Jaydeep N Pol

Osseous choristoma is the formation of normal mature bone at an abnormal position. These are rare benign tumor-like growth usually asymptomatic except growth or swelling as the clinical presentation. In oral cavity, osseous choristoma is rare and commonly found in posterior third of the tongue. Clinically it is misdiagnosed as malignancy because of its hardness. Clinically, it is also mistaken for other oral cavity lesions, especially those of minor salivary gland lesions of oral cavity. Hence, awareness amongst clinicians, general practitioners and oral pathologists about oral osseous choristomas is necessary. Here, we report two cases of osseous choristoma in the oral cavity located at sites other than tongue.   Keywords: Osseous, Choriostoma, Oral, Ectopic.

Angiomyolipoma (AML) is a rare benign mesenchymal neoplasm composed of a variable mixture of smooth muscle cells, adipose tissue and anomalous blood vessels. It belongs to the family of perivascular epithelioid cell tumors (PEComas). It is quite common in kidney but is rare at the extrarenal sites. In the uterus, only a few cases have been reported. We describe a case of uterine AML without evidence of tuberous sclerosis (TS). It was clinicoradiologically mistaken for fibroid. The clinical presentation of uterine AML is similar to more common uterine leiomyomas. AML can be suspected on the imaging but histopathology establishes a confirmed diagnosis. The case is presented for its rarity and likelihood of mistaking it for some other mesenchymal tumors. Overall, just 36 cases of Uterine AML have been reported in the English literature prior to this and this is only the second Indian case.   Keywords: Angiomyolipoma, Uterus, Extrarenal, Mesenchymal neoplasm

Chromophobe Renal Cell Carcinoma (ChRCC) is a rare distinct subtype of Renal cell carcinoma. It arises from intercalated cells of the renal cortex. The cytomorphological features of ChRCC show significant overlap with Clear cell Renal Cell Carcinoma (CCRCC) and Oncocytoma. The prognosis of ChRCC is intermediate between benign Renal Oncocytoma and the relatively aggressive CCRCC. Hence, a correct pre or intra-operative cytodiagnosis helps in deciding the extent of surgery. We report a case of eosinophilic variant of ChRCC in a 70 years female, diagnosed on Fine Needle Aspiration Cytology (FNAC).The Immunocytochemistry (ICC), histology and Immunohistochemistry confirmed the diagnosis of ChRCC. Diagnosing ChRCC; especially its eosinophilic variant on FNAC is very challenging. Prominent cellular heterogeneity, pleomorphism, perinuclear halos and binucleation are important diagnostic clues for cytodiagnosis of ChRCC. In difficult cases, ICC helps in confirming the diagnosis.   Keywords: Chromophobe, Renal Cell Carcinoma, Eosinophilic variant, FNAC

Follicular Cholecystitis (FC) is an extremely rare subtype of Chronic Cholecystitis (CC). It is characterized by hyperplastic lymphoid follicles along with prominent germinal centers. It constitutes about 2% of routine cholecystectomies. In this article, we report a case of FC in a 69 years lady. She had abdominal pain, clinically diagnosed as Calculus cholecystitis and managed by laparoscopic cholecystectomy. Grossly, thickening of the gall bladder wall was noted. Histopathological examination revealed gall bladder wall infiltrated by dense lymphoid infiltrate forming lymphoid follicles with prominent germinal centres. Hence, we rendered a diagnosis of FC. The purpose of presenting this case is to make pathologists aware about this entity. One should not mistake this lesion for lymphoma. A careful histopathological examination is diagnostic and Immunohistochemistry may be helpful in difficult cases. Key Messages: Follicular Cholecystitis is extremely rare variant of Chronic cholecystitis. It is characterized by at least 3 Lymphoid Follicles per cm of Gall Bladder tissue with inflammatory infiltrate composed almost exclusively of scattered well-formed Lymphoid Follicles. Pathologist must be familiar with this entity to avoid misdiagnosis of lymphoma.   Keywords: Follicular Cholecystitis, Gall Bladder, Lymphoid follicles, Hyperplastic

Background: Plasma cell dyscrasias are neoplastic proliferation of monoclonal plasma cells that encompass a wide range of entities. Plasmacytoma may present as one of two distinct clinical entities: Multiple myeloma and solitary plasmacytoma. The incidence of solitary plasmacytoma is 2-5% among all plasma cell neoplasms and it commonly involves long bones and vertebrae. Its occurrence in the jaw is extremely rare and only 4.4% are seen in mandible. Clinically, plasmacytoma of mandible presents as pain, tooth migration, hard and soft tissue swelling or pathological fracture. Radiologically, it presents as unilocular or multilocular lesion mimicking odontogenic tumour creating a diagnostic dilemma. Materials and Methods: We report a series of 3 cases of plasmacytoma of the mandible with comprehensive details of clinico-radiological, histological, immunohistochemistry findings and treatment with a review of the literature. Results: These three cases were clinically mistaken for Ameloblastoma, Odontogenic tumour and Oral cancer respectively. There was one case of Solitary Plasmacytoma and two cases on further workup proved to be multiple myeloma. All these cases were confirmed by immunohistochemistry. Conclusion: Plasmacytoma of mandible is very rare. It is usually mistaken for other common mandibular lesions and oral cancers. Every attempt must be made to diagnose them precisely as management is quite specific. To best of our knowledge, this is the first series of plasmacytoma of the mandible in the Indian literature.   Keywords: Plasmacytoma, Plasma cells, mandible, Myeloma

Background: Pancreatic tissue that has no direct or vascular connection to the main body of the pancreas constitutes ectopic pancreas or heterotopic pancreas (HP). Majority are located in the upper gastrointestinal tract (GIT). HP may be mistaken for neoplasms like neuroendocrine tumour (NET) and adenocarcinoma on endoscopy as well as on histopathology. We report six cases of HP along with review of literature; three of them were misdiagnosed as NET. To the best of our knowledge, this is the first case series of HP from India, rest being case reports. Materials and Methods: Histopathological features of six cases of HP were analyzed. Variables examined were clinical presentation, age at diagnosis, location, histopathologic type and immunohistochemical profile. Results: Two cases each were seen in duodenum and Meckel’s diverticulum while one case each was seen in stomach and an atretic segment of ileum, a site never reported previously. There were five males and one female with age ranging from one day to 48 years. Patients with gastric and duodenal HP were symptomatic. On histopathology, four cases were intramuscular and two were submucosal. Four cases were of Type I and two cases were of type II. Conclusion: HP should be considered in the differential diagnosis of submucosal upper GI lesions. Awareness, high degree of suspicion and thorough histopathological examination are necessary to arrive at a correct diagnosis. Immunohistochemistry for chromogranin and synaptophysin is useful for confirming the islets especially on small endoscopic biopsies. Key messages: HP must be considered in the differential diagnosis of submucosal upper GI lesions. Knowledge about this entity, high degree of suspicion and thorough histopathological examination help in arriving at a correct diagnosis and excluding mimics. Keywords: Heterotopia, Pancreas, Stomach, Duodenum.