetic basis of the lesions. Thus, it is important to mention these associations in the histopathology reports.[18] Understanding of the initiating molecular events in cyst formation & renal neoplasm in cystic diseases like Adult Polycystic Kidney Disease (APCKD), acquired cystic diseases, Von-Hippel Lindau (VHL) disease and tuberous sclerosis complex (TSC) is important as it has shown promise for developing targeted therapies for neoplasms which were previously being treated by surgical approach. Conclusion The aim of the present study was to emphasize the importance of recognizing that RCC may occur in what appears to be a simple renal cyst. Although, this association of RCC with simple renal cysts is seen in only one percent of cases, if the presence of malignancy is pathologically confirmed, an immediate partial or radical nephrectomy needs to be performed. Conflicts of Interest: None.         References ^ Truong LD,Choi YJ, Shen SS, Ayala G,Amato R, Krishnan B: Renal cystic neoplasms and renal neoplasms associated with cystic renal diseases: Pathogenetic and molecular links. Adv Anat Pathol 2003;10:135-159. ^ Siroky BJ, Czyzyk-Krzwska MF, Bissler JJ: Renal involvement in tuberous sclerosis and VHL disease: Shared disease mechanisms? Nature Clinb Pract , 2008;5:243-256. a, b Stephen M. Bonsib. Renal cystic diseases and renal neoplasms: A Mini-Review. Clin J Ann Soc Nephrol  2009;4:1998-2007. ^ Yanlan YU, Liang MA, Zhenghui Wang, Zhigen Zhang: Renal Cell Carcinoma presenting as a simple renal cyst. Mol Clin Oncol , 2017;6:550-552. ^ Bosniak MA: The current radiological approach to renal cysts. Radiology 1986;158:1?10. ^ Israel GM and Bosniak MA: An update of the Bosniak renal cyst classification system. Urology  2005;66:484?488. ^ Lin CJ, Chen YC, Chen HH, Wu CJ and Hsu JM: Renal cell carcinoma presenting as a huge simple renal cyst. Med Oncol  2008;25:104?106. ^ Visapää H, Glucker E, Haukka J, Taari K and Nisen H: Papillary renal cell cancer is strongly associated with simple renal cysts. Urol Int 2013; 91:269?272. ^ Sakai N, Kanda F, Kondo K, Fukuoka H and Tanaka T: Sonographically detected malignant transformation of a simple renal cyst. Int J Urol  20018:23?25. ^ Takao T, Gotoh T, Takada S and Sugao H: Cystic renal cell carci­noma diagnosed as a simple cyst preoperatively with incidental renal tumor: A case report. Hinyokika Kiyo ,1999;45:339?342 ^ Keith DS, Torres VE, King BF, Zincki H, Farrow GM: Renal cell carcinoma in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1994; 4:1661–1669. ^ Breysem L, Nijs E, Proesmans W, Smet MH: Tuberous sclerosis with cystic renal disease and multifocal renal cell carcinoma in a baby girl. Pediatr Radiol  2002;32: 677– 680. ^ Shehata BM, Stockwell CA, Castellano-Sanchez AA, Setzer S, Schmotzer CL, Robinson H: von Hippel-Lindau (VHL) disease: an update on the clinico-pathologic and genetic aspects. Adv Anat Pathol  2008;15:165–171. ^ Solomon D, Schwartz A: Renal pathology in von HippelLindau disease. Hum Pathol 1988;19:1072–1079. ^ Dunnill MS, Millard PR, Oliver D: Acquired cystic disease of the kidneys: a hazard of long-term intermittent hemodialysis. J Clin Pathol 1977;30:868 – 877. ^ Schwarz A, Vatandaslar S, Merkel S, Haller H: Renal cell carcinoma in transplant recipients with acquired renal cystic disease. Clin Am Soc Nephrol, 2007; 2:750 –756. ^ Farivar-Mohseni H, Perlmutter AE, Wilson S, Shingleton WB, Bigler SA, Fowler JE Jr: Renal cell carcinoma and end stage kidney. J Urol  2006;175: 2018 –2021. ^ Ying-Bei Chen, Satish K Tickoo: Spectrum of Preneoplastic and Nneoplastic Cystic Lesions of the Kidney. Arch Pathol Lab Med 2012 ;136:400-409.

Mature cystic teratomas are ovarian neoplasms derived from two to three germ cell layers i.e. ectoderm, mesoderm and endoderm. Ovarian teratomas are usually benign tumours of the reproductive age group. They usually have right-sided predisposition. However, only 10-20% of these neoplasms may have bilateral presentation. Here, we present a rare case of bilateral mature cystic teratoma of ovaries in a 32 years old multigravida female who presented with pain lower abdomen from one month. Ultrasonography showed bilateral solid-cystic adnexal lesions along with calcifications in the left adnexal mass. Serum level of CA-125 was within normal range. Laparoscopic bilateral oophorectomy was done along with bilateral tubal ligation. The histopathological examination confirmed the diagnosis of bilateral mature cystic teratoma of the ovaries. Keywords: Benign, Cyst, Dermoid, Ovary, Teratoma.

Axilla is the most common site for accessory breast tissue. Fibroadenoma is a very common benign lesion of breast but is not commonly found in accessory breast tissue. We report a case of fibroadenoma in a 19-year-old young unmarried girl who presented with a mobile swelling in left axilla since five months. The ipsilateral breast was normal. No FNAC was performed and excision biopsy was done and sent for histopathological examination which showed features of fibroadenoma. The most important clinical significance is that number of inflammatory, cystic and neoplastic diseases similar to those of a normal breast have also been reported in accessory breasts. For early detection of malignancy in the axilla, a vigilant self-examination and clinical assessment is required. Keywords: Fibroadenoma, Accessory breast, Ectopic breast tissue.

Sebaceous carcinoma is a rare locally aggressive neoplasm of the sebaceous gland, which occurs frequently in elderly males. It constitutes 0.2 to 4.6% of all the malignant cutaneous tumours and occurs commonly in the periocular area. Scalp is a rare site for this tumor. Here we report a case of sebaceous carcinoma in a young 28 years old male patient who presented with firm to hard exophytic growth over right posterior occipital region with enlarged suboccipital and post auricular lymph nodes. Wide local excision was done and a diagnosis of sebaceous carcinoma of the scalp with lymph node metastasis was rendered after histopathological and Immunohistochemical examination.   Keywords: Cutaneous tumor, Periocular area, Sebaceous carcinoma, Scalp