Ch Geetha

Abstract

Introduction: Mucinous lesions of appendix are rare with an incidence of about 0.2 to 0.7% of all the appendicetomy specimens. The mucinous lesions of appendix range from simple retention cyst to malignant mucinous adenocarcinoma. Majority of mucinous appendiceal neoplasia are epithelial type (70%) with circumferential involvement of mucosa. Peritoneal seeding and pseudomyxoma peritonei can occur with both frankly malignant as well as low-grade appendiceal neoplasms. Nearly 50% of appendiceal malignancies present clinically as acute appendicitis and can be detected by imaging modalities. Aim of this study is to analyse the incidence, age and sex prediliction, clinical presentation and histopathology of mucinous lesions of appendix. Materials and Methods: It is a reterospective study of all the mucinous lesions of appendix diagnosed at Dept. of Pathology, Kamineni Academy of Medical Sciences and Reserch Centre (KAMSRC) from 2013- 2017. Clinical details and relevant radiological investigations are noted from case sheets. Microscopic examination is done on slides stained with routine H & E and AB-PAS. Diagnosis and classification is based on WHO 2010 and recommendations in the AJCC 8th edition. Results: Mucinous lesions accounted for 0.8% (10/1200). of all appendicetomy specimens. The study included 10 cases of mucinous lesions of appendix(10 cases): Simple mucocele (2 cases), Benign mucinous adenomas(3 cases), Low grade Appendiceal Mucinous Neoplasm (LAMN) with pseudomyxoma peritoni (PMP) (1 case), Mucinous cystadeno carcinomas (4 cases). Benign lesions are seen in females and at a younger age as compared to malignancies which are common in males and at a older age. Most common presentation is abdominal pain followed by appendicitis. Mucosal hyperplasia and high grade appendiceal mucinous neoplasms(HAMN) are not seen in our study. Conclusion: Mucinous lesions of appendix are rare. They are more common in females and associated with non-specific clinical features. Histopathology is critical for establishing diagnosis, further management and prognostication of all the mucinous lesions of appendix. Keywords: Appendiceal mucinous tumors, Cystadenoma, Cystadenocarcinoma, Mucocele, Histopathology.

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Abstract

Introduction: Spindle cell sarcomas are a heterogeneous group including various histopathologic entities. Grading of these tumors is the most important prognostic factor and has a bearing on patient management. Cytology is well established tool for primary diagnosis of spindle cell sarcomas, particularly for recurrent and metastatic lesions. Herein, we describe our experience with respect to morphology and cytologic grading of spindle cell sarcomas and its histology correlation. Aims and objectives of this study is to analyse cytological features of soft tissue spindle cells sarcomas and to grade spindle cells sarcomas on cytology and to correlate with corresponding grading on histology wherever available. Materials and Methods: All spindle cell sarcomas diagnosed on FNAC from January 2007 to May 2012 were included in the study. May-Grunwald-Giemsa and Pap stained smears with minimum of 4 slides with at least 20 clusters were examined for each case. The sarcomas were subtyped wherever possible. Cytologic and histopathologic grading was performed using Weir et al criteria and FNLCC system respectively. The histopathology was correlated with the help of cell block, biopsy or subsequent resections. Summary and Conclusion: Primary diagnosis of sarcoma is possible on FNAC with good clinical and imageological correlation along with the use of ancillary techniques like Immunocytochemistry Sub-typing is challenging for spindle cell sarcomas due to complex heterogeneity and morphological overlap. Subtyping is possible for Synovial sarcomas. There is an overall 81.8% concordance on grading. Though useful, Cytologic grading cannot be used as a single tool for prognostication. There is a need to modify the histologic criteria of grading so that more accurate and precise Cytologic grading can be possible. Keywords: Spindle cell sarcoma, Cytology, Histology, Subtyping, Grading.

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