Publications (19)25.94 Total impact
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Article: Osteosarcoma of the femur mimicking Ewing sarcoma/primitive neuroectodermal tumour on biopsy and metastatic carcinoma on resection.
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ABSTRACT: Osteosarcoma (OS) is known to have several morphological appearances, small cell osteosarcoma and epithelioid osteosarcoma being two well recognized patterns. The former can be mistaken for a Ewing sarcoma/primitive neuroectodermal tumour (ES/PNET), whereas the latter mimics metastatic carcinoma. Herein we present an osteosarcoma in a 17-year-old girl that was diagnosed as an ES/PNET on biopsy; however, the resected specimen revealed a very unusual morphology mimicking a metastatic carcinoma with a sex cord stromal tumour-like pattern.Skeletal Radiology 05/2012; 41(9):1163-8. · 1.54 Impact Factor -
Article: Chemotherapy compliance in patients with osteosarcoma.
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ABSTRACT: PURPOSE: Histological response (HR) to neoadjuvant-chemotherapy (NACT) is considered as a robust prognostic marker in treated osteosarcomas. Chemotherapy compliance can affect both, dose intensity and density and may affect the final outcome in these cases. This vital aspect has been inadequately addressed and therefore merits further investigation. METHOD: A retrospective study of NACT-treated osteosarcoma patients, during the year 2010 was conducted. Compliance was defined as receipt of planned cycles of chemotherapy in the planned doses, within the planned duration or up to 25% additional time. HR was assessed by grading for histological necrosis (HN). Good responders (GR) included those with tumors showing ≥90% HN. RESULTS: Of 124 patients, 115 were analyzed for post-NACT HR. Of the 73 (64%) compliant patients, 47 were GR and of the 42 (36%) non-compliant patients, 18 were GR. There was significant association between GR and compliance (P = 0.031). However, at a median follow-up of 7.9 months, there was no significant difference in survival between the noncompliant versus compliant group. Non-compliance was justifiable in 26 patients and not justifiable in 16 patients. Using univariate analysis, T-size, pain, performance status, albumin, LDH, and education were identified as significant factors, while in multivariate analysis, only poor performance status was identified as an independent variable for non-compliance. CONCLUSIONS: Two-thirds patients were found to be compliant with NACT. There was a significant association between GR and compliant patients. Significant correlation between compliance and survival may be established with a longer follow-up particularly since "good necrosis" is generally predictive of good survival. Pediatr Blood Cancer © 2012 Wiley Periodicals, Inc.Pediatric Blood & Cancer 04/2012; · 1.89 Impact Factor -
Article: Sudden cardiac death: look closely at the coronaries for spontaneous dissection which can be missed. A study of 9 cases.
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ABSTRACT: Spontaneous coronary artery dissection is a rare cause of death seen largely in young women, with many cases occurring in the early postpartum period. Nine cases with this condition were examined from our histopathology records comprising 6 women and 3 men with an age range of 26 to 47 years. All deaths were sudden, and only one patient complained of chest pain and she was 8 weeks postpartum. All cases showed dissection macroscopically, though 4 of the 6 cases, which were sent for a second opinion, were described as having normal coronaries by the referring pathologists. One heart seemed to have postmortem coronary artery thrombus and dissection was difficult to discern on gross examination. All cases were examined histologically and confirmed acute dissection of the coronary arteries, with more than 2 arteries affected in 2 cases. Histologic features of myocardial ischemia/infarction were noted in 4 cases so the explanation for the sudden death in the other 4 cases remains a possible fatal arrhythmia. The macroscopic changes in the heart of acute coronary artery dissection can be difficult to detect and can be easily mistaken for postmortem clot or a thrombus overlying an atheromatous plaque. All such cases with thrombus in the arteries, even the normal-looking coronary arteries, in young adults should be examined microscopically for dissectionThe American journal of forensic medicine and pathology: official publication of the National Association of Medical Examiners 03/2012; 33(1):26-9. · 0.71 Impact Factor -
Article: Phosphaturic mesenchymal tumor with chondromyxoid fibroma-like feature: an unusual morphological appearance.
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ABSTRACT: Phosphaturic mesenchymal tumor (PMT) is a rare and distinctive tumor almost always associated with oncogenic osteomalacia. This tumor is often misdiagnosed due to its widely varied histomorphological spectrum. More recently the term PMT or its variants has been used whatever the histomorphological features. Herein, we present a case of a 32-year-old woman who presented with a 2-year history of oncogenic osteomalacia. The clinical examination failed to detect any tumor. The F-18 FDG PET scan and subsequent MRI revealed a tumor in the soft tissues of the right popliteal fossa. The histological features resembled a chondromyxoid fibroma (CMF), a feature documented only in two cases so far.Skeletal Radiology 05/2011; 40(11):1481-5. · 1.54 Impact Factor -
Article: Desmoplastic small round cell tumor of the pancreas: An unusual primary site for an uncommon tumor.
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ABSTRACT: Pancreas is a rare location for desmoplastic small round cell tumor. The present case highlights the dilemma in diagnosis and ascertaining the site of tumor origin. Morphologic and immunohistochemical features were complemented with the molecular markers and tumor origin which was initially nebulous was subsequently confirmed on exploratory laparotomy.Journal of Indian Association of Pediatric Surgeons 04/2011; 16(2):66-8. -
Article: Epidermoid cyst in the kidney.
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ABSTRACT: We report an extremely rare case of an epidermoid cyst in the kidney of a 74-year-old man who had presented with painless hematuria. Radiologic examination revealed a cyst in the kidney that was thought to be neoplastic. The patient underwent surgery to remove the cyst, and we received the nephrectomy specimen. A 6-cm cyst with no solid areas was seen. On histologic examination, this was an epidermoid cyst. We reviewed the published data and discuss the possible theories of origin of this rare condition.Urology 03/2011; 78(3):563-4. · 2.43 Impact Factor -
Article: Primary leiomyosarcoma of bone--a clinicopathologic study of 8 uncommon cases with immunohistochemical analysis and clinical outcomes.
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ABSTRACT: Primary leiomyosarcoma of bone is a rare and a diagnostically challenging tumor entity. Over a 7-year period, we identified 8 such cases that fulfilled the diagnostic criteria in 6 men and 2 women, with age ranging from 25 to 59 years (mean, 42.7 years). All cases were noted in the lower limbs, including femur and tibia as the commonly involved bones in 4 and 3 cases, respectively. On radiography, the most consistent feature was a solitary osteolytic lesion with cortical destruction, unassociated with matrix formation. On histopathology, all cases showed spindly sarcomatous cells, mostly arranged in fascicles and whorls. Of 8 cases, 6 (75%) were of high grade. Prominent vasculature was noted in 5 cases. Two cases displayed focal mineralization, including calcification and heterotropic woven bone formation in 1 case each, but lacked malignant osteoid or chondroid matrix. One case showed osteoclast-like giant cells. On immunohistochemistry, smooth muscle actin was diffusely positive in all cases (100%), desmin was positive in 6 (75%) of 8 cases, and h-caldesmon was positive in 5 (83.3%) of 6 cases. Five cases underwent surgery, including 3 amputations and 2 wide excisions. One case underwent chemotherapy. On follow-up, 5 cases developed metastasis, including 1 case with another, who died within 17 and 5 months. Leiomyosarcoma of bone is uncommon and diagnostically challenging. An index of suspicion is necessary for this diagnosis, especially in cases of lytic, destructive bone lesions, unassociated with matrix production, that show spindly sarcomatous cells on histopathology. Immunohistochemical analysis, including an optimum panel formed by smooth muscle actin (diffuse positivity), desmin, and h-caldesmon, is necessary for substantiating this diagnosis. Surgery forms the treatment mainstay. The prognosis appears to be dismal.Annals of diagnostic pathology 03/2011; 15(3):147-56. -
Article: Melanotic neuroectodermal tumor of infancy in thigh of an infant--a rare case report with diagnostic implications.
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ABSTRACT: Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon tumor of neural crest origin, almost invariably identified in the head and neck region. It is a relatively benign tumor but can recur and rarely metastasize. Herein, a rare case of MNTI in the thigh of an infant is documented. Radiographic imaging showed a sclerotic and lytic lesion in the metadiaphyseal region of the right femur with a soft tissue component. The clinicoradiological impression was of a malignant round cell tumor and osteomyelitis. The patient's urinary vanil mandelic acid (VMA) level was elevated. FNAC smears revealed a tumor with round to polygonal cells, focally containing black melanin pigment. Biopsy and tumor excision revealed a tumor with cells in cords and nests embedded in a fibrocollagenous stroma and showed bone and soft tissue infiltration. On immunohistochemistry, tumor cells displayed immunoreactivity to vimentin, cytokeratin (CK), CK7, CK19, and MIC2, and focal reactivity for synaptophysin and HMB45. Diagnosis of an MNTI was made. The patient underwent induction chemotherapy with extracorporeal radiotherapy, followed by a soft tissue excision that revealed residual tumor. Surgically, free marrow margins were accomplished, and the patient is currently being followed-up. To the best of our knowledge this case is the fifth documented case in the English literature of MNTI in the thigh. The diagnostic and therapeutic implications are discussed.Skeletal Radiology 02/2011; 40(8):1079-84. · 1.54 Impact Factor -
Article: Rhinosporidiosis isolated to the distal clavicle: a rare presentation clinicoradiologically mimicking a bone tumor.
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ABSTRACT: Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi, which commonly affects young men and predominantly involves the mucous membranes of the nose, nasopharynx and eyes. Involvement of extranasal sites including bone has been reported, but rarely. We present a case of a 32-year-old farmer, who presented with a non-tender, fixed swelling over his right shoulder. Radiography and CT imaging showed an expansile, lytic, destructive lesion involving the lateral end of the right clavicle with soft tissue extension. The clinicoradiological impression was that of a primary bone tumor. Biopsy and wide excision of the lesion revealed features of rhinosporidiosis. There were no mucocutaneous lesions. Involvement of bone without associated mucocutaneous lesions is exceedingly rare in rhinosporidiosis. Involvement of the clavicle, as seen in the present case, has not been reported in the English language-peer reviewed literature, to the best of our knowledge.Skeletal Radiology 02/2011; 40(2):225-8. · 1.54 Impact Factor -
Article: Cystic primary pulmonary synovial sarcoma presenting as recurrent pneumothorax: report of 4 cases.
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ABSTRACT: Pleuropulmonary synovial sarcoma is a rare malignancy that often presents like any other thoracic tumor with symptoms such as chest pain or cough. Here we describe 4 young adults who underwent surgery for apparently benign recurrent pneumothoraces and who, unexpectedly, were found upon histologic and molecular examination of the resection specimen to have cystic primary pleuropulmonary synovial sarcoma. These cases highlight (a) the importance of cytogenetic analysis in making the diagnosis, as confusion with other spindle cell sarcomas or cystic neoplasms can occur and (b) the importance of thorough examination of all resected tissue in cases of recurrent pneumothorax.The American journal of surgical pathology 08/2010; 34(8):1176-9. · 4.06 Impact Factor -
Article: Secondary vascular changes in pulmonary sequestrations.
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ABSTRACT: Whilst parenchymal changes in pulmonary sequestrations are well described, there are comparatively little data on associated vascular changes and their extent. The aim of this study was to retrospectively review morphological changes within sequestrations, concentrating on vascular changes and associations with clinical parameters. Twenty-seven resected cases of sequestrations (intralobar n = 20, extralobar n = 7) showed a male predominance (n = 16) and an age range of 2 months-60 years (average 13 years). Plexogenic vascular changes (medial hypertrophy and intimal fibrosis) were seen in 15 of 27 cases, as well as plexiform lesions in seven cases. Patients with plexogenic changes had a higher mean age compared with those lacking vascular changes (19 versus 6 years) and were more commonly female. Respiratory tract infections were associated solely with intralobar sequestrations. No other associations between presenting symptoms and histopathological parameters were identified. Adjacent lung showed lesser plexogenic changes in six of 22 intralobar cases. There were features of type 2 congenital cystic adenomatoid lesions in 63% of cases. Dissection of the supplying systemic artery (n = 1), intralesional aspergilloma (n = 1) and coexistent lymphangiomatosis (n = 1) were also identified. Hypertensive vascular changes are not uncommon in both intrapulmonary and extrapulmonary sequestrations, although their relative severity seems unrelated to presenting symptoms.Histopathology 07/2010; 57(1):121-7. · 3.08 Impact Factor -
Article: Pathology of Ewing′s sarcoma/PNET: Current opinion and emerging concepts
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ABSTRACT: Ewing′s sarcoma/PNET are small round cell tumors showing a varying degree of neuroectodermal differentiation. They are one of the commonest tumors of childhood and occur in bone and within soft tissues. Traditionally, light microscopy with the aid of immunohistochemical stains was suitable for diagnosis. But now translocation analyses are being used not only for the diagnosis and classification of small round cell tumors, but to ascertain their prognostic significance, detect micrometastasis, and monitor minimal residual disease, with potential for targeted therapy. This article analyzes the pathology, biology, and molecular aspects of Ewing′s sarcoma/PNET and discusses their clinical and therapeutic implications.Indian Journal of Orthopaedics. 01/2010; -
Article: Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study.
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ABSTRACT: To characterise the demographics and aetiology of sudden cardiac death (SCD) in athletes referred to a tertiary cardiac pathology centre in the UK. Retrospective non-case controlled analysis. Cardiac pathology centre at the National Heart and Lung Institute and Royal Brompton Hospital. Between 1996 and 2008, the hearts of 118 athletes were referred for pathological assessment to ascertain the precise aetiology of SCD. The majority of athletes (n = 113; 96%) were male and most (107; 91%) were amateurs participating predominantly in football, rugby and running. The mean (SD) age of death was 28 (12) years (range 7-59); 75% athletes were aged < or =35 years. Most deaths (81%) occurred during or immediately after exercise. Antecedent symptoms of cardiac disease were reported in 21 (18%) subjects, and 20 (17%) had a family history of premature cardiovascular disease and/or SCD. 25 (21%) athletes had relevant past medical history which included a known history of cardiac disease. Cardiomyopathy was the commonest cause of death and accounted for 62% of all the SCDs. A significantly high proportion of athletes (23%) exhibited a morphologically normal heart. Atherosclerotic coronary disease accounted for only 3% of cases and was confined to athletes aged >35 years. SCD in sport is largely due to clinically silent cardiomyopathies or primary electrical disorders (morphologically normal heart). Antecedent symptoms and family history are absent in over 80% of cases, and therefore clinical screening with health questionnaires will fail to identify most athletes with potentially sinister cardiac disorders.Heart (British Cardiac Society) 06/2009; 95(17):1409-14. · 4.22 Impact Factor -
Article: Unusual presentation of primary cardiac lymphoma.
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ABSTRACT: Cardiac lymphomas are rare neoplasms and account for a minor proportion of primary cardiac malignancies. Secondary involvement of the heart and pericardium by systemic lymphoma is well documented, but primary lymphomas of heart and pericardium are extremely rare, accounting for approximately 2% of all primary cardiac tumours. Most cases are diagnosed at autopsy, but nowadays, with modern imaging technologies, early diagnosis and treatment is possible. Here, we present two unique incidental presentations of primary cardiac lymphomas (PCL), one in an atrial myxoma and other involving a valvular homograft and discuss the potential pitfalls and prognosis of this rare entity.Interactive cardiovascular and thoracic surgery 05/2009; 9(1):127-9. -
Article: Osteoblastoma: a study of 12 cases.
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ABSTRACT: This study comprises of 12 cases of osteoblastoma. There were 8 males and 4 females, with a mean age of 17.8 years. The vertebral column, including the sacrum was the most frequent site (10 of 12 cases). Radiologically the lesions were lytic, well circumscribed and expansile. The histology consisted of intercommunicating osteoid seams lined by plump osteoblasts with numerous intervening ectatic stromal vessels. Despite these characteristic features, the distinction of osteoblastoma from osteoblastic osteosarcoma can at times be very problematic. The lack of lace-like osteoid or sheets of osteoblasts, and inconspicuous mitotic activity are useful distinguishing features. The purpose of this communication is to highlight the microscopic features for the correct recognition of osteoblastoma and its distinction from other osteoid forming bone lesions.Indian Journal of Pathology and Microbiology 11/2006; 49(4):487-90. · 0.68 Impact Factor -
Article: Recurrent melanotic neuroectodermal tumour of infancy of the epididymis and testis: a case report.
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ABSTRACT: Melanotic neuroectodermal tumor of infancy or melanotic progonoma is an uncommon tumor, presenting in infants. The epididymis and testis are rare sites of occurrence. This tumor can be confused with round cell tumor (RCT). Since the treatment modality and prognosis of melanotic progonoma and RCT are very different, it is imperative to make a correct diagnosis.Indian Journal of Pathology and Microbiology 08/2005; 48(3):363-4. · 0.68 Impact Factor -
Article: Recurrent giant cell tumor of bone with simultaneous regional lymph node and pulmonary metastases.
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ABSTRACT: Giant cell tumors of bone are known for their unpredictable behavior characterized occasionally even by metastases. Most metastases lodge in the lungs but other rare sites are regional lymph nodes, mediastinum, skin, scalp and the pelvis. In this case report we document a case of giant cell tumor of the patella in which, associated with local recurrence, there were simultaneous metastases to lymph nodes and lungs.Skeletal Radiology 05/2005; 34(4):225-8. · 1.54 Impact Factor -
Article: A study of histopathological features of medullary carcinoma of the thyroid: Cases from a single institute in India
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ABSTRACT: BACKGROUND: The microscopic features of medullary carcinoma have been described in world literature, together with its behavior and molecular biology. However, no large study has been reported from India. AIMS: This study aims to analyse the clinical, and especially the pathological features of medullary carcinoma of the thyroid, and the surrounding thyroid. MATERIALS AND METHODS: In this study a total of 234 cases of medullary thyroid carcinoma (MTC) were gathered over a period of 3 decades. The clinical presentation, the microscopic features and the clinical outcome were analyzed. RESULTS: MTC was found to be twice as common in men as in women and for some reason it occurred 10 years earlier in women. The histology revealed certain interesting features like the presence of apoptosis in over half of the tumors, in addition to the other common and not so common histological findings (encapsulated variant, small cell variants, follicular pattern, rosettes, oncocytic change, osteosarcoma-like pattern, and cribriform pattern). The adjacent thyroid in about 19% of the cases showed optically clear nuclei in the follicles that were close to the tumor cells. These features were similar to those seen in papillary thyroid carcinoma. CONCLUSIONS: The thyroid adjacent to MTC showed nuclear changes, which are also found in papillary carcinoma of the thyroid. The occasional concurrent occurrence of these two tumors and the involvement of the RET gene in both medullary and papillary carcinomas, makes this observation worth discussing and studying further.Indian Journal of Cancer. 01/2005; -
Article: Epithelioid variant of a pleomorphic liposarcoma displaying arborizing vascular arrangements on cytology smears: a case report of an interesting cytomorphologic pattern in an uncommon tumor.
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ABSTRACT: There is limited documentation on cytologic features of liposarcomas, especially pleomorphic liposarcomas (PLPSs), in view of their rarity. We present cytomorphologic features of an uncommon case of epithelioid variant of a PLPS appearing as a recurrent mass in a young adult man. Fine needle aspiration cytology smears displayed prominent arborizing vasculature with numerous lipoblasts with well-defined vacuolated cytoplasm, indenting the nuclei. In addition, mitoses were conspicuously noted. Biopsy from the scar recurrence and following wide excision showed a multinodular tumor with solid arrangement of tumor cells, separated by delicate vessels. Cells displayed well defined cytoplasmic borders, including several lipoblasts and focal areas of spindly sarcomatous differentiation. Typical and atypical mitoses were conspicuously seen and myxoid areas were absent. Immunohistochemistry showed diffuse positivity for vimentin and S-100; cytokeratin showed weak, focal cytoplasmic positivity. CD34 highlighted the delicate vasculature on tissue sections. Diagnosis of an epithelioid variant of a PLPS was finally offered. This rare case describes cytomorphologic features of an epithelioid variant of a PLPS, including prominent arborizing vasculature, a pattern that has invariably been described in a myxoid liposarcoma. Additionally, presence of numerous lipoblasts and mitoses led to the diagnosis of this rare variant.Acta cytologica 54(5 Suppl):963-7. · 0.49 Impact Factor
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2010
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Royal Brompton & Harefield NHS Foundation Trust
Harefield, ENG, United Kingdom
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