Undifferentiated Malignant Tumor Research Articles

Metastasis in the mandible involving gingiva

Oral metastasis, although rare, tends to involve jawbones, particularly the posterior region of the mandible, and involvement of oral soft tissues, even when less likely, is most often seen on the gingiva and tongue. Clinically, the soft-tissue masses tend to mimic pyogenic granuloma, peripheral giant cell granuloma or an epulis and thus are difficult to diagnose and identify. The jaw bone is preferred by prostate carcinoma as a metastatic target. Prostate malignancy, which is more common in Western countries than in India, may be adenocarcinomas or carcinomas. Oftentimes, metastatic lesions develop in the alveolar region and are a cause for tooth mobility, yet, they tend to be detected only after extraction of the affected tooth. In such cases, the symptomatic presentation therefore, is vague and indicative of tooth mobility secondary to periodontal pathology unless, a detailed history and follow-up is done. We report a case of a male patient who presented to our department with a proliferative, painful, swelling postextraction of the left first molar region, and the lesion was seen at the extraction site as well as in the mandibular anterior tooth region. The swelling was associated with palpable lymph nodes. Orthopantomogram showed an irregular, radiolucent lesion extending from the lower left central incisor to the left first molar region in the mandibular alveolus. Incisional biopsy tissue came with provisional diagnosis of osteomyelitis or squamous cell carcinoma as the patient was a habitual bidi smoker for more than 20 years. Histologically, it was an undifferentiated tumor with tumor cells seen in deep connective tissue with a lack of lineage differentiation. An undifferentiated malignant tumor represents either a metastasis of unknown origin or a primary neoplasia without obvious cell line of differentiation. Immunohistochemistry (IHC) of undifferentiated tumors helps to categorize them into small round blue cell tumors or large cell tumors. The oral pathologist was perplexed as there was no mention of any other malignancy in the patient's history, which, however, was noted by the surgeons few days later. Hence, initially, a hematopoietic malignancy was suspected which was ruled out by IHC, and later, staining with cytokeratin 7 (CK7), CK-high molecular weight and P63 confirmed prostate metastases as all three were negative.

Histological and immunohistochemical evaluation of epithelial and mesenchymal tumors of psittacines

This study describes histological and immunohistochemical evaluation of 50 epithelial and mesenchymal tumors of psittacines that were found in the archives of the pathology departments of veterinary faculties at Utrecht University and Istanbul University Cerrahpasa. In each case, cellular morphological features, tumoral pattern and mitotic activity were evaluated histologically, and immunohistochemistry was performed by the streptavidin-biotin immunoperoxidase method using a panel of commercially available antibodies raised against pan-cytokeratin, vimentin, muscle-specific actin, desmin, smooth muscle actin and Factor VIII/von Willebrand Factor. The histological evaluation revealed that 30 epithelial tumors were squamous cell carcinoma (n: 20), renal adenocarcinoma (n: 3), basal cell carcinoma (n: 2), abdominal carcinoma (n: 2), uropygial gland carcinoma (n: 1), cloacal carcinoma (n: 1) and cholangiocarcinoma (n: 1). Out of the 50 tumors, 13 had a mesenchymal origin and were diagnosed as fibrosarcoma (n: 4), hemangioma (n: 3), hemangiosarcoma (n: 4) and leiomyosarcoma (n: 2). Histological diagnosis could not be made for 7 tumors, and they were evaluated as undifferentiated malignant tumors (UDMT). Two tumors diagnosed as fibrosarcoma and three tumors diagnosed as UDMT showed strong SMA staining and were re-diagnosed as leiomyosarcoma. In view of the IHC findings, two other UDMTs were re-diagnosed as fibrosarcoma and anaplastic carcinoma. Although only a limited number of antibodies were used in the control panel, they were useful in establishing a definite diagnosis in some cases

Diagnostic duplicity of spindle cell sarcoma: Stitch in time saves nine

The prime cause of low backache with radiculopathy is prolapsed intervertebral disc, but in conditions where the radiology and scans of the lumbosacral spine are insignificant and the symptoms are progressive, it can be a tumor involving the sciatic nerve. Here, we present a case of a 26-year-old female managed conservatively for her low backache with radiculopathy which ultimately turned out to be an undifferentiated malignant nerve sheath tumor of the sciatic nerve. It is one of the largest nerve sheath tumors reported in the literature. Combined transabdominal and Kocher–Langenbeck approaches were used to resect the tumor. Histopathology confirmed the diagnosis of the undifferentiated malignant nerve sheath tumor. Through this case report, we emphasize to screen the pelvis early if symptoms of sciatica are progressive along with insignificant scans of the spine.

Enigma of CD56 and S100 positive-high-grade undifferentiated malignant tumor of uncertain histogenesis of the mandible - A rare case report

Enigma of CD56 and S100 positive-high-grade undifferentiated malignant tumor of uncertain histogenesis of the mandible - A rare case report

P1262 If anything can go wrong, it will: management of a pericardial effusion in a young patient

Abstract Case Report A 25 year-old male patient with an unremarkable past medical history presented to the Emergency Department due to a hemodynamically stable wide complex tachycardia at 260bpm with no response to adenosine, which was successfully treated with synchronized electrical cardioversion. Post cardioversion EKG revealed a pre excitation pattern and the transthoracic echocardiogram showed a large pericardial effusion with diastolic right atrial collapse. The patient was admitted in the Cardiology Department for emergent pericardiocentesis and further investigation. A total of 800 mL of bloody pericardial fluid was removed, compatible with an exudate, but fluid culture and cytology were inconclusive. Due to a rapid reaccumulation of pericardial fluid, the patient underwent a pericardial window, after which he developed an intractable pleuritic thoracalgia, refractory to the combination of ibuprofen, colchicine and oral steroid, despite the resolution of the pericardial effusion. He was also submitted to an electrophysiologic study with successful ablation of a right sided accessory pathway. Analysis of the pericardial fluid and biopsy were inconclusive once again, including a low level of adenosine deaminase and negative acid-fast bacilli test and nucleic acid amplification test for Mycobacterium tuberculosis. The patient was afebrile and denied any constitutional symptoms or relevant epidemiological context. The remainder etiological study was unremarkable, with the exception of fluctuating antibody titers for adenovirus, Borrelia burgdorferi and Mycoplasma pneumoniae, which were interpreted as a result of cross-reactivity. Nevertheless, a course of 21 days of doxycycline was tried without any significant improvement. Thoracic-abdominal-pelvic CT and PET scan were normal. Direct inoculation in guinea pig led to positive results for Mycobacterium tuberculosis and antituberculous therapy was started. Despite pathogen directed antibiotic treatment, there was no clinical improvement and the pericardial effusion gradually relapsed, evolving to cardiac tamponade requiring emergent drainage. Histologic examination of pericardial fragments finally revealed massive infiltration by an undifferentiated malignant tumor compatible with a malignant epithelioid hemangioendothelioma. Due to the patient’s poor performance status and rapidly deteriorating clinical course, it was decided not to start chemotherapy. The patient eventually died, 6 months after his admission to the ED and 2 weeks after the neoplasm’s diagnosis. Conclusion In regions with a high Tuberculosis incidence, there should be a high degree of suspicion for tuberculous pericarditis, especially in cases of recurrent pericardial effusion. Immunosuppressed individuals, such as oncologic patients, are at an increased risk for tuberculosis. The management of relapsing pericardial effusion remains a diagnostic challenge as described in this clinical case.

The role of immunohistochemistry for diagnosing undifferentiated malignancy in the head and neck region

Background: Undifferentiated tumours in the head and neck region are not uncommon. They can arise from different sites like in mucosa as well as in salivary glands, soft tissues or lymph nodes. Histopathological examination plays a central role in the diagnosis but difficulties arise with some tumours which are poorlydifferentiated due to their high inter- and intra-observer variability. In those cases, immunohistochemistry has greatly assisted to diagnose the tumours that cannot be accurately identified using routine histopathological procedures. The correct histopathological diagnosis is essential especially in case of malignant tumourwhere subsequent specific therapy is required. The aim of this study was to determine the role of immunohistochemistry for diagnosing undifferentiated malignancy in the head and neck region.
 Methods: This cross-sectional study was conducted during July 2014 to June 2015. A total of 35 Bangladeshi patient’s specimens of head and neck swelling were collected from two renowned laboratories in Dhaka city.These cases were diagnosed as undifferentiated tumour in histopathological examination.Standard protocol was followed for immunohistochemistry.Then primary immunohistochemical panel which included the markers for Epithelial CK (AE1/AE3),mesenchymal marker (Vimentin) and lymphoid marker (LCA) were used.The cases which were not resolved by primary immunohistochemistry panel, the second panel was applied for further sub classification (Desmin, Chromogranin, CK20, CEA, CD20, CD30, HMB45, NSE). Based on interpretation of immunohistochemical findings final diagnoses were made.Data analysis was performed using the Statistical Package for the Social Sciences for Windows version 22.0 (SPSS, Chicago, Illinois, USA).
 Results: A total of 35 undifferentiated tumorsof head-neck region were studied.The mean age was 46.3±17.6 years and male to female ratio was 4.8:1. The majority 13 (37.1%) patient had cervical lymphadenopathy, 11 (31.4%) had neck mass and 4(11.4%) had in nasal/sinonasal mass.Regarding histopathologicalcell types, round cell was 21 (60.0%), spindle cell 6 (17.1%), pleomorphic cells 6(17.1%) and epithelioid cells 2(5.7%). In initial histopathological examination, majority 25(71.4%) were undifferentiated malignant neoplasm, 8(22.8%) were metastatic undifferentiated carcinoma, 1(2.9%) was pleomorphic sarcoma and the remaining 1(2.9%) had malignant adnexal tumour. By application of immunohistochemistry, most (33, 94.3%) of the cases were resolved and the two cases remained unresolved. Among the resolved cases majority (15, 45.5%) were lymphoma, 4(12.1%) were metastatic carcinoma, 3(9.1%) were Ewing’s sarcoma and malignant melanoma were found in 3(9.1%) cases.
 Conclusion: This study supports that the immunohistochemical technique has a fundamental role in the investigation of undifferentiated tumour origin, to determine the correct guidance for treatment and improving the prognosis for head and neck tumour patients.
 Birdem Med J 2020; 10(1): 48-53

LANGERHANS CELL HISTIOCYTOSIS

Langerhans cell histiocytosis (LCH) is a rare condition of uncertain etiology resulting from a clonal proliferation of Langerhans cells, which mainly affects children. In March 2018, parents of a 1-year-old male patient reported a volume increasing on the right side of the child's jaw. The imaging tests revealed a lytic lesion with aggressive aspect in the mandible. In view of this, it was decided to perform an incisional biopsy of the affected area and subsequent histopathologic examination. The histologic slices showed a diffuse infiltration of large monocyte cell resembling histiocytes, numerous plasma cells, lymphocytes, and eosinophils. It was concluded that it was an undifferentiated malignant neoplasm. To confirm the diagnosis, immunohistochemical examination was required, which was positive for vimentin (V9), Ki67 (20% of cells), S100, and CD-1 a. Morphologic and immunohistochemical findings were consistent with Langerhans cell histiocytosis. After the diagnosis the patient underwent chemotherapy for a minimum of 6 months. Currently, the patient is undergoing treatment and progressing well.

AGGRESSIVE DIFFUSE LARGE B-CELL LYMPHOMA IN ANTERIOR MAXILLARY REGION: CASE REPORT

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma and is rarely seen in the maxillofacial region. A case of DLBCL in a 50-year-old man who is immunocompetent (no reagent HIV-1 and -2, and human T-cell lymphotropic virus tests) is reported. The patient complained of a painful and aberrant mass in the anterior maxillary region with fast growing in 2 months. A facial computed tomography (CT) shows a large mass with soft tissue density, measuring approximately 7.4 × 6.6 cm, which invaded and destroyed the maxillary bone. The incisional biopsy showed an undifferentiated malignant neoplasm compatible with lymphoma. Immunohistochemical analysis proved the lesion to be a DLBCL, strongly positive for CD20 and CD79 a, weakly positive for VS38 c+ and Bc16 e MUM1, and negative for CD3, cyclin A D1, CD7, C43, CD10, B CD30, and CS1-4. The proliferation index, as indicated by Ki-67 immunohistochemistry, was over 80%. The patient was referred for oncological treatment. Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma and is rarely seen in the maxillofacial region. A case of DLBCL in a 50-year-old man who is immunocompetent (no reagent HIV-1 and -2, and human T-cell lymphotropic virus tests) is reported. The patient complained of a painful and aberrant mass in the anterior maxillary region with fast growing in 2 months. A facial computed tomography (CT) shows a large mass with soft tissue density, measuring approximately 7.4 × 6.6 cm, which invaded and destroyed the maxillary bone. The incisional biopsy showed an undifferentiated malignant neoplasm compatible with lymphoma. Immunohistochemical analysis proved the lesion to be a DLBCL, strongly positive for CD20 and CD79 a, weakly positive for VS38 c+ and Bc16 e MUM1, and negative for CD3, cyclin A D1, CD7, C43, CD10, B CD30, and CS1-4. The proliferation index, as indicated by Ki-67 immunohistochemistry, was over 80%. The patient was referred for oncological treatment.

2613 A Rare Case of Undifferentiated Malignant Epithelioid Neoplasm

INTRODUCTION: The small bowel is rarely a site for development of tumor malignancy and accounts for less than 1% of all GI malignancies. We present a case of a 53-year-old male with recurrent episodes of gastrointestinal bleeding and negative upper and lower GI endoscopies found to have high-grade undifferentiated high-grade malignant epithelioid neoplasm. CASE DESCRIPTION/METHODS: A 53-year old male with history of peptic ulcer disease, duodenal ulcer perforation presented to the ED with right upper and lower extremity pain for last few weeks along with black stools. He had required several units of blood transfusion with recurrent admissions to hospital and had also lost about 20 lbs in last 2 months. EGD and colonoscopy 3 months before had shown duodenal angiectasia and colonic polyps which were removed. Outpatient capsule endoscopy was recommended but patient did not follow up. Bleeding scan was negative and CT abdomen pelvis with contrast showed thickening in distal jejunum concerning for mass-like lesion. Patient underwent laparoscopic small bowel resection of 18 cm and pathology showed high-grade undifferentiated malignant epithelioid neoplasm with macro-metastatic tumor. The tumor showed diffuse staining for vimentin,pancytokeratin, CK7 with subset moderate cytoplasmic staining for calretinin and CK8/18.Port-A-Cath was placed and patient was started on standard adjuvant chemotherapy including combination of 5-FU, leucovorin, and oxaliplatin. DISCUSSION: Small bowel tumors are very rare and aggressive and have poorer prognosis than colon cancer. They present a diagnostic challenge as access to small bowel is limited during conventional diagnostic procedures and symptoms present late. We present a patient who was having recurrent gastrointestinal bleeding requiring multiple blood transfusions and found to have high-grade undifferentiated high-grade malignant epithelioid neoplasm. The differential for this includes monophonic synovial sarcoma, malignant epithelioid mesothelioma, and large cell lung carcinoma vs others. Video capsule endoscopy has rapidly become the conventional standard for small bowel evaluation, followed by other methods such as magnetic resonance enteroclysis. Standard chemotherapy treatment closely resembles that of large bowel cancer, including combinations of 5-FU, leucovorin, and oxaliplatin/irinotecan/capecitabine.

Histopathological study of non-neoplastic and neoplastic lesions of salivary gland

Histopathological study of non-neoplastic and neoplastic lesions of salivary gland - ACHR- Print ISSN No: - 2581-5725 Online ISSN No:- 2456-9267 Article DOI No:- 10.18231/2456-9267.2019.0013, IP Archives of Cytology and Histopathology Research-IP Arch Cytol Histopathol Res

Undifferentiated malignant tumors of small round cell in nasal cavity and paranasal sinuses: report of one case and review of literature

目的 提高对鼻腔鼻窦小圆细胞未分化恶性肿瘤的认识。 方法 报道吉林大学第二医院收治的1例鼻腔鼻窦小圆细胞未分化恶性肿瘤患者的诊疗情况，并复习相关文献。 结果 该患者明确诊断为鼻腔鼻窦小圆细胞未分化恶性肿瘤，行局部根治性放疗后，肿瘤得到有效控制，放疗后2个月发生脑转移、胰腺转移，未行进一步治疗，1周后患者死亡。 结论 鼻腔鼻窦小圆细胞未分化恶性肿瘤在临床上极为少见，肿瘤恶性程度高，预后极差；免疫组织化学技术对其病理类型的鉴别具有重要意义；目前早诊断、早治疗仍为改善患者预后的关键。

"Z4" Complex Member Fusions in NUT Carcinoma: Implications for a Novel Oncogenic Mechanism.

Nuclear protein in testis (NUT) carcinoma (NC) is a rare, distinctly aggressive subtype of squamous carcinoma defined by the presence of NUT-fusion oncogenes resulting from chromosomal translocation. In most cases, the NUT gene (NUTM1) is fused to bromodomain containing 4 (BRD4) forming the BRD4-NUT oncogene. Here, a novel fusion partner to NUT was discovered using next-generation sequencing and FISH from a young patient with an undifferentiated malignant round cell tumor. Interestingly, the NUT fusion identified involved ZNF592, a zinc finger containing protein, which was previously identified as a component of the BRD4-NUT complex. In BRD4-NUT-expressing NC cells, wild-type ZNF592 and other associated "Z4" complex proteins, including ZNF532 and ZMYND8, colocalize with BRD4-NUT in characteristic nuclear foci. Furthermore, ectopic expression of BRD4-NUT in a non-NC cell line induces sequestration of Z4 factors to BRD4-NUT foci. Finally, the data demonstrate the specific dependency of NC cells on Z4 modules, ZNF532 and ZNF592. IMPLICATIONS: This study establishes the oncogenic role of Z4 factors in NC, offering potential new targeted therapeutic strategies in this incurable cancer.Visual Overview: http://mcr.aacrjournals.org/content/molcanres/16/12/1826/F1.large.jpg.

High-grade myoepithelial carcinoma can show histologically undifferentiated/anaplastic features

High grade malignant tumors with a poorly-/un-differentiated morphology pose significant diagnostic challenges. Increasingly, the use of adjunct immunohistochemical and molecular tests to characterize and delineate the histopathologic phenotype of these tumors has become necessary, particularly in head and neck tumors. Recently, several entities with a poorly-/un-differentiated light microscopic morphology have been defined based on specific immunohistochemical and genetic characteristics. We herein describe two cases of high-grade myoepithelial carcinoma, one occurring in the submandibular gland and the other occurring in the left nasal cavity, both showing undifferentiated histological and anaplastic cytomorphological features. This led to very broad differential diagnostic considerations and the diagnosis was only established after extensive immunohistochemical studies. Molecular testing for HPV was negative in both cases. Gene fusion analysis using a targeted sequencing assay (Archer® FusionPlex® system) did not identify fusions involving PLAG1, HMGA2, EWSR1 or ALK genes in either case. The submandibular tumor showed an aggressive clinical course, with diffuse pulmonary metastases at presentation, whilst the nasal cavity tumor showed only localized disease. Awareness of a subcategory of high-grade myoepithelial carcinomas with undifferentiated light microscopical features is of significant importance in antibody selection for immunohistochemical investigation of poorly-/undifferentiated malignant tumors in the head and neck region. This histological variant of myoepithelial carcinoma adds to the growing list of differential diagnoses in this diagnostically complex and multifaceted field.

Role of ancillary techniques in profiling unclassified laryngeal malignancies.

Laryngeal biopsies, contrary to biopsies from many other sites of the body, very often contain minute amounts of tumour tissue that may consist of morphologically undifferentiated tumour only. In haematoxylin- and eosin-stained sections, there may be no indicative features of what specific tumour entity that is present. In the larynx, particularly small round cell neoplasms, primary or metastatic, often cause a diagnostic dilemma and where an incorrect diagnosis can induce substantial clinical consequences for the patient (e.g., primary neuroendocrine carcinomas vs metastatic variants, certain sarcomas). If sufficient/representative material has been obtained, the application of immunohistochemistry and/or molecular techniques should in virtually every case reveal the true nature of the malignancy. In cases with sparse amount of material, and therefore a limited number of sections to be cut, a careful and thoughtful stepwise approach is necessary to ascertain a reliable diagnosis, or at least guide the clinician to the most likely diagnoses. With today's advanced and widely available technology with an abundance of markers to discriminate different tumours, the use of the term "undifferentiated" should be largely unnecessary. In the exceptional, and indeed exceedingly rare cases, when a classification is not possible, even after repeat biopsy, we suggest that the laryngeal neoplasm is better termed "unclassified malignant neoplasm" rather than "undifferentiated malignant neoplasm".

Partial Nephrectomy as Treatment of an Atypical Metastasis from Prostate Cancer—A Case Report and Review of Literature

Background: Prostate cancer is the second most common type of cancer in man and the second in cancer-specific deaths in this population in the world. Most of the causes of death related to prostate cancer are due to its distant metastases, with the most common sites being: skeleton, distant lymph nodes, liver and lung. Renal metastasis is rare, and studies suggest infiltration due to arterial microembolization of the tumor. A key point in this scenario is the clinical suspicion of differential diagnoses, to offer the patient an effective therapy in such a specific case. Aim: To report a case of a patient with prostate cancer undergoing partial nephrectomy whose histopathological report revealed a metastatic lesion of that primary site. Case Presentation: 74 years old man, referred in May 2015 due to high PSA level and lumbago. PSA 323.11 ng/dl, rectal examination cT3a; biopsy was performed and histopathological study reported bilateral prostate adenocarcinoma, Gleason’s score 8 (4 + 4). Patient’s staging showed multiple secondary implants on skeletal scintigraphy. Tomography revealed solid exophytic lesion in the lower pole of the right kidney (4.7 × 3.6 cm); prostate without cleavage planes with seminal vesicles and pelvic node enlargement. Hormone therapy was initiated, PSA levels dropped to 9.51 ng/dl and total testosterone < 50 ng/dl. Partial nephrectomy was planned, initially by laparoscopy, but converted to laparotomy in December 2015. Procedure lasting 3 hours, minimal blood loss, no perioperative complications, discharged on the 3rd postoperative day. Histopathological report described undifferentiated malignant neoplasm, requiring immunohistochemistry that confirmed prostate adenocarcinoma. Patient remains hormone therapy, with no progression of the disease so far. Conclusion: Given the rarity of these cases, it is not possible to presume that nephrectomy enhances the survival rates. However, we observed that partial nephrectomy was a good choice for our patient, being the first case described in the literature. More reports should be available and studies with higher levels of evidence should be conducted to assist us in patient orientation and decision making.

THE ROLE OF IMMUNOHISTOCHEMISTRY IN THE EVALUATION OF UNDIFFERENTIATED GASTRIC CANCER

Background: With the advance in medical practices, gastric cancer remains one of the deadly diseases with poor prognosis. Appropriate diagnosis of the histological gastric cancer type may improve the treatment and the prognosis. The objective of this study is to apply immunohistochemical (IHC) markers for the diagnosis of undifferentiated gastric malignancies. Among 126 patients diagnosed as cases with malignant gastric tumors, from September 2008 to September 2013, 55 cases were assigned as undifferentiated tumors and were subjected to IHC evaluation by application of many IHC markers and special stains for further categorization; Results: After the application of different IHC markers and special stains, the 55 cases which were assigned as undifferentiated revealed to be carcinoma (37 cases), lymphoma (9 cases), gastrointestinal stromal tumors (GIST) (7 cases) and leiomyosarcoma and neuroendocrine tumor one case for each. IHC findings had changed the primary diagnoses based on morphological data in 4 instances; two cases were thought to be signet ring carcinoma and proved by IHC to be lymphomas and other two cases were thought to be poorly differentiated adenocarcinoma and proved to be GIST. Therefore; IHC is a valuable tool for the diagnosis of undifferentiated malignant gastric tumors.

Renal Rhabdomyosarcoma in a Young Woman with Gross Hematuria: A Case Report

Introduction: Renal rhabdomyosarcoma is a rare malignant mesenchymal tumor, representing 1% - 3% of all renal malignant tumors. Case Presentation: In the present study, we discussed about a 33-year-old woman with a botryoid type embryonal rhabdomyosarcoma of the left kidney presented with gross hematuria. Conclusions: This very rare tumor in adults should be considered in differential diagnosis among undifferentiated malignant tumors.

Genomic Alterations in Undifferentiated Malignant Tumors With Loss Of BRG1 Immunoexpression Diagnosed By Cytology

Genomic Alterations in Undifferentiated Malignant Tumors With Loss Of BRG1 Immunoexpression Diagnosed By Cytology

Clinicopathological Analysis of Undifferentiated Malignant Neoplasms of the Sinonasal tract

Background: Sinonasal tumours are characterized by low incidence, non specific symptoms, and late presentation. Aggressive, non–squamous cell epithelial and nonepithelial malignant neoplasms of varying histogenesis occurring in sinonasal region are grouped under the term undifferentiated malignant neoplasms. Frequently, these undifferentiated malignancies share clinical and light microscopic features, which make differentiation of one from the other virtually impossible without the use of adjunct immunohistochemical analysis . Methods: Undifferentiated malignant sinonasal tumors biopsied or surgically excised over a period of 5 years were studied.Result: We encountered 22 cases of undifferentiated malignant sinonasal tumors with an incidence of 0.05%, with a mean age of 41 to 50 years and the male to female ratio was 2.1:1. Epithelial tumors (18 cases) constituting 81.82 % predominated over non epithelial tumors (4 cases) constituting 18.18% with a ratio of 4.5:1. 16 tumors involved the nasal cavity (72.7%) and 6 involved paranasal sinuses (27.3%). The most common clinical presentation was mass in the nose 19 cases (86.36%). The most common Undifferentiated malignant tumor encountered was Sinonasal undifferentiated carcinoma-10 cases (45.45%).Conclusion: A variety of undifferentiated malignant neoplasms occur in the sinonasal tract with overlapping clinical and pathologic findings. In limited biopsy material, differentiation of these tumor types can be challenging and differentiating these tumors with the help of immunohistoochemistry has clinical importance because advances in therapeutic intervention may increase survival with good quality of life, and in some instances may achieve a cure. DOI: 10.21276/APALM.1417

PUB021 Sonographic Echo-Pattern of Various Lung Carcinomas among the Cytology Positive Patients

Over the last decades, due to the widespread availability, low financial cost, non-invasivity and a zero ionizing radiation effect, ultrasound is used as the leading medical imaging modality for the initial diagnostic work-up of various multi-organ medical disorders including lung related pathologies like pleural effusion, lung growths etc. And its basic display mode (which is called the brightness mode) reflects different degrees of echogenicity, depending upon the study organs, areas and their underlying pathologies. It can also be done either as trans-wall or endo-luminal means along with the capability of vascular blood flow study. While low dose computed tomography is used presently as the screening test among the high-risk population groups for lung cancer detection, ultrasonography (as a stand-alone modality or as the part of hybrid imaging technique) can be used as a convenient guide for the collection of small biopsies from which efficient interpretation regarding cytological classification and molecular typing are performed as state of the art technology. This study was conducted at the Institute of Nuclear medicine and Allied Sciences, Rajshahi, Bangladesh during the period between 1st May, 2009 and 31st October, 2010. The patients having positive lung lesions on digital radiography are referred at this Institute by the clinicians for ultrasonography of chest and transthoracic ultrasonography-guided fine-needle aspiration biopsy (FNAB) cytological examination, with the co-operation of pathology department of Rajshahi Medical College, Rajshahi, Bangladesh. Under the basis of convenient sampling technique, 77 patients are included as sample. Their age, gender, sonographic echo-patterns of lung carcinomas and cytological findings are recorded and analyzed with statistical software IBM SPSS v. 16. Among the sample (n=77), 67 (87 %) were male and 10 (13 %) were female. Mean (± SD) age was 56 ± 14 years (range=28 to 85 years). Regarding the cytological findings, 30 (39 %) had squamous cell carcinoma, 18 (23.4 %) had undifferentiated large cell carcinoma and 17 (22.1%) had undifferentiated malignant epithelial tumor. And, in relation to the sonographic echo-pattern underlying a single cytology based lung carcinoma among this study sample (n=77), multiple echo-patterns or heterogeneous patterns are noted. The results of this study will be helpful toward the relevant studies which are related to the management algorithm of lung carcinomas, in addition to the role of hybrid imaging techniques as well as histologic classification, molecular typing, genetic and epigenetic profiling from the resected or imaging technique-guided taken small biopsies and cytology specimens.