Giant pleomorphic adenoma of the parotid gland: a case report

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly. Most are 2 to 6 cm in size when resected. We report the resection of a benign mixed tumour of the left parotid gland with a history of bleeding. The resected tumour measured 21 cm in diameter, weighed 1.81 kg, and on pathologic examination was a benign mixed tumour without malignant degeneration. The implications of this unusual case for the management of mixed tumours are discussed with a review of the literature.

Chondroid syringoma: an unusual presentation in a 7-year-old boy

Coined in 1961 by Hirsch and Helwig, the term chondroid syringoma refers to a rare mixed tumour of subcutaneous tissue. Histologically, these tumours are almost identical to pleomorphic adenomas, arising from salivary glands. With the obvious difference being the presence of sweat gland tissue (syringoma) within a matrix of cartilage (chondroid). These mixed tumours remain scarce throughout the world, with an incidence of less than 0.098%. The vast majority of cases are reported in middle-aged and older adults, where they typically present as painless swellings in the head and neck, which gradually grow in size.

Benign mixed tumour of the upper lip – Report of a rare case

Introduction: Pleomorphic adenomas are the most common non-malignant neoplasms of salivary gland tumours that present mixed histopathological patterns. The purpose of our study was to report an unusual case of a pleomorphic adenoma which was located in the upper lip that had been initially considered as cyst. Case report: The patient was a middle aged man who had a painless, slow-growing swelling in the upper lip. At first, the round-shaped and mobile mass was considered as cystic lesion. However during the operation, it was discovered instead of a cyst, an encapsulated solid tumour that demonstrated both epithelial and mesenchymal cells in histopathology and the diagnosis of pleomorphic adenoma was set. One year postoperatively the patient had no recurrence of tumour. Conclusions: Occurrence of intraoral lip swelling could be attributed, even rarely, to benign mixed tumours. Despite its nonmalignant features, these masses have a relatively low but still existing risk for recurrence or malignant transformation and thus in similar cases a systematic follow-up should be performed even years after surgery.

Clinico-pathological study of ovarian tumors at tertiary care hospital, Udaipur

Background: Diagnosis of malignancy in ovarian tumour is always questionable clinically as well as by investigation. Ovarian tumour arise in any age group and any type of body tissue present in tumour like epithelial tissues, germ cells, embryonic cells due to varied histology of ovary and metastatic non ovarian tumours. Aim and objective of the study was to study the correlation ovarian masses regarding their clinical presentation investigation and histo-pathological report.Methods: All the women who presented with lump and/or pain or menstrual problem attending Gynecology, Surgery and oncology OPD of GMCH, Udaipur. Our study design is prospective hospital based study. The statistical analysis was performed using IBM statistical for social sciences (SPSS).Results: In our study, 85.43% were benign tumour and 12.67% were malignant tumour. Among this, 70.87% were cystic, 14.56% were solid and 14.56% were mixed tumours. Mostly they were epithelial tumours (85.43%). Main surgery was total hysterectomy with bilateral salpingoopherectomy. In malignant tumours 61.53% also had Chemotherapy and 0.97 % had debulking.Conclusions: There is strong correlation of ultrasonography finding with histopathology report. Though clinically it was 55 % only. Specificity of the Ultrasonography was 73.33% but sensitivity was 100%. Positive predictive value was 95.65% and negative predictive value was 100%.

A PROSPECTIVE STUDY ON CLINICOPATHOLOGICAL & RADIOLOGICAL EVALUATION OF PAROTID TUMOURS IN A TERTIARY CARE CENTRE

Background: Salivary gland tumours are relatively rare clinical entities encountered in the frequent day-to-day clinical practice. They exhibit a wide variety of behaviour and widely diversified histology. Proper management of these tumours require an accurate diagnosis by the pathologist, correct clinical correlation by the surgeon. With this background, we have conducted a study on the incidence, age, gender, clinical features of parotid swellings, histological distribution, the efficacy of FNAC as a diagnostic modality, the role of ultrasound and MRI in the diagnosis and various treatment modalities in the management of parotid swellings and their outcome in our institute. Methods: Our study was a prospective study conducted on 60 patients over a period of 20 months from August 2018 to March 2020. All patients were evaluated by taking proper history, thorough clinical examination, routine laboratory investigations and specific investigations like FNAC, MRI, USG and biopsy. Results: The mean age of presentation in our study was 35.73 years. Seventy percent of tumours were pleomorphic adenoma, malignant mixed tumours constituted 13%, Warthin's neoplasm constituted 7.01%, Basal cell adenoma, Oncocytoma and Acinic cell carcinoma each of these tumours constituted 3.33%. All the patients presented with swelling (100%) in the parotid region, 46.67% patients presented with pain in swelling, out of which majority were benign. Pain occurred in 100% of the patients with malignant tumours and only in 36% of the patients with benign tumours. No patient presented with features of facial nerve paralysis, fungating mass or cervical lymphadenopathy. On FNAC, 56 were reported as benign (50 cases were reported as benign and remain six were reported as malignant on HPE) remaining 4 cases were reported as malignant. Similar results were obtained on ultrasound. Fifty-one cases were reported as benign and remaining 9 cases were reported as malignant on MRI. Superficial parotidectomy was done in 83.33% of cases, the remaining were treated with conservative total parotidectomy. No radical parotidectomy and radical neck dissection (RND) were done. Conclusion: Parotid tumours were commonly noticed in the 5th decade of life, males were predominantly affected. Pleomorphic adenoma is the most common tumour encountered. Malignant mixed tumours were most commonly observed malignant tumour followed by Acinic cell carcinoma. Parotid swelling is the most common presenting complaint followed by pain. Histopathological examination was more accurate when compared to FNAC. Superficial parotidectomy was the most commonly performed procedure.

Thyroid haemangiosarcoma in a seven-year-old female Shih Tzu

Canine thyroid tumours are uncommon and the majority of tumours are carcinomas or adenomas, with only very few mixed tumours or metastases from distant sites described to date. A primary thyroid haemangiosarcoma has never been reported in veterinary medicine. In this case report, we describe a dog with a history of a large, non-painful, mobile ventral neck mass in the right paralaryngeal region. CT and ultrasound-guided fine needle aspirates were used for clinical staging. The mass was surgically excised and histopathological examination indicated a haemangiosarcoma. Abdominal ultrasound revealed the presence of splenic nodules and splenectomy indicated the presence of haemangiosarcoma. Chemotherapy with doxorubicin was started, but the dog was euthanased after three rounds of therapy, 97 days after the mass was discovered.

Germ cell tumours

Central nervous system germ cell tumours are mysterious tumours, which are common in young male adults in eastern Asia, and include germinoma, mature and immature teratoma, teratoma with malignant transformation, yolk sac tumour, embryonal carcinoma, choriocarcinoma, and mixed tumours of these components. The aetiological mechanism why they mostly develop in the pineal and neurohypophyseal region is still unknown. Their treatment is also a challenge; surgery is demanding, and sometimes biopsy would be preferred. Radiotherapy is effective, but its dose and field would be better reduced for young adults and children. Chemotherapy is effective but not enough for especially non-germinomatous tumours. This chapter presents a comprehensive discussion about those challenging diseases.

An intrasellar pituitary adenoma–gangliocytoma presenting as acromegaly

Summary Most cases of acromegaly are due to growth hormone (GH)-secreting pituitary adenomas arising from somatotroph cells. Mixed pituitary adenoma and gangliocytoma tumours are rare and typically associated with hormonal hypersecretion, most commonly GH excess. Differentiating these mixed tumours from conventional pituitary adenomas can be difficult pre-operatively, and careful histological analysis after surgical resection is key to differentiating the two entities. There is little literature addressing the possible mechanisms for the development of mixed pituitary adenoma–gangliocytomas; however, several hypotheses have been proposed. It still remains unclear if these mixed tumours differ from a clinical perspective to pituitary adenomas; however, the additional neural component of the gangliocytoma does not appear to modify the aggressiveness or risk of recurrence after surgical resection. We report a unique case of acromegaly secondary to a mixed GH-secreting pituitary adenoma, co-existing with an intrasellar gangliocytoma. Learning points: Acromegaly due to a mixed GH-secreting pituitary adenoma and intrasellar gangliocytoma is rare. These mixed tumours cannot be distinguished easily from ordinary pituitary adenomas on the basis of clinical, endocrine or neuroradiologic findings, and histological analysis is required for a definitive diagnosis. Surgical resection is usually sufficient to provide cure, without the need for adjuvant therapy. These mixed tumours appear to have a good prognosis although the natural history is not well defined. The pathogenesis of these mixed tumours remains debatable, and ongoing research is required.

Presence of Cytokeratin 19-Expressing Cholangiocarcinoma-Like Tumour in a Liver Metastatic Lesion of Rectal Neuroendocrine Tumour

Introduction: Tumours with adenocarcinoma and neuroendocrine components have often been reported, although the reason underlying the dual components remains unclear. Case Presentation: A 43-year-old woman with multiple liver metastatic lesions of rectal neuroendocrine tumour underwent primary tumour resection and subsequent liver transplantation. Pathological examination indicated a cholangiocarcinoma-like tumour with gland formation, adjacent to a liver metastatic lesion of the neuroendocrine tumour. This tumour comprised atypical columnar epithelium, and stained positively for neuroendocrine markers and the ductal marker cytokeratin 19, indicating amphicrine properties and a partial cholangiocarcinoma phenotype – features not observed in the primary and metastatic neuroendocrine tumours. Conclusion: The presence of adenocarcinoma only at the metastatic site indicated that neuroendocrine tumour cells acquired stemness and differentiated into adenocarcinoma through metastasis, or that the adenocarcinoma newly arose from the adjacent epithelium influenced by the neuroendocrine tumour. We propose a novel mechanism for the pathogenesis of mixed tumours in neuroendocrine tumours.