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Objective: Primary Spindle cell tumors of the thyroid are very rare and comprise a myriad of differential diagnoses ranging from reactive proliferations to neoplastic processes. Differentiation amongst these rare entities is of utmost importance as it defines the prognosis and also guides future therapy. Case Report: Hereby, we present a rare case of spindle cell variant of papillary thyroid carcinoma in a sixty-four-year-old female which posed a diagnostic challenge on histology. Microscopy showed a well-circumscribed spindle cell lesion with areas of infiltration and entrapment of colloid-filled thyroid follicles. There were no characteristic features of papillary carcinoma. A panel of immunohistochemistry markers was advised which clinched the diagnosis as the spindle tumor cells were positive for thyroid papillary carcinoma markers. Although papillary carcinoma usually has an indolent course, however interestingly this patient presented with lymph node metastasis one month after surgery which cytologically showed features of malignant spindle cell neoplasm. Conclusion: Through this case report we wish to highlight the cytological, histopathological as well as immunohistochemical features of this rare variant of papillary carcinoma. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to histopathologically evaluate the morphological spectrum, apoptotic index (AI), and mitotic index (MI) of endometrial lesions in patients presenting with abnormal uterine bleeding (AUB).Methods: A cross-sectional study was done over a period of 18 months where a total of 60 newly diagnosed cases of perimenopausal women presenting with AUB were included. All H and E stained pathology slides from the specimens were reviewed for initial histopathological evaluation and diagnosis. Immunohistochemistry for Bcl-2 and Bax was done. The study subjects were divided into two groups: Group 1 included 30 cases of histologically proven proliferative endometrium (PE) and endometrial polyps and Group 2 included 30 cases of hyperplasia, endometrial epithelial neoplasia (EIN)/or carcinoma. For all cases, AI and MI were calculated and compared among the two groups.Statistical Analysis: Quantitative variables were compared using the Independent t-test/Mann-Whitney test between the two groups and Kruskal-Wallis test for comparison between more than two groups. Qualitative variables were correlated using the Chi-square test. P < 0.05 was considered statistically significant.Results: In our study of 60 patients of AUB, the mean age was 45.87 years with a parity of 2 or more in most of the patients. Most of the patients in our study had heavy menstrual bleeding (66.67%) with associated complaints of weakness, pallor, and low backache. Out of 60 patients of AUB, Endometrial carcinoma was diagnosed in 13 (21.67%) patients, with the most common histopathological type being Endometrioid carcinoma. There was a significant difference in the AI, MI, and the ratio of AI/MI among various histopathological diagnoses. AI was highest for Endometrial carcinoma and lowest for hyperplasia and polyps. MI was also highest for Endometrial carcinoma and lowest for hyperplasia and polyps. However, the ratio was incongruent as it was highest for hyperplasia without atypia and lowest for PE with endometrial carcinoma being midway. The Bcl-2 expression of relatively benign conditions (Group 1) was significantly higher than Group 2 (Endometrial epithelial neoplasia/carcinoma). Bax intensity showed an almost inverse pattern, being highest in endometrial carcinoma and lower in hyperplasia and polyps with the lowest expression in PE. Even the Bcl-2:Bax ratio was also highest for PE and lowest for endometrial carcinoma with others falling in between them.Conclusion: It can be concluded that the combination of the proliferative and apoptotic markers and the ratio will help as a tool in aiding the diagnosis of endometrial lesions for patients presenting with AUB. [ABSTRACT FROM AUTHOR]

Background/Aim: Xanthogranulomatous cholecystitis (XGC) is a rare destructive inflammatory disease of the gallbladder. It is frequently misdiagnosed as gallbladder carcinoma (GBC) as it mimics latter with regard to clinical manifestations, imaging and intraoperative findings, often leading to extended surgical resection in these patients. The aim of this study was to evaluate the diagnostic dilemma of XGC cases clinico-radiologically diagnosed with GBC. Materials and Methods: From January 2017 to June 2019, a total of eight cases histopathologically diagnosed as XGC, were misdiagnosed with GBC based on preoperative and intra-operative findings. The clinical characteristics, imaging, intra-operative findings, and surgical data of these patients were collected and analyzed. Results: A total of 2154 cholecystectomy specimens were received in the histopathology section during the study period. Sixty-nine cases (3.2%) were histologically diagnosed as XGC, of which 8 cases (11.6%) were preoperatively diagnosed with GBC. These cases were predominantly seen in males in the age range of 24–62 years. The most common clinical presentation was chronic cholecystitis. Gallstones were present in all the 8 cases. Six cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging. Intraoperatively, adhesions to adjacent organs were observed in seven cases. All these eight cases misdiagnosed with GBC underwent aggressive surgical treatment following which histopathology ultimately revealed XGC. Conclusion: Neither clinical manifestations nor laboratory tests/radiological methods can provide an effective means of differentiating between XGC and GBC. Preoperative diagnosis is difficult, and histopathology remains the gold standard to differentiate the two entities. [ABSTRACT FROM AUTHOR]

Brenner tumors of ovary are usually an incidental finding. It is an uncommon tumor which is seen affecting women of fifth to sixth decade. It is classified under transitional cell tumors of ovary, which includes benign, borderline, and malignant Brenner tumors and transitional cell carcinoma. These tumors have been associated with synchronous and metachronous neoplasia, most commonly other ovarian epithelial tumors such as mucinous cystadenoma. Occasionally, these tumors may be associated with endometrial hyperplasia or carcinomas which are due to hormones elaborated by the stromal component of Brenner tumor. The hormone produced is estrogen and less commonly androgens, which alters the estrogen and progesterone levels, causing hyperstimulation of endometrium. We present a case of 50-year-old postmenopausal women who presented with coexisting incidental Brenner tumor with leiomyoma and Endometrial adenocarcinoma. Only few authors have reported similar tumor occurrence in the past. [ABSTRACT FROM AUTHOR]

Malignant thyroid tumors of follicular origin comprise a spectrum, with the indolent well-differentiated thyroid carcinoma (WDTC) at one end and lethal anaplastic thyroid carcinoma (ATC) at the other. Poorly differentiated thyroid carcinoma (PDTC) lies intermediately between WDTC and ATC in terms of morphology and prognostic standpoint. This thyroglobulin producing neoplasm accounts for 4-7% of all thyroid malignancies. PDTC has been controversial due to lack of defined diagnostic criteria. We hereby report a case of PDTC in a 42-year-old female presenting with neck swelling, pain, and dysphagia for 10 months. She was diagnosed as colloid goiter on fine-needle aspiration cytology. On imaging, a large complex thyroid with central neck nodes was seen. Total thyroidectomy and central neck node dissection were done. Based on the morphology, immunostaining, and the diagnostic criteria, a diagnosis of PDTC was made. PDTC is a diagnostic challenge due to its rarity and previous equivocal diagnostic criteria. [ABSTRACT FROM AUTHOR]

Bacillus Calmette-Guerin (BCG) has been used as an intravesical instillation for nonmuscle invasive (superficial) bladder cancer for the last 3 decades. Although intravesical BCG therapy is well-tolerated by most of the patients, adverse reactions have also been reported which are usually local, benign, and self-limited. Systemic complications such as miliary tuberculosis (TB) are very rare with few documented reports in literature. We hereby report a rare case of disseminated TB in bilateral lungs, adrenal, cervical, mediastinal, and para-aortic lymph nodes in a patient with recurrent transitional cell carcinoma (TCC) of renal pelvis and urinary bladder. Peculiar feature of this case was the development of TB 2 years following last BCG instillation, which is unlike most of the cases in the literature where TB developed within few weeks of last dose of BCG. [ABSTRACT FROM AUTHOR]

Atypical fibroxanthoma (AFX) is an uncommon spindle cell tumor with intermediate or borderline malignant potential. Clinically, it may be misdiagnosed as a squamous cell carcinoma (SCC) or malignant melanoma. Solar irradiation has been implicated in its pathogenesis. The diagnosis of AFX rests on a combination of histopathological features and a negative immunohistochemical profile. AFX is a rare tumor usually found in sun exposed skin of head and neck region in elderly Caucasian men. Rarely, it has a second peak in young adults, where it is found in trunk and extremities. The present case is reported as AFX is quite unusual in a young female with a nodule in the leg which was clinically diagnosed as a malignant melanoma. Only a few cases of AFX have been reported in young women. This case highlights the fact that accurate diagnosis of atypical fibroxanthoma is very crucial so as to avoid overenthusiastic and overzealous treatment as required for a malignant tumor. [ABSTRACT FROM AUTHOR]

Large cell lung carcinoma (LCLC), rhabdoid phenotype (RP) is a rare entity, accounting for 0.1-1% of all lung tumors. It is characterized by presence of more than 10% cells with rhabdoid morphology-large cells with abundant cytoplasm, eccentric nuclei, prominent nucleoli and eosinophilic cytoplasmic inclusions. We report a case of rhabdoid variant of large cell carcinoma in a 65-year-old female. Patient presented with a lump in the right axilla. Computed tomography showed a large mass lesion in right lung with involvement of the chest wall. Tru-cut biopsy from the lung lesion was performed and histopathology was compatible with LCLC. A RP was considered due to the presence of tumor cells with eosinophilic cytoplasmic globules and eccentric nuclei. Cytokeratin and vimentin were diffusely positive while thyroid transcription factor was focally positive. INI-1, desmin, calretinin, HMB-45, and neuroendocrine markers were negative. This case highlights that recognition of large cell carcinoma lung, RP is very important because of its aggressive nature and adverse outcome. [ABSTRACT FROM AUTHOR]

Lymphoid hyperplasia of the gall bladder is an extremely rare condition that may be missed on associated radiological or clinical evaluation but is diagnosed on biopsy. We are reporting hereby, a case of reactive lymphoid hyperplasia masquerading as a lymphoma on histopathology. A 58.year.old male was referred to our hospital with complaints of pain abdomen infrequently since last one year. Ultrasonography revealed the presence of single calculus along with features of chronic cholecystitis. Laparoscopic cholecystectomy was performed and the gall bladder was sent for routine histopathological evaluation. On microscopic examination, there were sheets of cells, lymphoid in origin and numerous lymphoid follicles spread throughout the wall of the gall bladder. It was diagnosed as a case of reactive lymphoid hyperplasia with chronic cholecystitis on histopathology. [ABSTRACT FROM AUTHOR]