Annals of Pathology and Laboratory Medicine

A Rare Case of Epithelial-Myoepithelial Carcinoma Breast in A Young Female with HER2neu Positivity

Shipra Verma — 2023-11-01

Epithelial-myoepithelial tumors of breast are biphasic neoplasms, with dual participation of epithelial and myoepithelial components. It is a very rare tumor, common in elderly females. EMC breast resembles its salivary gland counterpart, which itself forms less than 1% of all salivary gland tumors. Herein, we report one such rare case of EMC breast in a young female with aberrant HER2 positivity, a feature not yet reported in literature.

A Rare Case Report of Serous Cystadenoma with Coexisting Sclerosing Stromal Tumor of Ovary

Lachit Kalita — 2023-11-01

Various forms of collision tumors have been reported in literature before. Ovarian tumors also exhibit different histological components at times. The epithelial neoplasm of ovary in coexistence with sertoli leydig cell tumor, granulosa cell tumor, cystic teratoma and stromal tumor with minor sex cord elements are known to exist. However, literature related to association of serous neoplasm of ovary with sclerosing stromal tumor is not known. We report a case of serous cystadenoma with coexisting sclerosing stromal tumor in a 31-year-old lady which is probably one of the first case reports of such a combination till date.

Metachronous Testicular Mixed Germ Cell Tumour and Gastric Marginal Zone Lymphoma: A Case Report with An Unusual Association

Mayur Parkhi — 2023-11-01

Background

Second primary malignancies (SPMs), irrespective of location, are characterized by two or more distinct neoplasms in the same patient. Gastric marginal zone lymphoma of mucosa-associated lymphoid tissue (MZL) shows a higher risk of developing a second primary malignancy and exhibits inferior overall survival.

Case Report and Discussion

We report a case of a 55-year-old male who presented with a painless, hard, right testicular mass, which progressively grew over 3 months. He was diagnosed with gastric MZL on biopsy 4 years back and was treated by CHOP regime; 6 cycles. At the time of testicular mass diagnosis, the contrast-enhancing computed tomography imaging revealed metastasis involving both lungs and retroperitoneal lymph nodes with inferior vena cava thrombus. He underwent right inguinal orchidectomy and showed histopathological features of the mixed germ cell tumour composed of seminomatous and non-seminomatous components (embryonal and yolk sac tumours). This morphology was confirmed using a wide panel of immunohistochemistry markers (OCT3/4, PLAP, c-KIT, CD30, AFP, Glypican 3, β-HCG, and EMA). He received 4 cycles of the BEP (bleomycin, etoposide, and cisplatin) regime and was doing well at 13 months of follow-up.

Conclusion

The index case highlights an exceedingly rare association of gastric MZL with testicular mixed germ cell tumour with rare age presentation. Thus, surgeons, radiologists and pathologists should be aware of considering the differential of non-lymphoid malignancy at the distant site apart from the systemic spread of primary extranodal non-Hodgkin lymphoma. This will help in deciding and providing the appropriate treatment to the patient on time.

Effusion Cytology of Dysgerminoma: A Case Report with Review of Literature

Meera Balakrishnan — 2023-11-01

Ovarian dysgerminoma is a rare malignant ovarian germ cell tumor (MOGT) with its peak incidence in women younger than 20 years. Peritoneal and pleural dissemination of ovarian tumors is a major prognostic parameter in ovarian malignancies. Effusion cytology of germ cell tumors are not frequently reported in the literature. We report a case of a MOGT in a 15 year old female who presented with severe painful abdominal distention and respiratory distress. Ascitic and pleural fluid cytology were positive for malignant cells which on immunocytochemistry supported the diagnosis of metastatic dysgerminoma. The histopathology of the ovarian mass was confirmed to be dysgerminoma FIGO stage IVA. This case report highlights the salient cytomorphologic features of metastatic dysgerminoma in ascitic and pleural fluid discussing the differential diagnoses.

Renal Medullary Carcinoma, A Rare But Aggressive Sickle Cell Nephropathy: A Case Report

Lakshmy S Kumar — 2023-10-19

Renal Medullary Carcinoma (RMC) is a highly aggressive cancer that typically affects adults in second to third decades of life with male preponderance and dismal prognosis. As the name indicates, it is medulla centric and is almost exclusively associated with sickle cell hemoglobinopathy. Tumor shows SMARCB1 /INI-1 deficiency and hence called SMARCB1 deficient renal medullary carcinoma. As there are only around 600 cases been reported worldwide till date, we report this case as an eye opener for having high degree of clinical and pathological suspicion in renal cancer patients of younger age, especially if there is no known history of hemoglobinopathy. Prompt diagnosis and treatment is warranted to prolong survival. Our case is that of a 36yr old male who presented with hematuria and loin pain of six months without any significant past history. Radiological evaluation showed right renal mass with extensive metastatic disease. Palliative right radical nephrectomy was done which on thorough histomorphological and immunohistochemical examination was diagnosed as renal medullary carcinoma. Tumor cells showed loss of INI 1 expression which is a surrogate marker for SMARCB1 deficient status. High performance liquid chromatography was done which revealed sickle cell trait. He was started on immunotherapy and chemotherapy, following which he had a favorable treatment response.

Adrenal Gland Incidentalomas: Case reports

Archana N Rijhsinghani — 2023-11-01

Adrenal lesions are serendipitously discovered in upto 5% of cross-sectional examinations performed for other purposes and are hence labeled incidentalomas. Here is the presentation of two cases, one of which is myelolipoma, second common cause of adrenal tumor and other is a rare bronchogenic cyst.

Human Parvovirus B19 Induced Pure Red Cell Aplasia in a Known Case of Hereditary Spherocytosis; A Bone Marrow Diagnosis

Tejaswini Priyadarshan Waghmare — 2023-11-01

Human Parvovirus B19 (HPV B19) is a single stranded DNA virus belonging to parvoviridae family causing an acute self-limiting viral infection transmitted through respiratory droplets. However, in patients with hemolytic anemia, it can cause pure red cell aplasia and eventually aplastic crisis. We report a case of 27-year-old male, who presented with complaints of fever, nausea and body ache for 15 days. Physical examination showed pallor, icterus and splenomegaly. Complete blood count (CBC) revealed pancytopenia. Plasmodium Vivax infection was seen on peripheral blood smear (PBS) and hence was treated with antimalarials, however fever persisted. Bone marrow examination done in view of panytopenia revealed large proerythroblast with eosinophilic intranuclear inclusions. The impression given was hypercellular marrow with erythroblastopenia with parvoviral inclusions. Parvovirus B19 quantitative PCR showed elevated titers. He is also a diagnosed case of Hereditary Spherocytosis and Gilberts syndrome since 2015. Acute onset pancytopenia in individuals suffering from chronic hemolytic anemias should raise a suspicion of viral infection. Timely diagnosis and supportive management is vital.

Peritoneal De-differentiated Liposarcoma: A Rare Case Report

Gauri Vinod Hardas — 2023-10-19

Peritoneal de-differentiated liposarcoma is a rare malignancy with a poor prognosis. Our patient, 67 years/Male presented with complaints of constipation & distension of abdomen for one month. Initially based on histology, diagnosis of Gastrointestinal Stromal Tumor (GIST) was thought. On PET scan, he had multiple peritoneal deposits & serosal deposits along recto-sigmoid colon and ileal loop which on immunohistochemistry (IHC) proved to be de-differentiated liposarcoma. The patient was given chemotherapy. Patient responded well to treatment. Such peritoneal tumors pose a challenge to the pathologist as only morphology is not of much help & IHC becomes necessity.