Search

Thyroid gland, despite being a highly vascular organ, is an extremely unusual site for metastasis from primary carcinoma like breast. We, hereby, report a case of metastatic lesion in the thyroid with breast carcinoma as a primary, in a 55-year-old postmenopausal female. The metastatic focus had masqueraded as nodular goitre, thereby, creating diagnostic difficulty. The case was suspected on Fine Needle Aspiration (FNA) and confirmed by immunocytochemistry on cell block with progesterone and Her2neu positivity. Also, we have attempted to review the literature reporting similar occurrences. Although breast cancer is less frequent to metastasize to thyroid, it is advised to always exclude metastasis from breast carcinoma especially if new thyroid lesions occur in patients with this malignancy. Such cases create diagnostic dilemma on cytology due to morphologic similarities between primary and metastatic thyroid lesions. Cell block is a crucial technique where ancillary techniques like immunocytochemistry can be applied and help in early and timely diagnosis, hence, rendering better prognostic outcome.

Langerhans Cell Histiocytosis (LCH) is a disease of abnormal clonal proliferation of langerhans cell of the bone marrow derived monocyte-macrophage lineage. Cells with characteristic coffee bean/grooved/indented nuclei with a background of histiocytes, lymphocytes, eosinophils and other inflammatory cells are seen. Clinical presentation varies from unifocal unisystem to multifocal unisystem to multifocal multisystem. We present a rare case of multisystem LCH involving high risk organs in a two and a half year old child. presented with the chief complaints of fever and red raised maculopapular lesions on trunk, palm, forehead and scalp for one and a half yrs with hepatosplenomegaly. There were no lytic lesions of the bones. Haematological parameters showed anaemia with thrombocytopenia while Bone Marrow Aspirate showed increase in histiocytic cell with some cells showing characteristic coffee bean, cleaved irregularly contoured nuclei. However, eosinophilia was not seen. Sections from the skin lesions showed cells with similar morphology without usually accompanied eosinophilia. The cells were CD1a and S100 positive. So a FINAL DIAGNOSIS of langerhans cell histiocytosis was made. The emphasis here lies on thorough analysis of the clinical presentations, imaging studies and scrupulous histomorphological and immunohistochemical examination, so that early diagnosis and timely intervention is ensured in such cases where the characteristic features like lytic lesions of bone and eosinophilia is not found.

Behçet’s disease is a multi-systemic vasculitis which is characterized by recurrent oral and genital ulceration with positive pathergy test. These features may also be seen in various hematological malignancies. In patients with leukemia who present with Behçet’s disease-like features, it is often difficult to ascertain whether the clinical manifestations are due to leukemia, or there is co-existing Behçet’s disease too. The authors report an Indian farmer who presented with clinical features suggestive of Behçet’s disease with profound neutropenia. On bone marrow examination he was found to have acute monocytic leukemia (AML-M5). Chemotherapy for leukemia did not relieve his oral and genital ulcers, for which glucocorticoids and colchicine had to be given. So the patient had co-existence of Behçet’s disease along with AML-M5, which has never been reported in the literature before.

Cysticercosis is a well known parasitic infestation occurring at multiple sites including brain, muscles, liver, lungs, heart and peritoneum. Clinical presentation may be misleading most of the times. We herewith report two cases of oral cysticercosis which we encountered in our setup within a week. Both patients were young, urban vegetarian females presenting with cheek swelling. One had a diffuse swelling while other developed a cystic lesion. We found dead worm in the haematoxylin and eosin stained sections, but one may not always find it. Therefore, a high index of suspicion is needed in endemic areas. In cases of nonspecific inflammation serial sectioning and processing of the whole specimen is recommended before signing off a case as non specific inflammation even more, if we have calcific deposits. The correct diagnosis is of huge importance as involvement of other organs may give rise to serious complications. We report two cases of oral cysticercosis which reveal the importance of the histopathologic examination, emphasizing the need to include cysticercosis in the differential diagnosis of oral nodular lesions in endemic areas. Informed consent was taken from both the patients prior to the examination.