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   Table of Contents - Current issue
Coverpage
October-December 2016
Volume 59 | Issue 4
Page Nos. 439-574

Online since Monday, October 10, 2016

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EDITORIAL  

From Editor's desk p. 439
Vatsala Misra
DOI:10.4103/0377-4929.191748  PMID:27721270
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GUEST EDITORIALS Top

Talking KIT of the gastrointestinal stromal tumors p. 441
Kim Vaiphei
DOI:10.4103/0377-4929.191749  PMID:27721271
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Soft tissue amyloidoma in association with plasmacytoma p. 444
Ranjan Agrawal
DOI:10.4103/0377-4929.191752  PMID:27721272
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REVIEW ARTICLE Top

Plasmacytic or lymphoplasmacytic infiltrate in lymph nodes: Diagnostic approach and differential considerations Highly accessed article p. 446
Yi Xie, Bethany Vallangeon, Xin Liu, Anand S Lagoo
DOI:10.4103/0377-4929.191756  PMID:27721273
Plasmacytosis is a common finding in lymph node biopsies and can be seen in diverse circumstances ranging from reactive lymphadenopathy to malignant lymphoma. Familiarity with various histopathologic features of the different entities and awareness of their typical clinical and ancillary study findings are essential for an accurate diagnosis. In this review, we present common and representative nonneoplastic entities and lymphomas that have plasmacytic differentiation or associated plasmacytosis. We focus on the histological classification with an emphasis on the diagnostic approach and areas of diagnostic challenge.
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ORIGINAL ARTICLES Top

Comparison of histological grading methods in mucoepidermoid carcinoma of minor salivary glands p. 457
Ahmed Qannam, Ibrahim O Bello
DOI:10.4103/0377-4929.191765  PMID:27721274
Context: Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy and its grading is greatly consequential in the management and prognosis of patients with the disease. Aims: To compare histologic grading systems in MEC of minor salivary glands. Settings and Design: Two qualitative (modified Healy and Memorial Sloan-Kettering Cancer Center [MSKCC] methods) and two quantitative (Armed Forces Institute of Pathology [AFIP] and Brandwein methods) were evaluated. Subjects and Methods: Diagnostics slides of 19 patients including one recurrent case were evaluated using the four grading systems. Statistical Analysis Used: Percentages and proportions were used. Results: Agreement across all grading system was found to be very low (32%) while there was a better agreement between AFIP and MSKCC methods (84%) between modified Healy and Brandwein (58%). The method that gave the poorest agreement with all the others was the Brandwein grading. In general, the AFIP and MSKCC methods tended to grade the tumors lower while the Brandwein and modified Healy methods seemed to grade them higher. Conclusions: Most MEC of minor salivary glands appear to be low-grade tumors. It is conceivable that some grading methods (Brandwein and modified Healy) may lead to an unnecessary escalation of management methods in these tumors. The MSKCC method may have emphasized some parameters which may not have much importance in minor salivary gland MEC. The AFIP method appears to be the most appropriate to use for the grading of minor salivary gland MEC. Further studies are required to confirm or disprove this finding.
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Evaluation of pathological parameters and morphometric data of desmoplastic lobular breast carcinoma p. 463
Ivan R Ilic, Nikola M Stojanović, Pavle J Randjelović, Marina N Mihajlović, Niko S Radulović, Ratko S Ilić
DOI:10.4103/0377-4929.191775  PMID:27721275
Background: Invasive lobular breast cancer (ILC) is the second most frequent form of breast cancer. While cancer cells are regularly investigated, tumor stroma represents a highly unexplored field. Aims: The aim of this study is to perform a detailed investigation of clinical, immunohistochemical, and morphometric characteristics of desmoplastic (D) and nondesmoplastic (ND) ILC. Materials and Methods: This study included twenty cases of ILC that were divided into two groups designated as D and ND groups. Medical histories and diagnosis data were obtained from the archives of the Center of Pathology, Clinical center Niš (Serbia). Morphometric analysis of hematoxylin and eosin stained slides was performed using ImageJ software, and the obtained data were further statistical processed. Results: Statistical analyses of the data revealed that no significant differences between D and ND groups when patient age, estrogen receptor (ER), and progesterone receptor (PR) expressions and morphometrical parameters (such as the distance between groups of cancer cells and nucleocytoplasmic ratio) were compared. However, D and ND groups statistically, significantly differed in the occurrence of axillary lymph node metastasis, and when the ER and PR data were included, in certain nuclear parameters (cell/nucleus area, perimeter, Feret's diameter, and circularity). Conclusions: Desmoplastic stroma was observed more frequently in patients without axillary lymph node metastases, whereas the expression of ER and PR had no influence on its development. According to the measured morphometric parameters larger cells/nuclei belonged to ND group.
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Assessment of antigen presenting cell infiltration in lung tissues of patients with bronchiectasis p. 469
Waseem M Hajjar, Abdulaziz H Alzeer, Amany A Fathaddin, Hadil A Al-Otair, Ammar C Al-Rikabi, Zahid Shakoor
DOI:10.4103/0377-4929.191779  PMID:27721276
Background: Bronchiectasis is a chronic disease characterized by permanent dilatation of the conducting airways accompanied by sustained inflammation. Aims: To assess whether chronic inflammation of lungs in bronchiectasis is associated with alterations in the numbers of infiltrating antigen presenting cell (APC). Setting and Design: Lobectomy specimens from 12 nonsmoker, nonasthmatic patients with acquired (noncongenital) bronchiectasis and six control patients were included in the study. Histopathology slides were reviewed, and immunohistochemical markers for dendritic cells (DCs) macrophages and Langerhans cells have been applied and analyzed. Materials and Methods: Tissue specimens were stained by immunohistochemistry using markers for DCs (CD83 and CD23), macrophages (CD68 and CD163), and Langerhans cells (CD1A and S-100 protein). The mean cell counts of stained cells in five high power microscopic fields were recorded. Statistical Analysis Used: Descriptive statistics, mean, standard deviation, median, and interquartile range were used. A nonparametric Mann-Whitney U-test was used to compare cell counts between bronchiectasis and control patients. P <0.05 was considered significant. Results: The mean age of patients with bronchiectasis and controls was 36.7 ± 16.6 and 31.8 ± 22.6 years, respectively. The predominant cell type among the patients was macrophage (median 50.5) followed by DCs (median 44.85), histiocytes (median 32), and Langerhans cells (median 5%). Compared to the controls a significantly higher number of macrophages (P = 0.01), DCs (P = 0.001), and Langerhans cells (P = 0.014) were present. Conclusion: Chronic inflammatory response in acquired (noncongenital) bronchiectasis is most probably mediated by increased infiltration of APCs in lung tissues.
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Does Hepatocyte Paraffin 1 expression stand a role in determining the site origin of an adenocarcinoma from unknown gastrointestinal primary? p. 474
Rajni Yadav, Saurav Chopra, Aayushi Garg, Brijnandan Gupta, Prateek Kinra, Siddhartha Datta Gupta, Prasenjit Das
DOI:10.4103/0377-4929.191781  PMID:27721277
Background: Hepatocyte Paraffin 1 (Hep Par 1) was being extensively used to recognize the hepatocellular carcinomas, until recognition of its expression in tumors without hepatocellular differentiation. Aims and Objectives: The aim of this study was to analyze if Hep Par 1 stain can serve as a specific marker of the small intestinal (SI) adenocarcinomas, versus other gastrointestinal tract (GIT) primary tumors. Materials and Methods: In this retrospective cross-sectional study, normal GIT mucosa (n - 60), corresponding adenocarcinomas (n - 60) and nodal metastatic foci (n - 60) from the same patients, including 10 cases each from the esophagus, stomach, SI periampullary region, colon, rectum, and gall bladder were included. H-score was calculated by multiplying the stain distribution and intensity scores. The H-scores were compared with other clinical and histological parameters. Results: While normal SI mucosa showed diffuse strong Hep Par 1 staining, normal esophageal and gastric epitheliums were negative and normal colon, rectal, and biliary epithelium showed weak focal positivity. Adenocarcinomas from all these sites, however, showed Hep Par 1 expression, irrespective of the tumor type, site or origin, and tumor stage. The corresponding metastatic sites also showed variable Hep Par 1 positivity, without any site specificity. Conclusion: Hep Par 1 stain cannot help to determine the exact site of origin of primary GIT tumors. Its expression in adenocarcinomas across the GIT and their metastatic foci proves that it cannot be regarded as a marker of SI differentiation, especially in malignancy.
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Secretory cell outgrowths, p53 signatures, and serous tubal intraepithelial carcinoma in the fallopian tubes of patients with sporadic pelvic serous carcinoma p. 481
Neha Mittal, Radhika Srinivasan, Nalini Gupta, Arvind Rajwanshi, Raje Nijhawan, Upasana Gautam, Swati Sood, Lakhbir Dhaliwal
DOI:10.4103/0377-4929.191789  PMID:27721278
Context: High-grade serous carcinomas of ovarian, tubal, and peritoneal origin are together referred as pelvic serous carcinoma. The fallopian tubes, ovarian surface epithelium, and the tuboperitoneal junctional epithelium are all implicated in pelvic serous carcinogenesis. Aims: The aim of this study is to identify putative precursor lesions of serous carcinoma including secretory cell outgrowths (SCOUTs), serous tubal intraepithelial carcinoma (STIC), and p53 signatures and assign its probable site of origin. Settings and Design: Prospective case-control study of consecutive specimen comprising 32 serous carcinomas and 31 controls (10 normal adnexa, 10 benign and 6 atypically proliferative surface epithelial tumors, and 5 other carcinomas). Subjects and Methods: Sectioning and extensive examination of the fimbrial end (SEE-FIM) protocol along with immunohistochemistry for Bcl-2, p53, and Ki-67 was employed for evaluating invasive carcinoma and precursor lesions in cases versus controls. Results: SCOUT, p53 signatures, and STIC were most frequent in the serous carcinomas. p53 signatures and STIC were always seen in the fimbrial end. STICs were exclusively present in serous carcinomas, more common in ipsilateral tubes of cases with dominant ovarian mass. Multifocal p53 signatures with STIC were seen in 7 (21.9%) cases. STIC was present with or without an invasive carcinoma in 25% and in 6.25% of cases of pelvic serous carcinomas, respectively. The junctional epithelia did not show any lesion in any group. Conclusions: SEE-FIM protocol is recommended for evaluation of sporadicpelvic (ovarian/tubal/peritoneal) serous carcinoma. Based on the presence of STIC or invasive carcinoma, nearly 60% of all pelvic serous carcinomas are of fallopian tubal origin.
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Immunohistochemical expression of Ets-related gene-transcriptional factor in adenocarcinoma prostate and its correlation with Gleason score p. 489
Rahul Mannan, Tejinder Singh Bhasin, Mridu Manjari, Gagandeep Singh, Puneet Kaur Bhatia, Sonam Sharma
DOI:10.4103/0377-4929.191794  PMID:27721279
Background: Prostate carcinoma is the second leading cause of cancer-related deaths in males worldwide. The burden is expected to grow 1.7 million new cases and 499,000 new deaths by 2030. In developing countries such as India, prostate carcinoma will show an increase by 140% in the next few years. Although the diagnosis of prostate carcinoma can usually be made on histological features, now a days many immunohistochemical (IHC) markers are used to distinguish it from benign mimickers as well as in predicting prognosis and treatment. Out of these markers, Ets-related gene (ERG product) is a proto-oncogene which participates in chromosomal translocations and is frequently over expressed in prostate carcinoma which harbors ERG-transmembrane protease, serine 2 fusion. Materials and Methods: Fifty cases of carcinoma prostate diagnosed in needle biopsies and prostatic chips, in the Department of Pathology of a tertiary care teaching hospital in Punjab, India, were included in the present study. The slides were observed under the light microscope, and Gleason scoring was done using the 2005 International Society of Urological Pathology modified Gleason system. IHC study for ERG expression was done on all the cases, for which anti-ERG monoclonal rabbit clone antibody EP111 (Dako, Denmark) was used. Lymphocytes and endothelial cells were taken as in built positive controls for staining. The intensity of ERG positivity was scored as no staining (0), weak staining (+1), moderate staining (+2) and intense staining (+3). The H score was then calculated by multiplying the intensity of the stain with the percentage (0-100) of the cells showing that staining intensity. The H-score has a range of 0-300. The relationship between IHC expression and clinico-pathological parameters was compared and analyzed using Chi-square test. P < 0.05 was considered statistically significant. Results: Majority of patients included in the study were in the age group of 61-80 (84% of the total). When ERG expression was studied with age-specific rates, it was not found to be statistically significant. The most common pattern noted in the present study was 4 + 3, constituting 36% of total, followed by 3 + 4 constituting 32%. Calculating the score, the majority of patients had a Gleason score of 5-8, constituting 76% of total. Out of the total fifty cases of prostate carcinoma, ERG was positive in 29 cases (58%) and negative in 21 cases (42%). Fourteen out of 21 (48%) of the ERG positive cases had an intensity score of 3. When the ERG intensity was correlated with the Gleason score group, it was seen that patients having Gleason score 7-8 showed ERG positivity in 19 out of 38 cases (50%), with 11/19 (57%) cases showing an ERG intensity score of 3. The Gleason score group 9-10 showed ERG positivity in 83% (10/12) cases, 20% (2/10) cases showing intensity score of 3. This correlation was found to be statistically significant. Conclusion: ERG immunostaining was performed in a small Indian cohort of prostate cancer patients, diagnosed in trucut biopsy specimens and prostatic chips. ERG expression was found in 58% patients. An increase in the ERG expression was observed with an increase in Gleason score. The intensity of ERG expression, however, decreased with an increasing Gleason score.
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In vitro activity of ceftaroline: A novel antibiotic against methicillin-resistant Staphylococcus aureus p. 496
Vaishali Gaikwad, Tejash Gohel, Shrijeet Panickar, Vijay Chincholkar, Santosh Mangalkar
DOI:10.4103/0377-4929.191798  PMID:27721280
Introduction: Staphylococcus is one of the most common causes of nosocomial infection, especially pneumonia, surgical site infections, blood stream infections, and continues to be a major cause of community-acquired infections. The emergence of penicillin resistance followed by the development and spread of strains resistant to the semisynthetic penicillins such as methicillin, oxacillin and nafcillin, macrolides, tetracycline, and aminoglycosides has made the treatment of staphylococcal infection a global challenge. To treat this multidrug-resistant methicillin-resistant Staphylococcus aureus (MRSA), the only option available is glycopeptides such as vancomycin. However, recently, vancomycin-intermediate S. aureus and vancomycin-resistant S. aureus strains have emerged with different resistance mechanism. There are newer drugs in the pipeline against MRSA such as ceftaroline, dalbavancin, oritavancin, and tedizolid; however, very little data are available for their use. Recently, ceftaroline has been approved by the US Food and Drug Administration for the treatment of acute bacterial skin and soft tissue infections and community-acquired bacterial pneumonia due to MRSA. Hence, we tried to evaluate in vitro activity of ceftaroline against MRSA. Aim: The aim of this study was to detect in vitro activity of new cephalosporin, ceftaroline, against MRSA. Materials and Methods: Thirty nonduplicate MRSA strains were collected from various clinical samples, and minimum inhibitory concentration (MIC) was detected using ceftaroline E-test strips. Results: Twenty-eight MRSA isolates (93.33%) were found to be susceptible to ceftaroline. Conclusion: Ceftaroline demonstrated promising potency and coverage against MRSA isolates and can be considered an effective alternative treatment keeping vancomycin and linezolid as a reserved option.
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Application of serology and nested polymerase chain reaction for identifying Chlamydophila pneumoniae in community-acquired lower respiratory tract infections in children p. 499
Surinder Kumar, Sanjeev R Saigal, Gulshan Rai Sethi, Sanchit Kumar
DOI:10.4103/0377-4929.191803  PMID:27721281
Context: Chlamydophila pneumoniae is a common cause of community-acquired respiratory infections, including pneumonia, bronchitis, and upper respiratory tract infections. Since it is difficult to detect C. pneumoniae in clinical practice, specific etiological diagnosis is established only in a minority of cases. Aims: To investigate the role of C. pneumoniae in community-acquired lower respiratory tract infections (LRTIs) in children, with the use of serological tests and nested polymerase chain reaction (PCR) analysis. Settings and Design: One hundred children, age of 2 months to 12 years, hospitalized for community-acquired LRTIs were investigated for C. pneumoniae etiology. Materials and Methods: We investigated 100 children hospitalized for community-acquired LRTIs, using enzyme-linked immunosorbent assay for detecting anti-C. pneumoniae immunoglobulin M, and immunoglobulin G antibodies and nasopharyngeal aspirates for analysis of C. pneumoniae PCR. The demographic, clinical, and radiological findings for C. pneumoniae antibody positive and C. pneumoniae antibody negative cases were compared. Statistical Analysis Used: Data analysis was performed by Chi-square test and Fisher's exact tests using Epi Info (2002). Results: Clinical and radiological findings in both the groups were comparable. A relatively higher rate of C. pneumoniae infection in children was observed below 5 years of age. Serological evidence of C. pneumoniae infection was observed in 12 (12%) patients and nested PCR was positive in 5 (5%) children. Thirteen (13%) patients were diagnosed with C. pneumoniae infection by serology and/or nested PCR. Conclusions: Our study confirms that C. pneumoniae plays a significant role in community-acquired LRTIs in children of all ages, even in children aged <5 years.
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BRIEF COMMUNICATIONS Top

Impact of methylene blue staining in the retrieval of lymph nodes in resected colorectal cancer specimens p. 504
Anjaneyulu Vasala, Haripreetha G Nair, Subramanyeshwar T Rao, K Ravindranath Tagore, Sudha S Murthy, Daphne Fonseca
DOI:10.4103/0377-4929.191804  PMID:27721282
Adequate lymph node harvest in resected colorectal cancer (CRC) specimens is important in staging and choosing appropriate therapeutic options. The yield of lymph nodes and metastatic nodes by methylene blue dye injection in 30 randomly selected resected CRC specimens was compared with an equal number of CRC specimens (control) with matched grade and stage.The mean number of lymph nodes retrieved in the study group was 22 ± 9 compared to 17 ± 8 in the control group which was statistically significant (P = 0.04).Methylene blue technique is an effective aid in increasing the yield of lymph nodes in the resected CRC specimens.
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Incidentally detected clear cell renal cell carcinoma with rhabdoid differentiation p. 507
Venkatesh Krishnamoorthy, Kiran Krishne Gowda, Raman Narayana Rao
DOI:10.4103/0377-4929.191805  PMID:27721283
Renal cell carcinoma with rhabdoid differentiation (RCC-R) has an aggressive biologic behavior and poor prognosis. A recent consensus statement of the International Society of Urological Pathology (ISUP) proposed a nucleolar grading system (ISUP grade) for RCC to replace Fuhrman system and recommended reporting the presence of rhabdoid differentiation and considering tumors with rhabdoid differentiation to be ISUP Grade 4. We report a case of incidentally detected clear cell RCC-R in a 52-year-old man. This is one of the earliest cases of RCC-R (pT1b) detected and first such case from Indian subcontinent.
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The rising trend of coagulase-negative staphylococci in neonatal septicemia p. 510
Vijaya Shivanna, SR Sunkappa, D Venkatesha
DOI:10.4103/0377-4929.191806  PMID:27721284
Neonatal septicemia is one of the leading causes of neonatal mortality and morbidity worldwide. Hence, the present study was undertaken to isolate the bacteria causing neonatal sepsis and determine their antibiotic susceptibility pattern. Fifty neonates suspected to have septicemia were screened for 2 months (July and August 2014). Out of 50 specimen, 15 (30%) were blood culture positive. Coagulase-negative staphylococci was the most common isolate (10, 66.6%), with 60% (6 isolates) methicillin resistance. In view of the increasing antibiotic resistance, periodic surveillance should be conducted to control the emergence and spread of antimicrobial resistance.
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CLINICOPATHOLOGICAL FORUM Top

A child with neurological deficits, electrolyte imbalance, and arrhythmia p. 513
Pradeep Vaideeswar, Sunil Karande, Sandeep Bavdekar, Sarfaraz Momin, Naina Goel
DOI:10.4103/0377-4929.191807  PMID:27721285
A child presented with an acute febrile illness associated with neurological symptoms. The differential diagnoses of such a presentation with effects of prolonged hospitalization is discussed.
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CASE REPORTS Top

Low-grade papillary adenocarcinoma of nasopharynx with expression of thyroid transcription factor-1: Case report and review of literature p. 518
Binitha Rajeswari, Reghu K Sukumaran Nair, Kusumakumary Parukuttyamma, Anitha Mathews
DOI:10.4103/0377-4929.191809  PMID:27721286
Low-grade papillary adenocarcinomas with expression of thyroid transcription factor-1 (TTF-1) are rare tumors of the nasopharynx, with only a few cases reported in the literature. These tumors have an excellent prognosis following complete surgical excision. We report a 13-year-old boy with this rare tumor in the nasopharynx. The patient underwent complete surgical excision of the tumor and was on follow-up without evidence of recurrence.
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An atypical nonsebaceous lymphadenoma with diffuse lymphoepithelial differentiation p. 521
Min-Kyung Yeo, Da Mi Kim, Jin Man Kim
DOI:10.4103/0377-4929.191810  PMID:27721287
Nonsebaceous lymphadenoma is an uncommon salivary gland tumor. It consists of lymphoid and epithelial components that lack sebaceous differentiation. Herein, we present a 44-year-old woman with left a submandibular gland tumor. The tumor is well-circumscribed and solid without ductal or cystic formation. The epithelial cells intermingle with lymphoplasma cells. The epithelial cells show moderate cytologic atypia and a few mitoses with no viral infection. Histologically, the tumor had features of nonsebaceous lymphadenoma with unusual findings of nuclear atypia and marked lymphoepithelial differentiation. Atypical nonsebaceous lymphadenoma with diffuse lymphoepithelial differentiation is rare and important to recognize to avoid misdiagnosis.
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Xanthogranulomatous pyelonephritis and renal tubulopapillary adenomas: A rare coexistence p. 524
Deval Parekh, Moumita Sengupta, Mou Das, Uttara Chatterjee
DOI:10.4103/0377-4929.191812  PMID:27721288
Xanthogranulomatous pyelonephritis is an uncommon inflammatory condition accounting for 1% of chronic pyelonephritis cases. Clinically and radiologically it mimics other renal space occupying lesions. Hence, correct preoperative diagnosis is not possible in all cases and nephrectomy is done in most patients. Renal tubulopapillary adenomas are benign epithelial lesions of kidney found to be associated with papillary renal cell carcinoma, acquired renal cystic disease, long term hemodialysis, arteriosclerotic renal vascular disease, etc. Here, we report two cases of Xanthogranulomatous pyelonephritis associated with the rare finding of renal tubulopapillary adenomas.
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Unilateral gonadoblastoma with dysgerminoma in normal fertile woman having a child: Extremely rare occurrence with characteristic immunohistomorphology p. 527
Maithili Mandar Kulkarni, Siddhi Gaurish Sinai Khandeparkar, Avinash R Joshi, Pallavi V Bhayekar
DOI:10.4103/0377-4929.191815  PMID:27721289
Gonadoblastomas (GBYs) are rare gonadal tumors almost always arising from a dysgenetic gonad with a Y chromosome. Very rarely, GBYs appear in otherwise normal women with a history of pregnancy. The typical histological appearance of GBY can be altered by extensive deposition of basement membrane material, calcification, or overgrowth by a malignant tumor. Less than 10 cases have been reported with normal 46XX karyotype. Only six cases of GBY have been described in pregnant women. We present a unique case of GBY with dysgerminoma in a genotypically and phenotypically normal woman with a history of normal pregnancy, absence of virilization, and characteristic immunohistomorphological features.
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Minimal deviation adenocarcinoma of endometrium: A rare entity in a 72-year-old female p. 530
Thambi Renu, Mathew Siji, N Shilpa, A Vijayalakhmi
DOI:10.4103/0377-4929.191817  PMID:27721290
Minimal deviation adenocarcinoma (MDA) of endometrium is considered a differentiated state of endometrioid adenocarcinoma. It is a low-grade tumor associated with areas histologically typical of endometrioid adenocarcinoma in the majority of the cases. Due to deceptively benign microscopy, MDA may be overlooked leading to incorrect assessment of tumor extend and staging.
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Metastatic malignant melanoma of the urinary bladder: A case report and review of the literature p. 532
Cumhur Selçuk Topal, Gözde Kır, Taner Daş, Billur Sarbay, Muzaffer İlkay Tosun
DOI:10.4103/0377-4929.191820  PMID:27721291
Metastatic bladder tumors constitute <5% of all bladder tumors and metastatic malignant melanoma of the urinary bladder is very rare. We present a case report of a metastatic malignant melanoma of the urinary bladder. A 70-year-old woman without any apparent significant clinical history was admitted to the Department of Urology for gross hematuria. Microscopic findings of the transurethral resection specimen revealed fascicles, sheets, and diffuse areas composed of oval and fusiform cells with focal pigmentation. Immunohistochemical analysis revealed that the tumor cells were positive for human melanoma black-45, Melan-A, and S100, and negative for pancytokeratin. Subsequently, we contacted the patient and learned that she was admitted to the Department of Ophthalmology for painless and progressive visual field loss 15 years ago. She had been diagnosed with a primary ocular (uveal) melanoma. A detailed patient history coupled with histological and immunohistochemical findings were necessary to make the final diagnosis of metastatic melanoma.
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Soft-tissue amyloidoma with associated plasmacytoma p. 535
Bibhas Saha Dalal, Piyabi Sarkar, Namrata Maity, Sayed Mahmood Nadeem
DOI:10.4103/0377-4929.191821  PMID:27721292
Soft tissue amyloidoma with features similar to plasmacytoma, in absence of systemic amyloidosis, is an extremely rare finding. We hereby report the case of a 77 year old man who presented with a painless, nodular swelling on chest wall, diagnosed as soft tissue amyloidoma with plasma cell infiltration. Congo red staining was done to prove the presence of amyloid which showed characteristic "apple-green" birefringence on polarized microscopy. The plasma cells were monoclonal in origin as demonstrated by serum protein and immunofixation electrophoresis. To the best of our knowledge, this is the second such reported case. However close follow up is required, as this patient may develop multiple myeloma in future.
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Expression pattern of programmed death-1 in lymphocyte-rich classical Hodgkin lymphoma according to the growth patterns p. 538
Jai Hyang Go
DOI:10.4103/0377-4929.191819  PMID:27721293
We present a rare case of lymphocyte-rich classical Hodgkin lymphoma (LRCHL), which exhibited different expression patterns of programmed death-1 (PD-1) in nodular and interfollicular areas. A 57-year-old male patient presented with neck masses. Neck computed tomography showed enlargement of multiple lymph nodes in right Level II and III. Histologic examination of the excised lymph node revealed LRCHL with nodular and interfollicular patterns. Immunohistochemical analysis for PD-1 revealed a small number of weakly stained cells in the interfollicular area. PD-1 (+) cells were markedly increased in cell number and staining intensity in the nodular area and formed rosettes around the tumor cells.
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Primary plasma cell leukemia: A report of two cases of a rare and aggressive variant of plasma cell myeloma with the review of literature p. 541
Prithal Gangadhar, Zulfikar Ahmed, Muktha R Pai, I Sandhya
DOI:10.4103/0377-4929.191818  PMID:27721294
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma accounting for 2-3% of all plasma cell dyscrasias characterized by the presence of circulating plasma cells. The diagnosis is based on the % (≥20%) and absolute number (≥2x10 9 /L) of plasma cells in the peripheral blood. The incidence of primary PCL (pPCL) is very rare and reported to occur in <1 in a million. It is classified as either pPCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. pPCL is a distinct clinicopathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. We report two cases of pPCL, both having acute onset of illness, varied clinical presentation with one of them showing "hairy cell morphology," with rapidly progressing renal failure, and was not suspected to be plasma cell dyscrasia clinically. A detailed hematopathological evaluation clinched the diagnosis in this case. It is recommended that techniques such as immunophenotyping by flow cytometry and protein electrophoresis must be performed for confirmatory diagnosis. A detailed report of two cases and a review of PCL are presented here.
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Acute myeloid leukemia with t(4;12)(q12;p13): A morphological dilemma p. 545
Umang V Patel, SR Arun, Deepak Kumar Mishra, Mayur Parihar
DOI:10.4103/0377-4929.191814  PMID:27721295
Cytogenetics has a pivotal role in risk stratification of acute myeloid leukemia (AML). We report a case of AML with a t(4;12)(q12;p13). To the best of our knowledge, there are about 24 cases of t(4;12) reported in AML which are usually misdiagnosed as lymphoproliferative disorders on morphological assessment. This case showed specific clinical, morphological, and immunophenotypic features such as (1) pseudo lymphoid morphology, (2) dysplasia in granulocytic series, (3) an immature immunophenotype with positivity for CD34 and CD117, and (4) poor treatment response.
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Vancomycin-resistant enterococci in neonatal stool as a cause of septicemia: Challenges for infection control practices p. 548
Satyendra Kaushal, Tuhina Banerjee, Shampa Anupurba, Ashok Kumar
DOI:10.4103/0377-4929.191802  PMID:27721296
The increasing reports of vancomycin-resistant enterococci (VRE) as a cause of neonatal septicemia are of recent interest. However, in majority of the cases, the source of VRE could not be located. As a consequence, the real importance of VRE and its control measures is undermined. Herein, we report a case of neonatal septicemia due to VRE (Enterococcus faecalis) of vanA genotype with VRE carriage in stool of the neonates as a possible source of sepsis. The report put forwards some lacunae in the infection control practices that are presently followed in the country.
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Urinary tract infection due to Chryseobacterium gleum, an uncommon pathogen p. 551
Prabha Rajendran, Swapna Muthusamy, Vignesh K Balaji, Gerard J Rakesh, Joshy M Easow
DOI:10.4103/0377-4929.191800  PMID:27721297
Chryseobacterium species are gaining importance as an emerging opportunistic nosocomial pathogen. Limited availability of clinical data necessitates reporting of such isolates. We report a case of nosocomial urinary tract infection by metallo-β-lactamase-producing Chryseobacterium gleum in an elderly diabetic male with chronic renal disease. Identification and antibiotic sensitivity test performed by conventional methods were confirmed by Matrix-assisted Laser Desorption Ionization Time-of-Flight and VITEK-2 systems, respectively. The patient responded well to intravenous ciprofloxacin therapy.
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Bacillus cereus causing intratumoral brain abscess p. 554
Karnika Saigal, Vikas Gautam, Gagandeep Singh, Pallab Ray
DOI:10.4103/0377-4929.191799  PMID:27721298
We report a case of intratumoral brain abscess due to Bacillus cereus in an adult male patient, which was managed successfully with excision of lesion and piperacillin-tazobactam for the duration of 5 weeks. To the best of our knowledge, this is a first case report of B. cereus infection leading to intratumoral brain abscess in a patient with a history of steroid administration by the intravenous route.
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IMAGES Top

The fire flares which lead to grave p. 557
Heena Maulek Desai, Jyothi B Shetty, Kusum D Jashnani
DOI:10.4103/0377-4929.191795  PMID:27721299
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LETTERS TO EDITOR Top

Primary synovial sarcoma of the parotid gland: An unusual entity p. 559
Abhimanyu Sharma, Mayurika Tyagi, Sanjay Gupta, Vinod Kumar Arora
DOI:10.4103/0377-4929.191768  PMID:27721300
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Co-existing tuberculosis and adenocarcinoma of colon p. 560
Sudha Sharma, Arun Kumar Vijay Kumar, Nandita Kakkar, Vikas Gupta
DOI:10.4103/0377-4929.191770  PMID:27721301
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Primary mediastinal melanoma: A rare presentation p. 561
Sohaila Fatima, Nazima Haider, Nihal Ibrahim Mirza, Bouvier Francis Valere D'sa
DOI:10.4103/0377-4929.191772  PMID:27721302
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Coexistence of breast carcinoma, pseudoangiomatous stromal hyperplasia, and neurofibromatosis type 1 in a male patient p. 563
Poulios A Christos, Koletsa D Triantafyllia, Hytiroglou M Prodromos, Kostopoulos S Ioannis
DOI:10.4103/0377-4929.191773  PMID:27721303
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Renal cell carcinoma with rhabdoid differentiation: A novel entity with immunohistochemical study p. 565
A Ail Divya, G Sinai Kandheparkar Siddhi, R Joshi Avinash, D Bhayekar Pallavi
DOI:10.4103/0377-4929.191778  PMID:27721304
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A pathologist's role in evaluation of postneoadjuvant chemotherapy epithelial ovarian carcinomas p. 567
Anuja Prakash Pradhan, Bharat Rekhi, Santosh Menon, Kedar K Deodhar
DOI:10.4103/0377-4929.191780  PMID:27721305
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Adult T-cell leukemia/lymphoma: Unusual immunophenotype by flow cytometry p. 569
Renu Sukumaran, Rekha A Nair, Jayasudha A Vasudevan
DOI:10.4103/0377-4929.191785  PMID:27721306
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dic(7;9) with loss of Tp53 gene in acute lymphoblastic leukemia p. 571
Anurag Gupta, Krishna G Reddy, Manu Goyal, Pankaj Karwa, Divya G Swarupa, Mukkanteeswara Rao Kasaragadda
DOI:10.4103/0377-4929.191790  PMID:27721307
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Streptococcus pneumoniae: An unusual and forgotten pathogen in neonatal sepsis p. 573
Shilpa Arora, Navneet Kaur, Shipra Galhotra, Neerja Jindal
DOI:10.4103/0377-4929.191791  PMID:27721308
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