Primary bone lymphoma (PBL) is an uncommon clinical entity and a rare presentation of non-Hodgkin's lymphoma. PBL accounts for less than 5% of malignant bone tumors, 4–5% of extra nodal lymphoma and less than 1% of all non-Hodgkin's lymphoma. Diffuse large-B-cell lymphoma (DLBCL) accounts for the majority of cases of PBL. The incidence of PBL is so rare that many of its aspects remain unknown. A number of studies have been reported from western countries but only a few reports are available from Asia. Out of 20,000 bone lesions received in our department over 5 years, only 5 cases were primary bone lymphoma; all of which were DLBCL. We report our experience on PBLs with main emphasis on two unusual presentations of this rare tumor.
Cholesterol granuloma of the breast is an unusual non-neoplastic condition which frequently resembles malignancy clinically as well as radiologically. We herein report a case of a 28-year-old woman who presented with a lump in the upper outer quadrant of right breast. Physical examination and ultrasonography strongly suggested a carcinomatous lesion, but histopathological examination confirmed the diagnosis to be cholestrol granulomas. This article highlights the perplexing clinical presentation of cholesterol granulomas and affirms the role of histopathological examination in diagnosing these lesions correctly.
Primary renal sarcomas are exceptionally rare, constituting 1% of all malignant renal tumours. Since the prognosis for a renal sarcoma is particularly poor, differentiation from sarcomatoid renal cell carcinoma (RCC) is necessary. Histopathology and immunohistochemistry are the only modes of diagnosing these sarcomas as they have no specific features clinically and radiologically. We report a case of renal leiomyosarcoma which was clinically diagnosed as RCC. Histopathology revealed a spindle cell sarcoma and immunohistochemistry (IHC) confirmed a renal leiomyosarcoma. She also had a liver nodule and mass in the right side of neck and left arm. Biopsy from these sites revealed a similar morphology and IHC confirmed leiomyosarcoma. We report a case illustrating the rarity of this disease and its aggressive nature owing to fatal metastatic potential.
Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer after papillary carcinoma. Based on the extent of invasion, it has been classified into minimally and widely invasive subtypes. The minimally invasive type usually grows slowly and is clinically indolent but in rare cases has an aggressive behavior with distant metastases. The lungs and bones are the most common sites of metastasis. The literature mentions very few cases of scalp metastases. We report an unusual case of minimally invasive FTC with multiple scalp and bone metastases as the initial presenting complaint. In conclusion, awareness of the histopathological characteristics and variations in the metastatic behavior of thyroid carcinomas can help us overcome the difficulty in the diagnosis of such lesions.
Introduction
Oral squamous cell carcinoma, the fifth most common cancer worldwide, is a major cause of morbidity and mortality in India. It most commonly occurs in middle-aged and older individuals. Typically, they tend to be preceded by a premalignant state for a long time. The present study evaluates the clinicopathological profile of patients with oral lesions and the role of malpractices that promote carcinogenesis in the oral mucosa and the use of Ki-67 as an important predictor of the same.
Materials and methods
The expression of Ki-67 was studied in paraffin-embedded tissue sections of oral lesions of all the cases after taking a detailed history and examination.
Results
The study was conducted on 65 patients with 25 dysplastic and 40 malignant lesions. Males were affected more frequently than females. The most common age group affected was 31 to 60 years with mean age of 45.4 years. Anterior twothird of tongue (41%) was the most commonly affected site. 95% of the patients had a history of addiction in form of smoking, tobacco chewing and betel nut. Out of 25 cases of dysplasia, 11 showed low expression while out of 40 cases of squamous cell carcinoma only three showed low and 29 showed high expression of Ki-67.
Conclusion
The expression of Ki-67 correlates well with the disease progression from dysplasia to carcinoma of the oral cavity. It is therefore a marker of malignant transformation and carcinogenesis in oral premalignant lesions and in future it may serve as a prognostic tool in the early detection of malignancy.
How to cite this article
Maheshwari V, Sharma SC, Narula V, Verma S, Jain A, Alam K. Prognostic and Predictive Impact of Ki-67 in Premalignant and Malignant Squamous Cell Lesions of Oral Cavity. Int J Head Neck Surg 2013;4(2):61-65.
Actinomycosis is a rare, torpid, suppurative and chronic granulomatous infection caused by a Gram-positive organism that was initially thought to be a fungus. These organisms normally live as commensals in the human oral cavity, respiratory and digestive tracts, but become invasive when they gain access to the subcutaneous tissue through a musosal lesion, the triggering events being dental caries, dental manipulation and maxillofacial trauma. It is often misdiagnosed as it can mimic numerous infectious and non-infectious diseases. We describe an interesting case of cervical actinomycosis that was misdiagnosed as sebaceous cyst and precisely identified after histopathological examination of the tissue.
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