Annals of Pathology and Laboratory Medicine
Annals of Pathology and Laboratory Medicine (APALM) is a double-blind, peer-reviewed, open-access journal for pathologists, microbiologists, biochemists, and clinical laboratory scientists, published by Pacific Group of e-Journals (PaGe), India. Founded in 2014. pISSN: 2394-6466 | eISSN: 2349-6983 DOI prefix: 10.21276/APALM Indexed in: Embase (Elsevier)
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Diagnostic Traps in Papillary Thyroid Carcinoma: Correlation of The Bethesda System for Reporting Thyroid Cytopathology with Histopathology: A Case Series
Fine-needle aspiration cytology is a widely used first-line tool for evaluating thyroid lesions, with histopathology serving as the diagnostic gold standard. Despite its advantages, interpretation challenges arise due to overlapping cytomorphologic features, suboptimal sample adequacy, and inter-observer variability, occasionally leading to discordance and affecting patient management. This case series describes four diagnostically challenging cases of classical papillary thyroid carcinoma in which initial cytological interpretations differed from final histopathological findings. Each case was re-evaluated systematically with emphasis on adequacy of the aspirate, radiologic correlation, characteristic cytological features, and potential diagnostic pitfalls. Contributing factors such as papillary hyperplasia mimics, misleading ultrasound impressions, and low cellularity were analyzed to understand the basis of discordance. Final diagnoses were established through multidisciplinary collaboration among the surgeon, radiologist, and cytopathologist. Case 1 was initially reported as a benign colloid nodule (TBSRTC II) but was later confirmed as classical papillary carcinoma with nodal metastasis. Case 2 was categorized as AUS (TBSRTC III); histopathology revealed classical papillary carcinoma, infiltrating follicular subtype. Case 3 was diagnosed as follicular neoplasm (TBSRTC IV) on cytology, while final evaluation confirmed NIFTP. Case 4, also categorized as follicular neoplasm (TBSRTC IV), was ultimately diagnosed as encapsulated angioinvasive follicular variant of papillary thyroid carcinoma. TBSRTC remains a robust and standardized framework for thyroid cytology, providing consistent terminology and risk stratification. However, diagnostic limitations persist, emphasizing the need for meticulous cytologic assessment, close radiologic correlation, and interdisciplinary collaboration to minimize discordance and improve patient outcomes.
Copyright (c) 2026 Bindhuja Joseph, Arya Prakash, Kitty J Kuruvilla https://creativecommons.org/licenses/by/4.0
Cyclin D1 Overexpression in Breast Carcinoma and Its Correlation with Standard Clinicopathological Parameters
Background: Breast cancer remains the most frequently diagnosed malignancy among women worldwide, with a significant disease burden in India where incidence is rising at younger ages. Conventional prognostic and predictive markers, including ER, PR, and HER2, play a central role in guiding management, yet outcomes remain variable. Cyclin D1, a cell cycle regulatory protein encoded by CCND1, is increasingly recognized as a potential biomarker in breast cancer due to its role in cell cycle control and interaction with hormone receptor pathways. Evaluating Cyclin D1 expression and its association with established prognostic markers may provide valuable insights into disease behavior and therapeutic response. Materials and Methods: This study was carried out on 40 histologically confirmed cases of breast carcinoma. Expression of Cyclin D1, ER, PR, and HER2/neu was assessed using standard IHC protocols and scored according to ASCO/CAP guidelines. Statistical analysis was performed, with p < 0.05 considered significant. Results: Cyclin D1 expression was detected in 23 (57.5%) out of 40 cases. Cyclin D1 expression showed a significant positive correlation with ER (p < 0.001) and PR (p < 0.001) status, but not with HER2/neu. Significant association was also observed between Cyclin D1 and molecular subtypes (p < 0.001), with positivity in all Luminal A and Luminal B cases, and negative correlation with TNBC. Conclusion: Cyclin D1 expression was significantly associated with ER, PR, and Luminal A/B subtypes, but not with HER2, age, or nodal status, and showed negative correlation with TNBC. These findings suggest Cyclin D1 as a potential biomarker in hormone receptor–positive breast cancers, meriting validation in larger studies.
Copyright (c) 2026 Jasmine, Ajay Kumar Kochhar, Aditi Baghla, Karandeep Singh https://creativecommons.org/licenses/by/4.0
Clear Cell Sarcoma of the Pelvis in a Male Child, Diagnosed Using Ancillary Techniques - A Rare Case Report
Clear cell sarcoma is a rare malignant neoplasm of uncertain differentiation that typically arises in the deep soft tissues, most frequently involving the tendons and aponeuroses of the extremities in young adults, particularly females. Diagnostic challenges often arise due to its striking histological and immunohistochemical resemblance to metastatic malignant melanoma. We report an exceptionally rare case of clear cell sarcoma occurring in a nine-year-old male child, located in the pelvis with direct extension into the right pelvic bone. Non-Contrast Computed Tomography (NCCT) and Magnetic Resonance Imaging (MRI) demonstrated tumour extension into the presacral space with intraspinal involvement, resulting in widening of the spinal canal and neural foramina. Trucut biopsy revealed nests of epithelioid to spindle-shaped cells with clear to eosinophilic cytoplasm and prominent nucleoli. Bone marrow aspiration from the right iliac region yielded tumour cells, confirming marrow infiltration. The diagnosis was established through a multimodal approach integrating radiological assessment, bone marrow aspiration cytology, and trucut core biopsy findings. Ancillary studies, including flow cytometry, immunohistochemistry, and special stains, further supported the diagnosis in this challenging presentation. A review of the relevant literature is provided, highlighting distinguishing features from morphologically similar lesions to enhance recognition of this aggressive, metastasis-prone malignancy.
Copyright (c) 2026 Pushpit Gupta, Bembem Khuraijam, Varuna Mallya, Shaad Vali, Sujoy Neogi https://creativecommons.org/licenses/by/4.0
Bacteriological Profile of Bloodstream Infections Among Adults in a Tertiary Care Hospital From Central India: An Analytical Cross-Sectional Study
Background: Bloodstream infections (BSIs) represent a significant cause of morbidity and mortality in hospital settings. The increasing emergence of antimicrobial resistance among the causative pathogens has further complicated patient management and is a pressing public health concern. This study aimed to identify the etiological agents responsible for BSIs and to provide their antibiotic susceptibility patterns. Methods: An analytical cross-sectional study was conducted from 1 June 2021 to 30 May 2023 in a tertiary care hospital. Blood samples were collected from adult patients with a clinical diagnosis of septicemia. Isolation and identification of organisms were performed according to standard microbiological guidelines. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer disc diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 430 clinically suspected adult bacteraemia cases, blood cultures were positive in 196 cases (45.58%). Gram-negative bacteria were the most common causative agents, accounting for 71.42% of isolates, among which Klebsiella pneumoniae (21.93%) was predominant, followed by Escherichia coli (13.26%), Acinetobacter baumannii (9.69%). Extended-spectrum beta-lactamase (ESBL) production was observed in 38.55% of Gram-negative isolates, with the highest rates among Klebsiella pneumoniae (54.76%). Gram-positive cocci comprised 26.02%, while Candida albicans was detected in 2.55% of cases. Methicillin resistance was detected in 33.33% of Staphylococcus aureus isolates. Conclusions: BSIs remain a major concern in tertiary care hospitals, with Gram-negative organisms being the predominant pathogens. Prompt diagnosis and timely reporting of antibiotic susceptibility results are crucial for guiding early and appropriate therapy.
Copyright (c) 2026 Prerna Robinson, M. S. Qazi, Bhawana Bajare https://creativecommons.org/licenses/by/4.0
Non-syndromic unilateral sex cord tumor with annular tubules in an adolescent female: A Rare Diagnosis
Sex cord tumor with annular tubules (SCTAT) is a rare tumor of ovarian origin which is usually benign in origin but can show extraovarian spread in some cases. Here we present a case of 14-year-old female with abdominal pain which on radiology show unilateral ovarian cyst. Based on histopathological findings, diagnosis of SCTAT was confirmed. Non syndromic unilateral SCTAT usually presents in older women but can also be seen in younger age group and it should always be considered a differential diagnosis in ovarian tumors.
Copyright (c) 2026 Vaishali Rohilla, Shalini Gupta, Manju Raghava, Vishal https://creativecommons.org/licenses/by/4.0
Spectrum of Pleural Fluid Cytology in a Tertiary Care Hospital: A Prospective Observational Study
Background: Pleural effusion (PE) is a frequent clinical finding with a wide spectrum of underlying etiologies, including infections, malignancies, and systemic disorders. Cytological examination of pleural fluid remains a valuable first-line diagnostic tool, offering rapid, minimally invasive, and cost-effective results. The adoption of standardized reporting frameworks such as The International System for Reporting Serous Fluid Cytopathology (ISRSFC/TIS) enhances diagnostic clarity and consistency. Methods: This was a prospective observational study conducted at a tertiary care hospital. A total of 155 pleural fluid samples were evaluated using cytological analysis and classified according to the TIS system. Patient demographics, sample adequacy, fluid appearance, predominant cellular patterns, and final cytological diagnoses were recorded and interpreted. Results: Out of 155 samples, mean age of patients was 49.93 years, with male predominance (62.6%). Straw-colored fluid was the most common macroscopic presentation (41.9%). Cytological, chronic inflammation with lymphocyte dominance was observed in 68.4% of cases. Malignant cells were identified in three cases (1.9%). Using the TIS classification, 92.9% of samples were categorized as Category II: Negative for Malignancy (NFM), facilitating standardized reporting system. Conclusion: Cytological examination of pleural fluid remains a valuable initial diagnostic tool for evaluating serous effusions. Incorporating the TIS system enhances diagnostic accuracy and consistency, thereby supporting timely clinical decision-making and improved patient outcomes.
the international system for reporting serous fluid cytopathology
Copyright (c) 2026 Sakshi Sharma, Vishesh Dhawan, Ayushi Kediya, Anshul Kedia https://creativecommons.org/licenses/by/4.0
Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma Mimicking Benign Lymphocytic Infiltrates: A Pathologic Masquerade
Monomorphic Epitheliotropic Intestinal T-cell Lymphoma (MEITL) is a rare aggressive T-cell lymphoma mostly found in Asia. It accounts for less than 5% of primary gastrointestinal malignant lymphomas, is rapidly progressing, and has a poor prognosis with a median survival of 7 months. The relatively small size of atypical cells coupled with brisk cryptitis can result in a misdiagnosis of lymphocytic proctocolitis. A strong index of suspicion is required to employ an appropriate IHC panel for this diagnosis. In this case report, we want to describe a 50-year-old patient who presented with chronic lower gastrointestinal symptoms and was diagnosed with MEITL involving the large intestine and ileum.
monomorphic epitheliotropic intestinal t-cell lymphoma
Copyright (c) 2026 Kuljeet Kaur, Maitrayee Roy, Vishesh Dhawan, Ayushi Kediya https://creativecommons.org/licenses/by/4.0
Prevalence and Spectrum of Hemoglobinopathies Among Antenatal Women in Gujarat: An HPLC-Based Screening Study at a Tertiary Care Center
Background: Hemoglobinopathies pose a significant public health challenge in India. Antenatal screening is vital for early detection and informed reproductive choices. While traditional complete blood count (CBC) methods lack specificity, High-Performance Liquid Chromatography (HPLC) offers a precise diagnostic tool. This study evaluated HPLC's effectiveness in antenatal females at a tertiary care center in Gujarat. Methods: This retrospective, observational study analyzed data from 484 pregnant women who underwent HPLC screening during their antenatal period at a tertiary civil hospital in Ahmedabad, Gujarat. Inclusion criteria ensured complete demographic, hematological (CBC), and interpretable HPLC results. Data were analyzed using descriptive statistics. Ethical approval with a waiver of informed consent was obtained. Result: Of 484 antenatal women screened, 86 (17.8%) were diagnosed with a hemoglobinopathy. Beta-thalassemia minor was most common (n=62, 72% of positive cases), followed by sickle cell trait (n=14, 16%). Less common findings included HbD Punjab (n=5, 6%), HbE trait (n=2, 3%), and single cases of HbE homozygous, SCD+BT, and delta-beta thalassemia (1% each). Hematological analysis showed elevated HbA2 and microcytosis in beta-thalassemia minor, distinct variant percentages (e.g., HbS 27.82% in sickle cell trait), and varying red cell indices. Conclusion: This study revealed a high prevalence of hemoglobinopathies (17.8%) among antenatal women in Ahmedabad, Gujarat, predominantly beta-thalassemia minor and sickle cell trait. HPLC proved crucial for accurate diagnosis of these diverse variants. The significant carrier burden underscores the urgent need for comprehensive antenatal screening, genetic counseling, and prenatal diagnostic options to reduce severe hemoglobinopathy incidence in India.
Copyright (c) 2026 Nirali Rakeshbhai Panchal, Meena Avinash Patel, Bhargav Babulal Darji https://creativecommons.org/licenses/by/4.0
Embryonal Rhabdomyosarcoma of the Urinary Bladder: A Case Report
Embryonal rhabdomyosarcoma accounts for 4.5% of the childhood cancers. Rhabdomyosarcoma is the most common malignant soft tissue sarcoma in children and has the following subtypes: embryonal, alveolar, pleomorphic and spindle cell/sclerosing. About 17% of rhabdomyosarcomas occur in genito-urinary tract. A 2-year-old male child presented with complaints of excessive crying while passing urine and dribbling of urine for 1 day. Patient underwent cystoscopic biopsy and histopathological examination was done after taking written consent by the parents following which showed a cyst arising from bladder neck extending into right lateral wall of prostate. Partial excision of the cystic lesion was done. Gross examination of the biopsy revealed multiple grey-white to grey-brown soft tissue bits largest measuring 2cms in length and smallest measuring 0.2cm in length. Microscopy revealed a malignant neoplasm composed of poorly differentiated tumor cells arranged in sheets. Individual cells are primitive ovoid to spindle shaped with moderate pleomorphism and hyperchromatic nuclei with minimal cytoplasm admixed with myxoid areas. Few scattered Rhabdomyoblast like elongated cells with cytoplasmic eosinophilia and sparse atypical mitosis noted. Cambium layer was seen. Margin status were not assessed as the specimen was received in piece meal. Differential diagnosis of small round blue cell tumor was considered. Immunohistochemistry showed positivity for smooth muscle Actin, Desmin, Myogenin and MyoD1 suggesting Embryonal Rhabdomyosarcoma. Embryonal Rhabdomyosarcoma is the most common subtype of pediatric rhabdomyosarcoma. Age, Stage at diagnosis and treatment received are the predictors of the survival of Embryonal RMS.
Copyright (c) 2026 Mythreyi M U, Priyadarshini Devendrappa, Jyothi A Raj, Shashikala K, Dedena Khumbongmayum https://creativecommons.org/licenses/by/4.0
The Association of Red Blood Cell Indices with Glycosylated Hemoglobin and Microalbuminuria in Patients with Type 2 Diabetes Mellitus in a Tertiary Care Hospital – A Prospective Cross-sectional Study
Background: Type 2 Diabetes Mellitus (T2DM) is a major global health concern, often presenting asymptomatically and diagnosed only after complications arise. Poor glycemic control is linked to increased morbidity, including diabetic nephropathy. This study investigates the association between red blood cell (RBC) indices, glycosylated hemoglobin (HbA1c), and urinary albumin-to-creatinine ratio (UACR) to explore their potential in predicting early diabetic complications. Methods: A prospective cross-sectional study was conducted in a tertiary care hospital after institutional ethical clearance. Relevant clinical and laboratory data—including hemoglobin, MCV, MCH, MCHC, RDW, HbA1c, and UACR—were collected from patients with T2DM. Statistical analysis was performed using SPSS and EZR software. Normality was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Associations were analyzed using Spearman’s correlation and the Mann–Whitney U test, with p < 0.05 considered statistically significant. Results: A weak, though statistically non-significant, positive correlation was observed between RDW and HbA1c (p = 0.50). No significant association was found between HbA1c and other RBC indices. A statistically significant positive correlation was observed between HbA1c and UACR, suggesting that poor glycemic control is associated with early renal impairment. Conclusion: RDW may serve as a useful indicator for early hematologic alterations in T2DM, while elevated UACR reflects early nephropathy associated with poor glycemic control. These markers could aid in the timely detection and prevention of diabetic complications.
Copyright (c) 2026 Sandra Peter, Varughese Padinjattadathu George, Varsha Jose https://creativecommons.org/licenses/by/4.0
Clinical Relevance of Anti-S and Anti-M Antibodies in Crossmatch Incompatibility: A Case Series
Background: Alloimmunization is a challenge in transfusion medicine, especially among patients with prior transfusions or pregnancies. Crossmatch incompatibility from unexpected red cell antibodies can delay transfusions, impact outcomes, and cause hemolysis.Aim: To highlight the clinical significance of anti-S and anti-M antibodies of the MNS system in crossmatch incompatibility, by summarizing six cases managed in our department.Methods: We present a retrospective case series of six patients exhibiting serologic incompatibility during pre-transfusion testing between May 2024 and May 2025 at a tertiary care center. Antibody screening and identification were conducted using column agglutination technology (CAT, Ortho vision) with 3-cell and 11-cell commercial panels. Quality control was ensured according to manufacturer protocols. Compatible and incompatible units were recorded using standardized grading and QC systems.Results: Among 55,542 crossmatched patients, six (all females; mean age 36 years; range 11–53) showed crossmatch incompatibility owing to Anti-S (4/6) or Anti-M (2/6) antibodies. Most had prior transfusion or pregnancy history. Anti-M was reactive at 37°C/AHG phase in both cases. Compatible units were identified and transfused as indicated; overall, 51 units were crossmatched (29 incompatible, 22 compatible, see Table 1). Four patients were transfused uneventfully with compatible antigen-negative units.Conclusion: Early identification of clinically significant red cell antibodies and provision of antigen-negative blood are crucial for safe transfusion. Anti-S and Anti-M antibodies, although uncommon, should be considered during incompatibility evaluation, particularly in settings with high transfusion exposure or pregnancy rates.
Copyright (c) 2026 Dipshikhaa Ravi, Ashwin Anadan, R. Krishnamoorthy, Niranj Rathan, Sampat Kumar https://creativecommons.org/licenses/by/4.0
Antimicrobial Resistance Dynamics of Pseudomonas Aeruginosa in a Tertiary Care Hospital in Delhi
Background: Pseudomonas aeruginosa, non-fermenting gram-negative bacilli are a major cause of healthcare-associated infections. The rise in multidrug-resistant (MDR) strains globally has been associated with increased morbidity and mortality. In India, antimicrobial resistance (AMR) presents a significant challenge, necessitating effective policies and infection control measures. This study explores the resistance dynamics of P. aeruginosa in a tertiary care hospital, evaluating the findings in relation to the data from the Indian Council of Medical Research (ICMR). Methods: A total of 1,536 P. aeruginosa isolates from 31997 clinical samples of pus, wound, and burn swabs, respiratory specimens and body fluids submitted for routine culture were analyzed. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Blood, urine, cerebrospinal fluid (CSF), and stool were excluded. Results: P. aeruginosa accounted for 5th most frequent pathogen with prevalence declining from 15.7% (136/869) in 2020 to 7.7% (249/3236) in 2024. Among the isolates, 34.2% (525/1536) were susceptible to all tested antimicrobials, while 13.2% (203/1536) were MDR and 10.6% (163/1536) were extensively drug-resistant (XDR). Improved susceptibility was observed for piperacillin-tazobactam, carbapenems, aztreonam, and aminoglycosides, whereas, fluoroquinolones and monobactams showed persistently low susceptibility. Conclusion: Continuous monitoring of MDR pathogens like P. aeruginosa and their resistance dynamics are crucial for guiding treatment strategies and infection control measures.
Copyright (c) 2026 Seema Gangar, Nisha Goyal, Nimisha Jain, Hage Yaja, Neha Sharma, Shukla Das https://creativecommons.org/licenses/by/4.0
A Case Series of Rhinosporidiosis at Unfamiliar Sites: An Experience from a Tertiary Care Centre of Eastern India
Classical anatomic sites are implicated in most diseases. They help the clinician to make a substantial diagnosis. However there exists indistinct chances of occurrence of diseases at sites that are unusual and unexpected. The same is true for the disease Rhinosporidiosis as well. We have attempted to illustrate cases of Rhinosporidiosis with presentations at infrequent sites in this compilation of cases. Tissue diagnosis has ultimately culminated in formulating the conclusive diagnosis here.
Copyright (c) 2026 Chhanda Das, Soumyadip Das, Anannya Ghatak, Asmita Das, Ayan Saha https://creativecommons.org/licenses/by/4.0
Histopathological diagnosis of lymph node biopsies and subtyping of lymphomas based on immunohistochemistry at a tertiary care centre in South Kerala
Background: Lymph node enlargement is a clinical sign with uncertain definitive diagnosis since the causes are many. In view of the wide spectrum of the possible differential diagnoses, it is imperative for the clinicians and pathologist to have a knowledge of the common causes of lymphadenopathy in their locality. Aim: To study the spectrum of histopathological diagnosis of lymph node biopsies received at a tertiary care centre in South Kerala and to find out the proportion of neoplastic and non-neoplastic lesions and to subtype lymphoma based on immunohistochemistry. Method: This work involved all the lymph node biopsies received in the department during the study period (138 cases) and their histological analysis. In all cases of lymphoproliferative disorders, immunohistochemistry was done. Results and Discussion: The male to female ratio was 1.1:1 with a slight male preponderance. The most common site biopsied was the cervical lymph node. Non-neoplastic lesions were more common and comprised 71% of all biopsies. Overall, the most common lesion was reactive lymphadenopathy. Tuberculous lymphadenitis was the next common lesion with highest incidence in individuals aged 30-39 years showing a female preponderance. Among neoplastic lesions, metastasis to lymph node showed a slight predominance over lymphoproliferative disorders. Metastasis from adenocarcinoma was the most common. All metastatic lesions were in the age group more than 30 years with a male preponderance. Non-Hodgkin’s lymphoma was more common than Hodgkin’s Lymphoma. Follicular lymphoma was the commonest among NHL. Among the 17 cases of NHL, 15 of the cases could be subtyped with the available basic IHC panel, rest 2 cases could not be precisely subtyped. All 3 cases of Hodgkin’s Lymphoma were males with Classic Hodgkin’s Disease- Mixed Cellularity type. Conclusion: In the present study of 138 lymph node biopsies, non-neoplastic lesions were more frequent than neoplastic lesions, with reactive lymphadenitis being the most common diagnosis, followed by tuberculous lymphadenitis. Among neoplastic conditions, metastatic deposits—predominantly from adenocarcinoma—were observed more frequently than lymphomas, with a predilection for older males. Non-Hodgkin’s lymphoma was more frequent than Hodgkin’s lymphoma, with follicular lymphoma being the commonest subtype identified. These findings underscore the predominance of non‑neoplastic causes of lymphadenopathy and reaffirm the critical role of histopathology, supplemented by immunohistochemistry, in arriving at a definitive diagnosis—particularly in cases where lymphoproliferative disorders are suspected.
Copyright (c) 2026 Anu Jose Markose, Siji Mathew, Suma S, Rema Priyadarshini https://creativecommons.org/licenses/by/4.0
Proximal-Type Epithelioid Sarcoma with Unusual Morphology: A Diagnostic Challenge with Detailed Immunohistochemical Workup
Background:An uncommon and aggressive soft tissue sarcoma, Epithelioid sarcoma (ES) has a significant risk of recurrence and metastasis. The proximal variant overlaps with other epithelioid malignancies, it can be diagnostically challenging particularly in young patients. Case Presentation:We report a single-patient case of a 14-year-old male with a painful deep-seated calf mass. Trucut biopsy showed deceptively bland epithelioid–rhabdoid cells with lymphocytic admixture. After Immunohistochemistry (IHC), lesion was reported as a polygonal cell neoplasm on biopsy. Wide local excision was performed, morphology showed myxoid matrix making it more difficult to diagnose and extended IHC demonstrated PanCK and EMA positivity with complete loss of INI1, while S100, GFAP, CD34, Desmin, SALL4, and CD138 were negative, confirming proximal-type epithelioid sarcoma. Conclusion:This case emphasizes that proximal-type epithelioid sarcoma may present with deceptively bland histology and unusual myxoid stromal changes. Definitive diagnosis requires extended immunohistochemical panel, particularly assessment of INI1 loss.
Copyright (c) 2026 Suguna Badiginchala, Aruna kumari Prayaga, Rukmangadha Nandyala, Manilal.B https://creativecommons.org/licenses/by/4.0
Malakoplakia in a Transplant Kidney: A Rare Case Report
Malakoplakia is a rare inflammatory condition, commonly associated with immunosuppression. It usually affects the urinary bladder. Involvement of renal parenchyma is uncommon. This is a case report of a 49 year old renal transplant recipient with persistent graft dysfunction following an episode of urinary tract infection. Creatinine level was high and urine analysis showed pus cells and E.Coli organisms. Renal allograft biopsy was performed to rule out rejection and interstitial nephritis. The biopsy showed interstitial inflammation with histiocytes showing Michaelis-Gutmann bodies which were highlighted by Perls Prussian blue stain. Hence, the diagnosis of Malakoplakia was made. Treatment with prolonged antibiotics led to significant improvement in the creatinine value and graft function. This is a rare case which involves the renal parenchymal tissue following transplantation and correct diagnosis is required for graft survival and good prognosis.
Copyright (c) 2026 Praveen Shankar Balasubramanian, Veenaa Venkatesh https://creativecommons.org/licenses/by/4.0
Left Atrial Myxoma: An Enigma in Itself – Two Case Reports
Background: Cardiac myxomas are rare primary cardiac tumours with variable clinical presentation.Case Presentation: We report two cases of left atrial myxoma, a 40-year-old female with dyspnoea and syncopal episodes, and a 16-year-old male with atypical chest pain and a prior neurological event. Routine laboratory parameters and ECG were unremarkable in both cases, while transthoracic echocardiography and CECT chest identified left atrial masses. Both patients underwent surgical excision. Histopathology revealed classic myxoma morphology with nests and cords of lepidic cells in a myxoid matrix. The older patient developed postoperative sepsis and expired, whereas the adolescent recovered uneventfully.Conclusion: These two case reports highlight the broad age spectrum and diverse clinical manifestations of left atrial myxoma, reinforcing the importance of timely imaging and histopathological confirmation.
Copyright (c) 2026 Fiza Chopra, Neha Singh, Rupinder Kaur, Sanjukta https://creativecommons.org/licenses/by/4.0
Pulmonary Amyloidosis: Diverse Clinical and Histopathological Manifestations - A Series of Five Cases
Pulmonary amyloidosis, a rare condition caused by the abnormal deposition of protein fibrils, most often the AL (light chain) type, within the lung, frequently presents a diagnostic challenge. Its clinical manifestations often resemble more prevalent lung diseases like cancer or infections. A crucial step is to differentiate between disease limited to the respiratory system and widespread systemic involvement, as this guides the appropriate treatment. This report provides a retrospective analysis of five histologically confirmed cases of pulmonary amyloidosis, detailing their presenting clinical features, radiological findings, microscopic tissue characteristics, immunohistochemical analysis, and results from systemic evaluations. Our patient group, comprising three males and two females aged between 38 and 67 years, presented with varied initial symptoms: three had lung masses, one exhibited pleural effusion with concurrent liver disease, and another was being treated for tuberculosis. Microscopic examination revealed discrete amyloid nodules in three cases, diffuse interstitial deposition in one, and a pleural based accumulation in another. Immunohistochemical studies confirmed AL-type amyloid in three cases, AA-type in one, while the specific amyloid type remained undetermined in a fifth case. A confirmed diagnosis of systemic amyloidosis was made in only one patient. In one instance, nodular pulmonary amyloidosis occurred alongside fungal colonization. Pulmonary amyloidosis often poses a diagnostic conundrum in lung pathology. While localized nodular forms generally follow a benign clinical course, diffuse patterns necessitate a thorough systemic evaluation, even when serological indicators are negative. Advanced techniques like mass spectrometry and extensive imaging are becoming more vital for accurate subtyping and informed treatment decisions.
Copyright (c) 2026 Richa Bhartiya, Pallavi Mehra, Vishal Tayade, Navin K. Bariar, Mansi Karwa, Pritisha Choudhury https://creativecommons.org/licenses/by/4.0
Beyond the Matrix: A Rare Case of Pilomatrix Carcinoma with Histologic Insights
Pilomatrix carcinoma is rare entity which arises from matrical cells of hair follicle and misdiagnosed quite often. A 27 years female with presented with a swelling on right side of nape of neck for approximately 3 years which was painless, slowly progressive, soft to firm in consistency. Previously misdiagnosed as squamous cell carcinoma, the lesion recurred and was excised again in our institution and was diagnosed here as Pilomatrix carcinoma with regional lymph node metastasis. Since she had metastasis, the patient is currently undergoing radiotherapy. Considering the rarity of this carcinoma it was noteworthy to report this case as correct diagnosis aids patient’s treatment protocol and improves prognosis.
Copyright (c) 2026 Nidhi Priya Barla, Prima Shuchita Lakra, Rahul Kumar Bharti, Amiy Arnav, Sanjeet Kumar Singh, Monalisa Katyare https://creativecommons.org/licenses/by/4.0
Sarcomatoid carcinoma of prostate: A rare variant
Sarcomatoid carcinoma of the prostate is an extremely rare aggressive variant of prostatic adenocarcinoma, which causes diagnostic and therapeutic challenges due to its mixed histological features. It represents less than 0.1% of prostate cancer cases.
Copyright (c) 2026 Archana N Rijhsinghani https://creativecommons.org/licenses/by/4.0