Annals of Pathology and Laboratory Medicine

Study of Histopathological Changes in Fibroadenoma of the Breast

Sneha P — 2023-03-19

Background: Fibroadenoma of the breast is a relatively frequently occurring tumor. Although often considered a benign tumour, several reports describe a higher risk of subsequent breast carcinoma in patients diagnosed with fibroadenoma. Increased risk depends on presence of complex changes within fibroadenoma, presence of hyperplasia and positive family history for breast cancer.

Aims and Objectives: Our main aim was to study the histological variations within the fibroadenoma of the breast and also to identify those lesions with the possible risk of malignancy.

Methods: Descriptive study of three years. A total of 250 cases of fibroadenoma were studied. Slides were stained with Hematoxylin and Eosin (H & E) and were thoroughly reviewed. Slides were screened for proliferative epithelial changes, fibrocystic epithelial changes, stromal changes and various other changes such as foci of tubular adenoma and phyllodes tumour. Slides with invasive malignancies were excluded from the study.

Result: Apocrine change among fibrocystic changes was the commonest variation within the fibroadenoma. Complex fibroadenoma, moderate and atypical ductal hyperplasia was seen in older age groups.

Conclusion: Increased risk of breast cancer is seen patients with presence of hyperplasia and complex fibroadenoma of the breast. So exclusive study of histopathological changes in epithelial and stromal elements of fibroadenoma is required and are essential to be reported so as to alert the clinician for follow up of the patient. This will help in timely management to reduce morbidity and mortality.

Endometriosis : A Rare Etiology for Small Bowel Obstruction

Arpita Sutradhar — 2023-03-19

Endometriosis affecting gastrointestinal tract has been reported in 3-37% of menstruating women. It is seen in the recto-sigmoid, caecum, small bowel and the appendix in decreasing frequency. Involvement of the ileum by endometriosis is quite rare ,1-7% cases have been documented..Endometriosis of ileal segment of gastrointestinal tract leading to intestinal obstruction ranges from 7% to 23%.We report a 40 year. old female who presented with complete intestinal obstruction ten days with history of recurrent subacute intestinal obstruction for one year. She was previously treated with empirical Antitubercular drug to which she did not respond. Now histology of the resected specimen showed endometriosis in muscular propria and submucosa , leading to fibrosis and stricture formation.

A Case of Acute Promyelocytic Leukemia Presenting as Sternal Infiltrate

Kalyani Bapat — 2023-03-19

Granulocytic sarcoma (GS) or myeloid sarcoma (MS) is a localized extramedullary tumor composed of immature myeloid cells which can develop de novo or concurrently with acute myeloid leukemia (AML), myeloproliferative disorders (MPN) or myelodysplastic syndrome (MDS). It can present before, along with or after the diagnosis of acute myeloid leukemia, MPN, MDS or may present as a manifestation of relapse in a previously treated AML patient. The occurrence of MS in an acute promyelocytic leukemia (APL) patient is a very uncommon clinical event especially as initial or primary presentation. APL is often associated with a life threatening coagulopathy making prompt diagnosis and initiation of therapy critical. Unusual clinical localization may lead to misdiagnosis, or delayed diagnosis and treatment. Hence being aware of such atypical presentations of APL is crucial. Here we report a patient with acute promyelocytic leukemia who presented with sternal infiltrate but without any systemic symptoms. The diagnostic challenges are of particular interest given the unusual clinical presentation along with atypical morphology of the abnormal promyelocytes.

A Rare Primary Mucocutaneous Presentation of Chronic Disseminated Histoplasmosis in an Immunocompetent Young Female: A Case Report

Ankita Shashikant Shende — 2023-03-19

Classical Histoplasmosis also known as Darling’s disease is a systemic mycosis caused by dimorphic fungus, Histoplasma capsulatum var capsulatum and Histoplasma capsulatum var duboisii. It is an opportunistic fungal infection that usually affects immunocompromised patients. Though microbiology culture methods are the gold standard, scrape cytology and histopathology give a relatively rapid diagnosis. It may pose a diagnostic dilemma on histopathology and morphology needs to be carefully studied to rule out other differentials. We present a rare case of chronic disseminated histoplasmosis with primary mucocutaneous lesions in an immunocompetent young female patient. This study is ethically approved from the institute and due written consent for publication from the patient has been taken.

A Case of ACTH Independent Macronodular Adrenocortical Hyperplasia Presenting with Conns Syndrome

Neethika Menon — 2023-03-19

Backgound: ACTH Independent macronodular adrenocortical hyperplasia (AIMAH)is a rare cause of hyperaldosteronism and is characterised by bilateral adrenal hyperplasia . One of the most common presenting symptoms is refractory hypertension. Clinical features and hypertension usually resolve following adrenalectomy. Timely diagnosis of such conditions are pertinent as they are completely treatable and thus prevents further comorbidities associated with hypertension and hypokalemia like arrhythmia.

Case Presentation: A 57 year old male patient presented with unresolved hypertension since 15 years even after treatment with three different antihypertensives drugs since last one year. He was detected with raised serum aldosterone levels. Adrenal venous sampling showed lateralisation to the left adrenal. CT abdomen and pelvis revealed enlarged and nodular left adrenal gland and a bulky right adrenal gland. Laparoscopic left adrenalectomy was performed. Grossly left adrenal showed multiple well circumscribed yellow coloured nodules restricted to the cortex. Microscopy showed multiple well circumscribed unencapsulated nodules comprising of compact cells with clear to vacuolated cytoplasm and round central nucleus along with few foci of myelometaplasia.

Conclusion: Conns syndrome causes a high rate of mortality and morbidity of left untreated. Serum aldosterone, serum cortisol and serum electrolyte levels should be carried out in every case of refractory hypertension to rule out adrenocortical lesions. Timely diagnosis goes a long way in reducing morbidities associated with hypertension and dyselectrolytemia.