Unusual coexistence of Stewart-Treves syndrome and sickle cell anaemia: a case of dual pathology

Chronic lymphoedema can rarely be complicated by an angiosarcoma. This combination called Stewart-Treves syndrome usually observed in upper limb in patients of post-mastectomy with axillary lymph node resection. Here, we report a male patient who had a 10-year history of right leg elephantiasis. Later on, he developed two large ulceronodular masses in the same leg with few satellite nodules in the surrounding skin. With the clinical suspicion of malignancy, a wedge biopsy was performed which revealed histological features of angiosarcoma with sickled red cells. The above knee amputation specimen received further confirmed the histological diagnosis. The investigation for haemoglobinopathy also suggested the presence of sickle cell trait. This report describes a multifocal tumour as a rare manifestation of Stewart-Treves syndrome in a post-filariasis case with sickle cell trait, which is an extremely uncommon combination.

An Insight into Maternal Deaths: A Retrospective Analysis and Pathologists Perspective in Series of 16 Autopsy Cases

Introduction: Maternal mortality continues to be of great concern with most maternal deaths occurring in developing countries which accounts for about one in 180 deaths during childbirth as compared to 1 in 4,900 in developed nations. Aim: To determine the common causes of maternal deaths and to study their clinicopathological profile. Materials and Methods: The present study included series of 16 cases of maternal deaths from January 2018 to June 2020. The study was conducted at Indira Gandhi Medical College, Nagpur, Maharashtra, India. The post mortem examination in all these deaths was conducted as per institutional policy. The external, in-situ examination along with histological findings are studied in each case. Results: The study group comprised of 16 cases, in the range of 21 to 37 years with a mean age of 27 years. Nine deaths were in antepartum, while seven in postpartum period and all the deliveries took place in hospital. Amongst these 16 deaths, 11 were brought dead while in rest five, deaths were hospital based. Conclusion: The autopsy provides an invaluable information and insights about pathophysiological changes and sequence of events leading to death. Usefulness of relevant clinical data in complementing the diagnosis cannot be overemphasized. Their in-depth analysis can certainly help to prevent future maternal deaths and also in early picking up of complications; which further can avoid this preventable and inevitable loss and reduces the national burden on maternal mortality.

High Grade Serous Carcinoma Presenting as a Huge Pelvic Mass with Normal Looking Ovaries: A Diagnostic Challenge for Pathologist

High-grade serous carcinoma represents 50-60% of all ovarian cancers and is the most common type of malignant surface epithelial tumour. Serous carcinoma is often diagnosed in the sixth and seventh decade, while the mean age for high-grade tumours is 63 year. It’s not only the non-specific symptoms like vague abdominal pain, nausea, gastrointestinal disturbances, but also the unusual presentation which is responsible for delayed diagnosis. This diagnostic delay can become the reason for increased mortality, despite advances in surgical management and chemotherapy. Here, authors discuss a case of 60-year-old postmenopausal women who presented with a huge pelvi-peritoneal mass and with grossly normal ovaries. Considering clinical findings and histomorphology, the possibility of malignant mesothelioma was considered as the first differential diagnosis; however extensive sampling of ovaries and supportive immunohistochemical markers helped us to arrive at a definitive diagnosis. The present case emphasises the importance of extensive tissue sampling and ancillary techniques in arriving at a correct diagnosis.

Pulmonary hydatid cyst with co-existent aspergillosis: A rare cytology finding

Pulmonary hydatid cyst with co-existing aspergillosis is rare. Till date, there are only two documented reports of this double pathology being diagnosed on cytology. The present case is of a young immunocompetent female who presented with respiratory complaints including intermittent hemoptysis. Chest X-ray and CT thorax revealed two well-defined lesions in the lower lobe of left lung that was suggestive of either infective or benign neoplastic etiology. But as hydatid cyst was not suspected either clinically or radiologically, FNA was performed. Based on the typical cytomorphological features a definitive diagnosis of hydatid cyst with aspergillosis was offered on cytology that was later confirmed on histopathology. To the best of our knowledge this is only the third report of pulmonary echinococcosis with aspergillus co-infection being diagnosed on cytology. The purpose of reporting this case is to draw attention to the rare possibility of co-existing aspergillus infection in pulmonary echinococcosis even in immunocompetent individuals, which can complicate the clinico-radiological picture. However, both pathologies can be effectively and accurately diagnosed on cytology, based on which proper treatment can be initiated. Diagn. Cytopathol. 2016;44:696-699. © 2016 Wiley Periodicals, Inc.