Paraganglioma of the urinary bladder is a rare tumor and may be misdiagnosed as urothelial cancer especially on TURBT, but a high index of suspicion, careful search for the characteristic histological features and supportive immunohistochemical studies should lead to a correct diagnosis.

Neuroendocrine carcinomas (NEC) of the female genital tract are aggressive and uncommon tumors. They usually involve the cervix and ovary, and are seen very rarely in the endometrium. The overwhelming majority of endometrial NECs are of conventional small cell type (up to 60 cases). Only seven cases of large cell type NEC of the endometrium have been reported. We report a case of large-cell neuroendocrine carcinoma (LCNEC) of the endometrium in a 70-year-old female. The case is described for its rarity and shows that a high index of suspicion can help the pathologist to use immunohistochemistry and in turn help in selection of appropriate chemotherapy.

A 17-year-old male patient presented with lower back pain and weakness of lower limbs. On radiological investigation, a destructive bony lesion involving the third lumbar vertebra was seen associated with soft tissue extension and an extradural component. The lesion was surgically excised in view of the rapidly progressing symptoms. The histologic diagnosis was histiocytic sarcoma. Further investigations did not reveal any other lesion elsewhere. The case is being presented in view of the uncommon occurrence of a primary extranodal histiocytic sarcoma of the lumbar spine, which simulated a primary bone tumor.

Context.—Advanced cases of retinoblastoma are treated with chemoreduction followed by enucleation. Further adjuvant therapy is recommended in patients with known pathologic risk factors (PRFs). Objectives.—To determine the PRFs in enucleated specimens after chemoreduction and their association for adverse events of recurrence, metastasis, or death. Design.—This was a retrospective study of 77 enucleation specimens from patients treated between January 2000 and September 2008 with prior chemoreduction that were accessioned in the pathology department of a tertiary referral cancer center with an average follow-up of 24 months. Various PRFs were noted and their association with the development of an adverse event was recorded. Results.—Of 77 patients, (male to female ratio, 51∶26), the incidence of overall PRF was 51.9%, and retrolaminar optic nerve invasion (32.5%), optic nerve cut margin (12.9%), massive choroidal invasion (26%), scleral invasion (23.4%), vitreous seedings (44.2%), and anterior segment invasion (20.8%). Undifferentiated tumor (>60%) was seen in 60.3% of cases (41 of 68 patients with differentiation available). Adverse event occurred in 18 of 72 patients with available follow-up (25%). Retrolaminar optic nerve invasion, optic nerve cut margin involvement, and scleral invasion were independent prognostic factors predicting the occurrence of an adverse event. Undifferentiated tumor (>60%) was a significant risk factor in univariate analysis, which is the unique feature in this study. Conclusions.—Classic PRF with the addition of a predominant presence from the undifferentiated component were associated with adverse outcomes in retinoblastoma treated with anterior chemotherapy. The latter may represent chemoresistant clones and more intensive adjuvant chemotherapy may be warranted in these patients.

We report a study of 84 extranodal natural killer/T cell lymphomas (ENKTCLs) from India to understand the disease pattern. Sixty-one patients had nasal disease and three had Waldeyer's ring tumors, while 20 had extranasal sites of presentation, namely: cervix (n = 1), oral cavity (n = 3), orbit (n = 3), liver (n = 1), ileum (n = 1), and soft tissue and lymph nodes (n = 9). Staging of patients with extranasal disease revealed that either they had disseminated disease or the nasal mass was missed during the initial staging. Extranasal presentation, performance status (PS), international prognostic index (IPI), Korean prognostic index, marrow involvement, radiotherapy and type of chemotherapy affected overall survival, while lymphopenia, performance status, radiotherapy and type of chemotherapy impacted disease-free survival. In the multivariate analysis, IPI and response to chemotherapy emerged as significant prognostic factors. Thus most patients with extranasal ENKTCL have a nasal lesion or disseminated disease and pure extranasal disease is uncommon in non-endemic regions.