Indian Journal of Pathology: Research and Practice

Papillary Adenofibroma is an extremely rare condition and is benign biphasic tumor composed of epithelial and mesenchymal components. It occurs more often in extra uterine sites and in the female genital tract it is known to occur more common in the endometrium. The presence of this condition in cervical region is extremely rare and even the available cases show young to middle age predilection. In the present case report we had a sixty year old post menopausal female who came with the complaints of bleeding per vaginum for five days and complaints of burning micturition with a provisional diagnosis of endocervical polyp clinically. Radiologically imaging was suggestive of papillary neoplasm. Biopsy studied showed features of lobulated papillae covered by bland endocervical epithelium with a foci showing squamous metaplasia features suggestive of benign papillary adenofibroma of cervix and reiterated with special stain as well. It is a rare tumor having high chance of recurrence, with a very low incidence rate and account for less than 10% of uterine adenofibromas. Usually this condition presents as broad based polypoidal mass with abnormal vaginal bleeding. They need a differential diagnosis with Adenomyoma, Adenosarcoma and Carcinosarcoma which share many common features on histology.

Context: Mast cells are a heterogenous group of immune cells involved in a variety of biological processes. The presence of mast cells intumours has been described as an evidence of a host immunologic anti-tumor response, and their abundance as an indicator of a favourable prognosis. However, it is also stated to be extremely closely associated with angiogenesis and tumour invasion. Because the literature on mast cells in uterocervical lesions is limited, the current study seeks to look for changes in mast cells in some of the common uterocervical lesions and their potential implications in diagnosis and prognosis. Aims: To study the mast cell density in various neoplastic and non-neoplastic lesions of uterocervical lesions. Settings and Design: Prospective study done over a period of one year in a tertiary care hospital. Methods and Material: Hysterectomy specimens received in the department of pathology a tertiary care hospital, were stained with H&E and toluidine blue for the identification of mast cell. Statistical Analysis used: For categorical variables, frequencies, proportions, Chi square test for proportion is used and for continuous variables, mean, standard deviation, independent test will be used. Results: The most common neoplastic and non-neoplastic lesions were leiomyoma and chronic cervicitis respectively and the highest mean mast cell count was more in non-neoplastic lesions. Conclusions: The study revealed that the mast cell count decreased progressively from non-neoplastic and benign to malignant lesions, implying that the mast cell count appeared to be inversely related to the degree of dysplasia and thus may be an additional diagnostic tool in different uterocervical lesions and may act as a good prognostic indicator of the lesions' benign nature.

Benign inclusions are defined as foci of non neoplastic ectopic tissues in lymph nodes encompassing various types of tissues. Benign epithelial inclusions have been reported in lymph nodes of various anatomical locations including head and neck, mediastinum, axilla, peritoneal, pelvic and inguinal regions. Epithelial inclusions can be divided into epithelial, nevomelanocytic and decidual. Further subtypes based on the tissue of origin include salivary gland tissue, thyroid tissue, squamous epithelial cells, breast tissue, mesothelial cells etc. The nature of tissue in heterotopic inclusions varies according to the location of the lymph nodes. The accurate diagnosis of these benign epithelial inclusions is of utmost clinical importance to prevent misinterpretation of this entity as malignant and hence save the patient from overzealous and inappropriate treatment. Hence, great importance should be given to detailed morphological evaluation of lymph nodes with epithelial inclusions in reaching at an accurate diagnosis. The cytological criteria favouring benign epithelial inclusions over metastatic carcinoma include a lack of significant nuclear atypia, pleomorphism and hyperchromasia. It is very important to create awareness of this rare entity among pathologists to prevent misdiagnosis or overdiagnosis of a malignant lesion.

Leiomyoma with bizarre nuclei (LBN) is an uncommon variant of uterine smooth muscle neoplasm. A 52 year female presented with complained of intermittent pelvic pain, abnormal uterine bleeding, and abdominal discomfort of 6 month duration. On ultrasonic evaluation showed well defined uterine masses suggestive of leiomyomas. The systemic examinations were normal. On histopathologycal finding reported as uterine leiomyoma with bizarre nuclei. Patient responded well to treatment. On follow up there was no evidence of recurrence. We are presenting this uncommon case of leiomyoma with bizarre nuclei for its clinical, radiological and histopathological findings. On histopathological findings this tumor should be properly differentiated form various uterine spindle cell tumors with nuclear atypia for better management of patients.