Completely giant lumbar extradural spinal Schwannomas are a rare subgroup of spinal nerve sheath tumors in the pediatric age group. Single stage, single approach, complete, and safe surgical removal while preserving the spinal stability is the mainstay of treatment of giant lumbar extradural Schwannomas. In the present case, we report a case of a 9-year-old male child studying in 2 nd standard presented with pain in both thighs and legs for 3 months. Magnetic resonance imaging lumbosacral spine showed lobulated dumbbell-shaped lesion extending from L4 superior endplate to inferior endplate of L5 in intraspinal space displacing the nerve roots. The patient underwent a posterior midline approach, L4 and L5 laminectomy and complete excision of the tumor. Histopathological confirmed the diagnosis of benign extradural dumbbell Schwannoma. Postoperatively, the child was showing gradual improvement in motor power, but his pain was significantly relieved.
Hemithyroidectomy is an adequate initial surgical procedure for FNAC-proven follicular neoplasm. The incidence of carcinoma is 3.9%. Older subjects with high normal TSH are likely to have malignancy. Routine employment of intraoperative frozen section, elastography and molecular markers is not necessary if locally unavailable, since the incidence of malignancy in FNAC-proven follicular neoplasm is low.
Background: Synovial sarcoma is a translocation-associated mesenchymal neoplasm that represents around 10% of all soft tissue sarcomas. Diagnosing biphasic synovial sarcoma is generally straight forward, owing to distinctive histologic features. Transducer-like enhancer of split 1 (TLE1) is overexpressed in synovial sarcomas. Study aimed to evaluate sensitivity and specificity of TLE1 immunohistochemical expression in synovial sarcoma and its histological mimics. Methods: Conventional sections from 30 cases of synovial sarcoma, 24 cases of monophasic synovial sarcoma mimics and 6 cases of poorly differentiated sarcoma mimics were subjected to TLE1 IHC staining. TLE1 immunostaining was graded from 0, 1+, 2+, 3+, with 2+ or 3+ grades interpreted as positive staining. Results: Of the 60 tumours, majority are monophasic spindle cell type (56.6%), followed by biphasic (16.6%), monophasic epithelial (6.6%), poorly differentiated (13.3%) and calcifying type (6.6%). Upon expression of TLE1 in tumors, 20 cases showed Grade 3, 8 cases shown Grade 2, 2 cases shown Grade 1 TLE1 Expression in Synovial sarcoma. 2 cases shown Grade 3 and 2 cases shown Grade 2 TLE1 expression in Schwannoma. Whereas 1case shown grade 2 in Rhabdomyosarcoma. 1case shown grade 2 in Hemangiopericytoma. TLE1 sensitivity for diagnosis of synovial sarcomas was 93.3%, and specificity of 73.3% with positive predictive value of 77.77% and negative predictive value of 91.6%. Conclusion: Specificity can be increased with optimal IHC panel which includes BCL2, Pan Cytokeratin, EMA, CD99 and CD34. Molecular confirmation is the diagnostic gold standard for synovial sarcoma, TLE1, in view of its high sensitivity may be a useful marker within the optimal IHC panel for substantiating a diagnosis of synovial sarcoma. Awareness of TLE1 expression in other tumours and its correct interpretation are necessary.
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