Context: The diagnosis of malignant and potentially malignant epithelial lesions of the oral mucosa is based on a careful histologic evaluation of a representative biopsy specimen. The site for the biopsy, however, is always a subjective choice that raises doubts about its representativeness. So far, no simple and reliable method is available for selecting the most appropriate area for biopsy. Colposcopy, a well-known gynecological diagnostic procedure, is helpful in the selection of these sites of epithelial dysplasia depending upon the vascular patterns. Aims: The present study aimed at assessing the vascular patterns by colposcopic findings and selecting the biopsy site in leukoplakia patients and compared the two methods, clinical criteria, and colposcopic examination, for selecting the biopsy site. Settings and Design: Sixty patients between the ages of 30-60 years clinically diagnosed with leukoplakia were included in the study. Materials and Methods: For each of the subject, a thorough clinical examination was carried out followed by colpospopic examination for the selection of biopsy site. The histopathological findings were then compared in the two cases. Statistical Analysis Used: The statistical analysis was done using paired t-test. Results: Based on clinical criteria, a sensitivity of 0.5714 (57%) and a specificity of 0.5000 (50%) and that guided by colposcopic examination to be 0.8571 (85%) and 0.6667 (66%), respectively, was found. Conclusions: From the study, it was concluded that colposcopic examination could prove to be a valuable diagnostic adjunct in the selection of biopsy site for leukoplakia patients.

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Adenocarcinomas are the second most common type of cervical cancers in women comprising 10-20% of the cases. Villoglandular papillary carcinoma is a rare histological subtype of invasive adenocarcinoma which usually afflicts young women and carries an excellent prognosis. However, additional histological subtypes mixed with villoglandular papillary adenocarcinoma are very common; therefore, a careful inspection of the specimen should be undertaken and only if it is an exclusive or almost exclusive pattern, should a diagnosis of villoglandular papillary adenocarcinoma be made. This is because the mixed patterns do not present with the same favorable prognosis as the villoglandular adenocarcinoma; moreover, the treatment modalities would also differ. One should consider whether conservative therapy is sufficient because of the predominance of concomitance of other carcinomas besides the villoglandular papillary adenocarcinoma. We present the case of a 47-year-old lady who, on initial biopsy from cervical growth, revealed a villoglandular adenocarcinoma, but subsequent hysterectomy revealed moderately differentiated adenocarcinoma with extrauterine extension.

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Context and Aim: Radiotherapy is alternative to concurrent chemoradiation or surgery for locally advanced squamous cell carcinoma of head and neck (LAHNSCC) due to comorbid conditions. The aim of this study was to compare efficacy and toxicity among hypofractionated, pure accelerated and conventional radiotherapy schedules. Settings and Design: Interventional randomized controlled study. Materials and Methods: Between May 2008 and May 2012, 132 LAHNSCC patients, AJCC stages III to IVB, creatinine clearance <60 ml/min, age more than 50 years, comorbidities like uncontrolled diabetes, cardiac disease, ECOG 3 and 4, or combination of these were randomized into three arms: Arm A, "Christie Regimen", 50 Gray (Gy) in 16 fractions, 3.125 Gy per fraction over 3 weeks; Arm B, 66 Gy in 33 fractions in 6 fractions per week in 5.5 weeks; and Arm C, 66 Gy in 33 fractions, 5 fractions per week, in 6.5 weeks. The endpoints of the study were overall response (ORR = complete response + partial response), diseasefree survival (DFS), toxicities, and overall survival (OS). Statistical Analysis Used: All statistical tests were done using ANOVA. OS and DFS were calculated using KaplanMeier analysis. Result: ORRs were comparable in all arms, P value = 0.401. DFS were in favor of altered radiation, P value = 0.034. Acute Grade 3 cutaneous toxicity (P value = 0.018) and mucositis (P value = 0.011) were high with altered fractionation. Chronic grade 2 and 3 toxicities were higher in altered fractionations. Conclusion: There was no difference in the ORR between three arms but DFS was in favor of altered fractionation arms with manageable toxicity. Both altered fractionation had short overall treatment time which is radiobiologically superior and is beneficial for centers like ours where the patient load is much higher than the facility available.

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Primary Clear cell adenocarcinoma of the colon is extremely rare, with only a handful of cases reported in literature. We herein report a case of such a tumor in a 42-year-old male who presented with rectal bleeding and pain abdomen. A circumferential growth occluding the lumen at the hepatic flexure was visualized on colonoscopy. The right hemicolectomy specimen revealed an ulceroinfiltrative growth which showed histologic features of clear cell adenocarcinoma.

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Ovarian tumors are broadly classified into surface epithelial, germ cell, sex cord, and stromal tumors and other rarer special categories under the WHO scheme. The Brenner tumors of the surface epithelial group pose a diagnostic challenge in special context of its histogenesis. We present a case of 46-year-old female with an ovarian mass and ascitis. The surgico-pathological evaluation of gross and microscopic features suggested a malignant Brenner tumor. Transitional cell carcinoma (non-Brenner) was kept as a diagnostic differential and a challenging pitfall.

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Background: Orbito-ocular tumors are a common cause of morbidity and mortality in our environment. Patients often present late with unsightly fungating tumors resulting in difficult management and poor outcome. The aim of the study was to determine the clinical profile, diagnostic work-up, treatment and histo-pathological types of orbito-ocular tumors seen at Ahmadu Bello University Teaching Hospital, Shika-Zaria from June 2006 to June 2011. Materials and Methods: A retrospective analysis of all patients who presented to the eye clinic with orbito-ocular tumors during the study period was made. Information extracted incwudes patient demographics, clinical diagnoses, radiological and sonological reports, surgery performed, and histology reports as well as adjuvant chemotherapy and radiotherapy where indicated. Results: A total of 54 patients were managed during the study period. Those without histology reports were excluded from the study. Forty-nine patients were included for analysis. There were 29 male and 20 female patients giving a male to female ratio of 1.8:1. Their age range was 1.5-74 years with a mean of 22 years. Eighteen of the patients had retinoblastoma, eleven had squamous cell carcinoma, two had Kaposi' sarcoma, and one case of nasopharyngeal carcinoma. There were 2 patients with pre-malignant conditions and 10 patients with benign lesions. Thirty-two of the patients had exenterations, sixteen had excisional biopsies, and one had enucleation. Seventy eight percent of the tumors were malignant. Conclusion: Most of the orbito-ocular tumors seen in this study were malignant. Delayed hospital presentation is a characteristic feature. Retinoblastoma and squamous cell carcinoma are the most common orbito-ocular tumors.

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Oral cancers are malignant neoplasms that affect the mouth. Oral cancer remains a major personal tragedy and public health problem. There is a very high incidence of oral cancer in Southern Asia. In India, the oral cavity is the most common site for cancer. The majority of oral squamous cell carcinomas are related to tobacco, areca nut / betel quid chewing, alcoholism. Control of oral potentially malignant diseases will only be achieved by effective and comprehensive primary and secondary prevention by recognizing that the risk factors are common to most other diseases.

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Background: Fine needle aspiration cytology (FNAC) is a simple, rapid, reliable, and cost-effective method in diagnosing mass lesions. In spite of its advances and advantages, conventional Hematoxyline and Eosin (H and E)-stained wet-fixed smear of FNAC fails to achieve 100% accuracy. To improve the accuracy of cytodiagnosis, toludine blue (TB)-stained wet film preparation of fine needle aspirates is supplemented along with conventional wet-fixed smear. We have assessed the morphology and accuracy of supravital-stained (TB) wet film study of FNAC, which has not been previously reported. Materials and Methods: A total of 197 fine needle aspirates from various body sites were studied both in supravital toludine blue (TB)-stained wet film and hematoxylin and eosin (H and E)-stained wet-fixed smear preparation. The results were interpreted with final diagnosis made by histopathological study, clinical, radiological follow-up and were statistically analyzed. Results: For the entire series, TB-stained wet film study gave a sensitivity of 93.7%, a specificity of 98%, a positive predictive value (PPV) of 96.6%, a negative predictive value (NPV) of 96.9%, and an efficacy of 96.3%. H and E-stained wet smear study revealed a sensitivity of 86.2%, specificity of 97.9%, PPV of 95.4%, NPV of 93.4%, and an efficacy of 93.2%. The combined wet film and wet smear study results showed a sensitivity of 98%, specificity of 99.2%, PPV of 98.4%, NPV of 98.9%, and an efficacy of 98.6%. The decreased sensitivity of wet smear study due to inadequate cellularity, loss of cell sample during fixation and staining, artifactual morphological distortion were minimized by supplementary wet film study and that yielded high accuracy rate. Conclusion: Wet film study gave a good cytomorphological picture and this immediate interpretation was useful for assessing the adequacy of material. False negative and false positive reports were reduced significantly when we combined this toludine blue-stained wet film study and wet smear study. Therefore, it could be regularly undertaken as a supplementary diagnostic procedure for wet smear to improve the diagnostic accuracy.

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Adenocarcinoma of rete testis is a rare tumor. It has varied presentation with either a painless mass in the scrotum or with metastasis. It is seen associated with hydrocele, hematocele, inguinal hernia, or undescended testis. Here, we present a case of adenocarcinoma of rete testes presenting as a hydrocele.

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Human papillomaviruses (HPV) have been an area of interest since last two decades because of its potential role in the pathogenesis of malignant tumors. Approximately 35 years ago a role of human papillomaviruses (HPV) in cervical cancer has been postulated. Today it is well established that this very heterogeneous virus family harbours important human carcinogens, causing not only the vast majority of cervical, but also a substantial proportion of other anogenital and head and neck cancers. This review article has attempted to briefly analyze the present state of linking HPV to human cancers and have discussed some emerging developments. We have emphasized on the fact that HPV positive and negative cancer behave differently and should have separate treatment strategy.

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Association of lung cancer with pulmonary tuberculosis is approximately 1-2% and pulmonary tuberculosis is associated with lung cancer in approximately 1-5% of cases. A 46-year-old male presented to us with low-grade fever for 3 months, increased severity of cough for 2 months, and painful swelling of fingers with both wrist joints for 1 month. Chest X-ray PA view revealed a homogenous opacity in the right upper and mid zone. Contrast-enhanced CT scan of the thorax showed soft tissue density, enhancing lesion (11.5 × 8.6 cm) with areas of necrosis in the right upper lobe. The patient suffered from squamous cell lung cancer as well as active pulmonary tuberculosis. As a complication of these two coexisting conditions, the patient developed hypertrophic pulmonary osteoarthropathy.

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Collecting-duct carcinomas (CDCs) comprise approximately 1% of renal epithelial malignancies. We report a case of collecting duct carcinoma with prominent signet ring cell features in a 60-year-old man. Grossly, the tumor measured 7.5 cm in greatest dimension, occupied the entire lower pole of the kidney, and was well-circumscribed. Microscopically, it displayed a predominant tubulopapillary pattern of growth with a desmoplastic stroma. The tumor tubules were lined by a single layer of cells with large, pleomorphic nuclei, some of which had a hobnail appearance. Large intracytoplasmic vacuoles with compression of nuclei (signet ring cells) were present throughout the tumor. Alcian blue, mucicarmine, and periodic acid-Schiff stains failed to identify intracellular mucin or glycogen in the signet ring cells. The tumor cells were immunohistochemically positive for cytokeratin (cytokeratin 7) and vimentin. To the best of our knowledge, this is the second reported case of renal CDC with prominent signet ring cell features.

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Epithelioid sarcoma is an uncommon soft tissue malignancy with a known propensity for recurrence as well as metastasis. We report epithelioid sarcoma in 50 year old male with a recurrent ulcerative nodule over the right ankle since five months, initially misdiagnosed as malignant fibrous histiocytoma. The article aims at assessing the key cytological features of epithelioid sarcoma and their reliability in the diagnosis of the lesion. Also described are its histopathological and immunohistochemical features.

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Pleomorphic xanthoastrocytoma (PXA) has been considered an astrocytic tumor with a relatively favorable prognosis. However, PXA cases having several recurrent patterns with poor prognosis have been reported in recent years, and a new concept of "PXA with anaplastic features" has been proposed. The present case was of a 55-year-old male who presented with weakness and numbness of right upper and lower limbs since 3 months along with difficulty in walking as well as difficulty in speaking since then. He also complained of headache since 9 months. The magnetic resonance imaging study revealed two nodular, homogeneously enhancing lesions, approximately 1 cm in size in the right cerebral hemisphere. Clinical and radiological examinations were suggestive of a metastatic neoplasm. A right frontal craniotomy was performed for excisional biopsy of both lesions. Histopathological findings showed that the tumor was PXA with strong pleomorphism, xanthomatous changes, extensive areas of tumor necrosis, and increased mitotic activity. From these findings, the histopathological diagnosis "PXA with anaplastic features" was given. Synchronous multicentric PXA presents unique challenges in that gross total resection would impose significant surgical morbidity; histological homogeneity among the lesions cannot be confirmed; and the well-described potential for anaplastic transformation may be increased with multiple lesions. The optimal treatment for patients with this rare and challenging diagnosis awaits further study.

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The association of pregnancy with cancer is rare. This case shows pregnancy exhibiting an inhibitory effect on Burkitt's lymphoma (BL) as well as demonstrates the extremely aggressive nature of the disease.

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Primitive neuroectodermal tumor of the kidney is a rare entity. Only a few cases have been reported in the literature and they revealed a variable presentation and an aggressive behavior. Most commonly it is seen in the relatively young population. The diagnosis is usually made at histopathology.

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Solid-Pseudopapillary tumor is a rare pancreatic neoplasm with uncertain to low malignant potential. This rare neoplasm with many pseudonyms occurs predominantly in young woman under the age of thirty years. We present a rare case of Solid-Pseudopapillary tumor of pancreas in an elderly female. The tumor was located in the tail of pancreas; clinically and radiologically diagnosed as Mucinous cystadenocarcinoma. Preoperative CT guided FNA revealed numerous papillary tissue fragments with slender branching fibrovascular cores lined by several layers of uniform tumor cells with round to oval eccentrically placed bland nucleus and abundant light basophilic, finely vacuolated cytoplasm. Occasional tumor cells showed longitudinal nuclear grooves and intracytoplasmic hyaline inclusions. Some of the papillary fragments showed mucinous change in their stalks. Cytological features were suggestive of Solid-Pseudopapillary tumor of pancreas. Histopathological examination of resected specimen confirmed the diagnosis.

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Background: It has been emphasized that the molecular gatekeeper p53 has a key role in carcinogenesis and its mutation is seen in more than 50% of the human cancers including head and neck carcinomas and tobacco is the most important etiological agent in head and neck cancer. Aims: To assess p53 mutations in relation to tobacco usage in oral squamous cell carcinoma (OSCC) to understand the role of tobacco in the complex process of carcinogenesis. Materials and Methods: Forty formalin-fixed paraffin-embedded archival tissue samples were taken, of which 20 cases were associated with tobacco and 20 were not, and assessed immunohistochemically. Results: Enhanced expression of p53 was found to be associated with tobacco. Conclusions: p53 mutations are etiologically associated with the development of head and neck carcinomas and are associated with exposure to specific carcinogens of tobacco.

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