Gross Appearance of Fine Needle Aspiration Smears: Can Adequacy of the Sample be Assessed and Correlated with their Microscopic Cytological Yield

Background

Fine needle aspiration cytology (FNAC) is a simple procedure that is widely accepted as a first-line investigation. It should ideally be performed near the patient with microscopic assessment for evaluation of adequacy of aspirate. Since this is not always possible, a worthwhile substitute is to assess the gross appearance of the material obtained. This study was aimed to determine the value of this alternative rapid, bed-side approach.

Method

This study was carried out in a tertiary care hospital for a duration of 1 year, where 50 cases undergoing FNAC in the out-patient department (OPD) were included. Unstained smears of commonly encountered lesions were photographed and assessed by three independent observers, who graded them into four grades, viz. Grade 1: unlikely to contain diagnostic material. Grade 2: possibly contains diagnostic material. Grade 3: probably contains diagnostic material. Grade 4: material suggesting a specific diagnosis. Results were subsequently compared with the microscopic findings of stained smears.

Results

Distribution of the 50 cases between grades 1, 2, 3, and 4 were 5, 6, 17, and 22, respectively.

Conclusion

Gross appearances of FNA smears are helpful in predicting the adequacy of the sample and sometimes the final microscopic diagnosis. The cellularity of a sample can be gauged by inspection and sometimes a likely diagnosis can be made. Some lesions show typical gross appearance easily detected by the experienced eye so a likely diagnosis can be predicted prior to microscopic examination. However, near-patient microscopic assessment of FNA specimens for rapid onsite evaluation, if available, should be the preferred mode.

Atypical MYC rearrangement pattern of 3' deletion and 5' amplification along with independent IGH rearrangement: A case study

A spectrum of Cellular homolog of the v-myc oncogene (cMYC) alterations such as translocation, overexpression, mutation, and amplification plays an important role in lymphomagenesis, particularly in high-grade lymphomas, and are associated with prognostic significance. Accurate identification of cMYC gene alteration is important for diagnostic, prognostic, and therapeutic implications. With the application of different FISH (fluorescence in situ hybridization) probes that helped overcome the analytical diagnostic challenges as a result of variant patterns, we report rare, concomitant, and independent gene alterations in cMYC and Immunoglobulin heavy-chain gene (IGH) with detailed characterization of its variant rearrangement. Short-term follow-up post R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy seemed to be favorable. Accumulation of many more literature studies on such cases with their therapeutic implications would lead to the categorization of these cases as a separate subclass in large B-cell lymphomas followed by molecular targeted therapy.

Enabling methanol oxidation by interacting hybrid nano system of spinel Co3O4 nanoparticles decorated MXene

For the successful implementation of direct methanol fuel cells in the commercial applications, highly efficient and durable non-noble electrocatalyst based on conducting and stable non-carbonaceous support can be a potential...

Modelling and optimization of factors influencing adsorptive performance of agrowaste-derived Nanocellulose Iron Oxide Nanobiocomposites during remediation of Arsenic contaminated groundwater

Nanocellulose Iron Oxide Nanobiocomposites (NIONs) were synthesized from rice husk and sugarcane bagasse derived nanocelluloses for adsorptive removal of arsenic and associated contaminants present in groundwater samples. These NIONSs were superparamagnetic, hence magnetically recoverable and demonstrated promising recyclability. Synthesis of NIONs was confirmed by Transmission electron microscopy (TEM), X-Ray Diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopic (XPS). FTIR and XPS data together with adsorption kinetics provide insights into probable adsorption mechanism of Arsenic by NIONs. The experimental conditions for 10 different variants were modelled using response surface methodology (RSM) based on central composite design (CCD), considering the parameters; adsorbate dosage, adsorbent dosage, pH and contact time. The results identified the best performing variants and the optimal conditions for maximal absorption (~99%). These results were validated using a three-layer feed-forward Multilayer Perceptron (MLP) based Artificial Neural Network (ANN) model. Both RSM and ANN chemometric models were in close conformity for optimized conditions of highest adsorption by specific variants. The standardized conditions were used to expand the study to field-based arsenic contaminated groundwater samples and their performance to commercial adsorbents. NIONs show promising commercial potential for water remediation applications due to their high adsorptive performance, magnetic recoverability and recyclability.

Indian Academy of Cytologists National Guidelines for Cytopathology Laboratories for Handling Suspected and Positive COVID-19 (SARS-CoV-2) Patient Samples

COVID-19, caused by the SARS-CoV-2 virus, has been declared a pandemic by the World Health Organization. This scenario has impacted the way we practice cytopathology. Cytology laboratories receive fresh and potentially infectious biological samples including those from the respiratory tract, from COVID-19 positive or suspected patients. Hence, the Indian Academy of Cytologists thought it necessary and fit to bring forth appropriate guidelines starting from transportation, receipt, processing, and reporting of samples in the COVID-19 era. The guidelines are prepared with the aim of safeguarding and protecting the health care personnel including laboratory staff, trainees and cytopathologists by minimizing exposure to COVID-19 so that they remain safe, in order to able to provide a continuous service. We hope that these national guidelines will be implemented across all cytopathology laboratories effectively.

Indian Academy of Cytologists Guidelines for Collection, Preparation, Interpretation, and Reporting of Serous Effusion Fluid Samples

Cytological examination plays an important role in the initial work-up of the serous cavity effusion fluids to find out the possible etiology as benign or malignant. Among malignant effusions, cytology is helpful in determining the exact type, site, and stage of the tumor. However, for reporting effusion cytology specimens, there is no consistent and reproducible reporting system.

Histopathological Evaluation of Inferior Alveolar Neurovascular Bundle in Cases of Trigeminal Neuralgia

Background

Trigeminal neuralgia is a painful disease that has been afflicting mankind since time immemorial. The etiology and pathophysiology have been widely studied but poorly understood. There are well-documented researches analyzing ultrastructural changes in trigeminal root specimens obtained following microvascular decompression surgery. However, there are no studies evaluating microscopic changes following peripheral neurectomy.

Purpose

The present study examined microscopic changes in inferior alveolar neurovascular bundle in trigeminal neuralgia patients of mandibular division with no underlying cause.

Materials and Methods

The biopsy specimens were obtained from peripheral neurectomy of 11 trigeminal neuralgia patients' refractory to anti-neuralgic medications. The autopsy specimens from 10 cadavers were used as control. The specimens were subjected to histopathological examination by hematoxylin and eosin, Masson trichrome and Luxol fast blue stains.

Results

All biopsy specimens reported luminal occlusion of small vessels, medial degeneration and intense mononuclear inflammatory infiltrate. Focal myelin digestion chambers were observed in large and small axons. No pathological alterations of either blood vessel or nerve fibers were reported in autopsy specimens.

Conclusion

The demyelination of inferior alveolar nerve due to pathologic vascular changes in peripheral vasculature may have a role in initiation and precipitation of trigeminal neuralgia, and hence, peripheral neurectomy has a significant role in alleviating pain.

Performance of A Convolutional Neural Network in Screening Liquid Based Cervical Cytology Smears

Context

Cervical cancer is the second most common cancer in women. The liquid based cervical cytology (LBCC) is a useful tool of choice for screening cervical cancer.

Aims

To train a convolutional neural network (CNN) to identify abnormal foci from LBCC smears.

Settings and Design

We have chosen retrospective study design from archived smears of patients undergoing screening from cervical cancer by LBCC smears.

Materials and Methods

2816 images, each of 256 × 256 pixels, were prepared from microphotographs of these LBCC smears, which included 816 "abnormal" foci (low grade or high grade squamous intraepithelial lesion) and 2000 'normal' foci (benign epithelial cells and reactive changes). The images were split into three sets, Training, Testing, and Evaluation. A convolutional neural network (CNN) was developed with the python programming language. The CNN was trained with the Training dataset; performance was assayed concurrently with the Testing dataset. Two CNN models were developed, after 20 and 10 epochs of training, respectively. The models were then run on the Evaluation dataset.

Statistical Analysis Used

A contingency table was prepared from the original image labels and the labels predicted by the CNN.

Results

Combined assessment of both models yielded a sensitivity of 95.63% in detecting abnormal foci, with 79.85% specificity. The negative predictive value was high (99.19%), suggesting potential utility in screening. False positives due to overlapping cells, neutrophils, and debris was the principal difficulty met during evaluation.

Conclusions

The CNN shows promise as a screening tool; however, for its use in confirmatory diagnosis, further training with a more diverse dataset will be required.

A study of BRAF mutation in colorectal carcinoma in Indian population

Context

BRAF mutation has been extensively studied and associated with various tumors. Targeted therapeutic intervention against BRAF mutation is established modality against many such tumors. Various studies have estimated that the prevalence of BRAF mutation in colorectal carcinoma (CRC) is 5%-25%. Considering epidemiology differences from Western population and paucity of studies on BRAF mutation in CRC in Asian patients, the present study was done to study the BRAF mutation in CRC in Indian population.

Aims

The aim is to study the distribution of BRAF mutation and its correlation with the American Joint Committee on Cancer (AJCC) stage, grade, and other clinicopathological parameters in CRC.

Settings and Design

This was a cross-sectional study.

Subjects and Methods

Immunohistochemistry study was done using BRAFV600E monoclonal antibody (Clone VE1) for 65 consecutive cases of CRC in a tertiary care center. The results were statistically analyzed using SPSS version 2.0.

Results

This study found that BRAF mutation is not significantly present in CRC as only 4.6% of cases were positive for BRAFV600E mutation. However, there was statistically significant relation between increasing AJCC stage and BRAF mutation.

Conclusions

This study concluded that BRAF mutation is not prevalent in Indian population with CRC. However, it is significantly related with advanced AJCC stages.

Clear cell sarcoma arising from paraspinal ligament of thoracic spine: Report of an unusual case

Clear cell sarcoma (CCS) is an unusual but aggressive soft-tissue tumor with an incidence of <1% of all soft-tissue sarcomas. It was previously termed "malignant melanoma of soft parts" due to its resemblance clinically and morphologically. Normally CCS is seen in patients aged 20-40 years. A rare case of CCS of paraspinal ligament in a 5-year-old boy is being reported. Histopathology and immunohistochemistry markers confirmed the diagnosis. The present case is unique since the entity itself is rare and also due to its occurrence in a child.

Pilot Study of an Open-source Image Analysis Software for Automated Screening of Conventional Cervical Smears

Introduction

The Pap stained cervical smear is a screening tool for cervical cancer. Commercial systems are used for automated screening of liquid based cervical smears. However, there is no image analysis software used for conventional cervical smears. The aim of this study was to develop and test the diagnostic accuracy of a software for analysis of conventional smears.

Materials and Methods

The software was developed using Python programming language and open source libraries. It was standardized with images from Bethesda Interobserver Reproducibility Project. One hundred and thirty images from smears which were reported Negative for Intraepithelial Lesion or Malignancy (NILM), and 45 images where some abnormality has been reported, were collected from the archives of the hospital. The software was then tested on the images.

Results

The software was able to segregate images based on overall nuclear: cytoplasmic ratio, coefficient of variation (CV) in nuclear size, nuclear membrane irregularity, and clustering. 68.88% of abnormal images were flagged by the software, as well as 19.23% of NILM images. The major difficulties faced were segmentation of overlapping cell clusters and separation of neutrophils.

Conclusion

The software shows potential as a screening tool for conventional cervical smears; however, further refinement in technique is required.

Ectopic adrenocorticotropic hormone syndrome in a case of duodenal neuroendocrine tumor presenting with liver metastasis

Ectopic adrenocorticotropic hormone (ACTH) syndrome is an uncommon disorder and comprises about 15% of all patients with Cushing's syndrome (CS). Duodenal carcinoids are rare, indolent tumors usually associated with a benign progression. We hereby report a rare case of CS resulting from ectopic ACTH secretion from a duodenal neuroendocrine tumor (NET) presenting with liver metastasis. A 37-year-old female presented with abdominal discomfort and dyspepsia of 1-month duration. Ultrasound abdomen suggested a well-defined hypoechoic lesion in the left lobe of the liver, suggestive of neoplasia. On clinical examination, she had Cushingoid features and persistent hypokalemia. Midnight ACTH and cortisol levels were grossly elevated at 1027 pg/ml (n < 46 pg/ml) and 87.56 μg/dl (n < 7.5 μg/ml), respectively. Both overnight and high-dose dexamethasone suppression test confirmed nonsuppressed cortisol levels - 86.04 and 84.42 μg/dl (n < 1.8 μg/ml), respectively. Magnetic resonance imaging brain showed a structurally normal pituitary gland. Computed tomography scan of the abdomen revealed hepatic lesion with bilateral adrenal enlargement. A diagnosis of ectopic ACTH-dependent CS was made. Intraoperatively, a duodenal lesion of 0.5 cm × 0.5 cm was identified alongside an 8 cm × 6 cm exophytic lesion in segment IV of the liver. Frozen section of the duodenal lesion was positive for NET. She underwent a Whipple's surgery, cholecystectomy, and left hepatic lobectomy. Postoperatively, she showed clinical and biochemical remission. Herewith, we report the third case of duodenal carcinoid tumor presenting as ectopic ACTH syndrome and the first with liver metastasis.

Chronic Subdural Hematoma: Role of Vascular Endothelial Growth Factor and Craniotomy in Pathophysiology and Prevention of Recurrence

Current body of evidence suggests that the maintenance or enlargement of chronic subdural hematoma (cSDH) is caused by multiple factors. Inflammatory and vascular endothelial growth factor (VEGF)–induced accumulation of hematoma plays an important role in pathophysiology of cSDH. If neomembrane is implicated in the propagation of inflammatory mediators, excision of the culprit membrane becomes essential to treat and prevent recurrence of cSDH. This retrospective study was conducted in a service hospital where 48 cases of cSDH were operated in 2 years. Patients were evaluated clinically and radiologically. Surgical procedure offered included burr hole craniotomy (BHC), twist drill craniotomy (TDC), or craniotomy (Cr) with excision of neomembrane. Cr was offered whenever there was suspicion or evidence of reaccumulation, solid or calcified hematoma formation, nonobliteration of the subdural space, or numerous thick membranes as were demonstrated in imaging. In Cr maximum part of outer neomembrane was excised and margins were coagulated. The excised outer neomembrane was sent for immunohistochemical examination to assess the VEGF expression. Depending on the VEGF expression as seen on the microscope, these expressions were grouped into weak, moderate, or strong VEGF expression. The study showed that cSDH patients with neomembrane formation benefit from Cr. The strong VEGF expression from the excised neomembrane further strengthens the proinflammatory VEGF theory propagation of cSDH. It further proves that excision of the culprit membrane is essential to prevent recurrences.

Rare case of radiologically distinct but pathologically admixed vestibular schwannoma and meningioma in the cerebellopontine angle: A case report

Primary intracranial tumors generally occur as solitary tumors. The association of two primary intracranial tumors of different histogenesis in the same individual is rare, except in cases of phakomatoses or radiation-induced tumors. Meningiomas and vestibular schwannomas (VSs) are one of the commonest tumors occurring intracranially. VS account for 80% of cerebellopontine angle (CPA) tumors, with meningiomas being the second most common tumor of the CPA. The occurrence of both a schwannoma and a meningioma in the CPA is rare. We report a case with coexistent CPA meningioma and VS, which were distinct radiologically on preoperative imaging, however had admixed areas of VS and meningioma on histopathological evaluation.

Renal cell carcinoma, unclassified with unique features

Renal cell carcinoma, unclassified constitute about 3-4% of all renal carcinomas. It essentially is a tumor where more than morphological variants or subtypes are seen in a single tumor. Usually there is a mixture of 2-3 different types. However, in this particular case there were at least 5 different types of morphological patterns in a single tumor including areas of so-called rhabdoid differentiation. The patient underwent nephrectomy and has been asymptomatic for the last 3.5. years. To the best of our knowledge, this is the first case of its own kind in the published literature.

Use of contralateral spinal accessory nerve for ipsilateral suprascapular neurotization in global brachial plexus injury: a new technique

Nerve transfer between the spinal accessory nerve (SAN) and the suprascapular nerve (SSN) is a standard technique in shoulder reanimation. In cases of global brachial plexus injury, donor nerves are few and at times severely traumatized owing to extensive traction forces. This precludes the application of standard nerve transfer techniques. The authors offer the use of the contralateral SAN as an additional option in the reinnervation of an injured SSN in such circumstances. To the best of their knowledge, this is the first successful attempt of this technique to be reported in the literature.

Mucinous tubular and spindle cell carcinoma of kidney: A case report of an unusual tumor

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare and unusual variant of renal cell carcinoma (RCC). It is important to differentiate this from the other variants particularly papillary RCC since MTSCC is generally low-grade, has low malignant potential and favorable prognosis. We are reporting a 40-year-old female presenting with right flank pain and well-circumscribed renal mass confined to the lower pole. Tumor consisted of tubules and cords separated by pale mucinous material in some areas, whereas other areas showed dense cellularity without significant mucin. The tumor cells were cuboidal or spindle and did not show significant atypical features. The patient underwent nephrectomy and is asymptomatic clinically and radiologically after 2 years.

Management of Isolated Musculocutaneous Injury: Comparing Double Fascicular Nerve Transfer With Conventional Nerve Grafting

PURPOSE

To compare the functional outcomes of nerve grafts and nerve transfers in the management of isolated musculocutaneous nerve (MCN) injuries.

METHODS

We performed a retrospective case-control study of isolated MCN injury managed at a tertiary care center. The study group was composed of 12 patients managed with double nerve transfer whereas the 8 patients in the grafted group constituted the control group.

RESULTS

In the study group, stab and missile injuries constituted most cases with a denervation period ranging between 3 and 9 months. Eleven patients in this group experienced a full range of active elbow flexion whereas one had antigravity flexion of 120°. Electromyography revealed the first sign of reinnervation of biceps at 10 ± 2 weeks, compared with 20 ± 2 weeks in the grafted group. The overall trend was for patients in the study group to have earlier return of active elbow flexion and better restoration of elbow flexion strength and range of (presumably active) elbow motion than those treated with grafting, although none of these measures reached statistical significance.

CONCLUSIONS

We found that distal nerve transfer was a superior method of managing isolated MCN injury compared with conventional nerve grafting.

Greater auricular nerve masquerading as lymph node

Hansen's disease is on the verge of being eliminated from India and often missed by clinicians due to low index of suspicion. We present an unusual case in which greater auricular nerve thickening masqueraded as enlarged lymph node in the neck. The patient was referred for fine needle aspiration cytology, which revealed epithelioid cell granulomas suggestive of Hansen's disease. Further clinical examination and investigations including the skin biopsy confirmed the disease, highlighting the role of pathologist in the management of such unusual presentation of a common disease.

Hybrid nanostructured C-dot decorated Fe3O4electrode materials for superior electrochemical energy storage performance

Here, the novel Fe₃O₄-C hybrid nanocomposite demonstrates high specific capacitance (S.C.) than the pristine Fe₃O₄nanospheres due to the presence of the highly conducting carbon quantum dots.

Primary intracranial benign fibrous histiocytoma: report of an unusual case

Benign fibrous histiocytomas (BFH) are neoplasms of the soft tissue and bone composed of fibroblastic and histiocytic components without any nuclear pleomorphism or histological anapalsia. Primary intracranial fibrous histiocytomas are rare entities. In comparison with the malignant counterpart, BFH are more uncommon. We describe a case of a 54-year-old woman, who presented with complaints of headache, giddiness, and gait instability of six months' duration. Magnetic resonance imaging (MRI) studies revealed an extra-axial lesion in the inferior aspect of the left temporal lobe suggestive of en-plaque meningioma. Subsequent histopathological examination of the biopsy sample revealed a benign fibrous histiocytoma, with involvement of the overlying temporal bone. Immunohistochemical analysis showed positivity for vimentin and CD68, with MIB-1 labeling index (MIB-1LI) of 2%, confirming the diagnosis.

An unusual case of cavernous haemangioma of the Fallopian tube

Fallopian tubes are one of the uncommon sites for neoplastic lesions in the female genital tract. Haemangiomas of the fallopian tubes are rare benign neoplasms that are documented as isolated case reports only. We present a rare case of incidentally detected cavernous haemangioma of the fallopian tube in a post menopausal female who underwent hysterectomy and bilateral salphingoopherectomy for dysfunctional uterine bleeding.

A rare case of familial reactive perforating collagenosis

A 4 year old boy presented with history of itchy raised lesions on body of 2 years duration. Though parental consanguinity was not present, his elder brother had similar complaints. Dermatological examination revealed multiple hyperpigmented papules with a central keratotic plug distributed mainly over face and extensors of upper and lower extremities. Koebnerisation was present. Skin biopsy revealed perforating collagen bundles in the upper dermis and epidermis which was confirmed by Van Gieson staining. Patient was being treated with topical retinoids and intralesional corticosteroids with minimal relief.

Correlation of expression pattern of aquaporin-1 in primary central nervous system tumors with tumor type, grade, proliferation, microvessel density, contrast-enhancement and perilesional edema

OBJECTIVES

Brain edema, a hallmark of malignant brain tumors, continues to be a major cause of mortality. The underlying molecular mechanisms are poorly understood and thought to be mediated through membrane water-channels: aquaporins (AQP1,4,9). The abnormal upregulation of AQP1 in certain glial neoplasms has suggested a potential role in tumor pathogenesis, apart from being a novel target for newer therapeutic regimen. This study was undertaken to evaluate the expression of AQP1 in primary CNS tumors of various histologic types and grades, and its correlation with contrast-enhancement, perilesional edema, histomorphology, proliferation index and microvessel density.

MATERIALS AND METHODS

Biopsy tissues from 30 patients (10 each from gliomas, meningiomas and other primary CNS tumors) were studied. Autopsy brain sections served as control. AQP1-immunoreactivity was correlated with histomorphology, radiology, proliferation index and microvessel density (MVD).

RESULTS

AQP1 expression was increased in gliomas and ependymal tumors as compared to meningiomas. Intratumoral expression was homogenous in high-grade and membranous in low-grade neoplasms, while peritumoral areas showed expression around vessels and reactive astrocytes. High-grade tumors showed peritumoral upregulation, while low-grade had intense intratumoral expression. A trend of positive correlation was observed between AQP1-immunopositivity and increasing grade, higher MIB-1LI, increasing contrast-enhancement and more perilesional edema, and elevated MVD with raised AQP1:MVD ratio.

CONCLUSIONS

AQP1-immunoexpression had a good correlation with high-grade tumors. AQP-upregulation in perilesional areas of high-grade tumors suggests its role in vasogenic edema. Further studies involving other AQP molecules, vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1 α (HIF-1α) should be undertaken to evaluate its possible role as a potential surrogate marker of high-grade tumors heralding poor outcome, inhibition of which may serve as the basis for future targeted therapy.

Posterior approach for both spinal accessory nerve to suprascapular nerve and triceps branch to axillary nerve for upper plexus injuries

Restoration of stability and movements at the shoulder joint are the 2 most important goals in the management of brachial plexus injuries. The 2 nerves that are preferentially targeted for this purpose are the suprascapular (SSN) and the axillary (AXN) nerves. These nerve transfers have conventionally been performed by the anterior approach, but recently transfers performed by posterior incisions have been gaining popularity, by virtue of being selective and located close to the target muscles. Herein, we describe the technical details of spinal accessory nerve (SAN) to SSN and triceps branch to AXN for upper plexus injuries, both performed by the posterior approach.

Pemphigus foliaceus masquerading as IgA pemphigus and responding to dapsone

A 14-year-old male presented with seven years history of recurrent episodes of fluid filled, itchy and eroded lesions over the body not responding to oral corticosteroids and azathioprine. Dermatological examination revealed crusted plaques and erosions in a seborrheic distribution. Histopathology of skin lesions and direct immunofluorescence were characteristic of pemphigus foliaceus. He was treated with dexamethasone pulse therapy with inadequate response. However, relapsing skin lesions revealed a circinate arrangement with a predilection to trunk and flexures. In view of clinical features suggestive of IgA pemphigus, he was started on dapsone, to which he responded dramatically in four weeks. However, repeat biopsy continued to reveal features of pemphigus foliaceus and ELISA for anti-desmoglein 1 antibodies was positive.

Correlation of histomorphologic prognostic markers and proliferative index with loss of heterozygosity 1p/19q and MGMT status in diffusely infiltrating gliomas

BACKGROUND

Loss of heterozygosity (LOH)1p/19q, and epigenetic silencing of O(6)-methylguanine-DNAmethyltransferase (MGMT) gene, displayed promising role as predictive and prognostic markers in brain tumours. The present study correlated both with conventional histomorphologic prognostic markers and proliferative index in diffusely infiltrating gliomas (DIG).

METHODS

Tissues from 45 patients were evaluated for LOH1p/19q using polymerase chain reaction based microsatellite analysis; and for MGMT using immunohistochemistry. Results were correlated with age, histologic type, WHO grade, and proliferation index.

RESULTS

Mean MIB-1 LI showed significant correlation with tumour grade. MGMT-staining in grade II and IV tumours were 31.1% and 16.8%, respectively, while in DA and GBM it was 88.2% and 19.0%, respectively, which were statistically significant. Sixteen cases showed LOH 1p and/or 19q of which 10 (5 oligodendroglial, 3 GBM, AA, DA) had combined LOH; while three each showed 1p (all GBM) and 19q (2 DA and GBM) loss. In the MIB-1LI ≤ 5% and >5% groups LOH 1p and/or 19q was encountered in 6 and 10 cases, respectively. A significant inverse association was noted between LOH with MGMT.

CONCLUSIONS

LOH1p/19q and MGMT shows good correlation with conventional histomorphologic and proliferation markers, and should constitute part of the optimal diagnostic workup of DIG.

Haemangioma of the nasal bone

A 16 year-old female presented for her cosmetic deformity with a slowly progressing swelling of insidious onset on the upper part of the bridge of the nose slightly towards the left side for 3 year duration. Clinical & radiological examination revealed an intra-osseous tumor of nasal bone. Histopathologically the tumor was a cavernous haemangioma of nasal bone. A follow up study upto 13-year showed no recurrence. A detailed search of world literature is carried out with clinical history & history of trauma. It could that nasal bone haemangioma is separate disease entity. The patients usually seek advise for their cosmetic deformity & sometime for nasal bleeding.

Adrenal haemangioblastoma presenting as phaeochromocytoma: a rare manifestation of extraneural hemangioblastoma

PURPOSE

Adrenal haemangioblastoma presenting clinically as pheochromocytoma is a rare manifestation of extraneural haemangioblastoma. We present an unusual case of von Hippel-Lindau (VHL) disease that had adrenal and cerebellar haemangioblastoma with multiple renal cysts, and a review of the literature.

METHODS

Unlike the usual manifestations of secondary polycythemia or increased intracranial pressure and hydrocephalus due to cerebellar lesion, this 36-year-old male presented with hypertension. Investigations revealed right suprarenal mass with raised urinary catecholamines and serum vanillylmandelic acid (VMA) levels, apparently confirming the clinical diagnosis of phaeochromocytoma.

RESULTS

Histopathology of the biopsy specimen showed features of haemangioblastoma, which was confirmed by immunohistochemistry using antibodies to neuron specific enolase and aquaporin-1. Based on this, the patient was screened for possible features of VHL, which revealed cerebellar haemangioblastoma and multiple renal cysts with angiomatous lesion. Postoperative follow-up showed normal levels of catecholamines without any symptoms of phaeochromocytoma.

CONCLUSIONS

Adrenal haemangioblastoma is a rare entity with only four cases reported in the literature. Surgical removal is the treatment of choice. However, screening for other possible features of VHL, even in the absence of clinical features, is essential to exclude other potential lesions.