1
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Kannan K, Bains A, Alam A, Bano N, Thirunavukkarasu B. Non-pruritic blisters over extensors in a young male. Indian J Dermatol Venereol Leprol 2024; 0:1-4. [PMID: 38594989 DOI: 10.25259/ijdvl_22_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/18/2023] [Indexed: 04/11/2024]
Affiliation(s)
- Karthick Kannan
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anupama Bains
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
| | - Afroz Alam
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
| | - Nazneen Bano
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
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2
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Yadav SK, Jamal A, Kantiwal P, Elhence A, Elhence P, Thirunavukkarasu B, Saxena S. Multifocal lower limb hemangioendothelioma in a young female: a case report and review of the literature. Int J Clin Exp Pathol 2024; 17:83-89. [PMID: 38577695 PMCID: PMC10988090 DOI: 10.62347/yrcf9861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
A 26-year-old female presented with pain and swelling of distal thigh and distal leg. She was diagnosed with multifocal epitheloid hemangioendothelioma (EHE) and was successfully treated with wide resection of femoral and tibial lesions followed by their reconstruction using vascularised fibular graft and local bone grafting. One year into follow-up, the patient remained asymptomatic with full Range Of Motion (ROM) and full weight bearing walking. This case illustrates a unique multifocal presentation of hemangioendothelioma and early surgical intervention leading to complete recovery, highlighting the importance of early diagnosis and intervention to help improve prognosis and quality of life of the patient.
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Affiliation(s)
| | - Ashraf Jamal
- Department of Orthopedics, AIIMSJodhpur, Rajasthan, India
| | | | - Abhay Elhence
- Department of Orthopedics, AIIMSJodhpur, Rajasthan, India
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3
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Salman SS, Thirunavukkarasu B, Yadav R, Chauhan VS, Peddinti RS, Shalimar, Gamanagatti S. Diagnosis of peritoneal metastasis in an unruptured hepatocellular carcinoma on ascitic fluid cytology: A rare scenario with brief review of literature. Diagn Cytopathol 2024; 52:E54-E58. [PMID: 38031825 DOI: 10.1002/dc.25259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/26/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy in adults occurring in a background of cirrhosis. Peritoneal dissemination of HCC is an unusual presentation with an incidence of 2%-16%. Peritoneal metastasis of an unruptured HCC is extremely uncommon. Despite low yield, ascitic fluid cytology serves as a valuable tool for diagnostic evaluation in a patient of cirrhosis with suspicion of malignant transformation. We present a rare case scenario in an elderly female with cirrhosis where the diagnosis of peritoneal metastasis was established on ascitic fluid cytology and confirmed by immunocytochemistry. This report illustrates the unique clinical presentation of an unruptured HCC with its cytological features and a brief review of literature.
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Affiliation(s)
- Syed Saad Salman
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Singh Chauhan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Shekar Peddinti
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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4
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Hruaii V, Thirunavukkarasu B, Prabha V, Mathur S, Iyer VK, Nambirajan A, Jain D. Claudin-4 immunocytochemistry is specific and sensitive for the diagnosis of malignant carcinomatous effusions: Results from a pilot study. Diagn Cytopathol 2024; 52:30-41. [PMID: 37837242 DOI: 10.1002/dc.25238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Claudin-4, a tight junction associated protein expressed in epithelial cells, is purported as a highly specific and sensitive marker for epithelial malignancies. Our aim was to assess the sensitivity, specificity and real-time utility of claudin-4 immunocytochemistry (ICC) in the diagnostic work-up of suspected malignant effusions. METHODS Claudin-4 (3E2C1 clone) ICC was performed prospectively in effusion cell blocks where other ICC markers were being performed as part of reporting over 3 months. Based on claudin-4 staining in unequivocal malignant and reactive effusions, the sensitivity and specificity was calculated. In cases signed out as inconclusive encompassing atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) and negative for malignancy, change in diagnostic category based on addition of claudin-4 ICC was assessed. RESULTS Study included 107 effusions. Claudin-4 stained 100% of metastatic adenocarcinomas including those with primaries in lung, breast, ovary, female genital tract, gastrointestinal tract and pancreatic-biliary tract, and was negative in all reactive mesothelial and mesothelioma effusions with sensitivity of 100% (48/48) and specificity of 95% (20/21) for adenocarcinoma. Claudin-4 upgraded the diagnostic category to positive in 70% (16/23) of SFM, 20% (1/5) of AUS, and in 50% (5/10) of negative effusions. Among cases with confirmed serosal involvement status on follow-up, claudin-4 showed sensitivity, specificity, positive predictive value and negative predictive values of 85% (11/13), 100% (3/3), 100% (10/10) and 75% (3/4), respectively, for metastatic adenocarcinoma. CONCLUSION Claudin-4 as a single marker is sensitive and specific for adenocarcinoma and is a valuable addition to the ICC armamentarium.
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Affiliation(s)
- Vanlal Hruaii
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vindhya Prabha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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5
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Sarangi S, Thirunavukkarasu B, Khera S, B S, Yadav T. Vascular tumors of the liver: A brief review. Ann Hepatobiliary Pancreat Surg 2023; 27:329-341. [PMID: 37953709 DOI: 10.14701/ahbps.23-046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 11/14/2023] Open
Abstract
Vascular tumors of the liver are mesenchymal lesions from endothelial cells. They range from common benign lesions such as haemangioma, intermediate tumors like Kaposi sarcoma, and perivascular epithelioid cell tumor to malignant tumors such as hepatic epithelioid hemangioendothelioma and hepatic angiosarcoma in adults. Pediatric vascular tumors of the liver also include benign, locally aggressive, borderline, and malignant masses with haemangiomas being the most common benign tumors and epithelioid hemangioendothelioma being an uncommon pediatric malignancy. The list of these lesions is completed by nodular regenerative hyperplasia, solitary fibrous tumour, and hepatic small vessel neoplasms (HSVN). Some of these tumors are uncommon and rare. This review article aimed to enumerate hepatic vascular tumors along with their imaging, histopathology, molecular findings for accurate diagnosis that can result in better management.
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Affiliation(s)
- Sujata Sarangi
- Department of Pathology, Grant Govt. Medical College, Mumbai, India
| | | | - Sudeep Khera
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Selvakumar B
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
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6
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Benny B, Kaur M, Thirunavukkarasu B, Singh S, Patra S. Recent-onset erythematous tender plaques and nodules in a child with nephrotic syndrome. Clin Exp Dermatol 2023; 48:1071-1073. [PMID: 37070403 DOI: 10.1093/ced/llad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Abstract
A 10-year-old girl with nephrotic syndrome who was on systemic corticosteroids presented with multiple erythematous tender nodules over her trunk and extremities. Histopathology showed mild lobular panniculitis with needle-shaped crystals. The lesions subsided spontaneously without any sequelae within 3 weeks.
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Affiliation(s)
- Benetta Benny
- Department of Dermatology, Venereology and Leprology
| | - Maninder Kaur
- Department of Dermatology, Venereology and Leprology
| | | | - Saurabh Singh
- Department of Dermatology, Venereology and Leprology
| | - Suman Patra
- Department of Dermatology, Venereology and Leprology
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7
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Gupta D, Jaine NS, Bairwa SK, Thirunavukkarasu B, Vishwajeet V, Purohit AHL. Case of angioimmunoblastic T-cell lymphoma presenting as peripheral and bone marrow plasmacytosis: A diagnostic conundrum. INDIAN J PATHOL MICR 2023:00004270-990000000-00017. [PMID: 38391301 DOI: 10.4103/ijpm.ijpm_277_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/23/2022] [Indexed: 02/24/2024] Open
Abstract
ABSTRACT Angioimmunoblastic T-cell lymphoma (AITL), a subtype of peripheral T-cell lymphoma (PTCL), is associated with unique clinical, morphological, and immunohistochemical features. The peripheral circulation might show presence of an occasional reactive plasma cell but significant plasmacytosis masquerading as plasma cell leukemia is rare. We report a case of AITL in a 42-year-old male, who presented with two-month history of generalized lymphadenopathy. On investigations, he had hypergammaglobulinemia and plasmacytosis in the peripheral blood and bone marrow masquerading as plasma cell leukemia. Immunohistochemistry and serum protein electrophoresis revealed polyclonal nature of plasma cells. Diagnosis of AITL was made on cervical lymph node biopsy. This case highlights the diagnostic challenge faced due to heterogeneity in the clinical presentation and pathological findings and to alert the clinician so that timely accurate diagnosis can be made to initiate the treatment.
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Affiliation(s)
- Deepika Gupta
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nagarjun S Jaine
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sandeep K Bairwa
- Department of Medical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Vikarn Vishwajeet
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Abhishek H L Purohit
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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8
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Gupta P, Saxena S, Sharma V, Thirunavukkarasu B, Tiwari S, Goyal A. Neurosarcoidosis - A diagnostic challenge? Indian J Otolaryngol Head Neck Surg 2023:1-4. [PMID: 37362102 PMCID: PMC10148611 DOI: 10.1007/s12070-023-03801-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Sarcoidosis is an inflammatory granulomatous multisystem disease with an unknown etiology. Neurosarcoidosis is a cryptogenic neuroinflammatory manifestation of sarcoidosis. Objective: This article aims at better understanding of one of the rarer diseases whose diagnosis may be difficult leading to delay in definitive management of the patient. Method: We describe a case of neurosarcoidosis with initial presentation similar to acute invasive fungal rhinosinusitis, whose diagnosis was challenging and delayed owing to the presenting symptoms. Conclusion: The diagnosis of neurosarcoidosis becomes challenging when it presents as isolated clinical neurological symptoms. We want to highlight the variable nature of neurosarcoidosis and its consideration as diagnosis after excluding other common infectious and inflammatory conditions.
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Affiliation(s)
- Palak Gupta
- Department of ENT, AIIMS Jodhpur, Jodhpur, Rajasthan 342005 India
| | - Suvinay Saxena
- Department of Diagnostic & Interventional Radiology AIIMS Jodhpur, Jodhpur, Rajasthan 342005 India
| | - Vidhu Sharma
- Department of ENT, AIIMS Jodhpur, Jodhpur, Rajasthan 342005 India
| | | | - Sarbesh Tiwari
- Department of Diagnostic & Interventional Radiology AIIMS Jodhpur, Jodhpur, Rajasthan 342005 India
| | - Amit Goyal
- Department of ENT, AIIMS Jodhpur, Jodhpur, Rajasthan 342005 India
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9
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Tiwari R, Devnani B, Thirunavukkarasu B, Pareek P, Daga P, Kumar A. Multi-modality management of chondrosarcoma of scapula: A case report and review of literature. Cancer Treat Res Commun 2023; 35:100710. [PMID: 37148651 DOI: 10.1016/j.ctarc.2023.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 05/08/2023]
Abstract
Chondrosarcoma are malignant tumours in which neoplastic cells produce cartilage. The most commonly affected sites are pelvis, femur, humerus and ribs. Scapula involvement is relatively rare. Surgery remains the primary modality of treatment for chondrosarcoma. Radiotherapy is used as an adjuvant therapy in high grade tumours and in cases of residual disease. Present study reports a rare case of scapular chondrosarcoma in a 37 year old male, managed with multimodality treatment and discusses briefly the prognostic parameters and treatment modalities. Only few studies have discussed about scapular chondrosarcoma and more studies with larger number of patients are needed to develop an evidence-based treatment and follow-up protocol for these patients.
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Affiliation(s)
- Ramakant Tiwari
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharti Devnani
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | | | - Puneet Pareek
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prateek Daga
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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10
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Sharma R, Thirunavukkarasu B, Nalwa A, Pathak M, Garg PK. Malignant rhabdoid tumour of liver: Conundrum on ascitic fluid. Diagn Cytopathol 2023; 51:276-279. [PMID: 36786382 DOI: 10.1002/dc.25115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
Ascitic fluid analysis is an important tool for diagnosis and staging. Cytological analysis is routinely done as a part of workup for ascites. This is challenging in paediatric malignancies where multiple differentials need to be considered at times with limited cellularity. We present a case of malignant rhabdoid tumour of liver in a young child presenting with abdominal lump and ascites. The diagnosis was offered on ascitic fluid cytology based on cytomorphology, supporting immunohistochemistry and later confirmed on biopsy. This report briefly discusses its differentials and approach to diagnosis.
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Affiliation(s)
- Rashim Sharma
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Aasma Nalwa
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manish Pathak
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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11
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Agrawal A, Budania A, Thirunavukkarasu B, Verma V, Kaur M. Nonhealing exuberant red ulcers on the genitalia in an immunocompromised patient. Clin Exp Dermatol 2023; 48:280-283. [PMID: 36763713 DOI: 10.1093/ced/llac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 01/22/2023]
Abstract
We report a case of atypical exuberant ulcers on the genitals, groin and lower abdomen in an HIV-positive patient. Histopathology of the lesion revealed hyperkeratosis, acanthosis and intraepidermal bulla formation.
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Affiliation(s)
- Akriti Agrawal
- Departments of Dermatology, Venereology and Leprology and
| | - Anil Budania
- Departments of Dermatology, Venereology and Leprology and
| | | | - Vikrant Verma
- Pathology All India Institute of Medical Sciences, Jodhpur, India
| | - Maninder Kaur
- Departments of Dermatology, Venereology and Leprology and
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12
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Waghmare P, Patra S, Thirunavukkarasu B, Bairwa S. Azacytidine-induced Sweet's syndrome. BMJ Case Rep 2022; 15:15/12/e252329. [PMID: 36572451 PMCID: PMC9806094 DOI: 10.1136/bcr-2022-252329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Prajakta Waghmare
- Dermatology, Venereology and Leprology, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | - Suman Patra
- Dermatology, Venereology and Leprology, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | | | - Sandeep Bairwa
- Medical Oncology, All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
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13
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Abstract
Background: Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm with unknown etiology and recurrent potential. They are widely reported in children and young adults. Nearly 50% of inflammatory myofibroblastic tumor harbor rearrangement in anaplastic lymphoma kinase (ALK) gene with the majority expressing ALK protein. ALK-negative IMTs harbor alteration in ROS1 gene in a subset of cases. Few reports have shown association of IMT with Epstein-Barr virus (EBV). Case report: We report a case of IMT of the spleen in an 18-month-old infant presenting with abdominal distention and failure to thrive. Workup for ALK-1, ROS1, and EBV small-encoded RNA in-situ hybridization using immunohistochemistry was negative. Conclusions: IMT can arise in an infant spleen.
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Affiliation(s)
| | - Pritam Singha Roy
- Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aravind Sekar
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Mittal T, Thirunavukkarasu B, Kathuria P, Verma M. Cervical deciduosis: precarious mimicker of malignancy during pregnancy. Int J Gynecol Cancer 2022; 32:690-691. [PMID: 35504626 DOI: 10.1136/ijgc-2021-003257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Tushar Mittal
- Pathology and Lab Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | | | - Priyanka Kathuria
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Manisha Verma
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
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15
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Shahid AH, Randhawa TS, Tripathi M, Thirunavukkarasu B, Bal A, Mohindra S. Pathological Fractures and Management Dilemmas in Primary Intracranial Hemangiopericytoma with Diffuse Metastasis. Neurol India 2022; 70:1309-1311. [PMID: 35864704 DOI: 10.4103/0028-3886.349628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Adnan H Shahid
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Tejasvi S Randhawa
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Balamurugan Thirunavukkarasu
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
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16
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Abstract
Acute fulminant necrotising colitis is an uncommon presentation of amoebiasis, which can be precipitated after corticosteroid therapy. Clinicians treating patients with COVID-19 with corticosteroid therapy should be familiar with this condition to avoid delay in diagnosis. The disease is associated with high mortality, and prompt diagnosis and management are essential for salvaging patients. We report successful management of a patient who developed this complication following administration of steroids for COVID-19.
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Affiliation(s)
- Renu Saini
- General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Vivek Kumar Bhagat
- General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Aditya Baksi
- General Surgery, All India Institute of Medical Sciences, Jodhpur, India
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17
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Kumar R, Halder V, Ghosh S, Kumar B, Guha Neogi S, Thirunavukkarasu B, Bal A. Calcified Amorphous Tumor of Left Ventricle: A Rare Cardiac Tumor. Cureus 2021; 13:e17908. [PMID: 34660103 PMCID: PMC8509095 DOI: 10.7759/cureus.17908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiac calcified amorphous tumor (CAT) is a rare, non-neoplastic, intra-cavity cardiac mass. Only a few cases have been described in the literature. A 46-year-old Indian female presented with decompensated heart failure. On echocardiography, 1.9 x 1.7 cm pedunculated mobile mass in the left ventricle attached to the intraventricular septum was seen. On cardiac magnetic resonance imaging (MRI), the lesion was isointense. Histopathology of the excised mass revealed fibrin deposition with eosinophilic amorphous material in the center with the periphery of the lesion showing calcification without any myxomatous tissue. A final diagnosis of CAT of the heart was established. CAT is composed of calcium deposits in the background of amorphous degenerating fibrinous material. It presents as a pedunculated mass in any chamber of the heart with a very high preponderance of distal embolization. Differentiation from calcified atrial myxoma, calcified thrombi, or other cardiac neoplasms is very difficult. Histopathological examination is the mainstay of diagnosis. Treatment is emergency excision to prevent distal embolization. CAT is a rare non-neoplastic tumor, which is mainly a tissue diagnosis after its resection.
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Affiliation(s)
- Rupesh Kumar
- Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vikram Halder
- Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Soumitra Ghosh
- Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Basant Kumar
- Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Subhrashis Guha Neogi
- Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | | | - Amanjit Bal
- Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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18
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Das L, Dutta P, Thirunavukkarasu B, Gupta K, Tripathi M, Gupta P, Aggarwal N, Rai A, Radotra BD, Bhansali A, Suri V. Course and outcomes of pregnancy in women treated for acromegaly: Discerning a contemporary cohort. Growth Horm IGF Res 2021; 60-61:101417. [PMID: 34271296 DOI: 10.1016/j.ghir.2021.101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze pregnancy course and outcomes in women treated for acromegaly and compare outcomes based on disease activity at the time of conception. DESIGN Retrospective study. PATIENTS Women with acromegaly diagnosed prior to or during pregnancy from 2010 to 2019, representing cases (14 pregnancies in 12 cases), were later stratified based on active (n = 5) or controlled disease (n = 9) at time of conception. Female acromegalic patients over the same period constituted the 'acromegaly cohort' (AC) (n = 75). RESULTS All cases had macroadenomas with nadir GH of 15.06 ng/ml (IQR 9-30), IGF-I index of 3.04 (1.96-3.82), for which they had undergone pituitary surgery; except two patients diagnosed during pregnancy, who received pharmacotherapy followed by surgery 4 months postpartum. Adjuvant pharmacotherapy was required in 71.4% patients and radiotherapy in 35.7%. Pregnancy occurred at a median of 2 (0.8-5.1) years after surgery and 21.4% required assisted reproduction. All had term delivery with normal APGAR except one case with gestational hypertension, who delivered a preterm baby. None had congenital malformations. Despite higher baseline IGF-I, GH and tumor volume in those with pre-conceptional active acromegaly, materno-fetal outcomes were not different from those with controlled disease (p > 0.05). Similar or greater proportion of cases had normal GH and no residual tumor postpartum, even in those with pre-conceptional active acromegaly. CONCLUSION The current study showed conducive outcomes of gestation in women treated for acromegaly and no higher rates of pregnancy parameters or complications than non-acromegaly pregnancies in the same population. Active acromegaly does not seem to have an adverse bearing on outcomes.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India.
| | | | - Kirti Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | - Prakamya Gupta
- Scientist C, Indian Council of Medical Research, New Delhi, India
| | - Neelam Aggarwal
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Ashutosh Rai
- Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India
| | | | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India.
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Thirunavukkarasu B, Khandekar J, Parasha M, Dhiman B, Yadav K. Psychosocial health and its associated factors among Men who have sex with Men in India: A cross-sectional study. Indian J Psychiatry 2021; 63:490-494. [PMID: 34789937 PMCID: PMC8522621 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/05/2021] [Accepted: 08/11/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM MSM in India experience complex and multiple psychosocial challenges. The current study was conducted with an aim to assess the magnitude and predictors of psychosocial health-related problems including MSM registered in targeted intervention centers in Delhi. METHODS A cross-sectional study was conducted among 235 MSMs. Burden of psychosocial health issues among MSM including depression, anxiety, substance abuse, and partner violence was assessed using semistructured questionnaire. Chi-square test was used to study the association of sociodemographic characteristics and psychosocial issues among the study participants. RESULTS The prevalence of depression, anxiety, substance abuse, and partner violence was 45.1%, 37.8%, 27.6%, and 8%, respectively. Age (<24 years), education up to middle school, and being single had significant association with depression. Being sex worker as occupation had a significant association with anxiety and intimate partner violence. CONCLUSIONS The study reveals a significant burden of psychosocial problems and throws light toward broadening the spectrum of health assessment among this vulnerable group.
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Affiliation(s)
- B Thirunavukkarasu
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Jyoti Khandekar
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Mamta Parasha
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Balraj Dhiman
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Kartikey Yadav
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
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Gupta D, Thirunavukkarasu B, Bharti JN, Chugh A, Vishnoi JR. Post fine-needle aspiration near total infarction of Warthin tumor with squamous metaplasia: A diagnostic pitfall. Diagn Cytopathol 2021; 49:1144-1147. [PMID: 34427394 DOI: 10.1002/dc.24860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Deepika Gupta
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Jyotsna Naresh Bharti
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Jeewan Ram Vishnoi
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
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21
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Saraf P, Thirunavukkarasu B, Kathuria P, Solanki V. Lipoleiomyoma: incidental finding in a postmenopausal woman. Int J Gynecol Cancer 2021; 31:1092-1094. [PMID: 34226293 DOI: 10.1136/ijgc-2021-002657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pallavi Saraf
- Pathology and Lab Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | | | - Priyanka Kathuria
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Vrushti Solanki
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
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22
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Thirunavukkarasu B, Nada R, Ramachandran R, Sakhuja V. Epstein-Barr virus-associated hepatic smooth muscle tumor post-renal transplant. Kidney Int 2021; 99:1245. [PMID: 33892868 DOI: 10.1016/j.kint.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Raja Ramachandran
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinay Sakhuja
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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23
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Abstract
Spinal muscular atrophy (SMA) encompasses a group of disorders with loss of spinal motor neurons.The report describes the neuropathological findings including brain and spinal cord at autopsy in a five-and-half-month-old boy with suspected type 1 SMA. The anterior motor neurons, Clarke's column at all the levels of spinal cord showed neuronal loss and degeneration while neurons at all the deep grey nuclei were preserved apart from variable degree anoxic changes. Skeletal muscle biopsy revealed features of neurogenic atrophy consistent with SMA. A differential diagnosis like storage disorders was excluded using electron microscopy. No extra-neural manifestations were seen. Neuropathological features at autopsy have seldom been reported in the literature.
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Affiliation(s)
| | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akriti Bansal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendran Dhanasekaran
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Baranwal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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24
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Thirunavukkarasu B, Singh S, Sharma AP, Bal A. Atrophic Kidney-Like Lesion - Case Report of A Provisional Entity with Brief Review of Literature. Turk Patoloji Derg 2021; 38:148-152. [PMID: 34514572 PMCID: PMC9999679 DOI: 10.5146/tjpath.2021.01541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Atrophic kidney-like lesion is a recently recognized entity, post 2016 World Health Organization Classification of tumors of the urinary system. The behavior of this tumor is not fully known as only a handful of cases with limited follow-up are available. This entity closely mimics thyroid-like follicular carcinoma of the kidney, which has different prognosis. We report a case of incidentally detected atrophic kidney-like lesion in an elderly gentleman who had urothelial carcinoma of the urinary bladder with a brief review of literature. Atrophic kidney-like lesion and urothelial carcinoma of the urinary bladder association has not been reported in the literature.
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Affiliation(s)
- Balamurugan Thirunavukkarasu
- Departments of Histopathology, Post Graduate Institute of Medical Education & Research (PGIMER), CHANDIGARH , INDIA
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25
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Varshney VK, Swami A, Thirunavukkarasu B, Agarwal A, Baid G. Synchronous Small Bowel Gangrene With Pyelonephritis Secondary to Mucormycosis: A Disastrous Complication of COVID-19 Pandemic. Cureus 2021; 13:e15911. [PMID: 34322352 PMCID: PMC8310564 DOI: 10.7759/cureus.15911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 12/18/2022] Open
Abstract
Mucormycosis is a rare infection caused by fungi of the order Mucorales. The infection frequently involves the rhino-cerebral or respiratory system and involvement of the gastrointestinal (GI) tract and kidney are rare. It usually infects immunocompromised individuals due to various causes and an upsurge is hypothesized to be linked with irrational use of steroids during coronavirus disease 2019 (COVID-19) pandemic. We encountered a rare case of systemic mucormycosis that involved both renal as well as mesenteric vessels and led to ischemia of both vital organs. The patient developed massive bowel gangrene involving the duodenum, proximal jejunum, and left kidney due to angioinvasive mucormycosis. The diagnosis of GI mucormycosis may further increase during the current pandemic. The physicians, as well as surgeons, should be aware of this unwanted complication and keep a high index of suspicion for this rare disease.
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Affiliation(s)
- Vaibhav K Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Ashish Swami
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | | | - Ashish Agarwal
- Gastromedicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Gaurav Baid
- Urology, All India Institute of Medical Sciences, Jodhpur, IND
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26
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Sharma R, Thirunavukkarasu B, Elhence P, Vishnoi JR. Invasive solid papillary carcinoma with invasive lobular and invasive breast carcinoma, no special type: a rare association. BMJ Case Rep 2021; 14:14/5/e243628. [PMID: 34016637 DOI: 10.1136/bcr-2021-243628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rashim Sharma
- Pathology and Lab Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | | | - Poonam Elhence
- Pathology and Lab Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Jeewan Ram Vishnoi
- Surgical Oncology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
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27
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Thirunavukkarasu B, Samanta J, Bhatia P, Bal A. De novo double-hit B-cell precursor leukemia/lymphoma - an unusual presentation as peritoneal lymphomatosis. Autops Case Rep 2021; 11:e2021278. [PMID: 34307232 PMCID: PMC8214895 DOI: 10.4322/acr.2021.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022] Open
Abstract
Peritoneal lymphomatosis (PL) is a rare presentation of extranodal precursor leukemia/lymphoma. The presentation is often non-specific, leading to delayed diagnosis and treatment. In this case, though the preliminary diagnosis was established on ascitic fluid cytology, the disease progressed rapidly, leading to demise before initiating chemotherapy. Immunophenotyping and molecular studies, performed later, established a diagnosis of de novo B-cell precursor leukemia/lymphoma with MYC, BCL2 rearrangements (Double-hit lymphoma). MYC, BCL2 rearrangements are rarely reported in precursor B-lymphoma/leukemia which carry dismal prognosis. In this report, we illustrate autopsy findings of PL in an elderly gentleman who presented with ascites for evaluation.
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Affiliation(s)
| | - Jayanta Samanta
- Post Graduate Institute of Medical Education & Research, Department of Gastroenterology, Chandigarh, India
| | - Prateek Bhatia
- Post Graduate Institute of Medical Education & Research, Department of Pediatrics, Chandigarh, India
| | - Amanjit Bal
- Post Graduate Institute of Medical Education & Research, Departments of Histopathology, Chandigarh, India
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28
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Thirunavukkarasu B, Gupta K, Shree R, Prabhakar A, Kapila AT, Lal V, Radotra B. Primary diffuse large B-cell lymphoma of the CNS, with a "Lymphomatosis cerebri" pattern. Autops Case Rep 2021; 11:e2021250. [PMID: 33968825 PMCID: PMC8087396 DOI: 10.4322/acr.2021.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We describe an unusual case of lymphomatosis cerebri in a middle-aged lady presenting with rapid-onset dementia. The lymphomatous infiltrate, instead of forming mass lesions, percolated throughout the brain parenchyma, which is often missed on a stereotactic biopsy and hence warrants caution and awareness about this entity. The nonspecific symptoms at presentation and a variable picture at imaging make this entity diagnostically challenging.
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Affiliation(s)
| | - Kirti Gupta
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Ritu Shree
- Post Graduate Institute of Medical Education and Research, Department of Adult Neurology, Chandigarh. India
| | - Anuj Prabhakar
- Post Graduate Institute of Medical Education and Research, Department of Radiodiagnosis, Chandigarh. India
| | - Aastha Takkar Kapila
- Post Graduate Institute of Medical Education and Research, Department of Adult Neurology, Chandigarh. India
| | - Vivek Lal
- Post Graduate Institute of Medical Education and Research, Department of Adult Neurology, Chandigarh. India
| | - Bishan Radotra
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
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29
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Thirunavukkarasu B, Kithan LS, Kumar N, Jain A, Bal A. Fatal outcome of congenital aortopulmonary window with patent ductus arteriosus complicating pregnancy. Autops Case Rep 2021; 11:e2021265. [PMID: 33968832 PMCID: PMC8087394 DOI: 10.4322/acr.2021.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aortopulmonary window (APW) is a rare congenital heart defect with abnormal communication between the ascending aorta and the pulmonary trunk with two separate semilunar valves. We present an autopsy case report wherein a young primigravida woman presented with progressive breathlessness and central cyanosis at 21 weeks of gestation. Echocardiography performed in the emergency room revealed elevated right-sided cardiac pressures suggestive of severe pulmonary hypertension; however, no structural cardiac defect was discernible. The patient succumbed to congestive cardiac failure and progressive hypoxia within 5 days of hospitalization. The autopsy revealed a Type I aortopulmonary window (2 cm) with patent ductus arteriosus. The lungs showed changes of severe pulmonary hypertension with superadded bronchopneumonia. This report underscores a rare presentation of APW, undiagnosed until pregnancy, leading to the Eisenmenger syndrome and death.
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Affiliation(s)
- Balamurugan Thirunavukkarasu
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Histopathology, Chandigarh, India
| | - Lijanthung S Kithan
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Histopathology, Chandigarh, India
| | - Nikhil Kumar
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Internal Medicine, Chandigarh, India
| | - Arihant Jain
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Internal Medicine, Chandigarh, India
| | - Amanjit Bal
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Histopathology, Chandigarh, India
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30
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Sharma R, Thirunavukkarasu B, Elhence P, Rodha MS, Sureka B. Eosinophilic Solid and Cystic Renal Cell Carcinoma: From Unclassified to Classified, A Case Report. Turk Patoloji Derg 2021; 38:60-65. [PMID: 34514562 PMCID: PMC9999703 DOI: 10.5146/tjpath.2021.01531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is a novel tumour with unique morphological and immunohistochemical features. It is a recently described entity after the 2016 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs and is characterised by a solid cystic tumour composed of polygonal cells with voluminous eosinophilic cytoplasm and CK20 positivity. This tumour has uncertain malignant potential and also has an association with tuberous sclerosis complex (TSC). Sarcomatoid differentiation has not been reported in ESC RCC till now. ESC RCC poses a diagnostic challenge as many eosinophilic/oncocytic renal tumours are included in the differentials. We present a case of ESC RCC with sarcomatoid differentiation in an elderly female without any clinical features of TSC and discuss the differential diagnosis of oncocytic renal tumours.
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Affiliation(s)
- Rashim Sharma
- Departments of Pathology and Lab Medicine, All India Institute of Medical Sciences, RAJASTHAN, INDIA
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31
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Chaudhary K, Pareek T, Sharma A, Thirunavukkarasu B. Lipid-rich variant of urothelial carcinoma: a lethal enigma. BMJ Case Rep 2021; 14:14/3/e240593. [PMID: 33762284 PMCID: PMC7993342 DOI: 10.1136/bcr-2020-240593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Invasive urothelial carcinoma shows marked propensity for divergent differentiation. Several of these 'variant' morphologies have been described in literature and recognised in the 2004 WHO classification. In this report, we detail a case of bladder tumour, diagnosed to be a lipid-rich variant on histopathology after transurethral resection of bladder tumour. Our case encompasses the complete clinical spectrum of this rare and aggressive subtype of urothelial carcinoma starting from initial presentation to postoperative follow-up and recurrence. A keen eye for recognising these variants can ensure a timely diagnosis of these variant and administration of a therapy distinctive from that used in conventional invasive urothelial carcinoma.
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Affiliation(s)
- Kapil Chaudhary
- Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Pareek
- Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Sharma
- Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Thirunavukkarasu B, Gupta K, Nada R, Rathi M, Dhir V, Ahuja CK, Sharma A, Lal V, Radotra BD. Neuropathological spectrum in systemic lupus erythematosus: A single institute autopsy experience. J Neuroimmunol 2021; 353:577518. [PMID: 33601129 DOI: 10.1016/j.jneuroim.2021.577518] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022]
Abstract
AIM Systemic lupus erythematosus (SLE) is a prototype autoimmune disease characterized by circulating autoantibodies and immune complexes involving virtually every organ of the body. However, with respect to central nervous system (CNS), the mechanism of injury is still debated as complement mediated or thrombo-ischemic in nature. We studied the spectrum of neuropathological changes in twelve autopsy cases of SLE and evaluated the role of immune-complexes and complement activation in contributing to the thrombo-ischemic injury and correlated these features with clinical profile. METHODS Autopsy records of all cases of SLE over a period of 20 years (2000-2019) were reviewed. Clinical history including neuropsychiatric symptoms and detailed histopathological analysis was performed. Direct immunofluorescence for IgM, IgG, IgA, C1q, C3, C4d, Kappa, Lambda and immunohistochemistry for C5b-9 was performed on lesional areas in paraffin embedded brain sections. Control tissue from brain was taken from two patients who died of sudden cardiac event. RESULTS Our cohort comprised of 12 cases with age range from 12 to 40 years and all were female patients. Microinfarction and vasculopathy seen in eight cases were the commonest findings. Four cases with microinfarcts had non-bacterial thrombotic endocarditis in heart. Microthrombi adjacent to microinfarcts were seen in 4 cases. Variable deposition of immunoglobulins (predominantly IgG) and complements (C1q, C3, C4d) was evident in cortical arterioles (2 cases) and small capillaries (1 case). Neurological symptoms were seen in four cases, of which, three had associated invasive fungal infection with secondary vasculitis. Active lupus vasculitis was identified in a single case. C5b-9 immunoexpression was not detected in any of the cases. CONCLUSIONS Our study adds observational data to the existing literature that the predominant neuropathological features of SLE are related to thrombo-ischemic injury and small vasculopathic changes. Only in a minor subset (25%), it is mediated by immune-complexes and complements. Immune-complex deposition on immunofluorescence in cortical vessels (cerebral lupus vasculopathy) is a novel finding which has not been reported earlier.
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Affiliation(s)
| | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Department of Internal Medicne (Rheumatology), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Kamal Ahuja
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicne (Rheumatology), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Imaging and Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Dass Radotra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Srinivasan S, Mahajan JK, Dayal D, Kumar R, Thirunavukkarasu B, Yadav J. Neonatal Cushing Syndrome. Indian J Pediatr 2021; 88:74-75. [PMID: 32500487 DOI: 10.1007/s12098-020-03363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Santhiya Srinivasan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jai Kumar Mahajan
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jaivinder Yadav
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Peyam S, Thirunavukkarasu B, Gupta K, Trehan A. Entomophthoramycosis: A diagnostically challenging presentation of liver space-occupying lesion. SAGE Open Med Case Rep 2020; 8:2050313X20971405. [PMID: 33224500 PMCID: PMC7656861 DOI: 10.1177/2050313x20971405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022] Open
Abstract
Entomophthoramycosis, a rare fungal infection, can mimic various clinical entities. We present a case of entomophthoramycosis affecting a 3-year-old male masquerading as liver tumour, diagnosed on stereotactic biopsy and later on resected specimen. He improved following partial hepatectomy and antifungal therapy. A high index of suspicion and heightened awareness regarding its unique morphological characteristics are required for appropriate management.
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Affiliation(s)
- Srinivasan Peyam
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Jain A, Gupta P, Gupta N, Senguttuvan G, Kapadia AB, Thirunavukkarasu B, Nada R, Varma N. Acute monocytic leukemia presenting as generalized lymphadenopathy and skin rash in a toddler: highlighting the clinicopathologic mimics. Diagn Cytopathol 2020; 49:E156-E163. [PMID: 33095510 DOI: 10.1002/dc.24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023]
Abstract
Acute myeloid leukemia (AML) is the fifth most common malignancy in children. Extramedullary involvement in acute myeloid leukemia is rare and can be seen in soft tissues, central nervous system, skin and lymphoreticular organs. The clinical presentations can often be non-specific and hence, the diagnosis can be very challenging, especially in cases without a prior hematologic diagnosis. We report a case of pediatric acute monocytic leukemia presenting with generalized lymphadenopathy and cutaneous rash. Fine-needle aspiration was performed from the lymph nodes and a cytologic diagnosis of infiltration by a lymphoreticular malignancy was suggested. Peripheral blood, bone marrow and cerebrospinal fluid involvement were noted subsequently. Flow cytometry on the bone marrow aspirate confirmed a diagnosis of acute monocytic leukemia. The index case besides highlighting an uncommon presentation of acute monocytic leukemia in a toddler, also emphasizes the need to consider acute monocytic leukemia as a cytomorphologic differential in such presentations.
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Affiliation(s)
- Aleena Jain
- Department of Pathology, PGIMER, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | | | | | | | | | - Neelam Varma
- Department of Hematology, PGIMER, Chandigarh, India
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Thirunavukkarasu B, Gupta K, Chatterjee D, Gendle C, Salunke P. Intraoperative diagnosis and differentials of desmoplastic non-infantile astrocytoma. Diagn Cytopathol 2020; 48:692-694. [PMID: 32286733 DOI: 10.1002/dc.24435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/07/2022]
Affiliation(s)
| | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandrashekhar Gendle
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
| | - Ritambara Nada
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Dawra
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj Kant Sinha
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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38
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Menon J, Venkatesh V, Thirunavukkarasu B, Lal SB. Hennekam syndrome: an uncommon cause of chylous ascites and intestinal lymphangiectasia in the tropics. BMJ Case Rep 2019; 12:12/7/e229419. [PMID: 31326900 DOI: 10.1136/bcr-2019-229419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Paediatric chylous ascites in tropics is commonly caused by infections and trauma. We describe the clinical characteristics of an uncommon inherited cause of chylous ascites, Hennekam syndrome, treated by nutritional modification.
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Affiliation(s)
- Jagadeesh Menon
- Division of Paediatric Gastroenterology, Hepatology & Nutrition, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Vybhav Venkatesh
- Division of Paediatric Gastroenterology, Hepatology & Nutrition, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Sadhna Bhasin Lal
- Division of Paediatric Gastroenterology, Hepatology & Nutrition, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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39
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Thirunavukkarasu B, Mridha AR, Malhotra N, Chandrashekhara SH. Complete androgen insensitivity syndrome with concomitant seminoma and Sertoli cell adenoma: an unusual combination. BMJ Case Rep 2016; 2016:bcr-2016-217229. [PMID: 28039344 DOI: 10.1136/bcr-2016-217229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Androgen insensitivity syndrome is a rare disorder of sex development and its clinical manifestations vary from subtle male infertility to an overt complete androgen insensitivity syndrome (CAIS) with a female phenotype. CAIS is often diagnosed at puberty or in adolescence during investigation for primary amenorrhoea. Undiagnosed patients have an increased risk of development of malignancy in the harboured testes. Inguinal hernia is the commonest mode of presentation of CAIS in childhood and various screening methods are available during the initial herniorrhaphy procedure. Controversy exists in the need to screen and the methods of screening in all cases of premenstrual girls with inguinal hernia. Abnormal observation in a suspicious case requires karyotyping for confirmation. We describe a case of CAIS with simultaneous presence of seminoma and a Sertoli cell adenoma in a 17-year-old patient who had a history of surgery for inguinal hernia at age of 5 years.
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Affiliation(s)
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Thirunavukkarasu B, Mridha AR, Yadav S, Kumar R, Gamanagatti S. Fine Needle Aspiration Cytology Diagnosis of an Urachal Adenocarcinoma. J Clin Diagn Res 2016; 10:ED10-2. [PMID: 27190817 DOI: 10.7860/jcdr/2016/16115.7586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Urachal Carcinoma (UC) is a rare malignancy of urinary bladder. It is usually found in adults in advanced stages because the tumour often grows outside the bladder without producing clinical symptoms. Most of the cases are mucinous, intestinal or signet ring cell adenocarcinoma and the diagnosis is usually made on biopsy. Radiographic images of this tumour may show characteristic features with a midline solid or cystic mass in the anterior wall of bladder associated with small calcification, which is considered as a pathognomonic sign for the diagnosis of UC. We report a case of UC in an adult, whose radiographic images suggested an urachal tumour and Fine Needle Aspiration (FNA) cytology revealed an adenocarcinoma. Laparoscopic partial cystectomy with umbilectomy and pelvic node dissection was done without further histopathological confirmation. Surgical intervention of UC on the basis of FNA diagnosis has not been reported in the literature.
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Affiliation(s)
| | - Asit Ranjan Mridha
- Assistant Professor, Department of Pathology, All India Institute of Medical Sciences , New Delhi, India
| | - Siddharth Yadav
- Postgraduate Student, Department of Urology, All India Institute of Medical Sciences , New Delhi, India
| | - Rajeev Kumar
- Professor, Department of Urology, All India Institute of Medical Sciences , New Delhi, India
| | - Shivanand Gamanagatti
- Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi, India
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